This document discusses harm reduction, its goals and strategies. It defines harm reduction as policies and programs that aim to reduce health and social harms of drug use without requiring decreased use. The goals of harm reduction include empowering users to make safer choices and reducing transmission of diseases. Common strategies mentioned include needle exchange programs and supervised injection sites. The document also explores myths around harm reduction and its application among special populations such as Indigenous communities.
There are many misconceptions about harm reduction. In this presentation, we will debunk the myths, explain what harm reduction is and provide examples of harm reduction in action throughout our province and nation. This presentation also includes how individuals can become volunteers with our agency.
There are many misconceptions about harm reduction. In this presentation, we will debunk the myths, explain what harm reduction is and provide examples of harm reduction in action throughout our province and nation. This presentation also includes how individuals can become volunteers with our agency.
Harm reduction Project 25: Meeting of the Minds JOComm
Started in 2011, Project 25 aims to solve the many difficulties associated not just with chronic homelessness, but especially those who are frequent users of public systems such as local hospitals and law enforcement. In its first year alone, Project 25 demonstrated the following results and these trends have continued into subsequent years. First year results include:
• 56 percent decline in number of hospitalizations
• 58 percent decrease in days spent in the hospital
• 62 percent drop in ambulance rides
• 66 percent reduction in emergency room visits
• 63 percent cut in costs
This narrated powerpoint covers the Opioid Epidemic and harm reduction approaches to addressing problematic opioid use. This powerpoint is intended to help provide a baseline knowledge of harm reduction approaches for substance use treatment, including for the treatment of Opioid Use Disorder.
Zero Applied: From International Declaration to Local ActionDavid Covington
DRAFT: In 2017, RI International partnered with Suicide Prevention Australia and the International Initiative for Mental Health Leadership to host the fourth International Summit on Zero Suicide in Healthcare in Sydney, Australia.
Zero Suicide in Healthcare International Declaration (March 2016)David Covington
A diverse group of 50 peer leaders, government policy makers, and healthcare providers from 13 countries convened for Atlanta 2015: An International Declaration and Social Movement. Invited guests included “Zero Suicide” advocates and pioneers as well as others committed to suicide prevention and better healthcare.
AIDSTAR-One Breaking New Ground in VietnamAIDSTAROne
Gender norms affect the behavior and life choices of both men and women. In Vietnam, these norms sometimes drive people into situations where they are at increased risk of violence, STI acquisition, and/or incarceration. This case study (one of nine in a series) examines CARE International's STEP program, which seeks to ensure that both men and women have equal access to services to prevent STIs, safeguard their health, avoid gender-based violence, and participate in income-generating activities.
http://www.aidstar-one.com/focus_areas/gender/resources/case_study_series/step_vietnam
A formative study of drug-using women in Georgia: Setting the Stage for an RCTIrma Kirtadze M.D.
The study is assessing of development of an efficacious comprehensive women-centered drug treatment model. Thus, the proposed study will proceed by meeting four sequential aims.
Aim 1. Explore drug use (e.g., types and patterns), HIV and HCV injection and sexual risk behaviors, comorbid conditions (e.g., interpersonal violence, comorbid psychiatric disorders), and treatment barriers and experiences (e.g., gender discrimination) among IDU Georgian women.
Aim 2. Identify from treatment providers their practices and perceptions regarding IDU women in the current Georgian drug treatment system.
Aim 3. Adapt and pretest both a drug abuse treatment approach of Reinforcement-Based Treatment (RBT) that integrates the evidence-based Women’s Co-Op HIV prevention, and a case management approach for IDU Georgian women.
Aim 4. In a small-scale randomized trial, determine the feasibility and initial efficacy of our Georgian RBT model relative to a case management model in terms of their respective impacts on the frequency of unprotected sexual acts and syringe sharing at post-treatment and 3-month post-treatment follow-up.
Harm Reduction february 2013 Nursing Education Saskatchewangriehl
Here is a basic presentation on Harm Reduction, for Nursing Students, that can easily be adapted for health care providers in various fields of practice.
Harm reduction Project 25: Meeting of the Minds JOComm
Started in 2011, Project 25 aims to solve the many difficulties associated not just with chronic homelessness, but especially those who are frequent users of public systems such as local hospitals and law enforcement. In its first year alone, Project 25 demonstrated the following results and these trends have continued into subsequent years. First year results include:
• 56 percent decline in number of hospitalizations
• 58 percent decrease in days spent in the hospital
• 62 percent drop in ambulance rides
• 66 percent reduction in emergency room visits
• 63 percent cut in costs
This narrated powerpoint covers the Opioid Epidemic and harm reduction approaches to addressing problematic opioid use. This powerpoint is intended to help provide a baseline knowledge of harm reduction approaches for substance use treatment, including for the treatment of Opioid Use Disorder.
Zero Applied: From International Declaration to Local ActionDavid Covington
DRAFT: In 2017, RI International partnered with Suicide Prevention Australia and the International Initiative for Mental Health Leadership to host the fourth International Summit on Zero Suicide in Healthcare in Sydney, Australia.
Zero Suicide in Healthcare International Declaration (March 2016)David Covington
A diverse group of 50 peer leaders, government policy makers, and healthcare providers from 13 countries convened for Atlanta 2015: An International Declaration and Social Movement. Invited guests included “Zero Suicide” advocates and pioneers as well as others committed to suicide prevention and better healthcare.
AIDSTAR-One Breaking New Ground in VietnamAIDSTAROne
Gender norms affect the behavior and life choices of both men and women. In Vietnam, these norms sometimes drive people into situations where they are at increased risk of violence, STI acquisition, and/or incarceration. This case study (one of nine in a series) examines CARE International's STEP program, which seeks to ensure that both men and women have equal access to services to prevent STIs, safeguard their health, avoid gender-based violence, and participate in income-generating activities.
http://www.aidstar-one.com/focus_areas/gender/resources/case_study_series/step_vietnam
A formative study of drug-using women in Georgia: Setting the Stage for an RCTIrma Kirtadze M.D.
The study is assessing of development of an efficacious comprehensive women-centered drug treatment model. Thus, the proposed study will proceed by meeting four sequential aims.
Aim 1. Explore drug use (e.g., types and patterns), HIV and HCV injection and sexual risk behaviors, comorbid conditions (e.g., interpersonal violence, comorbid psychiatric disorders), and treatment barriers and experiences (e.g., gender discrimination) among IDU Georgian women.
Aim 2. Identify from treatment providers their practices and perceptions regarding IDU women in the current Georgian drug treatment system.
Aim 3. Adapt and pretest both a drug abuse treatment approach of Reinforcement-Based Treatment (RBT) that integrates the evidence-based Women’s Co-Op HIV prevention, and a case management approach for IDU Georgian women.
Aim 4. In a small-scale randomized trial, determine the feasibility and initial efficacy of our Georgian RBT model relative to a case management model in terms of their respective impacts on the frequency of unprotected sexual acts and syringe sharing at post-treatment and 3-month post-treatment follow-up.
Harm Reduction february 2013 Nursing Education Saskatchewangriehl
Here is a basic presentation on Harm Reduction, for Nursing Students, that can easily be adapted for health care providers in various fields of practice.
PYA Principal Kent Bottles, MD, who is also Chief Medical Officer of PYA Analytics, presented before healthcare information technology (IT) professionals at the Summit of the Southeast—Driving the Future of Technology held at Nashville Music City Center, September 16-17, 2014. Dr. Bottles’ presentation covered population health.
Allina Health used actionable data to identify potential areas of bias, then applied the right interventions to decrease implicit biases. For example, data revealed that the African American populations receiving care at Allina Health were not enrolling in hospice programs when they were eligible because the hospitalists weren’t referring African Americans at the same rate as other populations.
Vivian Anugwom, Health Equity Manager at Allina Health, shares how she led a team to implement new measures, including implicit bias trainings, to help address and overcome these biases to ensure health equity for all.
During this webinar, Vivian will help attendees:
- Understand how Allina Health uses data to identify disparities.
- Define bias and its impact on health disparities.
Marilyn Wise (Health Public Policy Centre for Health Equity Training and Evaluation) delivered the keynote address at the AFAO/NAPWA Gay Men's HIV Health Promotion Conference in May 2012.
She reflected on what she described as the 'system' of complex, multiple responses, that has evolved in Australia to contain HIV, and what we can learn from our successes in order to address the goals of the UN Political declaration on HIV and meet Australia's targets for HIV prevention and treatment.
Privileged perspectives working with vulnerable marginalized populations in ...griehl
Learn about personal experiences working with marginalized/vulnerable people, who are those people? And what have they taught me?
Memorable experiences lead me to embrace the Platinum Rule
I will describe the bronze silver gold platinum rules
Guide to acknowledging Indigenous Peoples, Land, and Traditional Territorygriehl
The goal of this speaker series is to encourage all faculty and staff to acknowledge, where appropriate, the Indigenous peoples, on whose land, and traditional territory we live, learn, and work. Acknowledgment by itself before a meeting, printed in an email or a course outline, is a small gesture, but it becomes more powerful and meaningful when coupled with personal statements, authentic local knowledge and relationships and informed action
topics of discussion:
Research ethical considerations
Sex vs Gender
Indigenous World view and ways of knowing
Sharing/talking circle
Land based teachings
Two eyed seeing
Strength based vs deficit based
Research Ethics Boards
In the eyes of our patients and families we are often the heroes of healthcare. But in our own eyes, or the eyes of our peers, we are often ‘just a nurse’. I have been a part of the nursing family for 3 decades and have had the privilege and honour to be with people on all aspects of their journeys through life and death. The challenges of being a nurse are only outweighed by the rewards of the profession and is why I remain dedicated to the next generation of nurses.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Pharynx and Clinical Correlations BY Dr.Rabia Inam Gandapore.pptx
Harm reduction Thunder Bay Ontario
1. Dispelling the Myths: The White
Tape of Harm Reduction
Greg Riehl December 5th, 2012
Thunder Bay District Health Unit
2. • Define harm reduction
• Identify the goals of harm reduction
• Explore harm reduction among key populations
• Identify myths and misconceptions
• Values, choice, culture and harm reduction.
• Discuss your role with harm reduction
Objectives
3. • Practical non-judgemental services that seek to
minimize drug related harm to the individual in
society
• Originated in Amsterdam and UK in the 1980s by
drug users themselves in response to rising HIV
rates
• Needle exchange, Methadone maintenance
• Abstinence is one of many strategies and services
that can be provided.
Harm Reduction
4. International Harm Reduction Association (2002):
“Policies and programs which attempt primarily to
reduce the adverse health, social and economic
consequences of mood altering substances to
individual drug users, their families and communities,
without requiring decrease in drug use”.
Harm Reduction
(As cited in Ministry of Health, 2005)
5. A neutral, non judgmental, low
threshold approach, geared
towards individual attributes and
context as well as social factors of
behavior and potential risk for
harm
Keane, 2003; Hathaway, 2002; Erikson, 2001
Harm Reduction
6. The GOAL of harm reduction
is to help users make
informed decisions and
empower themselves to
reduce the potential harm
from drug use.
7. Principles of Harm Reduction
• Humanistic Values
• Focus on Harms
• Priority of Immediate Goals
• Pragmatism
• Balancing costs and benefits to individuals and
society
Ministry of Health, 2005
Beirness, Jesseman, Notarandrea & Perron,
2008
8. More About Harm Reduction
• Reduces sharing of needles
• Saves lives by reducing drug-related health risks.
• Improves quality of life
• Reduces the spread of HIV
• Reduces OD deaths
• Opportunity for education and referrals
Health Canada, 2001
15. National Anti-Drug Strategy
•Government of Canada Launches New Anti-drug
Campaign: New Ads Latest in Effort to Help Parents
Keep their Children Drug-free
•This was October 2007
Knowledge does not equal behaviour change
http://www.hc-sc.gc.ca/ahc-asc/media/nr-cp/_2010/2010_196-eng.php
http://www.nationalantidrugstrategy.gc.ca/sp-dis/2007_10_04_1.html
16. • There is a disconnect with what is being said and
what is being practiced
• Compare federal, provincial, regional, local
practices.
• Who decides what we do? Unfortunately not our
clients.
Cultural Disconnect
17. “We have major concerns with some of the initiatives,
falling under the banner of Harm Reduction, that do
not include abstinence as a goal. Rather than reduce,
they only prolong the misery caused by addiction.
Whereas, properly funded, prevention and
abstinence-based treatment programs actually reduce
the number of people addicted and the related
harms.”
C.D.(Chuck) Doucette President
Drug Prevention Network of Canada
Drug Prevention Network of Canada
Prevention Education Treatment
18. Nature of Harm Reduction
• Harm reduction is not a black & white subject
• Harm reduction is not something you either know or
don’t know
• Harm reduction involves thinking and feeling, study
and practice, knowledge and intuition
19. Harm Reduction Does Not…
• Provide rules of ethical or moral behavior for
every circumstance
• Offer guidance about which values should take
priority or how they can be balanced in practice
20. When Do Values Collide?
• When one’s personal, professional or
institutional values conflict
• When an individual’s values conflict with
the values of another individual
21. MYTHS
• HR enables drug use and encourages drug use among non-
drug users
• HR drains resources from treatment services
• HR increases disorder and threatens public safety and
health
BC Community Guide, 2005
22. Saskatchewan Registered Nurses’ Association:
“Focus is on the assumption that harms
associated with certain behaviours can be
reduced without the elimination of the
behaviour”
Harm Reductionists accept abstinence as
a goal along a continuum…
SRNA Position Statement, 2008
23. Nurses have a responsibility to provide non-
judgmental care to individuals and families affected
by substance use, regardless of setting, social class,
income, age, gender or ethnicity, and they can
influence the development of organizational and
governmental harm reduction policies related to drug
use.
CNA CANAC
Joint Position Statement
24. 4 Pillars
Treatment
Prevention • Improve physical,
emotional, and
• Prevent or delay onset.
psychological health
Harm Reduction Enforcement
• Reduce harms for • Strengthen community
individuals, families, and safety by responding to
communities. crimes and community
disorder issues.
25. Harm Reduction Strategies
Related to Drug Use
• Needle exchange
• Supervised injection sites
• Methadone
• Street outreach programs
• Safe crack pipe programs
Beirness, Jesseman, Notarandrea, & Perron, 2008
26. • Methadone Reduces
• Illicit opiate use
• Overdose deaths
• Frequency of injecting
• Needle sharing
• HIV/HCV/HBV transmission
• Criminal activity, recidivism
T Kerr, R Jürgens. Methadone Maintenance Therapy in Prisons: Reviewing the Evidence. Montreal: Canadian HIV/AIDS Legal Network,
2004.
Substitution Therapy
27. • Assess patients fully and ask about their use, how they support their
use, &if they are withdrawing
• It isn’t your life, so avoid judgment
• Manage withdrawal properly –withdrawal is a MEDICAL
EMERGENCY
• Set realistic boundaries
• Understand the impact of trauma, pain and anxiety
• Ask patients to tell you if they use
• Don’t punish patients for using
• Keep the door open
• Be clear about what patients can expect from you & what you expect
from them
“They may have made some bad choices but your job is to
look after their needs” Remember Maslow????
Substance Use and Care
28. Maslow’s Hierarchy of Needs
Where is your client
at right now?
Social Determinants of Health
Maslow's hierarchy of needs and subpersonality work, Kenneth Sørensen
http://two.not2.org/psychosynthesis/articles/maslow.htm
29. • Aboriginal injection drug users are the fastest
growing group of new HIV cases in Canada.
• An estimated 6,380 Aboriginal people were living
with HIV (including AIDS) in Canada at the end of
2011 (8.9% of all prevalent HIV infections) which
represents an increase of 17.3% from the 2008
estimate of 5,440.
• The estimated prevalence rate among Aboriginal
people in Canada in 2011 was 544.0 per 100,000
population.
Epi in First Nations
30. Risk Factors for HIV in First Nations
• Injection Drug Use
• Unsafe sex
• Many sexual partners
• Sexual and physical abuse
• Incarceration
• Alcohol Abuse
• Lack of knowledge
• Low self esteem
• Residential school syndrome
• Loss of culture and spirituality
All Nations Hope, 2002
Joining the Circle, CAAN
31. •Culturally appropriate services
•There is a lack of harm reduction services to First Nations
(rural and on-reserve)
Wardman & Quartz, 2006 & Dell & Lyons, 2007)
“Programs and services for First Nations, Métis and Inuit people must
‘first and foremost, show respect and honour for all Aboriginal beliefs,
practices and customs’ and reflect the ‘pride and dignity that
Aboriginal heritage demands”
Culture and Harm Reduction
32. • Not all harm reduction measures are applicable to all people,
groups, or communities.
• Many Aboriginal communities adhere to models of abstinence
and prohibition and do not allow for moderate substance use.
• Stigma and discrimination
• Absence of services
Dell & Lyons, 2007
33. Community and Public Health
• What is your role in providing care,
treatment, and support for those who use
illicit drugs and are at risk for contracting .
• Nurses have a duty to provide safe,
competent, ethical care.
• Protect dignity and choice
• Enact social justice
CNA, 2007
34. Population Health Approach
• Consider underlying conditions that put people at risk of using,
abusing, and misusing drugs (ie. marginalization, poor support
networks, lack of access to health services, poor coping skills).
• Consider determinants of health:
Income and social status
Social support networks
Education
Employment
Coping skills
Culture
Physical environments
Health services Health Canada, 2001
35. What Can
YOU Do?
• HIV and HCV are PREVENTABLE
• Consider harm reduction within framework of
providing medical care
• goal is to minimize harm with a patient-first
approach
• maximize intervention options
• Knowledge ≠ behaviour
36. Summary
• As health care practitioners, we must provide culturally
competent care to our clients and citizens of our
communities.
• Western culture tends to blame the victim.
• Harm reduction can improve the quality of people’s lives.
• Some people are faced with several risk factors that put them
at risk for harm.
• We need to implement cultural elements when working with
our clients and with our partners.
37. “Ultimately we know deeply that the other side of
every fear is a freedom.”
Marilyn Ferguson
39. References
• All Nations Hope AIDS Network. (2002). Harm reduction in Saskatchewan: A resource guide. Regina, SK:
Author.
• Beirness, D.J., Jesseman, R., Notarandrea, R., & Perron, M. (2008). Harm reduction: What’s in a name? Ottawa,
ON: Canadian Centre of Substance Abuse.
• British Columbia Centre for Disease Control. (2003). The needs of someone living with HIV. Vancouver: Author.
• Canadian Aboriginal AIDS Network. (2007). Walk with me pathways to health: Harm reduction service delivery
model. Ottawa: Author.
• Canadian Aboriginal AIDS Network. Joining the Circle: An Aboriginal harm reduction model. Retrieved July 10 th,
2008 from http://www.healingourspirit.org/pdfs/publications/joincircle.pdf
• Canadian AIDS Treatment Information Exchange. (2007). Study looks at underlying causes of HIV, hepatitis C
and substance use in Aboriginal youth. Retrieved July 8, 2008 from
http://www.catie.ca/catienews.nsf/news/F78C7BC9B71F09388525733100608E31?OpenDocument
• Canadian Nurses’ Association. (2007). Promoting equity through harm reduction in nursing practice. Ottawa:
Author
• Dell, C. A., & Lyons, T. (2007). Harm reduction policies and programs for persons of Aboriginal descent.
Ottawa, ON: Canadian Centre on Substance Abuse.
• Health Canada. (2001). Reducing the harm associated with injection drug use in Canada. Ottawa: Author.
• Health Canada. (2001). Harm reduction and injection drug use: An international comparative study of contextual
factors influencing the development and implementation of relevant policies and programs. Ottawa: Author.
• International Harm Reduction Association. (2002).
• Ministry of Health. (2005). Harm reduction: A British Columbia community guide. British Columbia: Author.
• McLeod, A. (2004). As the wheel turns: The HIV/AIDS medicine wheel. The Positive Side, 6(4), 14-16.
• Saskatchewan Registered Nurses’ Association. (2008). SRNA position statement: Promoting equity through harm
reduction in nursing practice. Regina: Author.
• Wardman, D. & Quantz, D. (2006). Harm reduction services for British Columbia’s First Nation population: A
qualitative inquiry into opportunities and barriers for injection drug users. Harm Reduction Journal, 3(30), 1-
6.
Editor's Notes
*For seminar* Think about this: type II diabetes is a chronic medical condition that threatens those who are obese and have a sedentary lifestyle. Few people object to providing them with medication. Medication does not cure the condition, but the primary goal of treatment is to reduce the likelihood of secondary diseases (CV disease, retinopathy, neuropathy, etc). Losing weight and exercise is recommended but not everyone is successful in doing so. Compare that to your view of distributing condoms to prevent unwanted pregnancy and the spread of HIV. What’s the difference? What about seatbelts, bike helmets? Again, the goal is to reduce injury or harm.
There are several ways to define HR. It’s main goal is to reduce or minimize adverse health and social consequences associated with (in this case) drug use. Important to know that it doesn’t mean the discontinuation of drug use.
Translation: treating people as they are, providing education and options to reduce the harm associated with behavior (without changing behavior itself) I believe in the platinum rule. The golden rule states that we should treat other people how we want to be treated. The platinum rule treats other people how they want to be treated. And this is important when working with diverse population groups.
Our culture doesn’t look at the larger picture when it comes to substance abuse. We tend to focus on the individual and their problem instead of looking further. (victim blaming) Drug users are seen as “bad” and “it is their fault they are in that situation” In all drug users, we need to understand WHY, especially in FN peoples because of their past (abuse, residential schools, etc).
Humanistic Values – no moral judgements are made about the drug user. Acknowledgement of the respect of the dignity and the rights of the individual (CCSA, 2008). Focus on Harms – reduce the harms resulting from drug use rather than focusing on the extent of the drug use. The objective is to reduce the harmful consequences of drug use to the individual and others. Priority of Immediate goals – the most pressing, achievable and realistic goals are focused on first and are the first steps to a risk-free drug use. Starts with “where the person is”. Pragmatism – the improve the drug related harms short term rather than attempting to get the user to abstain completely. SRNA (in their 2008 pos’n statement) also includes autonomy, flexibility and maximization of intervention options, responsibility, education, dignity and advocacy.
- Insite reported 500 overdoses with no fatalities. On the street, these people would have most likely died.
Y do I believe in Harm Reduction is not the question. The real/riehl question is why don't I believe in abstinence. Treatment. Detox. List a bunch. B/c of the plat Rule. We r all different. Some of us R similar.
Concurrent Remanded HEP C 22 times higher and HIV 11times higher than general population Safer tattooing pilot program – 29,000 for HIV inmate and 26 000 hep c inmate treatment per year. Cost of pilot program 100 000 per year/per site project would have saved money if it prevented as few as four infections a year. Youth Ethical implications if under legal age, pragmatic for those over legal age. 3 areas that distinguish harm reduction policy as applied to you: Autonomy and ability to make informed choices (developmental processes) Specific harms and risks associated with youth (ie. laws re: access to alcohol) Unique opportunities for drug policies and programs targeting Youth (school based programming) These populations are underserved
Safe injection site? What about safe consumption sites, with regulations, and limits, and drugs that are monitored, measured, and dispensed by professionals.? http://www.health.gov.on.ca/english/providers/pub/aids/reports/ontario_needle_exchange_programs_best_practices_report.pdf
As Prime Minister Harper has said, our government is very concerned about the damage and pain drugs cause families and we take this issue very seriously. And that is why our new National Anti-Drug Strategy will place particular emphasis on educating Canadians, especially young people and their parents, about the negative effects – health and otherwise – of illicit drugs. My favorite Tony Clement quote “the party’s over” One size does not fit all Modelled after the failed War on Drugs. Nixon 1971
http://dpnoc.ca/about/a-letter-from-our-president/ “ Similarly, we do not agree with those involved in the Harm Reduction Movement wanting to legalize many of the currently illicit drugs. “ this is a myth or misconception
I have substituted HR for ethics……. Ethics is not a black & white subject Ethics is not something you either know or don’t know Ethics involves thinking and feeling, study and practice, knowledge and intuition
Substitute HR for The Code it of ethics is not a panacea Impossible to provide rules for every circumstance Does not tell you which value takes precedence over the other Provides guidance only- RNs must use critical thinking & problem solving skills to examine the values and how to weigh them in each situation E.g. Values and statements regarding ;promotion of health vs. patient Making informed smoke. Code can be overridden by other, stronger ethical or legal obligations: confidentiality vs. obligation to report child abuse cannot legally assist patient in committing suicide
We each have our own personal values, values about nursing, our institution has its values as well. At times these can collide. This is part of our culture as health care professionals A value is a belief or attitude about a goal, an object, a principle or a behavior. Our personal values affect our beliefs about health and illness and our sense of the “right” thing to do Values are reflected in the choices we make, in our actions and behaviors. But what about the choices of our clients In the process of making an ethical decision, our values can conflict. We may not be aware of it until we encounter conflict or something unexpected - Example: Individual-value life, value of freedom choice and control over one’s life pt with HIV and who becomes pregnant an informed choice to continue using injection drugs…the nursing values of choice and health and well-being come into direct conflict. situations in which one individual nurse’s values conflict with another individual’s personal or profession’s values or the institutions values.
It does not enable drug use. It can help prevent HIV and HCV for those that do not want to quit or can’t quit. It can be a gateway to addiction treatment. There is no evidence showing that that introduction of HR (ie. Needle exchange) increases drug use. This is only an assumption and isn’t looking at why people start to use drugs which is the main consideration that must be made. HR strategies are relatively inexpensive and cost effective (ie. By preventing the transmission of infection diseases or detecting the disease earlier before they have progressed into advanced states) Evidence has shown that HR doesn’t compromise the public’s safety in fact it does the opposite b/c it has been shown that more needles are recovered than are distributed therefore decreasing the public’s risk of contacting HIV or HCV
HR is not a moralistic concept that takes a stand on drug use. It’s a pragmatic solution in that some levels of drug use in society is expected and attempting to ameliorate drug related harms is more feasible in the short term rather than trying to eliminate the drug use all together. (in this case, we’ll focus on the spread of HIV in the Aboriginal population) It makes no assumptions about drug use and those that use drugs.
http://www2.cna-aiic.ca/CNA/documents/pdf/publications/JPS_Harm_Reduction_2012_e.pdf Why are position statements important
Used in Vancouver and Toronto
The primary objectives of these strategies is the reduction of adverse consequences associated with IDU. Needle exchange: provision of clean needles and syringes for IDU. Purpose is to prevent the spread of blood borne diseases and reduce the risk of infection. Injection sites: provide IDUs with a clean and safe environment where sterile equipment is provided and health care and social professionals are available to provide counselling and deal with health issues. Overdose intervention is available. (In Site) Individuals bring in their own drugs. The average amount of daily visits per day was 607. The average visits per person was 11. Methadone: substituting methadone for illegal drugs helps users establish a level of stability free from the use of injectable drugs. Street outreach: drug users often have limited access to health services and street outreach programs allow them to have access to clean syringes, testing, etc. Safe crack pipe programs: helps reduce the transmission of blood borne pathogens. Also gives users a chance to interact with health care professionals to provide education on reducing the risks. Other HR strategies that people don’t consider: seatbelts, bike helmets, low fat food
Historically, methadone maintenance programs underwent a political struggle. Methadone was available in Canada in the 1960’s but was only used for three to six percent of the injection drug using population. In the mid 1990’s government regulations changed increasing treatment availability which resulted in up to 24 percent of the injection drug using population receiving treatment in 1998 (Fisher, Rehm, & Blitz-Miller, 2000). Fisher et al., (2000) stated that. “…there were clear, instructive lessons… yet Canada’s policy-makers failed for the longest time to implement appropriate and sufficient measures to prevent and minimize injection drug use related harms” (p. 1712).
Focus on IDU because this is the method that causes the most HIV cases in Aboriginal pop’n however there are other methods. In total pop’n of Canadians, the method is MSM. (2007) Of all AIDS cases in FN 45% is attributed to IDU. Need to take a HOLISTIC approach and consider the social determinants of health. Illicit drug use among FN is double the rate of the general Canadian pop’n. https://mymail.siast.sk.ca/owa/attachment.ashx?attach=1&id=RgAAAACgBUjceA6RSIRe%2bXueIDitBwAs61ZeCi5PQrAmj7cmGBezADcScG0qAAAs61ZeCi5PQrAmj7cmGBezAEu946WTAAAJ&attid0=EACnk8wYziYtSp0OF5N6FADw&attcnt=1
In no particular order. All these result in physical, emotional, mental and spiritual pain. Aboriginals have social disadvantages and these put them more at risk to use illicit drugs. Poverty, low education, unstable family structure, physical abuse and poor social support network. (64% say they were raised in violent homes) They also suffer from culture barriers to health care services (language, lack of culturally appropriate services). Overall infection rate of HIV/AIDS is 2.8 times higher in FN than non-FN. (2007 stat) Alcohol abuse was a factor in 70% of homes. 126 Aboriginal IDUs themselves, say they may have ended up on the streets and turned to IDU b/c of the legacy of abuse they have gone through (Joining the Circle) Joining the Circle (from Abor. IDUs) : Alcohol 70% Violence 64% Suicide 50% Incest 44% Sexual abuse or assault in men 50% + Low education level 17% (<gr.9)
The most important element of developing and providing harm reduction services to FN people is incorporating traditional Aboriginal practices. Culturally appropriate services include: Aboriginal culture itself (medicine wheel), language, history and increased awareness of FN people among service providers. Harm reduction services need to be culturally appropriate in order for them to be accessed. IN a study, FN people identified they would like to see additional services provided (education along with needle exchange) in conjunction with HR services. Elders and community leader’s support is crucial. These people are respected by the community and hold the power to help. Similarities include: importance of links between the community and the individual. CAAN’s model (presented later) Healing journey is more in depth than in Western practices. Healing process includes: information, prevention activities, crisis interventions, counselling and follow-up. Difference includes the incorporation of community practices, customs, beliefs, ceremonies and use of Elders and Traditional medicine people. Using these culturally appropriate services is a key element in increasing pride and self-esteem.
Mood altering substances are incompatible for some Aboriginal peoples’ traditions, customs and cultural ways. (seen as out of balance) HR does not focus on abstinence, rather is looks at decreasing the risks, not specifically discontinuation. This has been seen as a barrier to offering Aboriginal people harm reduction services. For some Aboriginal communities, there is a stigma attached that HR in that it is seen as an indication of failure. This reason also makes FN peoples hesitant to access health care. There is a fear of discrimination and judgement among everyone, but this fear is even higher among Aboriginals. There is an absence of funded HR services in Aboriginal communities (specifically reserves and rural) which forces people to travel long distances and make other arrangements.
B/c of the settings nurses work in. They are in a unique pos’n to prevent many of the harms associated with drug use. Using HR strategies in nursing practice creates future opportunities to promote the health and well being of those experiencing substance use. Underlying principles of HR reflect the CNA’s code of ethics (2002)
Must look at the issue through a population health approach gov’ts at all levels can facilitate and create conditions within the social and physical environment that support and enhance health (Health Canada, 2001). The lack of these determinants of health may precede or exacerbate drug misuse. Strategy should include measures that address the underlying factors associated with drug misuse and measures to address the more immediate risk factors. Drug misuse: using drugs improperly Abuse: excessive use
Principles of Harm Reduction pragmatism human rights focus on harms maximize intervention options priority of immediate goals drug user involvement Why consider harm reduction programming? Many social, economic, mental health and personal reasons why people engage in higher risk behaviour Not all people are able to make the immediate changes necessary to eliminate risk
We now know the definition of harm reduction and its goals. There are several HR strategies that can be implemented to decrease adverse consequences of IDU. The risk factors are different from people in the Western culture