Specific High-risk Situations Research Articles

Stereotactic Body Radiotherapy for Lung Oligo-metastases: Systematic Review and International Stereotactic Radiosurgery Society Practice Guidelines

PurposeA systematic review of treatment characteristics, outcomes, and treatment-related toxicities of stereotactic body radiation therapy (SBRT) for pulmonary oligometastases served as the basis for development of this International Stereotactic Radiosurgery Society (ISRS) practice guideline. MethodsIn accordance with PRISMA guidelines, a systematic review was performed of retrospective series with ≥50 patients/lung metastases, prospective trials with ≥25 patients/lung metastases, analyses of specific high-risk situations, and all randomized trials published between 2012 and July 2022 in the MEDLINE or Embase database using the key words “lung oligometastases”, “lung metastases”, “pulmonary metastases”, “pulmonary oligometastases”, “stereotactic body radiation therapy (SBRT)” and “stereotactic ablative body radiotherapy (SBRT)”. Weighted random effects models were used to calculate pooled outcomes estimates. ResultsOf the 1884 articles screened, 35 analyses (27 retrospective-, 5 prospective, and 3 randomized trials) reporting on treatment of >3600 patients and >4650 metastases were included. The median local control was 90 % (Range: 57–100 %) at 1 year and 79 % (R: 70–96 %) at 5 years. Acute toxicity ≥3 was reported for 0.5 % and late toxicity ≥3 for 1.8 % of patients. A total of 21 practice recommendations covering the areas of staging & patient selection (n = 10), SBRT treatment (n = 10), and follow-up (n = 1) were developed, with agreements rates of 100 %, except for recommendation 13 (83 %). ConclusionSBRT represents an effective definitive local treatment modality combining high local control rates with low risk of radiation-induced toxicities.

Development and validation of the Stimulant Refusal Self-Efficacy Questionnaire (SRSEQ) in stimulant users in treatment

BackgroundSelf-efficacy is a core component of Social Cognitive Theory. Refusal self-efficacy is an individual's belief in their ability to refuse a substance in specific high-risk situations. Change in refusal self-efficacy is predictive of positive treatment outcomes. Measurement of refusal self-efficacy is critical as it directs coping skills development techniques though existing behavioural treatments. There is no validated measure of stimulant refusal self-efficacy. This study developed and validated the Stimulant Refusal Self-Efficacy Questionnaire (SRSEQ) to measure confidence in the ability to refuse stimulants in specific high-risk situations. MethodTwo hundred and seven stimulant-using patients referred for assessment completed the SRSEQ and measures including stimulant dependence severity (Severity of Dependence Scale-Stimulant, SDS-S). Confirmatory Factor Analysis (CFA) using structural equation modelling (SEM) was conducted to test the theoretically-driven three-factor structure of the SRSEQ. Criterion validity was tested with severity of stimulant dependence. ResultsThe CFA supported the three-factor structure. Emotional Relief (β = −0.27, p = .008), Opportunistic (β = −0.24, p = .013) and Social Facilitation (β = −0.32, p < .001) refusal self-efficacy were uniquely associated with stimulant dependence severity, explaining 55.1% variance. ConclusionsThe SRSEQ is psychometrically sound and may be clinically useful to assist with assessment and treatment planning for stimulant use disorder.

Why do medication errors occur in veterinary practice?

Medication errors are common in veterinary practice. While many of these do not result in harm to a patient, those that do can have serious consequences for the patient and also affect the people involved. Patient safety event reporting provides insight into how and why medication errors occur in practice. Although human error plays a part, there are many contributing factors that make mistakes more likely to happen. This article discusses the types of errors that are reported, common error-producing conditions and specific high-risk situations where errors can have the most serious consequences.

Do arteriovenous fistulas increase cardiac risk?

An effectively functioning arteriovenous fistula is the life line for patients on long-term hemodialysis, and for most an upper limb, native vessel fistula has significant short- and long-term advantages. There are, however, situations where a fistula has deleterious effects, including the relatively uncommon problem of severe heart failure exacerbated in particular by high-flow fistulas. There is also increasing evidence that a fistula can add to the already high burden of cardiovascular risk in patients with advanced kidney disease, including by promoting water and salt retention, and by inducing or worsening left ventricular hypertrophy. While cases periodically arise where a fistula needs to be ligated with some urgency, such as severe heart failure, an increasingly persuasive case can be made for electively ligating fistulas that are not being used. The most common example of this is in stable renal transplant recipients, where the risks of ligation are outweighed by the potential risks of maintaining an unused fistula. Surgically reducing the blood flow in large (usually upper arm) fistulas is also a legitimate maneuver in specific high-risk situations.

The development and evaluation of the Harm Reduction Self-Efficacy Questionnaire.

The authors recruited 99 injection drug users to assess the psychometric properties of a new self-report questionnaire--the Harm Reduction Self-Efficacy Questionnaire (HRSEQ)--designed to measure injection drug users' confidence to employ 15 specific health-preserving coping skills in different types of high-risk situations (experiencing withdrawal, feeling depressed, and feeling social pressure to use drugs unsafely). Scores for each high-risk situation had good internal consistency (alphas = .89 -.92) and good 1-week test-retest reliability (rs = .70 -.85). Comparison with measures of drug-related problems, use of coping skills, and health self-efficacy supported both construct and discriminant validity of the HRSEQ. Exploratory factor analyses revealed 3 major themes (cleanliness precautions, overdose precautions, and safer injection practices) that summarized most, but not all, of the 15 items. Mean differences among the 3 situations suggest that harm reduction self-efficacy should be assessed in the context of specific high-risk situations.

Changes in Coping Following Treatment for Child Molesters

Relapse prevention theory assumes that specific coping skills deficits contribute to sexual reoffending. Recent research suggests that the general coping style of sexual offenders is also ineffective. In this study changes were examined in specific and general coping deficits following a treatment program that incorporated specific skills training as well as modifying general styles. Treated incarcerated child molesters were compared to a group of incarcerated child molesters on a waiting list for treatment. Groups completed various measures aimed at identifying coping strategies used in specific high-risk situations and general coping styles. Compared to the waiting list group, treated child molesters identified more effective coping strategies in specific high-risk situations. Changes are noted in their general coping styles with an increase in the endorsement of task-focused strategies and social diversion strategies. No changes in their endorsement of ineffective strategies such as emotion-focused or distraction strategies occurred. Implications for treatment are discussed.

Towards Prevention: A Situational Study of Police Deaths on Duty in Queensland

Research findings from a study of 45 police deaths on duty in the state of Queensland since 1950 are presented and this research identified situational variables that appear amenable to preventive efforts, with direct practical application in the development of protective measures for frontline officers. The findings show the need for an extremely cautious and meticulously planned approach by police to specific high-risk situations such as raids, sieges, roadblocks and vehicle pursuits, highlighting the importance of greater caution in more routine activities, such as speed detection, approaching stationary vehicles and driving to non-urgent calls for assistance.

Relapse prevention. An overview of Marlatt's cognitive-behavioral model.

Relapse prevention (RP) is an important component of alcoholism treatment. The RP model proposed by Marlatt and Gordon suggests that both immediate determinants (e.g., high-risk situations, coping skills, outcome expectancies, and the abstinence violation effect) and covert antecedents (e.g., lifestyle factors and urges and cravings) can contribute to relapse. The RP model also incorporates numerous specific and global intervention strategies that allow therapist and client to address each step of the relapse process. Specific interventions include identifying specific high-risk situations for each client and enhancing the client's skills for coping with those situations, increasing the client's self-efficacy, eliminating myths regarding alcohol's effects, managing lapses, and restructuring the client's perceptions of the relapse process. Global strategies comprise balancing the client's lifestyle and helping him or her develop positive addictions, employing stimulus control techniques and urge-management techniques, and developing relapse road maps. Several studies have provided theoretical and practical support for the RP model.

Thai Program Increases Men's Use of Condoms With Sex Workers

To curtail the acquired immunodeficiency syndrome (AIDS) epidemic the government of Thailand launched a program to promote condom use in encounters with commercial sex workers through safe sex education and the provision of condoms to commercial sex establishments. This program has been credited in part with substantial declines in human immunodeficiency virus (HIV) infection among Thai men during 1991-95. To confirm this trend a survey was conducted involving 4311 young men from northern Thailand (the region with the highest HIV prevalence) who were inducted into the Thai military during 5 1-month periods in 1991 1993 and 1995. At induction 10-13% of men in the 1991 and 1993 cohorts were HIV-positive compared to only 7% in 1995; the proportion infected with syphilis also fell significantly from 3% in 1991 to 1% in 1995. The proportion of men who had visited a prostitute in the 12 months preceding the survey declined from 57% in 1991 to 24% in 1995 and the incidence of condom use in such encounters rose from 61% to 93%. Multivariate analyses indicated that the risk of HIV infection was significantly elevated in each cohort among men who had sex with a prostitute (odds ratios 3.5-10.8) and those with a history of a sexually transmitted disease (odds ratios 2.5-5.1). Only 3.8% of men who became sexually active in 1991 or later were HIV-positive compared to 10.16% of those who initiated sexual activity in earlier years. These findings suggest that in developing countries programs that target specific high-risk situations may be more effective than interventions relying only on general AIDS education.

High-risk situations for engaging in substance abuse and binge-eating behaviors.

Self-reports of high-risk events, situations and experiences associated with substance abuse and binge-eating behaviors were examined in a sample of hospitalized patients being treated for both problems. The question being posed in the present study is: Are the high-risk situations for heavy drinking and binge eating similar or different? Results suggest some similarities in the intensity of specific high-risk situations as represented by questionnaire subscale scores, for both of the problem behaviors, but they point to interesting differences as well. The hierarchical importance of the high-risk situations for the two behaviors were markedly different.

Behavioral use of disulfiram in the treatment of problem drinking.

As part of an outpatient treatment research project alternative ways of using Antabuse (disulfiram) in the treatment of problem drinkers are developed. Instead of forced regular use, Antabuse was administered as a voluntary situational therapeutic tool. Subjects were 84 men and 51 women. Thirty percent of both men and women decided to use Antabuse. Men most often used disulfiram continuously for a longer period or to stop an ongoing drinking period. The women used Antabuse to secure shorter periods of abstinence as part of their drinking schedules and to prevent drinking in specific high-risk situations. The subjects using Antabuse reduced their ethanol consumption significantly (p less than .05) at the end of the follow-up period, compared to the nonusers.