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PubMed2004

A small observational study of the longevity of syringe driver sites in palliative care.

Although the use of portable syringe drivers is common in palliative care, problems do occur. A small observational study of local practice was undertaken to establish the rate of syringe driver reactions and duration of sites; to determine whether a predictable relationship existed between the number of days on a syringe driver and the number of sites used consecutively; and to discover whether the location of a syringe driver site influenced the site longevity. Eighty-six syringe driver sites were established in 27 patients during the 3-month study period. Site duration ranged between 1 hour and 9 days (mean 2 days). An association was found between the number of days on a syringe driver and the number of sites used. However, this relationship is not close enough to predict when a site may be discontinued. Thirty-eight syringe drivers (44%) were discontinued because of site reactions. The location of a syringe driver site appeared to be an important factor influencing the site longevity, with cannula dislodgment three times more prevalent from the chest wall than the upper arm (P=0.05). However, the findings suggest that if it is possible to prevent dislodgement from the chest wall, then this site can be used for significantly longer before a site reaction develops (P=0.02). In view of the unpredictability of site reactions, it is concluded that sites must be assessed regularly and changed as soon as problems develop. As this was a small study in one unit without standardization of site reaction assessment, the results should be interpreted with caution. However, given the lack of published work in this area, this study contributes to the evidence base and raises important questions for both clinical practice and future research.

Adult↗
PubMed2003

Would you consider prescribing syringes to injection drug users? Addiction Medicine Conference Survey.

In order to assess attitudes and practices of physicians regarding prescribing syringes to injection drug users (IDUs) to prevent disease transmission, a survey was conducted at the 2000 ASAM Conference. Of 497 physicians, 104 responded, representing 30 states and 3 countries. Seventy-eight percent provided care for IDUs. Only 2% had prescribed syringes to IDUs for safer injection of illegal drugs. Nineteen percent had prescribed syringes to diabetic patients whom they believed would use the syringes for injecting illegal drugs. Overall, 61% of physicians (74% of internists, 37% of psychiatrists) (p = 0.04) would consider prescribing syringes to IDUs. Prescribing syringes to IDUs can be part of a comprehensive approach to preventing spread of HIV and other infections, decreasing complications of syringe reuse, and bringing IDUs into medical and substance abuse treatment. The majority of physicians surveyed expressed interest in prescribing syringes. Psychiatrists may be less willing to do so.

Adult↗
PubMedDate not supplied

Pharmacy student knowledge, attitudes, and beliefs about selling syringes to injection drug users.

OBJECTIVE: To explore pharmacy school education and pharmacy students' knowledge, attitudes, and beliefs about human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS), drug use, and syringe sales to injection drug users (IDUs). DESIGN: Qualitative study of a convenience sample of pharmacy school students. SETTING: A pharmacy school in the southeastern United States. INTERVENTION: Two focus groups and nine in-depth interviews were conducted about HIV/AIDS education and counseling, syringe sales to possible IDUs, and related pharmacy school education. PARTICIPANTS: 19 Doctor of Pharmacy students, including 88 students in their third professional year and 11 in their fourth professional year. RESULTS: Most participants believed that they would benefit from more class time on HIV/AIDS topics, including AIDS treatment medications and HIV prevention. Most participants believed that the laws and regulations governing syringe sales in their state were vague, leaving syringe sale decisions to pharmacists' discretion. Nine study participants supported selling syringes to possible IDUs, five opposed it, and five were undecided or ambivalent. Classroom education focused on addiction to prescription drugs, with limited attention to illicit drug use. CONCLUSION: Pharmacy students have divided opinions about selling syringes to IDUs. To prepare students for helping their patients with drug-use problems, pharmacy schools should increase training about HIV/AIDS and addiction. Policy makers should consider changing laws and regulations of syringe sales to recognize prevention of blood-borne infections as a legitimate medical purpose for selling syringes to IDUs.

HIV Infections↗
PubMedDate not supplied

Individual and structural influences shaping pharmacists' decisions to sell syringes to injection drug users in Atlanta, Georgia.

OBJECTIVE: To better understand the individual (e.g., attitudes and beliefs) and structural (e.g., laws and regulations) factors that influence and shape pharmacists' decisions about selling syringes to injection drug users (IDUs). DESIGN: Qualitative research. SETTING: Metropolitan Atlanta. PARICIPANTS: 20 practicing pharmacists who work in or near areas of high drug use in Atlanta, and nine pharmacists who are considered leaders in their profession in Georgia. INTERVENTIONS: Semistructured, in-depth interviews. MAIN OUTCOME MEASURES: Individual and structural factors that influence pharmacists' decisions about selling syringes to IDUs. RESULTS: Pharmacists reported that they use their professional discretion in making syringe sale decisions and that these decisions are influenced by individuals factors such as their personal attitudes and beliefs about the nature and causes of drug use, and by structural factors such as the Georgia Board of Pharmacy regulation stating that syringes cannot be sold if they will be used for an "unlawful purpose." CONCLUSIONS: IDUs' access to sterile syringes from pharmacies in Atlanta, would likely be increased by (1) providing practicing pharmacists with professional education programs that describe the broad professional support for IDU access to sterile syringes and why blood-borne infection prevention is a legitimate medical purpose for selling syringes and (2) removing or modifying the restrictive Board of Pharmacy regulation governing syringe sales.

Black or African American↗
PubMedDate not supplied

Contact with hospital syringes containing body fluids. Implications for medical waste management regulation.

OBJECTIVE: To determine amount of syringes used in the hospital and extent of contact with blood and body fluids of these syringes. MATERIAL AND METHODS: Syringe use was surveyed at a tertiary care center for one week; syringes were classified into the following four categories according to use: a) contained blood; b) contained other body fluids (urine, gastric secretion, cerebrospinal fluid, wound drainage); c) used exclusively for drug dilution and application in plastic intravenous (i.v.) tubes, and d) for intramuscular (i.m.), subcutaneous (s.c.), or intradermic (ID) injections. RESULTS: A total of 7,157 plastic disposable syringes was used; 1,227 (17%) contained blood during use, 346 (4.8%), other body fluids, 5,257 (73%) were used exclusively for drug dilution and application in plastic i.v. lines, and 327 (4.5%) were utilized for i.m., s.c., or ID injections. An estimated 369 140 syringes used annually, or eight syringes per patient per in-hospital day. All syringes were disposed of as regulated medical waste, in observance of the law. CONCLUSIONS: There is an urgent need to review recommendations for medical waste management by both international agencies and local governments, based on scientific data and a cost-benefit analysis, to prevent resource waste and further environmental damage. The English version of this paper is available too at: http://www.insp.mx/salud/index.html.

Body Fluids↗
PubMed2002

Effectiveness of ear syringing in general practice: a randomised controlled trial and patients' experiences.

BACKGROUND: Ear syringing is a common procedure performed for a variety of symptoms in primary care. Reports of its effectiveness vary considerably and no randomised controlled trials (RCTs) have been performed. AIM: To estimate the effect of ear syringing on hearing thresholds and on symptoms leading to ear syringing in general practice. DESIGN OF STUDY: Randomised single-blind controlled trial. Before-and-after self-assessments of symptoms. SETTING: Patients from three general practices in the Bristol area attending twice-weekly clinics dedicated to ear syringing over a 12-week period. METHOD: Patients were randomly assigned to have their hearing tested before and after ear syringing, or twice before ear syringing. Changes in hearing threshold were measured by pure tone audiometry (PTA). All patients completed sef-assessment forms of symptoms using Likert scales before, and one week after, ear syringing. RESULTS: Hearing threshold improved by 10 dB or more in 34% (95% confidence interval [CI] = 21% to 47%) of the intervention group and 1.6% of control group (number needed to treat = 3.1, 95% CI = 2.2 to 5.2, P<0.001). The levels of improvement in the intervention group ranged between 15 dB and 36 dB. The symptoms that most commonly improved included hearing on the phone, pain, a feeling of blocked ears, and hearing one-to-one. There was a strong relationship between the change thresholds, as measure using PTA, and self-reports of hearing improvement. Secondary analysis was unable to identify predictors of objectively measured improvement. CONCLUSION: Ear syringing improved hearing threshold in a substantial proportion of patients. An even larger proportion reported an improvement in symptoms. It was not possible to predict which patients would benefit.

Adult↗
PubMedDate not supplied

Needle sharing and participation in the Amsterdam Syringe Exchange program among HIV-seronegative injecting drug users.

To enhance the prevention of human immunodeficiency virus infection, factors related to regular participation in the Amsterdam Syringe Exchange and the borrowing of syringes were studied in 131 HIV-seronegative injecting drug users in a 1989-90 survey. A total of 29 percent of the users reported borrowing syringes, that is injecting drugs at least once in the past 4-6 months with a needle or syringe previously used by someone else. Users at increased risk of borrowing are previous borrowers, long term moderate-to-heavy alcohol users, current cocaine injectors, and drug users without permanent housing. Regular clients of the syringe exchange, when compared with other injecting drug users, were found more often to be frequent, long term injectors. They borrowed slightly less often than other users, but this was not statistically significant, even after controlling for frequency of injecting or other potential confounders. The results suggest that, 5 years after the start of the Amsterdam Syringe Exchange, drug use characteristics govern an individual injecting drug user's choice of exchanging or not exchanging syringes. The conclusion is that it seems more important to direct additional preventive measures at injecting drug users with an increased risk of borrowing rather than at users who do not participate in the syringe exchange or who do so irregularly.

Adult↗
PubMed1987

Stability of terbutaline sulfate repackaged in disposable plastic syringes.

The stability of terbutaline sulfate injection repackaged in disposable plastic syringes and stored for a 60-day period under one of three conditions, dark at 4 degrees C, dark at 25 degrees C, and light at 25 degrees C, was studied. Terbutaline sulfate from 1-mg/mL ampuls was repackaged into 63 3-mL polypropylene syringes. Twenty-one syringes were protected from light by storage in ultraviolet-light-inhibiting bags in a dark cabinet. Twenty-one syringes were exposed to continuous fluorescent light at room temperature, and the remaining syringes were stored in the dark under refrigeration. Samples were visually inspected and assayed on days 0, 1, 4, 7, 14, 28, and 60 after repackaging. Drug concentrations were determined by a stability-indicating high-performance liquid chromatographic method. Terbutaline concentrations ranged from 89.2% to 98.5% of initial concentration. The contents of the light-exposed syringes had yellowed by day 60. Terbutaline sulfate in polypropylene syringes is stable for 60 days under refrigeration and at room temperature when protected from light, but substantial degradation and discoloration of the drug can occur when the syringes are not protected from light.

Drug Packaging↗
PubMed1984

Compatibility of paraldehyde with plastic syringes and needle hubs.

The compatibility of paraldehyde with plastic syringes and needle hubs was evaluated. Paraldehyde, USP, was stored in three types of 5-ml syringes: Plastipak, Glaspak, and all glass; the latter type served as the control. At specified times up to 24 hours, the contents of the syringes was evaporated to constant weight, and the residue was weighed. To evaluate the effect of paraldehyde on plastic needle hubs, needles with plastic and metal hubs were immersed in paraldehyde for 24 hours, and the paraldehyde was evaporated. No measurable change in residue weight was noted in any syringes for up to three hours. Compared with the control, there was a significant increase in the average weight of residue in the Glaspak and in the Plastipak syringes at 6, 12, and 24 hours. There was no significant difference in the weight of residue between the Glaspak and Plastipak syringes at those times, however. The amount of residue for the plastic and metal needle hubs was not significantly different. The source of the extractive residue appeared to be the rubber plunger tip. Since the nature of the extractive material in the residue is not known, paraldehyde should be administered in all-glass syringes if possible; other syringe types can be used only if the drug is administered immediately. The use of needles with plastic hubs is acceptable.

Acetaldehyde↗
PubMed1995

Impact of increased legal access to needles and syringes on practices of injecting-drug users and police officers--Connecticut, 1992-1993.

To determine whether the simultaneous, partial repeal of needle prescription and drug paraphernalia laws in Connecticut affected purchasing and usage of needles and syringes (syringes) by injecting-drug users (IDUs) and risk of needlestick injuries to police officers, we conducted two serial cross-sectional surveys with IDUs recruited in drug treatment centers, correctional facilities, and health department settings. Reports of needlestick injuries among Hartford police officers were reviewed before and after the new laws. Among IDUs who reported ever sharing a syringe, syringe-sharing decreased after the new laws (52% before vs. 31% after; p = 0.02). Fewer IDUs reported purchasing syringes on the street after the new laws (74% before vs. 28% after; p < 0.0001). More IDUs reported purchasing syringes from a pharmacy after the new laws (19% before vs. 78% after; p < 0.0001). Eight to eleven months after the new laws were enacted, over two thirds (91 of 134) of active IDUs interviewed were aware of both new laws. Needlestick injury rates among Hartford police officers were lower after the new laws (six injuries in 1,007 drug-related arrests for 6-month period before new laws vs. two in 1,032 arrests for 6-month period after new laws). The changes in Connecticut laws were associated with decreases in self-reported syringe-sharing and increases in purchasing by IDUs of sterile syringes from reliable sources, suggesting that the simultaneous repeal of both prescription and paraphernalia laws is an important HIV prevention strategy.

Adolescent↗
PubMed1995

Operational issues in syringe exchanges: the New York City tagging alternative study.

It is estimated that 50% of the approximate 200,000 intravenous drug users (IDUs) in New York City (NYC) are infected with HIV. Syringe exchange, a common method of HIV prevention in many countries was legalized in NYC in 1992. As syringe exchange has gained public support and the number of functioning exchangers has grown in the country, more attention has been given to the study of operational characteristics of syringe exchanges. Syringe exchanges may be considered health service delivery organizations, and the specific methods of service delivery may greatly influence their effectiveness in reducing HIV risk behavior among injecting drug users. Improving operational characteristics of syringe exchanges requires both careful data collection, in order to reduce ambiguity in interpretation, and methods for cumulating knowledge, so that previous learning experiences need not be repeated with each new exchange. We report here on the practice of marking ("tagging") syringes distributed by exchanges in NYC during the period from 1990 through 1994. During this period the NYC exchanges operated illegally as underground exchanges, and then received legal status and expanded greatly. Developing regulations that reflect the reality of the program operations while allowing for monitoring and oversight is a complicated process, especially when implemented in states that maintain paraphernalia and prescription laws and where "unauthorized" possession of injection equipment remains a criminal activity under existing legal statutes. The particular situation in NYC which required the revision of existing regulations during a period of rapid program expansion and implementation of a large system of syringe exchange further illustrates the multiple pressures which accompany such a process. In order to implement meaningful regulations which maximize the public health benefits of syringe exchange programs on an individual and community level, recommendations are made.

HIV Infections↗
PubMed1995

A visual inspection protocol for measuring characteristics of used syringes.

This article reports on the use of a Visual Inspection Protocol (VIP) to measure observable characteristics of syringes deposited at the San Francisco needle exchange program. Syringes received by the program were evaluated by several inspectors using the VIP, and interrater reliability was assessed for each item. In Study I, syringes bearing individual markings made by the user (n = 568) were more likely to be capped at the point end and plunger end, and more often were new in appearance when compared with unmarked syringes (n = 2,820). In Study II, syringes with a short street life (n = 250) were more often new in appearance and were less likely to contain blood than syringes with a long street life (n = 246). Syringes having individual markings also show signs of more careful use, and marking syringes may represent an ad hoc HIV prevention strategy for some injection drug users.

HIV Infections↗
PubMed2001

Syringe borrowing persists in Dublin despite harm reduction interventions.

AIMS: To measure the frequency of syringe borrowing in young Irish injecting drug users (IDUs) and identify associated characteristics. DESIGN: Cross-sectional survey. SETTING: Addiction treatment services in Dublin. PARTICIPANTS: Treated IDUs (N = 246). MEASUREMENTS: Data on drug injecting and syringe borrowing in the previous 6 months. FINDINGS: The median age was 22 years and the median length of injecting history was 19 months. Syringe borrowing was reported by 173 (70.3%) participants. A multivariate analysis identified seven characteristics significantly associated with syringe borrowing. These included early school leaving and parental unemployment. IDUs with long injecting histories who had injected less frequently were more likely to borrow. Injection of more than one substance was significantly associated with borrowing of syringes. Syringe borrowing was associated with having more intimate social relationships with other IDUs, less perceived risk in borrowing from acquaintances and usually opting to inject in the company of other IDUs. CONCLUSIONS: Syringe borrowing is commonly practised by young IDUs. Those with a background of social deprivation are more likely to engage in this risk behaviour. IDUs who report borrowing are more intimately involved with other IDUs and tend to perceive less risk or dangerousness in borrowing. In addition to syringe exchange, there is a need to work cognitively with IDUs to identify and challenge assumptions that they may have regarding the safety involved in borrowing from others, particularly from those with whom they have close social relationships.

Adult↗
PubMed1996

Role of syringeal muscles in gating airflow and sound production in singing brown thrashers.

1. The role of syringeal muscles in song production, particularly in regulating airflow through the syrinx, was studied in singing brown thrashers (Toxostoma rufum). In nine individuals, muscle activity was recorded electromyographically together with bilateral syringeal airflow, subsyringeal air sac pressure, and vocal output. 2. Dorsal muscles, m. syringealis dorsalis (dS) and m. tracheolateral dorsalis (dTB), are consistently activated during ipsilateral closing of the syrinx or increasing syringeal resistance, suggesting that their main role is adduction. This interpretation is supported by the motor patterns accompanying syllables with rapid oscillations in the rate of airflow. Bursts of electrical activity (2-10 ms) in dorsal muscles are precisely synchronized with decreasing airflow. 3. Electrical activity in m. tracheobronchialis ventralis (vTB) and m. tracheolateralis (TL) is associated with active abduction. An important contribution of vTB is to open the syringeal lumen for short inspirations in between syllables. In syllables with oscillatory flow modulations, vTB bursts show variable alignment with the phase of increasing flow. From this and activity during other syllables, it appears that, during phonation, vTB activity fine tunes the syringeal configuration, which is set by action of the dorsal muscles into a partially constricted state. 4. Activity in the ventral portion of TL, an extrinsic muscle, is strikingly similar to that of vTB, an intrinsic muscle, suggesting that the two muscles have a similar functional role. This supports the notion that intrinsic syringeal muscles of songbirds evolved from extrinsic muscles of nonpasserines. 5. M. syringealis ventralis (vS) does not appear to contribute directly to gating of airflow. Its activity is not consistently correlated with active changes in syringeal resistance. 6. Activity in m. sternotrachealis (ST) is most prominent during rapid changes in the rate of airflow or when switching between expiratory and inspiratory flow, suggesting a role in stabilizing the syringeal framework.

Animal Communication↗
PubMed2006

Syringeal muscles fit the trill in ring doves (Streptopelia risoria L.).

In contrast to human phonation, the virtuoso vocalizations of most birds are modulated at the level of the sound generator, the syrinx. We address the hypothesis that syringeal muscles are physiologically capable of controlling the sound-generating syringeal membranes in the ring dove (Streptopelia risoria) syrinx. We establish the role of the tracheolateralis muscle and propose a new function for the sternotrachealis muscle. The tracheolateralis and sternotrachealis muscles have an antagonistic mechanical effect on the syringeal aperture. Here, we show that both syringeal muscles can dynamically control the full syringeal aperture. The tracheolateralis muscle is thought to directly alter position and tension of the vibrating syringeal membranes that determine the gating and the frequency of sound elements. Our measurements of the muscle's contractile properties, combined with existing electromyographic and endoscopic evidence, establish its modulating role during the dove's trill. The muscle delivers the highest power output at cycle frequencies that closely match the repetition rates of the fastest sound elements in the coo. We show that the two syringeal muscles share nearly identical contraction characteristics, and that sternotrachealis activity does not clearly modulate during the rapid trill. We propose that the sternotrachealis muscle acts as a damper that stabilizes longitudinal movements of the sound-generating system induced by tracheolateralis muscle contraction. The extreme performance of both syringeal muscles implies that they play an important role in fine-tuning membrane position and tension, which determines the quality of the sound for a conspecific mate.

Animals↗
PubMed2002

Strategies to improve access to sterile syringes for injection drug users.

The high prevalence of infection with HIV and other blood-borne pathogens in injection drug users (IDUs) is directly related to the lack of syringe access. Needle exchange programs (NEPs), syringe prescription, and syringe deregulation are 3 approaches to increasing access to sterile syringes for IDUs. The benefits of NEPs have been repeatedly demonstrated, but the impact of NEPs has been limited by a lack of federal funding. Syringe prescription for IDUs is a promising new strategy supported by many organizations; legalizing syringe purchase and possession has led to a substantial improvement in syringe access in many states. Because each approach has unique advantages, providing IDUs with a variety of options for syringe access is likely to be most beneficial.

HIV Infections↗
PubMed2005

Water as a fast acting wax softening agent before ear syringing.

BACKGROUND: Dispute exists over the best treatment for softening occlusive earwax. Some require the patient to go away for days before returning for syringing. Some syringe immediately with no preparation. METHODS: An open, nonblinded, randomised controlled trial was conducted in one rural general practice. Effects of instillation of water into the ear canal for 15 minutes before syringing were compared to effects of syringing immediately. RESULTS: Thirty-nine ears (of 26 patients) were randomised. Ear wax was removed entirely by syringing in all ears. Prior instillation of water required a mean 7.5 (+/- 7.3) attempts at syringing versus a mean 25.4 (+/- 39.4) attempts for ears that were syringed immediately (p=0.043). DISCUSSION: Prior installation of water before syringing seems to be an effective and simple method of reducing the number of attempts required to clear the ear of occlusive wax.

Administration, Topical↗
PubMed1995

Safety, effectiveness and ease of use of a non-reusable syringe in a developing country immunization programme.

Unsterile needles and syringes may transmit blood-borne infectious agents such as HIV and hepatitis B virus. The emergence of these diseases as major public health concerns and the risk of nosocomial transmission has heightened interest in the development of single-use injection devices. WHO and UNICEF embarked on a programme to develop and introduce these devices in 1987. We report on a field trial in Karachi, Pakistan, of the SoloShot (SS) plastic disposable syringe, which has a metal clip in the syringe barrel to prevent second-time withdrawal of the plunger. A conventional disposable syringe (CS) was used as a comparison. We observed 48 vaccinators giving 2400 injections with the SS and 1440 with the CS; 98.7% of SS performed as designed. The average volume required per delivered dose was comparable for the two syringes and was delivered more quickly with SS. Training and experience had a small but statistically significant effect on several aspects of SS use. Vaccinators who indicated a syringe preference preferred SS on 7 out of 9 indicators. SS is safe and effective in preventing reuse and is easier and quicker to use than the CS. Vaccinators require little, if any, special training. It could directly replace disposable syringes in expanded programmes on immunization (EPI) in countries where use of unsterile disposable devices occurs or when sterilization is not practical.

Allied Health Personnel↗