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By I. Darmok. Nebraska Wesleyan University. 2019.

It also calls for a multi pronged approach targeting demand buy fincar 5 mg without a prescription, supply and harm reduction buy fincar 5mg mastercard. The following recommendations are made for different campaigns: Social Mobilisation Campaigns The following general recommendations are in order:  Use the ecological framework as a basis for designing programmes and interventions to combat drug abuse. Evidence in literature suggests that there is a need for more structured and evidence based campaigns which will be able to advocate increased focus and resources to combating drug use. The effort should be maintained throughout the course of the year, with campaign renewals at peak high recreational periods. These campaigns need to adopt the framework outlined in the South African Drug Prevention Master Plan in order for them to be easily monitored against the 3 pillars. In addition, the campaign should be multi disciplinary with a range of stakeholders as suggested in Table 5 below. Impact of alcohol advertising and media exposure on adolescent alcohol use: A systematic review of longitudinal studies. School violence and adolescent mental health in South Africa: Implications for school health programs. Sociological Practice: A Journal of Clinical and Applied Sociology, 1(4), 285-303. Adolescent multiple risk behaviour: an asset approach to the role of family, school and community. National strategy for the prevention and management of alcohol and drug use amongst learners in schools. Prevalence patterns and predictors of alcohol use and abuse among secondary school students in Southern KwaZulu-Natal, South Africa: Demographic factors and the influence of parents and peers. Botvin, (2011), Evidence-Based Interventions for Preventing Substance Use Disorders in Adolescents, Child Adolesc Psychiatr Clin. Audit of prevention programmes targeting substance use among young people in Greater Cape Town Metropole. Jacobs, L and Steyn, N (2013) commentary: If You Drink Alcohol, Drink Sensibly: Is This Guideline Still Appropriate? The experience review of interventions and programmes dealing with youth violence in urban schools in South Africa. Factors associated with substance use among orphaned and nonorphaned youth in South Africa. Sikkema (2014), The Impact of methamphetamine (“tik”) on a peri-urban community in Cape Town, South Africa, International Journal of Drug Policy, Mar; 25(2): 219–225. Morojele and L Ramsoomar, (2016), Addressing adolescent alcohol use in South Africa, S Afr Med J 2016;106(6):551-553. Perceptions of sexual risk behaviours and substance abuse among adolescents in South Africa: a qualitative investigation. A qualitative study of home-brewed alcohol use among adolescents in Mankweng District, Limpopo Province, South Africa. Alcohol consumption and non-communicable diseases: Epidemiology and policy implications. A prospective study of metaphetamine use as a predictor of high school non-attendance in Cape Town, South Africa. Women’s discourses about secretive alcohol dependence and experiences of accessing treatment. Unpublished dissertation presented for the degree of Doctor of Philosophy in the Department of Psychology at the University of Stellenbosch; Pretorius, C. Umthente Uhlaba Usamila – The 2 nd South African Youth Risk Behaviour Survey 2008. Umthenthe uhlaba usamila – the 1st South African youth risk behaviour survey 2002. The comparative risk assessment for alcohol as part of the global burden of disease 2010 study: What changed from the last study? Alcohol consumption as a risk factor for pneumonia: A systematic review and meta-analysis. Setlalentoa M, Elma Ryke and Herman Strydom (2015) Intervention strategies used to address alcohol abuse in the North West province, South Africa Social work (Stellenbosch. Religious activity and risk behavior among African American adolescents: Concurrent and developmental effects. Evaluation of a Primary Prevention of Substance Abuse Programme Amongst Young people at Tembisa. Baseline study of the liquor industry including the impact of the national liquor act 59 of 2003. Conducting effective Substance abuse prevention work among the youth in South Africa. Identification and prediction of drinking trajectories in early and mid-adolescence. Violence as an impediment to a culture of teaching and learning in some South African schools. All rights reserved, worldwide The designations employed and the presentation of material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the United Nations concerning the legal status of any country, territory, city or area, or of its authorities, or concerning the delimitation of its frontiers or boundaries.

The physician must be careful that their own personal beliefs and perspectives do not interfere with effective care cheap fincar 5mg without prescription. Coping with an adverse event buy fincar 5mg lowest price, complaint or litigation Canadian Medical Protective Association Objectives Physicians invest inordinate amounts of time and energy This chapter will in their work, and their self-image is often centred on their • discuss the effects of medical errors, complaints and litiga- status as a physician. Legal allegations and patient complaints tion on physicians in training and throughout their career frequently depict doctors as callous, negligent or incompetent; in medicine, and physicians may feel this is a direct assault on their essence as • present an approach to dealing with errors and complaints a person. The legal claim is made by the family coverage of the clinical event, their trial, or college hearing. Internal emotions • sorrow The physician scans the document quickly but has to get • guilt back to work. The physician has diffculty completing the • loss of self-esteem shift and experiences feelings of insecurity bordering on • shame panic. Although the physician believes his family will be • fear supportive, the physician is ashamed to tell them about External pressures the legal action and the mistakes the physician presumes • social isolation from friends and family to have made in the case. Physicians are also susceptible to feelings of isolation during Approximately two per cent of physicians are named in a legal diffcult moments in their career. Far more are involved in a wide variety of it hard to maintain a social network of friends and colleagues other medico-legal diffculties. Patients or other parties may with whom they can commiserate and share experiences. They complain about a physician to a regulatory authority (college), may also feel shame or embarrassment about presumed medi- hospital or privacy commissioner or to the Human Rights cal errors. Physicians may be referred for college disciplin- as a failure, they may be inclined to keep the matter from their ary hearings or have their practice reviewed. Maintaining perspective Although it is impossible to erase a physician’s sadness and Medico-legal diffculties are stressful for physicians for several regret associated with a poor patient outcome, feelings of reasons. In some cases, the problem arises from a clinical out- guilt, inadequacy or fear can be greatly attenuated by keeping come that is unexpected and even disastrous to the patient. Physicians may be consoled by the is normal for a doctor to feel distressed when a patient dies following facts and observations. Physicians ex- perience empathy and sorrow for the patient and family when A poor patient outcome, even if unexpected, does not signify a tragic clinical outcome occurs. Doctors may beat up on themselves and won- sis or a surgical complication does not equate with negligence. They may be tormented have determined that the clinical standard of care by which a by doubts and second thoughts, even if their management of claim is judged is not one of perfection, but rather one that the case, viewed prospectively, had appeared reasonable at the might reasonably be expected from a normal, prudent health time. In spite of a deep commitment to patient care counsel, so as to maintain legal privilege. Provincial and university- or community-based physician health programs are available to provide support and assistance to Doctors often work in suboptimal conditions; they may be physicians going through diffcult moments. Contact informa- overloaded with work and may suffer from fatigue or sleep tion is available in Chapter 12-B of this guide. A physician may be loath to use fatigue as an excuse for a poor outcome, but the reality is that fatigue and Practical considerations other system and organizational issues often contribute to the Most physicians do cope reasonably well with adverse events occurrence of adverse events. Many come to realize that a medico- legal diffculty is not the cataclysmic event they may have All colleagues and most patients are aware that any physician, imagined. A medico-legal diffculty may induce a physician to even the most competent and knowledgeable among them, may appraise their practice and lifestyle and to implement construc- encounter a medico-legal diffculty at one time or another. Doctors should endeavour to achieve a satisfying unusual for patients to leave a physician’s practice because of work–life balance, and if a phase of practice becomes par- another patient’s complaint or legal action. Colleagues, patients, ticularly stressful they may wish to modify their practice to other health professionals, family and friends are appreciative allow for more time to invest in and take care of themselves. It can also be helpful to engage the services cian are rarely affected by a medico-legal diffculty. Physicians’ worries about the effect of a lawsuit or patient complaint on their career are often exaggerated. However, Positive practice changes can enhance patient safety, but physi- even when the medico-legal problem is reported in the me- cians should also avoid the urge to practise overly defensive dia, in most cases it is quickly forgotten by all but the parties medicine with excessive and clinically unwarranted investiga- involved. Above all, physicians should strive to do their best, to be thorough and conscientious, and to realize that perfection There is, of course, no magic remedy for the regret and sadness is unattainable. Case resolution The physician’s spouse is also a family physician and is Managing the stress unwavering in their support during the legal process. Kind Physicians should not be ashamed to seek help when facing a words from colleagues and patients helped to restore the medico-legaldiffculty. CanadianMedicalProtectiveAssociation physician’s confdence in themselves and the system.

It also includes partnerships with researchers and communities cheap fincar 5 mg otc, affected communities such as drug user organisations cheap fincar 5mg with mastercard, Aboriginal and Torres Strait Islander communities, and other priority populations. Coordination and collaboration Coordination and collaboration at the international level, nationally and within jurisdictions leads to improved outcomes, innovative responses and better use of resources. The Strategy coordinates the national response to alcohol, tobacco and other drugs by establishing the harm minimisation approach. The Strategy also facilitates collaboration by describing the wide variety of responsibilities within the harm minimisation approach and their interdependence, as well as through the Strategy’s governance structure. Evidence informed responses Funding, resource allocation and implementation of strategies should be informed by evidence where possible. However, evidence is constantly improving and priorities and effective responses will develop during the term of the Strategy. Innovation and leadership in the development of new approaches is encouraged within the framework of harm minimisation. Supporting research and building and sharing evidence is a key mechanism that allows a national approach to leverage better outcomes from local implementation. Where evidence is not available or limited, effective policy should still be implemented, especially when this will expand the knowledge base. National direction, jurisdictional implementation The Strategy describes a nationally agreed harm minimisation approach to reducing the harm from alcohol, tobacco and other drug use. However, funding and implementation occurs at all levels of government and the Commonwealth Government, state and territory governments and local governments are all responsible for regulation and the funding of programs that reduce the harms of drug use. Jurisdictional implementation allows for governments to take action relevant to their jurisdiction within the national harm minimisation approach. Strategies should reflect local circumstances and address emerging issues and drug types. Coordination and collaboration supports jurisdictions to develop better responses and innovations within the national approach that can inform and benefit all jurisdictions by sharing practices and learning. National Drug Strategy 2016-2025 7 Demand reduction Prevent uptake & delay first use. Harm minimisation Safe, healthy and resilient Australian communities through minimising alcohol, tobacco and other drug- related health, social and economic harms among individuals, families and communities. The Strategy describes an overall national commitment to the harm minimisation approach. In the implementation of harm minimisation, jurisdictions will have programs, initiatives and priorities reflecting local circumstances and areas of responsibility. They have been identified through consultation, by incorporating available data and evidence, and by reviewing existing projects under the National Drug Strategy. The Priorities for the National Drug Strategy are: • Increase participatory processes that facilitate community engagement and involvement in identifying and responding to the key national alcohol, tobacco and other drug issues. There are many reasons that people use drugs, including socialising, experimentation, coping with stress or difficult life situations, peer pressure, increasing pleasure or to intensify feelings and behaviours. Demand reduction strategies influence these factors to delay, prevent or reduce use. An effective demand reduction approach includes strategies such as price mechanisms, building community knowledge and changing acceptability of use, regulation of advertising and promotional activities, early intervention and treatment, ongoing care and addressing underlying determinants of demand. Demand reduction strategies also include building social inclusion and resilience. Resilient individuals can adapt to change and negative events more easily, reducing the impact of stressors and use of alcohol, tobacco or other drugs. Socially inclusive communities have strong social networks and work together to support individuals who need assistance. They promote safe and healthy lifestyles and can prevent the uptake of drug use, identify drug use in its early stages and help individuals access and maintain treatment. For many people alcohol, tobacco or other drug use is one factor in complex social issues. Harmful drug use is associated with social and health concerns that have as common determinants factors such as discrimination, unemployment, homelessness, poverty and family breakdown. Strong protective factors that guard against harmful drug use and are important in preventing or overcoming drug-related problems include employment, income, participation in education, appropriate housing and supportive family and community. Along with strategies specifically aimed at drug use, many areas of government and the community can impact on demand reduction as part of activities to build stronger and healthier communities through addressing social, health and economic determinants of drug use. Specialist alcohol and other drug services can partner or collaborate with other service providers on providing education, employment, infrastructure, addressing stigma and discrimination and other factors influencing the social determinants of health. The proportion of Australians using any illicit drug in the preceding 12 months has also reduced slightly 9 since 2001 (16.

Shiftwork buy fincar 5 mg lowest price, fatigue fincar 5mg for sale, and safety in emergency career trajectory are examples of roadmaps to success. Patient Safety in Emergency the most out of these priorities, a well-organized work space Medicine. Finally, it is important to manage available resources, whether assistants, colleagues, mentors, or technologies. Other forms of intimidation and • discuss the elements of intimidation and harassment and harassment reported by resident physicians have included inap- how they affect residents during training, and propriate physical contact, sexual harassment, the assignment • describe an approach to dealing with intimidation and of work as a punishment, loss of privileges and opportunities, harassment within the context of a residency program. Dealing with intimidation and harassment Case For intimidation and harassment to be tackled effectively, it is Your residency program is under accreditation next year. In some cases, it is faculty who may you will institute as a faculty administrator to prepare for be more concerned about the repercussions of reporting for this event? On the fip side, trainees should recognize that, in many cases, the individuals Introduction involved in bullying are not aware of the effect they are hav- Intimidation, harassment and workplace bullying have prob- ing. In many cases, individuals who intimidate and/or harass ably existed as long as the institution of medicine, but have others need education in effective communication as teachers started to be addressed by medical faculties only within the last and administrators, rather than disciplinary action. At a fundamental level, intimidation and harass- cal schools have now adopted directors or deans of equity to ment are defned not only by the behaviour and motivations deal with confict issues between faculty and trainees. Many of the perpetrator, but by the response of the individual who of these individuals directly report to the dean of medicine or is targeted. It should be seen as causing a negative effect on to “high-level” faculty committees with the ability to institute the victim (e. They focus on the content, psychological issues and or harassment is ever appropriate, such acts must be persistent procedures surrounding the issue of confict. Program directors, faculty members and importance of reporting such events, not only so that medical residents must be aware of these resources and deem them trainees can protect themselves, but also to help prevent their to be effective in dealing with such concerns. By taking action against bullying are unable to demonstrate such mechanisms may be put on behaviours, medical students and resident can help to change probation and risk losing their accreditation status. In tying such importance to this issue, the Royal College ensures Where intimidation and harassment leads that programs will endeavour to create a training environment Intimidation and/or harassment can lead to poor job satisfac- that limits intimidation and harassment, adequately deals with tion and psychological distress. It has been associated with issues that arise, and takes steps against the perpetuation of mental health problems and a desire to leave medical train- unacceptable behaviours, for the beneft of future generations ing. Where intimidation and harassment occur Physicians in training experience intimidation and/or harass- ment in all areas of medical training—that is, in the clinical, research, administrative and political realms. More than half of respondents to a recent Canadian survey reported that they had experienced intimidation and/or harassment while in residency training. Training status and gender were felt to be the two main bases for the intimidation and/or harassment. The happy docs teaching faculty are aware of policy and procedures for study: a Canadian Association of Internes and Residents well- dealing with intimidation and harassment (e. A meeting could be organized with the tion within and outside of residency training in Canada. This may be done with a teaching session using case examples or role playing from the director of equity. Residents should also be encouraged not to conceal, but rather report concerns around intimidation and harass- ment so that the accreditation team can make appropriate recommendations that will ultimately be addressed by the individual programs. Challenges to collegiality are dis- Collegiality involves certain rights and is tempered by specifc cussed with respect to disruptive physician behaviours, confict obligations. In academic contexts, it pertains to a commitment management, and gender-based and generational tensions. Collegiality allows physicians to educate one an- on the health care team are discussed. Physicians have an obligation to put restrictions Resident leaders, medical educators and program directors on their collegiality: in particular, they must give the welfare of should all endeavour to foster collegiality in professional rela- their patients priority over their collegial relationships. One method of doing so is to encourage the mentor- ing of residents by faculty members, and of medical students Although collegiality is highly prized by individual practitioners by residents, whether in person, by email or through websites. One cannot become an effective Scholar and Medical academic half-days), between supervisors and residents, and Expert without sharing information with peers. As a body, residents be an effective Health Advocate without the cooperation of can decide on a topic concerning physician health that could one’s supervisors and peers—which will itself be shaped by be mediated by increased collegial relations (e. One learns stress related to time pressures in training) and invite a faculty effective approaches through the wisdom and example of member who feels comfortable sharing personal experience to other practitioners. To fulfll the general observation, more formal methods include a 360 de- obligations of their Professional Role with respect to patient gree evaluation process by which residents are evaluated by all care, ethical behaviour and self-regulation, physicians cannot members of the health care team, including their peers. In addition to supporting these domains feedback is often perceived as less critical and constructive of competency, collegiality by defnition engenders the kind of in criticism, when discussing topics of communication with mutual respect and support that helps to prevent the intimida- colleagues. This kind of evaluation process can ensure that the tion and harassment of colleagues. Moreover, where healthy resident is evaluated fairly by all members of the team and collegiality exists, physicians will not only support one another removes pressure off of the physician preceptor who may during good times, but will also protect one another’s health by have challenges providing critical feedback. For the residents recognizing when colleagues are in trouble and helping them involved, it builds skills in giving feedback on professional to get the support they need.