scholarly journals Contact with treatment services among arrested drug users

2003 ◽  
Vol 27 (6) ◽  
pp. 214-216 ◽  
Author(s):  
Mervyn London ◽  
Juan Canitrot ◽  
Adrian Dzialdowski ◽  
Robert Bates ◽  
Alan Gwynn
Keyword(s):  
Drug Users ◽  
Cost Effective ◽  
Evidence Base ◽  
Opiate Dependence ◽  
Drug Misuse ◽  
Police Custody ◽  
Face To Face ◽  
Treatment Services ◽  
Previous Contact ◽  
Local Research

Aims and MethodTo identify the proportion of arrested drug misusers with prior contact with treatment services, police surgeons' records were examined over a 12-month period and compared with the records of the local drug misuse services. Both referrals and those who attended with face-to-face contact were noted.ResultsSixty-seven per cent of drug-related cases had been referred to services prior to arrest and 58% had attended with face-to-face contact on at least one occasion. Homeless and male drug users were more likely to have had no past contact. Police surgeons treated three-quarters of the cases for opiate dependence. Drug misusers were much more likely to have had past contact with services than arrested alcohol misusers, and were more likely to reoffend.Clinical ImplicationsThe evidence base for motivational enhancement in the transient coercive setting of police custody is not established, and arrest referral schemes might not be cost-effective in areas where most cases have had previous contact with services. Local research may contribute to more informed decisions about these treatment-related criminal justice initiatives.

scholarly journals Contact with treatment services among arrested drug users

2003 ◽  
Vol 27 (06) ◽  
pp. 214-216
Author(s):  
Mervyn London ◽  
Juan Canitrot ◽  
Adrian Dzialdowski ◽  
Robert Bates ◽  
Alan Gwynn
Keyword(s):  
Drug Users ◽  
Cost Effective ◽  
Evidence Base ◽  
Opiate Dependence ◽  
Drug Misuse ◽  
Police Custody ◽  
Face To Face ◽  
Treatment Services ◽  
Previous Contact ◽  
Local Research

Aims and Method To identify the proportion of arrested drug misusers with prior contact with treatment services, police surgeons' records were examined over a 12-month period and compared with the records of the local drug misuse services. Both referrals and those who attended with face-to-face contact were noted. Results Sixty-seven per cent of drug-related cases had been referred to services prior to arrest and 58% had attended with face-to-face contact on at least one occasion. Homeless and male drug users were more likely to have had no past contact. Police surgeons treated three-quarters of the cases for opiate dependence. Drug misusers were much more likely to have had past contact with services than arrested alcohol misusers, and were more likely to reoffend. Clinical Implications The evidence base for motivational enhancement in the transient coercive setting of police custody is not established, and arrest referral schemes might not be cost-effective in areas where most cases have had previous contact with services. Local research may contribute to more informed decisions about these treatment-related criminal justice initiatives.

scholarly journals The future of specialised alcohol treatment services: a matter of policy?

2009 ◽  
Vol 15 (4) ◽  
pp. 253-259 ◽  
Author(s):  
Harish Rao ◽  
Jason Luty
Keyword(s):  
Alcohol Misuse ◽  
Alcohol Treatment ◽  
Evidence Base ◽  
Alcohol Problems ◽  
Stepped Care ◽  
Drug Misuse ◽  
Cost Of Treatment ◽  
High Profile ◽  
Treatment Services ◽  
Alcohol Harm Reduction

SummaryAround 7.1 million people in England drink hazardously or harmfully and a further 1.1 million are dependent on alcohol. Motivational interviewing is widely used to treat people with alcohol problems and is probably the best described example of a brief intervention. However, some recent trials have been disappointing. Specialised alcohol treatment services have also suffered from weakness in the evidence base. Investment in treating alcohol misuse has fallen far behind that for drug misuse. The Department of Health's Alcohol Harm Reduction Strategy for England embraces policies that are high-profile and cheap but are ineffective and ignore many effective measures. It recommends stepped care for alcohol treatment, but unlike the equivalent for drugs treatment, it sets no targets and leaves the small (7%) increase in funding to the discretion of local purchasers. UK spending on specialised treatment for drug misuse is estimated to be around £600 million for 2007 – around three times the estimated cost of treatment for alcohol misuse.

Extended Routine Follow-up of Primary Uncomplicated Hip and Knee Arthroplasty is not Necessary

2019 ◽  
Vol 13 (1) ◽  
pp. 266-271
Author(s):  
Georgina Kakra Wartemberg ◽  
Thomas Goff ◽  
Simon Jones ◽  
James Newman
Keyword(s):  
Aseptic Loosening ◽  
Revision Surgery ◽  
Revision Arthroplasty ◽  
Cost Effective ◽  
Face To Face ◽  
Primary Surgery ◽  
Effective System ◽  
Knee Revision Surgery ◽  
Knee Revision

Aims: To create a more effective system to identify patients in need of revision surgery. Background: There are over 160,000 total hip and knee replacements performed per year in England and Wales. Currently, most trusts review patients for up to 10 years or more. When we consider the cost of prolonged reviews, we cannot justify the expenditure within a limited budget. Study Design & Methods: We reviewed all patients' notes that underwent primary hip and knee revision surgery at our institution, noting age, gender, symptoms at presentation, referral source, details of the surgery, reason for revision and follow up history from primary surgery. Results: There were 145 revision arthroplasties (60 THR and 85 TKR) that met our inclusion criteria. Within the hip arthroplasty group, indications for revision included aseptic loosening (37), dislocation (10), and infection (3), periprosthetic fracture, acetabular liner wear and implant failure. All thirty-seven patients with aseptic loosening presented with pain. Twenty-five were referred from general practice with new symptoms. The remaining were clinic follow-ups. The most common reason for knee revision was aseptic loosening (37), followed by infection (21) and then progressive osteoarthritis (8). Most were referred from GP as a new referral or were clinic follow-ups. All patients were symptomatic. Conclusion: All the patients that underwent revision arthroplasty were symptomatic. Rather than yearly follow up, we recommend a cost-effective system. We are implementing a 'non face-to-face' system. Patients would be directly sent a questionnaire and x-ray form. The radiographs and forms will be reviewed by an experienced arthroplasty surgeon. The concerning cases will be seen urgently in a face-to-face clinic.

scholarly journals Implementation of podiatry telephone appointments for people with rheumatic and musculoskeletal diseases

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
J. L. Palmer ◽  
H. J. Siddle ◽  
A. C. Redmond ◽  
B. Alcacer-Pitarch
Keyword(s):  
Musculoskeletal Diseases ◽  
Cost Effective ◽  
Time Frame ◽  
Teaching Hospitals ◽  
Potential Cost ◽  
Foot Health ◽  
Telephone Consultation ◽  
Face To Face ◽  
Initial Intervention

Abstract Background Foot health problems are common in the general population, and particularly so in people with rheumatic and musculoskeletal disorders (RMD). Several clinical guidelines state that people with RMDs should have access to foot health services, although service capacity is often limited. The current COVID-19 pandemic has increased the need for alternative ways to provide patient care. The aim of this clinical audit was to review a newly implemented telephone follow-up appointment service conducted within the Rheumatology Podiatry Department in Leeds, UK. Methods Fifty-eight patients attending the Rheumatology Podiatry Department at Leeds Teaching Hospitals NHS Trust were contacted by telephone approximately 6–8 weeks following initial intervention. During the telephone consultation, all patients were asked pre-defined questions relating to their symptoms, intervention efficacy, the need for further appointments and their preference for the type of consultation. To assess the cost of the telephone consultation the number of attempts needed in order to make successful contact, the duration of the call and the number of telephone follow-up appointments completed in a working day were also recorded. Results Twenty-five patients (43%) were successfully contacted within the 6–8 weeks stipulated time frame and were included in the analysis. Of the 25 contacted, twelve (48%) patients were successfully contacted on the first attempt. Ten (40%) were successfully contacted on the second attempt. The remaining three patients (12%) required 3 or more attempts to make successful contact. Telephone consultations were estimated not to last longer than 10 min, including notes screening and documentation. Eleven patients (44%) reported an improvement in their symptoms, thirteen (52%) reported no change and one patient (4%) reported their symptoms to be worse. Conclusion Telephone follow-up consultations may be a potentially cost-effective alternative to face-to-face appointments when implemented in a Rheumatology Podiatry Department, and provide an alternative way of providing care, especially when capacity for face-to-face contact is limited. The potential cost saving and efficiency benefits of this service are likely to be enhanced when telephone consultations are pre-arranged with patients.

scholarly journals Feasibility and Acceptability of an mHealth Delivered Mindfulness Therapy for Caregivers

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 316-316
Author(s):  
Elissa Kozlov ◽  
XinQi Dong
Keyword(s):  
Older Adults ◽  
Behavioral Interventions ◽  
Pilot Trial ◽  
Evidence Base ◽  
Negative Effects ◽  
Face To Face ◽  
Proven Efficacy ◽  
Managing Stress ◽  
With Memory ◽  
Mindfulness Therapy

Abstract Decades of research have documented the profound, negative effects of caregiving on unpaid caregivers. Mindfulness Therapy (MT) is a promising, non-pharmacological technique with proven efficacy and effectiveness in managing stress, depression and anxiety in diverse populations. While the evidence-base for MT in caregiving is growing, traditional MT (8+ hours of face-to-face treatment with trained providers) is likely not a realistic treatment model for most caregivers due to lack of trained personnel, time constraints of the caregiver, and reimbursement issues. Therefore, in order to meet the unique needs of caregivers of older adults with cognitive impairment, an innovative delivery model is required. MHealth can be a useful tool to deliver behavioral interventions, as it overcomes barriers of traditional psychotherapy such as provider availability, scheduling conflicts, and cost. The objective of this paper is to report the feasibility, acceptability and preliminary efficacy of a pilot trial of mHealth delivered MT for stress and caregiver burden in caregivers of persons with dementia. The average age of participant was 63.2 years old. After two weeks, 93% of participants reported using the mindfulness app for an average of 48.38 minutes per week. At eight weeks, 88% of users reported using the mindfulness app for an average of 35 minutes per week. At 8 weeks, 100% of users reported practicing mindfulness without using the app for an average of 45.6 minutes per week. MHealth mindfulness therapy appears to be a feasible method of delivering mindfulness to caregivers of older adults with memory impairment.

scholarly journals Reaching consensus on reporting patient and public involvement (PPI) in research: methods and lessons learned from the development of reporting guidelines

BMJ Open ◽  
2017 ◽  
Vol 7 (10) ◽  
pp. e016948 ◽  
Author(s):  
Jo Brett ◽  
Sophie Staniszewska ◽  
Iveta Simera ◽  
Kate Seers ◽  
Carole Mockford ◽  
...  
Keyword(s):  
Public Involvement ◽  
Evidence Base ◽  
Patient And Public Involvement ◽  
Lessons Learned ◽  
Reporting Guidelines ◽  
Consensus Development ◽  
Face To Face ◽  
Three Phase ◽  
Health And Social Care ◽  
The Impact

IntroductionPatient and public involvement (PPI) is inconsistently reported in health and social care research. Improving the quality of how PPI is reported is critical in developing a higher quality evidence base to gain a better insight into the methods and impact of PPI. This paper describes the methods used to develop and gain consensus on guidelines for reporting PPI in research studies (updated version of the Guidance for Reporting Patient and Public Involvement (GRIPP2)).MethodsThere were three key stages in the development of GRIPP2: identification of key items for the guideline from systematic review evidence of the impact of PPI on health research and health services, a three-phase online Delphi survey with a diverse sample of experts in PPI to gain consensus on included items and a face-to-face consensus meeting to finalise and reach definitive agreement on GRIPP2. Challenges and lessons learnt during the development of the reporting guidelines are reported.DiscussionThe process of reaching consensus is vital within the development of guidelines and policy directions, although debate around how best to reach consensus is still needed. This paper discusses the critical stages of consensus development as applied to the development of consensus for GRIPP2 and discusses the benefits and challenges of consensus development.

scholarly journals Self-fill oxygen technology: benefits for patients, healthcare providers and the environment

Breathe ◽  
2016 ◽  
Vol 12 (2) ◽  
pp. 113-119 ◽  
Author(s):  
Phyllis Murphie ◽  
Nick Hex ◽  
Jo Setters ◽  
Stuart Little
Keyword(s):  
Positive Impact ◽  
Healthcare Providers ◽  
Cost Savings ◽  
Cost Effective ◽  
Evidence Base ◽  
Environmental Benefits ◽  
List Type ◽  
Potential Cost ◽  
Unlimited Supply ◽  
Technology Benefits

“Non-delivery” home oxygen technologies that allow self-filling of ambulatory oxygen cylinders are emerging. They can offer a relatively unlimited supply of ambulatory oxygen in suitably assessed people who require long-term oxygen therapy (LTOT), providing they can use these systems safely and effectively. This allows users to be self-sufficient and facilitates longer periods of time away from home. The evolution and evidence base of this technology is reported with the experience of a national service review in Scotland (UK). Given that domiciliary oxygen services represent a significant cost to healthcare providers globally, these systems offer potential cost savings, are appealing to remote and rural regions due to the avoidance of cylinder delivery and have additional lower environmental impact due to reduced fossil fuel consumption and subsequently reduced carbon emissions. Evidence is emerging that self-fill/non-delivery oxygen systems can meet the ambulatory oxygen needs of many patients using LTOT and can have a positive impact on quality of life, increase time spent away from home and offer significant financial savings to healthcare providers.Educational aimsProvide update for oxygen prescribers on options for home oxygen provision.Provide update on the evidence base for available self-fill oxygen technologies.Provide and update for healthcare commissioners on the potential cost-effective and environmental benefits of increased utilisation of self-fill oxygen systems.

scholarly journals Opiate dependence and pregnancy: 20-year follow-up study

2007 ◽  
Vol 31 (12) ◽  
pp. 450-453 ◽  
Author(s):  
Marie Whitty ◽  
John O'Connor
Keyword(s):  
Psychosocial Functioning ◽  
Substance Misuse ◽  
Opiate Dependence ◽  
Drug Misuse ◽  
Clinical Implications ◽  
Follow Up Study ◽  
Treatment Centre ◽  
Long Term Follow Up

AIMS AND METHODThis study examined the 20-year outcome of 55 women who were pregnant and using opiates in 1985 and were attending the Drug Treatment Centre and Advisory Board, Dublin. We established outcome across a number of variables, including mortality, psychiatric and physical morbidity, psychosocial functioning, ongoing drug misuse and outcome of offspring.RESULTSAt 20-year follow-up 29 women (53%) were deceased. HIV was the commonest cause of death, accounting for 17 deaths (59%). Those who were alive at follow-up displayed high rates of unemployment (84%), illicit substance misuse (74%) and most were dependent on state-subsidised accommodation (78%).CLINICAL IMPLICATIONSMortality was higher in our group compared with other long-term follow-up samples. These findings suggest that such participants and their offspring require intensive long-term support and treatment.

scholarly journals SPECIAL TUTORIAL CLASSES TO UPGRADE LEARNING ACHIEVEMENT OF STUDENTS ENROLLED IN MATHEMATICS FOR SOCIAL SCIENCE AT STOU

2008 ◽  
Vol 3 (2) ◽  
pp. 122-133
Author(s):  
Sakorn Boondao
Keyword(s):  
Social Science ◽  
Cost Effective ◽  
Developed Countries ◽  
Pass Rate ◽  
Final Exam ◽  
Face To Face ◽  
Tutorial Program ◽  
Significant Difference ◽  
Level Scale ◽  
Teaching Programs

Unlike distance education institutions in developed countries Sukhothai Thammathirat Open University makes very limited use of assignments in its teaching programs. The main means of interaction between tutors and students consists of free face-to-face tutorials conducted three times per semester in provincial centers throughout the country. In courses with low enrolments (less than 1000 students) such tutorials have recently been deemed not to be cost effective. Alternative regional or central intensive programs have been developed. These involve 20 hours of tutorial classes and assignment work over two weekends in the final month of the semester and count for 30% of the assessment. A small charge is made for registration. The Mathematics for Social Science course was affected by this change. Since mathematics is a difficult subject for students, (only about 30% normally passed the course) the special tutorial program was used to help students in the second semester of 2006. Students were more interested in this approach than in the regular face-to-face tutorials. After the project was advertised, 98 students applied. While this was more than three times the number who had attended the free tutorials in the previous semester, it was not sufficient to justify tutorials in the four regions. Instead, three classes were conducted in Bangkok. Only 71 of the original applicants attended. During the program the better students were asked to assist those who needed help. Student questionnaires indicated that more than half identified themselves as weak in mathematics, most had completed year 12 and just over three-quarters had never attended regular face-to-face tutorials. They were asked to rank items about the classes on a five-level scale. The availability of up to 30% of the marks for the course was the major attraction. Most indicated that they were pleased with the classes, and gained more knowledge; while assignments, as well as the solutions given after submission, helped them understand the contents. Having classmates help them with learning also encouraged them with their study. They felt that they needed more time to study and do assignment work, and would like more marks to be allocated for the assignments. It was found that the achievement of students who attended the special tutorial classes was significantly higher than that of those who did not. The pass rate in this semester dramatically increased compared to the previous semester, 50.72% and 30.34% respectively. But when comparing students' final exam scores for both groups, it was found that there was no significant difference in the scores. However students were satisfied with these special tutorial classes.

scholarly journals Epidemiological methods for research with drug misusers: review of methods for studying prevalence and morbidity

1999 ◽  
Vol 33 (2) ◽  
pp. 206-215 ◽  
Author(s):  
John Dunn ◽  
Cleusa P. Ferri
Keyword(s):  
Drug Users ◽  
Epidemiological Studies ◽  
Drug Misuse ◽  
Contact Tracing ◽  
Epidemiological Methods ◽  
Snowball Sampling ◽  
Sampling Frame ◽  
Lack Of Information ◽  
Random Samples ◽  
Capture Recapture

Epidemiological studies of drug misusers have until recently relied on two main forms of sampling: probability and convenience. The former has been used when the aim was simply to estimate the prevalence of the condition and the latter when in depth studies of the characteristics, profiles and behaviour of drug users were required, but each method has its limitations. Probability samples become impracticable when the prevalence of the condition is very low, less than 0.5% for example, or when the condition being studied is a clandestine activity such as illicit drug use. When stratified random samples are used, it may be difficult to obtain a truly representative sample, depending on the quality of the information used to develop the stratification strategy. The main limitation of studies using convenience samples is that the results cannot be generalised to the whole population of drug users due to selection bias and a lack of information concerning the sampling frame. New methods have been developed which aim to overcome some of these difficulties, for example, social network analysis, snowball sampling, capture-recapture techniques, privileged access interviewer method and contact tracing. All these methods have been applied to the study of drug misuse. The various methods are described and examples of their use given, drawn from both the Brazilian and international drug misuse literature.

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