scholarly journals Setting up a methadone maintenance clinic in a hostel in London's West End

2006 ◽  
Vol 30 (9) ◽  
pp. 337-339
Author(s):  
John Dunn ◽  
David Robertson ◽  
Paul Davis ◽  
Babak Khosrawan ◽  
Suneel Christian
Keyword(s):  
Treatment Outcomes ◽  
Substance Misuse ◽  
Methadone Maintenance ◽  
Homeless People ◽  
Clinical Implications ◽  
Original Cohort ◽  
Heroin Use ◽  
The Past ◽  
Outreach Clinic ◽  
Set Up

Aims and MethodA satellite methadone prescribing service was set up in a hostel in London's West End. The aim was to investigate if it were feasible to engage and retain these hard-to-reach, chaotic, polydrug users in treatment. A basic needs assessment was undertaken with staff and clients at the hostel. Treatment outcomes were assessed at 16 weeks using the Maudsley Addiction Profile.ResultsAt 16 weeks 87% of the original cohort (26 out of 30) were still in treatment. There were also significant reductions in mean heroin use (from 29.7 to 14.5 out of the past 30 days, P<0.001) and in the frequency of injecting (from 25.9 to 15.9 days, P<0.001).Clinical ImplicationsThis outreach clinic offers a model for developing services to homeless people with substance misuse problems.

scholarly journals Severe and enduring mental health problems within an established substance misuse treatment partnership

2014 ◽  
Vol 38 (5) ◽  
pp. 216-219 ◽  
Author(s):  
Kathryn Walsh ◽  
Alex Copello
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Suicide Risk ◽  
Substance Misuse ◽  
Mental Health Problems ◽  
Health Problems ◽  
Clinical Implications ◽  
The Past ◽  
Self Harm ◽  
Effective Service

Aims and methodThe study reports findings of an investigation into the presence of severe and enduring mental health problems within the four statutory and non-statutory teams of an established substance misuse treatment partnership.ResultsOf a total of 772 clients in the four teams surveyed, 69 (8.9%) were identified as having severe and enduring mental health problems and problem substance use in the past 12 months. Alcohol was the most prevalent substance used by this predominantly male group. Different rates were found across the four teams, with higher numbers in the non-statutory teams. The clients displayed significant levels of self-harm and suicide risk and were responsible for 131 acute service contacts over the past 12 months.Clinical implicationsClients with severe and enduring mental health problems engaged with substance misuse services display high levels of complex need. It is important to identify the best and most effective service response to this group.

scholarly journals Treatment preferences of opiate-dependent patients

2004 ◽  
Vol 28 (2) ◽  
pp. 47-50 ◽  
Author(s):  
Jason Luty
Keyword(s):  
Substance Misuse ◽  
Treatment Options ◽  
Treatment Preferences ◽  
Clinical Implications ◽  
Card Sorting ◽  
Heroin Use ◽  
Injectable Drugs ◽  
Oral Methadone ◽  
Sorting Technique ◽  
Drug Free

Aims and MethodTo assess the preferences of people attending a substance misuse facility towards the treatment options available for opiate dependency. Interviews were conducted using a card sorting technique.ResultsThe majority (60%) of the 101 participants believed that detoxification was superior to maintenance in preventing illicit heroin use. The preferred treatment options were oral methadone, buprenorphine, drug-free rehabilitation, in-patient detoxification and prescription of injectable drugs.Clinical ImplicationsBoth pharmacological and psychosocial options, including in-patient detoxification and rehabilitation, are among the treatments preferred by clients of substance misuse services. There is also a significant demand for both injectable drugs and dihydrocodeine.

Mental health services for single homeless people

2020 ◽  
pp. 1-11
Author(s):  
Philip Timms ◽  
Jenny Drife
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Personality Disorder ◽  
Health Services ◽  
Substance Misuse ◽  
Homeless People ◽  
Psychiatric Services ◽  
Background Information ◽  
The Past ◽  
The Uk

SUMMARY Homelessness has long been associated with high rates of psychosis, alcohol and substance misuse, and personality disorder. However, psychiatric services in the UK have only recently engaged actively with homeless people. This article provides some background information about homelessness and mental illness and describes the elements of inclusion health and some of the models of service for homeless people that have been established over the past 30 years.

scholarly journals Reduced Vancomycin Susceptibility in Staphylococcus aureus, Including Vancomycin-Intermediate and Heterogeneous Vancomycin-Intermediate Strains: Resistance Mechanisms, Laboratory Detection, and Clinical Implications

2010 ◽  
Vol 23 (1) ◽  
pp. 99-139 ◽  
Author(s):  
Benjamin P. Howden ◽  
John K. Davies ◽  
Paul D. R. Johnson ◽  
Timothy P. Stinear ◽  
M. Lindsay Grayson
Keyword(s):  
Staphylococcus Aureus ◽  
Cell Wall ◽  
Treatment Failure ◽  
Treatment Outcomes ◽  
Susceptibility Testing ◽  
Point Mutations ◽  
Resistance Mechanisms ◽  
Wall Thickening ◽  
Clinical Implications ◽  
The Past

SUMMARY The emergence of vancomycin-intermediate Staphylococcus aureus (VISA) and heterogeneous vancomycin-intermediate Staphylococcus aureus (hVISA) over the past decade has provided a challenge to diagnostic microbiologists to detect these strains, clinicians treating patients with infections due to these strains, and researchers attempting to understand the resistance mechanisms. Recent data show that these strains have been detected globally and in many cases are associated with glycopeptide treatment failure; however, more rigorous clinical studies are required to clearly define the contribution of hVISA to glycopeptide treatment outcomes. It is now becoming clear that sequential point mutations in key global regulatory genes contribute to the hVISA and VISA phenotypes, which are associated predominately with cell wall thickening and restricted vancomycin access to its site of activity in the division septum; however, the phenotypic features of these strains can vary because the mutations leading to resistance can vary. Interestingly, changes in the staphylococcal surface and expression of agr are likely to impact host-pathogen interactions in hVISA and VISA infections. Given the subtleties of vancomycin susceptibility testing against S. aureus, it is imperative that diagnostic laboratories use well-standardized methods and have a framework for detecting reduced vancomycin susceptibility in S. aureus.

California Civil Commitment: A Decade Later

1976 ◽  
Vol 6 (4) ◽  
pp. 368-379 ◽  
Author(s):  
William H. McGlothlin
Keyword(s):  
Methadone Maintenance ◽  
Policy Changes ◽  
Heroin Use ◽  
Alternative Sentencing ◽  
The Past ◽  
Program Policy ◽  
Civil Commitments ◽  
Comparable Sample ◽  
Better Than

Both the court criteria for commitment and program policies have undergone significant changes in the past several years. The large majority of current commitments follow a felony conviction and typically occur only when the alternative sentencing disposition is more severe. Civil commitments without a criminal conviction are very rare. Program policy changes have resulted in a parole-incarceration time ratio of nearly 3:1 in comparison to 1:1 prior to 1970. A follow-up study of early commitments found that those continuing in the program generally performed better than a comparable sample discharged shortly after admission. Comparisons under the strict (pre-1970) and more lenient regimens showed roughly comparable behavior, but the availability of methadone maintenance was also a significant factor in reducing heroin use during the latter period.

scholarly journals Liaison psychiatry services in Wales

2018 ◽  
Vol 43 (1) ◽  
pp. 17-20 ◽  
Author(s):  
Tayyeb A. Tahir ◽  
Adam Watkins ◽  
Philip Slack ◽  
Phil Chick ◽  
William Lee ◽  
...  
Keyword(s):  
Public Health ◽  
Service Provision ◽  
Clinical Implications ◽  
Liaison Psychiatry ◽  
Systematic Data ◽  
Staffing Levels ◽  
The Past ◽  
Set Up ◽  
Systematic Data Collection ◽  
Health Boards

Aims and methodRecent funding from Welsh Government for mental health has helped to develop liaison psychiatry services in Wales. Systematic data collection was undertaken to map the liaison psychiatry services in Wales in collaboration with the Royal College of Psychiatrists in Wales and Public Health Wales 1000 Lives Improvement. A questionnaire was designed and circulated to all the health boards in Wales to gather information to map liaison psychiatry services in Wales. Up-to-date information was confirmed in January 2018, via email.ResultsOver the past 2 years, liaison psychiatry services have been set up in six out of seven health boards in Wales. Staffing levels have increased and the remit of services has broadened.Clinical implicationsMapping has highlighted that liaison psychiatry services in Wales continue to evolve. It will be important to continue to monitor these developments and their effects. Comparison with services in England will provide a useful comparison of service provision. A particular challenge will be to establish and monitor liaison psychiatry standards in Wales.Declaration of interestNone.

Injection heroin use and methadone maintenance treatment outcomes

2017 ◽  
Vol 171 ◽  
pp. e115-e116 ◽  
Author(s):  
David M. Ledgerwood ◽  
Jamey J. Lister ◽  
Benjamin V. LaLiberte ◽  
Mark Greenwald
Keyword(s):  
Treatment Outcomes ◽  
Methadone Maintenance Treatment ◽  
Maintenance Treatment ◽  
Methadone Maintenance ◽  
Heroin Use

Laryngeal Manifestations of Autoimmune Diseases

2020 ◽  
Vol 5 (2) ◽  
pp. 439-456
Author(s):  
Jenny L. Pierce
Keyword(s):  
Autoimmune Disease ◽  
Autoimmune Diseases ◽  
Patient Outcomes ◽  
Correct Diagnosis ◽  
Upper Airway ◽  
Clinical Implications ◽  
Laryngeal Function ◽  
The Past ◽  
Referral Practices ◽  
Timely Referral

Purpose This review article provides an overview of autoimmune diseases and their effects on voice and laryngeal function. Method A literature review was conducted in PubMed. Combinations of the following keywords were used: “autoimmune disease and upper airway,” “larynx,” “cough,” “voice,” “dysphonia,” and “dyspnea.” Precedence was given to articles published in the past 10 years due to recent advances in this area and to review articles. Ultimately, 115 articles were included for review. Results Approximately 81 autoimmune diseases exist, with 18 of those highlighted in the literature as having laryngeal involvement. The general and laryngeal manifestations of these 18 are discussed in detail, in addition to the clinical implications for a laryngeal expert. Conclusions Voice, breathing, and cough symptoms may be an indication of underlying autoimmune disease. However, these symptoms are often similar to those in the general population. Appropriate differential diagnosis and timely referral practices maximize patient outcomes. Guidelines are provided to facilitate correct diagnosis when an autoimmune disease is suspected.

scholarly journals Personal Carbon Trading—Lost in the Policy Primeval Soup?

2021 ◽  
Vol 13 (8) ◽  
pp. 4592
Author(s):  
Fabio Bothner
Keyword(s):  
Ghg Emissions ◽  
Emission Trading ◽  
Political Agenda ◽  
Carbon Trading ◽  
Multiple Streams ◽  
Policy Proposal ◽  
The Past ◽  
Multiple Streams Approach ◽  
Carbon Taxation ◽  
Set Up

The number of emission trading and carbon taxation schemes implemented has grown rapidly over the past decade. Together, they cover approximately 16% of global greenhouse gas (GHG) emissions. Although more than two-thirds of global GHG emissions are related to household consumption, approaches that directly target households, such as personal carbon trading (PCT), do not play a role in the fight against climate change. This is especially puzzling as measures taken so far are not sufficient to reach the 2 °C target. One clue to solving this puzzle comes from political science in the form of the multiple streams approach, which defines criteria that a policy proposal must meet to become part of the political agenda. Based on these criteria, this article conducts a systematic review on PCT to clarify why PCT does not play a role in the reduction of GHG emissions. The results show that there are three main problems with the PCT proposal. First, scholars often criticize the set-up costs as well as the running costs of such a system. Second, there is no clear consensus within the research community on public acceptance of PCT. Third, it is still unclear whether politicians are receptive to PCT or not.

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