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Treatment Episodes (treatment + episode)

Distribution by Scientific Domains

Medical Sciences	92%
Psychology	8%

Selected Abstracts

Treatment retention in adolescent patients treated with methadone or buprenorphine for opioid dependence: a file review

DRUG AND ALCOHOL REVIEW, Issue 2 2006
JAMES BELL
Abstract The aim of this study was to compare retention and re-entry to treatment between adolescent subjects treated with methadone, those treated with buprenorphine, and those treated with symptomatic (non-opioid) medication only. We used a retrospective file review of all patients aged less than 18 at first presentation for treatment for opioid dependence. The study was conducted at the Langton Centre, Sydney, Australia, an agency specialising in the treatment of alcohol and other drug dependency. Sixty-one adolescents (age range 14,17 years at the time of commencing treatment); mean reported age of initiation of heroin use was 14 ± 1.3 years (range 11,16). Sixty-one per cent were female. The first episode of treatment was methadone maintenance in 20 subjects, buprenorphine in 25, symptomatic medication in 15; one patient underwent assessment only. These 61 subjects had a total of 112 episodes of treatment. Subjects treated with methadone had significantly longer retention in first treatment episode than subjects treated with buprenorphine (mean days 354 vs. 58, p<0.01 by Cox regression) and missed fewer days in the first month (mean 3 vs. 8 days, p<0.05 by t-test). Subsequent re-entry for further treatment occurred in 25% of subjects treated with methadone, 60% buprenorphine and 60% symptomatic medications. Time to reentry after first episode of buprenorphine treatment was significantly shorter than after methadone treatment (p < 0.05 by Kaplan-Meier test). Methadone maintenance appears to have been more effective than buprenorphine at preventing premature drop-out from treatment of adolescent heroin users. [source]

A systematic review of the effectiveness of smoking relapse prevention interventions for abstinent smokers

ADDICTION, Issue 8 2010
Shade Agboola
ABSTRACT Aims To carry out a systematic review of the effectiveness of relapse prevention interventions (RPIs) among abstinent smokers who had completed an initial course of treatment or who had abstained unassisted, pooling only outcome data from similar follow-up time points. Methods We used the same search strategy as was used in Cochrane reviews of RPIs to identify randomized trials of behavioural and pharmacological studies of smoking RPIs published up to July 2008. Abstinence from smoking was defined as either continuous abstinence or point prevalence abstinence, measured at three follow-up time points: short term (1,3 months post randomization), medium term (6,9 months) and long term (12,18 months). Abstinence among pregnant/postpartum women was also measured at delivery or the last follow-up prior to delivery. Random effect meta-analysis was used to estimate pooled odds ratios (OR) with 95% confidence intervals (CI). Results Thirty-six studies randomizing abstainers were included. Self-help materials appeared to be effective in preventing relapse at long-term follow up in initially unaided quitters (pooled OR 1.52; 95% CI 1.15 to 2.01, I2 = 0%, NNT = 11, 3 studies). Other behavioural interventions for relapse prevention appeared effective in the short term only. There were positive results for the use of pharmacotherapies for relapse prevention. Bupropion was effective at long-term follow-up (pooled OR 1.49; 95% CI 1.10 to 2.01; I2 = 0%; NNT = 11; 4 studies). Nicotine replacement therapy (NRT) was effective at medium-term (pooled OR 1.56; 95% CI 1.16 to 2.11; I2 = 37%; NNT = 14; 4 trials) and long-term follow-ups (pooled OR 1.33; 95% CI 1.08 to 1.63; I2 = 0%; NNT = 20; 4 trials). Single trials of extended treatment of Varenicline and rimonabant were also found to be effective at short-term and medium-term follow-ups. Conclusions Self-help materials appear to prevent relapse in initially unaided quitters. Use of NRT, bupropion and varenicline appears to be effective in preventing relapse following an initial period of abstinence or an acute treatment episode. There is currently no good evidence that behavioural support prevents relapse after initial unaided abstinence or following an acute treatment period. [source]

The effect of time spent in treatment and dropout status on rates of convictions, cautions and imprisonment over 5 years in a primary care-led methadone maintenance service

ADDICTION, Issue 4 2010
Phillip Oliver
ABSTRACT Background Methadone maintenance treatment (MMT) in primary care settings is used increasingly as a standard method of delivering treatment for heroin users. It has been shown to reduce criminal activity and incarceration over periods of periods of 12 months or less; however, little is known about the effect of this treatment over longer durations. Aims To examine the association between treatment status and rates of convictions and cautions (judicial disposals) over a 5-year period in a cohort of heroin users treated in a general practitioner (GP)-led MMT service. Design Cohort study. Setting The primary care clinic for drug dependence, Sheffield, 1999,2005. Participants The cohort comprised 108 consecutive patients who were eligible and entered treatment. Ninety were followed-up for the full 5 years. Intervention The intervention consisted of MMT provided by GPs in a primary care clinic setting. Measurements Criminal conviction and caution rates and time spent in prison, derived from Police National Computer (PNC) criminal records. Findings The overall reduction in the number of convictions and cautions expected for patients entering MMT in similar primary care settings is 10% for each 6 months retained in treatment. Patients in continuous treatment had the greatest reduction in judicial disposal rates, similar to those who were discharged for positive reasons (e.g. drug free). Patients who had more than one treatment episode over the observation period did no better than those who dropped out of treatment. Conclusions MMT delivered in a primary care clinic setting is effective in reducing convictions and cautions and incarceration over an extended period. Continuous treatment is associated with the greatest reductions. [source]

Opioid agonist pharmacotherapy in New South Wales from 1985 to 2006: patient characteristics and patterns and predictors of treatment retention

ADDICTION, Issue 8 2009
Lucy Burns
ABSTRACT Aims The aims of this study were to: examine the number and characteristics of patients entering and re-entering opioid replacement treatment between 1985 and 2006, to examine select demographic and treatment correlates of leaving treatment between 1985 and 2000, and to compare retention rates in methadone and buprenorphine maintenance treatment from 2001 to 2006. Design A retrospective cohort study using register data from the Pharmaceutical Drugs of Addiction System. Setting Opioid substitution treatment in New South Wales (NSW), Australia. Participants A total of n = 42 690 individuals prescribed opioid replacement treatment between 1985 and 2006 in NSW. Measurements Client characteristics over time, retention in days in first treatment episode, number of episodes of treatment and proportion switching medication. Findings Overall, younger individuals were significantly more likely to leave their first treatment episode than older individuals. In 2001,06, after controlling for age, sex and first administration point, the hazard of leaving treatment was 1.9 times for those on buprenorphine relative to those on methadone. Retention in treatment varied somewhat across historical time, with those entering during 1995,2000 more likely to leave at an earlier stage than those who entered before that time. Conclusions Retention in treatment appears to fluctuate in inverse proportion to the availability of heroin. Individuals in contemporary treatment are older users with a lengthy treatment history. This study has provided population-level evidence to suggest that retention in methadone and buprenorphine differ in routine clinical practice. Future work might investigate ways in which patient adherence and retention may be improved. [source]

Methadone in pregnancy: treatment retention and neonatal outcomes

ADDICTION, Issue 2 2007
Lucy Burns
ABSTRACT Aim To examine the association between retention in methadone treatment during pregnancy and key neonatal outcomes. Design Client data from the New South Wales Pharmaceutical Drugs of Addiction System was linked to birth information from the NSW Midwives Data Collection and the NSW Inpatient Statistics Collection from 1992 to 2002. Measurements Obstetric and perinatal characteristics of women who were retained continuously on methadone maintenance throughout their pregnancy were compared to those who entered late in their pregnancies (less than 6 months prior to birth) and those whose last treatment episode ended at least 1 year prior to birth. Findings There were 2993 births to women recorded as being on methadone at delivery, increasing from 62 in 1992 to 459 births in 2002. Compared to mothers who were maintained continuously on methadone throughout their pregnancy, those who entered treatment late also presented later to antenatal services, were more likely to arrive at hospital for delivery unbooked, were more often unmarried, indigenous and smoked more heavily. A higher proportion of neonates born to late entrants were born at less than 37 weeks gestation and were admitted to special care nursery more often. Conclusion Continuous methadone treatment during pregnancy is associated with earlier antenatal care and improved neonatal outcomes. Innovative techniques for early engagement in methadone treatment by pregnant heroin using women or those planning to become pregnant should be identified and implemented. [source]

Intensive referral to 12-Step self-help groups and 6-month substance use disorder outcomes

ADDICTION, Issue 5 2006
Christine Timko
ABSTRACT Aims This study implemented and evaluated procedures to help clinicians make effective referrals to 12-Step self-help groups. Design Randomized controlled trial. Setting Out-patient substance use disorder treatment. Participants Individuals with substance use disorders (SUDs) entering a new treatment episode (n = 345) who were assigned randomly to a standard referral- or an intensive referral-to-self-help condition. Measurements Self-reports of 12-Step group attendance and involvement and substance use at baseline and a 6-month follow-up. Intervention The intensive referral intervention focused on encouraging patients to attend 12-Step meetings by connecting them to 12-Step volunteers. Findings Among patients with relatively less previous 12-Step meeting attendance, intensive referral was associated with more meeting attendance during follow-up than was standard referral. Among all patients, compared with those who received standard referral, those who received intensive referral were more likely to be involved with 12-Step groups during the 6-month follow-up (i.e. had provided service, had a spiritual awakening and currently had a sponsor). Intensive referral patients also had better alcohol and drug use outcomes at 6 months. Twelve-Step involvement mediated part of the association between referral condition and alcohol outcomes. Conclusions The brief intensive referral intervention was associated with improved 12-Step group involvement and substance use outcomes even among patients with considerable previous 12-Step group exposure and formal treatment. Future 12-Step intensive referral procedures should focus on encouraging 12-Step group involvement in addition to attendance to benefit patients most effectively. [source]

Characteristics and smoking cessation outcomes of patients returning for repeat tobacco dependence treatment

INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 9 2006
E. S. HAN
Summary Previous studies of tobacco dependence treatment have reported very low cessation rates among smokers who relapse and return to make a subsequent formal attempt to quit. This retrospective cohort study examined 1745 patients who attended a tobacco dependence clinic between 2001 and 2005, and the characteristics and outcomes of those who relapsed and returned for repeat treatment. Patients who returned for repeat treatment showed higher markers of nicotine dependence and were more likely to have a history of treatment for mental health problems than patients who attended the clinic for only one treatment episode. Among patients who relapsed and returned for repeat treatment, the 26-week abstinence rates were similar for each consecutive quit attempt (23%, 22% and 20%). Clinicians should encourage smokers who relapse after an initial treatment episode to return for treatment, and repeat treatment should focus on addressing high nicotine dependence and potentially co-occurring mental health problems in order to improve cessation outcomes. [source]

Three-Year Chemical Dependency and Mental Health Treatment Outcomes Among Adolescents: The Role of Continuing Care

ALCOHOLISM, Issue 8 2009
Stacy Sterling
Background:, Few studies have examined the effects of treatment factors, including the types of services [chemical dependency (CD), psychiatric, or both], on long-term outcomes among adolescents following CD treatment, and whether receiving continuing care may contribute to better outcomes. This study examines the effect of the index CD and ongoing CD and psychiatric treatment episodes, 12-step participation, and individual characteristics such as CD and mental health (MH) severity and gender, age, and ethnicity, on 3-year CD and MH outcomes. Methods:, Participants were 296 adolescents aged 13 to 18 seeking treatment at 4 CD programs of a nonprofit, managed care, integrated health system. We surveyed participants at intake, 1 year, and 3 years, and examined survey and administrative data, and CD and psychiatric utilization. Results:, At 3 years, 29.7% of the sample reported total abstinence from both alcohol and drugs (excluding tobacco). Compared with girls, boys had only half the odds of being abstinent (OR = 0.46, p = 0.0204). Gender also predicted Externalizing severity at 3 years (coefficients 18.42 vs. 14.77, p < 0.01). CD treatment readmission in the second and third follow-up years was related to abstinence at 3 years (OR = 0.24, p = 0.0066 and OR = 3.33, p = 0.0207, respectively). Abstinence at 1 year predicted abstinence at 3 years (OR = 4.11, p < 0.0001). Those who were abstinent at 1 year also had better MH outcomes (both lower Internalizing and Externalizing scores) than those who were not (11.75 vs. 15.55, p = 0.0012 and 15.13 vs. 18.06, p = 0.0179, respectively). Conclusions:, A CD treatment episode resulting in good 1-year CD outcomes may contribute significantly to both CD and MH outcomes 3 years later. The findings also point to the value of providing a continuing care model of treatment for adolescents. [source]

Impact of regulatory labeling for troglitazone and rosiglitazone on hepatic enzyme monitoring compliance: findings from the state of Ohio medicaid program,

PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 1 2005
Robert J. Cluxton Jr PharmD
Abstract Purpose Troglitazone, the first drug of the thiazolidinediones class for type II diabetes, was first marketed in March 1997 and was removed from the U.S. market 36 months later after 90 cases of liver failure were reported despite multiple warnings containing liver enzyme monitoring recommendations. Rosiglitazone has been available since June 1999 and is still on the market. The purpose of this study was to evaluate the impact of labeled hepatic enzyme monitoring for troglitazone and rosiglitazone. Methods Drug cohorts were assembled, using population-based fee-for-service Medicaid claims, for patients between 18 and 65 years of age who had received at least one troglitazone (n,=,7226) or rosiglitazone (n,=,1480) prescription between 1 April, 1997, and 21 March, 2000. The outcome of interest was the percentage of patients, based on their first treatment episode, who had baseline and post-baseline liver enzyme testing. Results Overall baseline testing was under 9% before regulatory actions, increased to 14% after the first two ,Dear Doctor' letters issued by the FDA in October and December 1997, and peaked to about 26% afterwards. Coincident with the marketing of rosiglitazone and the fourth ,Dear Doctor' letter issued in June 1999, baseline testing dropped to 18%. Baseline testing increased 2.5-fold (race-sex-age adjusted) after regulatory action. Achieving 50% post-baseline testing took approximately 6 months for both drugs. Conclusion Regulatory actions had only modest effects on the incidence of liver monitoring. More effective and timely communication strategies, health provider prescribing interventions and modification of health provider behaviors to enhance compliance with recommended risk management measures need to be identified, evaluated and implemented. Copyright © 2004 John Wiley & Sons, Ltd. [source]

Criminal Behavior in Antisocial Substance Abusers between Five and Fifteen Years Follow-Up

THE AMERICAN JOURNAL ON ADDICTIONS, Issue 1 2007
Mats Fridell PhD
Antisocial personality disorder (ASPD) is one of the most common co-occurring disorders in substance abusers, characterized among other things by a high propensity for criminal actions. A cohort of 125 substance abusers were followed in a longitudinal design. Patients were diagnosed with ASPD at an index treatment episode, interviewed at five-year follow-up, and followed-up through the Swedish criminal justice register by 2005 for the years 1995,2003. ASPD and non-ASPD subjects were compared using Mann Whitney U test for ordinal variables (number of offenses and months in prison) and chi-square tests for categorical variables. A total of 107 were alive by 1995, when the period of observation began. ASPD diagnosed at baseline was related to criminal offenses and incarceration during the follow-up from 5 to 15 years. For most categories, ASPD diagnosis was associated with higher frequency of offense. An ASPD diagnosis based on SCID-II interview made at five-year follow-up was related to the number of offenses but unrelated to incarceration. In a sample of drug abusers, ASPD was associated with high levels of criminal behavior, even years after the diagnosis was given. A diagnosis based on clinical observation during treatment was at least as predictive of criminal behavior as a diagnosis based on a SCID-II interview. [source]

Combined Therapy with Atorvastatin and Calcineurin Inhibitors: No Interactions with Tacrolimus

AMERICAN JOURNAL OF TRANSPLANTATION, Issue 9 2005
W. P. D. Lemahieu
Increased systemic exposure to statins and consequent risk for complications has been reported in patients concomitantly treated with cyclosporin A (CsA). This has been ascribed to inhibition of drug catabolism by cytochrome P450 3A4 (CYP3A4) or drug transport by P-glycoprotein (PGP) and organic anion transporting polypeptide (OATP1B1). It is not known whether the combination of statins and tacrolimus (Tac) also suffers from this drawback. Therefore, a pharmacokinetic study of atorvastatin and its metabolites was performed in 13 healthy volunteers after 4 days' treatment, and after short (12 h) concomitant exposure to CsA and Tac. A complementary assessment of overall CYP, and hepatic and intestinal CYP3A4 + PGP activity was performed after each treatment episode and compared to baseline (no drugs). Systemic exposure to atorvastatin acid and its metabolites was significantly increased when administered with CsA. In contrast, intake of Tac did not have any impact on atorvastatin pharmacokinetics. Concomitantly, a profound decrease of hepatic and intestinal PGP and an increase of intestinal CYP3A4 were noted with CsA, whereas no effect was seen after atorvastatin therapy with or without Tac. Based on these findings treatment with Tac appears a safer option for patients needing a combination of statins and calcineurin inhibitors. [source]

Comparison of costs and utilization among buprenorphine and methadone patients

ADDICTION, Issue 6 2009
Paul G. Barnett
ABSTRACT Aims Buprenorphine is an effective alternative to methadone for treatment of opioid dependence, but economic concerns represent a barrier to implementation. The economic impacts of buprenorphine adoption by the US Veterans Health Administration (VHA) were examined. Design Prescriptions of buprenorphine, methadone treatment visits, health-care utilization and cost, and diagnostic data were obtained for 2005. Findings VHA dispensed buprenorphine to 606 patients and methadone to 8191 other patients during the study year. An analysis that controlled for age and diagnosis found that the mean cost of care for the 6 months after treatment initiation was $11 597 for buprenorphine and $14 921 for methadone (P < 0.001). Cost was not significantly different in subsequent months. The first 6 months of buprenorphine treatment included an average of 66 ambulatory care visits, significantly fewer than the 137 visits in methadone treatment (P < 0.001). In subsequent months, buprenorphine patients had 8.4 visits, significantly fewer than the 21.0 visits of methadone patients (P < 0.001). Compared to new methadone episodes, new buprenorphine episodes had 0.634 times the risk of ending [95% confidence interval 0.547,0.736]. Implementation of buprenorphine treatment was not associated with an influx of new opioid-dependent patients. Conclusion Despite the higher cost of medication, buprenorphine treatment was no more expensive than methadone treatment. VHA methadone treatment costs were higher than reported by other providers. Although new buprenorphine treatment episodes lasted longer than new methadone episodes, buprenorphine is recommended for more adherent patients. [source]

Drop-out from inpatient treatment for anorexia nervosa: can risk factors be identified at point of admission?

EUROPEAN EATING DISORDERS REVIEW, Issue 2 2004
Lois J. Surgenor
Abstract Despite renewed interest in drop-out from eating disorders treatment, few studies have investigated the issue in respect to the most expensive and intensive form of treatment, that is, inpatient treatment for anorexia nervosa (AN). This study investigates whether risk of treatment drop-out can be determined from information routinely collected at point of admission. Using information from a multi-site database collected in Australia and New Zealand, demographic and clinical data at point of admission were collated for 213 inpatient treatment episodes. One in five admissions ended with the patient unilaterally deciding to leave treatment without clinician endorsement. A lower body mass index, AN purging subtype and active fluid restriction made significant independent contributions to this risk. Drop-out remains a highly disruptive method of discharge and while there is utility in predicting those most at risk, few variables commonly collated by clinicians contribute to their identification. The implications for clinical practice and future research are discussed. Copyright © 2003 John Wiley & Sons, Ltd and Eating Disorders Association. [source]

Treatment-emergent behavioural side effects with selective serotonin re-uptake inhibitors in adults with learning disabilities

HUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue 2 2001
A. B. Biswas
Abstract Selective serotonin re-uptake inhibitors are widely used for the treatment of depression suffered by adults with learning disabilities. However, the presentation, time of onset and prevalence of treatment emergent symptoms, have not been extensively studied in adults with learning disabilities. The aim of this study was to determine these aspects of treatment. The study design involved retrospective analysis of case notes of all adults with learning disabilities treated with either fluoxetine or paroxetine for depression. During 31% of treatment episodes, patients suffered treatment emergent symptoms during treatment with either selective serotonin re-uptake inhibitor (SSRI). These symptoms subsided on discontinuation of the SSRI. The common emergent symptoms in this group were elevated mood (39%), decreased sleep (35%), hyperactivity (30%), overtalkativeness (26%), agitation (24%) and aggression (37%). In 20% symptoms developed within 1 month and in 67% within 7 months of starting treatment with a SSRI. There were no significant differences noted in the frequency and nature of treatment emergent symptoms between fluoxetine and paroxetine. Few guidelines, if any, exist for initiating and continuing antidepressant treatment for therapeutic or prophylactic use in this patient population. Close monitoring of efficacy and tolerability, including treatment emergent psychiatric symptoms is warranted. Copyright © 2001 John Wiley & Sons, Ltd. [source]

Update of radiosurgery at the Royal Adelaide Hospital

JOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 2 2006
DE Roos
Summary This is an update of the Royal Adelaide Hospital radiosurgery experience between November 1993 and December 2004 comprising 165 patients with 168 intracranial lesions. Including re-treatment, there were 175 treatment episodes (163 radiosurgery and 12 stereotactic radiotherapy) at an average of 1.3 per month. The commonest lesions were acoustic neuroma (65), arteriovenous malformation (58), solitary brain metastasis (23) and meningioma (14). The clinical features, treatment details and outcome are described. Our results continue to be well within the range reported in the published work. Radiosurgery provides an elegant, non-invasive alternative to neurosurgery and conventional external beam radiotherapy for many benign and malignant brain tumours. [source]

Prospective Follow-Up of Empirically Derived Alcohol Dependence Subtypes in Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC): Recovery Status, Alcohol Use Disorders and Diagnostic Criteria, Alcohol Consumption Behavior, Health Status, and Treatment Seeking

ALCOHOLISM, Issue 6 2010
Howard B. Moss
Background:, We have previously reported on an empirical classification of Alcohol Dependence (AD) individuals into subtypes using nationally representative general population data from the 2001 to 2002 Wave 1 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) and latent class analysis. Our results suggested a typology of 5 separate clusters based upon age of onset of AD, multigenerational familial AD, rates of antisocial personality disorder (ASPD), endorsement of specific AD and Alcohol Abuse (AA) criteria, and the presence of comorbid mood, anxiety, and substance use disorders (SUD). In this report, we focus on the clinical follow-up of these cluster members in Wave 2 of the NESARC (2004 to 2005). Methods:, The mean interval between NESARC Wave 1 and NESARC Wave 2 interviews was 36.6 (SD = 2.6) months. For these analyses, we utilized a Wave 2 NESARC sample that was comprised of a total of 1,172 individuals who were initially ascertained as having past-year AD at NESARC Wave 1 and initially subtyped into one of 5 groupings using latent class analysis. We identified these subtypes as: (i) Young Adult, characterized by very early age of onset, minimal family history, and low rates of psychiatric and SUD comorbidity; (ii) Functional, characterized by older age of onset, higher psychosocial functioning, minimal family history, and low rates of psychiatric and SUD comorbidity; (iii) Intermediate Familial, characterized by older age of onset, significant familial AD, and elevated comorbid rates of mood disorders SUD; (iv) Young Antisocial, characterized by early age of onset and elevated rates of ASPD, significant familial AD, and elevated rates of comorbid mood disorders and SUD; (v) Chronic Severe, characterized by later onset, elevated rates of ASPD, significant familial AD, and elevated rates of comorbid mood disorders and SUD. In this report, we examine Wave 2 recovery status, health status, alcohol consumption behavior, and treatment episodes based upon these subtypes. Results:, Significantly fewer of the Young Adult and Functional subtypes continued to meet full DSM-IV AD criteria in Wave 2 than did the Intermediate Familial, the Young Antisocial, and the Chronic Severe subtypes. However, we did not find that treatment seeking for alcohol problems increased over Wave 1 reports. In Wave 2, Young Antisocial and Chronic Severe subtypes had highest rates of past-year treatment seeking. In terms of health status, the Intermediate Familial, the Young Antisocial, and the Chronic Severe subtypes had significantly worse mental health scores than the Young Adult and Functional subtypes. For physical health status, the Functional, Intermediate Familial, Young Antisocial, and the Chronic Severe subtypes had significantly worse scores than the Young Adult subtype. In terms of alcohol consumption behavior, the Young Adult, Functional, and Young Antisocial subtypes significantly reduced their risk drinking days between Wave 1 and Wave 2, whereas the Intermediate Familial and the Chronic Severe subtypes did not. Discussion:, The results suggest that the empirical AD typology predicts differential clinical outcomes 3 years later. Persistence of full AD, treatment seeking, and worse mental health status were associated most strongly with those subtypes manifesting the greatest degree of psychiatric comorbidity. Reductions in alcohol consumption behavior and good physical health status were seen among the 2 younger subtypes. Overall, the least prevalent subtype, the Chronic Severe, showed the greatest stability in the manifestations of AD, despite having the highest rate of treatment seeking. [source]

Three-Year Chemical Dependency and Mental Health Treatment Outcomes Among Adolescents: The Role of Continuing Care

Temporal Vulnerability of Fetal Cerebellar Purkinje Cells to Chronic Binge Alcohol Exposure: Ovine Model

ALCOHOLISM, Issue 10 2007
Jayanth Ramadoss
Background: Human magnetic resonance imaging (MRI) and autopsy studies reveal abnormal cerebellar development in children who had been exposed to alcohol prenatally, independent of the exposure period. Animal studies conducted utilizing the rat model similarly demonstrate a broad period of vulnerability, albeit the third trimester-equivalent of human brain development is reported to be the most vulnerable period, and the first trimester-equivalent exposure produces cerebellar Purkinje cell loss only at high doses of alcohol. However, in the rat model, all 3 trimester-equivalents do not occur prenatally, requiring the assumption that intrauterine environment, placenta, maternal interactions, and parturition do not play an important role in mediating the damage. In this study, we utilized the ovine model, where all 3 trimester-equivalents occur in utero, to determine the critical window of vulnerability of fetal cerebellar Purkinje cells. Methods: Four groups of pregnant sheep were used: first trimester-equivalent pair-fed saline control group, first trimester-equivalent alcohol group (1.75 g/kg), third trimester-equivalent pair-fed saline control group, and third trimester-equivalent alcohol group (1.75 g/kg). The alcohol exposure regimen was designed to mimic a human binge pattern. Alcohol was administered intravenously on 3 consecutive days beginning on day 4 and day 109 of gestation in the first and third trimester-equivalent groups, respectively, and the alcohol treatment was followed by a 4-day inter-treatment interval when the animals were not exposed to alcohol. Such treatment episodes were replicated until gestational day 41 and 132 in the first and third trimester-equivalent groups, respectively. All fetal brains were harvested on day 133 and processed for stereological cerebellar Purkinje cell counting. Results: Significant deficits were found in the fetal cerebellar Purkinje cell number and density in the first and third trimester-equivalent alcohol exposed fetuses compared with those in the saline controls. However, there was no difference between the first and third trimester-equivalent alcohol administered groups. When comparing the present findings to those from a previous study where the duration of alcohol exposure was all 3 trimester-equivalents of gestation, we did not detect a difference in fetal cerebellar Purkinje cell number. Conclusions: We conclude that the fetal cerebellar Purkinje cells are sensitive to alcohol exposure at any time during gestation and that women who engage in binge drinking during the first trimester are at a high risk of giving birth to children with cerebellar damage even if drinking ceases after the first trimester. Our findings also support the hypothesis that only a certain population of Purkinje cells are vulnerable to alcohol-induced depletion irrespective of the timing or duration of alcohol exposure. [source]

Community-based treatment for chronic hepatitis C in drug users: high rates of compliance with therapy despite ongoing drug use

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 1 2009
M. WILKINSON
Summary Background, Chronic hepatitis C infection is common in drug users. Treatment of injectors is possible under controlled conditions, but many have not yet been included in treatment programmes as there are concerns about their ability to comply with therapy. It is not known which factors influence compliance. Aim, To examine the hypothesis that active drug users would comply with anti-viral therapy if treatment was delivered in a convenient manner. Methods, We established a community-based treatment programme and offered anti-viral therapy to all drug users who wanted it. Few pre-treatment requirements were imposed and, by design, compliance with therapy was reviewed after 50 patients had completed treatment. Results, Of the 441 patients who were known to be HCV RNA positive and attended the specialist addiction services during the period of this study, eighty three patients considered therapy. Twenty patients did not undergo treatment: 14 declined and 6 had medical conditions that precluded it. In 60 episodes (58 patients) where treatment had been completed, compliance was greater than 80% and homelessness, active illicit drug use and pre-treatment antidepressant therapy were not associated with noncompliance. In 25 of 49 treatment episodes that were assessed 6 months after treatment cessation, a sustained virological response (51%) was seen. Conclusion, Active drug users using illicit drugs can be successfully treated in community-based clinics. [source]

Theatre times and delays in elective oral and maxillofacial lists

ORAL SURGERY, Issue 4 2009
W. Aleid
Abstract Aim:, Cancelled operations are a major drain on hospital resources. The maxillofacial department at the Leicester Royal Infirmary (LRI) performs at least 14 elective operating sessions each week. A study reported that our cancellation rate or performance indicator (PI) was 0.3% at LR1. The most common reasons for cancellation of procedures at that time were lack of post-operative beds and insufficient operating time. This study aimed to continue to develop a methodology for looking at this complex issue and to further investigate the reasons for delay to assess whether the system could be managed more efficiently. Material and Methods:, In this study, the computerised theatre records system has been utilised to investigate the reasons for theatre delays. A retrospective analysis of data for 1212 patients treated in the 1 year period between December 2006 and December 2007 was performed. Results and Conclusions:, Eight hundred and forty-nine patients were treated on a day-surgery basis, of which 710 were dentoalveolar procedures and 139 were other operations. The remaining 363 patients were treated as in-patients of which 97 were oncological patients, 84 orthognathic, 35 salivary gland surgery, 65 traumas, and 82 other operations. Sixty-four (5.28%) of these treatment episodes were logged as delayed. The main reasons for delays were related to the ward (17%) or anaesthetist (22%). The operating time consumed 74% of the overall time in theatre complex. The utilisation of operating time was much better for in-patient operations (81%) than day-surgery procedures (64%). Suggestions have been made to reduce theatre delays. [source]

Young people who attend specialist alcohol treatment: who are they and do they need special treatment?

AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 4 2008
Devon Indig
Abstract Objective: Patterns of drinking in adolescence and young adulthood may have major short term impacts and influences on later drinking, yet little is known about the characteristics of young people who seek help for alcohol problems. Here we examine the characteristics of treatment episodes for adolescents and young adults who present to specialist alcohol treatment in New South Wales (NSW). Methods: The NSW Minimum Data Set for Alcohol and Other Drug Treatment Services was examined for all alcohol-related treatment episodes (N=21,012) reported between July 2004 and June 2005. We compared treatment episodes for adolescents aged 12-19 years, young adults aged 20-29 years and clients aged 30 years or more for their demographics, drug use and service delivery characteristics. Results: Clients aged under 30 years were significantly more likely to be referred into specialist treatment by a police, court or criminal justice diversion program compared with older clients (adolescent: OR=3.7, 95%CI: 3.1-4.4; young adult: OR=2.2, 95%CI: 1.9-2.4). Concern about cannabis use was significantly higher among younger clients (adolescents: OR=2.8 95%CI: 2.3-3.3; young adults: OR=2.1, 95%CI: 2.0-2.4) than those aged 30 years or more. Younger clients were also more likely to be of Indigenous origin or seen in a rural setting. Conclusions: Adolescent and young adult alcohol treatment clients include a higher proportion of clients who are Indigenous, legally coerced, and who have concerns with polydrug use. Service providers should seek to tailor their treatment programs to better meet these unique needs and to better attract young people into voluntary treatment. [source]

Patterns and costs of treatment for heroin dependence over 12 months: fndings from the Australian Treatment Outcome Study

AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 4 2006
Marian Shanahan
Objective: To determine patterns and costs of treatment for heroin dependence over a 12-month period among a cohort of heroin users seeking treatment. Methods: The design was a longitudinal cohort study of heroin users seeking treatment who participated in the Australian Treatment Outcome Study (ATOS), which was conducted in Sydney, Melbourne and Adelaide, Australia. Treatment for heroin dependence, for those who were followed up at 12 months, was recorded and costed. Unit costs, obtained from secondary sources, were used to estimate the cost of treatment. This study does not include wide societal costs and only includes personal costs as they pertain to treatment. Results: A follow-up rate of 81% at 12 months was achieved, resulting in data for 596 participants. Participants spent an average of 188 days in treatment over 2.7 episodes. Sixty-nine per cent of the sample reported at least one episode of treatment following their index treatment. There was a noticeable trend for subjects who received maintenance or residential rehabilitation as their index treatment to return to the same form of treatment for subsequent episodes. In contrast, those who received detoxifcation as index treatment accessed a wider variety of treatment types over the follow-up period. The cost of treatment over the 12-month follow-up totalled 3,901,416, with a mean of 6,517 per person. Conclusions and Implications: This study demonstrates that individuals seeking treatment have multiple treatment episodes throughout a 12-month period, with a tendency to return to the same form of treatment. This study also demonstrates that it is feasible and affordable to provide ongoing treatment for a group of heroin users seeking treatment. [source]

Three-year registry data on biological treatment for psoriasis: the influence of patient characteristics on treatment outcome

BRITISH JOURNAL OF DERMATOLOGY, Issue 3 2009
R.J.B. Driessen
Summary Background, The course of biological treatment in clinical practice may be highly different from treatment schedules in clinical trials. Treatment modifications and patient characteristics may influence treatment safety and efficacy. So far, long-term results from the use of biological treatment in clinical practice are lacking. Objectives, To report short- and long-term efficacy and safety data on biologics, especially etanercept, used in daily clinical practice. Special attention has been paid to patient characteristics that may have influenced the response to therapy. Methods, Prospectively collected registry data of all patients with psoriasis treated with biologics in the Radboud University Nijmegen Medical Centre outpatient clinic were used for analysis. Patient and treatment characteristics were surveyed. Efficacy and safety of etanercept for up to 3 years were analysed. Moreover, the influence of patient characteristics on etanercept treatment response was studied. Results, The analysed cohort, consisting of 118 patients, went through 142 treatment episodes in total. Patients treated with biologics had an extensive medical history. Optimization of biological treatment was established in various ways, including treatment switches and introduction of concomitant therapies. Short-term etanercept efficacy analysis showed a mean Psoriasis Area and Severity Index (PASI) improvement at week 24 of 59·7%. No significant influence of gender, age, baseline PASI, body mass index, number of previous systemic therapies or duration of psoriasis was found on week 24 efficacy results, although trends were discernible. The efficacy of etanercept remained stable for up to 156 weeks. Long-term daily practice treatment with etanercept was only occasionally accompanied by major safety concerns. Conclusions, The current study demonstrates that etanercept is able to improve psoriasis symptoms for a considerable time, and that serious side-effects are infrequent. The influence of patient characteristics on treatment response is limited. [source]

Comparison of potassium titanyl phosphate vascular laser and hyfrecator in the treatment of vascular spiders and cherry angiomas

CLINICAL & EXPERIMENTAL DERMATOLOGY, Issue 6 2003
G. Dawn
Summary Patients with vascular spiders and angiomas, especially on exposed sites, demonstrate considerable psychological morbidity and therefore request treatment. Traditionally, electrosurgical modalities have been used to treat such lesions, but more recently lasers have been introduced. This open study assesses the efficacy of these two treatment modalities, scoring patients' preference and psychological morbidity before and after treatment. All patients had two vascular spiders or angiomas. One lesion was randomized for treatment with the hyfrecator, whilst the other lesion was treated with the potassium titanyl phosphate (KTP) vascular laser. The end-point of the study was either clearance of lesions or a maximum of three treatments at 2-month intervals. In this first comparative study, we demonstrate that both therapeutic modalities were effective in treating these lesions and in significantly reducing the post-treatment psychological morbidity score. However, on average, only one treatment with the KTP laser was required to achieve clearance compared with two treatments with the hyfrecator. This would result in less clinic visits. In addition, patients favoured the KTP laser because of the lack of side-effects. Both the KTP vascular laser and the hyfrecator were able to clear vascular spiders and angiomas, but the KTP laser was superior as fewer treatment episodes were required and patients preferred this treatment modality because of the lack of side-effects. [source]