Supervision and Collection of Data about Client

The need for knowledge-based social work is being widely discussed internationally. The Department of Social Work at Stockholm University has taken part in a pilot project in Lithuania, the aim of which is to develop community-based and knowledge-based social work. An educational and training programme has been adopted for this purpose. An important part of this effort is the implementation of a computerised case management system backed by advisory supervision at 14 social service centres throughout Lithuania. The objective of the computerised case management system is to enable social service centres to simply and effectively gather key information about clients, activities and treatment procedures. The objective of the advisory supervision programme is to implement new methods,including a psychosocial approach to relating to clients. The purpose of both programmes is to strengthen the development of the social service centres. The strategy is to analyse the empirical material generated by the computerised case management system. This analysis makes it possible to evaluate and monitor the client population, as well as the procedures employed and the results achieved by the treatment centres. Thus, the computerised case management system enables the staffs of the social service centres to be more aware of what their work entails. This heightened awareness then forms the basis for advisory supervision. The integration of the computerised case management system with advisory supervision is a powerful tool for broadening the interface between research and practice in social work, thereby making social work more securely knowledge-based

Is There a Need for Congruent Treatment Goals Between Alcohol-Dependent Patients and Caregivers?

Background: Alcohol-dependent patients have different treatment goals when entering treatment. Furthermore, different treatment settings advocate different treatment goals. Earlier studies have pointed out that treatment goal is important for treatment outcome, both in the treatment setting as well as in the patients themselves. However, to our knowledge, no study has so far investigated the interaction between patient's goal and the goal of the treatment setting. The aim of the study was therefore to study the interaction between these 2 factors on treatment outcome. Methods: Patients' (n = 201) goals from 2 treatment settings one that had an abstinence-oriented goal and one with a low-risk drinking goal—were investigated. The patients were followed up 2.5 years after treatment entry and effectiveness of congruent treatment goals on treatment outcome was investigated. Results: There was no significant association between congruent goals and treatment outcomes (p = 0.060). However, when comparing the effectiveness of congruent treatment goal between the 2 treatment settings, the abstinence-oriented treatment setting was significantly more effective (p < 0.01). Conclusions: The major finding was that there appeared to be no association between congruence itself and treatment outcome. On the other hand, we found that the treatment outcome was more successful if the patient as well as the treatment setting had abstinence as a goal (i.e., congruent goals of abstinence)

Kuravimas (supervizija) ir duomenų apie klientą rinkimas

Žiniomis grįsto, arba kvalifikuoto, socialinio darbo poreikis plačiai diskutuojamas tarptautiniu mastu. Stokholmo universiteto Socialinio darbo katedra dalyvavo eksperimentiniame projekte Lietuvoje, kurio tikslas – plėsti bendruomenines socialines paslaugas ir gerinti socialinio darbo kokybę. Tam tikslui buvo parengta mokymo programa. Vienas iš svarbiausių šio projekto tikslų yra sukurti kompiuterinę dokumentacijos sistemą, kurią papildytų konsultacijų teikimas ir kuravimas 14-oje eksperimentinių socialines paslaugas teikiančių centrų visoje Lietuvoje. Ši kompiuterinė dokumentacijos sistema buvo sukurta siekiant, kad socialinių paslaugų centrai galėtų paprastai ir efektyviai rinkti pagrindinę informaciją apie klientus, centrų veiklą ir reabilitacijos procedūras. Konsultacijų ir kuravimo programos tikslas – įgyvendinti naujus metodus, įskaitant ir psichosocialinį požiūrį į socialinių centrų klientus. Abiejų šių programų tikslas yra skatinti socialinių paslaugų centrų plėtrą. Strategijos pagrindas yra analizuoti empirinę medžiagą, surinktą kompiuterinėje dokumentacijos sistemoje. Remiantis tokia analize, įmanoma atlikti centrų klientų populiacijos, taip pat atliktų procedūrų ir reabilitacijos centruose pasiektų rezultatų įvertinimą ir monitoringą. Pasitelkęs kompiuterinę informacijos apdorojimo sistemą, socialinių centrų personalas gali geriau suvokti savo darbo rezultatus, t. y. didėja jų sąmoningumas, o tai savo ruožtu sukuria konsultacijų ir kuravimo pagrindą. Kompiuterinės dokumentacijos sistemos bei konsultavimo ir kuravimo integracija yra galingas įrankis, plečiant mokslo ir praktikos sąlyčio spektrą socialinio darbo srityje, tokiu būdu įvedant didesnį kiekį žinių į praktinį socialinį darbą

Pharmacokinetics, safety, and tolerability of a depot formulation of naltrexone in alcoholics: an open-label trial

BACKGROUND: Naltrexone is an effective medication for treatment of alcohol dependence, but its efficacy is limited by lack of adherence to the oral dosage form. A long-acting depot formulation of naltrexone may increase adherence. METHODS: A single site, 6-week open label study was conducted with 16 alcohol dependent subjects each receiving 300 mg of Naltrexone Depot by intramuscular injection. The main outcomes were safety and tolerability of the Naltrexone Depot formulation, blood levels of naltrexone and its main metabolite 6-beta naltrexol, and self-reported alcohol use. All subjects received weekly individual counseling sessions. RESULTS: The medication was well tolerated with 88% of subjects completing the 6-week trial. The most common side effect experienced was injection site complications. There were no serious adverse events. Subjects had naltrexone and 6-beta-naltrexol concentrations throughout the trial with mean values ranging from 0.58 ng/mL to 2.04 ng/mL and 1.51 ng/mL to 5.52 ng/mL, respectively, at each sampling time following administration. Compared to baseline, subjects had significantly reduced number of drinks per day, heavy drinking days and proportion of drinking days. CONCLUSION: Naltrexone Depot is safe and well tolerated in alcoholics and these findings support the further investigation of its utility in larger double-blind placebo controlled trials

Hormone response to repeated electroconvulsive therapy: Effects of naloxone

Plasma prolactin (PRL), cortisol, and growth hormone (GH) were measured before, and at 15-min intervals for 1 hr after, electroconvulsive therapy (ECT). This was repeated over a series of 6 consecutive treatments for each of 12 depressed drug-free inpatients. Patients received naloxone, 2 mg or 20 mg, by intravenous infusion before the third and fifth treatment. ECT was consistently followed by a release of PRL and cortisol, although two patterns of PRL response could be distinguished. In eight patients, the PRL response did not change significantly with repeated ECT, whereas in four patients, the plasma PRL increased tenfold after the first treatment and decreased after each successive treatment. The GH level varied widely, with no evidence of a reliable response to ECT. Opiate receptor blockade with low- or high-dose naloxone did not alter the release of PRL or cortisol after ECT. These findings demonstrate a reliable PRL and cortisol response to ECT, but do not support a role for endogenous opiates in these hormonal changes.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/25658/1/0000210.pd

Aquatic therapy for children with Duchenne muscular dystrophy: a pilot feasibility randomised controlled trial and mixed-methods process evaluation.

BACKGROUND: Duchenne muscular dystrophy (DMD) is a rare disease that causes the progressive loss of motor abilities such as walking. Standard treatment includes physiotherapy. No trial has evaluated whether or not adding aquatic therapy (AT) to land-based therapy (LBT) exercises helps to keep muscles strong and children independent. OBJECTIVES: To assess the feasibility of recruiting boys with DMD to a randomised trial evaluating AT (primary objective) and to collect data from them; to assess how, and how well, the intervention and trial procedures work. DESIGN: Parallel-group, single-blind, randomised pilot trial with nested qualitative research. SETTING: Six paediatric neuromuscular units. PARTICIPANTS: Children with DMD aged 7-16 years, established on corticosteroids, with a North Star Ambulatory Assessment (NSAA) score of 8-34 and able to complete a 10-m walk without aids/assistance. Exclusions: > 20% variation between baseline screens 4 weeks apart and contraindications. INTERVENTIONS: Participants were allocated on a 1 : 1 ratio to (1) optimised, manualised LBT (prescribed by specialist neuromuscular physiotherapists) or (2) the same plus manualised AT (30 minutes, twice weekly for 6 months: active assisted and/or passive stretching regime; simulated or real functional activities; submaximal exercise). Semistructured interviews with participants, parents (n = 8) and professionals (n = 8) were analysed using Framework analysis. An independent rater reviewed patient records to determine the extent to which treatment was optimised. A cost-impact analysis was performed. Quantitative and qualitative data were mixed using a triangulation exercise. MAIN OUTCOME MEASURES: Feasibility of recruiting 40 participants in 6 months, participant and therapist views on the acceptability of the intervention and research protocols, clinical outcomes including NSAA, independent assessment of treatment optimisation and intervention costs. RESULTS: Over 6 months, 348 children were screened - most lived too far from centres or were enrolled in other trials. Twelve (30% of target) were randomised to AT (n = 8) or control (n = 4). People in the AT (n = 8) and control (n = 2: attrition because of parental report) arms contributed outcome data. The mean change in NSAA score at 6 months was -5.5 [standard deviation (SD) 7.8] for LBT and -2.8 (SD 4.1) in the AT arm. One boy suffered pain and fatigue after AT, which resolved the same day. Physiotherapists and parents valued AT and believed that it should be delivered in community settings. The independent rater considered AT optimised for three out of eight children, with other children given programmes that were too extensive and insufficiently focused. The estimated NHS costs of 6-month service were between £1970 and £2734 per patient. LIMITATIONS: The focus on delivery in hospitals limits generalisability. CONCLUSIONS: Neither a full-scale frequentist randomised controlled trial (RCT) recruiting in the UK alone nor a twice-weekly open-ended AT course delivered at tertiary centres is feasible. Further intervention development research is needed to identify how community-based pools can be accessed, and how families can link with each other and community physiotherapists to access tailored AT programmes guided by highly specialised physiotherapists. Bayesian RCTs may be feasible; otherwise, time series designs are recommended. TRIAL REGISTRATION: Current Controlled Trials ISRCTN41002956. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 27. See the NIHR Journals Library website for further project information