Patient and clinician's ratings of improvement in methadone-maintained patients: Differing perspectives?

<p>Abstract</p> <p>Background</p> <p>In the last few years there seems to be an emerging interest for including the patients' perspective in assessing methadone maintenance treatment (MMT), with treatment satisfaction surveys being the most commonly-used method of incorporating this point of view. The present study considers the perspective of patients on MMT when assessing the outcomes of this treatment, acknowledging the validity of this approach as an indicator. The primary aim of this study is to evaluate the concordance between improvement assessment performed by two members of the clinical staff (a psychiatrist and a nurse) and assessment carried out by MMT patients themselves.</p> <p>Method</p> <p>Patients (n = 110) and their respective psychiatrist (n = 5) and nurse (n = 1) completed a scale for assessing how the patient's condition had changed from the beginning of MMT, using the Patient Global Impression of Improvement scale (PGI-I) and the Clinical Global Impression of Improvement scale (CGI-I), respectively.</p> <p>Results</p> <p>The global improvement assessed by patients showed weak concordance with the assessments made by nurses (Quadratic-weighted kappa = 0.13, p > 0.05) and by psychiatrists (Quadratic-weighted kappa = 0.19, p = 0.0086), although in the latter, concordance was statistically significant. The percentage of improved patients was significantly higher in the case of the assessments made by patients, compared with those made by nurses (90.9% vs. 80%, Z-statistic = 2.10, p = 0.0354) and by psychiatrists (90.9% vs. 50%, Z-statistic = 6.48, p < 0.0001).</p> <p>Conclusions</p> <p>MMT patients' perception of improvement shows low concordance with the clinical staff's perspective. Assessment of MMT effectiveness should also focus on patient's evaluation of the outcomes or changes achieved, thus including indicators based on the patient's experiences, provided that MMT aim is to be more patient centred and to cover different needs of patients themselves.</p

Feasibility of Double-Blind Clinical Trials with Oral Diacetylmorphine: A Randomized Controlled Phase II Study in an Inpatient Setting

The aim of this study was to evaluate the feasibility of conducting double-blind controlled randomized clinical trials using twice-a-day immediate-release oral diacetylmorphine (DAM) in heroin-dependent patients, by means of measuring the capacity of oral DAM to block opiate withdrawal and clinicians' ability to distinguish it from morphine and methadone. This was a randomized, phase II, double-blind, multicenter pilot study comparing immediate-release oral DAM, slow-release oral morphine and oral methadone administered twice a day during 10 days. Forty-five heroin-dependent patients were randomly assigned to these three treatment groups in an inpatient regime. Patients were stabilized with a mean of 350 mg (SD = 193) of immediate-release oral DAM, 108 mg (SD = 46.2) of slow-release oral morphine and 40 mg (SD = 17.9) of methadone. No statistically significant differences were found between any studied medication in clinical outcome. Neither patients nor clinicians were able to identify the administered medication. This study shows the feasibility of double-blind clinical trials using b.i.d. immediate-release oral DAM allowing further phase III clinical trials in the process of introducing oral DAM as a medication for heroin-dependent patients not responding to standard maintenance treatments

Impact of a Primary Care Antimicrobial Stewardship Program on Bacterial Resistance Control and Ecological Imprint in Urinary Tract Infections

Antimicrobial stewardship programs (ASPs) are a central component in reducing the overprescription of unnecessary antibiotics, with multiple studies showing benefits in the reduction of bacterial resistance. Less commonly, ASPs have been performed in outpatient settings, but there is a lack of available data in these settings. We implemented an ASP in a large regional outpatient setting to assess its feasibility and effectiveness. Over a 5-year post-implementation period, compared to the pre-intervention period, a significant reduction in antibiotic prescription occurred, with a reduction in resistance in E. coli urinary isolates. ASP activities also were found to be cost-effective, with a reduction in medication prescription

04. Presentación de Proyectos Wokshop EMILA

Presentació de Projectes de l' EMILA Summer Workshop. Coordinació de Pepa Morán i Enric Batlle, Director del Màster

Jornada ON Landscape. Sessió matí

MBLandArch ha organitzat la Jornada ON Landscape el divendres 31 de maig a la Sala de Graus de l' ETSAB És una Jornada oberta al públic amb l'objectiu de generar una reflexió sobre les línies principals de treball desenvolupades actualmente des del projecte del Paisatge per professionals amb una reconeguda experiència. La Jornada es divideix en dues parts, a cadascuna el ponent fa una presentació pròpia del seu treball i tot seguit es realitza una Taula rodona amb la participació dels conferenciants amb un moderador que coordina el debat.Sessió matí de la Jornada ON Landscape. Inauguració a càrrec de Pepa Morán, Arquitecta, paisatgista i coordinadora de MBLandArch. Ponents: Anna Noguera, Arquitecta | Martí Franch, Ing. Agrònom i paisatgista | Michèle & Miquel, Arquitectes i paisatgistes | Anna Zahonero, Biòloga, paisatgista i coordinadora MBLandArch. Taula rodona amb les intervencions d'Anna Noguera, Martí Franch i Michèle & Mique

Jornada ON Landscape. Sessió tarda

Sessió tarda de la Jornada ON Landscape amb les intervencions a càrrec d' Ana Coello, Arquitecta i paisatgista | Elena Albareda, Arquitecta, sòcia de Cíclica Arquitectura | Scob, Arquitectes i paisatgistes ( Sergi Carulla i Óscar Blasco) | Xavier Fàbregas, Ing. Agrònom i coordinador MBLAndArch | Javi Zaldívar, Arquitecte i paisatgista | Enric Batlle, Dr. Arquitecte i Director MBLandArch