A pilot study to assess the feasibility and impact of a brief motivational intervention on problem drug and alcohol use in adult mental health inpatient units: study protocol for a randomized controlled trial.

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly creditedBACKGROUND: Substance misuse in those with severe mental health problems is common and associated with poor engagement in treatment and treatment outcomes. Up to 44% of those admitted into psychiatric inpatient facilities have coexisting substance-misuse problems. However, this is not routinely addressed as part of their treatment plan. A mental health admission may present a window of opportunity for inpatients to reevaluate the impact of their substance use. This study will aim to evaluate the effectiveness of a targeted brief motivational intervention in improving engagement in treatment and to assess how feasible and acceptable this intervention is to inpatients and staff as a routine intervention. METHODS/DESIGN: This randomized controlled trial will use concealed randomization; blind, independent assessment of outcome at 3 months; characterization of refusers and dropouts; and be analyzed according to the intention-to-treat principle. After baseline assessments, eligible participants will be randomized either to the Brief Integrated Motivational Intervention plus Treatment As Usual, or Treatment as Usual alone. Eligible participants will be those who are new admissions; >18 years; ICD-10 diagnosis of -schizophrenia or related disorder, bipolar affective disorder, recurrent depressive disorder, and DSM-IV diagnosis of substance abuse or dependence over the last 3 months. The primary outcome is engagement in treatment for substance misuse, and secondary outcomes include readiness to change substance misuse together with a cost-effectiveness analysis. Qualitative interviews with staff and participants will assess the acceptability of the intervention. DISCUSSION: This pilot randomized trial will provide the first robust evidence base for inpatient care of people with severe mental health problems and co-morbid substance misuse and provide the groundwork for confirmatory trials to evaluate a potentially feasible, cost-effective, and easy-to-implement treatment option that may be readily integrated into standard inpatient and community-based care. TRIAL REGISTRATION: ISRCTN43548483 Date of ISRCTN assignation: 4/17/2014.This study is funded by the National Institute for Health Research (NIHR) Research for Patient Benefit Programme: PB-PG-1010-23138. It is sponsored by Birmingham & Solihull Mental Health NHS Foundation Trust and the University of Birmingham. This manuscript presents independent research funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (number PB-PG-1010-23138)

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

The effectiveness of tax policy on the EU national tax systems

The aim of this work is to determine how national tax systems respond to main challenges of EU tax policy. The method of solution is to analyze the development of implicit tax rates on labour and reduced VAT rates for labour-intensive services. Using the statistics of EU tax systems

Population dynamics of two caprellid species (Crustaceae: Amphipoda: Caprellidae) from shallow hard bottom assemblages

The community structure of caprellids associated with shallow hard bottom assemblages was studied in four locations around Pagasitikos Gulf, western coast of the Aegean Sea. Samplings were carried out every 3 months from April 2009 to April 2010. Samples were collected by scraping off the hard substrate, using 400-cm(2) handmade quadrate samplers. Water temperature, pH, salinity, dissolved oxygen and sea current velocity were measured in situ. Two caprellid species were found, Caprella acanthifera and Phtisica marina, with a clear dominance of C. acanthifera at all locations. The abundance of both species followed a seasonal pattern with a peak in spring or summer and a decline in winter. Lower abundances were detected at the locations with high current velocity and higher abundances at the locations with low water flow speed. This is an indication that the species might prefer areas with low hydrodynamism. Strong sexual dimorphism in body size was observed for both species, and the sex ratio was 1:1 throughout the samplings. It appears that reproduction for both species is continuous throughout the year, with a possible major breeding event in winter