Compulsory treatment in Australia: a discussion paper on the compulsory treatment of individuals dependent on alcohol and/or other drugs

This discussion paper presents a national perspective of the current operation of compulsory alcohol and/or other drug (AOD) treatment, within the context of existing research evidence, ethical considerations and international practice. It is intended to inform ongoing debate on the place of compulsory treatment in Australia. Particular areas of interest are the development, implementation and effectiveness of drug diversion and civil commitment practices

Teaching Hidden History: A Case Study of Dialogic Scaffolding in a Hybrid Graduate Course

Using an expanded version of Alexander’s (2008) theory of dialogic teaching developed by Rojas-Drummond, Torreblanca, Pedraza, Vélez, and Guzmán (2013), this case study explored how instructors and students in a hybrid graduate course engaged in the process of dialogic teaching and learning (DTL). In particular, we examined the ways in which scaffolding strategies used in the course supported inquiry-based learning. Our findings suggest that instructors and students engaged in all five dimensions of DTL as defined by Rojas-Drummond et al. (2013), and illuminate the ways in which scaffolding can facilitate inquiry-based learning in interdisciplinary instructional settings

Evidence-based commissioning in the English NHS : who uses which sources of evidence? A survey 2010/2011

Objectives: To investigate types of evidence used by healthcare commissioners when making decisions and whether decisions were influenced by commissioners’ experience, personal characteristics or role at work. Design: Cross-sectional survey of 345 National Health Service (NHS) staff members. Setting: The study was conducted across 11 English Primary Care Trusts between 2010 and 2011. Participants: A total of 440 staff involved in commissioning decisions and employed at NHS band 7 or above were invited to participate in the study. Of those, 345 (78%) completed all or a part of the survey. Main outcome measures: Participants were asked to rate how important different sources of evidence (empirical or practical) were in a recent decision that had been made. Backwards stepwise logistic regression analyses were undertaken to assess the contributions of age, gender and professional background, as well as the years of experience in NHS commissioning, pay grade and work role. Results: The extent to which empirical evidence was used for commissioning decisions in the NHS varied according to the professional background. Only 50% of respondents stated that clinical guidelines and cost-effectiveness evidence were important for healthcare decisions. Respondents were more likely to report use of empirical evidence if they worked in Public Health in comparison to other departments (p<0.0005, commissioning and contracts OR 0.32, 95%CI 0.18 to 0.57, finance OR 0.19, 95%CI 0.05 to 0.78, other departments OR 0.35, 95%CI 0.17 to 0.71) or if they were female (OR 1.8 95% CI 1.01 to 3.1) rather than male. Respondents were more likely to report use of practical evidence if they were more senior within the organisation (pay grade 8b or higher OR 2.7, 95%CI 1.4 to 5.3, p=0.004 in comparison to lower pay grades). Conclusions: Those trained in Public Health appeared more likely to use external empirical evidence while those at higher pay scales were more likely to use practical evidence when making commissioning decisions. Clearly, National Institute for Clinical Excellence (NICE) guidance and government publications (eg, National Service Frameworks) are important for decision-making, but practical sources of evidence such as local intelligence, benchmarking data and expert advice are also influential

Alcohol and other drug withdrawal: practice guidelines.

Clinical guidelines seek to direct clinical practice by outlining recognised, evidence-based treatment interventions. They draw on current literature and clinical practice expertise. These Guidelines provide guidance for clinical decision-making in the context of individual client requirements, withdrawal setting, treatment availability and individual service protocols. These Guidelines are consistent with the World Health Organisation’s (WHO) United Nations Principles of Drug Dependence Treatment (United Nations Office on Drugs and Crime and World Health Organization, 2008). They outline current best practice for the management of AOD-dependent clients accessing withdrawal care. 1 Introduction - page 1 2 Definitions of dependence and withdrawal - page 5 3 Principles of AOD withdrawal care - page 9 4 Continuity of Care - page 11 5 Features of AOD withdrawal - page 13 6 Special needs groups - page 19 7 Presentation to AOD withdrawal - page 29 8 AOD withdrawal settings - page 31 9 Assessment - page 37 10 Alcohol withdrawal - page 45 11 Opioid withdrawal - page 65 12 Benzodiazepines - page 87 13 Amphetamine-type substances (ATS) - page 99 14 Cannabis - page 111 15 Nicotine - page 121 16 AOD withdrawal for clients with a dual diagnosis - page 133 17 References - page 16

Collaboration Matters: Honey Bee Health as a Transdisciplinary Model for Understanding Real-World Complexity

We develop a transdisciplinary deliberative model that moves beyond traditional scientific collaborations to include nonscientists in designing complexity-oriented research. We use the case of declining honey bee health as an exemplar of complex real-world problems requiring cross-disciplinary intervention. Honey bees are important pollinators of the fruits and vegetables we eat. In recent years, these insects have been dying at alarming rates. To prompt the reorientation of research toward the complex reality in which bees face multiple challenges, we came together as a group, including beekeepers, farmers, and scientists. Over a two-year period, we deliberated about how to study the problem of honey bee deaths and conducted field experiments with bee colonies. We show trust and authority to be crucial factors shaping such collaborative research, and we offer a model for structuring collaboration that brings scientists and nonscientists together with the key objects and places of their shared concerns across time

Moving from ‘what we know works’ to ‘what we do in practice’::An evidence overview of implementation and diffusion of innovation in transition to adulthood for care experienced young people

Global research has shown that most young people who are care experienced are not prepared to transition to independent living at 18 years of age and require support into early adulthood. We used rigorous systematic methods to identify English‐based peer reviewed and grey literature describing innovations relevant to care experienced young people as they transition into adulthood, with a focus upon lessons for their implementation and diffusion. We synthesised the evidence narratively and organise data linked to seven key areas important to the transition to adulthood: (1) Health and well‐being; (2) relationships; (3) education and training; (4) employment; (5) participation in society; (6) accommodation; (7) other. Twenty‐five papers met our inclusion criteria. This review has found that, whilst there are a broad spectrum of innovations taking place within the social care environment for care experienced young people to support their transition into adulthood, there exists limited insight into how best to support implementation and diffusion of evidence‐based innovation. We drew upon the ‘Consolidated Framework for Implementation Research’, developed in the setting of clinical service delivery, to highlight challenges in implementing and diffusing evidence‐based innovation for care experienced young people transitioning into adulthood

Factors associated with falls among hospitalized and community-dwelling older adults:the APPCARE study

Background: Falls are a leading cause of disability. Previous studies have identified various risk factors for falls. However, contemporary novel research is needed to explore these and other factors associated with falls among a diverse older adult population. This study aims to identify the factors associated with falls among hospitalized and community-dwelling older adults. Methods: Cross-sectional data from the ‘Appropriate care paths for frail elderly people: a comprehensive model’ (APPCARE) study were analyzed. The study sample consisted of hospitalized and community-dwelling older adults. Falling was assessed by asking whether the participant had fallen within the last 12 months. Multivariable logistic regression models were used to evaluate associations between socio-demographic characteristics, potential fall risk factors and falls. Results: The sample included 113 hospitalized (mean age = 84.2 years; 58% female) and 777 community-dwelling (mean age = 77.8 years; 49% female) older adults. Among hospitalized older adults, loneliness was associated with an increased risk of falls. Associations between female sex, secondary education lever or lower, multimorbidity, a higher score on limitations with activities of daily living (ADL), high risk of malnutrition and falling were found among community-dwelling participants. Conclusion: The results of this study confirm the multi-factorial nature of falling and the complex interaction of risk factors. Future fall prevention programs could be tailored to the needs of vulnerable subpopulations at high risk for falls.</p

Factors associated with health-related quality of life among community-dwelling older adults:the APPCARE study

This study aimed to identify the factors associated with health-related quality of life (HRQOL) among community-dwelling older adults. Physical and mental HRQOL were measured by the 12-item Short Form Health Survey (SF-12) at baseline and follow-up. Linear regression models were used to evaluate associations between socio-demographic, health, and lifestyle factors and HRQOL. The sample included 661 participants (mean age = 77.4 years). Frailty was negatively associated with physical HRQOL (B = − 5.56; P &lt; 0.001) and mental HRQOL (B = − 6.65; P &lt; 0.001). Participants with a higher score on activities of daily living (ADL) limitations had lower physical HRQOL (B = − 0.63; P &lt; 0.001) and mental HRQOL (B = − 0.18; P = 0.001). Female sex (B = − 2.38; P &lt; 0.001), multi-morbidity (B = − 2.59; P = 0.001), and a high risk of medication-related problems (B = − 2.84; P &lt; 0.001) were associated with lower physical HRQOL, and loneliness (B = − 3.64; P &lt; 0.001) with lower mental HRQOL. In contrast, higher age (B = 2.07; P = 0.011) and living alone (B = 3.43; P &lt; 0.001) were associated with better mental HRQOL in the multivariate models. Future interventions could be tailored to subpopulations with relatively poor self-reported HRQOL, such as frail or lonely older adults to improve their HRQOL.</p

Factors associated with health-related quality of life among community-dwelling older adults:the APPCARE study

This study aimed to identify the factors associated with health-related quality of life (HRQOL) among community-dwelling older adults. Physical and mental HRQOL were measured by the 12-item Short Form Health Survey (SF-12) at baseline and follow-up. Linear regression models were used to evaluate associations between socio-demographic, health, and lifestyle factors and HRQOL. The sample included 661 participants (mean age = 77.4 years). Frailty was negatively associated with physical HRQOL (B = − 5.56; P &lt; 0.001) and mental HRQOL (B = − 6.65; P &lt; 0.001). Participants with a higher score on activities of daily living (ADL) limitations had lower physical HRQOL (B = − 0.63; P &lt; 0.001) and mental HRQOL (B = − 0.18; P = 0.001). Female sex (B = − 2.38; P &lt; 0.001), multi-morbidity (B = − 2.59; P = 0.001), and a high risk of medication-related problems (B = − 2.84; P &lt; 0.001) were associated with lower physical HRQOL, and loneliness (B = − 3.64; P &lt; 0.001) with lower mental HRQOL. In contrast, higher age (B = 2.07; P = 0.011) and living alone (B = 3.43; P &lt; 0.001) were associated with better mental HRQOL in the multivariate models. Future interventions could be tailored to subpopulations with relatively poor self-reported HRQOL, such as frail or lonely older adults to improve their HRQOL.</p