Summary of the NECTOS study of specialist crack services

The Government acknowledges that crack and cocaine use is a significant public health issue. It has attached a high priority to getting more crack users into treatment and retaining them, and commissioning new research into the effectiveness of different treatment methods. Tackling Crack: A National Plan (Home Office, 2002) was implemented in 2003. There has been no independent assessment of existing crack and cocaine treatment services in this country to establish what interventions are delivered, how effective services are, and what lessons can be learned for future service planning. This evaluation aims to directly address this shortcoming. The National Evaluation of Crack Cocaine Treatment and Outcome Study (NECTOS) (NTA, 2007, forthcoming) evaluated a number of well-established specialist crack treatment services. The intention was to describe the interventions they provided, to measure how effective the services were in engaging and retaining crack users, and to assess whether they helped users reduce their consumption

Sensory-Friendly Mode For Mobile Devices

A system and method are disclosed for a sensory-friendly mode in a mobile device. The system allows users to adjust the display, sound or haptic feedback output of the device to optimize the ability of users to consume the information provided by the device. The system may vary the amount of visual complexity for display based on the user needs, either by blurring the screen to eliminate hard edges, making the unimportant areas of the screen entirely invisible or by applying time-based filters to prevent animations or prevent screen flickering. The system may adjust audio volume automatically when a volume change is detected. The system may ramp up haptic vibrations slowly to avoid startling a sensitive user. The system is intended to make a device much more usable to users with special needs (e.g. autistic users)

Short-term PsychoEducation for Carers To Reduce Over Medication of people with intellectual disabilities (SPECTROM): study protocol

Introduction Psychotropic medications that are primarily licenced for the treatment of psychiatric disorders are used widely (32%–85%) among people with intellectual disabilities (ID) often for the management of problem (challenging) behaviour in the absence of a psychiatric disorder. Care staff play a pivotal role in the prescribing process. Currently, no staff training programme exists to address the issue of overprescribing of psychotropic medication in people with ID, thus highlighting an urgent need for developing a psychoeducational programme (PEP) specifically designed to address this issue. We propose to develop a PEP for care staff using the methodology described in the UK Medical Research Council guide for complex interventions. Methods and analysis The development of the PEP will involve (1) gathering information on available relevant training programmes, (2) running four focus groups with care staff and other professionals to establish the content and format of the PEP, and (3) organising a co-design event involving all relevant stakeholders to discuss the format of the PEP. A core project team will develop the PEP under guidance from the PEP Development Group which will consist of 10–12 relevant stakeholder representatives. Feedback from selected stakeholders on a draft PEP will allow us to refine the PEP before implementation. The PEP will have web-based modules supplemented by face to face training sessions. When the final draft is ready, we will field test the PEP on six to eight care staff from community care homes for people with ID. After completing the field test, we will run a focus group involving participants in the PEP to get feedback on the PEP. Ethics and dissemination Ethics approval for this study was waived by the UK Health Regulatory Authority as the study does not collect any patient related information and only include care staff outside the UK NHS. This will be the first ever such universally freely available PEP supported by training manual and slides

Prophylactic Laparoscopic Gastrectomy for Hereditary Diffuse Gastric Cancer: A Case Series in a Single Family

This study suggests that a laparoscopic approach for prophylactic total gastrectomy for carriers of CDH1 gene mutation can be performed safely and effectively

Patients\u27 beliefs towards contingency management: Target behaviours, incentives and the remote application of these interventions

Introduction Contingency management interventions are among the most efficacious psychosocial interventions in promoting abstinence from smoking, alcohol and substance use. The aim of this study was to assess the beliefs and objections towards contingency management among patients in UK-based drug and alcohol services to help understand barriers to uptake and support the development and implementation of these interventions. Methods The Service User Survey of Incentives was developed and implemented among patients (N = 181) at three UK-based drug and alcohol treatment services. Descriptive analyses were conducted to ascertain positive and negative beliefs about contingency management, acceptability of different target behaviours, incentives and delivery mechanisms including delivering incentives remotely using technology devices such as mobile telephones. Results Overall, 81% of participants were in favour of incentive programs, with more than 70% of respondents agreeing with the majority of positive belief statements. With the exception of two survey items, less than a third of participants agreed with negative belief statements. The proportion of participants indicating a neutral response was higher for negative statements (27%) indicating greater levels of ambiguity towards objections and concerns regarding contingency management. Discussion and Conclusions Positive beliefs towards contingency management interventions were found, including high levels of acceptability towards a range of target behaviours, incentives and the use of technology devices to remotely monitor behaviour and deliver incentives. These findings have implications for the development and implementation of remote contingency management interventions within the UK drug treatment services

Process, outcome and experience of transition from child to adult mental healthcare : multiperspective study

Background Many adolescents with mental health problems experience transition of care from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS). Aims As part of the TRACK study we evaluated the process, outcomes and user and carer experience of transition from CAMHS to AMHS. Method We identified a cohort of service users crossing the CAMHS/AMHS boundary over 1 year across six mental health trusts in England. We tracked their journey to determine predictors of optimal transition and conducted qualitative interviews with a subsample of users, their carers and clinicians on how transition was experienced. Results Of 154 individuals who crossed the transition boundary in 1 year, 90 were actual referrals (i.e. they made a transition to AMHS), and 64 were potential referrals (i.e. were either not referred to AMHS or not accepted by AMHS). Individuals with a history of severe mental illness, being on medication or having been admitted were more likely to make a transition than those with neurodevelopmental disorders, emotional/neurotic disorders and emerging personality disorder. Optimal transition, defined as adequate transition planning, good information transfer across teams, joint working between teams and continuity of care following transition, was experienced by less than 5% of those who made a transition. Following transition, most service users stayed engaged with AMHS and reported improvement in their mental health. Conclusions For the vast majority of service users, transition from CAMHS to AMHS is poorly planned, poorly executed and poorly experienced. The transition process accentuates pre-existing barriers between CAMHS and AMH