The SUMMIT trial: a field comparison of buprenorphine versus methadone maintenance treatment.

This prospective patient-preference study examined the effectiveness in practice of methadone versus buprenorphine maintenance treatment and the beliefs of subjects regarding these drugs. A total of 361 opiate-dependent individuals (89% of those eligible, presenting for treatment over 2 years at a drug service in England) received rapid titration then flexible dosing with methadone or buprenorphine; 227 patients chose methadone (63%) and 134 buprenorphine (37%). Participants choosing methadone had more severe substance abuse and psychiatric and physical problems but were more likely to remain in treatment. Survival analysis indicated those prescribed methadone were over twice as likely to be retained (hazard ratio for retention was 2.08 and 95% confidence interval [CI] = 1.49-2.94 for methadone vs. buprenorphine), However, those retained on buprenorphine were more likely to suppress illicit opiate use (odds ratio = 2.136, 95% CI = 1.509-3.027, p < .001) and achieve detoxification. Buprenorphine may also recruit more individuals to treatment because 28% of those choosing buprenorphine (10% of the total sample) stated they would not have accessed treatment with methadone

A cohort study of influences, health outcomes and costs of patients' health-seeking behaviour for minor ailments from primary and emergency care settings

To compare health-related and cost-related outcomes of consultations for symptoms suggestive of minor ailments in emergency departments (EDs), general practices and community pharmacies

Estimating the burden of minor ailment consultations in general practices and emergency departments through retrospective review of routine data in North East Scotland

Minor ailment attendances in general practices and emergency departments (EDs) place significant burden on health care resources

A Study to Validate a Self-Reported Version of the ONS Drug Dependence Questionnaire

Aim: A prospective study to establish the reliability of a self-completion version of the Office for National Statistics (ONS) questionnaire for assessing drug dependence of substance misuse clients. Method: A total of 47 treatment seeking opioid-dependent clients completed the self-complete version of the ONS questionnaire (ONS-sc) followed by the interviewer-administered ONS questionnaire (ONS-ia) at a single clinic appointment. Scores for four Class A drugs (heroin, methadone, speed and crack/cocaine) from both formats were compared. Results: The observed agreement was 87% or more and Cohen's kappa was 0.7 (p < 0.001) or more for all four Class A drugs. Sensitivity for each Class A drugs was 56% or higher and specificity was 87% or higher. Sensitivity for severe heroin dependency was 98% (CI 89–100%). There was a 100% correlation between the ONS-sc and positive urine analysis for heroin use. However, methadone and crack/cocaine drug use appeared under reported. Conclusion: ONS-sc is a feasible, practical and time-saving alternative to a detailed interview on drug dependence. Further research with a larger sample size and non-opiate-dependent clients are needed, as this could prove a useful tool for monitoring clients in everyday practice, or for survey purposes where interviews are impractical

The experience of long-term opiate maintenance treatment and reported barriers to recovery: A qualitative systematic review

Background/Aim: To inform understanding of the experience of long-term opiate maintenance and identify barriers to recovery. Methods: A qualitative systematic review. Results: 14 studies in 17 papers, mainly from the USA (65%), met inclusion criteria, involving 1,088 participants. Studies focused on methadone prescribing. Participants reported stability; however, many disliked methadone. Barriers to full recovery were primarily ‘inward focused'. Conclusion: This is the first review of qualitative literature on long-term maintenance, finding that universal service improvements could be made to address reported barriers to recovery, including involving ex-users as positive role models, and increasing access to psychological support. Treatment policies combining harm minimisation and abstinence-orientated approaches may best support individualised recovery

The blue-green path to urban flood resilience

Abstract Achieving urban flood resilience at local, regional and national levels requires a transformative change in planning, design and implementation of urban water systems. Flood risk, wastewater and stormwater management should be re-envisaged and transformed to: ensure satisfactory service delivery under flood, normal and drought conditions, and enhance and extend the useful lives of ageing grey assets by supplementing them with multi-functional Blue-Green infrastructure. The aim of the multidisciplinary Urban Flood Resilience (UFR) research project, which launched in 2016 and comprises academics from nine UK institutions, is to investigate how transformative change may be possible through a whole systems approach. UFR research outputs to date are summarised under three themes. Theme 1 investigates how Blue-Green and Grey (BG + G) systems can be co-optimised to offer maximum flood risk reduction, continuous service delivery and multiple co-benefits. Theme 2 investigates the resource capacity of urban stormwater and evaluates the potential for interoperability. Theme 3 focuses on the interfaces between planners, developers, engineers and beneficiary communities and investigates citizens’ interactions with BG + G infrastructure. Focussing on retrofit and new build case studies, UFR research demonstrates how urban flood resilience may be achieved through changes in planning practice and policy to enable widespread uptake of BG + G infrastructure.EPSR

Systematic review and narrative synthesis of pharmacist provided medicines optimisation services in care homes for older people to inform the development of a generic training or accreditation process

Objectives: To develop a training programme to enable pharmacists with prescribing rights to assume responsibility for the provision of pharmaceutical care within care homes, a systematic review and narrative synthesis was undertaken to identify reported approaches to training pharmacists and use this literature to identify potential knowledge requirements. Methods: A PROSPERO‐registered systematic review was performed using key search terms for care homes, pharmacist, education, training and pharmaceutical care. Papers reporting primary research focussed on care of the older person within the care home setting were included. No restrictions were placed on methodology. Two researchers independently reviewed titles, abstracts and papers. Agreement on inclusion was reached through consensus. Data on titles, training and activities undertaken were extracted and knowledge requirements identified. Findings were synthesised and reported narratively. Key findings: Fifty‐nine papers were included, most of which were uncontrolled service evaluations. Four papers reported an accreditation process for the pharmacist. Thirteen papers reported providing tools or specific training on a single topic to pharmacists. The main clinical and therapeutic areas of activity (requiring codified knowledge) were dementia, pain, antipsychotic and cardiovascular medication. Provision of pharmaceutical care, effective multidisciplinary working and care home staff training represented the main areas of practical knowledge. Conclusions: Information regarding training and accreditation processes for care home pharmacists is limited. This study provides insight into potential codified and practical knowledge requirements for pharmacists assuming responsibility for the provision of pharmaceutical care within care homes. Further work involving stakeholders is required to identify the cultural knowledge requirements and to develop a training and accreditation process

A participatory process to support sustainable water resources management in the Ebbsfleet Garden City

This is the author accepted manuscript. The final version is available from IAHR via the link in this recordThe present work describes the development of a participatory System Dynamics Model (SDM) aiming to explore sustainable urban water management (UWM) in a structured way and to understand where policy interventions might be best focused. The proposed multi-step process is useful for supporting decision-making at a strategic, system-wide level and for exploring the long-term consequences of alternative strategies. The strongly participatory base of the SDM allows both to include local knowledge held by relevant stakeholders, and to support a collective learning process, which should improve the effectiveness of the selected strategies. In the following sections on the SDM co-development to enhance sustainable urban water management in the Ebbsfleet Garden City are provided.Engineering and Physical Sciences Research Council (EPSRC

Delivering And Evaluating The Multiple Flood Risk Benefits In Blue-Green Cities: An Interdisciplinary Approach

A Blue-Green City aims to recreate a naturally-oriented water cycle while contributing to the amenity of the city by bringing water management and green infrastructure together. The Blue-Green approach is more than a stormwater management strategy aimed at improving water quality and providing flood risk benefits. It can also provide important ecosystem services and socio-cultural benefits when the urban system is in a non-flood condition. However, quantitative evaluation of benefits and the appraisal of the relative significance of each benefit in a given location are not well understood. The Blue-Green Cities Research Project aims to develop procedures for the robust evaluation of the multiple functionalities of Blue-Green Infrastructure (BGI) components within flood risk management (FRM) strategies. The salient environmental challenge of FRM cuts across disciplinary boundaries, hence an interdisciplinary approach aims to avoid partial framing of the ongoing FRM debate. The Consortium, comprising academics from eight UK institutions and numerous disciplines, will investigate linkages between human behaviours and physical processes, and produce an urban flood model to simulate the movement of water and sediment through Blue-Green features. Individual and institutional agents will be incorporated into the model to illustrate how their behavioural changes impact on flooding and vice versa. A methodological approach for evaluating the interaction of urban FRM components within the wider urban system will be developed and highlight where, when and to whom a range of benefits may accrue from BGI and other flood management interventions under non-flood and flood conditions. Recognition of the compound uncertainties involved in achieving multiple benefits at scale will be part of the ongoing robust method of uncertainty evaluation. The deliverables will be applied to a chosen demonstration case study, Newcastle, UK, in the final year of the project (2015). This paper will introduce the Blue-Green Cities Research Project and the novel, interdisciplinary framework that is adopted to investigate multiple FRM benefits

The Care Home Independent Prescribing Pharmacist Study (CHIPPS)—a non- randomised feasibility study of independent pharmacist prescribing in care homes

Background Residents in care homes are often very frail, have complex medicine regimens and are at high risk of adverse drug events. It has been recommended that one healthcare professional should assume responsibility for their medicines management. We propose that this could be a pharmacist independent prescriber (PIP). This feasibility study aimed to test and refine the service specification and proposed study processes to inform the design and outcome measures of a definitive randomised controlled trial to examine the clinical and cost effectiveness of PIPs working in care homes compared to usual care. Specific objectives included testing processes for participant identification, recruitment and consent and assessing retention rates; determining suitability of outcome measures and data collection processes from care homes and GP practices to inform selection of a primary outcome measure; assessing service and research acceptability; and testing and refining the service specification. Methods Mixed methods (routine data, questionnaires and focus groups/interviews) were used in this non-randomised open feasibility study of a 3-month PIP intervention in care homes for older people. Data were collected at baseline and 3 months. One PIP, trained in service delivery, one GP practice and up to three care homes were recruited at each of four UK locations. For ten eligible residents (≥ 65 years, on at least one regular medication) in each home, the PIP undertook management of medicines, repeat prescription authorisation, referral to other healthcare professionals and staff training. Outcomes (falls, medications, resident’s quality of life and activities of daily living, mental state and adverse events) were described at baseline and follow-up and assessed for inclusion in the main study. Participants’ views post-intervention were captured in audio-recorded focus groups and semi-structured interviews. Transcripts were thematically analysed. Results Across the four locations, 44 GP practices and 16 PIPs expressed interest in taking part; all care homes invited agreed to take part. Two thirds of residents approached consented to participate (53/86). Forty residents were recruited (mean age 84 years; 61% (24) were female), and 38 participants remained at 3 months (two died). All GP practices, PIPs and care homes were retained. The number of falls per participating resident was selected as the primary outcome, following assessment of the different outcome measures against predetermined criteria. The chosen secondary outcomes/outcome measures include total falls, drug burden index (DBI), hospitalisations, mortality, activities of daily living (Barthel (proxy)) and quality of life (ED-5Q-5 L (face-to-face and proxy)) and selected items from the STOPP/START guidance that could be assessed without need for clinical judgement. No adverse drug events were reported. The PIP service was generally well received by the majority of stakeholders (care home staff, GPS, residents, relatives and other health care professionals). PIPs reported feeling more confident implementing change following the training but reported challenges accommodating the new service within their existing workload. Conclusion Implementing a PIP service in care homes is feasible and acceptable to care home residents, staff and clinicians. Findings have informed refinements to the service specification, PIP training, recruitment to the future RCT and the choice of outcomes and outcome measures. The full RCT with internal pilot started in February 2016 and results are expected to be available in mid late 2020