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Biomedical subjects

J Strang

Publications and source records attributed to J Strang.

At least 73 records · Page 4Linked to original sources
PubMed1998

The Maudsley Addiction Profile (MAP): a brief instrument for assessing treatment outcome.

AIM: To develop a brief, multi-dimensional instrument for assessing treatment outcome for people with drug and/or alcohol problems. The Maudsley Addiction Profile (MAP) is the first instrument to be developed in the United Kingdom for this purpose. DESIGN: Field testing with quota-recruitment of problem drug users and problem alcohol users in treatment with researcher and clinician-administered test-retest interviews. SETTING: Two community and two inpatient services at the Bethlem Royal and Maudsley Hospital, London. PARTICIPANTS: Subjects (160 drug users and 80 alcohol users) interviewed by eight interviews (four researchers and four clinicians), each of whom interviewed 30 subjects on two occasions. MEASURES: Sixty items across substance use, health risk, physical/psychological health and personal/social functioning domains. FINDINGS: Average completion time of the MAP was 12 minutes. The questionnaire was acceptable to a majority of subjects and performed well with both researcher and clinician interviewers. Internal reliability and feasible concurrent validity assessments of the scales and items were highly satisfactory. Test-retest reliability was good, average intraclass correlation coefficients across eight substances were 0.94 and 0.81 across health risk, health problems, relationship conflict, employment and crime measures. CONCLUSIONS: The MAP can serve as a core research instrument with additional outcome measures added as required. The collection of a set of reliable quantitative measures of problems among drug and alcohol users by research or treatment personnel for outcome evaluation purposes need not be time-consuming.

Adult↗
PubMed1998

Are practice nurses an unexplored resource in the identification and management of alcohol misuse? Results from a study of practice nurses in England and Wales in 1995.

Changes in the health promotional work undertaken in primary care, including the work needed to meet the 'Health of the Nation' alcohol targets, have led to a rapid expansion of the number of practice nurses in England and Wales. However, there has been little evaluation of this role. This study provides data, for the first time at a national level, about practice nurses' work in identifying and managing patients drinking above recommended sensible guidelines. Data were collected by postal questionnaire from all nurses in a 50% random sample of 1852 practices (drawn from a general practitioner (GP) national study, undertaken at the same time). 43% of nurses responded from 62% of the targeted practices. Respondents reported identifying a mean of 3.1 patients per month who were drinking above recommended sensible guidelines. These patients tended to be male, above 40 years of age and in contact with the nurse for the first time about this problem. Most patients were categorized as having a potential alcohol problem; few were classified as currently dependent. Very little intervention work was undertaken by nurses except for referral to the GP. If real progress is to be made in meeting the 'Health of the Nation' targets on population alcohol consumption, then primary care work in identifying alcohol misusing patients needs to be developed as a matter of urgency. The patients identified by practice nurses are those patients relevant to the 'Health of the Nation' alcohol targets. More emphasis needs to be placed on the valuable contribution practice nurses can make, particularly through the use of screening instruments and brief interventions.

Adult↗
PubMed1998

Route of drug use and its implications for drug effect, risk of dependence and health consequences.

Route of administration has a profound, but often overlooked, influence on the actual experience of the drug use itself, on the risk of resulting development of dependence, and on the nature of the harms to which drug users are exposing themselves. These three areas are reviewed. The influence of route of administration on drug effect is considered first with regard to overall effectiveness of absorption, and also with regard to speed of onset of effect. The implications for risk of dependence cover animal and human laboratory studies of reinforcement schedules, epidemiological studies, the attitudes of drug users themselves to the different routes of possible drug use and associated dependence risk and the postulated influences on progression to dependence. Finally, the relationship between route of drug use and health sequelae is explored for the three most widely used routes of administration of illicit drugs-snorting, smoking and injecting.

Journal Article↗
PubMed1998

Low detection rates, negative attitudes and the failure to meet the "Health of the Nation" alcohol targets: findings from a national survey of GPs in England and Wales.

The appropriateness of the primary care setting to undertake the health promotional activities needed to meet 'Health of the Nation' alcohol targets has been acknowledged in UK government policy and the scientific literature. However, the latest data suggest these targets are not being met. A 20% random sample of all general practitioners in England and Wales were surveyed by postal questionnaire to examine their work in detecting alcohol misuse and their attitudes towards the work. Four mailing waves produced a 44% response rate. GPs had identified a mean of 3.2 patients per month drinking above recommended 'sensible' guidelines. These patients were mostly male (73%) and above 40 years of age (45%), with nearly half (45%) already dependent drinkers. Most GPs perceived alcohol misuse patients as a difficult group with whom to work. None the less, over half the respondents believed general practice was an appropriate setting for the detection of the problem. However, most did not feel trained or supported in this area of their work. More emphasis needs to be placed on the valuable contribution GPs can make with the larger number of patients who are drinking regularly above 'sensible' levels but not yet suffering adverse affects. Our findings point towards not an unwilling profession, but a profession lacking confidence. The provision of support and basic training are major factors in how GPs perceive alcohol misusers and their own role in this work. Twenty years after the Maudsley Alcohol Pilot Project research it is disappointing that, despite greater recognition by GPs of their potential impact, lack of training and lack of support are still so central to their continued low levels of therapeutic commitment.

Journal Article↗
PubMed1998

How do general practitioners manage alcohol-misusing patients? Results from a national survey of GPs in England and Wales.

The appropriateness of the primary care setting to undertake health promotional activities has been emphasized, but little is known about the clinical work of GPs with patients misusing alcohol. This study examines how GPs managed alcohol-misusing patients. A 20% random sample of all general practitioners in England and Wales were surveyed using a postal questionnaire. A 44% response rate was achieved. GPs reported managing different levels of severity of drinking problems differently. Basic interventions, such as reporting the alcohol misuse diagnosis and the provision of advice and information, were routine. Health promotion leaflets were not used uniformly, even with the less severe problem drinkers. Detoxification, prescribing of drugs and the management of medical complications were undertaken mainly with dependent patients. Dependent drinkers were the most likely group to be referred to specialist services, while internal practice referrals occurred with all drinking status categories. Anti-depressants were the drugs most usually prescribed to alcohol-misusing patients. The data point to a need for basic guidelines, not only on how to manage and refer dependent drinkers, but also on how to detect and manage those who are not yet manifesting problems but are drinking above recommended guidelines. One of the most evident areas in which there appears to be a need for guidelines is that of prescribing within primary care.

Journal Article↗
PubMed1998

3D visual presentation of shoulder joint motion.

The 3D visual presentation of biodynamic events of human joints is a challenging task. Although the 3D reconstruction of high contrast structures from CT data has been widely explored, then there is much less experience in reconstructing the small low contrast soft tissue structures from inhomogeneous and sometimes noisy MR data. Further, there are no algorithms for tracking the motion of moving anatomic structures through MR data. We represent a comprehensive approach to 3D musculoskeletal imagery that addresses these challenges. Specific imaging protocols, segmentation algorithms and rendering techniques are developed and applied to render complex 3D musculoskeletal systems for their 4D visual presentation. Applications of our approach include analysis of rotational motion of the shoulder, the knee flexion, and other complex musculoskeletal motions, and the development of interactive virtual human joints.

Adult↗
PubMed1998

Tackling alcohol misuse: opportunities and obstacles in primary care.

Alcohol misuse is a major public health issue. Primary care has been recognized as an ideal setting for the health promotional activity needed to reduce the general population's alcohol consumption. This paper explores the background to the current belief that primary care is suitable for this work by examining the evidence of the potentially successful interventions the general practitioner (GP) can undertake with alcohol misusing patients, GPs' attitudes towards this work, and the impediments that exist. Computer searches of the MEDLINE database up to 1997 and a manual literature search of the bibliographies of published papers that were identified as relevant were carried out. Research points to GP interventions being effective, but it also provides evidence of their negative attitudes. It concludes that more training and support from local services are needed if primary care is to meet its rich potential.

Alcoholism↗
PubMed1997

Double-blind randomised controlled trial of lofexidine versus clonidine in the treatment of heroin withdrawal.

Lofexidine is an analogue of clonidine, an agonist at the alpha 2 noradrenergic receptor. Reports from preliminary open studies have suggested that it may be at least as effective as clonidine in the management of opiate withdrawal, and without the same limitation of postural hypotension. We report on a randomised double-blind comparison of lofexidine versus clonidine in the treatment of heroin withdrawal. A total of 80 hospitalized heroin addicts were randomly assigned to treatment with lofexidine or clonidine during in-patient opiate withdrawal. Maximum daily doses were 1.6 mg for lofexidine and 0.6 mg for clonidine. There was marked diurnal variation of withdrawal symptoms with severity being greatest at the daytime reading at 16.00 h and being markedly less at the night-time reading (recorded at 08.00 h). Lofexidine and clonidine were equally effective in treating the withdrawal syndrome. However, significantly more problems relating to hypotension were encountered with subjects on clonidine, with twice as many instances of withholding medication due to hypotension in the clonidine group. Better treatment retention rates were seen in the lofexidine group, although no difference was found in the proportion who had reached minimal symptom severity by the time of their discharge. We conclude that lofexidine and clonidine are equally effective, but with significantly fewer hypotensive problems with lofexidine. Further benefit from lofexidine may be possible with revised dosing regimens. Outpatient studies of lofexidine are now indicated.

Adult↗
PubMed1997

How constant is an individual's route of heroin administration? Data from treatment and non-treatment samples.

Three routes of heroin use were identified--injecting, 'chasing the dragon' and snorting. Whilst injecting and 'chasing the dragon' accounted for virtually all current heroin use, snorting had been the first route of use for nearly a fifth of heroin users in both the treatment and community samples. Overlap of lifetime experience of the different routes was widespread, with the majority of heroin users in both the treatment and community samples having used heroin by more than one route. Although less than half of the treatment sample had used heroin by injection on the first occasion, more than 90% had injected at least once, and over 80% had at some time used by 'chasing the dragon'. Only a quarter of the community sample had first used heroin by injecting, and yet, by the time of interview, two-thirds of the sample had injected. The majority of durable changes in route of heroin use were towards injecting and 'chasing the dragon', with transitions to snorting being extremely rare. For both the samples, transitions to injecting were twice as frequent as transitions to 'chasing'. Snorting appeared to be an unstable route of use, with almost all who initially snorted their heroin now using by injecting or 'chasing the dragon'.

Administration, Inhalation↗
PubMed1997

Adverse effects of stimulant drugs in a community sample of drug users.

A sample of drug users (n = 158) were contacted and interviewed in non-clinical community settings about their use of Ecstasy, cocaine powder, and amphetamines and the adverse effects of these drugs. Subjects reported a wide range of adverse effects including anxiety problems, depression, mood swings, feelings of paranoia, and panic attacks. Sleep and appetite disturbances were the most commonly reported problems. About half of all subjects reported depression and paranoid feelings associated with their stimulant use. Many of those reporting problems stated that these were mild. However, for all drugs, a substantial minority of users reported adverse effects which they rated as 'severe'. Between 30 and 55% of the sample reported having had at least one 'severe' adverse effect (30% cocaine, 35% Ecstasy and 55% amphetamine). There were clear differences between the different drugs in the likelihood and reported severity of adverse effects. Amphetamine use was associated with significantly more adverse effects and with more severe adverse effects than Ecstasy or cocaine. Cocaine powder was associated with the least severe adverse effects. A common pattern of drug use involved the use of depressant drugs such as opiates and benzodiazepines in addition to stimulants. The stimulant and depressant users were more likely than the stimulants-only users to use stimulants by injection and more likely to report adverse effects associated with stimulant use. The stimulant and depressant users were also more likely to have been treated for a drug problem. Approximately a quarter of the sample stated that they had stopped using stimulants up to the point of interview as a result of their bad experiences.

Adolescent↗
PubMed1997

Time of day of methadone consumption and illicit heroin use.

One hundred clients receiving methadone substitution treatment participated in an investigation of the relationship between methadone dose, time of daily self-administration and reported illicit heroin and other drug use. The study was conducted at two outpatient clinics operating from a single site at the Maudsley Hospital, London. Forty-seven per cent of clients reported using illicit heroin on one or more occasions in the week before interview. Multivariate analysis of methadone dose, time of methadone administration and duration of treatment indicated that the time of methadone administration was the most important predictor of illicit heroin use. Clients who took their methadone before 1500 h were less likely to use heroin than those who consumed methadone later in the day. This finding suggests the possibility of reducing illicit heroin use by methadone maintenance clients through the structuring of treatment programmes so that supervision of methadone consumption occurs during the early part of the day.

Adult↗
PubMed1997

Functional magnetic resonance imaging of the acute effect of intravenous heroin administration on visual activation in long-term heroin addicts: results from a feasibility study.

This preliminary report is the first demonstration of the acute effects of diacetylmorphine (heroin) administration on functional activation in the human brain using functional magnetic resonance imaging (fMRI). Four opiate addicts who received regular prescriptions for heroin, underwent fMRI using a visual activation paradigm before and after a dose of 30 mg heroin. All four showed a decrease after the heroin dose in the extent of significant activation. This method shows promise for sequential scanning to determine brain activity in response to different drugs and routes of drug administration.

Acute Disease↗
PubMed1997

Heroin smoking by 'chasing the dragon': origins and history.

The history of heroin smoking and the subsequent development and spread of 'chasing the dragon' are examined. The first heroin smoking originated in Shanghai in the 1920s and involved use of porcelain bowls and bamboo tubes, thereafter spreading across much of Eastern Asia and to the United States over the next decade. 'Chasing the dragon' was a later refinement of this form of heroin smoking, originating in or near Hong Kong in the 1950s, and refers to the ingestion of heroin by inhaling the vapours which result when the drug is heated-typically on tin-foil above a flame. Subsequent spread of 'chasing the dragon' included spread to other parts of South East Asia during the 1960s and 1970s, to some parts of Europe during the late 1970s and early 1980s, and to much of the Indian sub-continent during the 1980s. At the time of writing, 'chasing the dragon' has now been reliably reported from many parts of the world but not from others with an established heroin problem-such as the United States and Australia. The significance of this new form of heroin use is examined, including consideration of the role of the different effect with this new form of use, the different types of heroin, and changing public attitudes to injecting.

Administration, Inhalation↗
PubMed1997

Heroin prescribing in the "British System" of the mid 1990s: data from the 1995 national survey of community pharmacies in England and Wales.

Prescribing heroin in the treatment of addiction has been, until recently, an exclusively UK practice. However, despite international fascination with such prescribing, no recent report exists on the extent or nature of the practice. Furthermore, no data have ever previously been available on dispensing arrangements and geographical localization of heroin-prescribing to addicts. Data are presented on heroin prescriptions being dispensed to addicts in 1995, collected through the national survey of a 1 in 4 sample of the 10 616 community pharmacies in England and Wales. The 64 heroin prescriptions constituted only 1.7% of the 3846 prescriptions for opiates being issued to addicts by regarding community pharmacists, while methadone accounted for 96.0%. Heroin daily doses were more than three times higher than for methadone. Heroin was mainly prescribed in injectable form and, in contrast to methadone prescriptions, was mainly dispensed on a daily basis. Major regional variations in the extent of heroin-prescribing in the United Kingdom have been identified, with these variations appearing to relate to the practice of individual doctors rather than the nature of the local problem.

Journal Article↗