Seroprevalence of HTLV-I and HTLV-II.
Explore the source record for details and available documents.
Deltaretrovirus Infections↗
Biomedical subjects
W E McAuliffe
Publications and source records attributed to W E McAuliffe.
Implementation issues and techniques in randomized trials of outpatient psychosocial treatments for drug abusers: recruitment of subjects.
We reviewed nine randomized clinical trials of outpatient psychosocial treatments for drug abuse to ascertain implementation problems and solutions that the researchers developed. The most common problem was subject recruitment. Inadequate recruitment can disrupt a project's timetable, preoccupy its staff, reduce the trial's ability to detect treatment differences, and perhaps result in the trial's abandonment. The causes of recruitment problems include the need for large samples and multiple eligibility criteria, subject reluctance to be a "guinea pig," low client treatment motivation, client dislike of research procedures, clinicians' distrust of research, and difficulties collaborating with treatment agencies. Solutions include realistic assessment of the target population's size, use of mass media, statistical adjustments to minimize unnecessary sample exclusions, variable treatment assignment ratios, and prevention of common collaboration difficulties.
Adolescent↗
Alcohol use and abuse in random samples of physicians and medical students.
BACKGROUND: This study sought to resolve conflicting views about whether physicians are especially prone to alcohol abuse. METHODS: Using an anonymous, mailed questionnaire on substance use, we surveyed 500 physicians, 510 pharmacists, and 974 of their students. The physicians and pharmacists were selected randomly from the state society's membership lists, and students selected were from local school lists. Follow-up surveys were sent to nonresponders at two-week intervals. RESULTS: The physicians and medical students did not drink especially heavily and were no more vulnerable to alcoholism than were their counterparts in pharmacy and other professions. Physicians differed from pharmacists in their style of drinking (greater frequency, smaller quantity), but not in total amount of alcohol consumed. Drinking habits among physicians were not associated with medical specialty or type of practice, but were positively related to gender (males drank more than females) and to age (older doctors were more apt to qualify as heavy drinkers than were younger doctors). CONCLUSIONS: Physicians were no more likely to abuse substances nonmedically than were other professionals. Any group in which alcohol use is nearly universal incurs a risk of abuse and impairment that cannot be ignored.
Adult↗
Assessment of drug abuser treatment needs in Rhode Island.
BACKGROUND: Rhode Island's Division of Substance Abuse asked us to assess the State's drug treatment needs and make recommendations regarding its treatment system for the next three years. METHODS: We used a statewide telephone drug use survey of 5,176 households supplemented by drug-related hospital discharges, Division of Drug Control statistics, and interviews with providers, state officials, and out-of-state experts. Drug abuse was measured with items from the Diagnostic Interview Schedule. Abusers were asked if they were receiving or wanted to receive treatment. RESULTS: Survey responses, used to estimate the unmet need for drug treatment, indicated a need to triple drug treatment services. Regression models using survey data indicated that the treatment network was overly centralized in the Providence area. Interviews with state officials, clinicians, and out-of-state experts provided material for recommendations on reimbursement policy, treatment mix, quality assurance, and cost containment. CONCLUSIONS: The RI Department of Health's certificate-of-need program adopted our overall recommendation for tripling the drug treatment system as its guideline in evaluating proposals for new treatment facilities. With State funding of a new adolescent center and expansion of outpatient slots in the private sector, this recommendation has now been fully implemented.
Amphetamines↗
Measuring the quality of medical care: process versus outcome.
The controversy over appropriate and efficient ways to measure the quality of medical care continues. Many experts call for increased attention to assessment of the outcome of care. Others maintain that process measurements are more direct and practical. But both measurement techniques are of questionable validity, and each obscures important problems of the differences among patients, disease severity, and medical performance.
Analysis of Variance↗
Studies of process-outcome correlations in medical care evaluations: response to Dr. Brook.
Explore the source record for details and available documents.
Evaluation Studies as Topic↗
Studies of process--outcome correlations in medical care evaluations: a critique.
The validity of process evaluations of medical care has been challenged by a number of studies which purport to show that process and outcome measures are unrelated. However, each of the studies had numerous methodological flaws which biased their results against finding a relationship: either their outcome measures had questionable validity, their research designs were inappropriate, or the statistical analyses were poorly conceived. Better studies have found significant, although modest, correlations between process and outcome measures. Since the validity of outcome measures has never been determined, there is little reason at present for believing that outcome measures are more valid than process measures.
Evaluation Studies as Topic↗
On the statistical validity of standards used in profile monitoring of health care.
In current methods of profile monitoring, standards of acceptability (cut-offs) are set either by consulting panels of experts, or by selecting an arbitrary point (e.g., the 75th percentile) on the profile (statistical distribution). However, experts have only vague ideas of what outcome rates ought to be, while profile statistics stem from samples for which unknown percentages of cases have received acceptable care. Poorly chosen standards could cause profile monitoring to be ineffective, inefficient, or unnecessarily disruptive. A new method proposes to set standards by using statistics for which the percentage of adequate care has been predetermined by examining the process of care. Plans to circumvent the pitfalls involved are described, as are two approaches to estimating the degree of process adequacy from routinely produced outcome rates.
Hospitals↗
Contributions to a social conditioning model of cocaine recovery.
This article describes recent developments in a theory of recovery from drug addiction and in the adaptation of Recovery Training and Self Help (RTSH) to cocaine addiction. RTSH is an example of a new element of treatment known as "relapse prevention" (RP), which is an application of the discovery that addiction follows the laws of operant conditioning. We learned, however, that to understand and to treat cocaine addiction, we had to expand upon the conditioning paradigm to include a sociological analysis of the deviant lifestyle from which cocaine addiction stems. The theory presented here postulates three stages of recovery from cocaine addiction. Cocaine addicts can recover as outpatients by (1) initially building "walls" against drug triggers and supplies, (2) extinguishing addiction in the protective community of recovering persons, and (3) gradually lowering the walls and expanding beyond the recovering community to function more fully in conventional society. We have developed an outpatient group treatment system based on this recovery model. The Cocaine Recovery System includes a month-long cessation program, followed by a six-month recovery program, and active participation in the recovering community. A professional and a recovering person colead both the cessation and recovery programs, which feature Recovery Training sessions designed to help cocaine addicts achieve treatment goals and avoid or cope with threats to recovery. Clients in the recovery program also meet weekly for a support session, a weekend recreational activity, and individual counseling. The program also encourages group members to attend 12-step fellowship meetings. Clients achieve difficult lifestyle changes by taking a series of "commitment steps," which increasingly engage the clients in a recovering lifestyle and make relapse more difficult.
Adaptation, Psychological↗