Search results

The purpose of this paper is to explore factors affecting implementing the National Institute for Health and Care Excellence (NICE) quality standard on alcohol misuse (QS11) and barriers and facilitators to its implementation.

Qualitative interview study analysed using directed and conventional content analyses. Participants were 38 individuals with experience of commissioning, delivering or using alcohol healthcare services in Southwark, Lambeth and Lewisham.

QS11 implementation ranged from no implementation to full implementation across the 13 statements. Implementation quality was also reported to vary widely across different settings. The analyses also uncovered numerous barriers and facilitators to implementing each statement. Overarching barriers to implementation included: inherent differences between specialist vs generalist settings; poor communication between healthcare settings; generic barriers to implementation; and poor governance structures and leadership.

QS11 was created to summarise alcohol-related NICE guidance. The aim was to simplify guidance and enhance local implementation. However, in practice the standard requires complex actions by professionals. There was considerable variation in local alcohol commissioning models, which was associated with variation in implementation. These models warrant further evaluation to identify best practice.

Little evidence exists on the implementing quality standards, as distinct from clinical practice guidelines. The authors present direct evidence on quality standard implementation, identify implementation shortcomings and make recommendations for future research and practice.

Dual Diagnosis Anonymous (DDA) is a peer-led programme developed in the USA, which aims to address mental and addictive disorders in an integrated manner. This study is part of a mixed-methods evaluation of the first DDA pilot in the UK, and the purpose of this study is to explore the impact and mechanism of change of the programme through the perspective of DDA attendees, facilitators and the funding commissioners.

Six DDA members were interviewed three times over a period of 12 months, the facilitators were interviewed twice and the commissioner was interviewed once. The qualitative longitudinal data were analysed using a trajectory thematic analysis.

DDA attendance was perceived to have had a positive impact on five main areas: acceptance of self, of others and from others; social functioning; self-development; recovery progression; and feeling of hope. The possibility of addressing both mental health and addiction at the same time was a key factor in the recovery process. The facilitators observed that DDA had contributed to integrate members into employment and education, while the commissioner stressed the importance of joint commissioning and sustainability.

The longitudinal approach provided a unique insight into the recovery process of DDA members. Being able to address the mental health as well as the substance use problems was considered to be a fundamental strength of DDA in comparison to the single purpose peer-support fellowships.

The purpose of this paper is to test the discriminative validity of the Substance Use Beliefs Questionnaire (SUBQ) with alcohol dependent users, by assessing if the new tool can successfully differentiate between two extreme groups.

The criterion used to select the two extreme groups was participation or not in treatment for alcohol dependence. Score of the Severity of Alcohol Dependence Questionnaire (SADQ) was used as a secondary confirmation criterion of extreme difference.

In all, 98 staff and 94 people in treatment for alcohol dependence were recruited. The treatment group scored 30.83 higher than the control on SADQ, 10.76 on positive and 28.98 on negative expectancies. Negative expectancies score had correctly classified 88.5 per cent and positive expectancies score only 66 per cent of the original grouped cases. The area under the Receiver Operating Characteristics (ROC) curve for negative expectancies was 0.94 (very good) with a cut-off point of 43.5 with 89 per cent sensitivity and 92 per cent specificity. The area under the ROC curve for positive expectancies was 0.73 (fair). Due to the shape it was difficult to identify a cut-off point.

The results support the discriminative validity of the negative expectancies sub scale of the SUBQ between two extreme groups. With only the use of negative expectancies score participants could be classified correctly to those of the control and those of the treatment group.

SUBQ is the first tool to measure outcome expectancies across substances, facilitating relevant research with poly substance users. Future research needs to explore the discriminative validity of the tool with the other three substance groups (smokers, stimulant and opioids users), involved in the development and validation of the SUBQ.

The purpose of this paper is to review the substance misuse literature on how outcome expectancies are measured, how they are related with the level of use and other factors as well as their role into treatment and recovery.

A narrative review of the literature for all major substances of abuse was undertaken.

Existing measurement tools are substance specific. Most research has been in the field of alcohol, and involved students or light and moderate drinkers. Positive expectancies have been found to be related to initiation and level of alcohol, nicotine and cannabis use and also to be modifiable with repeated cue exposure. Negative expectancies have been found to be associated with prevention of smoking, positive changes in drinking and positive effect on treatment outcome for alcohol.

Both positive and negative outcome expectancies have been found to predict development of substance misuse and recovery from it respectively, but cross-substance comparisons are hindered by lack of appropriate measures.

The concept of outcome expectancies is present in several theories of addiction. To date there has been no comprehensive review of the extent to which different types of expectancy play a role in different substances and their treatment.

The purpose of this paper is to develop a brief outcome expectancies questionnaire applicable across nicotine, alcohol, opioid and stimulant users seeking or willing to seek treatment and to assess its construct and predictive validity.

The items were generated using semi-structured interviews. A cross-sectional study was used to determine the factor structure and internal reliability, to compare the factor structure across the groups and to assess construct validity. Scores were used to predict reduction in dependence at three-month follow-up.

The qualitative study produced 98 items. For the cross-sectional study 99 nicotine, 96 alcohol, 98 opioid and 77 stimulant misusers were recruited. Factor analysis produced a two-factor (positive and negative expectancies) solution, similar across groups. A 28-item common version had scale correlations above 0.94 with the long versions of each group, and high internal consistency (Cronbach's α>0.90). The Positive expectancies sub-scale was positively correlated with urges across all groups, and negatively correlated with self-efficacy in three groups. Negative sub-scale scores were positively correlated with motivation sub-scales and self-efficacy in three groups. Urges and negative expectancies predicted reduction of dependence at three months.

The study suggested that outcome expectancies are similar across substance sub-groups. The new tool appears to have good construct and predictive validity. Further validation with larger samples is required.

This is the first tool to measure outcome expectancies across substances, facilitating relevant research with poly-substance users.

Examines the political and ideological significance of measures of quality of life, specifically Quality Adjusted Life Years (QALYs). Briefly reviews recent developments in the debate surrounding the economic and political functions of quality of life measures. The dialectic between conceptions of the quality of life and the implicit realpolitik of socio‐economic pressures, ecological conditions, political ethos and cultural norms and expectations, is conceived as a powerful means for the critique of our aspirations concerning health. Argues that existing approaches to assessing quality of life, in denying this dialectic, have jeopardized their potential contribution to the planning, implementation and evaluation of health care policy. Resource allocation challenges us to develop openly ideological strategies and measures.

The purpose of this paper is to explore Chinese food safety issues by analysing select incidents within he Chinese agricultural marketing system.

A marketing utility framework is utilized to discuss some of the major food safety incidents in China and potential solutions are explored.

The paper finds that food safety issues arise from problems of asymmetric information which leads to the profit seeking behaviour of agents distorting rather than enhancing the creation of one of the four types or marketing utility (time, form, place and possession). Additionally, structural causes found within the Chinese food marketing system have contributed to the food safety problems.

This is not an empirical research with numerical data.

This study is one of the first to address Chinese food safety problems from an agricultural marketing utility perspective. Key anecdotes are used to support the claims made in this study.

The Development and Evaluation Committee (DEC) provides local guidance on the value of new and existing health care technologies, including drugs, devices, procedures and health care settings. The system is made up of two components: i) literature review and cost‐effectiveness estimation of the proposed and current technologies, and ii) consideration by the Development and Evaluation Committee which arbitrates, makes recommendations and disseminates results across the South and West region. Sixty‐three reviews have been undertaken to date, including, for example, beta interferon for multiple sclerosis, pulsed dye laser in the treatment of port‐wine stains, and paclitaxel in ovarian cancer. The outcomes of this service are guides to purchasing which are both carefully researched and scrutinized.

In the last four years, since Volume I of this Bibliography first appeared, there has been an explosion of literature in all the main functional areas of business. This wealth of material poses problems for the researcher in management studies — and, of course, for the librarian: uncovering what has been written in any one area is not an easy task. This volume aims to help the librarian and the researcher overcome some of the immediate problems of identification of material. It is an annotated bibliography of management, drawing on the wide variety of literature produced by MCB University Press. Over the last four years, MCB University Press has produced an extensive range of books and serial publications covering most of the established and many of the developing areas of management. This volume, in conjunction with Volume I, provides a guide to all the material published so far.