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1 – 10 of over 35000Nishadi Darsha Dharmarathna, Akila Randika Jayamaha, Nadeeka Dimuthu Kumari Ranadeva, Harshini Rajapakse, Chinthika Gunasekara, Neluka Fernando and Lalitha Meegoda
This study aims to evaluate the perceived effectiveness of residential treatment which follows the therapeutic community (TC) model for Sri Lankan individuals with substance use…
Abstract
Purpose
This study aims to evaluate the perceived effectiveness of residential treatment which follows the therapeutic community (TC) model for Sri Lankan individuals with substance use disorder (SUD).
Design/methodology/approach
A descriptive cross-sectional study was carried out in two selected residential treatment centers which follow the TC model as a rehabilitation approach. All the clients of the selected residential treatment centers were invited to take part in the study and data were collected from 75 consented male participants using an interviewer-administered questionnaire. The perceived effectiveness of the residential treatment was assessed using the Treatment Effectiveness Assessment instrument. Data were analyzed using descriptive statistics.
Findings
Most of the participants were Sinhalese (98.7%, n = 74) with a mean age of 27.0 ± 6.0 years. The average duration in which participants stayed at selected centers was 8.0 ± 4.0 months. Most of the participants reported that the encouragement during the program was sufficient (89.3%, n = 67), psychological support was satisfactory (89.3%, n = 67), freedom (69.5%, n = 52) and facilities were adequate (76.0%, n = 57) within the program. A higher proportion of participants said that the counselors and program guides were friendly (80.0%, n = 60), and participants were allowed to communicate with their family with restrictions (92.0%, n = 69). The mean perceived effectiveness score (score range 1–40) was 34.0 ± 7.0 and the four domain scores (score range 1–10) were substance use (9.0 ± 2.0), health (8.0 ± 2.0), lifestyle (9.0 ± 2.0) and community (9.0 ± 2.0). The majority (88.0%, n = 66) of the participants perceived a high level of treatment effectiveness.
Originality/value
There is a paucity of empirical evidence on effectiveness of TC model for individuals with SUD in South Asian countries including Sri Lanka. The findings of this study highlight that the participants perceived higher effectiveness of the residential treatment which follows the TC approach for Sri Lankan individuals with SUD.
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In times of information overload, researchers have found ways to synthesise a large amount of data from numerous studies bearing on the effectiveness of treatment for alcohol…
Abstract
In times of information overload, researchers have found ways to synthesise a large amount of data from numerous studies bearing on the effectiveness of treatment for alcohol problems. Two of these ways are discussed: formal meta‐analysis and the box‐score ‘mesa grande’. It is concluded that meta‐analysis cannot answer questions regarding which treatments give the best results in the alcohol field. The mesa grande has certain limitations, which are described, but is useful for the formation of treatment policies when a clear summary of the research evidence on treatment effectiveness is needed. By contrast, large multi‐centre randomised controlled trials with enough statistical power to detect small effects of treatment should normally be preferred when a decision has to be made as to which of two or more specified treatments should be implemented in practice. Unfortunately, two multi‐centre trials, one in the USA and one in the UK, have given rise to the ‘dodo bird’ verdict of equivalent effectiveness of four treatment modalities. The findings of the UK Alcohol Treatment Trial cannot be used to advise treatment providers and practitioners which one of two treatments, MET or SBNT, should be preferred in practice. In the absence of relevant research findings, four possible ways of making this decision are outlined, including the suggestion that MET should serve as the first step in a stepped‐care model of treatment provision.
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Abram Rosenblatt and Laura Compian
Systems of care and evidence-based practice possess distinct histories. Though each developed out of attempts to improve services to youth with emotional and behavioral disorders…
Abstract
Systems of care and evidence-based practice possess distinct histories. Though each developed out of attempts to improve services to youth with emotional and behavioral disorders, they did so from perspectives so different as to appear diametrically opposed. Service systems exist at multiple levels, including the practice, program, and system levels (Rosenblatt, 1988, 2005; Rosenblatt & Woodbridge, 2003). Research on health and mental health service systems similarly varies, often by level of the service system, with the research methods, independent and dependent variables, populations of interest, and ultimately the consumers of the research product interacting differentially in the creation and understanding of what constitutes a knowledge base for service delivery. Systems of care and, with limited exceptions, evidence-based practices exist at different levels of the service delivery structure, require and derive from different research approaches, and speak to overlapping but historically different audiences.
David H. Howard and Yu-Chu Shen
Purpose – Policymakers hope that comparative effectiveness research will identify examples of widely used therapies that are no better than less expensive alternatives and…
Abstract
Purpose – Policymakers hope that comparative effectiveness research will identify examples of widely used therapies that are no better than less expensive alternatives and, consequently, reduce health care spending. Comparative effectiveness research is unlikely to reduce spending if physicians are quick to adopt effective treatments but slow to abandon ineffective ones.
Methodology/approach – We present a theoretical model that shows how physicians will adopt new treatments in response to positive evidence more readily than they abandon existing treatments in response to negative evidence if the marginal costs of production decline post-adoption. We report trends in the use of two common procedures, percutaneous coronary intervention (PCI) for patients with stable angina and routine episiotomy in vaginal childbirth, where comparative effectiveness research studies have failed to find evidence of a benefit.
Findings – Use of PCI and episiotomy have declined over time but are still excessive based on the standards implied by comparative effectiveness research.
Practical implications (if applicable) – The findings suggest that comparative effectiveness research has the potential to reduce costs but additional efforts are necessary to fully realize savings from abandonment.
Originality/value of chapter – There is a large literature on technological adoption in health care, but few studies address technological abandonment. Understanding abandonment is important for efforts to decrease health care costs by reducing use of ineffective but costly treatments.
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Terje Ogden, Kristine Hagen and Oddbjørn Andersen
In order to examine the sustainability of programme effectiveness, we investigated whether the effects of multisystemic treatment (MST) on a second group of adolescents would…
Abstract
In order to examine the sustainability of programme effectiveness, we investigated whether the effects of multisystemic treatment (MST) on a second group of adolescents would match those reported in an earlier randomised controlled trial (RCT). Pre‐ and post‐treatment assessments were analysed in a participant group of 105; 55 youths were referred to MST in the programme's second year of operation (MST2), and 50 youths were included in the RCT the first year in which 30 were randomly assigned to MST (MST1) and 20 to regular services (RS).At two project sites, MST clinical outcomes in the second year of programme operation matched and, for key indices of anti‐social behaviour, surpassed those achieved during the first year. In addition the MST treatment delivered in the second year was more effective than regular child welfare services in preventing out of home placement and reducing internalising and externalising behaviour. Together, these results demonstrated sustained effectiveness of the programme as well as indication of programme maturation effects. No group differences were registered for social competence. MST youths treated in the second year were significantly younger than those referred to treatment in the first year (MST1) but age had no moderating effect on the outcomes.
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Outi Simonen, Marja Blom and Elina Viitanen
The purpose of this paper is to map out managers' understanding of effectiveness and to assess the application of knowledge of effectiveness in secondary healthcare management…
Abstract
Purpose
The purpose of this paper is to map out managers' understanding of effectiveness and to assess the application of knowledge of effectiveness in secondary healthcare management. Additionally, the study aims to assess the present situation of effectiveness research and the measures used in divisions of treatment.
Design/methodology/approach
The study was conducted by interviewing department directors, chief medical officers and directors of nursing (n=38) in the surgical, medical and psychiatric divisions of the five largest hospital districts in Finland.
Findings
The concept of effectiveness was complex, and difficult to concretise and understand uniformly. Knowledge of effectiveness supports both clinical and administrative management. Managers have different ways of applying knowledge of effectiveness depending on their managerial role. Effectiveness studies and measurement are still relatively rare in secondary healthcare and rarely identified as such by management.
Practical implications
The concept of effectiveness is not clear in management. Managers have an unclear understanding of knowledge of effectiveness and its application in secondary healthcare management.
Originality/value
The paper addresses the need for a discussion on effectiveness in secondary health care. In addition, managers need knowledge and support for implementing the policy of effectiveness on all levels of management.
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Zoe Meropi Hepburn and Sam Clark-Stone
The purpose of this paper is to investigate the effectiveness of a day treatment programme (DTP) in reducing psychosocial impairment, changing attitudes, restoring body-weight and…
Abstract
Purpose
The purpose of this paper is to investigate the effectiveness of a day treatment programme (DTP) in reducing psychosocial impairment, changing attitudes, restoring body-weight and decreasing binge/vomit symptoms among 52 individuals (aged 16+) with eating disorders. It was hypothesized that day treatment would result in improvements across all variables measured.
Design/methodology/approach
In a within-participants design, demographic, physiological and psychological measures were taken on admission to and at discharge from a DTP in the UK. Quantitative outcomes were analysed.
Findings
In total, 40 participants were considered to have received an adequate dose of the DTP, having completed at least four weeks on the programme. Analyses supported all hypotheses, with all improvements being statistically significant. Large effect sizes were evident for all outcomes across the whole sample other than shape concern attitudes and weight concern attitudes, which reduced with moderate and moderate-to-large effect sizes, respectively.
Originality/value
This study provides new evidence of the effectiveness of day treatment in reducing psychosocial impairment resulting from eating disorder psychopathology. It remains for future research to determine whether these outcomes can be sustained over the longer term.
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Onn Laingoen, Tawatchai Apidechkul, Panupong Upala, Ratipark Tamornpark, Chaleerat Foungnual and Rattakarn Paramee
The purpose of this paper is to estimate the cost-effectiveness of tuberculosis (TB) treatment and care in two Thai hospitals located on the borders with Myanmar and Laos.
Abstract
Purpose
The purpose of this paper is to estimate the cost-effectiveness of tuberculosis (TB) treatment and care in two Thai hospitals located on the borders with Myanmar and Laos.
Design/methodology/approach
A retrospective data collection was conducted to analyze all costs relevant to TB treatment and care from Mae Sai and Chiang Sean Hospitals. The cost related to TB treatment and care and the number of successful TB treatment from January 1 to December 31, 2017 were used for the calculation. The cost-effectiveness ratio (C/E) and the incremental cost-effectiveness ratio (ICER) were the outcomes.
Findings
In 2017, the total cost of the TB treatment and care program at Mae Sai Hospital was 482,728.94 baht for 57 TB patients. The cast per treated case per year was 8,468.93 baht. The C/E was 10,971.11 baht per successful TB treatment (44 successful cases). The total cost of the TB treatment and care program at Chiang Sean Hospital was 330,578.73 baht for 39 TB patients. The cost per treated case per year was 8,476.38 baht. The C/E was 22,038.58 baht per successful TB treatment (15 successful cases). The ICER was 5,246.56 baht. The Mae Sai Hospital model was more cost-effective in terms of the treatment and care provided to Burmese patients with TB than the Chiang Sean Hospital model for Laotian patients with TB.
Originality/value
To improve the cost-effectiveness of TB treatment and care programs for foreign patients in hospitals located on the Thai border, focus should be placed on patient follow-up at the community or village level.
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John Taylor, Raymond Novaco and Lucy Johnson
Anger has been shown to be associated with aggression and violence in adults with learning disabilities in both community and secure settings. Emerging evidence has indicated that…
Abstract
Anger has been shown to be associated with aggression and violence in adults with learning disabilities in both community and secure settings. Emerging evidence has indicated that cognitive behavioural anger treatment can be effective in reducing assessed levels of anger in these patient populations. However, it has been suggested that the effectiveness of these interventions is significantly affected by verbal ability. In this service evaluation study the pre‐ and post‐treatment and 12‐month follow‐up assessment scores of 83 offenders with learning disabilities who received cognitive behavioural anger treatment were examined in order to investigate whether participants' responsiveness to treatment was a function of measured verbal IQ. The results indicate that, overall, the effectiveness of anger treatment was not the result of higher verbal ability as reflected in verbal IQ scores. It is concluded that cognitive behavioural therapy for anger control problems can be effective for people with moderate, mild and borderline levels of intellectual functioning and forensic histories.
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Existing experimental and quasi-experimental results have demonstrated that both anticorruption initiatives that provide information and/or authority to the recipients of…
Abstract
Existing experimental and quasi-experimental results have demonstrated that both anticorruption initiatives that provide information and/or authority to the recipients of government programs – so-called “bottom-up” interventions – and initiatives that rely on government agencies for enforcement – “top-down” interventions – can be effective in some settings. Yet, in other instances, both forms of intervention have been found to be ineffective in combating corruption. These contrasting results strongly suggest that the effectiveness of both “top-down” and “bottom-up” anticorruption interventions is conditional on other factors. Unfortunately, the existing literature says little regarding the conditions conducive to the success of either forms of intervention. Assessing the conditional effects of anticorruption treatments poses substantial challenges for researchers – particularly for those employing experimental or quasi-experimental approaches. This chapter (1) discusses factors that may condition the effectiveness of both top-down and bottom-up interventions; (2) illustrates the difficulties in assessing these conditional relationships, with particular reference to experimental and quasi-experimental settings; and (3) suggests approaches that might mitigate these problems.