Auricular acupuncture in the treatment of cocaine abuse. A study of efficacy and dosing.

A single-blind, randomized, placebo-controlled study was performed to evaluate auricular acupuncture (AAc) in the treatment of cocaine addiction. Two linked but concurrent studies were done. In Study 1, residential clients (N = 236) were randomized to true acupuncture (Ac), sham Ac, and conventional treatment without Ac. Treatment group subjects received Ac at three ear points considered to be specific for the treatment of substance abuse (SA). Control subjects received three nonspecific (sham) points. In Study 2, day treatment clients (N = 202) were randomized to one of three dose levels of true Ac (28, 16, or 8 treatments). Subjects received Ac at five, rather than three, specific ear points. Nonspecific (sham) points were not used in Study 2. With rare exception, the data failed to identify significant treatment differences among the true and sham Ac, and psychosocial groups. Furthermore, no differences were observed among the three dose levels of true Ac.

Characteristics and complaints of patients seeking therapy at a hospital-based alternative medicine clinic.

BACKGROUND: Patient use of complementary and alternative medicine (CAM) is on the rise. With millions of Americans using CAM, it has become imperative from the public health point of view to undertake a coordinated research effort that will thoroughly evaluate the role and effectiveness of CAM modalities. METHODS: We developed a prospective data-collection system to capture presenting complaints, patient health histories, and demographic information on the patients of a hospital-based alternative medicine clinic. RESULTS: Of 760 patients in the present cohort, 248 different complaints or complaint combinations were entered. Of 16 major categories, the largest was musculoskeletal, followed by the addictions, psychiatric, and nonspecific categories. Slightly more than one in five patients requested treatment on the recommendation of their physician. Over two-thirds of patients in this study group were female. CONCLUSIONS: Given the growing interest and use of complementary and alternative therapies, a system such as described can demonstrate the types of patients presenting for treatment, a more detailed picture of their complaints, and, over time, measurable outcomes.

Overview of substance abuse acupuncture treatment research.

The research on the efficacy of acupuncture substance abuse treatment is generally still in an early stage. The methodological weaknesses found in the acupuncture research can be found in most substance abuse research. Sufficient early trial, empirical findings suggest that there are positive treatment effects. Certainly, use of the treatment is popular and widespread. Overall, the research has progressed beyond early clinical trials, and the method has been documented to be safe and potentially useful.

The evaluation of candidates for renal transplantation. The current practice of U.S. transplant centers.

The criteria for acceptance of candidates for renal transplantation varies throughout the United States. The Patient Care and Education Committee of the American Society of Transplant Physicians conducted a survey of all U.S. centers that participate in the United Network for Organ Sharing (UNOS) concerning their evaluation of adult candidates for kidney transplantation. The response to each question was examined according to the specialty of the individual who filled out the questionnaire, as well as the type of transplant center (university or private) and the size of the center. The response rate to the survey was 81% (147/182). We found the following: (1) university-based and larger centers accepted more medically complicated patients; (2) 83% noted that attendance to dialysis was an important indicator of compliance after transplantation; (3) 79% did not require preoperative blood transfusions for cadaver kidney recipients; (4) 66% set no specific upper age limit for transplantation; (5) 56% excluded patients with chronic active hepatitis in the setting of hepatitis B antigenemia; (6) 50% had no specific policy for evaluating hepatitis C antibody-positive patients, while 54% excluded the use of hepatitis C antibody-positive donors, and (7) 15% obtained coronary angiography on all diabetic patients. U.S. transplant centers have a heterogeneous approach to the evaluation of patients for renal transplantation, particularly in the areas of viral hepatitis, cardiovascular disease, and noncompliance. University-based centers and centers that perform a larger number of transplants accept more medically complicated patients.

Measurement of goal attainment in clinical and health care programs.

Goal attainment scaling (GAS) is a method of measurement that attempts to tailor measures to the relevant and often unique characteristics of an event, individual, program, or organization. The general approach is common in industry, management, service delivery, and most forms of contractual arrangements or agreements. GAS has quantification characteristics that make it useful in a variety of research and management areas, and it is popularly used as a clinical and educational facilitator. This article describes the method within a recent historical context, relating the method to current thinking and problems in evaluation, and attempts to make the method accessible to potential users. Special emphasis is placed on the use of analyses that assess readiness to change or adopt new practices.

An operational model to achieve accountability for social work in health care.

This paper describes a social work accountability structure developed and implemented at the Social Service Department of University of Minnesota Hospitals. The structure is founded in a framework derived from Management by Objectives and is composed of the following elements: (a) a transaction-based Management Information System; (b) service definitions developed by the Southern Regional Educational Board; (c) problem identification and record keeping with Problem-Oriented Medical Records; and (d) outcome evaluation through Goal Attainment Scaling. The purpose of the structure is to monitor and document departmental activities, providing feedback reports to staff, management reports to the director, and summary reports to hospital administration. The structure is not a response to a particular set of organizational problems, but an attempt to develop a coherent operational model to guide department development, remaining responsive to future as well as current needs.

Goal attainment scaling: A general method for evaluating comprehensive community mental health programs.

A mental health enterprise may be described by either (a) rather general philosophical total mental health goals, or (b) highly diverse and individualized patient-therapist goals. Goals a. have not provided a workable framework for program evaluation. This paper proposes that evaluation be done in the framework of goals b. by setting up, before treatment, a measurable scale for each patient-therapist goal, and specifying, for each patient, a transformation of his overall goal attainment into a standardized T-score. This method, together with random assignment of patients to treatment modes, was devised to permit comparison of treatment modes within a program, but it also provides a good basis for a judgmental evaluation of the total program.