Validation and implementation of the Australian Treatment Outcomes Profile in specialist drug and alcohol settings.

INTRODUCTION AND AIMS: The measurement of clinical outcomes is an important, but lacking, component of drug and alcohol treatment in Australia. This study aimed to psychometrically validate the Treatment Outcomes Profile under Australian conditions, examining implementation and feasibility issues in three public opioid treatment program clinics in NSW. DESIGN AND METHODS: The Treatment Outcomes Profile was modified to reflect Australian conditions and re-named the Australian Treatment Outcomes Profile (ATOP). The ATOP was introduced into the participating clinics and administered by clinic staff at 3-month intervals as part of routine clinical practice. Participants completed a research interview, consisting of the ATOP and a suite of 'gold standard' instruments assessing substance use and related health and welfare domains, in the 72 h following completion of a routine clinical ATOP. The researcher- and clinician-administered ATOPs were compared to assess interrater reliability, and the researcher-administered ATOP and 'gold standard' instruments were compared to assess concurrent validity. Implementation and feasibility issues were assessed using questionnaires and focus groups with clinician and clients. RESULTS: The ATOP demonstrated acceptable concurrent validity and interrater reliability. It was well received by clients and clinicians, particularly for its ease of use, applicability and brevity. CONCLUSIONS: The ATOP is a psychometrically valid instrument for the measurement of treatment outcomes in Australian opioid treatment populations and can feasibly be implemented as part of routine clinical practice in specialist opioid treatment program clinics. The role of the ATOP to measure outcomes in other drug and alcohol treatment modalities requires exploration.

The outcome of a rapid hepatitis B vaccination programme in a methadone treatment clinic.

AIM: Injecting drug users are a high-risk population for hepatitis B (HBV), but are difficult to engage in vaccination programmes. This study examines the completion rates of a HBV vaccination schedule and seroconversion in a group of patients in methadone maintenance treatment. METHODS: Patients at a public methadone maintenance programme in Sydney, Australia, were screened for viral hepatitis (hepatitis A, B and C) and offered a rapid HBV vaccination schedule (0, 1 and 2 months). Hepatitis B surface antibody (antiHBs) was retested on completion of the vaccination schedule. RESULTS: A total of 143 patients [71.3% male, mean age 33.1 (standard deviation +/- 8.3)] enrolled in the project. Forty-nine per cent of patients were HAV antibody (Ab) positive, 81.1% hepatitis C virus (HCV) antibody (Ab) positive and 38.9% antiHBs positive. Exposure to multiple hepatitis viruses was common, with 24.5% testing positive for all three viruses. Seventy-three (83%) of the 88 antiHBs negative patients completed the vaccination schedule. Post-vaccination serology indicated a seroconversion rate of 75.4% (55 of 73) of completors, or 62.5% of eligible participants (55 of 88). CONCLUSION: While there was a high rate of completion of the rapid vaccination schedule in this population, a moderate seroconversion rate was achieved. Further work is required to identify an optimal vaccination schedule in opioid substitution patients.

An ultrasound mini-balance for measurement of therapy level ultrasound.

This paper describes a cost-effective method for measuring acoustic power using a radiation force balance. The device is based around a long established balance design with a gantry arrangement fitted with an absorbing target. The notion of this balance design is that it can easily be constructed from materials that would be readily available within a clinical or industrial environment. The mini-balance was calibrated using a transfer standard against an NPL Reference balance, so a comparison of the performance between the two systems could be assessed. The measurements were completed at 1 MHz and 3 MHz and over the acoustic power range of 1 W to 15 W. The results show the acoustic power measured on the mini-balance to be within 5% of the reference measurements made on the NPL Balance. A separate systematic uncertainty budget is also presented based on studies made on the balance and on similar systems. The overall expanded uncertainty was calculated to be within 14% at 1 W level, decreasing with increasing power level to 7.4% above 5 W.

Measurement of ultrasonic power using an acoustically absorbing well.

This paper describes a quick and cost-effective method for constructing a radiation force balance for measuring ultrasonic output power. It utilises a target manufactured from a high-quality acoustical absorber material. The target geometry is in the form of a cup or well that is water-filled and placed directly on the pan of a top-loading chemical balance, thus overcoming the need for the traditional gantry arrangement found in the majority of commercially available balances. The face of the transducer is placed directly in the water contained within the well. This simplification reduces time spent in setting up a balance for measurement, and targets can be manufactured to any required geometry and used on any suitable top-loading balance to measure output power. Within this study, the performance of the absorbing well method was evaluated over the frequency range of 1 MHz to 5 MHz, for acoustic power levels up to 1 W. Power measurements on three transducers were compared with measurements made on the National Physical Laboratory (NPL) primary standard radiation force balance and good agreement is demonstrated between the two systems. At a power of 50 mW, using a chemical balance of resolution 0.1 mg, typical type A (random) uncertainties were +/- 2.0% when expressed at the 95% confidence level.