Positive reinforcement targeting abstinence in substance misuse (PRAISe): Study protocol for a Cluster RCT & process evaluation of contingency management.

There are approximately 256,000 heroin and other opiate users in England of whom 155,000 are in treatment for heroin (or opiate) addiction. The majority of people in treatment receive opiate substitution treatment (OST) (methadone and buprenorphine). However, OST suffers from high attrition and persistent heroin use even whilst in treatment. Contingency management (CM) is a psychological intervention based on the principles of operant conditioning. It is delivered as an adjunct to existing evidence based treatments to amplify patient benefit and involves the systematic application of positive reinforcement (financial or material incentives) to promote behaviours consistent with treatment goals. With an international evidence base for CM, NICE recommended that CM be implemented in UK drug treatment settings alongside OST to target attendance and the reduction of illicit drug use. While there was a growing evidence base for CM, there had been no examination of its delivery in UK NHS addiction services. The PRAISe trial evaluates the feasibility, acceptability, clinical and cost effectiveness of CM in UK addiction services. It is a cluster randomised controlled effectiveness trial of CM (praise and financial incentives) targeted at either abstinence from opiates or attendance at treatment sessions versus no CM among individuals receiving OST. The trial includes an economic evaluation which explores the relative costs and cost effectiveness of the two CM intervention strategies compared to TAU and an embedded process evaluation to identify contextual factors and causal mechanisms associated with variations in outcome. This study will inform UK drug treatment policy and practice. Trial registration ISRCTN 01591254.

[Quantitative flow determinations in the superior femoral artery and the popliteal artery using angiodynography (color-coded duplex sonography) before and after percutaneous transluminal laser angioplasty]. / Quantitative Flussbestimmungen in der A. fem. sup. und A. poplitea mit der Angiodynographie (Farbkodierte Duplexsonographie) vor und nach perkutaner transluminaler Laserangioplastie.

The primary angiographic PTLA-success correlates with the angiodynographically measured blood flow. 24 hours after the treatment the measured flow values in the AFS and AP allow prognoses: 1. Flow volumes in the AP less than 15 ml/min do not allow successful PLTA-therapy. 2. Slight clinical improvement can be expected for flow values greater than 50 ml/min in the AFS and between 20 and 30 ml/min in the AP. 3. AP-values greater than 30 ml/min correlate in this pilot investigations with an excellent clinical result 4 months after intervention.

[Limits of the diagnostic capability of pulmonary digital subtraction angiography]. / Grenzen der diagnostischen Aussagekraft der pulmonalen digitalen Subtraktionsangiographie (DSA).

Digital subtraction pulmonary angiography was performed in 70 patients suspected of having pulmonary emboli. In 35 patients this diagnosis proved to be correct. The technical quality of all ECG-gated studies was scored and was found to be satisfactory in 31 patients (44%), moderate in 23 (33%) and unsatisfactory in 16 patients (23%). This was mainly due to the lack of patient cooperation. In patients with direct injection into the pulmonary artery (27%) the motion artifacts were less disturbing. We therefore suggest that even when using ECG-gated acquisitions, the injection should be performed into the pulmonary artery to overcome technical problems in the diagnosis of pulmonary embolism.