Individualized and Standardized Outcome Measures: Further Arguments in Favor of Cohabitation.

Ashworth et al. (Admin Policy Ment Health Ment Health Serv Res 46:425-428, 2019) recently published a paper in this journal making a cogent argument for the cohabitation of standardized and individualized outcome measures. In the present Point of View article, we consider additional arguments in favor of this cohabitation.

A typology of heroin-dependent patients based on their history of self-injurious behaviours.

Self-injurious behaviours (SIB) can provide useful criteria for subtyping heroin-dependent patients, since SIB have been related to an opioid system dysfunction and they hinder patient management. The frequency of nine varieties of moderate/superficial SIB during active heroin use was assessed retrospectively in 164 heroin-dependent patients. A principal component analysis of SIB episodes revealed a four-component solution which accounted for 69.3% of the variance. The components were named as follows (percentage of variance explained by each component is enclosed in parentheses): 'SIB with objects' (27.3%), 'SIB by biting/scratching/hair-pulling' (18.2%), 'SIB by hitting' (12.3%), and 'SIB by picking scabs' (11.5%). A cluster analysis using the results of the principal component analysis enabled us to define three types of heroin-dependent patients, labelled: 'low-occurrence SIB cluster' (59.8%), 'high-occurrence scab-picking cluster' (31.7%) and 'high-occurrence hitting and cutting cluster' (8.5%). SIB by hitting was the most discriminatory component among clusters: its frequency was at a minimum in the low-occurrence SIB cluster, and attained a maximum in the high-occurrence hitting and cutting cluster. However, there were no differences among clusters regarding heroin-use variables. Patients from the low-occurrence SIB cluster, compared with those from the other two clusters, reported fewer episodes of SIB or suicide attempts and were diagnosed less frequently with bulimia. Patients from the high-occurrence scab-picking cluster had a very frequent history of these SIB, while the opposite was true in patients from the high-occurrence hitting and cutting cluster. Patients from this cluster probably presented staff members with the main management problems.

Quality of life and well-being from the perspective of patients on opioid agonist maintenance treatment: study protocol for a systematic review of qualitative research and a scoping review of measures.

BACKGROUND: Opioid agonist maintenance treatment (OAMT) is a first-line treatment for heroin dependence, but its effectiveness has been assessed primarily through clinical outcomes with a limited attention to patient perspectives. Despite the increased use of patient reported outcome measures their patient-centeredness is highly questionable. This is the protocol of a systematic review of qualitative research on how OAMT users construct the meaning of their quality of life and well-being and a scoping review of instruments that measure these domains. METHODS: We will conduct a systematic review of qualitative research exploring the views of quality of life of patients on OAMT (registration number CRD42018086490). According pre-specified eligibility criteria, we will include studies from a comprehensive search of bibliographical databases from their inception. We will extract data from included studies and assess their risk of bias with the CASP appraisal criteria, and will implement a thematic analysis to generate a set of interpretative analytical themes ascertaining their confidence using the CERQual approach. We will implement similar methods to conduct a scoping review to assess to what extent the existing measures of these domains were focused on user's views, assessing their validity using the COSMIN methodology, and summarizing their characteristics and level of patient centeredness. CONCLUSION: The findings from the reviews will contribute to obtain a genuine understanding of the perspective from users on OAMT regarding their perception of well-being and quality of life and will likely lead to greater patient centeredness when assessing such variables, which in turn may contribute to a more patient-centered care.

Evolución de una muestra de mujeres que acuden a un programa de tratamiento especializado para dejar de fumar / Outcomes in a sample of women in a specialized smoking cessation program

Introducción y objetivo: Las mujeres parecen tener más dificultades para dejar de fumar. El objetivo del presente trabajo es valorar la evolución, en un tratamiento protocolizado, de un grupo de mujeres que acudieron a una unidad especializada. Material y método: La muestra la componen un total de 240 mujeres que realizaron una primera visita en el Programa de Tratamiento de Tabaco de la Unidad de Conductas Adictivas del Hospital de la Santa Creu i Sant Pau durante los años 1996-2006. Se valora de forma retrospectiva su evolución en términos de abstinencia en un protocolo estructurado multicomponente, con seguimiento de 12 meses a partir del día D. El procesamiento y el análisis de los datos se realizaron mediante el paquete estadístico SPSS 11.5 para Windows. Resultados: Del total de 240 pacientes, 27 de ellas no fijaron un día D como fecha de inicio de la abstinencia. Estas mujeres, al compararlas con el grupo de mujeres que finalizaron los 12 meses (n = 87), presentaron diferencias significativas en mayor presencia de trastorno psicótico y en mayor puntuación de dependencia, y convivían con mayor frecuencia con sujetos fumadores. La cifra de abstinencia continua a los 12 meses fue del 38,5%, sin diferencias significativas del grupo de varones en nuestro programa. Conclusiones: La mayor parte de los estudios clínicos muestra una mayor dificultad de la cesación entre las mujeres. Dado el incremento del consumo de tabaco en las mujeres, es necesario que la investigación aporte datos diferenciales por sexo para permitir intervenciones específicas que mejoren los resultados

Introduction and objective: Women seem to have greater difficulties in smoking cessation than men. The aim of this study was to evaluate a sample of women receiving treatment for smoking cessation at a specialized unit. Material and method: Between 1996 and 2006, 240 women were admitted to the tobacco treatment program at the Addictive Behavior Unit of the Hospital de la Santa Creu i Sant Pau. Abstinence was retrospectively assessed following a structured multi-component protocol, with a 12-month follow-up starting from D-day (smoking cessation day). Statistical analyses were carried out using SPSS version 11.5. Results: Of the 240 patients, 27 did not set a D-day for smoking cessation. Compared with the group of women who completed the 12 months (n=87), this group presented significant differences in terms of a greater presence of psychotic disorders and higher dependency scores; this group also had a higher number of women living with smokers. A total of 38.5% of the women achieved continuous abstinence over the 12 months. No significant differences were found with the group of men in our program. Conclusions: Most clinical studies report greater difficulties in smoking cessation among women. Given the present trend of increasing consumption in women, research should aim to determine gender differences so that specific interventions can be carried out to improve results