Aims and method The impact of flexible assertive community treatment (FACT) has been observed in people previously supported by assertive community treatment (ACT) teams, but its effect on those previously with a community mental health team (CMHT) has not been studied in the UK. An observational study was conducted of 380 people from 3 CMHTs and 95 people from an ACT team, all with a history of psychosis, following service reconfiguration to 3 FACT teams.Results People previously with a CMHT required less time in hospital when the FACT model was introduced. A smaller reduction was observed in people coming from the ACT team. Both groups required less crisis resolution home treatment (CRHT) team input.Clinical implications FACT may be a better model than standard CMHT care for people with a history of psychosis, as a result of reduced need for acute (CRHT and in-patient) services.
The results demonstrate that ACT is associated with reduced bed use in the UK and that it is possible to use an observational design with enhanced analysis techniques to increase evidence for causality. These techniques may have value in other service evaluations.
Donezepil and those with learning disabilities Sir: We read with interest of the protocolbased approach for prescribing donezepil described by Jani and Prettyman (Psychiatric Bulletin, May 2000, 25, 174-177). However, the criteria suggested as guidelines for making the diagnosis of Alzheimer's disease and tests used to determine the therapeutic outcome are not appropriate for assessment of the population with learning disability, in whom, particularly in those with Down's syndrome, there is a high prevalence of dementia. There are, however, scales such as the Dementia Questionnaire for Mentally Retarded Persons and the Dementia Scale for Down's syndrome, which can give useful measurements. It is therefore unfortunate that the guidelines on prescribing donezepil and similar treatments recently produced by the National Institute for Clinical Excellence lean so heavily on the Mini Mental State Examination, which is not a validated instrument for this purpose in those with learning disability, who will score poorly whether they have dementia or not. They also seemingly limit the initiation of such treatments to old age psychiatrists, neurologists and care of the elderly physicians, many of whom do not deal with those with learning disabilities. This policy would seem to clash with the recent White Paper Valuing People, which states that all health services should be available to those with learning disabilities with a significant role for learning disability psychiatrists such as ourselves, who know this patient group best, and should surely also be authorised to initiate these treatments.
Anaerobic digestate applied to land is a source of readily available nutrients, yet there is a paucity of knowledge regarding effects on grassland. To address this, we investigated the viability of using digestate as an alternative to mineral fertilizer for Lolium perenne L. grassland maintenance. We present findings of two independent field-trials, where food-waste digestate was applied over two growing seasons at two rates (100 and 200 kg N ha À1 year À1 ) and compared to mineral fertilizer (N:P:K-12:4:6 at 100 kg N ha À1 year À1 ) and control (no additions) plots. L. perenne nutrition (N, P and K), chlorophyll and sward composition were assessed in the summer and autumn to observe treatment and seasonal effects. The sward benefited from digestate application in the summer with reduced occurrence of dead L. perenne. Both the digestate and mineral fertilizer shifted the sward composition similarly and in favor of Poa annua L. in summer and L. perenne in autumn, with reduced broad-leaved weeds and bare soil coverage regardless of season. Quantities of foliar N and K uptake were similar between the digestate and mineral fertilizer; however, the highest rate of digestate application was required to supply similar quantities of P to the grass compared to the mineral fertilizer. Grass chlorophyll was not adversely affected by the high ammonium-N in the digestate. These broadly positive results for digestate present opportunities for the development of digestate use as a fertilizer on amenity grassland such as outfields in sports facilities, parks, and road verges as well as showing potential for supplementing the fertility of pasture systems.
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