This study reports on a qualitative study of barriers to EBP implementation in one state that sought to implement supported employment and integrated dual diagnosis treatment. The study found that the most significant obstacles emanated from the behavior of supervisors, front-line staff and other professionals in the agency. A lack of synergy profoundly impeded implementation.

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This study reports on the strategies used to implement the evidence-based practices of supported employment and integrated dual diagnosis treatment. Using qualitative research methods, the study uncovered eight strategies that contributed to successful implementation in six sites.

Aims : The study aims to assess the cost effectiveness of medication review and advice by a consultant pharmacist to elderly people living in the community in Australia. Method : The quality of life and cost of health and social services for a cohort of elderly patients seen by an aged care assessment team (ACAT) was measured at initial referral and at one month follow up. Sites in Melbourne and Ballarat were chosen and analysed separately. A second subsequent cohort was assessed by a team, which included a pharmacist who provided advice to the team and the patient's GP. Quality of life was measured using the SF‐36 and the AQoL. Results: Patients seen by an ACAT had a quality of life considerably below full health. Overall there was no significant change in quality of life in either group by either measure. The additional cost of the pharmacist was less than 77 per patient. Compared to no intervention, there was some evidence of an increase in the cost of prescription Pharmaceuticals, and a reduction in home care assistance and medical care costs in Melbourne but not in Ballarat. Cost data were highly skewed however, making statistical tests of cost differences problematic. The addition of a pharmacist may be cost reducing in some settings especially if inpatient episodes for assessment and treatment can be avoided, but the study was not able to demonstrate a statistically significant reduction in overall costs associated with pharmacist review and advice.

Background TRACK-HD is a multi-centre, longitudinal study investigating a range of motor, cognitive, neuropsychiatric and imaging measures as potential biomarkers for clinical trials in Huntington's disease (HD). The neuropsychiatric battery includes the Frontal Systems Behaviour Scale (FrSBe), a 46-item scale measuring behaviours associated with damage to the frontal lobes of the brain. In addition to subjects rating their own behaviour on the FrSBe, companions also rated subjects' behaviour. This provided an opportunity to investigate HD patients' insight into their behaviour by studying discrepancies between subject and companion ratings. Method 225 TRACK-HD subjects (62 premanifest gene carriers far from onset, 52 near to onset, 70 stage 1 HD and 41 stage 2 HD) completed the FrSBe. In addition, 164 companions (77 of premanifest subjects and 87 of early HD subjects) rated subjects' behaviour with the FrSBe. Results Companion ratings indicate a worsening of FrSBe scores with disease progression, especially in subjects with manifest HD. In contrast, subjects' self ratings did not show the same deterioration in FrSBe scores across the pre-HD and stage 1 subgroups, with the biggest discrepancy between subject and companion ratings at stage 1 HD. Surprisingly, self-ratings of stage 2 subjects were markedly worse than those at stage 1, almost eliminating this discrepancy between companion and self-ratings. Companion FrSBe ratings correlated more strongly with objective measures of cognitive and behavioural function than did subjects own ratings. Conclusion The existence of a discrepancy between companion and subjects' own ratings using the FrSBe in stage 1 HD but not in those with more advanced disease suggests that denial (as a psychological defence mechanism) is a more likely explanation than a loss of insight secondary to cognitive impairment.

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Abstract. Advancing age is associated with an increased prevalence of illness, often resulting in the requirement for multiple medications, placing the older person at increased risk of adverse drug reactions (ADRs). Rather than simply attributing new signs and symptoms to progression of an old disease or the development of a new illness, the possibility that they are consequences of existing drug therapy should be considered. We present a case where symptoms associated with ADRs mimicked age‐related diseases. Nursing home admission was avoided through recognition of the problem, and withdrawal of the offending medications.

Background Brief cognitive assessments are of use both clinically and as outcome measures in clinical trials. To date, the most commonly employed of such measures has been the Mini-Mental State Examination but this has limited sensitivity to neurocognitive impairment in Huntington's disease (HD). A recently developed alternative to the Mini-Mental State Examination is the Montreal Cognitive Assessment (MoCA), which measures five indices of cognitive function, including language, memory, attention and executive function. Previous studies using the MoCA in HD have focused on direct comparison of these instruments; to date there has been no in-depth analysis of the sensitivity and specificity of the MoCA in HD. Aims Our aim was to examine the sensitivity of the MoCA and its component subscales to both cognitive impairment and disease stage in HD. A further aim was to explore whether the instrument's sensitivity could be improved by the removal of items with limited sensitivity and the use of modified scoring methods. Methods 59 manifest and premanifest HD patients were examined using the MoCA, in addition to the UHDRS. The association between total MoCA score and UHDRS indices of disease severity was examined. Following this, sensitivity of individual MoCA subscales to disease stage was explored using MANOVA and insensitive items were excluded. Finally, modified scoring criteria were composed and evaluated in terms of the strength of association between modified scores and disease stage. Results Total MoCA scores were significantly associated with both disease stage (n=55, p=<0.01, f=18.87) and UHDRS measures. Several of the MoCA subscales were poorly associated with disease stage. Removing these items from the total MoCA score improved sensitivity to both disease stage (n=55, p<0.01, f=30.47) and UHDRS measures. Moreover, the use of modified scoring methods further improved association with disease stage and UHDRS outcome measures, as well as eliminating ceiling effects in premanifest HD. Conclusions Although the MoCA is sensitive to neurocognitive function and disease stage in HD, the sensitivity of the instrument can be greatly improved by the exclusion of low sensitivity items and the use of expanded scoring criteria.