Modern-day illicit drugs were used to treat various mental illnesses back in the early 20th century. Famous re-known figures took these drugs to heighten their understanding of the world. Later on, further studies showed that many of these drugs presented a multitude of negative side effects to the users. Drugs not limited to cocaine, hallucinogens, and cannabis can cause mental health problems and this condition can get worse if paired with a pre-existing mental illness. Such drugs if taken frequently for long periods later manifest psychotic symptoms of schizophrenia and bipolar disorders (Lancaster & Ritter, 2014).Dual diagnosis is a term that describes the situation of a person experiencing two or more pathological or disease processes at the same time. It is also referred to as co-occurring disorder or co-morbidity. The Australian Injecting and Illicit Drug Users League suggest that illicit drugs are often used by people with severe psychotic disorders to control symptoms and to counteract the side effects of prescribed medications. The medical contraindications of self-medication are that dual diagnosis sufferers may be less compliant with prescribed treatment regimens (McCallum et al, 2015). Sufferers of dual diagnosis come into contact with the criminal justice system more often than people with mental health disorder. The Police Federation of Australia agrees that police officers are inadequately prepared to deal with the high level of need exhibited by dual diagnosis sufferers in the community. Such people end up in custody, then prison, rather than receive appropriate care.
The high needs of people with drug-induced psychosis/dual diagnosis incur a significant service burden with attendant costs. the rising cost serves as one of the greatest glaring challenges to the dissemination of proper healthcare to society. A solution-focused approach to this issue would be establishing community-based hubs and diverting from punishment to care of inmates suffering from mental illness (Thornicroft, Deb & Henderson, 2016). A community care healthcare approach is viable in as far as harmonizing the efforts of every member of the society to ensure that they do not fall short of the overall expectations and healthcare demands for the entire society inclusive of the inmates' healthcare demands. This would act as an advanced integrated recovery model that may reduce the burden on psychosis by enabling it to more adequately support the most complex clients. Development of psychiatric community-based hubs would provide a holistic approach to the treatment and support of clients through cognitive therapy, clinical models and behavior therapy. This will also enable nurses and mental health workers to get training as well as recognition for skills and experience in dealing with the dual diagnosis.
This psychosis healthcare solution approach is appropriate and would be supported at a local and service level. This is because of the general community increase in illicit substance misuse impacts in the number of presentations of first episode psychosis and also in the increased levels of violence concomitant to these presentations. It would be important to involve both government and non-government agencies, along with consumers and caregivers, in treatment models offering a mix of options to address the range of dual disorder diagnoses. The non-governmental parties have a strong and reliable way of establishing reliable mechanisms upon which they can recreate an informal solution to the psychosis treatment. The non-government is also at liberty to infuse the human-rights approach to the entire issue of inmates' healthcare provision. Having community-based hubs creates a holistic system approach where people can access the level of expertise that is required according to their needs. This will as well build links between the various service elements so that people can get the highly specialized care that they might need.
Statistical evidence confirms that substance abuse among those with mental health problems is pervasive. Research to estimate the prevalence of cooccurring substance use disorder and mental illness in a sample of Australian prisoners by Butler, & Mamoon, (2011), revealed the overall prevalence of any mental disorder was 42.7% and the prevalence of any substance use disorder was 55.3%. It was concluded that mental health services in prisons need to be adequately resourced to address cooccurring mental health and substance use problems, and these services need to be appropriately structured to effectively screen, manage and treat such cases.
Australian National Survey of Mental Health and Wellbeing (NSMHW), conducted a household survey assessing 10 641 respondents for symptoms of high prevalence mental health disorders, including substance disorders. The survey found a high correlation between mental illnesses and substance abuse disorders with 9.7 percent of the population having an anxiety disorder;7.7 percent having substance use disorder; and 5.8 percent meeting criteria for affective (mood) disorder. Fazel et al (2016) concluded that one in four persons with anxiety, effective or substance use disorder also had at least one other mental disorder.
The 2009 NSW, Young People in Custody Health Survey; High rates of mental illness and intellectual disability were observed among 2009 YPICHS participants, with the most common diagnoses found for conduct disorder, alcohol or substance abuse and ADHD. Prevalence of mood disorders among young people in custody was seven times higher for young women and four times higher for young men than found in the general community. At least one among the young participants was found to have a psychological disorder. However, Justice Health has expanded the number of Children's Courts attended by mental health nurses to divert young offenders with mental illness into appropriate treatment and away from juvenile detention.
1. Did the trial address a clearly focused issue?
Yes, the trial addressed a clearly focused issue by recruiting only children who were less than 24 months of age with bronchiolitis attending the emergency department of John Hunter Hospital or the medical unit of John Hunter Children's Hospital in New South Wales. The trial was focused on specifically 202 children during July 16, 2012, to May 2015 in which 101 children were assigned to HFWHO and another set of 101 children was assigned to standard therapy. The trial was run in accordance with the international Human Rights and meeting the Children's protection criteria that met the fundamental children's rights.
2. Was the assignment of patients to treatments randomized?
The assignment of patients to treatments was randomized; having assigned 202 children to HFWHO (101 children) or standard therapy (101 children). In the randomized control trial, recruited children were aged less than 24 months with moderate bronchiolitis attending the emergency department of the John Hunter Hospital in New South Wales, Australia.
3. Were all of the patients who entered the trial properly accounted for at its conclusion?
All patients were properly accounted for in the end. Median time to weaning was 24 h for standard therapy and 20 h for HFWHO because of the differences in survival distributions. The conclusion took care of every subject that was involved in the total study.
4. Were the patients, health workers, and study personnel 'blind' to treatment?
The patients were 'blind' to treatment because adverse events occurred including oxygen desaturation and condensation inhalation in the HFWHO group, and two incidences of oxygen tubing disconnection in the standard therapy group.
5. Were the groups similar at the start of the trial?
Yes, the groups used for the trial were similar from the beginning of the trial to the end because Patients were randomly allocated (1:1) to either HFWHO or standard therapy. They were both given maximum flow of 1 L/kg per min to a limit of 20 L/min using 1:1 air-oxygen ratio as well as 100% oxygen through infant nasal cannulae at either low-flow or Optiflow.
6. Aside from the experimental intervention were the groups treated equally?
The groups were treated equally aside from the experimental intervention. All randomized children were included in the primary and secondary safety analyses. Similarly, time was allocated equally as primary outcome was the time from randomization to last use of oxygen therapy.
7. How large was the treatment effect?
Four adverse events occurred including oxygen desaturation and condensation inhalation in the HFWHO group, as well as two incidences of oxygen tubing disconnection in the standard therapy group. However, none resulted in withdrawal from the trial. No oxygen-related serious adverse events occurred. Secondary
8. How precise was the estimate of the treatment effect?
Fewer children experienced treatment failure on HFWHO (14%) compared with standard therapy (33%). Of these children, those on HFWHO were supported for longer than were those on standard therapy before treatment failure. 20 of 33 children who experienced treatment failure on standard therapy were rescued with HFWHO. 12 of the children on standard therapy required to transfer to the intensive care unit compared with 14 of those on HFWHO.
9. Can the results be applied to the local population, or in your context?
Results of the trial are applicable to those suffering from drug-induced psychosis. The nurses/practitioners can adopt a rescue therapy for inmates suffering from dual diagnosis to reduce the proportion of patients requiring high-cost intensive care.
10. Were all clinically important outcomes considered?
Significant clinical outcomes were considered in the trial including outcomes for both clinicians and the parents or caregivers of the patients. However, complete outcome information was not made available until the final analysis of the trial results. The initial and the secondary safety outcomes were analyzed by an approach of a-priori interim analysis that was conducted towards the end of the winter period with 93 out of the 202 patients in the trial.
11. Are the benefits worth the harms and costs?
The benefits of the trial are worth than the cost and harms. This is because opportunities to help understand high-flow warm dehumidified oxygen versus standard low-flow nasal cannula oxygen for moderate bronchiolitis were discovered. Even though the costs of the trial were high, so are the number of children who are in need of intensive care as a result of HFWHO which was accomplished by the...
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