BackgroundThe provision of smoking cessation support in Australian drug and alcohol treatment services is sub-optimal. This study examines the cost-effectiveness of an organisational change intervention to reduce smoking amongst clients attending drug and alcohol treatment services.Methods/designA cluster-randomised controlled trial will be conducted with drug and alcohol treatment centres as the unit of randomisation. Biochemically verified (carbon monoxide by breath analysis) client 7-day-point prevalence of smoking cessation at 6 weeks will be the primary outcome measure. The study will be conducted in 33 drug and alcohol treatment services in four mainland states and territories of Australia: New South Wales, Australian Capital Territory, Queensland, and South Australia. Eligible services are those with ongoing client contact and that include pharmacotherapy services, withdrawal management services, residential rehabilitation, counselling services, and case management services. Eligible clients are those aged over 16 years who are attending their first of a number of expected visits, are self-reported current smokers, proficient in the English language, and do not have severe untreated mental illness as identified by the service staff. Control services will continue to provide usual care to the clients. Intervention group services will receive an organisational change intervention, including assistance in developing smoke-free policies, nomination of champions, staff training and educational client and service resources, and free nicotine replacement therapy in order to integrate smoking cessation support as part of usual client care.DiscussionIf effective, the organisational change intervention has clear potential for implementation as part of the standard care in drug and alcohol treatment centres.Trial registrationAustralian and New Zealand Clinical Trials Registry, ACTRN12615000204549. Registered on 3 March 2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1401-6) contains supplementary material, which is available to authorized users.

The Australian alcohol and other drugs (AOD) sector has a diverse range of actors, including the nongovernment (NGO) service providers. Representing these services in each of Australian states and territories are AOD sector peak bodies. Their national network commissioned an evaluation of their capacity building (CB) activities and outcomes. The network and the evaluator developed a working definition of CB: Capacity building is a strategy that improves the ability of AOD workers, services and/or the broader AOD system to achieve better AOD health and social outcomes. The utilisation-focused evaluation (UFE) model was adopted for this project. The evaluation found that sound outcomes have been produced by the peaks’ CB work, and that includes valued changes in the service delivery work of the NGO sector. The CB strategies that are particularly important for attaining the desired outcomes were identified. The CB strategies and activities have been implemented well, and have delivered value for money, though sustainability remains a concern. The evaluation concluded that the peak bodies are ideally placed to deliver CB initiatives. The evaluation’s recommendations have been implemented, and process utilisation of the evaluation has been observed among its participants.

Aim Aims were to test the effectiveness of an organizational change intervention integrating smoking cessation treatment into usual alcohol and other drug (AOD) treatment, compared with usual care, on (1) 7‐day point prevalence abstinence (PPA) at 8 weeks follow‐up; (2) prolonged abstinence; (3) cigarettes smoked per day; (4) number of quit attempts; and (5) offer and use of nicotine replacement therapy (NRT). All outcomes were assessed at 8 weeks and 6.5 months follow‐up. Design Cluster‐randomized controlled trial, with AOD service as unit of randomization, conducted January 2015–March 2016. Setting Thirty‐two eligible services (provided face‐to‐face client sessions to ≥ 50 clients/year) in Australia were randomized to control (usual care; n = 15) or intervention (n = 17) groups by an independent blinded biostatistician. Participants Eligible participants (≥ 16 years, current smoker) completed surveys at the service at baseline (n = 896) and telephone follow‐up surveys (conducted by blinded assessors) at 8 weeks (n = 471; 53%) and 6.5 months (n = 427; 48%). Intervention Intervention services received an intervention to establish routine screening, assessment and delivery of smoking cessation care. Measurements Primary outcome was biochemically verified 7‐day PPA at 8‐week follow‐up. Secondary outcomes included verified and self‐reported prolonged abstinence, self‐reported 7‐day PPA, cigarettes/day, quit attempts and offer and use of NRT. Intention‐to‐treat analyses were performed, assuming missing participants were not abstinent. Findings At 8 weeks, the findings in verified 7‐day PPA between groups [2.6 versus 1.8%, odds ratio (OR) = 1.72, 95% confidence interval (CI) = 0.5–5.7, P = 0.373] were inconclusive as to whether a difference was present. Significantly lower mean cigarettes/day were reported in the intervention group compared to the usual care group at 8 weeks [incidence rate ratio (IRR) = 0.88, 95% CI = 0.8–0.95, P = 0.001] but were similar at 6.5 months (IRR = 0.96, 95% CI = 0.9–1.02, P = 0.240) follow‐up. At both follow‐ups the intervention group reported higher rates of NRT use. Conclusions Integrating smoking cessation treatment into addiction services did not significantly improve short‐term abstinence from smoking.

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presence of a reaction of degeneration, at any rate -n the early stages. The importance of this is clear. While Willing to advise.decompression in the early stage of a Bell's palsy, one has been more reluctant when this reaction has developed, on the grounds that there was no prospect of immediate recovery. We may now be entitled to take a more optimistic view, if confirmation is obtainable. Summary 1. Permanent deformity after Bell's palsy is far commoner than is generally realized.2. In a young, sensitive woman its effects may be so serious as to justify operation.3. Up till now it has been impossible to advise operation owing to our ignorance as to the prognosis in any given case.4. A criterion is proposed for such cases, and indications for further research into the problem are outlined.My grateful thanks are due to the various colleagues who allowed me access to their files, and also to Miss Margaret Frank, without whose enthusiastic co-operation this laborious questionary could not have been compiled.