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Cordoba Torres IT, Fouda EA, Reinhardt ME, Souki FG. Perioperative Concerns in the Patient with History of Alcohol Use. Adv Anesth 2023; 41:163-178. [PMID: 38251616 DOI: 10.1016/j.aan.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Alcohol use is common in patients presenting for surgery and can result in significant physiologic changes and postoperative complications. Anesthesia providers must be aware of the potential risks associated with alcohol consumption and take steps to minimize them. Perioperative management includes assessing patients for alcohol use, providing alcohol cessation interventions, adjusting the anesthetic plan according to the patient's alcohol use history, providing appropriate pain management strategies, and closely monitoring patients during and after surgery for signs of alcohol withdrawal.
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Affiliation(s)
- Ivet T Cordoba Torres
- Department of Anesthesia, Jackson Memorial Hospital, University of Miami, 1611 Northwest 12th Avenue, DTC 318, Miami, FL, 33136, USA
| | - Eslam A Fouda
- Department of Anesthesia, Jackson Memorial Hospital, University of Miami, 1611 Northwest 12th Avenue, DTC 318, Miami, FL, 33136, USA
| | | | - Fouad G Souki
- Department of Anesthesia, Jackson Memorial Hospital, University of Miami, 1611 Northwest 12th Avenue, DTC 318, Miami, FL, 33136, USA.
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2
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Fernandez AC, Waljee JF, Gunaseelan V, Brummett CM, Englesbe MJ, Bicket MC. Prevalence of Unhealthy Substance Use and Associated Characteristics Among Patients Presenting for Surgery. Ann Surg 2023; 278:e740-e744. [PMID: 36538617 PMCID: PMC10205913 DOI: 10.1097/sla.0000000000005767] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To assess the prevalence of and identify characteristics associated with unhealthy use before surgery. BACKGROUND Although the escalation in US drug overdose deaths is apparent, the unhealthy use of substances among patients presenting for surgery is unclear. METHODS We conducted a retrospective study of patients presenting for elective surgical procedures between December 2018 and July 2021 and prospectively recruited to 1 of 2 clinical research studies (Michigan Genomics Initiative, Prevention of Iatrogenic Opioid Dependence after Surgery Study). The primary outcome was unhealthy substance use in the past 12 months as determined using the Tobacco, Alcohol, Prescription medication, and other Substance use tool. RESULTS Among 1912 patients, unhealthy substance use was reported in 768 (40.2%). The most common substances with unhealthy use were illicit drugs [385 (20.1%)], followed by alcohol 358 (18.7%)], tobacco [262 (13.7%)], and prescription medications [86 (4.5%)]. Patients reporting unhealthy substance use were significantly more likely to be younger, male [aOR: 1.95 (95% CI, 1.58-2.42)], and have higher scores for pain [aOR: 1.07 (95% CI, 1.02-1.13)], and anxiety [aOR: 1.03 (95% CI, 1.01-1.04)]. Unhealthy substance use was more common among surgical procedures of the forearm, wrist, and hand [aOR: 2.58 (95% CI, 1.01-6.55)]. CONCLUSIONS As many as 2 in 5 patients in the preoperative period may present with unhealthy substance use before elective surgery. Given the potential impact of substance use on surgical outcomes, increased recognition of the problem by screening patients is a critical next step for surgeons and perioperative care teams.
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Affiliation(s)
- Anne C Fernandez
- Department of Psychiatry, Addiction Center, University of Michigan, Ann Arbor, MI
| | - Jennifer F Waljee
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Opioid Prescribing Engagement Network, Institute for Healthcare Policy and Innovation, University of Michigan School of Public Health, University of Michigan, Ann Arbor, MI
| | - Vidhya Gunaseelan
- Opioid Prescribing Engagement Network, Institute for Healthcare Policy and Innovation, University of Michigan School of Public Health, University of Michigan, Ann Arbor, MI
| | - Chad M Brummett
- Opioid Prescribing Engagement Network, Institute for Healthcare Policy and Innovation, University of Michigan School of Public Health, University of Michigan, Ann Arbor, MI
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI
| | - Michael J Englesbe
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Opioid Prescribing Engagement Network, Institute for Healthcare Policy and Innovation, University of Michigan School of Public Health, University of Michigan, Ann Arbor, MI
| | - Mark C Bicket
- Opioid Prescribing Engagement Network, Institute for Healthcare Policy and Innovation, University of Michigan School of Public Health, University of Michigan, Ann Arbor, MI
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI
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3
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Hallgren KA, Jack HE, Oliver M, Berger D, Bobb JF, Kivlahan DR, Bradley KA. Changes in alcohol consumption reported on routine healthcare screenings are associated with changes in depression symptoms. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:1132-1142. [PMID: 37326806 PMCID: PMC10330324 DOI: 10.1111/acer.15075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/24/2023] [Accepted: 03/28/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND The Alcohol Use Disorders Identification Test-Consumption version (AUDIT-C) has been robustly validated as a point-in-time screen for unhealthy alcohol use, but less is known about the significance of changes in AUDIT-C scores from routine screenings over time. Unhealthy alcohol use and depression commonly co-occur, and changes in drinking often co-occur with changes in depression symptoms. We assess the associations between changes in AUDIT-C scores and changes in depression symptoms reported on brief screens completed in routine care. METHODS The study sample included 198,335 primary care patients who completed two AUDIT-C screens 11 to 24 months apart and the Patient Health Questionnaire-2 (PHQ-2) depression screen on the same day as each AUDIT-C. Both screening measures were completed as part of routine care within a large health system in Washington state. AUDIT-C scores were categorized to reflect five drinking levels at both time points, resulting in 25 subgroups with different change patterns. For each of the 25 subgroups, within-group changes in the prevalence of positive PHQ-2 depression screens were characterized using risk ratios (RRs) and McNemar's tests. RESULTS Patient subgroups with increases in AUDIT-C risk categories generally experienced increases in the prevalence of positive depression screens (RRs ranging from 0.95 to 2.00). Patient subgroups with decreases in AUDIT-C risk categories generally experienced decreases in the prevalence of positive depression screens (RRs ranging from 0.52 to 1.01). Patient subgroups that did not have changes in AUDIT-C risk categories experienced little or no change in the prevalence of positive depression screens (RRs ranging from 0.98 to 1.15). CONCLUSIONS As hypothesized, changes in alcohol consumption reported on AUDIT-C screens completed in routine care were associated with changes in depression screening results. Results support the validity and clinical utility of monitoring changes in AUDIT-C scores over time as a meaningful measure of changes in drinking.
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Affiliation(s)
- Kevin A. Hallgren
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
- University of Washington, Department of Health Systems and Population Health, Seattle, WA, United States
| | - Helen E. Jack
- Division of General Internal Medicine, University of Washington, Seattle, United States
| | - Malia Oliver
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Douglas Berger
- Division of General Internal Medicine, University of Washington, Seattle, United States
- General Medicine Service VA Puget Sound, Seattle, WA, United States
| | - Jennifer F. Bobb
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Daniel R. Kivlahan
- Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research and Development, Veteran Affairs Puget Sound HealthCare System, Seattle, WA, United States
| | - Katharine A. Bradley
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
- University of Washington, Department of Health Systems and Population Health, Seattle, WA, United States
- Division of General Internal Medicine, University of Washington, Seattle, United States
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4
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Cannizzaro E, Cirrincione L, Malta G, Fruscione S, Mucci N, Martines F, Plescia F. The Influence of the COVID-19 Pandemic Emergency on Alcohol Use: A Focus on a Cohort of Sicilian Workers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4613. [PMID: 36901622 PMCID: PMC10001951 DOI: 10.3390/ijerph20054613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 06/18/2023]
Abstract
The period between the beginning and the end of the COVID-19 pandemic emergency generated a general state of stress, affecting both the mental state and physical well-being of the general population. Stress is the body's reaction to events or stimuli perceived as potentially harmful or distressing. Particularly when prolonged over time, it can promote the consumption of different psychotropic substances such as alcohol, and thus the genesis of various pathologies. Therefore, our research aimed to evaluate the differences in alcohol consumption in a cohort of 640 video workers who carried out activities in smart working, subjects particularly exposed to stressful situations due to the stringent rules of protection and prevention implemented during the pandemic. Furthermore, based on the results obtained from the administration of the AUDIT-C, we wanted to analyse the different modes of alcohol consumption (low, moderate, high, severe) to understand whether there is a difference in the amount of alcohol consumed that could predispose individuals to health problems. To this end, we administered the AUDIT-C questionnaire in two periods (T0 and T1), coinciding with annual occupational health specialist visits. The results of the present research showed an increase in the number of subjects consuming alcohol (p = 0.0005) and in their AUDIT-C scores (p < 0.0001) over the period considered. A significant decrease in subgroups who drink in a low-risk (p = 0.0049) mode and an increase in those with high (p = 0.00012) and severe risk (p = 0.0002) were also detected. In addition, comparing the male and female populations, it emerged that males have drinking patterns that lead to a higher (p = 0.0067) health risk of experiencing alcohol-related diseases than female drinking patterns. Although this study provides further evidence of the negative impact of the stress generated by the pandemic emergency on alcohol consumption, the influence of many other factors cannot be ruled out. Further research is needed to better understand the relationship between the pandemic and alcohol consumption, including the underlying factors and mechanisms driving changes in drinking behaviour, as well as potential interventions and support strategies to address alcohol-related harm during and after the pandemic.
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Affiliation(s)
- Emanuele Cannizzaro
- Department of Health Promotion Sciences, Maternal and Child Care, Internal Medicine and Medical Specialties ‘Giuseppe D’Alessandro’, University of Palermo, Via del Vespro 133, 90127 Palermo, Italy
| | - Luigi Cirrincione
- Department of Health Promotion Sciences, Maternal and Child Care, Internal Medicine and Medical Specialties ‘Giuseppe D’Alessandro’, University of Palermo, Via del Vespro 133, 90127 Palermo, Italy
| | - Ginevra Malta
- Department of Health Promotion Sciences, Maternal and Child Care, Internal Medicine and Medical Specialties ‘Giuseppe D’Alessandro’, University of Palermo, Via del Vespro 133, 90127 Palermo, Italy
| | - Santo Fruscione
- Department of Health Promotion Sciences, Maternal and Child Care, Internal Medicine and Medical Specialties ‘Giuseppe D’Alessandro’, University of Palermo, Via del Vespro 133, 90127 Palermo, Italy
| | - Nicola Mucci
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 3, 50134 Florence, Italy
| | - Francesco Martines
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), Section of Audiology, University of Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - Fulvio Plescia
- Department of Health Promotion Sciences, Maternal and Child Care, Internal Medicine and Medical Specialties ‘Giuseppe D’Alessandro’, University of Palermo, Via del Vespro 133, 90127 Palermo, Italy
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5
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Fernandez AC, Chapman L, Ren TY, Baxley C, Hallway AK, Tang MJ, Waljee JF, Friedmann PD, Mello M, Borsari B, Blow F. Preoperative alcohol interventions for elective surgical patients: Results from a randomized pilot trial. Surgery 2022; 172:1673-1681. [PMID: 36283843 PMCID: PMC10686250 DOI: 10.1016/j.surg.2022.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 09/08/2022] [Accepted: 09/11/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND High-risk alcohol use is a common surgical risk factor. Stopping or reducing alcohol use in the weeks before and after surgery could improve surgical health and outcomes. The purpose of this study was to evaluate the feasibility and acceptability of 2 interventions that address high-risk alcohol use in the context of surgery. METHODS Participants included patients scheduled for elective surgeries at an academic health system in the Midwestern United States. Recruitment took place by phone and text. Participants were included if they were 18 to 75 years old, scheduled for elective surgeries, and scored ≥5 on the Alcohol Use Disorders Identification Test-Consumption Tool. Participants were randomized to either a low-intensity intervention, brief advice (10-minute phone-based psychoeducation plus feedback session), or a higher-intensity intervention, health coaching (two 45-minute sessions including education, feedback, motivational interviewing, and goal setting). Assessments took place at baseline and at 1-month and 4-month follow-ups. Alcohol biomarkers were collected the day of surgery. RESULTS The final study sample included (n = 51) participants randomized to brief advice and health coaching conditions. Participants in both conditions rated interventions as satisfactory and personally relevant. Trial retention was high (86.3%) at 4 months. Attrition was significantly higher in brief advice (n = 6) relative to health coaching (n = 1). Average weekly alcohol use decreased 50% to 60% between baseline and follow-ups in both conditions. Biomarkers corroborated self-report. CONCLUSION The trial demonstrated intervention feasibility and acceptability. Alcohol use changed in expected directions. The next steps include a randomized controlled trial to test intervention efficacy in reducing alcohol use and surgical complications.
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Affiliation(s)
- Anne C Fernandez
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI.
| | - Lyndsay Chapman
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI
| | - Tom Y Ren
- Central Michigan University College of Medicine, Mt. Pleasant, MI
| | - Catherine Baxley
- San Francisco Veterans Affairs Health Care System, San Francisco, CA; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA
| | | | | | - Jennifer F Waljee
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Peter D Friedmann
- Office of Research and Department of Medicine, University of Massachusetts Chan Medical School, Baystate, Springfield, MA
| | - Michael Mello
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI; Department of Health Services, Practice and Policy, Brown University School of Public Health, Providence, RI
| | - Brian Borsari
- San Francisco Veterans Affairs Health Care System, San Francisco, CA; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA
| | - Frederic Blow
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI; VA Center for Clinical Management Research, Ann Arbor, MI
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Modha K, Whinney C. Preoperative Evaluation for Noncardiac Surgery. Ann Intern Med 2022; 175:ITC161-ITC176. [PMID: 36343344 DOI: 10.7326/aitc202211150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The previous In the Clinic that addressed preoperative evaluation for noncardiac surgery was published in December 2016. This update reaffirms much of the information in the previous version and provides new information that has accumulated since then. The goal of preoperative assessment is to identify the risk for postoperative complications so health care teams can more fully understand how to implement strategies to mitigate risks before and after the operation.
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Affiliation(s)
- Kunjam Modha
- Cleveland Clinic Foundation, Cleveland, Ohio (K.M.)
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7
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Knox J, Shiau S, Kutner B, Reddy V, Dolezal C, Sandfort TGM. Information, Motivation and Behavioral Skills as Mediators Between Sexual Minority Stigma and Condomless anal Sex Among Black South African Men Who have Sex with Men. AIDS Behav 2022; 27:1587-1599. [PMID: 36318425 PMCID: PMC10149565 DOI: 10.1007/s10461-022-03892-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2022] [Indexed: 11/06/2022]
Abstract
We assessed pathways between sexual minority stigma and condomless anal intercourse (CAI) among two samples of Black South African men who have sex with other men (MSM). Two cross-sectional surveys were conducted in Tshwane, South Africa; one among 199 Black MSM and another among 480 Black MSM. Men reported on external and internalized experiences of sexual minority stigma, mental health, alcohol use, information-motivation-behavioral skills (IMB) model constructs, and CAI. Structural equation modeling was used to test whether external and internalized stigma were directly and indirectly associated with CAI. In both studies, external stigma and internalized stigma were associated with CAI through IMB model constructs. These results suggest a pathway through which stigma contributes to HIV risk. For HIV prevention efforts to be effective, strengthening safer sex motivation and thus decreasing sexual risk behavior likely requires reducing sexual minority stigma that MSM experience and internalize.
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Affiliation(s)
- Justin Knox
- Department of Psychiatry, Columbia University, New York, US. .,HIV Center for Behavioral Studies, New York State Psychiatric Institute, New York, US. .,Department of Sociomedical Sciences, Columbia University, New York, US. .,, 722 West 168th street, 10032, New York, US.
| | - Stephanie Shiau
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Bryan Kutner
- Department of Psychiatry, Columbia University, New York, US.,HIV Center for Behavioral Studies, New York State Psychiatric Institute, New York, US
| | - Vasu Reddy
- Faculty of Humanities, University of Pretoria, Pretoria, South Africa
| | - Curtis Dolezal
- HIV Center for Behavioral Studies, New York State Psychiatric Institute, New York, US
| | - Theo G M Sandfort
- Department of Psychiatry, Columbia University, New York, US.,HIV Center for Behavioral Studies, New York State Psychiatric Institute, New York, US.,Department of Sociomedical Sciences, Columbia University, New York, US.,Faculty of Humanities, University of Pretoria, Pretoria, South Africa
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8
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Blalock DV, Grubber J, Smith VA, Zulman DM, Weidenbacher HJ, Greene L, Dedert EA, Maciejewski ML. The association of alcohol use with all-cause and cardiovascular disease-related hospitalizations or death in older, high-risk Veterans. Alcohol Clin Exp Res 2021; 45:1215-1224. [PMID: 33844300 DOI: 10.1111/acer.14610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 03/31/2021] [Accepted: 03/31/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The prevalence of alcohol misuse among older adults has grown dramatically in the past decade, yet little is known about the association of alcohol misuse with hospitalization and death in this patient population. METHODS We examined the association between alcohol use (measured by a screening instrument in primary care) and rates of all-cause and cardiovascular disease (CVD)-related 6-month hospitalization or death via electronic health records (EHRs) in a nationally representative sample of older, high-risk Veterans. Models were adjusted for sociodemographic and clinical characteristics, including frailty and comorbid conditions. RESULTS The all-cause hospitalization or death rate at 6 months was 14.9%, and the CVD-related hospitalization or death rate was 1.8%. In adjusted analyses, all-cause hospitalization or death was higher in older Veterans who were nondrinkers or harmful use drinkers compared to moderate use drinkers, but CVD-related hospitalization or death was similar in all categories of drinking. CONCLUSIONS These findings suggest that the complex association between alcohol and all-cause acute healthcare utilization found in the broader population is similar in older, high-risk Veteran patients. These findings do not support an association between alcohol consumption and CVD-specific hospitalizations.
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Affiliation(s)
- Dan V Blalock
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT, Durham Veterans Affairs Health Care System, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Janet Grubber
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Valerie A Smith
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT, Durham Veterans Affairs Health Care System, Durham, NC, USA.,Department of Population Health Sciences, Duke University, Durham, NC, USA.,Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC, USA
| | - Donna M Zulman
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Hollis J Weidenbacher
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Liberty Greene
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Eric A Dedert
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.,Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Matthew L Maciejewski
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT, Durham Veterans Affairs Health Care System, Durham, NC, USA.,Department of Population Health Sciences, Duke University, Durham, NC, USA.,Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC, USA
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9
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Fernandez AC, Guetterman TC, Borsari B, Mello MJ, Mellinger J, Tonnesen H, Hosanagar A, Morris AM, Blow FC. Gaps in Alcohol Screening and Intervention Practices in Surgical Healthcare: A Qualitative Study. J Addict Med 2021; 15:113-119. [PMID: 32769774 DOI: 10.1097/adm.0000000000000706] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Risky alcohol use before surgery is associated with an increased risk of postoperative complications and longer hospital stays. Preoperative alcohol interventions can improve surgical outcomes but are not commonly integrated into routine care. This study sought to better understand patient's and provider's perceptions of alcohol-related surgical health and healthcare practices and illuminate gaps in care and how they could be improved. METHODS This study used a descriptive qualitative research design. Data were collected between July 2017 and March 2018. One-on-one interviews assessed domains related to knowledge, gaps in alcohol-related screening and intervention, and interest in enhancing alcohol-related care. Key themes emerged from a process of iterative coding and thematic analysis. RESULTS Participants included elective surgical patients who met alcohol screening criteria (n = 20) and surgical healthcare providers (n = 9). Participants had modest or low awareness of alcohol-related surgical health risks. Basic alcohol screening was a routine part of care, but results were often discounted or overlooked. Providers did not routinely initiate preoperative alcohol education or intervention. Providers viewed improving alcohol-related clinical practices as a low priority. Patients were interested in receiving alcohol interventions before surgery if they were delivered in a nonjudgement style and focused on surgical health optimization. CONCLUSIONS This study highlights potential gaps in alcohol-related knowledge and care, and found providers place a low priority on alcohol interventions in the perioperative context. Given the high complication rate associated with preoperative alcohol use, these topics are worthy of future research. To be successful strategies to overcome specific barriers to alcohol screening and intervention must address the needs of patients and providers.
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Affiliation(s)
- Anne C Fernandez
- Department of Psychiatry, University of Michigan, Ann Arbor, MI (ACF, AH, FCB); Department of Family Medicine, University of Michigan, Ann Arbor, MI (TCG); Mental Health Service, San Francisco VA Health Care System, San Francisco, CA (BB); Department of Psychiatry, University of California, San Francisco, 982 Mission St, San Francisco, CA 94103 (BB); Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI (MJM); Department of Health Services, Practice and Policy, Brown University School of Public Health, Providence, RI (MJM); Department of Gastroenterology, University of Michigan, Ann Arbor, MI (JM); Clinical Health Promotion Centre, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Denmark (HT); Mental Health Service, VA Ann Arbor Health System, Ann Arbor, MI (AH, FCB); S-SPIRE Center, Department of Surgery, Stanford University School of Medicine, Stanford, CA (AMM)
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10
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Hoonpongsimanont W, Ghanem G, Saadat S, Nguyen M, Louis C, Sahota PK, Danishgar L, Carroll C, Barrios C, Lotfipour S. Correlation between Alcohol Use Disorders, Blood Alcohol Content, and Length of Stay in Trauma Patients. J Emerg Trauma Shock 2021; 14:42-47. [PMID: 33911436 PMCID: PMC8054814 DOI: 10.4103/jets.jets_10_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 05/08/2020] [Accepted: 08/22/2020] [Indexed: 01/12/2023] Open
Abstract
Background: Patients with an alcohol use disorder (AUD) have an increased risk of developing complications during their hospital stays; however, how AUD impacts the length of stay (LOS) and the utilization of hospital resources remains inconclusive. Aim: This study aimed to identify the associations between AUD, defined by self-reported alcohol consumption, blood alcohol content (BAC), and hospital LOS (HLOS) including intensive care unit (ICU) LOS in the trauma patient population. Study Design: We conducted a retrospective study analyzing data obtained from 2010 to 2018 at a university-based, level-one trauma emergency department. We identified 1689 adult trauma patients who completed the AUDs identification test (AUDIT) and were admitted to the hospital. We retrieved BAC, age, gender, LOS, and injury severity score (ISS) from the patient charts. The independent samples' median test was used to assess the association of HLOS and ICULOS with ISS, BAC levels, or AUDIT scores. Results: ISS was directly associated with higher HLOS (P < 0.001) and ICULOS (P < 0.001); however there was no statistically significant association between AUDIT scores and ICULOS (P = 0.21) or HLOS (P = 0.86). There was also no statistically significant association between BAC and HLOS (P = 0.09) or ICULOS (P = 0.07). Conclusions: Our study found no associations between AUDIT, BAC, and both hospital and ICU LOS in trauma patients even though the literature supported an increased risk of medical complications in the AUD patients.
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Affiliation(s)
| | - Ghadi Ghanem
- Department of Emergency Medicine, University of California Irvine, California, USA
| | - Soheil Saadat
- Department of Emergency Medicine, University of California Irvine, California, USA
| | - Maria Nguyen
- Department of Emergency Medicine, University of California Irvine, California, USA
| | - Christine Louis
- Department of Emergency Medicine, University of California Irvine, California, USA
| | - Preet K Sahota
- Department of Emergency Medicine, University of California Irvine, California, USA
| | - Leila Danishgar
- Department of Emergency Medicine, University of California Irvine, California, USA
| | - Christy Carroll
- Center for Trauma and Injury Prevention Research, University of California Irvine, California, USA
| | - Cristobal Barrios
- Department of Surgery, University of California Irvine, California, USA
| | - Shahram Lotfipour
- Department of Emergency Medicine, University of California Irvine, California, USA
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11
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Harris AHS, Kuo AC, Bowe TR, Manfredi L, Lalani NF, Giori NJ. Can Machine Learning Methods Produce Accurate and Easy-to-Use Preoperative Prediction Models of One-Year Improvements in Pain and Functioning After Knee Arthroplasty? J Arthroplasty 2021; 36:112-117.e6. [PMID: 32798181 DOI: 10.1016/j.arth.2020.07.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/23/2020] [Accepted: 07/11/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Approximately 15%-20% of total knee arthroplasty (TKA) patients do not experience clinically meaningful improvements. We sought to compare the accuracy and parsimony of several machine learning strategies for developing predictive models of failing to experience minimal clinically important differences in patient-reported outcome measures (PROMs) 1 year after TKA. METHODS Patients (N = 587) in 3 large Veteran Health Administration facilities completed PROMs before and 1 year after TKA (92% follow-up). Preoperative PROMs and electronic health record data were used to develop and validate models to predict failing to experience at least a minimal clinically important difference in Knee Injury and Osteoarthritis Outcome Score (KOOS) Total, KOOS JR, and KOOS subscales (Pain, Symptoms, Activities of Daily Living, Quality of Life, and recreation). Several machine learning strategies were used for model development. Ten-fold cross-validation and bootstrapping were used to produce measures of overall accuracy (C-statistic, Brier Score). The sensitivity and specificity of various predicted probability cut-points were examined. RESULTS The most accurate models produced were for the Activities of Daily Living, Pain, Symptoms, and Quality of Life subscales of the KOOS (C-statistics 0.76, 0.72, 0.72, and 0.71, respectively). Strategies varied substantially in terms of the numbers of inputs required to achieve similar accuracy, with none being superior for all outcomes. CONCLUSION Models produced in this project provide estimates of patient-specific improvements in major outcomes 1 year after TKA. Integrating these models into clinical decision support, informed consent and shared decision making could improve patient selection, education, and satisfaction. LEVEL OF EVIDENCE Level III, diagnostic study.
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Affiliation(s)
- Alex H S Harris
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Palo Alto, CA; Department of Surgery, Stanford-Surgical Policy Improvement Research and Education (S-SPIRE) Center, Stanford, CA
| | - Alfred C Kuo
- San Francisco Veterans Affairs Medical Center, University of California, San Francisco, CA
| | - Thomas R Bowe
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Palo Alto, CA
| | - Luisa Manfredi
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Palo Alto, CA
| | - Narlina F Lalani
- Center for Care Delivery and Outcomes Research, VA Minneapolis Healthcare System, Minneapolis, MN
| | - Nicholas J Giori
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Palo Alto, CA; Department of Orthopedic Surgery, Stanford University School of Medicine, Stanford, CA
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12
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Bierle DM, Raslau D, Regan DW, Sundsted KK, Mauck KF. Preoperative Evaluation Before Noncardiac Surgery. Mayo Clin Proc 2020; 95:807-822. [PMID: 31753535 DOI: 10.1016/j.mayocp.2019.04.029] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/23/2019] [Accepted: 04/30/2019] [Indexed: 01/19/2023]
Abstract
The medical complexity of surgical patients is increasing and medical specialties are frequently asked to assist with the perioperative management surgical patients. Effective pre-anesthetic medical evaluations are a valuable tool in providing high-value, patient-centered surgical care and should systematically address risk assessment and identify areas for risk modification. This review outlines a structured approach to the pre-anesthetic medical evaluation, focusing on the asymptomatic patient. It discusses the evidence supporting the use of perioperative risk calculation tools and focused preoperative testing. We also introduce important key topics that will be explored in greater detail in upcoming reviews in this series.
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Affiliation(s)
- Dennis M Bierle
- Mayo Clinic Rochester, Division of General Internal Medicine, Rochester, MN.
| | - David Raslau
- Mayo Clinic Rochester, Division of General Internal Medicine, Rochester, MN
| | - Dennis W Regan
- Mayo Clinic Rochester, Division of General Internal Medicine, Rochester, MN
| | - Karna K Sundsted
- Mayo Clinic Rochester, Division of General Internal Medicine, Rochester, MN
| | - Karen F Mauck
- Mayo Clinic Rochester, Division of General Internal Medicine, Rochester, MN
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13
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Level of Alcohol Use Associated with HIV Care Continuum Targets in a National U.S. Sample of Persons Living with HIV Receiving Healthcare. AIDS Behav 2019; 23:140-151. [PMID: 29995206 DOI: 10.1007/s10461-018-2210-6] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We evaluated associations between levels of alcohol use and HIV care continuum components using national Veterans Aging Cohort Study data for all patients with HIV and AUDIT-C screening (2/1/2008-9/30/2014). Poisson regression models evaluated associations between alcohol use levels (non-drinking, low-, medium-, high-, and very high-level drinking) and: (1) engagement with care (documented CD4 cells/µl or viral load copies/ml labs), (2) ART treatment (≥ 1 prescription), and (3) viral suppression (HIV RNA < 500 copies/ml) within one year. Among 33,224 patients, alcohol use level was inversely associated with all care continuum outcomes (all p < 0.001). Adjusted prevalence of care engagement ranged from 77.8% (95% CI 77.1-78.4%) for non-drinking to 69.1% (66.6-71.6%) for high-level drinking. The corresponding range for ART treatment was 74.0% (73.3-74.7%) to 60.1% (57.3-62.9%) and for viral suppression was 57.3% (56.5-58.1%) to 38.3% (35.6-41.1%). Greater alcohol use is associated with suboptimal HIV treatment across the HIV care continuum.
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14
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Feng JE, Novikov D, Anoushiravani AA, Wasterlain AS, Lofton HF, Oswald W, Nazemzadeh M, Weiser S, Berger JS, Iorio R. Team Approach: Perioperative Optimization for Total Joint Arthroplasty. JBJS Rev 2018; 6:e4. [DOI: 10.2106/jbjs.rvw.17.00147] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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15
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Mutch WAC, El-Gabalawy R, Girling L, Kilborn K, Jacobsohn E. End-Tidal Hypocapnia Under Anesthesia Predicts Postoperative Delirium. Front Neurol 2018; 9:678. [PMID: 30174647 PMCID: PMC6108130 DOI: 10.3389/fneur.2018.00678] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 07/27/2018] [Indexed: 12/30/2022] Open
Abstract
Background: Postoperative delirium (POD) might be associated with anesthetic management, but research has focused on choice or dosage of anesthetic drugs. We examined potential contributions of intraoperative ventilatory and hemodynamic management to POD. Methods: This was a sub-study of the ENGAGES-Canada trial (NCT02692300) involving non-cardiac surgery patients enrolled in Winnipeg, Canada. Patients received preoperative psychiatric and cognitive assessments, and intraoperatively underwent high-fidelity data collection of blood pressure, end-tidal respiratory gases and anesthetic agent concentration. POD was assessed by peak and mean POD scores using the Confusion Assessment Method-Severity (CAM-S) tool. Bivariate and multiple linear regression models were constructed controlling for age, psychiatric illness, and cognitive dysfunction in the examination of deviations in intraoperative end-tidal carbon dioxide (areas over (AOC) and under the curve (AUC)) on POD severity scores. Results: A total of 101 subjects [69 (6) years of age] were studied; 89 had comprehensive intraoperative hemodynamic and end-tidal gas measurements (data recorded at 1 Hz). The incidence of POD was 11.9% (12/101). Age, cognitive dysfunction, anxiety, depression, and intraoperative end-tidal CO2 (AUC) were significant correlates of POD severity. In the multiple regression model, cognitive dysfunction and AUC end-tidal CO2 (0.67 kPa below median intra-operative value) were the only independent significant predictors across both POD severity (mean and peak) scores. There was no association between cumulative anesthetic agent exposure and POD. Conclusions: POD was associated with intraoperative ventilatory management, reflected by low end-tidal CO2 concentrations, but not with cumulative anesthetic drug exposure. These findings suggest that maintenance of intraoperative normocapnia might benefit patients at risk of POD.
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Affiliation(s)
- W Alan C Mutch
- Department of Anesthesia and Perioperative Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Canada North Concussion Network (www.CNCN.ca), Winnipeg, MB, Canada
| | - Renée El-Gabalawy
- Department of Anesthesia and Perioperative Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Department of Clinical Health Psychology, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Linda Girling
- Department of Anesthesia and Perioperative Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Kayla Kilborn
- Department of Anesthesia and Perioperative Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Eric Jacobsohn
- Department of Anesthesia and Perioperative Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
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16
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17
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Feng JE, Novikov D, Anoushiravani AA, Schwarzkopf R. Total knee arthroplasty: improving outcomes with a multidisciplinary approach. J Multidiscip Healthc 2018; 11:63-73. [PMID: 29416347 PMCID: PMC5790068 DOI: 10.2147/jmdh.s140550] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Total knee arthroplasty (TKA) is the most commonly performed inpatient surgical procedure within the USA and is estimated to reach 3.48 million procedures annually by 2030. As value-based care initiatives continue to focus on hospital readmission rates and patient satisfaction, it has become essential for health care providers to develop and implement a multidisciplinary approach to enhance TKA outcomes while minimizing unnecessary expenditures. Through this necessity, clinical care pathways have been developed to standardize, organize, and improve the quality and efficiency of patient care while simultaneously encouraging the collaboration among various medical care providers. Here, we review several systems based programs and specialty care practices that can be adopted into the standard orthopedic practice.
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Affiliation(s)
- James E Feng
- Division of Adult Reconstructive Surgery, NYU Langone Orthopedics, NYU Langone Health, New York, NY, USA
| | - David Novikov
- Division of Adult Reconstructive Surgery, NYU Langone Orthopedics, NYU Langone Health, New York, NY, USA
| | - Afshin A Anoushiravani
- Division of Adult Reconstructive Surgery, NYU Langone Orthopedics, NYU Langone Health, New York, NY, USA
| | - Ran Schwarzkopf
- Division of Adult Reconstructive Surgery, NYU Langone Orthopedics, NYU Langone Health, New York, NY, USA
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Chavez LJ, Liu CF, Tefft N, Hebert PL, Devine B, Bradley KA. The Association Between Unhealthy Alcohol Use and Acute Care Expenditures in the 30 Days Following Hospital Discharge Among Older Veterans Affairs Patients with a Medical Condition. J Behav Health Serv Res 2017; 44:602-624. [PMID: 27585803 PMCID: PMC5332352 DOI: 10.1007/s11414-016-9529-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Hospital readmissions and emergency department (ED) visits within 30 days of discharge are costly. Heavy alcohol use could predict increased risk for post-discharge acute care. This study assessed 30-day acute care utilization and expenditures for different categories of alcohol use. Veterans Affairs (VA) patients age ≥65 years with past-year alcohol screening, hospitalized for a medical condition, were included. VA and Medicare health care utilization data were used. Two-part models adjusted for patient demographics. Among 416,050 hospitalized patients, 25% had 30-day acute care use. Nondrinking patients (n = 267,746) had increased probability of acute care use, mean utilization days, and expenditures (difference of $345; 95% CI $268-$423), relative to low-risk drinkers (n = 105,023). High-risk drinking patients (n = 5,300) had increased probability of acute care use and mean utilization days, but not expenditures. Although these patients did not have greater acute care expenditures than low-risk drinking patients, they may nevertheless be vulnerable to poor post-discharge outcomes.
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Affiliation(s)
- Laura J Chavez
- Health Services Research & Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA, 98108, USA.
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, 1841 Neil Avenue, Columbus, OH, 43210, USA.
| | - Chuan-Fen Liu
- Health Services Research & Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA, 98108, USA
- Department of Health Services, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA
| | - Nathan Tefft
- Bates College, 2 Andrews Rd, Lewiston, ME, 04240, USA
| | - Paul L Hebert
- Health Services Research & Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA, 98108, USA
- Department of Health Services, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA
| | - Beth Devine
- Department of Pharmacy, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA
| | - Katharine A Bradley
- Health Services Research & Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA, 98108, USA
- Department of Health Services, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA
- Center of Excellence in Substance Abuse Treatment and Education, Veterans Affairs Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA, 98108, USA
- Department of Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA
- Group Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101, USA
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19
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Eriksen TR, Shumba L, Ekeberg Ø, Bogstrand ST. The association between hospital admission and substance use among trauma patients. JOURNAL OF SUBSTANCE USE 2017. [DOI: 10.1080/14659891.2017.1348557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - Linnea Shumba
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Øivind Ekeberg
- Division of Mental Health and Addiction, Oslo University Hospital Ullevaal, Nydalen, Oslo, Norway
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Blindern, Oslo, Norway
| | - Stig Tore Bogstrand
- Department of Drug Abuse Research, Norwegian Institute of Public Health, Nydalen, Oslo, Norway
- Lovisenberg University College, Oslo, Norway
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20
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Knox J, Reddy V, Lane T, Hasin D, Sandfort T. Substance Use and Sexual Risk Behavior Among Black South African Men Who Have Sex With Men: The Moderating Effects of Reasons for Drinking and Safer Sex Intentions. AIDS Behav 2017; 21:2023-2032. [PMID: 28025737 DOI: 10.1007/s10461-016-1652-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Research studies suggest an association between substance use and sexual risk behavior, but are not completely consistent. The moderating effects of other psychosocial factors might help explain these inconsistencies. The current study therefore assessed whether substance use is associated with sexual risk behavior, and whether this relationship is modified by expectancies about the effects of alcohol, reasons for consuming alcohol, or intentions to engage in safe sex. A cross-sectional survey was conducted among 480 black South African men who have sex with men recruited using respondent-driven sampling. In multivariable analyses, the effect of alcohol use on unprotected receptive anal intercourse (URAI) was modified by drinking to enhance social interaction (R2 change = 0.03, p < 0.01). The effect of drug use on URAI was modified by safe sex intentions (R2 change = 0.03, p < 0.001). Alcohol use was positively associated with URAI only among those who drink to enhance social interaction (β = 0.08, p < 0.05). Drug use was positively associated with URAI only among those with high safe sex intentions (β = 0.30, p < 0.001). Our findings suggest that efforts to minimize the impact of substance use on HIV risk behavior should target men who drink to enhance social interaction and men who intend to engage in safer sex. Efforts made to increase safer sex intentions as a way to reduce HIV risk behavior should additionally consider the effects of substance use.
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Affiliation(s)
- Justin Knox
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, 10032, USA.
| | - Vasu Reddy
- Faculty of Humanities, University of Pretoria, Pretoria, South Africa
| | - Tim Lane
- Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, USA
| | - Deborah Hasin
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, 10032, USA
| | - Theo Sandfort
- HIV Center for Clinical and Behavioral Studies, NYS Psychiatric Institute and Columbia University, New York, NY, USA
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21
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Bradley KA, Rubinsky AD, Lapham GT, Berger D, Bryson C, Achtmeyer C, Hawkins EJ, Chavez LJ, Williams EC, Kivlahan DR. Predictive validity of clinical AUDIT-C alcohol screening scores and changes in scores for three objective alcohol-related outcomes in a Veterans Affairs population. Addiction 2016; 111:1975-1984. [PMID: 27349855 DOI: 10.1111/add.13505] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 01/27/2016] [Accepted: 06/16/2016] [Indexed: 12/21/2022]
Abstract
AIMS To evaluate the association between Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) alcohol screening scores, collected as part of routine clinical care, and three outcomes in the following year (Aim 1), and the association between changes in AUDIT-C risk group at 1-year follow-up and the same outcomes in the subsequent year (Aim 2). DESIGN Cohort study. SETTING Twenty-four US Veterans Affairs (VA) healthcare systems (2004-07), before systematic implementation of brief intervention. PARTICIPANTS A total of 486 115 out-patients with AUDIT-Cs documented in their electronic health records (EHRs) on two occasions ≥ 12 months apart ('baseline' and 'follow-up'). MEASUREMENTS Independent measures were baseline AUDIT-C scores and change in standard AUDIT-C risk groups (no use, low-risk use and mild, moderate, severe misuse) from baseline to follow-up. Outcome measures were (1) high-density lipoprotein cholesterol (HDL), (2) alcohol-related gastrointestinal hospitalizations ('GI hospitalizations') and (3) physical trauma, each in the years after baseline and follow-up. FINDINGS Baseline AUDIT-C scores had a positive association with outcomes in the following year. Across AUDIT-C scores 0-12, mean HDL ranged from 41.4 [95% confidence interval (CI) = 41.3-41.5] to 53.5 (95% CI = 51.4-55.6) mg/l, and probabilities of GI hospitalizations from 0.49% (95% CI = 0.48-0.51%) to 1.8% (95% CI = 1.3-2.3%) and trauma from 3.0% (95% CI = 2.95-3.06%) to 6.0% (95% CI = 5.2-6.8%). At follow-up, patients who increased to moderate or severe alcohol misuse had consistently higher mean HDL and probabilities of subsequent GI hospitalizations or trauma compared with those who did not (P-values all < 0.05). For example, among those with baseline low-risk use, in those with persistent low-risk use versus severe misuse at follow-up, the probabilities of subsequent trauma were 2.65% (95% CI = 2.54-2.75%) versus 5.15% (95% CI = 3.86-6.45%), respectively. However, for patients who decreased to lower AUDIT-C risk groups at follow-up, findings were inconsistent across outcomes, with only mean HDL decreasing in most groups that decreased use (P-values all < 0.05). CONCLUSIONS When AUDIT-C screening is conducted in clinical settings, baseline AUDIT-C scores and score increases to moderate-severe alcohol misuse at follow-up screening appear to have predictive validity for HDL cholesterol, alcohol-related gastrointestinal hospitalizations and physical trauma. Decreasing AUDIT-C scores collected in clinical settings appear to have predictive validity for only HDL.
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Affiliation(s)
- Katharine A Bradley
- Health Services Research and Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA. .,Center of Excellence in Substance Abuse Treatment and Education (CESATE), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA. .,Group Health Research Institute, Seattle, WA, USA. .,Department of Health Services, University of Washington, Seattle, WA, USA. .,Department of Medicine, University of Washington, Seattle, WA, USA.
| | - Anna D Rubinsky
- Health Services Research and Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA.,Center of Excellence in Substance Abuse Treatment and Education (CESATE), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA.,The Kidney Health Research Collaborative, University of California, San Francisco and San Francisco VA Medical Center, San Francisco, CA, USA
| | - Gwen T Lapham
- Health Services Research and Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA.,Group Health Research Institute, Seattle, WA, USA
| | - Douglas Berger
- General Medicine Services, Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA
| | - Christopher Bryson
- Health Services Research and Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA.,General Medicine Services, Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Carol Achtmeyer
- Health Services Research and Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA.,Center of Excellence in Substance Abuse Treatment and Education (CESATE), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA.,General Medicine Services, Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Eric J Hawkins
- Health Services Research and Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA.,Center of Excellence in Substance Abuse Treatment and Education (CESATE), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Laura J Chavez
- Health Services Research and Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA
| | - Emily C Williams
- Health Services Research and Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA.,Department of Health Services, University of Washington, Seattle, WA, USA
| | - Daniel R Kivlahan
- Health Services Research and Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA.,Center of Excellence in Substance Abuse Treatment and Education (CESATE), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA
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Clark BJ, Rubinsky AD, Ho PM, Au DH, Chavez LJ, Moss M, Bradley KA. Alcohol screening scores and the risk of intensive care unit admission and hospital readmission. Subst Abus 2016; 37:466-473. [PMID: 26730984 PMCID: PMC5669033 DOI: 10.1080/08897077.2015.1137259] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The association between alcohol misuse and the need for intensive care unit admission as well as hospital readmission among those discharged from the hospital following a critical illness is unclear. This study sought to determine whether alcohol misuse was associated with (1) admission to an intensive care unit (ICU) among a cohort of patients receiving outpatient care and (2) hospital readmission among those discharged from the hospital following critical illness. METHODS This was a retrospective cohort study conducted with data from 24 Veterans Affairs (VA) health care facilities between 2004 and 2007. Scores on the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) questionnaire were used to identify patients with past-year abstinence, lower-risk alcohol use, moderate alcohol misuse, or severe alcohol misuse. The primary outcome was admission to a VA intensive care unit within the year following administration of the AUDIT-C. In an analysis focused on patients discharged from the ICU, the 2 main outcomes were hospital readmission within 1 year and within 30 days. RESULTS Among 486,115 veterans receiving outpatient care, the adjusted probability of ICU admission within 1 year was 2.0% (95% confidence interval [CI]: 1.7%-2.3%) for abstinent patients, 1.6% (95% CI: 1.3%-1.8%) for patients with lower-risk alcohol use, 1.8% (1.4%-2.3%) for patients with moderate alcohol misuse, and 2.5% (2.0%-2.9%) for patients with severe alcohol misuse. Among the 9,030 patients discharged from an ICU, the adjusted probability of hospital readmission within 1 year was 48% (46%-49%) in abstinent patients, 44% (42%-45%) in patients with lower-risk alcohol use, 42% (39%-45%) in patients with moderate alcohol misuse, and 55% (49%-60%) in patients with severe alcohol misuse. CONCLUSIONS Alcohol misuse may represent a modifiable risk factor for a cycle of ICU admission and subsequent hospital readmission.
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Affiliation(s)
- Brendan J. Clark
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Aurora, CO, U.S
| | - Anna D. Rubinsky
- Center of Excellence for Substance Abuse Treatment and Education, Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA, U.S
- Health Services Research and Development, Department of Veterans Affairs Puget Sound health Care System, Seattle, WA, U.S
| | - P. Michael Ho
- Division of Cardiology, Department of Medicine, Denver VAMC, Denver, CO; University of Colorado, Aurora, CO, U.S
| | - David H. Au
- Health Services Research and Development, Department of Veterans Affairs Puget Sound health Care System, Seattle, WA, U.S
| | - Laura J. Chavez
- Health Services Research and Development, Department of Veterans Affairs Puget Sound health Care System, Seattle, WA, U.S
| | - Marc Moss
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Aurora, CO, U.S
| | - Katharine A. Bradley
- Center of Excellence for Substance Abuse Treatment and Education, Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA, U.S
- Health Services Research and Development, Department of Veterans Affairs Puget Sound health Care System, Seattle, WA, U.S
- Group Health Research Institute – Seattle, WA, U.S
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23
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Chavez LJ, Liu CF, Tefft N, Hebert PL, Clark BJ, Rubinsky AD, Lapham GT, Bradley KA. Unhealthy alcohol use in older adults: Association with readmissions and emergency department use in the 30 days after hospital discharge. Drug Alcohol Depend 2016; 158:94-101. [PMID: 26644137 PMCID: PMC4749399 DOI: 10.1016/j.drugalcdep.2015.11.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 11/04/2015] [Accepted: 11/05/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Unhealthy alcohol use could impair recovery of older patients after medical or surgical hospitalizations. However, no prior research has evaluated whether older patients who screen positive for unhealthy alcohol use are at increased risk of readmissions or emergency department (ED) visits within 30 days after discharge. This study examined the association between AUDIT-C alcohol screening results and 30-day readmissions or ED visits. METHODS Veterans Affairs (VA) patients age 65 years or older, were eligible if they were hospitalized for a medical or surgical condition (2/1/2009-10/1/2011) and had an AUDIT-C score documented in their VA electronic medical record in the year before they were hospitalized. VA and Medicare data identified VA or non-VA index hospitalizations, readmissions, and ED visits. Primary analyses adjusted for demographics, comorbid conditions, and past-year health care utilization. RESULTS Among 579,330 hospitalized patients, 13.7% were readmitted and 12.0% visited an ED within 30 days of discharge. In primary analyses, high-risk drinking (n=7,167) and nondrinking (n=357,086) were associated with increased probability of readmission (13.8%, 95% CI 13.0-14.6%; and 14.2%, 95% CI 14.1-14.3%, respectively), relative to low-risk drinking (12.9%; 95% CI 12.7-13.0%). Only nondrinkers had increased risk for ED visits. CONCLUSIONS Alcohol screening results indicating high-risk drinking that were available in medical records were modestly associated with risk for 30-day readmissions and were not associated with risk for ED visits.
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Affiliation(s)
- Laura J. Chavez
- Health Services Research & Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, United States,Departments of Health Services, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, United States,Corresponding author at: University of Washington, Department of Health Services, 1959 NE Pacific Street, Box 357660, Seattle, WA 98195, United States. Tel.: +1 678 371 2197; fax: +1 206 543 3964
| | - Chuan-Fen Liu
- Health Services Research & Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, United States; Department of Health Services, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, United States.
| | - Nathan Tefft
- Bates College, 2 Andrews Rd, Lewiston, ME 04240, United States.
| | - Paul L Hebert
- Health Services Research & Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, United States; Department of Health Services, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, United States.
| | - Brendan J. Clark
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver, 12700 East 19th Ave, Aurora, CO 80045, United States
| | - Anna D. Rubinsky
- Health Services Research & Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, United States,Center of Excellence in Substance Abuse Treatment and Education, Veterans Affairs Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, United States
| | - Gwen T. Lapham
- Health Services Research & Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, United States,Group Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, United States
| | - Katharine A. Bradley
- Health Services Research & Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, United States,Center of Excellence in Substance Abuse Treatment and Education, Veterans Affairs Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, United States,Departments of Health Services, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, United States,Departments of Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, United States,Group Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, United States
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Wurst FM, Thon N, Yegles M, Schrück A, Preuss UW, Weinmann W. Ethanol Metabolites: Their Role in the Assessment of Alcohol Intake. Alcohol Clin Exp Res 2015; 39:2060-72. [DOI: 10.1111/acer.12851] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 07/22/2015] [Indexed: 01/12/2023]
Affiliation(s)
- Friedrich M. Wurst
- Paracelsus Medical University; Salzburg Austria
- Center for Interdisciplinary Addiction Research; University of Hamburg; Hamburg Germany
| | | | - Michel Yegles
- Service de Toxicologie; Laboratoire National de Sante; Luxembourg Luxembourg
| | - Alexandra Schrück
- Institute of Forensic Medicine; University of Bern; Bern Switzerland
| | - Ulrich W. Preuss
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine; University of Halle; Halle Germany
| | - Wolfgang Weinmann
- Institute of Forensic Medicine; University of Bern; Bern Switzerland
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Fernandez AC, Claborn KR, Borsari B. A systematic review of behavioural interventions to reduce preoperative alcohol use. Drug Alcohol Rev 2015; 34:508-520. [PMID: 26120973 DOI: 10.1111/dar.12285] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 03/21/2015] [Indexed: 11/29/2022]
Abstract
ISSUES Preoperative alcohol use is associated with an increase in postoperative morbidity and mortality. Short-term abstinence prior to elective surgery has been shown to reduce postoperative risks. Therefore, behavioural intervention (BI) targeting risky drinking may have significant utility in preventing surgical complications. APPROACH The literature was systematically reviewed to identify the scope and outcomes of BIs aiming to reduce alcohol use in risky drinkers before they underwent surgery. Five databases were searched using PRISMA criteria. Of 1243 studies identified, four met pre-established inclusion criteria: (i) implementation of a BI prior to an elective surgery; (ii) the BI-targeted alcohol use among risky drinkers; and (iii) printed in English. KEY FINDINGS Two studies indicated significant reductions in alcohol use at follow ups, and one study demonstrated reductions in postoperative risks. These findings are encouraging, but in light of methodological limitations, the efficacy of preoperative BIs for risky drinking could not be determined. IMPLICATIONS Future efforts to screen and implement BIs addressing alcohol use in preoperative patients should carefully define risky drinking, allow ample time for recruitment prior to surgery, implement empirically supported interventions, examine the impact of relevant covariates, and consider the statistical power needed to detect change in postoperative complications. CONCLUSION Given the strong link between preoperative alcohol use and postoperative risks, additional research on preoperative BIs is critically needed. Existing research suggests several promising directions for research that may enhance future intervention efforts with this high-risk population. [Fernandez AC, Claborn KR, Borsari B. A systematic review of behavioural interventions to reduce preoperative alcohol use. Drug Alcohol Rev 2015;34:508-20].
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Affiliation(s)
- Anne C Fernandez
- Brown School of Public Health, Center for Alcohol and Addiction Studies, Providence, USA
| | - Kasey R Claborn
- Brown School of Public Health, Center for Alcohol and Addiction Studies, Providence, USA
| | - Brian Borsari
- Brown School of Public Health, Center for Alcohol and Addiction Studies, Providence, USA.,Mental Health and Behavioral Sciences Service, Providence Veteran's Affairs Medical Center, Providence, USA
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A group-based brief intervention for surgery patients with high-risk substance use. Gen Hosp Psychiatry 2014; 36:637-43. [PMID: 25264340 DOI: 10.1016/j.genhosppsych.2014.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 08/07/2014] [Accepted: 08/08/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE This study examined the feasibility and efficacy of a psychosocial intervention to address high-risk substance use in patients scheduled for elective surgery. METHOD A group-format intervention, based on motivational interviewing principles, was provided prior to elective surgery to 107 participants with at-risk substance use, identified using the Alcohol Use Disorders Identification Test - Condensed (AUDIT-C) and self-report of illicit drug use. Patient satisfaction was assessed with an anonymous survey. Within-subject comparisons of substance use at baseline and at a postoperative follow-up evaluation were conducted. A control group of 67 surgery patients reporting high-risk substance use completed baseline assessments and received usual care. Medical outcomes and measures of utilization were compared between groups. RESULTS Patient satisfaction with the brief intervention was high. A paired t test comparing average pre- and post-AUDIT-C scores showed significant reduction in substance use postsurgery (t = 9.94, P = .000), and participants reported intention to maintain reduced substance use levels. Between-group analyses revealed no significant differences in medical complications or utilization. CONCLUSION Findings suggest that a group-based intervention for substance use disorder can be implemented as part of preoperative care and may contribute to decreased substance use prior to and following surgery. Further work is needed to identify methods to reduce adverse medical outcomes in surgical patients.
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Abstract
People with bipolar disorders report a lower quality of life than the general population does, and few mutable factors associated with health-related quality of life (HRQoL) among people with bipolar disorders have been identified. Using a cross-sectional design, these analyses examined whether self-efficacy was associated with mental and physical HRQoL in a sample of 141 patients with bipolar disorder who completed baseline assessments for two randomized controlled trials. Multiple linear regression analyses indicated that higher levels of self-efficacy were associated with higher mental and physical HRQoL, after controlling for demographic factors and clinical factors (including mood symptoms, comorbid medical conditions, and substance use). Future research should examine whether targeted treatments that aim to improve self-efficacy (such as self-management interventions) lead to improvements in HRQoL among people with bipolar disorder and other serious mental illnesses.
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Prevalence and 1-year course of alcohol misuse and smoking in persons with lower extremity amputation as a result of peripheral arterial disease. Am J Phys Med Rehabil 2014; 93:493-502. [PMID: 24508927 DOI: 10.1097/phm.0000000000000055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to describe prevalence of alcohol misuse and smoking among individuals with amputations as a result of peripheral arterial disease before surgery and 12 mos after surgery, changes in these behaviors over time, and factors associated with change. DESIGN This is a prospective cohort study of 75 veterans experiencing their first major unilateral amputation. Measures included demographic and general health information, Alcohol Use Disorders Identification Test, smoking behaviors, and social support. RESULTS Sixteen percent of the participants reported engaging in alcohol misuse at presurgical baseline; and 13% at 12 mos after amputation. Thirty-seven percent of the participants were categorized as smokers at baseline; this number dropped to 29% at 12 mos after amputation. Among those who decreased drinking and quit smoking, there was a trend indicating greater social support. CONCLUSIONS The participants endorsed drinking and smoking behaviors at levels consistent with other types of disability and with veterans using the Veterans Health Administration for their health care. Even with a variety of health concerns, after amputation, most of the smokers and those engaging in alcohol misuse continued to smoke and drink at their preamputation rate. The presence of social support may encourage health behavior change and is an important area for future research and intervention.
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Wurst FM, Thon N, Weinmann W, Yegles M, Preuss U. [What ethanol metabolites as biological markers tell us about alcohol use]. Wien Med Wochenschr 2013; 164:25-33. [PMID: 24322386 DOI: 10.1007/s10354-013-0254-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 11/12/2013] [Indexed: 01/12/2023]
Abstract
Alcohol and tobacco related disorders are the two leading and most expensive causes of illness in central Europe. In addition to self reports and questionnaires, biomarkers are of relevance in diagnosis and therapy of alcohol use disorders. Traditional biomarkers such as gamma glutamyl transpeptidase or mean corpuscular volume are indirect biomarkers and are subject to influence of age, gender and non alcohol related diseases, among others.Direct ethanol metabolites such as ethyl glucuronide (EtG), ethyl sulphate (EtS) and phosphatidylethanol (PEth) are direct metabolites of ethanol, that are positive after intake of ethyl alcohol. They represent useful diagnostic tools for identifying alcohol use even more accurately than traditional biomarkers. Each of these drinking indicators remains positive in serum and urine for a characteristic time spectrum after the cessation of ethanol intake--EtG and EtS in urine up to 7 days, EtG in hair for months after ethanol has left the body. Applications include clinical routine use, emergency room settings, proof of abstinence in alcohol rehabilitation programs, driving under influence offenders, workplace testing, assessment of alcohol intake in the context of liver transplantation and fetal alcohol syndrome.
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Affiliation(s)
- Friedrich Martin Wurst
- Universitätsklinik für Psychiatrie und Psychotherapie II, Christian-Doppler-Klinik, Salzburger Landeskliniken, Paracelsus Medical University (PMU), Ignaz-Harrer-Straße 79, 5020, Salzburg, Österreich,
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Gordon AJ, Bertholet N, McNeely J, Starrels JL, Tetrault JM, Walley AY. 2013 Update in addiction medicine for the generalist. Addict Sci Clin Pract 2013; 8:18. [PMID: 24499640 PMCID: PMC3819258 DOI: 10.1186/1940-0640-8-18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 10/28/2013] [Indexed: 11/10/2022] Open
Abstract
Increasingly, patients with unhealthy alcohol and other drug use are being seen in primary care and other non-specialty addiction settings. Primary care providers are well positioned to screen, assess, and treat patients with alcohol and other drug use because this use, and substance use disorders, may contribute to a host of medical and mental health harms. We sought to identify and examine important recent advances in addiction medicine in the medical literature that have implications for the care of patients in primary care or other generalist settings. To accomplish this aim, we selected articles in the field of addiction medicine, critically appraised and summarized the manuscripts, and highlighted their implications for generalist practice. During an initial review, we identified articles through an electronic Medline search (limited to human studies and in English) using search terms for alcohol and other drugs of abuse published from January 2010 to January 2012. After this initial review, we searched for other literature in web-based or journal resources for potential articles of interest. From the list of articles identified in these initial reviews, each of the six authors independently selected articles for more intensive review and identified the ones they found to have a potential impact on generalist practice. The identified articles were then ranked by the number of authors who selected each article. Through a consensus process over 4 meetings, the authors reached agreement on the articles with implications for practice for generalist clinicians that warranted inclusion for discussion. The authors then grouped the articles into five categories: 1) screening and brief interventions in outpatient settings, 2) identification and management of substance use among inpatients, 3) medical complications of substance use, 4) use of pharmacotherapy for addiction treatment in primary care and its complications, and 5) integration of addiction treatment and medical care. The authors discuss each selected articles' merits, limitations, conclusions, and implication to advancing addiction screening, assessment, and treatment of addiction in generalist physician practice environments.
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Affiliation(s)
- Adam J Gordon
- VA Pittsburgh Healthcare System and University of Pittsburgh, Pittsburgh, PA, USA
| | | | | | - Joanna L Starrels
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
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Rubinsky AD, Bishop MJ, Maynard C, Henderson WG, Hawn MT, Harris AHS, Beste LA, Tønnesen H, Bradley KA. Postoperative risks associated with alcohol screening depend on documented drinking at the time of surgery. Drug Alcohol Depend 2013; 132:521-7. [PMID: 23683792 DOI: 10.1016/j.drugalcdep.2013.03.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 03/27/2013] [Accepted: 03/29/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Both AUDIT-C alcohol screening scores up to a year before surgery and clinical documentation of drinking over 2 drinks per day immediately prior to surgery ("documented drinking >2d/d") are associated with increased postoperative complications and health care utilization. The purpose of this study was to evaluate whether documented drinking >2d/d contributed additional information about postoperative risk beyond past-year AUDIT-C screening results. METHOD Male Veterans Affairs (VA) patients who had a non-emergent, non-cardiac, major surgery assessed by the VA's Surgical Quality Improvement Program 10/2003-9/2006 and completed the AUDIT-C by mailed survey in the prior year were eligible for this study. Linear or logistic regression models compared 30-day postoperative complication(s), return to operating room (OR), hospital length of stay (LOS), and intensive care unit (ICU) days across eight groups defined by past-year AUDIT-C score and clinically documented drinking >2d/d, with AUDIT-C scores 1-4 and no documented drinking >2d/d as the referent, after adjusting for important covariates. RESULTS Overall 8811 patients met inclusion criteria. Among patients with documented drinking >2d/d immediately prior to surgery, postoperative risk varied widely depending on past-year AUDIT-C score; scores ≥5 were associated with increased risk of complication(s), and scores ≥9 with increased hospital LOS and ICU days. Among patients without documentation of drinking >2d/d, increasing AUDIT-C scores were not associated with these outcomes. CONCLUSIONS Clinical documentation of drinking >2d/d immediately prior to surgery contributed additional information about postoperative risk beyond past-year AUDIT-C score. However, among patients with documented drinking >2d/d, postoperative risk varied widely depending on the AUDIT-C score.
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Affiliation(s)
- Anna D Rubinsky
- Health Services Research and Development, Department of Veterans Affairs Puget Sound Health Care System, 1660 South Columbian Way (S-152), Seattle, WA 98108, United States; Department of Health Services, University of Washington, Seattle, WA, United States.
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Clark BJ, Williams A, Feemster LMC, Bradley KA, Macht M, Moss M, Burnham EL. Alcohol screening scores and 90-day outcomes in patients with acute lung injury. Crit Care Med 2013; 41:1518-25. [PMID: 23538449 PMCID: PMC4048714 DOI: 10.1097/ccm.0b013e318287f1bb] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The effects of excess alcohol consumption (alcohol misuse) on outcomes in patients with acute lung injury have been inconsistent, and there are no studies examining this association in the era of low tidal volume ventilation and a fluid conservative strategy. We sought to determine whether validated scores on the Alcohol Use Disorders Identification Test that correspond to past-year abstinence (zone 1), low-risk drinking (zone 2), mild to moderate alcohol misuse (zone 3), and severe alcohol misuse (zone 4) are associated with poor outcomes in patients with acute lung injury. DESIGN Secondary analysis. SETTING The Acute Respiratory Distress Syndrome Network, a consortium of 12 university centers (44 hospitals) dedicated to the conduct of multicenter clinical trials in patients with acute lung injury. SUBJECTS Patients meeting consensus criteria for acute lung injury enrolled in one of three recent Acute Respiratory Distress Syndrome Network clinical trials. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Of 1,133 patients enrolled in one of three Acute Respiratory Distress Syndrome Network studies, 1,037 patients had an Alcohol Use Disorders Identification Test score available for analysis. Alcohol misuse was common with 70 (7%) of patients having Alcohol Use Disorders Identification Test scores in zone 3 and 129 (12%) patients in zone 4. There was a U-shaped association between validated Alcohol Use Disorders Identification Test zones and death or persistent hospitalization at 90 days (34% in zone 1, 26% in zone 2, 27% in zone 3, 36% in zone 4; p < 0.05 for comparison of zone 1 to zone 2 and zone 4 to zone 2). In a multiple logistic regression model, there was a significantly higher odds of death or persistent hospitalization in patients having Alcohol Use Disorders Identification Test zone 4 compared with those in zone 2 (adjusted odds ratio 1.70; 95% confidence interval 1.00, 2.87; p = 0.048). CONCLUSIONS Severe but not mild to moderate alcohol misuse is independently associated with an increased risk of death or persistent hospitalization at 90 days in acute lung injury patients.
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Affiliation(s)
- Brendan J Clark
- Department of Medicine, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver, Aurora, CO, USA.
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Bradley KA, Rubinsky AD, Sun H, Blough DK, Tønnesen H, Hughes G, Beste LA, Bishop MJ, Hawn MT, Maynard C, Harris AS, Hawkins EJ, Bryson CL, Houston TK, Henderson WG, Kivlahan DR. Prevalence of alcohol misuse among men and women undergoing major noncardiac surgery in the Veterans Affairs health care system. Surgery 2012; 152:69-81. [DOI: 10.1016/j.surg.2012.02.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Accepted: 02/09/2012] [Indexed: 12/01/2022]
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