Associations between the stanford integrated psychosocial assessment for transplant and one-year lung transplant medical and psychosocial outcomes

The Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) is a standardized measure of the psychosocial risk profile of solid organ transplant candidates. While studies have found associations between this measure and transplant outcomes, to date this has not been examined in lung transplant recipients. We examined relations between pre-transplant SIPAT scores and 1-year lung transplant medical and psychosocial outcomes in a sample of 45 lung transplant recipients. The SIPAT was significantly associated with 6-minute walk test (χ2(1) = 6.47, p = .010), number of readmissions (χ2(1) = 6.47, p = .011), and mental health services utilization (χ2(1) = 18.15, p < .001). It was not a significantly associated with the presence of organ rejection or mortality (ps > 0.10). Results suggest that the SIPAT can help identify patients who are at an elevated risk for transplant complications and thus would benefit from services to mitigate risk factors and improve outcomes.

Medical outcomes associated with prescription opioid abuse via oral and non-oral routes of administration

BACKGROUND

Prescription opioid abuse and misuse is a serious and growing public health issue. While the most common form of abuse is swallowing intact tablets/capsules, some abusers manipulate, or tamper with, these medications by altering the dosage form to allow for non-oral routes of administration (e.g., injection, inhalation) in order to achieve more rapid or enhanced psychoactive effects. Because administration of opioids via non-oral routes results in greater systemic availability and more rapid central nervous system penetration, we hypothesized that death and major medical outcomes occur more frequently with non-oral routes compared to oral route alone.

METHODS

This retrospective cohort study analyzed data from the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS) System Poison Center Program to investigate relative risk of prescription opioid abuse via oral and non-oral routes.

RESULTS

While the oral route was the most commonly reported route of abuse (64.0%), non-oral routes were reported in 14.6% exposures and unknown routes in 21.4% exposures. The relative risk of an exposure resulting in death or major effect was 2.43 (95% CI 1.97, 2.99) if non-oral routes were reported compared to exposures involving oral route only.

CONCLUSION

Analysis of acute health events recorded by poison centers indicates that death or major effects are twice as likely to occur with intentional abuse of prescription opioids via non-oral routes of administration than ingestion alone. Effective interventions to prevent abuse via non-oral routes of solid dosage forms of prescription opioids, such as abuse-deterrent formulations could have a significant public health impact.

The impact of aggressive driving-related injuries in Ohio, 2004-2009

OBJECTIVE

This study describes the medical and financial impact (hospital charges) of aggressive driving-related injuries in Ohio.

METHODS

Statewide crash and hospital databases were probabilistically linked for 2004 through 2009. Descriptive analyses and multivariate regression modeling of multiply-imputed data on motor vehicle occupants involved in aggressive driving-related crashes were performed.

RESULTS

There were 821,136 motor vehicle occupants involved in aggressive driving-related crashes in Ohio from 2004 through 2009; injuries were sustained by 15.0%. The rate of aggressive driving-related crashes was highest among drivers ages 16 to 19 years (3787.1 crashes per 100,000 licensed drivers). Aggressive driving-related inpatients accrued more than $250.8 million in hospital charges and 28,366 inpatient days of treatment in 2004 through 2009. Occupants ages 16 to 19 years had higher odds of sustaining injury when involved in aggressive driving-related crashes (OR = 1.10; 95% CI = 1.07, 1.12; p < 0.001), but lower odds of death, inpatient admission, ISS ≥ 16, and rehabilitation.

DISCUSSION

Aggressive driving-related injuries have a substantial medical and financial impact in Ohio.

PRACTICAL APPLICATIONS

Compared with other highway safety issues, prevention efforts aimed specifically at aggressive driving are lacking. Targeted enforcement and public awareness campaigns are needed.