Mortality risk in a sample of emergency department patients who use cocaine with alcohol and/or cannabis.

Background: Illicit drug use is common among emergency department (ED) patients, yet the association between drug use and subsequent mortality is not well understood. This study examines 36-month mortality rates for a sample of ED patients based on reported use of alcohol, cannabis, and cocaine, both individually and in combination.

Methods: Patients (N = 1669) from 2 urban EDs were surveyed at the time of the visit.

Commingling effect of gynoid and android fat patterns on cardiometabolic dysregulation in normal weight American adults.

Aim: To determine the independent and commingling effect of android and gynoid percent fat (measured using Dual Energy X-Ray Absorptiometry) on cardiometabolic dysregulation in normal weight American adults.

Methods: The 2005-2006 data (n=1802) from the United States National Health and Nutritional Examination Surveys (NHANES) were used in this study. Associations of android percent fat, gynoid percent fat and their joint occurrence with risks of cardiometabolic risk factors were estimated using prevalence odds ratios from logistic regression analyses.

Using process indicators to optimize service completion of an ED drug and alcohol brief intervention program.

Objective: The strongest evidence for effectiveness of screening, brief intervention, and referral to treatment (SBIRT) programs is in primary care settings. Emergency department (ED) studies have shown mixed results. Implementation of SBIRT into ED settings is complicated by the type of patients seen and the fast-paced, high-throughput nature of the ED environment that makes it difficult to reach patients flagged for SBIRT services.

Combined abuse of clonidine and amitriptyline in a patient on buprenorphine maintenance treatment.

Buprenorphine/naloxone maintenance therapy is often prescribed in primary care to treat opioid dependence. Previous reports have described concomitant abuse of opioids and clonidine. In this case, a primary care patient on buprenorphine/naloxone maintenance therapy demonstrating altered mental status, hallucinations, falls, and rebound hypertension was found to be concomitantly abusing clonidine and amitryptyline, which share metabolic pathways with buprenorphine.

Impact of a medical student alcohol intervention workshop using recovering alcoholics as simulated patients.

Background: Alcohol screening and brief intervention (SBI) reduces drinking among at-risk drinkers. Lack of training and negative attitudes represents a barrier to SBI performance. This study evaluates the impact of a medical student workshop using recovering alcoholics in simulated patient interviews to teach SBI skills.

Use of AUDIT-based measures to identify unhealthy alcohol use and alcohol dependence in primary care: a validation study.

Background: As programs for screening, brief intervention, and referral to treatment (SBIRT) for unhealthy alcohol use disseminate, evidence-based approaches for identifying patients with unhealthy alcohol use and alcohol dependence (AD) are needed. While the National Institute on Alcohol Abuse and Alcoholism Clinician Guide suggests use of a single alcohol screening question (SASQ) for screening and Diagnostic and Statistical Manual checklists for assessment, many SBIRT programs use alcohol use disorders identification test (AUDIT) "zones" for screening and assessment. Validation data for these zones are limited.

Reinventing the reel: an innovative approach to resident skill-building in motivational interviewing for brief intervention.

To enhance the skills of primary care residents in addressing substance misuse, residency screening, brief intervention, and referral to treatment (SBIRT) programs increasingly offer motivational interviewing (MI) training, but seldom include feedback and coaching. This innovative 2-round "Virginia Reel" approach, supplementing 3 hours of basic MI instruction, was designed to teach and coach residents to use MI while providing ongoing medical care. SBIRT/MI-competent facilitators served as both trainers and actors at 8 carefully sequenced Objective Structured Clinical Examination (OSCE) stations, providing instruction, role-play practice, and feedback on 17 microskills in 2 successive clinical "visits"/rounds addressing alcohol misuse and diabetes management.

Skills-based residency training in alcohol screening and brief intervention: results from the Georgia-Texas "Improving Brief Intervention" Project.

Alcohol screening and brief intervention (SBI) is recommended for all primary care patients but is underutilized. This project trained 111 residents and faculty in 8 family medicine residencies to conduct SBI and implement SBI protocols in residency clinics, then assessed changes in self-reported importance and confidence in performing SBI and brief intervention (BI) rates. Clinicians reported significant increases in role security, confidence, and ability to help drinkers reduce drinking and decreased importance of factors that might dissuade them from performing SBI.

Ethnic and gender differences in lifestyle risk factors in a bi-ethnic primary care sample: prevalence and clinical implications.

Objective: To demonstrate how simple screening methods can be used to define modifiable lifestyle risk factors in primary care settings and educate clinicians regarding ethnic and gender differences in risk factor profiles.

Design: Observational study

Participants: 3286 patients (1613 African Americans, 1673 non-Hispanic Whites)

Intervention: Lifestyle risk factor assessment using nine-question health habits questionnaire and vital signs measurement.

Main Outcome Measures: Rates of tobacco use, risky drinking, obesity, and inactivity

Results: 29.

Primary care validation of a single screening question for drinkers.

Objective: The aim of this study was to conduct a primary care validation study of a single screening question for alcohol misuse ("When was the last time you had more than X drinks in 1 day?," where X was four for women and X was five for men), which was previously validated in a study conducted in emergency departments.

Method: This cross-sectional study was accomplished by interviewing 625 male and female adult drinkers who presented to five southeastern primary care practices. Patients answered the single question (coded as within 3 months, within 12 months, ever, or never), Alcohol Use Disorders Identification Test (AUDIT), and AUDIT consumption questions (AUDIT-C).

Implementing alcohol screening and intervention in a family medicine residency clinic.

The purpose of this study was to evaluate the impact of simultaneous systems interventions and clinician training on management of hazardous and harmful drinking in a residency clinic. Systems interventions included forming a multi-disciplinary implementation team, training registration clerks to distribute health risk questionnaires using the AUDIT-C alcohol screen, and training nurses to score the AUDIT-C and administer the AUDIT to screen-positive patients. Clinicians were trained to perform brochure-based interventions on screen-positive patients.

Celiac disease presenting as entero-enteral intussusception.

Cramping abdominal pain with intermittent intestinal obstruction finally prompted investigation in a 4 1/2-year-old boy with severe failure to thrive (FTT). An entero-enteric intussusception was corrected, and celiac disease was identified as the cause of his inanition. Concomitant FTT and cramping abdominal pain should prompt investigation for celiac disease and small-bowel intussusception.

Resuscitation in the hospital: relationship of year and rhythm to outcome.

Objective: determine the frequency of initial rhythms in in-hospital resuscitation and examine its relationship to survival. Assess changes in outcome over time.

Methods: retrospective cohort (registry) including all admissions to the Medical Center of Central Georgia in which a resuscitation was attempted between 1 January, 1987 and 31 December, 1996.

Resuscitation in the hospital: differential relationships between age and survival across rhythms.

Objective: Assess the frequency and outcome of inhospital resuscitation and determine the relationship between patient age and survival and whether it is affected by initial rhythm.

Design: Retrospective, single-institution, registry study of inhospital resuscitation.

Setting: A 550-bed, tertiary-care, teaching hospital in Macon, GA.