Alcohol consumption and casualties: a comparison of emergency room populations in the United States and Mexico

This study compares alcohol consumption and casualties in probability samples of emergency room populations in the U.S. and Mexico: four hospitals representative of a Bay Area California county (N = 3,609) and eight hospitals representative of Mexico City (N = 2,507). Both studies used similar methods and data collection instruments. Patients were breath analyzed and interviewed regarding self-reported alcohol consumption 6 hours prior to the injury or illness event, usual drinking patterns and alcohol-related problems. Similar associations of alcohol consumption and casualties were found between the two populations with positive admission breath-analyzer readings and moderate consumption being positively associated with injuries. Both samples reported higher rates of heavy drinking, drunkenness and alcohol-related problems than that found in general surveys of their respective populations. Differences found between the two samples were largely due to varying drinking patterns in the two cultures and to differing uses of the emergency room for treatment.     

Drinking patterns and problems: a comparison of emergency room populations in the United States and Spain.

The association of alcohol consumption and casualties is compared in probability samples of two culturally diverse emergency room populations: Barcelona, Spain (N = 2972) and Contra Costa County, California (N = 3609). Similar methods and data collection instruments were used to breathalyze and interview patients regarding self-reported alcohol consumption 6 h prior to the injury, usual drinking patterns and alcohol-related problems. Breathalyzer reading was positively associated with injury in both Contra Costa and Barcelona, but at the legal level only in Barcelona. Self-reported alcohol intake within 6 h prior to the event was positively associated with injury only among females in Contra Costa. Frequent light drinking was associated with injuries in Barcelona while heavier drinking was associated with injuries in Contra Costa. Little association was found between social consequences of drinking and injuries in either sample, however, the Contra Costa sample reported significantly higher rates of these problems than Barcelona, among moderate and high quantity drinkers. Although few differences were found between the two samples, findings suggest that usual drinking patterns within a culture may influence the association of alcohol and casualties, and future studies should explore these differences by type and cause of injury.     

Breath analysis and self-reports as measures of alcohol-related emergency room admissions

This study reports breath-analyzer readings and self-reports as measures of alcohol-related admission to the emergency room of San Francisco General Hospital. A 20% probability sample of patients admitted during a 60-day period was breath analyzed and interviewed. Interviews and breath samples were obtained on 75% of the sample of 2,516 patients. Twice the proportion of injury patients compared to noninjury patients had positive admission breath samples and reported drinking prior to the event. Alcohol involvement reached 41% for self-reports among injured men and over half of both men and women injured in fights or assaults reported drinking prior to the event. Self-reported alcohol use was found to be a valid measure of alcohol consumption when compared to breath-analyzer readings for the same individuals. Emergency room patients may be more likely than others to provide accurate reports of alcohol consumption if they feel that disclosure of amount and timing of drinking prior to an injury or illness could be important in their care. The data suggest that self-reports when used in conjunction with a quantifiable estimate of blood alcohol may be an appropriate method of ascertaining alcohol's involvement in emergency room cases.     

Blood alcohol level among emergency room patients: a multivariate analysis

This article examines the distribution of positive blood alcohol levels (BALs) among emergency room patients and the relationship between intoxication and other variables. Approximately one-quarter of the 640 subjects had positive blood alcohol levels and 16.3% had BAL readings above 0.10%, the legal limit for operating a motor vehicle in most states. Chi-square tests and logistic regression analysis indicated a significant relationship between employment status, gender, educational attainment, age and BAL. There were no significant racial differences. Analysis of the role of the presenting problem with BAL revealed that being involved in an accident was significantly predictive of a high BAL in a multivariate context. However, patients presenting with psychiatric problems had overall higher levels of intoxication than other patients. These findings have major implications for public policy formulation vis-à-vis public health delivery.     

Drug-related visits to a district hospital emergency room

The role of adverse drug reactions (ADRs) as a cause of hospital visits varies depending on the type of hospitals. Our aim was to determine the incidence of drug-related emergency department visits to a district hospital, and to identify the drugs and patient groups involved. All patient visits to the emergency department of a Finnish district hospital were evaluated prospectively for 6 months. The physician on duty and a clinical pharmacologist selected all possibly drug-related visits for further scrutinising. The causality assessment (drug-related or not) was judged according to WHO criteria, based on the patients' files, including laboratory and other data. Of the 7113 evaluated visits, 167 (2.3%) were "certainly" or "probably" drug-related; 102 (1.4% of all) were related to ADRs and 65 (0.9%) to intentional overdoses. The most common ADRs were gastrointestinal symptoms (n=17) caused by antibiotics, opioids, nonsteroidal antiinflammatory or cytostatic drugs. The International Classification of Disease (ICD-10) codes on patients' files were insensitive to disclose ADRs. The ADR patients were older (mean age 57 years) than the intentional overdose patients (38 years; P<0.001). Males predominated in the intentional overdose group (38 males, 27 females) but not in the ADR patients. The majority of intentional overdoses was caused by psychotropics. The ADRs lead to hospitalisation in a higher frequency (51%) than did the intentional overdoses (35%). In conclusion, the incidence of "certainly" or "probably" drug-related visits to the district hospital emergency room was relatively low. The ICH-10 codes on patients' files were found to be insensitive to disclose the ADRs, even when they lead to hospital admission, casting doubts on the usefulness of ICH codes alone in ADR evaluation.     

Screening instruments for alcohol problems: a comparison of cut points between Mexican American and Mexican patients in the emergency room

The performance of alcohol use disorder screening instruments (CAGE, BMAST, AUDIT, TWEAK) at various cut points were compared between a Mexican American emergency room (ER) sample (n = 586) and a sample of ER patients in Mexico (n = 1,417) using ICD-10 and DSM-IV criteria for alcohol dependence and harmful drinking/abuse by gender and injury status. Lowering cut points improved instrument performance substantially for females in both samples. Further research is needed to explore instrument performance by gender and level of acculturation.     

Latent class analysis of substance use: comparison of two American Indian reservation populations and a national sample

OBJECTIVE: Our goal was to carefully examine disparities in substance use between two American Indian reservation communities and a national sample. We sought to identify characteristic patterns of use-both across and within samples-that could be used to inform intervention efforts aimed at reducing disparities. METHOD: Latent class analyses were used to identify subgroups within each sample that were characterized by distinctive patterns of use of alcohol and eight drugs; the use patterns and prevalence of subgroups were then compared across samples. American Indian data were from the American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project (AI-SUPERPFP; N=2647), which comprised participants from two distinct cultural groups in the Southwest (SW; n=1244; 57% female) and Northern Plains (NP; n=1443; 52% female). National data were from the public use file of the 1999 National Household Survey of Drug Abuse (NHSDA; N = 39.152; 52% female). RESULTS: Four classes of lifetime users (abstainers, primarily alcohol users, primarily alcohol and marijuana users, and polysubstance users) and three classes of past-year users (abstainers, primarily alcohol users, and alcohol and drug users) were identified in each sample (SW, NP, NHSDA). Despite consistency in classes of users found across these samples, there were notable sample differences in class prevalence. The modal class for lifetime use, for example, was primarily alcohol users in the SW and NHSDA, and primarily alcohol and marijuana use in the NP. The concordance of lifetime and past-year use classes also varied across the three samples, and examination of past-year abstainers in conjunction with lifetime-use class suggested potentially important differences in the stability of substance-use patterns over time. CONCLUSIONS: Our findings highlight the utility of latent class techniques for understanding substance use, comparing substance use across populations and identifying key points of intervention, prevention, and treatment within different communities.     

Collecting data on alcohol use and alcohol-related victimization: a comparison of telephone and Web-based survey methods

OBJECTIVE: Traditionally, personal contact with an experienced interviewer has been thought to facilitate collection of data on alcohol use and victimization experiences. Recent studies indicate that Web-based surveys may be an efficient alternative for gathering these sensitive data. To date, telephone interviewing and Web-based collection of data on alcohol-related negative consequences, particularly victimization, have not been compared. This study was designed to compare data from an interviewer-administered and Web-based survey on alcohol use and alcohol-related negative consequences in a sample of college women. METHOD: Seven hundred women from a second semester freshmen college class were randomly selected to participate in either the telephone interview or Web-based modes of survey administration. RESULTS: Fifty-three percent of invited women (N = 370) completed the survey. Completion rates were higher, and estimated dollar costs were significantly lower, for the Web-based survey. There were no differences in reported rates of alcohol or drug use by survey method; however, there were differences in several specific alcohol-related negative consequences. CONCLUSIONS: These findings suggest that, for college women, Web-based surveys versus telephone interviews can be an effective and more cost-efficient means for collecting data on alcohol use and related negative consequences, particularly victimization. In addition, we found some evidence that women may be more forthcoming when responding to a Web-based survey as compared with an interviewer-administered telephone survey.     

FMEA在急诊输液室和注射室中的应用价值研究

目的探究失效模式与效应分析(FMEA)在急诊输液室及注射室中的应用价值。方法 2015年4月,笔者所在医院开展FMEA失效模式理论及操作培训,随机抽取培训前(2014年4月~2015年3月)急诊输液室和注射室接待的112例患者归为对照组,培训后(2015年4月~2016年1月)120例患者归为观察组。回顾性分析施行FMEA模式改造前后投诉情况、患者护理满意度、失效模式RPN值变化、患者等候时间变化。结果观察组输液室及注射室失效模式RPN值明显较对照组低,患者平均等候时间由对照组的(23.50±3.24)min缩短到(11.23±2.95)min;观察组输液投诉率(7.14%)较对照组(0.83%)低;观察组护理满意率(90.83%)较对照组的79.46%高。P均0.05。结论 FMEA模式应用在急诊输液室和注射室中具有以下作用:(1)有利于改善急诊输液室和注射室操作流程,从而提高工作效率,缩短患者等候时间;(2)排查潜在风险因素,提高护理人员责任心,减少操作遗漏和错误,提高整体质量;(3)创造良好的候诊环境,提高良好护理质量,从而减少患者投诉,提高护理满意度。     

Hypertensive crises: diagnosis and management in the emergency room

Hypertensive crises are commonly observed in an emergency room. Regardless blood pressure values, hypertensive crises are classified in emergencies, characterized by life-threatening acute organ damage, and urgencies, with no evidence of acute or progressive organ injury. In an hypertensive emergency an appropriate and immediate management with parenteral drugs is mandatory, while in an hypertensive urgency blood pressure should be decreased within 24-48 h with orally active agents. This article reviews the spectrum of clinical syndromes that comprise hypertensive emergencies, focusing on specific drugs and therapeutic strategies available in the emergency department, based on current literature. Since no randomized prospective trials are available, an evidence-based approach recommending an optimal therapeutical management is not possible. Much of the therapy is therefore entirely empirical and based on the underlying pathophysiologic and clinical findings. Further studies are needed to clarify pathophysiologic mechanisms in order to optimize therapeutic approach.     

Emergency room injury presentations as an indicator of alcohol-related problems in the community: a multilevel analysis of an international study

OBJECTIVE: This study describes and examines the development of surrogate measures of acute alcohol-related injury for use in the evaluation of community-based prevention initiatives. METHOD: An international collaborative study of alcohol and injury, the Emergency Room Collaborative Alcohol Analysis Project (ERCAAP), provided a subset of data on 8580 emergency room (ER) presentations from five countries and 28 ER facilities. RESULTS: Presentations most likely to be alcohol related were those made between 12:00 AM and 4:59 AM (56%), on Fridays, Saturdays or Sundays (26%); and those among injured persons who were male (28%), who were aged between 18 and 45 years (24%) or who were unmarried (24%). Multilevel logistic regression models confirmed the significance of the above variables as predictors of alcohol involvement prior to the injury event. The strongest predictor variable was presentation between 12 midnight and 4:59 AM with an odds ratio of 4.92 (Wald Test chi2 = 397.6, p < .001). Being male had an odds ratio of 3.01 (Wald Test chi2 = 247.25, p < .001), and presenting on a Friday, Saturday or Sunday night had an odds ratio of 1.50 (Wald Test chi2 = 49.6, p < .001), whereas being under 45 (odds ratio [OR] = 1.20, p < .05) and being unmarried (OR = 1.2, p < .01) were less strong predictors. Combining all these values for variables raised the probability of prior alcohol involvement in such injury presentations to 0.65, although only 3.37% of all cases met these criteria, limiting applicability of this combined variable as a surrogate measure for intervention studies. Probabilities of prior alcohol involvement are presented with other combinations of values for the predictor variables. CONCLUSIONS: Frequency of nighttime injury presentations to ER facilities, particularly by men, can be used as a reliable surrogate measure of alcohol-related injuries for various epidemiological and evaluation purposes.     

Multi-level analysis of causal attribution of injury to alcohol and modifying effects: Data from two international emergency room projects

Although alcohol consumption and injury has received a great deal of attention in the literature, less is known about patient's causal attribution of the injury event to their drinking or factors which modify attribution. Hierarchical linear modeling is used to analyze the relationships of the volume of alcohol consumed prior to injury and feeling drunk at the time of the event with causal attribution, as well as the association of aggregate individual-level and socio-cultural variables on these relationships. Data analyzed are from 1955 ER patients who reported drinking prior to injury included in 35 ERs from 24 studies covering 15 countries from the combined Emergency Room Collaborative Alcohol Analysis Project (ERCAAP) and the WHO Collaborative Study on Alcohol and Injuries. Half of those patients drinking prior to injury attributed a causal association of their injury with alcohol consumption, but the rate of causal attribution varied significantly across studies. When controlling for gender and age, the volume of alcohol consumed and feeling drunk (controlling for volume) were both significantly predictive of attribution and this did not vary across studies. Those who drink at least weekly were less likely to attribute causality at a low volume level, but more likely at high volume levels than less frequent drinkers. Attribution of causality was also less likely at low volume levels in those societies with low detrimental drinking patterns, but more likely at high volume levels or when feeling drunk compared to societies with high detrimental drinking patterns. These findings have important implications for brief intervention in the ER if motivation to change drinking behavior is greater among those attributing a causal association of their drinking with injury.     

Developing a unit-of-use drug distribution system for the hospital emergency room

The development of a unit-of-use drug distribution system for hospital emergency rooms (ERs) is described. Initially, each emergency room physician was requested to compile a list of medications for an emergency room formulary. These lists were edited into a single list and presented to the ER Committee for review. This committee was to recommend the least number of medications possible per therapeutic category. During this time, the support of the ER staff was gained, policies and procedures were established, and a unit dose cart system was chosen. The final step was to present the recommended emergency room drug formulary to the Pharmacy and Therapeutics Committee for their review and approval. The advantages of this system are: establishment of pharmacy drug control in the ER; reduction of ER inventory; greatly improved drug security; proper drug labeling; and automatic restocking of medications in the ER, resulting in time savings for ER personnel.     

Prediction of imipramine serum levels in enuretic children by a Bayesian method: comparison with two other conventional dosing methods

The aim of the present study was to characterize the kinetic behavior of imipramine (IMI) and desipramine in enuretic children and to evaluate the performance of different methods for dosage prediction based on individual and/or population data. The study was carried out in 135 enuretic children (93 boys) ranging in age between 5 and 13 years undergoing treatment with IMI in variable single doses (25-75 mg/day) administered at night. Sampling time was one-half the dosage interval at steady state. The number of data available for each patient varied (1-4) and was essentially limited by clinical criteria. Pharmacokinetic calculations were performed using a simple proportional relationship (method 1) and a multiple nonlinear regression program (MULTI 2 BAYES) with two different options: using the ordinary least-squares method (method 2) and the least-squares method based on the Bayesian algorithm (method 3). The results obtained point to a coefficient of variation for the level/dose ratio of the drug (58%) that is significantly lower than that of the metabolite (101.4%). The forecasting capacity of method 1 is deficient both regarding accuracy [mean prediction error (MPE) = -5.48 +/- 69.15] and precision (root mean squared error = 46.42 +/- 51.39). The standard deviation of the MPE (69) makes the method unacceptable from the clinical point of view. The more information that is available concerning the serum levels, the greater are the accuracy and precision of methods (2 and 3). With the Bayesian method, less information on drug serum levels is needed to achieve clinically acceptable predictions.     

Donepezil for alcohol-related dementia: a case report

A 75-year old man with a 40-year history of alcoholism was admitted to the hospital for intoxication and inability to care for himself. He had been admitted frequently in the past for detoxification and rehabilitation. The patient had no family history of Alzheimer's disease, no history of head injury, and single-photon emission computed tomography showed no typical findings of Alzheimer's disease. His cognitive function was impaired. He was treated with donepezil for alcohol-related dementia, and 3 months later, his cognitive function had improved. More research is needed to confirm donepezil's role in treating alcohol-related dementia.     

Intra-incisional cephaloridine: a comparison of two methods of administration

Serum cephaloridine concentrations were measured in the immediate post-operative period in 23 patients who had received a prophylactic dose of 1 g of the drug into the wound at the end of operation. Eleven patients received the antibiotic as a powder and 12 as a solution. The serum concentrations were higher, though not significantly so, in the group receiving powder, and this is thought to be due to the lesser amount of spillage and loss into dressings when the antibiotic is given in this form.