A comparison between instant and laboratory oral fluid analysis among arrestees

Research studies that collect biological measures of drug use have traditionally utilized laboratory urinalysis. Several recent studies have also documented the utility of laboratory oral fluid (OF) analysis. A new method of drug testing-instant OF technology--may offer a quicker, equally accurate alternative to laboratory OF assays. To date, however, no field studies have compared the two methods. In the current study, an instant OF test (ORALscreen) was administered to 65 adult arrestees surveyed through Maryland's Substance Abuse Need for Treatment among Arrestees (SANTA) study. Following a research interview, a second OF sample was collected (ORALconfirm) and shipped to the manufacturer's laboratory for analysis. The instant OF test was 96% sensitive and 83% specific for cocaine, 100% sensitive and 75% specific for opiates, and 100% sensitive and 94% specific for marijuana. Kappa statistics were low for all three drugs, suggesting poor agreement between the two tests. Moreover, while the marijuana sensitivity and specificity coefficients in the current study were high, a growing body of research has indicated that OF analysis is not as accurate as the gold standard of urinalysis in detecting recent marijuana use. Implications for these findings are discussed.     

Epworth sleepiness scale in obstructive sleep disordered breathing: the reliability and validity of the Thai version

Purposes  

The objectives of this study are to test the reliability and validity of the Thai version of the Epworth sleepiness scale (ESS) and to assess the relationship between the ESS score and the severity of obstructive sleep disordered breathing.     

Medical Director Responsibilities to the ESRD Network

The 18 regional ESRD Networks are established in legislation and contract with the Centers for Medicare and Medicaid Services to improve the quality and safety of dialysis, maximize patient rehabilitation, encourage collaboration among and between providers toward common quality goals, and improve the reliability and the use of data in pursuit of quality improvement. The Networks are funded by a $0.50 per treatment fee deducted from the reimbursement to dialysis providers, and their deliverables are determined by a statement of work, which is updated in a new contract every 3 years. The Conditions for Coverage require dialysis providers to participate in Network activities, and failure to do so can be the basis for sanctions against the provider. However, the Networks attempt to foster a collegial relationship with dialysis facilities by offering tools, educational activities, and other resources to assist the facilities in meeting the evolving requirements by the Centers for Medicare and Medicaid Services on the basis of national aims and domains for quality improvement in health care that transcend the ESRD program. Because of his/her responsibility for implementing the quality assessment and performance improvement activities in the facility, the medical director has much to gain by actively participating in Network activities, especially those focused on quality, safety, patient grievance, patient engagement, and coordination of care. Membership on Network committees can also foster the professional growth of the medical director through participation in quality improvement activity development and implementation, authorship of articles in peer-reviewed journals, creation of educational tools and presentations, and application of Network-sponsored materials to improve patient outcomes, engagement, and satisfaction in the medical director’s facility. The improvement of care of patients on dialysis will be beneficial to the facility in achieving its goals of quality, safety, and financial viability.     

Virtual reality: Feasibility of implementation in a regional burn center

Objective

Burn care providers continue to search for non-pharmacologic adjuncts for pain control. Virtual reality (VR) has been shown to be a useful adjunct by reducing pain during burn care and therapy. The feasibility of implementation for clinical use (non-research related) has not been studied in a burn center. The purpose of this study was to determine staff resources needed to implement VR in a regional burn center.

Methods

Ten patients with burns participated in VR during occupational or physical therapy sessions. A portable computer and VR head mounted device (Proview VO35, Kaiser Electro-Optics, Inc.) and the “SnowWorld” software (Patterson and Hoffman, University of Washington) were used. Two staff members trained in the use of VR participated in each session in order to adhere to infection control policies. VR set-up time, patient instruction time, VR therapy time, and equipment cleaning time were recorded and rounded to the nearest minute.

Results

A mean of 59 staff time minutes (S.D. 18; range 29–85) were required for set-up, instruction, VR therapy, and cleaning. Set-up required the most time, averaging 23 min. Instruction, participation, and clean-up means were 6, 13, and 16 min respectively. Time for set-up decreased over time, however technical difficulties with the VR equipment accounted for most of the variability in the time required.

Conclusions

These results suggest VR requires a significant time commitment from staff for implementation. One clear disadvantage was the lack of on-site technical support for equipment troubleshooting. In the current healthcare environment where therapists and nurses are accounting for each minute, it would be difficult for smaller burn centers to allocate staff and resources to implement a VR program. Further research is needed to determine if VR benefits are worth the implementation costs.     

Therapeutic community treatment for substance abusers with antisocial personality disorder.

This study compared treatment outcomes of substance abusers with and without antisocial personality disorder (APD) randomly assigned to two therapeutic communities, differing primarily in length of inpatient and outpatient treatment. We hypothesized that APD clients would be less likely to complete treatment, more likely to test positive for drugs and recidivate at follow-up, and that APD clients in the Standard program would have more favorable outcomes than those in the Abbreviated Inpatient program, because of the Standard program's longer inpatient treatment. Self-reports and objective measures of criminal activity and substance abuse were collected at pre- and posttreatment interviews. APD clients were as likely to complete treatment as other clients, and they exhibited the same patterns of reduced drug use and recidivism as did non-APD clients. Treatment program attended was unrelated to outcomes. Substance abusers diagnosed with APD can benefit from treatment in a therapeutic community combined with outpatient care.