Detection of substance use disorders in patients presenting with depression

Comorbidity between substance use disorders and major depression may complicate the treatment and adversely affect the outcome of either disorder. This study examines the frequency with which patients presenting with depression are evaluated for a substance use disorder in a university‐based family medicine residency program. A retrospective chart review was performed to identify 200 patients age 18 and older, seen between June 1, 1989, and June 1, 1999, who were diagnosed with depression (DSM IV code 300.4 or 311.0). The records were divided into two strata based on whether they were seen by resident or faculty physicians. The records were then reviewed for evidence of substance use screening. The overall percentage of patients with depression and evaluated for substance use disorders was calculated, and further stratified as to gender, age, previous psychiatric diagnosis, and previous substance use disorder diagnosis. Family physicians evaluated outpatients with a diagnosis of depression for substance use disorders only 24.5% of the time. Faculty evaluated depressed patients 18%, compared to residents doing so in 31 % of patients. Male patients were evaluated 34.7% as compared to 21.2 % of females. Patients over age 70 were screened at a rate of only 10.7%. Given the observed prevalence of substance use disorders in patients with a diagnosis of depression is between 40 and 50%, our finding that our depressed patients were evaluated for substance use disorders only 24.5% of the time, suggests that family physicians may be missing a significant number of patients with comorbid disease.     

Fascial fibroblast kinetic activity is increased during abdominal wall repair compared to dermal fibroblasts

Abdominal wall fascial wound healing failure is a common clinical problem for general surgeons, manifesting in early postoperative fascial dehiscence as well as delayed development of incisional hernias. We previously reported that abdominal wall fascial incisions normally recover breaking strength faster than simultaneous dermal incisions in a rodent model. The accelerated fascial repair was associated with greater fibroblast cellularity within fascial wounds and increased wound collagen deposition. The current study was designed to determine whether accelerated fascial healing is the result of increased fascial fibroblast kinetic activity as measured by a more efficient fibroblast phenotype for binding to and remodeling a collagen matrix. Using a new model of abdominal wall repair, fibroblast cell cultures were developed from uninjured and wounded fascia and compared to dermal fibroblasts in order to define the fibroproliferative kinetic properties of abdominal wall fibroblasts. Fascial wound fibroblasts produced a more efficient and greater overall collagen lattice compaction compared to dermal fibroblasts. Acute fascial wound fibroblasts also showed enhanced cell proliferation compared to dermal fibroblasts but no significant differences in collagen production when normalized to cell number. These results suggest that fascial fibroblasts express distinct acute repair phenotypes and therefore a specific mechanism for fascial repair following injury.     

Providing evidence‐based information to patients in general practice and pharmacies: what is the acceptability,usefulness and impact on drug use?

Background A common and often integral method of delivering patient information is the use of patient guides. However, the acceptability, utility and impact of evidence‐based therapeutic guides on physicians, pharmacists and patients have not been well evaluated. Methods This study was a prospective evaluation of 53 general practitioners' offices and 30 community pharmacies from three locations in Canada. Evidence‐based guides were provided to 1176 patients who presented to either a general practitioner or a community pharmacist and were interested in receiving information about sore throat, heartburn, or osteoporosis ( http://www.ti.ubc.ca/canadadrugguide ). The acceptability, utility and impact of the guides were assessed via structured patient telephone interviews, structured health professional interviews, and patient chart audits. Results Eighty to 90% of patients reported that the guides were ‘very easy’ to understand. Fifty six per cent/47%/38% (sore throat/heartburn/osteoporosis) of patients rated the guides as ‘very’ or ‘extremely’ useful. Seventy‐two per cent/67%/58% of respondents reported that the information helped them make decisions about their treatment. Ninety eight per cent of physicians and 92% of pharmacists reported that the guides helped their patients understand the issues involved in their treatment. None of the analyses showed any significant differences in prescribing of medications between the intervention and control groups. Interpretations Patients found these evidence‐based guides to be useful, easy to understand, and that they helped them in their understanding of treatment options and the decision‐making process. Physicians and pharmacists reported that the guides helped their patients understand the issues involved in their treatment. Further research is required to determine the degree to which providing evidence‐based guides to patients can impact on prescribing and patient outcomes.     

Knowing the patient and the impact on patient participation: A grounded theory study

Henderson S. International Journal of Nursing Practice 1997; 3: 111–118
Knowing the patient and the impact on patient participation: A grounded theory study
Currently, there is an emphasis on patient participation. Studies have demonstrated that when patients participate in their care, they experience positive outcomes such as greater satisfaction with care and decreased vulnerability. Nurses are of the opinion that patients should participate in their care. Literature and research indicate, however, that there is an incongruence between nurses' pro-participatory attitudes and actual practice. Grounded theory was used to identify factors relevant to patient participation from the nurses' and patients' perspectives. Using purposive sampling from four hospitals in Western Australia, in-depth interviews and participant observation were conducted. The constant comparative method of analysis was used. As this study is in progress, the core category and sub-categories are still being refined. One category that has emerged strongly is 'knowing the patient' and the outcome on patient participation. This paper will discuss this category from the nurses and patients perspective including recommendations.     

Smoking habits among Finnish middle-aged men: experiences and attitudes

The purpose of this study was to explain smoking habits amongst middle-aged men in Finland by describing their experiences of smoking and their attitudes towards smoking. As a pilot survey for a major health campaign targeted at 40-year-old men, the data for this study were collected using two questionnaires in connection with voluntary medical examinations. The first questionnaire was based on Prochaska's theory of stages of change in health behaviour. The second instrument was an attitude scale developed specifically for this study on the basis of Green and Kreuter's theory of factors influencing health behaviour. According to the results 31% of males aged 40 were regular smokers. Men with a lower level of education and out of work smoked more often than others. Non-smokers reported a better self-perceived health than smokers. Smoking cessation is a process in which men gradually proceed from one step to the next. In this study 12% of the men were in the contemplation stage and 11% in the preparation stage. One-quarter of the men had recently given up the habit and were in the action stage, while 2% had quit smoking over 6 months ago and were in the maintenance stage. One-quarter of the men regarded smoking as an integral part of their way of life and felt that public opinion towards smoking is hostile.