A Proposed Model of Relapse Prevention for Adolescents Who Abuse Alcohol

Adolescents who abuse alcohol are being admitted to treatment centers in increasing numbers. However, relapse prevention, a critical aspect of recovery, rarely is addressed in this high-risk population. This article briefly reviews adolescent development, the current literature on adolescent drinking patterns and relapse, and analyzes current models of relapse prevention in adults. This information is then used to propose a relapse prevention model for adolescents.     

Impact of Glycoprotein IIb/IIIa Inhibitors Use on Outcomes After Lower Extremity Endovascular Interventions From Nationwide Inpatient Sample (2006–2011)

• Anticoagulant and antiplatelet medications are necessary in peripheral endovascular intervention, but a standardized approach has not yet been established.
• Glycoprotein IIb/IIIa inhibitor use in endovascular lower extremity interventions decreased overall amputation rates.
• Glycoprotein IIb/IIIa inhibitor use in endovascular lower extremity interventions increased postprocedural bleeding and complications requiring intervention.

     

Update on Indications, Techniques, and Complications of Cardiac Implantable Device Lead Extraction

OPINION STATEMENT: All devices (quite simply and with rare exception) that are infected, or strongly suspected of being infected, need to be removed, with complete extraction of all intravascular hardware and foreign material in the pocket. Failure to do so nearly always results in a failure to clear the infection, with inevitable recurrence of infection. Having the skills and tools to extract leads can make access to the venous system possible when occlusion or stenosis is present, thus preserving the venous system on the contralateral side. The far more controversial question is how one should deal with leads that are functional and are no longer needed, as well as leads that are non-functional and not connected to a device. Patients who are expected to outlive their next device, or who are potential candidates for MRI scans in the future, should be considered for extraction of all unused lead hardware. Doing so at an earlier time prevents the need to extract when the leads are older and more difficult to remove, and eliminates the additional risk of infection by preventing an additional procedure on the device pocket at a later date.     

Management Strategies and Outcomes of ST‐Segment Elevation Myocardial Infarction Patients Transferred After Receiving Fibrinolytic Therapy in the United States

Fibrinolytic therapy is still used in patients with ST‐segment elevation myocardial infarction (STEMI) when the primary percutaneous coronary intervention cannot be provided in a timely fashion. Management strategies and outcomes in transferred fibrinolytic‐treated STEMI patients have not been well assessed in real‐world settings. Using the Nationwide Inpatient Sample from 2008 to 2012, we identified 18 814 patients with STEMI who received fibrinolytic therapy and were transferred to a different facility within 24 hours. The primary outcome was in‐hospital mortality. Secondary outcomes included gastrointestinal bleeding, bleeding requiring transfusion, intracranial hemorrhage (ICH), length of stay, and cost. The patients were divided into 3 groups: those who received medical therapy alone (n = 853; 4.5%), those who underwent coronary artery angiography without revascularization (n = 2573; 13.7%), and those who underwent coronary artery angiography with revascularization (n = 15 388; 81.8%). Rates of in‐hospital mortality among the groups were 20% vs 6.6% vs 2.1%, respectively (P < 0.001); ICH was 8.5% vs 1.1% vs 0.6%, respectively (P < 0.001); and gastrointestinal bleeding was 1.1% vs 0.4% vs 0.4%, respectively (P = 0.011). Multivariate analysis identified increasing age, higher Charlson Comorbidity Index score, cardiogenic shock, cardiac arrest, and ICH as the independent predictors of not performing coronary artery angiography and/or revascularization in patients with STEMI initially treated with fibrinolytic therapy. The majority of STEMI patients transferred after receiving fibrinolytic therapy undergo coronary angiography. However, notable numbers of patients do not receive revascularization, especially patients with cardiogenic shock and following a cardiac arrest.