PURPOSEScreening and brief intervention (SBI) is a seldom-used evidence-based practice for reducing unhealthy alcohol use among primary care patients. This project assessed the effectiveness of a ...regional consortium’s training efforts in increasing alcohol SBI.
METHODInvestigators combined alcohol SBI residency training efforts with clinic SBI implementation processes and used chart reviews to assess impact on SBI rates in four residency clinics. Data were derived from a random sample of patient charts collected before (2010; n = 662) and after (2011; n = 656) resident training/clinic implementation. Patient charts were examined for evidence that patients were asked about alcohol use by a validated screening instrument, the screening result (positive or negative), evidence that patients received a brief intervention, prescriptions for medications to assist abstinence, and referrals to alcohol treatment. Chi-square analyses identified differences in pre- and posttraining implementation of SBI practices.
RESULTSFollowing program implementation, screening with validated instruments increased from 151/662 (22.8%) at baseline to 543/656 (82.8%, P < .01), and identification of unhealthy alcohol use increased from 12/662 (1.8%) to 41/656 (6.3%, P < .01). Performance of brief interventions more than doubled (10/662 1.5% versus 24/656 3.7%, P < .01). There were no increases in the use of medications or referrals to treatment.
CONCLUSIONSResident training combined with clinic implementation efforts can increase the delivery of evidence-based practices such as alcohol SBI in residency clinics.
Previous research on training health professionals to identify and address unhealthy alcohol and drug use in patients through screening, brief intervention, and referral to treatment (SBIRT) has ...found that training increases knowledge about substance use and increases students' confidence in addressing substance use in patients. To date, however, there is little information on how health professional students integrate SBIRT into individual practice. Within a U.S. SBIRT training consortium, advanced practice registered nurse (APRN) students were required to practice SBIRT in clinical settings and complete assessment logs for each patient screened. Logs documented results from single item alcohol & drug screening questions; AUDIT or DAST responses; brief intervention (BI)/referral to treatment (RT) steps completed and patients' responses. 113 APRN students completed logs on 538 patients (mean age 44; SD 15.0; 53.5% female). Positive single question alcohol screens were more frequent than positive single question drug screens (55.3% vs. 25.5%). More than one third (36%) of the logs included high-risk AUDIT/DAST scores. The most utilized BI components were discussions regarding consequences of use (76%) and safe levels of use (70%), while the most utilized RT steps included referral to a mutual help group (15%) or a specialty treatment program (8%). Positive screening rates found by APRN students were higher than reported rates in most clinical settings. The logs also demonstrated that APRN students employed many of the SBIRT skills they were taught while also helping identify underutilized SBIRT steps, which may be addressed specifically in future SBIRT trainings.
•APRNs can play an important role in addressing unhealthy alcohol and drug use.•APRN students integrated alcohol and drug screening and intervention into practice.•APRN students utilized most brief intervention components covered in trainings.•Specialty treatment referrals were less frequent than referrals to self-help groups.•Lesser utilized components may warrant additional attention in APRN trainings.
Abstract The clinical diagnosis of atherosclerosis via the measurement of stenosis size is widely acknowledged as an imperfect criterion. The vulnerability of an atherosclerotic plaque to rupture is ...associated with its mechanical properties. The potential to image these mechanical properties using magnetic resonance elastography (MRE) was investigated through synthetic datasets. An image of the steady state wave propagation, equivalent to the first harmonic, can be extracted directly from finite element analysis. Inversion of this displacement data yields a map of the shear modulus, known as an elastogram. The variation of plaque composition, stenosis size, Gaussian noise, filter thresholds and excitation frequency were explored. A decreasing mean shear modulus with an increasing lipid composition was identified through all stenosis sizes. However the inversion algorithm showed sensitivity to parameter variation leading to artefacts which disrupted both the elastograms and quantitative trends. As noise was increased up to a realistic level, the contrast was maintained between the fully fibrous and lipid plaques but lost between the interim compositions. Although incorporating a Butterworth filter improved the performance of the algorithm, restrictive filter thresholds resulted in a reduction of the sensitivity of the algorithm to composition and noise variation. Increasing the excitation frequency improved the techniques ability to image the magnitude of the shear modulus and identify a contrast between compositions. In conclusion, whilst the technique has the potential to image the shear modulus of atherosclerotic plaques, future research will require the integration of a heterogeneous inversion algorithm.
The ability of postnatal testosterone propionate (TP) to masculinize both behaviour and gonadal cyclicity in the female rat
is well documented. We have investigated whether postnatal androgen also ...has an organizational effect on another sexually
dimorphic neuroendocrine system â the hypothalamo-pituitary-adrenal (HPA) axis. Female rats were exposed to a single injection
of testosterone propionate (TP) or oil within 24 h of birth. As adults, rats were either ovariectomized and given 17β-oestradiol
replacement (OVXE 2 ) or sham ovariectomized with cholesterol implants (SHOVX). An automated sampling system collected blood from unanaesthetized
adult female rats every 10 min over a 24-h period, during a mild psychological stress (noise) and following an immunological
lipopolysaccharide stress (LPS). Neonatal TP-treated SHOVX rats had a significant reduction in the number, height, frequency
and amplitude of corticosterone pulses over the basal 24-h period, compared to both the neonatal oil-treated and TP-treated
OVXE 2 animals. The corticosterone response to both noise and LPS was also significantly decreased for the TP-treated SHOVX females.
Three hours post-LPS administration, TP females had significantly lower values of paraventricular nucleus (PVN) corticotrophin
releasing hormone (CRH), arginine vasopressin (AVP) and anterior pituitary proopiomelanocortin (POMC) mRNAs and greater PVN
glucocorticoid receptor (GR) mRNA expression compared to the oil-treated controls. E 2 replacement in adult TP rats normalized all the mRNA levels, except for PVN GR mRNA which did fall towards the levels of
the oil-control animals. A single injection of TP within 24 h of birth disrupts the development of the characteristic female
pattern of corticosterone secretion and the normal female HPA response to stress, resulting in a pattern similar to that seen
in males. These effects can be reversed by E 2 treatment in the adult TP female rat.
— Aims: To explore the historical and cultural context of problem drinking in a Latin American indigenous population and identify possible areas for intervention. Methods: Focus group discussions. ...Results: Participants reported that prior to 1945, binge drinking and fighting were part of cultural festivals held several times each year. Alcohol was brewed in limited quantities by specially qualified individuals. Limited family violence and injuries resulted. Increasing contact with Western civilization resulted in year-round access to large supplies of commercial alcohol and exposure to alcohol-misusing role models. Increased heavy drinking and decreases in subsistence farming resulted in escalation of problems, including hunger, serious injury, family violence, divorce and legal problems. Communities are beginning to regain control by prohibiting sale of alcohol in villages, sponsoring alcohol-free celebrations, and increasing involvement in religious activities. Conclusions: Though alcohol may cause devastating consequences in cultures in transition, studies of community responses may identify useful strategies for reducing alcohol-related harm.
Screening and brief intervention (SBI) decreases alcohol use and related consequences among trauma patients. Although SBI is required in Level I and II trauma centers, implementation often is ...difficult. This study used the Plan-Do-Study-Act approach to identify and implement measures to increase the number of patients receiving SBI at a Level I trauma center. A multidisciplinary Quality Improvement Committee with representation from the Trauma Service and SBI Team met monthly during 2011. Stepwise interventions included identifying a resident “champion” responsible for screening, brief intervention, and referral to treatment, including an SBI report at monthly trauma conferences, and incorporating SBI into the trauma order set. Outcomes measures were number of patients screened, patients screening positive, and the number of patients receiving SBI. At baseline, 170 of 362 patients (47%) were screened, 68/170 (40%) had positive screens, and 30/68 (44% of those with positive screens) received SBI services. Quarter 2 saw increases in patients screened—275/437 (63%), patients screening positive (106/275; 39%) and those receiving SBI (60/106; 57%). Increases culminated in Quarter 4 with screening 401/466 (86%; P < 0.001) patients, 208/401 (52%; P < 0.001) patients screening positive, and 114 patients (55%; P = 0.296) receiving services. Use of similar quality improvement measures nationwide could improve rates of provision of this important service.
Aim: The purpose of this study was to translate the National Institutes of Health (NIH)-Diabetes Prevention Program (DPP) into a church-based setting. Methods: The lifestyle arm of the NIH-DPP was ...implemented in an African American Baptist church. Church members 18 years or older completed a risk screen during Sunday service followed by fasting glucose (FG) testing at the church during the week. Persons with prediabetes participated in a 16-session DPP conducted over 4 months. Participation rates, height, weight, blood pressure (BP) and FG were followed for 12 months post-intervention. Fifty participants completed the risk screen, 26 were at risk for diabetes, 16 of 26 received FG testing, and 8 had prediabetes (FG = 100–125 mg/dL). Results: The mean participation rate was 10.4 (65%) sessions. Following the intervention, weight, systolic and diastolic BP, and FG decreased by 7.5 Ib (3.6%), 16 mm Hg (11.7%), 12 mm Hg (14.0%), and 5 mg/dL (4.8%), respectively (P < .05). In comparison with baseline, significant reductions were evident at 6 and 12 months postintervention for all endpoints. Conclusions: This study demonstrated successful translation of the 16-session NIH-DPP into a church-based setting. Future studies should test this intervention in churches of different sizes and denominations.
To study smooth muscle function in atherosclerosis, we calculated dose-response curves in patients with coronary artery disease and in controls by measuring changes in brachial artery diameter after ...incremental sublingual doses of nitroglycerin. The doses required to produce a 50% maximal dilator response were significantly higher in patients with coronary artery disease than in controls (p <0.002), suggesting smooth muscle dysfunction in atherosclerosis.
The purpose of this study was to determine the feasibility of implementing a diabetes prevention program (DPP) in a rural African-American church.
A six-session DPP, modeled after the successful ...National Institutes of Health (NIH) DPP, was implemented in a rural African-American church. Adult members of the church identified as high risk for diabetes, based on results of a risk questionnaire, were screened with a fasting glucose. Persons with prediabetes, a fasting glucose of 100-125 mg/dL, participated in the six-session, Lifestyle Balance Church DPP. The primary outcomes were attendance rates and changes in fasting glucose, weight and body mass index measured at baseline, six- and 12-month follow-up.
Ninety-nine adult church members were screened for diabetes risk. Eleven had impaired fasting glucose. Ten of 11 participated in the six-session intervention, for an attendance rate of 78%. After the intervention and 12-month follow-up, there was a mean weight loss of 7.9 lbs and 10.6 lbs, respectively.
This pilot project suggests that a modified six-session DPP can be translated to a group format and successfully implemented in a church setting. Further randomized studies are needed to determine the effectiveness of such an intervention.
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