Consideration of Social Determinants Risks in Substance Use Disorder Assessment and Treatment Plan Formulation.

ABSTRACT: Substance use disorders continue to trend as an increasingly pervasive public health problem in the United States. Substance use disorders are recognized as a global health problem by the World Health Organization. It is imperative to explore all opportunities to improve outcomes of substance use disorder treatment. Consideration of social determinant risks in assessment, treatment planning, and treatment implementation is one such opportunity. Social determinant conditions can be conceptualized along a continuum of primary categories. Developing methods to help clinicians understand and incorporate social determinants into assessment and treatment plan formulation processes may help improve outcomes for those who are experiencing one or more substance use disorders. This column includes a proposal for a framework of primary categories of social determinants and offers a definition for each. The categories are identified as basic needs insecurity, past trauma, historical oppression, current/ongoing severe distress and layered/compounded risks. These categories and definitions are developed in the context of practical application for clinical assessment and treatment plan formulation.

Remotely supported prehospital ultrasound: A feasibility study of real-time image transmission and expert guidance to aid diagnosis in remote and rural communities.

Introduction Our aim is to expedite prehospital assessment of remote and rural patients using remotely-supported ultrasound and satellite/cellular communications. In this paradigm, paramedics are remotely-supported ultrasound operators, guided by hospital-based specialists, to record images before receiving diagnostic advice. Technology can support users in areas with little access to medical imaging and suboptimal communications coverage by connecting to multiple cellular networks and/or satellites to stream live ultrasound and audio-video. Methods An ambulance-based demonstrator system captured standard trauma and novel transcranial ultrasound scans from 10 healthy volunteers at 16 locations across the Scottish Highlands. Volunteers underwent brief scanning training before receiving expert guidance via the communications link. Ultrasound images were streamed with an audio/video feed to reviewers for interpretation. Two sessions were transmitted via satellite and 21 used cellular networks. Reviewers rated image and communication quality, and their utility for diagnosis. Transmission latency and bandwidth were recorded, and effects of scanner and reviewer experience were assessed. Results Appropriate views were provided in 94% of the simulated trauma scans. The mean upload rate was 835/150 kbps and mean latency was 114/2072 ms for cellular and satellite networks, respectively. Scanning experience had a significant impact on time to achieve a diagnostic image, and review of offline scans required significantly less time than live-streamed scans. Discussion This prehospital ultrasound system could facilitate early diagnosis and streamlining of treatment pathways for remote emergency patients, being particularly applicable in rural areas worldwide with poor communications infrastructure and extensive transport times.