A combined intervention strategy to increase linkage to and retention in substance use treatment for individuals accessing hospital-based services: study protocol.

Background: In 2020, New Mexico had the highest alcohol related death and the 11th highest drug overdose rate in the U.S. Towards the long-term goal of addressing this public health problem, we are implementing and evaluating an multi-level intervention designed to identify adults at risk of substance use disorder (SUD) and encourage linkage to and retention in treatment. The first level includes equipping the ED and medical inpatient units of a safety-net hospital with a method to screen individuals at risk of a SUD. The second level includes Seeking Safety (SS), a trauma-specific treatment for PTSD and SUD; and pharmacotherapy for SUD. Motivational Interviewing (MI) is used throughout both levels. Using the SPIRIT guidelines and checklist, this study protocol describes the multi-level intervention and the methodology we are using to assess feasibility and effectiveness. Methods: We are using a Type 1 hybrid implementation design with a non-randomized approach (ISRCTN registration # ISRCTN33100750). We aim to enroll 110 adults ( ≧ 18 ) who screen positive for unhealthy use of alcohol, prescription medications (used nonmedically) and/or illicit drugs. Peer support workers are responsible for screening, using MI to increase engagement in screening and treatment and delivery of SS. Pharmacotherapy is provided by addiction clinical specialists. Treatment is provided post hospital discharge via telehealth to increase access to care. Participants are identified through (1) review of electronic health records for individuals with a chief or secondary complaint or mental health condition relating to alcohol and/or other drug use, (2) referrals from clinical staff and (3) screening in the ED and medical inpatient units. Feasibility is being measured through process data. Effectiveness will be determined by changes in two primary outcomes: (i) PTSD symptom severity; and (ii) substance use. Discussion: Our study will expand on research related to the implementation of treatment strategies for patients presenting at EDs and admitted to medical inpatients units wherein there is a significant window of opportunity to link patients with follow-up behavioral and clinical services for alcohol and/or drug misuse. The challenges associated with implementation and strategies that have been helpful to address these challenges will further inform the field.

Sindrome nefrotico y embarazo. / Nephrotic syndrome and pregnancy

Se presenta un estudio retrospectivo de 17 casos de sindrome nefrotico y embarazo atendidos en el Hospital de Gineco-Obstetricia del Centro Medico Nacional del Instituto Mexicano del Seguro Social.En todos los casos el diagnostico de nefropatia primaria y la sintomatologia se establecieron antes del embarazo o antes de la semana 20 de gestacion por lo que se descarto el sindrome nefrotico secundario a preeclampsia. La toxemia y las infecciones fueron las complicaciones mas frecuentes.Hubo dos muertes maternas, una por embolia pulmonar consecutiva a hemodialisis en el puerperio y otra por coagulacion intravascular despues de un cuadro de aborto. La perdida total de embarazo fue del 76.48 por ciento. Aunque esta cifra podria abatirse con un control mas estricto, en caso de nefropatias conocidas antes de la gestacion, esta debe ser muy cuidadosamente considerada tanto por la pacientes misma como por el nefrologo y el obstetra