Injury Severity Score coding: Data analyst v. emerging m-health technology.

BACKGROUND: The cost of Abbreviated Injury Scale (AIS) coding has limited its utility in areas of the world with the highest incidence of trauma. We hypothesised that emerging mobile health (m-health) technology could offer a cost-effective alternative to the current gold-standard AIS mechanism in a high-volume trauma centre in South Africa. METHODS: A prospectively collected sample of consecutive patients admitted following a traumatic injury that required an operation during a 1-month period was selected for the study. AISs and Injury Severity Scores (ISSs) were generated by clinician-entered data using an m-health application (ISS eTHR) as well as by a team of AIS coders at Vancouver General Hospital, Canada (ISS VGH). Rater agreements for ISSs were analysed using Bland-Altman plots with 95% limits of agreement (LoA) and kappa statistics of the ISSs grouped into ordinal categories. Reliability was analysed using a two-way mixed-model intraclass correlation coefficient (ICC). Calibration and discrimination of univariate logistic regression models built to predict in-hospital complications using ISSs coded by the two methods were also compared. RESULTS: Fifty-seven patients were managed operatively during the study period. The mean age of the cohort was 27.2 years (range 14 - 62), and 96.3% were male. The mechanism of injury was penetrating in 93.4% of cases, of which 52.8% were gunshot injuries. The LoA fell within -8.6 - 9.4. The mean ISS difference was 0.4 (95% CI -0.8 - 1.6). The kappa statistic was 0.53. The ICC of the individual ISS was 0.88 (95% CI 0.81 - 0.93) and the categorical ISS was 0.81 (95% CI 0.68 - 0.87). Model performance to predict in-hospital complications using either the ISS eTHR or the ISS VGH was equivalent. CONCLUSIONS: ISSs calculated by the eTHR and gold-standard coding were comparable. Emerging m-health technology provides a cost-effective alternative for injury severity scoring.

The trajectory of client progress. A longitudinal pilot study.

Successful nonchemical drug treatment is a transformative experience: client change is the goal of treatment. Two domains in which programs intend to facilitate change are emotional well-being and the therapeutic relationship. Little previous research has addressed the question of what changes clients in drug treatment actually undergo while in treatment. This article presents results from a pilot longitudinal study of clients in two short-term drug treatment programs in Houston, TX. Results showed measurable increases in self-esteem and connection to counselor and decreases in anxiety and depression over the course of treatment for clients who completed treatment. Program graduates and early withdrawals showed distinctly different patterns of progress as measured by emotional and relationship scales.

Effectiveness of adjunct therapies in crack cocaine treatment.

Although intensive outpatient therapy is recommended for treatment of cocaine, psychosocial characteristics associated with crack cocaine abuse are also implicated in attrition from outpatient programs. Acupuncture, medications, and brainwave therapy (biofeedback), have all been used to encourage treatment retention and drug use outcomes. The effectiveness of three adjunct therapies in improving retention and drug use outcomes in intensive outpatient cocaine treatment was tested in a primarily young, indigent African-American sample of crack cocaine users at a community hospital in a low-income, high drug use neighborhood in Houston. Subjects were assigned to receive either neurobehavioral treatment alone or neurobehavioral with one of three adjunct therapies. These included acupuncture, anticraving medication, or brainwave therapy. Comparative results indicated that dosage of any adjunct therapy was associated with days in treatment and standard treatment sessions attended, and that standard treatment sessions attended was associated with negative urinalysis results at follow-up. None of the adjunct therapies were directly associated with drug use outcomes.

A pilot study of client progress in short-term drug abuse treatment.

This paper is a pilot study of client progress in two short-term (23-day) drug abuse treatment programs. Client progress is defined as those changes in cognitive functioning, emotional well-being, and social support resources that are th proximate goals of drug abuse treatment. In this study, client progress was measured by changes in cognitive functioning, emotional well-being, and social support domains over the course of treatment. This pilot study showed that client progress can be detected in short-term treatment and can be related to indicators of the quantity and quality of treatment. In general, results showed that both relationships and emotional well-being changed over the course of treatment. Cognitive functioning variables did not generally change over time, nor were they related to indicators of treatment quality. Evidence in this pilot study suggests that more attention needs to be given to the relational and emotional aspects of the drug abuse treatment process.

An experimental test of retention in residential and outpatient programs.

Previous studies of residential and outpatient drug treatment programs have found that retention is higher in residential than in outpatient programs. This study attempts to verify previous findings by conducting an experiment that controls for ecological, self-selection, and program content biases. The Houston Recovery Campus is a research-focused, multiple-provider drug treatment facility for the indigent of Harris County, Texas. During the study period, 646 applicants were randomly assigned to two comparable 28-day programs. The first program was a residential program; the second was an outpatient day treatment program. Twenty-eight day retention rates were significantly higher for the residential program (76%) compared to the day treatment program (64%).