Secondary analysis of an RCT on Emergency Department-Initiated Tobacco Control: Repeatedly assessed point-prevalence abstinence up to 12 months and extension of results through a 10-year follow-up.

INTRODUCTION: Emergency departments (EDs) are opportune places for tobacco control interventions. The 'Tobacco Control in an Urban Emergency Department' (TED) study, ISRCTN41527831, originally evaluated the effect of motivational interviewing on-site plus up to four booster telephone calls on 12-month abstinence. This study's aim was to evaluate the effect of the intervention on 7-day point-prevalence abstinence at 10 years follow-up (primary outcome) as well as on repeated point-prevalence abstinence at 1, 3, 6, 12 months and at 10 years (continual smoking abstinence, secondary outcome). METHODS: At the 10 years follow-up and after informed consent, study participants responded to a mailed questionnaire. The primary outcome was analyzed in observed-only and in all-cases analyses. The secondary outcomes were analyzed using a multiple adjusted GLMM for binary outcomes. RESULTS: Out of 1012 TED-study participants, 986 (97.4%) were alive and 231 (23.4% of 986) responded to the follow-up at 10 years. For observed-only and all-cases analyses, the effect of the baseline intervention on 7-day point-prevalence abstinence at the 10 years follow-up was statistically non-significant. However, when taking into account all repeated measures, the intervention significantly influenced continual abstinence with odds ratio 1.32 (95% CI: 1.01-1.73; p=0.042). Baseline motivation, perceived self-efficacy to stop smoking, and nicotine dependency were independently associated with long-term continual smoking abstinence (all p<0.05). CONCLUSIONS: A conventional analysis failed to confirm a significant effect of the ED-initiated tobacco control intervention on the point-prevalence abstinence at 10 years. Results from a more integrative analysis nonetheless indicated an enduring intervention effect on continual abstinence among smokers first encountered in the emergency department setting 10 years earlier.

Efficacy of emergency department-initiated tobacco control--systematic review and meta-analysis of randomized controlled trials.

AIM: Systematic review and meta-analysis of randomized controlled trials evaluating the efficacy of emergency department-initiated tobacco control (ETC). METHODS: Literature search in 7 databases and gray literature sources. Point prevalence tobacco abstinence at 1-, 3-, 6-, and/or 12-month follow-up was abstracted from each study. The proportionate effect (relative risk) of ETC on tobacco abstinence was calculated separately for each study and follow-up time and pooled, at different follow-up times, by Mantel-Haenszel relative risks. The effects of ETC on combined point prevalence tobacco abstinence across all follow-up times were calculated using generalized linear mixed models. RESULTS: Seven studies with overall 1,986 participants were included. The strongest effect of ETC on point prevalence tobacco abstinence was found at 1 month: Relative risk (RR) = 1.47 (3 studies) (95% confidence interval [CI]: 1.06-2.06), while the effect at 3, 6, and 12 months was RR = 1.24 (6 studies) (95% CI: 0.93-1.65); 1.13 (5 studies) (95% CI: 0.86-1.49); and 1.25 (1 study) (95% CI: 0.91-1.72). The benefit on combined point prevalence tobacco abstinence was RR = 1.33 (7 studies) (95% CI: 0.96-1.83), p = .08; with RR = 1.33 (95% CI: 0.92-1.92), p = .10, for the 5 studies combining motivational interviewing and booster phone calls. CONCLUSIONS: ETC combining motivational interviewing and booster phone calls showed a trend toward increased episodically measured tobacco abstinence up to 12 months. More methodologically rigorous trials are needed to effectively evaluate the impact of ETC.

Persistence of psychological distress in surgical patients with interest in psychotherapy: results of a 6-month follow-up.

OBJECTIVES: This prospective observational study investigated whether self-reported psychological distress and alcohol use problems of surgical patients change between preoperative baseline assessment and postoperative 6-month follow-up examination. Patients with preoperative interest in psychotherapy were compared with patients without interest in psychotherapy. METHODS: A total of 1,157 consecutive patients from various surgical fields completed a set of psychiatric questionnaires preoperatively and at 6 months postoperatively, including Patient Health Questionnaire-4 (PHQ-4), Brief Symptom Inventory (BSI), Center for Epidemiologic Studies Depression Scale (CES-D), World Health Organization 5-item Well-Being Index (WHO-5), and Alcohol Use Disorder Identification Test (AUDIT). Additionally, patients were asked for their interest in psychotherapy. Repeated measure ANCOVA was used for primary data analysis. RESULTS: 16.7% of the patients were interested in psychotherapy. Compared to uninterested patients, they showed consistently higher distress at both baseline and month 6 regarding all of the assessed psychological measures (p's between <0.001 and 0.003). At 6-month follow-up, neither substantial changes over time nor large time x group interactions were found. Results of ANCOVA's controlling for demographic variables were confirmed by analyses of frequencies of clinically significant distress. CONCLUSION: In surgical patients with interest in psychotherapy, there is a remarkable persistence of elevated self-reported general psychological distress, depression, anxiety, and alcohol use disorder symptoms over 6 months. This suggests high and chronic psychiatric comorbidity and a clear need for psychotherapeutic and psychiatric treatment rather than transient worries posed by facing surgery.

Does the alcohol use disorders identification test-consumption identify the same patient population as the full 10-item alcohol use disorders identification test?

The aim of this study was to evaluate whether a computer-based 3-item version (Alcohol Use Disorders Identification Test-Consumption [AUDIT-C]) of the Alcohol Use Disorders Identification Test (AUDIT) identifies alcohol use disorder (AUD) in the same patients as the full 10-item version in 809 women and 747 men in an anesthesiology preoperative assessment clinic. According to cutoffs used ( AUDIT: 5-8 points, AUDIT-C: 4-6 points), rate of disagreement (AUDIT-positive and AUDIT-C-negative or vice versa) ranged between 4% and 31% (men) and between 4% and 19% (women). In male patients, 15% were positive for both the AUDIT (≥8 points) and the AUDIT-C (≥6 points), 7% were positive for AUDIT-C only, and 4% were positive for AUDIT only. In female patients, using cutoffs of 5 more points (AUDIT) and 4 or more points (AUDIT-C), 16% were positive for both versions, 9% were positive for AUDIT-C only, and 2% were positive for AUDIT only. The AUDIT and AUDIT-C seem to identify AUD in differing patients.

Social influences on the motivation to quit smoking: main and moderating effects of social norms.

The present study extends the previous research on the social influences on quitting by investigating inconsistencies between different types of social norms and their main and moderating effects on quitting intentions. The theory of planned behaviour (TPB) served as the theoretical framework. Social influences were operationalised by subjective quitting norm (significant others' expectations that one should quit), descriptive quitting norm (significant others' quitting behaviour), and descriptive smoking norm (partner's smoking). Because gender differences had previously been reported, norm effects were also analysed with respect to gender. A total of 168 smokers who had a partner (47% men, mean age M=34, SD=16) completed measures of TPB variables (including subjective quitting norm), descriptive quitting norm, descriptive smoking norm, and smoking behaviour. Subjective and descriptive quitting norms were more inconsistent in women than in men. The descriptive quitting norm enhanced the TPB prediction of intention by 5%. A three-way interaction accounted for an additional 3% of the variance and revealed both that subjective and descriptive quitting norms interacted in their prediction and that gender moderated this effect: the subjective quitting norm correlated positively to quitting intention only in women with a strong descriptive quitting norm. All analyses were controlled for number of cigarettes per day. These findings confirmed that it is important to distinguish subjective and descriptive norms and that differences exist in how these norms motivate women and men to quit smoking. Consistent quitting norms such as quitting of significant others in combination with their expectations that one should quit appear to be less common but more important in women to form a corresponding intention.

[The Post-Traumatic Stress Syndrome 14-Questions Inventory (PTSS-14) - Translation of the UK-PTSS-14 and validation of the German version]. / Die posttraumatische Stressskala-14 (PTSS-14) - Validierung der richtlinienkonformen Übersetzung für den deutschsprachigen Raum.

BACKGROUND: Hospitalization may represent a stressor that can lead to Posttraumatic stress disorder (PTSD). METHODS: Translation of the UK-PTSS-14, conducted in accordance with ISPOR principles and validation with the PDS (86 patients). RESULTS: The ROC analysis showed that the German version of PTSS-14 is a valid instrument with high sensitivity (82%) and specificity (92%) with the optimum cut-off point at 40 points. The translation process was authorized by the author of the UK-PTSS-14. CONCLUSION: The validated German version of PTSS-14 is now ready for use as an efficient and reliable screening-tool for PTSD in a clinical setting.

Postoperative cognitive dysfunction: computerized and conventional tests showed only moderate inter-rater reliability.

PURPOSE: The incidence of postoperative cognitive dysfunction (POCD) depends on the test battery and calculation method used. The measurements may be performed with a paper and pencil test battery or with a computerized test battery. The objective of this study was to measure the incidence and congruence of POCD by comparing a computerized test battery with a paper and pencil test battery in the same patient population. METHODS: In total, 67 patients were included: 30 consecutive in-patients undergoing surgery under general anesthesia and 37 non-surgical out-patients as control. Patients were tested with a paper and pencil test battery and a computerized test battery on inclusion in the study and 7 days later. Both test batteries covered the cognitive domains: visual attention, visual learning, memory, and speed of processing. RESULTS: The computerized test battery classified 10.0% (95% CI 3.5-25.6%) of the patients as suffering from POCD whereas the paper and pencil test battery classified 30.0% (95% CI 16.7-47.9%) as suffering (95% CI for difference 3.9-36.5%, P = 0.03). The inter-rater reliability between both test batteries showed moderate agreement (Cohen's kappa of 0.41). All patients identified by use of the computerized test battery were also identified with the paper and pencil test battery. The paper and pencil test battery identified 6 additional cases. CONCLUSION: In our study we demonstrated that the incidence of POCD measured with computerized test battery and paper and pencil test battery showed moderate inter-rater reliability. Use of neuropsychological test batteries theoretically covering the same cognitive domains does not automatically lead to the same classification of POCD.

Socioeconomic factors, hazardous alcohol consumption, and smoking in patients with minor trauma in an inner-city emergency department.

Emergency Department (ED) patients show a high prevalence of hazardous alcohol consumption and smoking. The objective of this study was to determine if socioeconomic factors and smoking status help to optimize screening for hazardous alcohol consumption (HAC) in patients with minor trauma. A survey was conducted in an ED in an inner-city university hospital. A total of 2562 patients with minor trauma were screened for HAC (≥ 8 points in men and ≥ 5 points in women on the Alcohol Use Disorders Identification Test), smoking status, and socioeconomic factors. The median age of participants was 32 years, with 62.1% being male. A total of 84.2% of patients had an Injury Severity Score of 1, indicating minor trauma. Overall, 23.5% of patients showed a pattern of HAC, whereas 46.2% were current smokers. Compared to patients without HAC, those with HAC were characterized by lower incomes, no partnership, living in a single-household, and being unemployed. The strongest discriminative variable for HAC for patients aged ≤ 53 years was smoking status. Gender differences played a role only in patients older than 53 years. Although socioeconomic factors showed a non-equal distribution in patients with respectively without HAC, solely age, gender, and smoking status may provide a successful stratification for alcohol screening and intervention in these patients.

Screening trauma patients with the alcohol use disorders identification test and biomarkers of alcohol use.

BACKGROUND: Alcohol screening and brief interventions have been shown to reduce alcohol-related morbidity in injured patients. Use of self-report questionnaires such as the Alcohol Use Disorder Identification Test (AUDIT) is recommended as the optimum screening method. We hypothesized that the accuracy of screening is enhanced by combined use of the AUDIT and biomarkers of alcohol use in injured patients. METHODS: The study was conducted in the emergency department of a large, urban, university hospital. Patients were evaluated with the AUDIT, and blood sampled to determine carbohydrate-deficient transferrin, gamma-glutamyl-transferase, and mean corpuscular volume. Alcohol problems were defined as presence of ICD-10 criteria for dependence or harmful use, or high-risk drinking according to World Health Organization criteria (weekly intake >420 g in males, >280 g in females). Screening accuracy was determined using Receiver Operating Characteristic curves. RESULTS: There were 787 males and 446 females in the study. Median age was 33 years. The accuracy of the AUDIT was good to excellent, whereas all biomarkers performed only fairly to poorly in males, and even worse in females. At a specificity >0.80, sensitivity for all biomarkers was <0.43, whereas sensitivity for the AUDIT was 0.76 for males and 0.81 for females. The addition of biomarkers added little additional discriminatory information compared to use of the AUDIT alone. CONCLUSIONS: Screening properties of the AUDIT are superior to %CDT, MCV, and GGT for detection of alcohol problems in injured patients and are not clinically significantly enhanced by the use of biomarkers.

New strategies to detect alcohol use disorders in the preoperative assessment clinic of a German university hospital.

BACKGROUND: Although alcohol use disorders (AUDs) have enormous public health consequences, the rate of diagnosis of AUDs remains unsatisfactorily low. The primary aim of this study was to compare the detection of AUDs by anesthesiologists in a large preoperative assessment clinic to that by computerized self-assessment of the Alcohol Use Disorder Identification Test. Secondary outcome measures were to compare the actions taken by anesthesiologists upon a finding of an AUD. METHODS: One thousand five hundred fifty-six patients were included. Before preoperative assessment, patients were asked to complete the Alcohol Use Disorder Identification Test (positive scores: men > or = 8, women > or = 5) using a computer. The authors performed a retrospective chart analysis of the anesthesiologists' actions upon a finding of an AUD. The anesthesiologists were blinded to the results of the computer-based assessment and to the subsequent chart analysis. RESULTS: The prevalence rate of AUDs determined by the anesthesiologists was 6.9% (107 of 1,556), whereas the proportion of patients positive for an AUD using the computerised Alcohol Use Disorder Identification Test was 18.1% (282 of 1,556) (P < 0.001). The detection rate by the anesthesiologists of AUDs among men was significantly higher than among women (P < 0.001) as well as in the elderly compared with younger patients (P < 0.001). Action taken by anesthesiologists was mainly based on evaluating quantity of alcohol consumption. CONCLUSION: The computer-based self-assessment increases detection rates of AUDs in busy settings such as a preoperative assessment clinic. Prevalence rates of AUDs are underestimated. Best-practice guidelines for detection of AUDs are not implemented in the daily clinical routine. Barrier analysis is urgently required.