Assistance Scores Research Articles

Research on Patient Satisfaction of Robotic Telerounding: A Pilot Study in a Korean Population

ObjectivesTo evaluate the efficacy and functionality of robotic telerounding among Korean patients using the RP-7 robot system and a questionnaire survey comparing the results of robotic telerounding and standard rounding in Korean patients. MethodsA total of 40 patients who underwent urologic minimally invasive video-assisted minilaparotomy surgery, laparoscopic and robotic surgery, and endoscopic surgery were recruited. The patients were divided into 2 groups – telerounding (20) and standard rounding (20) – and underwent robotic telerounding and standard rounding. We assessed the patients using a 24-item questionnaire to evaluate the efficacy and functionality of their hospital care. ResultsThe hospital factors such as self-rated health, assistance, and pain control scores showed no statistically significant differences between groups. Patient satisfaction showed a statistically significant difference in MD confidence, medical communication, explanation understanding, explanation satisfaction, mutual communication, and mutual response. In the telerounding group, participants were satisfied with the audio and video qualities and believed that the robotic telerounding provided better care, and 85% of patients preferred telerounding in the absence of the attending physician. ConclusionRobotic telerounding can provide efficient and cost-effective medical rounding by reducing inconvenience and labor cost with greater patient satisfaction with postoperative care. However, there is no statistically significant difference in the hospital factors and postoperative morbidity. In addition, the patients doubted that the robotic telerounding could replace standard rounding due to the Eastern culture.

The effect of housing assistance on student achievement: Evidence from Wisconsin

Drawing on a unique data set that links information on all Wisconsin households receiving means-tested benefits with the educational performance of all Wisconsin public school students in these households, we estimate the effect of a family's initial receipt of housing assistance on students’ subsequent achievement outcomes. We estimate these effects using two different comparison groups. Our first comparison group consists of children living in households that receive housing assistance starting four years after our treatment group—we use observations from those students’ pre-receipt years as the basis for the comparison. Our second comparison group consists of low-income students whose families never received housing assistance, but did receive other forms of means-tested benefits, such as SNAP, TANF, or Medicaid. Overall, our results suggest a positive relationship between housing assistance and math achievement, but the magnitude of this relationship is modest and not consistently statistically significant. We provide evidence that this relationship varies by student race and by type of housing assistance—a voucher or public housing. Throughout, we find little evidence of any relationship between housing assistance and student reading scores.

Outcome of a "modified brief intervention" program delivered at work place for a population with hazardous alcohol use.

Introduction:At the population level, screening and brief intervention (BI) is the most cost-effective method to reduce the burden of disease due to hazardous alcohol use. In delivering BI at individual level, trained workforce as well as time is a limiting factor. Hence, a study was conducted to assess the outcome of a “modified brief intervention” program delivered at workplace in a group setting for the participants identified with hazardous alcohol use pattern, as a secondary prevention measure.Materials and Methods:Study was a pre- and post-intervention study without a control group. Following an educational lecture, conducted by a mental health team including a psychiatrist, participants were screened using the WHO ASSIST questionnaire, V3.0 version. Those screened positive for hazardous alcohol use were given “modified brief intervention” in a group setting at their workplace which consisted of two semi-structured sessions of 1-h duration each. The sessions were spaced in a month. First session was based on motivation enhancement measures along with gathering of current alcohol use details and second session focused on relapse prevention. Three months later, the outcomes were assessed using a semistructured questionnaire and ASSIST was reapplied. The analysis was done using the R-commander from R-software.Results:No significant difficulty was experienced in conducting the interventions. Fifty (55.6%) participants stayed alcohol abstinent following second session and another 22 (24.44%) had reduced both the quantity and frequency of use. Paired t-tests revealed statistically significant reduction in all secondary outcome parameters (ASSIST scores, usual dose in one sitting, maximum dose, and number of days of use in month). Eighty (88.89%) participants reported the program to be effective. Only 3 months of observation is a limitation.Conclusion:The study provides an efficient secondary prevention model to reduce hazardous drinking at the population level needing less workforce, cost, and time.

A Correlation-Experience-Demand Based Personalized Knowledge Recommendation Approach

Knowledge recommendation is an important means of knowledge reuse that can improve the efficiency and quality of product design. However, at present, there is no good way to fully consider the personalized demands of designers while ensuring the applicability of the recommendation results. Previous studies have usually been based on the similarity between tasks and knowledge or use collaborative filtering technology to accomplish knowledge recommendation. However, these methods do not consider the personal experience of designers and the characteristics of knowledge. This paper proposes a knowledge recommendation approach that integrates the degree of correlation between knowledge and tasks, the feedback-based personal experience, the collective experience of designers, and the degree of demand for knowledge based on the forgetting curve. A knowledge assistance score is generated based on these factors, and the knowledge recommendation list is obtained by ranking the knowledge in descending order of this score. Finally, the approach is applied to a machine shop layout design task and a computer numerical control (CNC) machine tool's spindle design and bearings selection task. The experimental results on two tasks demonstrate that the proposed approach outperforms three baselines on three ranking oriented evaluation metrics. This approach can effectively shorten the time for designers to acquire knowledge by recommending applicable knowledge to assist designers in completing design tasks with high quality and efficiency.

Prolonged Mechanical Ventilation Assistance Interacts Synergistically with Carbapenem for Clostridium difficile Infection in Critically Ill Patients.

Objectives: Interactions between mechanical ventilation (MV) and carbapenem interventions were investigated for the risk of Clostridium difficile infection (CDI) in critically ill patients undergoing concurrent carbapenem therapy. Methods: Taiwan’s National Intensive Care Unit Database (NICUD) was used in this analytical, observational, and retrospective study. We analyzed 267,871 intubated patients in subgroups based on the duration of MV support: 7–14 days (n = 97,525), 15–21 days (n = 52,068), 22–28 days (n = 35,264), and 29–60 days (n = 70,021). The primary outcome was CDI. Results: Age (>75 years old), prolonged MV assistance (>21 days), carbapenem therapy (>15 days), and high comorbidity scores were identified as independent risk factors for developing CDI. CDI risk increased with longer MV support. The highest rate of CDI was in the MV 29–60 days subgroup (adjusted hazard ratio (AHR) = 2.85; 95% confidence interval (CI) = 1.46–5.58; p < 0.02). Moreover, higher CDI rates correlated with the interaction between MV and carbapenem interventions; these CDI risks were increased in the MV 15–21 days (AHR = 2.58; 95% CI = 1.12–5.91) and MV 29–60 days (AHR = 4.63; 95% CI = 1.14–10.03) subgroups than in the non-MV and non-carbapenem subgroups. Conclusions: Both MV support and carbapenem interventions significantly increase the risk that critically ill patients will develop CDI. Moreover, prolonged MV support and carbapenem therapy synergistically induce CDI. These findings provide new insights into the role of MV support in the development of CDI.

Profile of substance use and health risk due to substance use in subjects attending outpatient departments of a tertiary care hospital, South India

Background: The pattern and prevalence of substance use change from region to region and differ from country to country. Most of the people who abuse the drugs do not know the ill effects of their habit. Objective: This study aimed to assess the profile and health risk involved in each subject who used substances. Materials and Methods: The study was conducted in the outpatient departments of Medicine and Pulmonary Medicine of a tertiary care hospital using cross-sectional descriptive design. A screening questionnaire, “Alcohol, Smoking, and Substance Involvement Screening Test” (ASSIST) was administered to assess the type of substances that had been used and the level of health risk associated with them based on the ASSIST score. Statistical Analysis: Sociodemographic variables and the level of risk were presented as frequency and percentage. Chi-square test and Fisher's exact test were used to assess the relationship between categorical variables and ASSIST scores. Results: Most of the participants participated in the present study came under moderate health-risk category. Majority of the participants 114 (53.53%) had a family history of substance use. There was a strong association for gender with alcohol and tobacco use. Conclusion: The most widely abused substances in the present setup were alcohol and tobacco.

Charting the territory: Describing the functional abilities of children with progressive neurological conditions

AimsLittle is known about the functional abilities of children with progressive genetic, metabolic, or neurological conditions (PNCs). In this study, children with PNCs were followed over a 2-year period to assess their functional abilities over time. Specific aims were to: 1) describe the changes in functional skills and the effects of age for children with PNCs, 2) assess changes in these children’s need for caregiver assistance over time, and 3) examine relationships between these children’s functional skills and need for caregiver assistance. MethodsThis study involved a longitudinal, descriptive design with three assessments occurring at Baseline, Year 1, Year 2. Functional skills and caregiver assistance were assessed by the Pediatric Evaluation of Disability Inventory (PEDI). The PEDI questionnaire was completed at baseline and then yearly by parents, along with the assistance of a trained research assistant (RA). ResultsThe study was completed with 83 children (mean age at Baseline=7.1yrs, SD=4.6). Mean Functional skills scores were in the low ranges at Baseline and did not change significantly across time points (F(2, 71)=0.437, p=0.58). Time point had no effect on caregiver assistance ratings (p<0.2); however, children required greater amounts of help with self-care at later time points than for other functional domains. Statistically significant correlations were found between PEDI-Functional skills and caregiver assistance ratings (r=0.80-0.90, p<0.01). ConclusionsFunctional skills were low for these children overall, irrespective of age. In children with PNCs: 1) mean functional skills did not change significantly over time; 2) caregiver assistance scores remained stable and 3) functional skills and levels of caregiver assistance were strongly positively correlated. Further research to explore the long-term functional trajectory in children with a PNC is recommended.

A controlled trial of screening, brief intervention and referral for treatment (SBIRT) implementation in primary care in the United Arab Emirates.

Substance use is increasing in the United Arab Emirates yet there has been no formal primary care intervention. SBIRT was considered an appropriate model given its endorsement by the WHO. A controlled trial (two intervention and two matched control clinics) was undertaken. Intervention physicians (n=17) were trained in SBIRT. Physicians' attitudes were measured before and after training and eight months after implementation. Target recruitment was 900 patients. Inclusion criteria were: consenting UAE national, ⩾18 years, using the 'walk-in' primary care clinic. Patient data was collected by physician-administered questionnaire. Prevalence of drug use was measured through electronic patient records. Findings A total of 906 patients were screened, aged 18-82 years and 496 (55%) were female. Of these, 5.7% reported use of amphetamine, 3.9% alcohol, 3.3%, sedatives, 1.7% opioids and 1.1% cannabis. In all, 21 people had a moderate/high ASSIST score and received a brief intervention, but did not attend follow-up; three high-risk people were referred for specialist treatment. Physicians' attitudes towards patients with problematic substance use and providing treatment improved after training, but returned to pre-training levels after eight months. Including the 21 individuals identified from intervention screening, the prevalence of substance use increased to 0.208% (95% CI 0.154-0.274), significantly higher than in control clinics (P<0.001). In conclusion, physicians were generally positive towards SBIRT and SBIRT increased recorded drug related conditions at a practice level. However, poor patient attendance at follow-up requires investigation.

Rapid Methods for Routine Frailty Assessment during Vascular Surgery Clinic Visits

Frailty assessment can help vascular surgeons predict perioperative risk and long-term mortality for their patients. Unfortunately, comprehensive frailty assessments take too long to integrate into clinic workflow. This study was designed to evaluate 2 rapid methods for assessing frailty during vascular clinics-a short patient-reported survey and a provider-reported frailty scale. We prospectively enrolled 159 patients presenting to an academic medical center vascular surgery clinic between May and November 2016. Patients underwent frailty assessment using 2 rapid methods: (1) the Frail Nondisabled (FiND) survey (5 questions) and (2) the Clinical Frailty Scale (CFS; 9-point scale from robust to severely frail). These were followed by administering the Fried Index, a validated frailty assessment method with 5 measures (weight loss, exhaustion, grip strength, walking speed, and activity level). The correlation between Fried scores (reference standard) with frailty diagnoses derived from FiND and CFS was analyzed using the Spearman-rank test, Cohen's kappa, sensitivity/specificity tests, and receiver operating curves. The evaluated cohort included 87 (55%) females, a mean age of 61years, 126 (79%) preoperative patients, and 32 (20%) categorized as frail using the Fried Index criteria. The FiND survey was very sensitive (91%) but less specific for diagnosing frailty. In comparison, the CFS was highly specific (96%) for diagnosing frailty and exhibited high inter-rater reliability between surgeon and medical assistant scores (kappa: 0.79; 95% CI: 0.72-0.87; P<0.001). There was moderate correlation between frailty assigned using the Fried Index and the CFS (rho: 0.41-0.44). Frailty can be quickly and effectively assessed during vascular surgery clinic using a combination of patient-reported (FiND) and provider-reported (CFS) methods to improve diagnostic accuracy. Implementing routine frailty assessment into clinic workflow can be a valuable tool for risk prediction and surgical decision-making.

The validity, reliability, and responsiveness of the modified Iowa Level of Assistance scale in hospitalized older adults in subacute care

Objective: The objective of this study was to investigate the psychometric properties of the Modified Iowa Level of Assistance scale in hospitalized older adults in subacute care.Design: A cohort, measurement-focused study.Participants and setting: Fifty-eight older adults, aged 65 years and older, were recruited from a subacute rehabilitation hospital.Methods: Inter-rater reliability was established by having two physiotherapists independently assess each participant within 24-h of each other. Construct validity was established using “known-groups” validity, while concurrent validity was also examined by correlating modified Iowa Level of Assistance scores with the Elderly Mobility Scale. Responsiveness was assessed by examining the difference in modified Iowa Level of Assistance scores from admission to discharge.Results: The mean age of participants was 82.8 years (SD 7.5; range 68–97). The modified Iowa Level of Assistance scale was found to be reliable, valid, and responsive in this sample of hospitalized older adults. It had excellent inter-rater reliability (intraclass correlation coefficient [2,1] 0.96; 95% confidence intervals (CI) 0.93, 0.98) and no systematic differences across the range of scores. The scale displayed a mean difference between two known groups of 11.4 points and correlated significantly and negatively with the Elderly Mobility Scale (Spearman’s rho − 0.90). The modified Iowa Level of Assistance score also changed significantly over the course of the hospital admission with an effect size of 1.2.Conclusions: The modified Iowa Level of Assistance scale is a valid measure with excellent inter-rater reliability in hospitalized older adults. It is responsive to functional change during hospital admission and may be useful for routine outcome assessment for hospitalized older adults in subacute care.Implications for RehabilitationThe mILOA scale is a valid, reliable, and responsive outcome measure that can be used to quantify the gait and mobility impairments in hospitalized older adults in subacute care.For optimal reliability and responsiveness, consistent administration of the mILOA scale will be required particularly for higher level mobility tasks such as negotiating a step.

Brief alcohol intervention in alcohol involved facial fracture patients-a survey of patient attitudes to screening and intervention.

Alcohol intoxication is an important contributor to traumatic facial injuries. The period following injuries afford clinicians a useful window of opportunity to provide alcohol screening and brief intervention (SBI) which may affect changes in patients' future drinking behaviour. Although SBI has been reported to decrease at risk drinking and potentially trauma recurrence, it is not routinely utilised in most clinical settings in the world. This study aims to assess utilisation of, as well as patients' knowledge and attitude towards SBI in the management of patients presenting with alcohol-related facial fractures. Twenty consecutive patients who presented to Western Health with facial fractures who met selection criteria were offered an alcohol screening and survey questionnaire. Ninety percent of patients were male and 50% were aged between 19 and 34. ASSIST score showed 65% were in the moderate risk category; 75% reported this was their first admission with alcohol related trauma. Although 75% acknowledged alcohol as a main cause of injury, only 40% agreed they drink too much. Forty-four percent felt that talking to a healthcare worker might help and 33% would consider accepting help. Forty-seven percent felt reading materials would be helpful in changing future drinking habits. Whilst 63% would like to know safe drinking limit, only 45% would like to have a discussion about alcohol-related harms. Most patients presented in this survey were in moderate risk category who are amenable to behavioural change with provision of SBI. However, there is resistance to implementation of this intervention due to lack of knowledge, self-awareness and willingness to change. Nonetheless, patients are prepared to accept advice from clinicians and some formats of intervention. It is important to formulate a simple screening questionnaire and intervention strategy that are easy to administer to affect positive changes in patients with harmful drinking behaviours.

Cross-Sectional Study of Risky Substance Use by Injured Emergency Department Patients

IntroductionSurvey data regarding the prevalence of risky substance use in the emergency department (ED) is not consistent. The objective of this study was to identify the prevalence of risky substance use among injured ED patients based on the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST v3.0). A secondary objective was to report on the feasibility of administering the ASSIST to this population, based on the time to conduct screening.MethodsThis cross-sectional study used screening data from a randomized controlled trial. Injured ED patients completed the ASSIST on a tablet computer, and an ASSIST score was computed that indicated the need for a brief or intensive treatment intervention (risky use) for alcohol and other substances. For a subsample, data on time to complete each step of screening was recorded.ResultsBetween July 2010 and March 2013, 5,695 patients completed the ASSIST. Most (92%) reported lifetime use of at least one substance and 51% reported current risky use of at least one substance. Mean time to complete the ASSIST was 5.4 minutes and screening was considered feasible even when paused for clinical care to proceed.ConclusionEstimates of risky substance use based on the ASSIST in our large sample of injured ED patients were higher than previously reported in other studies of ED patients, possibly due to the current focus on an injured population. In addition, it was feasible to administer the ASSIST to patients in the course of their clinical care.

Identifying substance misuse in primary care: TAPS Tool compared to the WHO ASSIST

BackgroundThere is a need for screening and brief assessment instruments to identify primary care patients with substance use problems. This study's aim was to examine the performance of a two-step screening and brief assessment instrument, the TAPS Tool, compared to the WHO ASSIST. MethodsTwo thousand adult primary care patients recruited from five primary care clinics in four Eastern US states completed the TAPS Tool followed by the ASSIST. The ability of the TAPS Tool to identify moderate- and high-risk use scores on the ASSIST was examined using sensitivity and specificity analyses. ResultsThe interviewer and self-administered computer tablet versions of the TAPS Tool generated similar results. The interviewer-administered version (at cut-off of 2), had acceptable sensitivity and specificity for high-risk tobacco (0.90 and 0.77) and alcohol (0.87 and 0.80) use. For illicit drugs, sensitivities were >0.82 and specificities >0.92. The TAPS (at a cut-off of 1) had good sensitivity and specificity for moderate-risk tobacco use (0.83 and 0.97) and alcohol (0.83 and 0.74). Among illicit drugs, sensitivity was acceptable for moderate-risk of marijuana (0.71), while it was low for all other illicit drugs and non-medical use of prescription medications. Specificities were 0.97 or higher for all illicit drugs and prescription medications. ConclusionsThe TAPS Tool identified adult primary care patients with high-risk ASSIST scores for all substances as well moderate-risk users of tobacco, alcohol, and marijuana, although it did not perform well in identifying patients with moderate-risk use of other drugs or non-medical use of prescription medications. The advantages of the TAPS Tool over the ASSIST are its more limited number of items and focus solely on substance use in the past 3months.

An Association Study of the COMT and GABA Gene Variants with Alcohol Dependence

Alcohol dependence (AD), associated with high mortality and morbidity is caused due to involvement of both environmental and genetic factors. Behavioral effects of alcohol including cognitive impairment, motor incoordination, tolerance and dependence are likely due to its effect on the multiple brain proteins including neurotransmitters. Dysfunction in these neurotransmitter systems may be at the level of enzymes involved in metabolic degradation, or receptors involved in neurotransmission like dopamine, Gamma-amino butyric acid (GABA), serotonin etc. Genetic polymorphisms in these neurotransmitter systems are implicated in conferring susceptibility to AD. Aim: To identify association of single nucleotide polymorphisms (SNPs) in COMT (rs4680 and rs2075507) and GABAA receptor genes (rs13172914 and rs211014) with AD. Method: A total of 100 AD patients diagnosed on the basis of DSM IV criteria from the outpatient clinic of the National Drug Dependence Treatment Centre (NDDTC) of All India Institute of Medical Sciences (AIIMS), and 100 healthy individuals from the general population were recruited. A detailed history including pattern of drug use and demographic details with pedigree information was noted. Genomic DNA from peripheral blood samples was processed for PCR amplification followed by restriction digestion to screen for the presence of polymorphisms. Genotype and allele frequencies were evaluated and correlated with alcohol use parameters including duration of alcohol use, age at onset of alcohol use, quantity of alcohol consumed (gms/day) and WHO ASSIST score and levels of liver function enzymes (SGPT and SGOT). Statistical analysis was performed using SPSS v21.0. Results: Genetic analysis of the study group revealed COMT rs4680 to be significantly associated with AD (p=0.03), while the other COMT SNP rs2075507 showed an association with increased levels of SGPT in the patients. GABAA receptor gene polymorphisms showed no association with AD. Conclusion: The study suggests a role of COMT gene polymorphism rs4680 in conferring susceptibility to AD.

An Association Study on the Glutamate Pathway GRIN2A Gene Polymorphisms with Heroin Dependence

Background: Heroin dependence (HD) is a complex disorder characterized by disruption in particular circuits of the brain and influenced by environmental and genetic factors. Glutamate pathway plays a role in normal brain functions including learning, memory, and cognition. Disturbances in Glutamate pathways are implicated in many psychiatric disorders, including heroin dependence, and polymorphisms present in these pathway genes are reported to increase the risk of developing heroin dependence. Aim: To identify association of single nucleotide polymorphisms (SNPs) of Glutamate pathway genes with heroin dependence and correlate with heroin use parameters. Method: A total of 103 HD patients were recruited as per DSM IV criteria from the Department of Psychiatry, and 100 healthy volunteers from the general population. Genomic DNA from peripheral blood samples was processed for PCR followed by restriction digestion to screen for presence of GRIN2A polymorphisms in the glutamate pathway. GRIN2A SNPs i.e. rs11866328, rs1071502, rs1375067, rs1530669, rs12325652, rs16966381, rs1104068, rs16966448, rs9927871 and rs1366076 were selected based on the Hap Map project and Tagger program (r2 ≥ 0.8). Genotype and allele frequencies were estimated and the difference between patient and control groups were assessed by chi-square test of significance and the results correlated with duration, age at onset of heroin use, the quantity of heroin consumed and WHO ASSIST score. Statistical analysis was done using Haploview v4.1 and SPSSv21.0. Results: Haplotype analyses revealed three SNPs (rs1071502-rs1366076-rs1104068) with alleles A-T-A to confer risk while the haplotypes A-T-G had a protective effect on HD. Another haplotype (rs1530669-rs9927871) was also found significantly associated with heroin dependence (p=0.039). Conclusion: The study reports for the first time, a possible association of GRIN2A SNPs with age at onset of heroin use, duration and quantity of use, and also suggests an important role in severity of heroin dependence.

Independence in self-care activities in children with myelomeningocele: exploring factors based on the International Classification of Function model

Purpose: To investigate the relationship between disease factors, body functions and structures, activities, personal and environmental factors with independence in self-care activities in children with myelomeningocele (MMC), utilizing the International Classification of Function model.Method: 113 children with MMC, aged 3–18 years were assessed during an annual MMC-clinic visit. Data on the personal and environmental factors, disease factors, hand function, mobility, visual perception, cognition, and communication were assessed in relation to the Pediatric Evaluation of Disability Inventory (PEDI) self-care domain.Results: The mean PEDI caregiver assistance score was 22.1 (ranged between <10 and 62) well below the norms. The most significant determinant of dependence in self-care activities was the presence of hydrocephalus, a child with hydrocephalus scored a mean of 9.2 points less on the PEDI caregiver scale (p = 0.02). By using a linear regression, the most significant factors associated with the PEDI scores among children with hydrocephalus were the age of the child, function of the non-dominant hand, ambulation, and cognitive function.Conclusion: In children with MMC the presence of hydrocephalus appears to be more significantly associated with functional independence than the neurological level. The International Classification of Function model provides an in-depth multidisciplinary model that facilitates in investigating independence in self-care activities in children with MMC. It is important to take personal factors and various functional impairments into account when working with these children to promote independence.Implications for RehabilitationWhen working with children with myelomeningocele on independence in daily living activities, it is necessary that health professionals demonstrate a holistic view of the child and his/her disability.Health professionals should take into account information on all factors of the International Classification of Function, in order to help the children, achieve maximal independence.It is important for health professionals to consider presence or lack of hydrocephalus when working with children with myelomeningocele to achieve functional gains.Improving upper extremity function and cognitive ability in children with myelomeningocele may help promote independence in activities of daily living.It is necessary for health professionals to continue to work with children with myelomeningocele on maximizing independence as they get older, for it is possible for them to achieve independence at a later age.While this study did not explore participation, this is an essential part of the International Classification of Function and is generally related to function. Participation allows a child to be involved in life situations, contributes to life satisfaction and prepares children for critical adult roles. It is therefore important to assess and monitor this measure. Further studies should examine associations between independence in self-care activities and participation.

121 Use of licit and ilicit psychoactive substances in hypertensive pregnant women compared to healthy pregnant

Introduction Know the additional risks associated with hypertensive disorders in pregnancy, such as the use of licit and illicit substances, may contribute to the adoption of strategies that minimize adverse outcomes. Objective Estabilish the prevelence of the use of harmful substances such as alcohol, tobacco and ilicit drugs in pregnant women in relation to healthy pregnant women. Methodology A transversal study has been conducted in the prenatal and maternity of the Hospital Guilherme Alvaro from April to June 2016. 61 patients were selected, 34 from the study group and 27 from de control group. Among the patients in the study group, are included pregnant or postpartum women with hypertensive disorders, according NHBPEP 2000. In the control group, are included only pregnant or postpartum women without previous comorbidity, which gave birth to one healthy live newborn, vaginal delivery. It was applied two questionnaires, ASSIST, screening test of involvement with alcohol, tobacco and illicit substances, developed by WHO, useful for health professionals to identify the use and dependence on psychoactive substances, evaluated through a score, the answer ranges from 0 to 4 points, and the sum can range from 0 to 20, it is considered casual use 0 to 3, 4 suggestive of abuse 4–15 and suggestive of addiction 16–20. And another that evaluates epidemiological woman information, current and obstetric pregnancy as well as age, color, living city, number of consultations prenatal, site of consultations, among others. The data were passed to the Excel program and analyzed quantitatively, to compare Study and Control groups on the ASSIST score related to each psychoactive drug, we used the Student’s T Test for unrelated samples. It was considered significant samples where p Results The obtained results, shown below, do not allow to say that the groups differ, although the sample size and the low frequency of drug use in the groups studied compromise the accuracy of information. In percentage, 80.32% of all pregnant women have proved any drugs. Among the groups, the Study 70.83% have used drugs and in the control group 81.48% have used drugs. Psychoactive drugs most used by pregnant women are: alcohol 77,0% and tobacco 42,6%. In the correlation between the use of each type of drug with additional information about pregnancy and previous pregnancies – The use of tobacco, the less prenatal consultations, higher the score, in the Study group – The use of marijuana, the number of children who died (fetal or neonatal previous) was higher in the Study group – The use of cocaine, the number of children who died (fetal or neonatal previous) was higher in the Study group – The use of sedatives, the number of prenatal consultations, the highest score in the Study group SUBSTANCE Study % Control % Total % P Tobacco Alcohol Marijuana Cocaine Amphetamine Inalants Sedatives Hallucinogens Opiates. Download : Download high-res image (180KB) Download : Download full-size image Conclusion Distribution ASSIST score among these drugs was more abuse and addiction to alcohol and tobacco in the Control group compared to the Study group. Although we saw that the Hypertensive group made greater use of cocaine, amphetamine and opioids than those of the Control group. The other comparisons were not significant and the larger sample can clear the results.

HIP4Hips (High Intensity Physiotherapy for Hip fractures in the acute hospital setting): a randomised controlled trial.

To investigate the effects of intensive acute hospital physiotherapy for patients with isolated hip fractures. Single-institution, prospective, randomised trial at a level 1 trauma centre in Melbourne, March 2014 - January 2015. 92 patients aged 65 years or more with isolated hip fractures. Patients were excluded if the fracture was subtrochanteric or pathological, or if post-operative orders required the patient to be non-weight-bearing on the operated leg. Randomisation to usual care physiotherapy (daily; control group) or intensive physiotherapy (three times daily; intervention group). Outcomes were assessed at post-operative Day 5, at discharge, and at 6 months. The primary outcome was the modified Iowa Level of Assistance (mILOA) score, with other outcome measures including Timed Up and Go test performance and hospital length of stay (LOS). After controlling for sex, anaesthetic type and home setting, the between-group difference in Day 5 mILOA score favoured the intervention group (mean difference v control group, -2.7 points; P = 0.04). Hospital LOS was also shorter for the intervention group (median, 24.4 days v 35.0 days; P = 0.01). A Cox proportional hazard model that controlled for potential confounders indicated that the probability of discharge was greater for intervention group patients at all time points following surgery (P <0.001). Re-admission and complication rates and 6-month outcomes for the two groups were not significantly different. Intensive acute hospital physiotherapy is safe and reduces hospital LOS after an isolated hip fracture. This has the potential to improve bed flow, given the large numbers of inpatient beds occupied by this patient population. Clinical Trials Registry #NCT02088437.

Pattern of drug abuse along with the criminal and demographic profile of prisoners admitted at the de-addiction facility at a Central Jail in Punjab

Background: To curb the social menace associated with rising illicit drug use among the youth, the law enforcing agencies have filled state prisons with people, who are in urgent need for the management of their drug use problems. This study was planned with a motive to understand the current changing needs of Indian prisons. Objective: To study the pattern of drug abuse and the criminal and demographic profile of the jail inmates who were admitted at the de-addiction facility of jail. Materials and Methods: A cross-sectional study carried out in the Modern Central Jail at Faridkot, Punjab. A total of 66 prisoners who were being treated at the de-addiction facility. The subjects were assessed by the WHO-based ASSIST questionnaire and by the investigator-designed proforma. Result: Among the 66 subjects majority of them were men (98.4%), less than 30 years (35%), married (53%), having rural background (63.6%), and heroin dependent (87.8%), booked for illegal possession of drugs (73%), high-risk behavior (47% intravenous drug abuser). ASSIST scores indicate high Specific Substance Involvement Score and Life-time Substance use Score with tobacco and opioids. Conclusion: High prevalence of intravenous drug abuse in Indian prisons is an alarming situation. The adequate management of such persons in prison, with minimizing associated risk for blood-borne infections has come up as an important issue, in the wake of rising number of arrests under Narcotic Drugs and Psychotropic Substances Act.

Managing Chronic Headache Disorders.

Headaches are a very common disorder, more common than asthma and diabetes combined. Migraine is the most common headache disorder, but it remains underdiagnosed and therefore undertreated. The treatment of migraines is divided into acute and prophylaxis. Patients who are experiencing 8 or more headaches a month or those who experience disability with their headaches as determined by the Migraine Disability Assistance Score or MIDAS should be placed on prophylaxis.