Patients In Medical Settings Research Articles

Electronic screening and brief interventions promoting healthy diet and physical activity among adult patients in medical settings: A systematic review

Background & AimsElectronic screening and brief interventions (eSBIs) are promising health promoting approaches but their utilization towards nutrition outcomes has been little documented so far. The aim of this systematic review is to examine the nature and findings of eSBIs targeting diet and/or physical activity (PA) among adult patients in healthcare settings since smartphone technologies emerged. MethodsThree systematic searches in PubMed, ScienceDirect and PsycINFO were conducted from January 2010 to May 2023. We include all studies assessing eSBI towards lifestyle habits (dietary habits and/or PA at least), implemented in healthcare settings and targeting adult participants. ResultsOf 1981 articles identified, 15 studies met inclusion criteria. Most of them documented eSBIs implemented in primary care (n=11), targeting PA (n=11) and diet (n=9) alone or combined (n=5). Some eSBIs targeted additional behaviors (e.g. smoking, drinking). Delivery modes included computer (n=8), printed documents (n=8) or phone (n=2) but only four eSBIs were interactive (or partially automated). In addition to personalized feedback, most common behavior change techniques were “information about social and environmental consequences” (n=9), “goal setting” (n=7), and “information about health consequences” (n=7). Most studies assessing behavior change had a control group (8 in 10), and eight studies found positive changes in behavior. ConclusionsAlthough implementing eSBIs towards PA/diet among adult patients in medical settings seems promising for primary, secondary and tertiary prevention, common conceptual framework, intervention and outcomes are severely lacking, and the extent to which they follow existing SBI guidelines remains unclear. Demonstrating their effectiveness requires fixing these issues before conducting prospective assessment studies in medical settings.

Bringing patients out of the gloom: Examining the effects of patient power and affect labeling on emotional experience reflected in emotional judgement

ObjectiveNegative emotions are common among patients in medical settings. It is important to investigate impacts of patient power and affect labeling on emotional experience in patients. MethodsBehavioral judgments and event-related potentials (ERPs) were recorded while participants with high or low patient power made emotional judgments (positive, negative) about neutral faces, as well as investigating how affect labeling (affect labeling, viewing) influenced emotional judgments about neutral faces in participants with low patient power. ResultsIndividuals with low patient power made more and faster negative emotion judgements. A larger late positive component (LPC) amplitude was found in negative emotion judgments for individuals with low patient power, a component related to allocation of attentional resources to motivationally salient stimuli. Affect labeling elicited less and slower negative emotion judgments in individuals with low patient power. ConclusionsThese results suggest that low patient power triggers negative emotion, which can be reduced by affect labeling. Practice implicationsThe current findings provide valuable insights into reducing negative emotions in patients, fostering promising targets for training for medical professionals and education for patients aiming to ensure more humanistic and higher-quality care delivery.

Optimizing the Implementation of a Lifestyle Dementia Prevention Intervention for Older Patients in an Academic Healthcare System.

Interventions that promote healthy lifestyles are critical for the prevention of Alzheimer's disease and Alzheimer's disease related dementias (AD/ADRD). However, knowledge of the best practices for implementing AD/ADRD prevention in healthcare settings remains limited. We aimed to qualitatively identify barriers and facilitators to implementing a clinical trial of a novel lifestyle intervention (My Healthy Brain) in our medical center for older patients with subjective cognitive decline who are at-risk for AD/ADRD. We conducted focus groups with 26 healthcare professionals (e.g., physicians, psychology, nursing) from 5 clinics that treat older patients (e.g., memory care, psychiatry). Our qualitative analysis integrated two implementation frameworks to systematically capture barriers and facilitators to AD/ADRD prevention (Consolidated Framework for Implementation Science Research) that impact implementation outcomes of acceptability, appropriateness, and feasibility (Proctor's framework). We found widespread support for an RCT of My Healthy Brain and AD/ADRD prevention. Participants identified barriers related to patients (stigma, technological skills), providers (dismissiveness of "worried well," doubting capacity for behavior change), clinics (limited time and resources), and the larger healthcare system (underemphasis on prevention). Implementation strategies guided by Expert Recommendations for Implementing Change (ERIC) included: developing tailored materials, training staff, obtaining buy-in from leadership, addressing stigmatized language and practices, identifying "champions," and integrating with workflows and resources. The results will inform our recruitment, enrollment, and retention procedures to implement the first randomized clinical trial of My Healthy Brain. Our study provides a blueprint for addressing multi-level barriers to the implementation of AD/ADRD prevention for older patients in medical settings.

Under-treatment of Pain in Black Patients: A Historical Overview, Case-based Analysis, and Legalities as Explored Through the Tenets of Critical Race Theory

Pain, also called the “fifth vital sign” is an important topic in healthcare settings. It requires urgent attention and treatment to minimize agony and discomfort. Unfortunately, multiple clinical studies conducted over the last few decades have repeatedly shown disparately inferior pain management in Black patients in medical settings when compared to White patients with similar pain levels. This Article utilizes Critical Race Theory to examine the understudied issue of under-treatment of pain in Black patients. It discusses the story of a real patient, Jacqui, who was under the medical care of the author. It examines her unfortunate experiences with poor pain management throughout different stages of her life, including a blood disorder as a child with, a traumatic arm fracture as a teen, during childbirth, and finally, later in life with advanced cancer. Three points are addressed in this Article: first, a discussion of Jacqui’sexperiences, and an analysis of those experiences through the available clinical data. This Article reveals the extent to which Black patient’s pain is undertreated, and how it led Black patients to mistrust our healthcare system. Second, the Article explores malpractice based legal analyses to these issues based on federal and state legislation. Third, various proposals to correct various systemicdiscrepancies in medical-education and clinical settings to minimize such racial biases in pain management are discussed. It concludes by talking about the final part of Jacqui’s clinical journey.

Treatment-As-Usual Control Groups in Brief Alcohol Intervention Trials: A Systematic Review and Meta-Analysis.

Brief alcohol interventions (BAIs) are evidence-based practices that can help reduce hazardous drinking among patients in medical settings. However, descriptions of the treatment-as-usual (TAU) control groups that BAIs are compared to in clinical trials often lack clarity and detail. This systematic review and meta-analysis quantified and compared descriptions of intervention and TAU control arms within reports of randomized controlled trials and examined whether treatment effects were affected by level of detail in narrative descriptions. A systematic literature search to identify eligible articles was performed. Studies were rated on methodological quality, and the Template for Intervention Description and Replication (TIDieR) checklist was used to rate the level of clarity and detail included in descriptions of the intervention and TAU conditions in eligible articles. Data were extracted from articles for use in meta-analysis and meta-regression. Twenty-one studies met inclusion criteria. Across the studies, TIDieR ratings for intervention arms were higher than ratings for control arms. BAIs were linked to reductions in drinks per week, heavy drinking episodes, and alcohol consequences over time when compared with TAU. TIDieR ratings for control groups were significantly associated with larger treatment effects on drinks per week and alcohol consequences but were not significant for heavy drinking episodes. This meta-analysis reiterated the effectiveness of BAIs in medical settings. Yet the lack of clarity in TAU descriptions raises concerns regarding the validity of BAI trials, suggesting need for more detailed reporting and use of the TIDieR guidelines for support.

Premature ventricular complexes and development of heart failure in a community-based population

ObjectiveA higher premature ventricular complex (PVC) frequency is associated with incident congestive heart failure (CHF) and death. While certain PVC characteristics may contribute to that risk, the current literature stems...

DEATH ITSELF - STUDENTS’ PERSPECTIVE OF AZAD JAMMU & KASHMIR MEDICAL COLLEGE

Objective: To outline a frame-work which would help to regulate the emotions of under graduate students, on the death of their patient.
 Study Design: An exploratory qualitative study.
 Place and Duration of Study: Azad Jammu & Kashmir Medical College (AJKMC), from Nov 2019 to Dec 2019.
 Methodology: Purposive sampling was done from the final year medical students and focus group discussions were carried out for data collection. Twenty five students shared their feelings at the death of first patient under their care. As a whole, 92% of volunteers experienced the death of their first patients in medical settings. Subsequently, four main themes have been emerged after data analysis. Including; unexpected death, crisis, anticipated death & resolution.
 Results: Inadequate preparation of medical scholars to handle this tragic incidence leads to anxiety, anger, guilt and sense of helplessness. These undesirable sentiments would seriously affect their performance in future. So, they must be handled wisely and professionally.
 Conclusion: Consequently, a curricular model emerged as a result of this study recommending following steps. There should be regular debriefing sessions of students from their supervisors and reflective journaling practice of students, as a part of curriculum. Likewise, faculty training for „end of life theme‟ would help their students to become more valuable for ailing community.

Screening for suicide risk in medical settings: From research to implementation

IntroductionSuicide is an international public health problem and a leading cause of death for youth and adults, worldwide. Prevention efforts in health care systems create opportunities for identifying medical patients with occult suicidality. Detecting suicide risk among patients in medical settings can be a challenge, but successful suicide risk screening programs have been demonstrated in hospital settings.ObjectivesThis presentation will discuss how a suicide risk screening tool that was developed for the pediatric emergency department was tested and then implemented in other medical settings in order to leverage healthcare providers as partners in combating the public health crisis of youth suicide..MethodsImplementation and quality improvement projects in various medical settings that have adapted the ASQ will be described. Effective management of pediatric patients that screen positive for suicide risk and how mental health clinicians can best be utilized in efficient ways will also be discussed.ResultsAverage time to administer the ASQ was 20 seconds. Positive screen rates across ED, inpatient and outpatient settings ranging from 2-14% equating to one additional psychiatric consultation per week. The ASQ Toolkit was developed to help medical providers implement screening including scripts for nurses, flyers for parents and a brief suicide safety assessment (ASQ BSSA) to operationalize next steps for patients at risk.ConclusionsThe medical setting is a key venue for youth suicide risk detection and linking patients with effective interventions. Mental health clinicians have a role in guiding non-mental health providers in the identification and management of patients found to be at risk.DisclosureNo significant relationships.

Training Directors Strive to Maintain Educational Mission Under Extraordinary Conditions

Back to table of contents Previous article Next article Education & TrainingFull AccessTraining Directors Strive to Maintain Educational Mission Under Extraordinary ConditionsMark MoranMark MoranSearch for more papers by this authorPublished Online:28 Apr 2020https://doi.org/10.1176/appi.pn.2020.5a39AbstractAfter COVID-19, a mental health “tsunami” is sure to follow, and psychiatry will be more essential than ever.Melissa Arbuckle, M.D., Ph.D., president of AADPRT, says that residents “are smart people who are capable of learning new things quickly. I have no doubt that they will save lives.”Joe Henson PhotographyThe hardest challenge for psychiatry training directors around COVID-19 has been managing the redeployment of psychiatry residents to medical settings, according to Melissa Arbuckle, M.D., Ph.D., president of the American Association of Directors of Psychiatric Residency Training (AADPRT).Associated with this challenge are concerns that the residents may not be adequately prepared for the roles they are being asked to do, “whether it is limited skills in critical care—which they were not trained to do—or the possibility of insufficient personal protective equipment.”She added, “We are also critically aware of the psychological toll our residents are facing, as they see firsthand the devastating impact of this disease and its casualties. We are concerned about the risks our residents are taking for themselves and their families.“Our communities desperately need every doctor available. Our residents understand how medical teams work. They understand the language and the culture and have worked in medical settings before. They are smart people who are capable of learning new things quickly. I have no doubt that they will save lives.”She said training directors around the country and across specialties are grappling with these complexities, uncertainties about the future, and whether the new medical school graduates will be able to begin training in June on time. “It’s hard to imagine what everything will be like in June and July.”Certainly, New York City has been uniquely overwhelmed. In areas where COVID-19 has not resulted in a surge of patients, some training directors reported little change outside of the transition from outpatient services and educational activities to telehealth and online technology. In Detroit—among the hottest spots in the country at press time outside New York—Richard Balon, M.D., director of training at Detroit Medical Center (DMC)/Wayne State University School of Medicine, said that psychiatry residents have not yet been deployed to care for COVID-19 patients in medical settings. But a list of residents who had volunteered to serve has been submitted to the Graduate Medical Education Office of the DMC, and some psychiatry residents have voluntarily gone to ICUs to provide emotional support and counseling to ICU residents and to help with contacting and talking with families.Arbuckle noted that training directors are also faced with providing emotional support to a cohort of residents experiencing a wide range of normal reactions, including fear, sadness, and anger. “And it’s not just about work—our residents are also in quarantine, social distancing, homeschooling children, and losing loved ones,” she said.She said that after COVID passes, “a mental health tsunami” is sure to follow. “Psychiatry will be more relevant than ever as our communities struggle with social isolation, the sorrow of lost friends and family members, the financial instability of a crippled economy and vast unemployment, and the trauma faced by essential workers on the front lines of this crisis.”. ■Resources created by AADPRT members for teaching psychiatry online and implementing telepsychiatry, as well as practical tips for addressing the psychological stresses associated with the COVID-19 crisis, are posted on the AADPRT website. ISSUES NewArchived

Exploration of the Depth of GIM with Medical Patients

Guided Imagery and Music (GIM) is a form of music psychotherapy known for its in-depth capacity. GIM has been applied to various medical patients; however, literature shows that patients in medical settings have physical limitations related to receiving GIM. The current research study asked why therapists use GIM with medical patients, how they perceive the depth of GIM, how limitations influence the therapists’ choice of the depth of GIM, and how therapists know the appropriate depth for medical patients. Modified grounded theory was used to analyze semistructured interviews with four GIM therapists. Five main categories emerged: Medical GIM, Past-present-future, Limitations, Competency, and Depth. The findings illustrated that the depth of GIM was understood through a delicate balance among patients’ needs, limitations, and therapists’ competency.

Childhood Sexual Abuse Survivors Undergoing Cancer Treatment: A Case for Trauma-Informed Integrated Care

Patients in medical settings with more adverse childhood experiences (ACEs), such as sexual abuse, demonstrate reduced treatment adherence and greater relational difficulties with providers, potentially contributing to negative health outcomes. Integrated care addresses holistic patient healthcare needs within an interdisciplinary treatment team. Trauma-informed care serves as a potential approach to address patient and provider difficulty, yet practical guidance as to how to implement this approach within integrated care settings is lacking. This article makes the case for trauma-informed integrated care and provides a case example in an oncology setting to illustrate the utility of trauma-informed integrated care with the use of an embedded mental health counselor. Resulting training and practice recommendations include (a) universal screening for ACE in medical settings, (b) enhanced interprofessional education, and (c) provision of embedded counseling and supervision services within integrated care settings. Future research directions are explored.

Healthcare Experiences of Men Who Have Sex with Men: Understanding Trauma, Patient-Provider Relationships, and the Lasting Impacts of the AIDS Crisis

Studies of patients’ health outcomes and the quality of healthcare services show that the patient-provider relationship is crucial, and further, that a patient-centered approach to care is essential for effective public reporting and ensuring high quality health-care results (Theis 2016). However, what might happen if a patient-provider relationship is undeveloped, or even hostile? Inadequate treatment of patients in medical settings is a common experience of sexual minorities, who have historically experienced greater burdens of disease and discrimination. This study explores the narratives and lived-experiences of MSM to better understand the patient-provider relationships for MSM, and to some extent queer people in general, given the growing social and political acceptance of queer identities. MSM is the population of interest because it is a historically marginalized group that reports significant incidence of stigma, especially surrounding their sexual health and sexual behaviors. In order to assess how the evolving social landscape has affected the experiences of MSM, 20 men were interviewed about their healthcare experiences; 10 of these men were between the ages of 18 and 49, and the remaining 10 men were 50 years old or older. Through a comparative analysis, this study assesses differences and similarities in healthcare experiences—as well as the subsequent health-related needs and preferences—of participants, particularly with regard to social trauma, medical trauma, and their proximity to the AIDS crisis of the 1980s. Studies of patients’ health outcomes and the quality of healthcare services show that the patient-provider relationship is crucial and that a patient-centred approach to care is essential for ensuring high-quality healthcare results. However, what might happen if a patient-provider relationship were undeveloped, or even hostile? Inadequate treatment of patients in medical settings is a common experience of sexual minorities, who have historically experienced greater burdens of disease and discrimination. This study explores the lived experiences of men who have sex with men (MSM) to better understand their patient-provider relationships. MSM are the population of interest because they are historically marginalised and stigmatised, especially surrounding their sexual health and sexual behaviours. In order to assess how an evolving social landscape has affected the experiences of MSM, 20 men were interviewed. Among them, 10 men were between the ages of 18 and 49, and 10 were 50 or older. Through a comparative analysis, this study assesses differences and similarities in healthcare experiences – and the resulting health-related needs and preferences – of participants, particularly with regard to social trauma, medical trauma, and their proximity to the 1980s AIDS crisis. Additionally, race, ethnicity, and language emerged during interviews with participants of colour as salient factors which impacted their healthcare experiences.

Validation of the Korean Version of the Depression in Old Age Scale and Comparison with Other Depression Screening Questionnaires Used in Elderly Patients in Medical Settings.

ObjectiveThe Depression in Old Age Scale (DIA-S) is a new screening tool for assessing depression in the elderly. The primary aims of this study were to describe the validation of the Korean version of the DIA-S (K-DIA-S) and to compare its validity with that of other depression screening questionnaires used in elderly outpatients in medical settings.MethodsA total of 385 elderly outpatients completed the K-DIA-S and underwent the Mini International Neuropsychiatric Interview to diagnose depressive disorders. Other measures included the 15-item short form of the Geriatric Depression Scale (SGDS), the 9-item depression module of the Patient Health Questionnaire (PHQ-9), and the Montgomery–Asberg Depression Rating Scale (MADRS). Reliability and validity tests, an optimal cutoff point estimate, and receiver operating characteristic curve analysis were performed to investigate the diagnostic validity of the K-DIA-S. Areas under the curves (AUCs) for the K-DIA-S, SGDS, and PHQ-9 were compared statistically.ResultsThe K-DIA-S showed good internal consistency and strong correlations with the SGDS (r = 0.853), PHQ-9 (r = 0.739), and MADRS (r = 0.772). The cut-off point of the K-DIA-S that can be recommended for screening depressive symptoms was a score of 4. For “any depressive disorder”, the AUC (standard error) for the K-DIA-S was 0.896 (0.015), which was significantly larger than that for the PHQ-9 (p = 0.033).ConclusionThe present findings suggest that the K-DIA-S has good psychometric properties and is a valid and reliable tool for assessing depressive symptoms in elderly populations and medically ill patients.

Identifying Risk Factors for Disordered Eating among Female Youth in Primary Care.

Eating disorders are a serious, life-threating condition impacting adolescents and young adults. Providers in primary care settings have an important role in identifying disordered eating (DE) symptoms. Unfortunately, symptoms go undetected in 50% of patients in medical settings. Using the behavioral health screen, this study identified DE risk profiles in a sample of 3620 female adolescents and young adults (ages 14-24), presenting in primary care. A latent class analysis with twenty psychosocial factors identified three DE risk groups. The group at highest risk for DE was characterized by endorsement of internalizing symptoms and a history of trauma. The next risk group consisted of those with externalizing symptoms, particularly substance use. The group at lowest risk for DE reported more time spent with friends compared to their peers. Primary care providers and psychiatric teams can benefit from knowing the psychosocial risk patterns affiliated with DE, and using brief, comprehensive screening tools to identify these symptoms.

A Shortened Version of the Suicide Cognitions Scale for Identifying Chronic Pain Patients at Risk for Suicide.

Research in psychiatric outpatient and inpatient populations supports the utility of the Suicide Cognitions Scale (SCS) as an indicator of current and future risk for suicidal thoughts and behaviors. Designed to assess suicide-specific thoughts and beliefs, the SCS has yet to be evaluated among chronic pain patients, a group with elevated risk for suicide. The purpose of the present study was to develop and test a shortened version of the SCS (the SCS-S). A total of 228 chronic pain patients completed a battery of self-report surveys before or after a scheduled appointment. Three outpatient medical clinics (pain medicine, orofacial pain, and clinical health psychology). Confirmatory factor analysis, multivariate regression, and graded item response theory model analyses. Results of the CFAs suggested that a 3-factor solution was optimal. A shortened 9-item scale was identified based on the results of graded item response theory model analyses. Correlation and multivariate analyses supported the construct and incremental validity of the SCS-S. Results support the reliability and validity of the SCS-S among chronic pain patients, and suggest the scale may be a useful method for identifying high-risk patients in medical settings.

Bridging the gap between medical settings and specialty addiction treatment.

Keywords: Alcohol misuse; care linkage; medical settings; specialty addiction treatment

Patients Are from Mars, Doctors Are from Venus: Patients Prefer Placebos and Paternalism; Doctors Don't

Current medical ethics, law, and education all emphasize patient empowerment and shared decision making as a means of avoiding paternalism. But what if doctors are paternalistically deciding that patients may not choose paternalism by forcing them to be involved when they would rather just feel better and leave it to the professionals? Two separate surveys were administered to a cross section of adult Americans through Amazon's Mechanical Turk to measure attitudes toward paternalism in various scenarios. This review discusses the results of these surveys and how they may be implemented in order to better understand how to interact with patients in medical settings.

The diagnostic accuracy of the Patient Health Questionnaire-2 (PHQ-2), Patient Health Questionnaire-8 (PHQ-8), and Patient Health Questionnaire-9 (PHQ-9) for detecting major depression: protocol for a systematic review and individual patient data meta-analyses.

BackgroundMajor depressive disorder (MDD) may be present in 10%–20% of patients in medical settings. Routine depression screening is sometimes recommended to improve depression management. However, studies of the diagnostic accuracy of depression screening tools have typically used data-driven, exploratory methods to select optimal cutoffs. Often, these studies report results from a small range of cutoff points around whatever cutoff score is most accurate in that given study. When published data are combined in meta-analyses, estimates of accuracy for different cutoff points may be based on data from different studies, rather than data from all studies for each possible cutoff point. As a result, traditional meta-analyses may generate exaggerated estimates of accuracy. Individual patient data (IPD) meta-analyses can address this problem by synthesizing data from all studies for each cutoff score to obtain diagnostic accuracy estimates. The nine-item Patient Health Questionnaire-9 (PHQ-9) and the shorter PHQ-2 and PHQ-8 are commonly recommended for depression screening. Thus, the primary objectives of our IPD meta-analyses are to determine the diagnostic accuracy of the PHQ-9, PHQ-8, and PHQ-2 to detect MDD among adults across all potentially relevant cutoff scores. Secondary analyses involve assessing accuracy accounting for patient factors that may influence accuracy (age, sex, medical comorbidity).Methods/designData sources will include MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, PsycINFO, and Web of Science. We will include studies that included a Diagnostic and Statistical Manual or International Classification of Diseases diagnosis of MDD based on a validated structured or semi-structured clinical interview administered within 2 weeks of the administration of the PHQ. Two reviewers will independently screen titles and abstracts, perform full article review, and extract study data. Disagreements will be resolved by consensus. Risk of bias will be assessed with the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Bivariate random-effects meta-analysis will be conducted for the full range of plausible cutoff values.DiscussionThe proposed IPD meta-analyses will allow us to obtain estimates of the diagnostic accuracy of the PHQ-9, PHQ-8, and PHQ-2.Systematic review registrationPROSPERO CRD42014010673

The Mini-Mental State Examination as a diagnostic and screening test for delirium: systematic review and meta-analysis

ObjectiveTo analyse the evidence concerning the accuracy of the Mini-Mental State Examination (MMSE) as a diagnostic and screening test for the presence of delirium in adults. MethodTwo authors searched MEDLINE, PsychINFO and EMBASE from inception till March 2014. Articles were included that investigated the diagnostic validity of the MMSE to detect delirium against standardised criteria. A diagnostic validity meta-analysis was conducted. ResultsThirteen studies were included representing 2017 patients in medical settings of whom 29.4% had delirium. The meta-analysis revealed the MMSE had an overall sensitivity and specificity estimate of 84.1% and 73.0%, but this was 81.1% and 82.8% in a subgroup analysis involving robust high quality studies. Sensitivity was unchanged but specificity was 68.4% (95% CI=50.9–83.5%) in studies using a predefined cutoff of <24 to signify a case. In high-risk samples where delirium was present in 25% of patients, then the Positive predictive value and Negative predictive value would be 50.9% (48.3–66.2%) and 93.2% (90.0–96.5%). ConclusionThe MMSE cannot be recommended as a case-finding confirmatory test of delirium, but may be used as an initial screen to rule out high scorers who are unlikely to have delirium with approximately 93% accuracy.

Exploring Structural Relationships Between Blood Alcohol Concentration and Signs and Clinical Assessment of Intoxication in Alcohol-Involved Injury Cases

Although the relationship between the Y90 (blood alcohol concentration, BAC) and Y91 (clinician intoxication assessment) ICD-10 codes has received attention recently, the role of 10 signs of intoxication in the Y91-Y90 relationship has not been studied yet. This work examines these signs in the estimation of alcohol intoxication levels of patients in medical settings. Collected and analyzed were data on 1997 injured emergency room patients from 17 countries worldwide reporting drinking prior to injury or presenting with a non-zero BAC from 17 countries worldwide. A model is estimated describing how the 10 signs inform the Y91, Y90 prediction with the goal of the use of observations on patients in place of a biological measure. Signs were consistent with a single underlying construct that strongly predicted Y91. Smell of alcohol on breath predicted Y91 above its contribution through the construct and was stronger for those with tolerance to alcohol than for those without. Controlling for Y91, no sign further contributed to prediction of Y90 indicating that Y91 incorporated all intoxication sign information in predicting Y90. Variance explained was high for Y91 (R(2) = 0.84) and intoxication signs (above 0.72 for all but smell on the breath, 0.57) and lower for Y90 (0.38). Intoxication assessments are well predicted by overall intoxication severity, which itself is well represented by intoxication signs along with differential emphasis on smell of alcohol on breath, especially for those with alcohol tolerance. However, BAC levels remain largely unexplained by intoxication signs with a clinician's assessment serving as the primary predictive measure.