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Biomedical subjects

Daniel C Vinson

Publications and source records attributed to Daniel C Vinson.

16 recordsLinked to original sources
PubMed2005

Screening for hazardous or harmful drinking using one or two quantity-frequency questions.

AIMS: To address the accuracy of quantity-frequency (QF) questions in screening for hazardous or harmful drinking. METHODS: Three groups were interviewed: patients presenting to emergency departments for care of an acute injury (n = 1537) or a medical illness (n = 1151), and community controls interviewed by telephone (n = 1112). The first question about alcohol was a single alcohol screening question (SASQ), 'When was the last time you had more than X drinks in one day?', where X = 4 for women and 5 for men, with any time in the past 3 months considered a positive screen (1 drink = 14 g ethanol). The subsequent alcohol questions were a calendar-based review of recent drinking and the alcohol questions from the diagnostic interview schedule (DIS), which included questions about usual frequency and average quantity. Hazardous drinking was defined as drinking >4 drinks in 1 day or >14 drinks in 1 week for men (women 3 and 7) (Guidelines of the US National Institute on Alcohol Abuse and Alcoholism). Current alcohol use disorders were defined using DSM-IV criteria. The areas under the receiver operating characteristic (ROC) curves in identifying hazardous drinking or current alcohol use disorder were compared. RESULTS: The area under the ROC curves in the three samples combined were 0.81 for SASQ (95% confidence interval (CI) 0.79-0.82), 0.80 for a question about average quantity alone (0.79-0.82) and 0.85 for the product of usual frequency times average quantity (0.84-0.86). The QF product and the question about average quantity performed consistently across the three groups. CONCLUSIONS: In clinical settings, one way to put these findings into practice is to screen first with a single question, such as the SASQ, a single question about typical quantity, or a question about the frequency of heavy drinking such as the third item of the alcohol use disorders test (AUDIT).

Adult↗
PubMed2005

Experiential curriculum improves medical students' ability to answer clinical questions using the internet.

BACKGROUND AND OBJECTIVES: Teaching about evidence-based medicine (EBM) is widespread, yet physicians still use rapid references preferentially over EBM techniques such as literature searching and appraisal of original research. The Internet now provides rapid access to preappraised evidence. We provided clinically integrated teaching of using the Internet to answer clinical questions for third-year medical students and assessed the change in their search skills. METHODS: The curriculum included two 90-minute computer lab sessions with teaching of search skills related to clinical questions. Immediately before the first and after the second session, students recorded sites searched, time needed for searching, and answers found for three standardized questions. Pretest and posttest questions were matched and reversed with each block. RESULTS: Eighty-six students completed pretests and posttests. For two questions about conventional medical care, posttest answer quality was significantly higher, and posttest search times were significantly shorter, by 1.6 minutes for question 1 (mean pretest search time 6.3 minutes, mean posttest search time 4.7 minutes) and 1.9 minutes for question 2 (mean pretest search time 8 minutes, mean posttest search time 6.1 minutes). For a question about herbal medicine, results were similar, but there were smaller differences that did not reach statistical significance. Students used or found significantly fewer sites on the posttest than on the pretest to find answers for all three question types (absolute difference=0.3 sites for each question). CONCLUSIONS Introducing students to useful Web sites, practicing answering clinical questions, and integrating this process with clinical rotation experiences can reduce the effort that students need to find answers and improve the quality of answers they find.

Biomedical Research↗
PubMed2003

The risk of intentional injury with acute and chronic alcohol exposures: a case-control and case-crossover study.

OBJECTIVE: Alcohol is associated with intentional injury, but most studies have operationalized it as alcoholism and have not examined acute exposure. The study aimed to clarify the relative contributions of drinking over a few hours and of alcohol use disorders to the risk of intentional injury inflicted by another person. METHOD: The study used a case-control design with two control groups: (1) Community controls matched to cases, and (2) the cases themselves, comparing consumption on the day of injury with consumption on previous days, in a case-crossover comparison. Cases were patients with an acute injury presenting to any of the three emergency departments in one county; 102 had an intentional injury. Community controls (N = 1,856) were recruited by random-digit dialing. Recent alcohol consumption was recorded in self-reported standard drinks. Current alcohol use disorders were defined using DMS-IV criteria. RESULTS: In the case-control analysis, drinking in a 6-hour window was associated with risk of intentional injury (odds ratio [OR] = 10, 95% confidence interval [CI]: 4.7-22). In case-cross-over comparison of the cases' own drinking in the 6 hours prior to injury with their own drinking the day before, the OR was 34 (95% CI: 4.7-250). In case-control analyses, alcohol dependence was associated with intentional injury (OR = 6.0, 95% CI: 3.5-10), but alcohol abuse was not (OR = 0.7, 95% CI: 0.4-1.3). CONCLUSIONS: Drinking over a few hours is strongly associated with intentional injury. Current alcohol dependence is also, but with a lower OR. The findings may have implications for efforts to prevent intentional injury.

Adolescent↗
PubMed2003

A population-based case-crossover and case-control study of alcohol and the risk of injury.

OBJECTIVE: This study investigated the relationship between alcohol and the risk of acute injury, examining both short-term (drinking over a few hours) and long-term exposures (past-month hazardous drinking and current alcohol use disorders). METHOD: The study was a case-crossover and population-based case control study. Cases (N = 2,517; 1,432 men) were injured patients recruited from all three emergency departments in Boone County, Missouri. Each case's alcohol consumption in the 6 hours prior to injury was compared to his or her consumption the day before in a case-crossover analysis. Community controls (N = 1,856; 948 men) were recruited by telephone and matched to cases by age, gender, day of week and hour. Case-control analyses examined recent alcohol consumption (past 6 hours), past-month hazardous drinking and past-year alcohol use disorders. RESULTS: The odds ratios (ORs) for injury associated with short-term alcohol exposure were similar, whether cases were compared with themselves (case-crossover analyses) or with others (case-control analyses). After 1 or 2 drinks in a 6-hour interval, the ORs were 1.8 (95% confidence interval [CI]: 1.3-2.6) and 1.5 (0.96-2.2), respectively. Similar dose-response curves were seen in the two comparisons, with ORs of 6.2 and 3.7, respectively, after 3 or 4 drinks and 9.5 and 13.5 after 5 or 6 drinks. For past-month hazardous drinking, the OR was 1.7 (95% CI: 1.2-2.3). Current alcohol dependence was associated with injury (OR = 1.9; 95% CI: 1.5-2.6), but alcohol abuse was not (OR = 0.9; 95% CI: 0.8-1.1). CONCLUSIONS: Alcohol's effect on injury risk is related more strongly to acute exposure than to measures of long-term exposure. The risk is significant even at low levels of consumption.

Adolescent↗
PubMed2003

Factors affecting the validity of a Timeline Follow-Back interview.

OBJECTIVE: The Timeline Follow-Back (TLFB) interview is a calendar-prompted, retrospective measure of alcohol consumption. This report examines limitations of the TLFB's validity by examining change in reported consumption going back in time. METHOD: This report analyzes data from a case-control study. Cases (N = 2,517; 56.9% men) were patients presenting for care of an acute injury to one of three emergency departments in Boone County, MO. Two control groups were recruited. Community controls (N = 1,856; 51.1% men) were recruited by random-digit dialing and interviewed by telephone (response rate, 46.5%); medical patients (N = 2,103; 50.9% men) presenting for care of a noninjury illness were interviewed in person and, a few months later, by telephone (complete data obtained on 2,082). A 28-day TLFB interview was conducted with cases and community controls and an 8-day TLFB was done twice with medical controls. RESULTS: A linear regression analysis was done on each individual's drinking over the 28 or 8 days. Averaging participants' regression slopes, cases as a group showed a significant decay in self-reported consumption (0.011 drink per day for each day going back in time). Among community controls, the decay was significantly greater (0.018 drink per day). Analyzing only the 8 days prior to the day of interview, medical controls showed more evidence of bias than either cases or community controls. CONCLUSIONS: The smaller decay in cases' reporting is consistent with an effect of motivation (e.g., engagement in the interview process). Whether the interview is conducted in person (cases and first interviews with medical controls) or by telephone (community controls and second interviews with medical controls) may be relatively less important.

Adolescent↗
PubMed2002

Obstacles to answering doctors' questions about patient care with evidence: qualitative study.

OBJECTIVE: To describe the obstacles encountered when attempting to answer doctors' questions with evidence. DESIGN: Qualitative study. SETTING: General practices in Iowa. PARTICIPANTS: 9 academic generalist doctors, 14 family doctors, and 2 medical librarians. MAIN OUTCOME MEASURE: A taxonomy of obstacles encountered while searching for evidence based answers to doctors' questions. RESULTS: 59 obstacles were encountered and organised according to the five steps in asking and answering questions: recognise a gap in knowledge, formulate a question, search for relevant information, formulate an answer, and use the answer to direct patient care. Six obstacles were considered particularly salient by the investigators and practising doctors: the excessive time required to find information; difficulty modifying the original question, which was often vague and open to interpretation; difficulty selecting an optimal strategy to search for information; failure of a seemingly appropriate resource to cover the topic; uncertainty about how to know when all the relevant evidence has been found so that the search can stop; and inadequate synthesis of multiple bits of evidence into a clinically useful statement. CONCLUSIONS: Many obstacles are encountered when asking and answering questions about how to care for patients. Addressing these obstacles could lead to better patient care by improving clinically oriented information resources.

Clinical Competence↗
PubMedDate not supplied

Alcohol-related injuries: evidence for the prevention paradox.

PURPOSE: The risk of an injury increases exponentially with alcohol consumption on a given occasion, but the conclusion that alcohol-related injuries are attributable primarily to heavy drinking may or may not be correct. The prevention paradox states that a large number of people at small risk may contribute more cases of a particular condition than a smaller number of people who are individually at greater risk. We sought to determine the extent to which the prevention paradox applies in the relationship between alcohol consumption and injury. METHODS: We conducted a population-based case-control and case-crossover study in all 3 emergency departments in Boone County, Mo. Data were collected from 2,517 patients with an acute injury and 1,856 age- and sex-matched controls selected by random digit dialing. RESULTS: The population attributable fraction (PAF) associated with drinking in the 6 hours before injury-the proportion of injuries that would not have occurred in the absence of drinking-was 10.6% in case-crossover analysis and 8.5% in case-control analysis. The PAF that was due to what is usually considered nonhazardous alcohol consumption (fewer than 5 drinks for men, fewer than 4 for women) was 4.5% in case-crossover analysis and 3.1% in case-control analysis. The PAF that was due to alcohol dependence was 4.0%. CONCLUSIONS: Injury is associated more with an occasion of alcohol consumption than with alcohol dependence. A substantial proportion of the PAF that is due to an occasion of alcohol consumption is from what are usually considered low-risk quantities.

Adolescent↗
PubMedDate not supplied

State anger and the risk of injury: a case-control and case-crossover study.

PURPOSE: Previous studies have examined anger at a given moment (state anger) and proxies for injury, or anger as a trait and injuries per se. Findings have been inconsistent. We sought to define further the relationship between state anger and risk of injury. METHODS: We conducted a case-control and case-crossover study in all 3 emergency departments in 1 county in Missouri. Cases were patients seeking care for an acute injury. They were compared with 2 controls: the patient himself or herself 24 hours before, and an individual recruited by telephone from the community and matched for age-group, sex, and time. Self-reported anger was assessed with 3 Likert scale items. Anger just before the injury was compared in case-crossover analyses with the respondent's own level of anger 24 hours before, and in standard case-control analyses with community participants' level of anger at the same hour the same day of the week in a subsequent week. RESULTS: Of 2,517 patients, 2,446 provided data on anger just before the injury, and 2,117 reported data for 24 hours before injury. Of 1,856 community individuals, 1,533 provided complete data. Anger was prevalent. Of injured patients, 9%, 7%, and 4% reported feeling "quite a bit" or "extremely" "irritable," "angry," and "hostile," respectively, just before injury. Odds ratios for risk of injury were notably higher for greater degrees of anger; for example, for "angry," they were 1.8 (95% confidence interval, 1.1-2.7) for "quite a bit" and 7.2 (3.9-13) for "extremely." Odds ratios in women were substantially lower than those in men. Anger was not associated with fall and traffic injuries, but anger was strongly associated with intentional injuries inflicted by another person in both men and women. CONCLUSIONS: High levels of self-reported state anger increase the risk of injury, especially among men, and specifically the risk of intentional injury in both sexes.

Accidents↗
PubMedDate not supplied

Comfortably engaging: which approach to alcohol screening should we use?

PURPOSE: We wanted to compare 2 screening instruments for problem drinking, the CAGE and a single question, assessing frequency of use, patient and clinician comfort, and patient engagement in change. METHODS: The study was a crossover, cluster-randomized clinical trial with 31 clinicians in Missouri and 13 in the American Academy of Family Physicians (AAFP) National Network for Family Practice and Primary Care Research; 2,800 patients provided data. The clinician was the unit of randomization. Clinicians decided whether to screen each patient; if they chose to screen, they used the screening approach assigned for that block of patients. The clinician and patient separately completed questionnaires immediately after the office visit to assess each one's comfort with screening (and any ensuing discussion) and the patient's engagement in change. RESULTS: Missouri clinicians screened more patients when assigned the single question (81%) than the CAGE (69%, P = .001 in weighted analysis). There was no difference among AAFP network clinicians (96% of patients screened with the CAGE, 97% with the single question). Eighty percent to 90% of clinicians and 70% of patients reported being comfortable with screening and the ensuing discussion, with no difference between approaches in either network. About one third of patients who were identified as problem drinkers reported thinking about or planning to change their drinking behavior, with no difference in engagement between screening approaches. CONCLUSIONS: Clinicians and patients reported similar comfort with the CAGE questions and the single-question screening tools for problem drinking, and the 2 instruments were equal in their ability to engage the patient. In Missouri, the single question was more likely to be used.

Adult↗
PubMedDate not supplied

Three measures of sleep, sleepiness, and sleep deprivation and the risk of injury: a case-control and case-crossover study.

PURPOSE: Sleepiness and sleep deprivation are associated with injury, but few case-control studies have addressed them. We sought to add to the body of analytic observational studies. METHODS: Case-control and case-crossover study of 2517 injured patients interviewed in person in 3 emergency departments and matched by age, sex, rural versus urban, day of week, and hour of day with 1856 controls. Sleep constructs were measured by the following: (1) self-perceived sleepiness at injury or matched control time using 3 adjectives (tired, sleepy, drowsy); (2) usual sleep quality and quantity, and differences in those in the past 7 days; and (3) hours of sleep in the 24 hours before injury and the 24 hours before that. RESULTS: Better sleep quality in the past 7 days was associated with a lower risk of injury (odds ratio (OR) 0.88, 95% confidence interval (CI) 0.80 to 0.97). Self-reported sleepiness just before injury compared with control time was associated with a lower risk of injury, with ORs of 0.82 per unit on a 0-to-12 scale (95% CI 0.78 to 0.86) in case-control analysis and 0.76 (0.73 to 0.80) in case-crossover analysis. In case-crossover analysis, additional sleep in the 24 hours before injury compared with the 24 hours before that was associated with an increased risk of injury (OR 1.06 per hour, 95% CI 1.03 to 1.09), but this effect disappeared when we controlled for activity, location, and recent alcohol consumption. CONCLUSIONS: Better recent sleep quality was associated with a lower risk of injury, but surprisingly, feeling sleepy was also.

Adolescent↗
PubMedDate not supplied

Marijuana and other illicit drug use and the risk of injury: A case-control study.

OBJECTIVES: Assess the associations between marijuana or other illicit drug use and injury risk. METHODS: Case-control study. Cases were emergency department patients with acute injury. Age-sex matched controls were interviewed by telephone. RESULTS: Marijuana use in the past seven days was associated with decreased risk, and use of other illicit drugs was associated with increased risk. Controlling for confounding had little effect. CONCLUSIONS: Marijuana use may be associated with a decreased risk of injury. Other illicit drug use was associated with increased risk.

Adolescent↗