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Biomedical subjects

R Saitz

Publications and source records attributed to R Saitz.

28 records · Page 2Linked to original sources
PubMed1997

The impact of alcohol-related diagnoses on pneumonia outcomes.

BACKGROUND: There is controversy regarding the role of alcoholism as a prognostic factor in hospitalized patients with pneumonia. OBJECTIVE: To assess the impact of alcohol abuse on hospitalization charges, length of hospital stay, intensive care unit use, and in-hospital mortality. METHODS: We studied a cohort of all adults hospitalized in 1992 in Massachusetts with a principal diagnosis of pneumonia, and all Massachusetts residents hospitalized for pneumonia in 6 bordering states. RESULTS: For the 23,198 pneumonia cases the mean total hospitalization charges were $9925, mean length of hospital stay was 9.6 days, 12% of the cases had intensive care unit stays, and 10% of the cases died during the hospitalization. In bivariate analyses, pneumonia cases with alcohol-related diagnoses had higher charges (mean, $11,232 vs $9877, P = .07), had shorter length of hospital stay (9.2 vs 9.6 days, P = .02), were more likely to experience an intensive care unit stay (19% vs 12%, P < .001), and had lower in-hospital mortality (6.0% vs 10.2%, P < .001). Multivariable analyses adjusting for comorbidity, pneumonia etiology, and demographics revealed that for pneumonia cases with alcohol-related diagnoses, risk-adjusted hospital charges were $1293 higher (adjusted mean, $11,179 vs $9888, P < .001), length of hospital stay was 0.6 days longer (10.1 vs 9.5 days, P = .001), intensive care unit use was higher (18% vs 12%; adjusted odds ratio, 1.63; 95% confidence interval, 1.33-1.98), and mortality was no different (10% with or without an alcohol-related diagnosis). CONCLUSIONS: Having an alcohol-related diagnosis is associated with more use of intensive care, longer inpatient stays, and higher hospital charges. To understand resource utilization in cases of pneumonia, alcohol abuse is a comorbid factor that must be considered.

Aged↗
PubMed1997

Pharmacotherapies for alcohol abuse. Withdrawal and treatment.

Pharmacologic management of alcoholism is only one part of the management of both alcohol dependence and withdrawal, which also includes the provision of a calm, quiet environment; reassurance; ongoing reassessment; attention to fluid and electrolyte disorders; treatment of coexisting addictions and common medical, surgical, and psychiatric comorbidities; and referral for ongoing psychosocial and medical treatment. For further discussion of these topics, the reader is referred to previously published sources. A survey of alcoholism treatment programs revealed that although benzodiazepines were the most commonly used drugs, standardized monitoring of patients' withdrawal severity was not common practice, and a significant minority of clinicians were using a variety of other drugs, some not known to prevent or treat the complications of withdrawal. Treatment should be based on the available evidence (Working Group on Pharmacological Management of Alcohol Withdrawal: American Society of Addiction Medicine Committee on Practice Guidelines: Pharmacological management of alcohol withdrawal: An evidence-based practice guideline. Unpublished draft, 1997). Patients with significant symptoms, patients with complications such as seizures or delirium tremens, and patients at higher risk for complications of alcohol withdrawal should receive benzodiazepines, particularly chlordiazepoxide, diazepam, or lorazepam, because of their safety and documented efficacy in preventing and treating the most serious complications of alcohol withdrawal. These drugs may be dosed on a fixed schedule for a predetermined number of doses on a tapering schedule over several days, or they may be administered by front-loading. An alternative approach for selected patients without seizures or acute comorbidity is symptom-triggered therapy, which individualizes treatment and decreases the duration and dose of medication administration. With either of the regimens, patients should have their withdrawal severity monitored until symptoms are resolving. Once withdrawal from alcohol is safely completed, the focus should turn to helping to prevent relapse. Disulfiram may be useful in highly motivated subsets of patients and when compliance-enhancing strategies are used. Naltrexone is useful in the broader population of patients entering treatment for alcohol dependence. These pharmacologic interventions should be given in the context of ongoing psychosocial support. There is substantial evidence that pharmacologic management of alcohol abuse and dependence is effective. As would be predicted from alcohol's myriad cellular effects, no panacea exists for alcoholism. For alcohol withdrawal, however, although treatment regimens have only recently been refined, evidence for effective treatment of symptoms and prevention of complications with benzodiazepines has been available for decades. Within the last decade, effective treatments, including naltrexone, have been shown to reduce alcohol intake in alcohol-dependent persons. Given the prevalence and cost of alcohol-related problems, all effective therapies (including pharmacologic treatments) should be considered to treat alcohol abuse and dependence.

Alcohol Withdrawal Delirium↗
PubMed1997

Physician unawareness of serious substance abuse.

PURPOSE: To describe and assess the prevalence of perceived physician unawareness of serious substance abuse. PATIENTS AND METHODS: We report an observational study with validation of multivariable results of data collected by interview from persons presenting for addictions treatment in the public system who reported having a physician. RESULTS: Of 3,253 patients interviewed, 87% (2,843) responded to the question about having a physician. Of 1,440 patients who stated that they had physicians, 45% (651) reported that the physician who cared for them was unaware of their substance abuse. In multivariable logistic regressions adjusting for sociodemographics, health status, and substance abuse histories, the following patient characteristics were found to be independently associated with physician unawareness of substance abuse and were confirmed in a validation analysis (OR = Odds Ratio, CI = 95% Confidence Interval); no prior episodic medical illness (OR = 1.98, CI = 1.35-2.92), no health insurance (OR = 1.89, CI = 1.33-2.70), no prior mental health treatment (OR = 1.75, CI = 1.06-2.88), no chronic medical illness (OR = 1.69, CI = 1.18-2.40), no prior substance abuse treatment (OR 1.64, CI 1.17-2.31), and no prior detoxification (OR = 1.54, CI = 1.14-2.22). CONCLUSIONS: Forty-five percent of patients with substance abuse serious enough to prompt a presentation for treatment stated that the physician who cared for them was unaware of their substance abuse. Patients without health insurance, a history of medical illness, or prior substance abuse or mental health treatment were more likely to have reported physician unawareness. Even among substance abusing patients requesting addiction treatment, many perceive that their physicians do not recognize their substance abuse.

Adult↗
PubMed1995

Recognition and management of occult alcohol withdrawal.

Many patients experience withdrawal because an acute illness has interrupted their usual alcohol intake. Medical and psychiatric complications of alcoholism may also coexist with withdrawal. Several findings predict the likelihood of seizures of delirium tremens and thus are useful in making initial treatment decisions.

Acute Disease↗
PubMed1995

Alcohol withdrawal: a nationwide survey of inpatient treatment practices.

OBJECTIVE: To describe current practices employed in the inpatient treatment for alcohol withdrawal. DESIGN: Survey. SETTING: Inpatient alcoholism treatment programs in the United States. PARTICIPANTS: Medical directors of 176 (69%) of 257 eligible programs randomly selected from a national listing. RESULTS: The medical directors estimated that of all inpatients treated for alcohol withdrawal at the programs, 68% received one of the following medications. Benzodiazepines, including the long-acting chlordiazepoxide (33%) and diazepam (16%), and less frequently the short-acting oxazepam (7%) and lorazepam (4%), were the most commonly used agents. Barbiturates (11%), phenytoin (10%), clonidine (7%), beta-blockers (3%), carbamazepine (1%), and antipsychotics (1%) were less frequently given. Drug was most often given on a fixed dosing schedule with additional medication "as needed" (52% of the programs). Only 31% of the programs routinely used a standardized withdrawal severity scale to monitor patients. Mean duration of sedative treatment was three days; inpatient treatment, four days. Use of fixed-schedule regimens was associated with longer sedative treatment (mean four vs three days, p < 0.01). Northeast census region location and psychiatrist program director were significantly associated with longer sedative and inpatient treatment duration. CONCLUSIONS: The most commonly reported regimen for alcohol withdrawal included three days of long-acting benzodiazepines on a fixed schedule with additional medication "as needed." Standardized monitoring of the severity of withdrawal was not common practice. The directors reported using a variety of other regimens, some not known to prevent the major complications of withdrawal. Although geographic location and director specialty were significantly associated with treatment duration, much of the variation in treatment for alcohol withdrawal remains unexplained.

Adrenergic beta-Antagonists↗
PubMed1995

Adolescents' preferences regarding human immunodeficiency virus (HIV)-related physician counseling and HIV testing.

OBJECTIVE: To assess adolescents' preferences regarding human immunodeficiency virus (HIV)-related physician counseling and HIV testing. DESIGN: Anonymous, self-report survey. SETTING: Metropolitan Boston public schools. PARTICIPANTS: Students in 9th and 12th grade from 10 schools. RESULTS: Of the 845 students (99%) who completed the survey, 53% were female, 50% seniors, and 76% white. Although 86% had regular physicians, only 27% reported ever discussing HIV with a physician. The majority wanted a physician to give them information about sexually transmitted diseases (82%), condoms (73%), sex (70%), safe sex (80%), and HIV (85%). Most wanted physicians to ask about personal experiences with sexually transmitted diseases (64%), condoms (59%), safe sex (67%), and HIV (72%). Seniors, students with female physicians, and students who had previously discussed sex with physicians were significantly more likely to want physicians to ask personal questions about HIV-related risk behaviors. Most, however, felt uncomfortable initiating a discussion about safe sex (59%), condoms (67%), sex (69%), and homosexuality (78%). More students preferred to speak with physicians (36%) than with family members (16%) or teachers (2%) about their personal risk of acquiring HIV, although 32% preferred to speak with friends. More preferred to be tested for HIV by someone who did not know them (40%) than by someone who did (32%). When asked about specific testing sites, 25% preferred a place that does only HIV testing, and 22% preferred their regular physicians' offices. CONCLUSIONS: Adolescents want physicians to give them information and to ask personal questions about HIV and HIV-related risk behaviors, and they prefer that the physicians initiate the discussion. Although they have no clear preference for testing sites, many teenagers prefer to be tested by someone who does not know them.

Adolescent↗
PubMed1994

Individualized treatment for alcohol withdrawal. A randomized double-blind controlled trial.

OBJECTIVE: To assess the effect of an individualized treatment regimen on the intensity and duration of medication treatment for alcohol withdrawal. DESIGN: A randomized double-blind, controlled trial. SETTING: An inpatient detoxification unit in a Veterans Affairs medical center. PATIENTS: One hundred one patients admitted for the treatment of alcohol withdrawal who could give informed consent and had no history of seizures or medication use that might alter the clinical course of withdrawal. INTERVENTION: Patients were randomized to either a standard course of chlordiazepoxide four times daily with additional medication as needed (fixed-schedule therapy) or to a treatment regimen that provided chlordiazepoxide only in response to the development of the signs and symptoms of alcohol withdrawal (symptom-triggered therapy). The need for administration of "as-needed" medication was determined using a validated measure of the severity of alcohol withdrawal. MAIN OUTCOME MEASURES: Duration of medication treatment and total chlordiazepoxide administered. RESULTS: The median duration of treatment in the symptom-triggered group was 9 hours, compared with 68 hours in the fixed-schedule group (P < .001). The symptom-triggered group received 100 mg of chlordiazepoxide, and the fixed-schedule group received 425 mg (P < .001). There were no significant differences in the severity of withdrawal during treatment or in the incidence of seizures or delirium tremens. CONCLUSIONS: Symptom-triggered therapy individualizes treatment, decreases both treatment duration and the amount of benzodiazepine used, and is as efficacious as standard fixed-schedule therapy for alcohol withdrawal.

Adult↗