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Biomedical subjects

Richard D Blondell

Publications and source records attributed to Richard D Blondell.

14 recordsLinked to original sources
PubMed2006

Differences among those who complete and fail to complete inpatient detoxification.

Some individuals hospitalized for alcohol or drug detoxification leave against medical advice (AMA). We hypothesized that certain characteristics would be associated with AMA discharges. A case-control study of 1,426 hospital admissions for detoxification (representing 1,080 individuals) was conducted to compare patients leaving the hospital AMA (n=231) with a random sample of those completing detoxification (n=286). Latino ethnicity, detoxification from drugs, Friday or Saturday discharge, Medicaid or no health insurance, and not being treated by one specific attending physician were characteristics associated with an AMA discharge in a backward logistic regression model. Although 85% of the patients with all these characteristics left AMA, only one patient, without any of these five characteristics, did so. We conclude that clinicians can use certain clinical features to predict AMA discharge. Additional research could evaluate if treatment strategies that consider these ethnic and socioeconomic disparities may reduce rates of AMA discharge.

Adolescent↗
PubMed2005

Ambulatory detoxification of patients with alcohol dependence.

Detoxification from alcohol can be undertaken in ambulatory settings with patients who are alcohol-dependent and show signs of mild to moderate withdrawal when they are not drinking. An appropriate candidate for outpatient detoxification should have arrangements to start an alcohol treatment program and a responsible support person who can monitor progress, and should not have significant, acute, comorbid conditions or risk factors for severe withdrawal. Long-acting benzodiazepines, the preferred medications for alcohol detoxification, can be given on a fixed schedule or through "front-loading" or "symptom-triggered" regimens. Adjuvant sympatholytics can be used to treat hyperadrenergic symptoms that persist despite adequate sedation. Progress can be monitored with the use of a standard withdrawal-assessment scale and daily physician contact. Detoxification is not a stand-alone treatment but should serve as a bridge to a formal treatment program for alcohol dependence.

Alcoholism↗
PubMed2005

Toxicology screening results: injury associations among hospitalized trauma patients.

BACKGROUND: Substance abuse is associated with injuries, but these associations have not been well characterized by type of substance and injury type. METHODS: A cross-sectional study of patients selected for toxicology screening compared those with positive and those with negative test results for drugs and alcohol. RESULTS: Patients with positive alcohol toxicology results were more likely to have violence-related and penetrating injuries than patients with negative results. However, after adjustment for positive cocaine toxicology results, the association between alcohol and penetrating injury was no longer significant. Positive test results for any drug were not associated with any specific injury type, but cocaine was independently associated with violence-related injury. The associations of alcohol and cocaine with violence-related injury appear to be additive. In contrast, opiates were independently associated with nonviolent injuries and burns. CONCLUSIONS: Alcohol and cocaine use is independently associated with violence-related injuries, whereas opiate use is independently associated with nonviolent injuries and burns.

Adolescent↗
PubMed2005

Toxicology screening in orthopedic trauma patients predicting duration of prescription opioid use.

Following hospitalization for orthopedic trauma, some patients continue to use opioids following fracture healing. This retrospective cohort study of 50 patients with high-energy fractures was conducted to determine if toxicology screening tests upon admission can predict subsequent opioid use. Data were collected from clinical records and a statewide electronic database of prescription records. Six months following hospital discharge, those with positive toxicology used more Following hospitalization for orthopedic trauma, some patients continue to use opioids following fracture healing. This retrospective cohort study of 50 patients with high-energy fractures was conducted to determine if toxicology screening tests upon admission can predict subsequent opioid use. Data were collected from clinical records and a statewide electronic database of prescription records. Six months following hospital discharge, those with positive toxicology used more. Following hospitalization for orthopedic trauma, some patients continue to use opioids following fracture healing. This retrospective cohort study of 50 patients with high-energy fractures was conducted to determine if toxicology screening tests upon admission can predict subsequent opioid use. Data were collected from clinical records and a statewide electronic database of prescription records. Six months following hospital discharge, those with positive toxicology used more opioids (730 mg vs. 364 mg; P = .04) expressed as morphine equivalents than those with negative toxicology and were more likely to continue using opiates at the end of the 3rd, 4th, 5th, and 6th month after discharge. Patients hospitalized for high-energy fractures with positive admission toxicology are at risk for prolonged opiate use during the initial six months following discharge.

Adult↗
PubMed2004

Admission characteristics of trauma patients in whom delirium develops.

BACKGROUND: The purpose of this study was to describe the admission characteristics of trauma victims that are predictive of the development of delirium during hospitalization. METHODS: In this case-control study, data (demographics, injury type, medical histories, admission laboratory values, medications, and outcomes) were obtained from the records of 120 patients in whom delirium developed and 145 in whom it did not after admission for traumatic injury. Odds ratios were employed to identify significant predictors used in a stepwise logistic regression analysis. RESULTS: Admission characteristics, retained after stepwise logistic regression, that were independently predictive of delirium were age more than 45 years, positive admission blood alcohol, and an elevated mean corpuscular volume. Those in whom delirium developed had longer hospital and intensive care unit lengths of stay than in whom it did not. CONCLUSIONS: Older patients and alcoholics are at increased risk for delirum. Therapies directed at prevention have the potential to improve care and decrease lengths of stay.

Age Distribution↗
PubMed2004

What is Alcoholics Anonymous affiliation?

An increasing body of research evidence supports the use of 12-step program affiliation as an effective adjunct and aftercare for formal treatment. Recently, three brief (9- or 10-item) measures of affiliation have been developed. However, the brief scales are difficult to interpret, and the question of exactly what is affiliation (or disaffiliation) remains unclear. This analysis examines the question of what is the essence of affiliation vs. disaffiliation. Data from the Project MATCH 1-year posttreatment Alcoholics Anonymous Involvement (AAI) scale (N=1506) are used to identify the most salient items of Alcoholics Anonymous (AA) affiliation predicting 1-year posttreatment drinking outcomes. Analysis using stepwise regression suggests that a three-item solution can explain a similar amount of variance in the proportion of days abstinent in months 9 through 12 posttreatment, as does using the nine items. These three "core items predicting recovery" include AA attendance, sum of steps completed, and identifying self as an AA member. As an affiliation composite scale, these three items are easier to interpret and administer than the full AAI scale, and when combined, possess adequate reliability (alpha=0.72).

Adult↗
PubMed2004

Is the Kentucky prescription reporting system useful in the care of hospitalized patients?

Patients who are physically dependent on prescription drugs often create clinical management problems during hospitalization. Identifying those patients who have prescription drug problems can be difficult at the time of admission, but the information of the Kentucky All Schedule Prescription Electronic Reporting (KASPER) system can be useful clinically. The purpose of this study was to examine the value of the KASPER system in the management of patients admitted to an acute care hospital. A convenience sample of 58 hospitalized patients was evaluated. The patients' clinical and demographic data were abstracted from the medical record. The KASPER data were used to confirm the patients' history of drug use. In this sample, the KASPER data supplied additional, clinically useful information that was not available from the clinical history or screening toxicology from 30 (51.7%) of these patients. We conclude that the KASPER system has the potential to assist physicians in the care of hospitalized patients who take controlled drugs that are obtained by physician prescription and filled in Kentucky pharmacies.

Adult↗
PubMed2002

Risk factors for delirium tremens in trauma patients.

BACKGROUND: The development of delirium tremens (DT) is associated with significant morbidity and mortality. This study identifies characteristics in trauma patients that are predictive of DT. METHODS: Data from 1,856 trauma patients who either developed DT (n = 105) or had a positive blood alcohol concentration but did not develop DT (n = 1,751) were collected from the trauma registry of a Level I trauma center. Odds ratios were used to measure the association between predictors and DT as an outcome and between DT and length of stay as an outcome. RESULTS: Of seven significant (p < 0.05) predictors of DT, four were retained after stepwise logistic regression: age >40, white race, burn as a mechanism of injury and, as a negative predictor, motor vehicle collision as a mechanism of injury. The DT group stayed an average of 6.5 and 5.2 days longer in the hospital and the intensive care unit, respectively, than those in the control group. CONCLUSION: It is possible to determine which intoxicated trauma patients are at increased risk for DT using the above predictors. Patients who develop DT have worse outcomes than those who do not. Whether routine DT prophylaxis would improve outcomes among those at increased risk for DT is unknown, but deserves further study.

Adult↗
PubMed2002

Hospital Use of Ethanol Survey (HUES): preliminary results.

Little information exists about alcohol use within health facilities. We sought to determine alcohol use and control in acute-care hospitals by mailing a questionnaire to a convenience sample of Pharmacy Directors of 24 hospitals in two regions. Of 23 responders, in-patient alcohol was dispensed by 21 (91%) within the last 5 years. Of these 21, both beverage and intravenous alcohol were dispensed by 13 (62%), only beverage alcohol by seven (33%), and only intravenous alcohol by one (5%). No institutional policies regarding alcohol dispensing existed in 16 (70%) hospitals. Alcohol was frequently used as a patient courtesy (14/20, 70%), and to prevent withdrawal (7/20, 35%). All pharmacies procured intravenous alcohol in a formal process, but 60% (12/20) obtained beverage alcohol informally. Alcohol is widely dispensed with few guidelines in this sample of acute-care hospitals. Additional research on therapeutic efficacy, consequences, and institutional oversight of alcohol in hospitals is needed.

Alcohol Withdrawal Delirium↗
PubMed2002

Characteristics of intoxicated trauma patients.

Of 1320 patients who were hospitalized for injuries, a total of 315 were known to be intoxicated with alcohol at the time of trauma. A retrospective chart review was performed to determine which biopsychosocial markers correlated with increasing severity of alcohol use disorders in a sample of 184 (58.4%) of these 315 patients. Markers associated with increased severity were: an increased mean corpuscular volume (MCV; p = 0.007), previous legal problems (p = 0.023), previous alcohol rehabilitation (p < 0.001), previous attendance at self-help meetings (p < 0.001), admitting to having an alcohol problem (p < 0.001), and a willingness to change drinking behavior (p < 0.001). Routine toxicology screening tests, simple questions about previous alcohol or drug abuse treatment, and direct questions about the patient's own perception of the severity of disease and readiness to change drinking behavior can identify many victims of major trauma who could potentially benefit from a referral for alcohol rehabilitation.

Adult↗
PubMed2002

A comparison of alcohol-positive and alcohol-negative trauma patients.

OBJECTIVE: Hospital admission for an alcohol-related traumatic injury may offer a "teachable moment" to address a patient's alcohol problem. Although trauma teams provide a number of other health-related services, there may be characteristics of alcohol-positive victims that act as barriers toward providing alcohol counseling. The purpose of this study was to compare the characteristics and hospital outcomes of trauma patients who tested positive for alcohol at the time of hospital admission with those who did not. This information is useful for planning interventions and referrals for treatment. METHOD: The study was a retrospective comparison of alcohol-positive and alcohol-negative patients who were admitted for at least 48 hours to a Level-I trauma center. Data from 1,049 trauma victims (736 male, 742 alcohol-negative) were abstracted from clinical records. RESULTS: Several characteristics were found to be associated with alcohol-related injuries: being male, aged 40 years or less, having a toxicology screen positive for illicit drugs, lacking health insurance, being indigent and sustaining an injury related to violence. Alcohol-positive patients were also found to spend fewer days in a critical care unit, to be less likely to die and to be less likely to be transferred to another hospital than alcohol-negative patients, despite having similar injury severity. CONCLUSIONS: Patient characteristics suggest that there are obstacles to providing interventions and referrals by healthcare professionals for victims of alcohol-related injuries. Less expensive options that consider the demographic features of this patient population need to be developed as an alternative to expensive, professional interventions.

Adolescent↗
PubMedDate not supplied

Abstinence and initiation of treatment following inpatient detoxification.

This prospective cohort study compared in-patients who remained abstinent and initiated aftercare treatment following detoxification with those who did not. Of 110 patients enrolled, 58% (46/79) were totally abstinent and 72% (67/93) initiated treatment during the first 30 days following hospital discharge. Patients who relapsed after hospital discharge were more likely than those who remained abstinent to have a primary drug-use disorder (p = 0.05), prior mental health treatment (p = .007), or previous incarceration (p = 0.035). Those who initiated aftercare treatment were less likely to have had prior mental health treatment than those who did not (p = .046).

Adult↗