Dataset Information

The influence of substance misuse on clinical outcomes following burn.

ABSTRACT:

Introduction

Ongoing increases in the prevalence of substance misuse among burn-injured patients necessitate a contemporary analysis of the association between substance misuse and clinical outcomes in burn-injured adults.

Methods

We conducted a retrospective cohort study of 1199 patients admitted to a regional burn center. History of substance misuse was derived from a prospective clinical registry and categorized as alcohol, illicit drug, or both. The primary outcome was hospital length of stay; association of substance misuse and inpatient complications were secondary outcomes. Multivariable logistic regression was used to model the association between categories of substance misuse and each outcome, adjusting for patient and injury characteristics.

Results

The incidence of substance misuse was 34% overall. After adjustment for patient and injury characteristics, drug misuse was associated with a significantly longer length of stay (RR 1.12; 95% CI 1.00-1.25), as was alcohol misuse (RR 1.32; 95% CI 1.14-1.52), and drug/alcohol misuse (RR 1.34; 95% CI 1.16-1.56). Drug/alcohol misuse was associated with significantly higher rates of bacteremia (OR 3.84; 95% CI 1.83-8.04) and sepsis (OR 2.50; CI 1.13-5.53).

Conclusions

A history of substance misuse is associated with an increased risk of inpatient complications and longer hospital stay. Providers should be cognizant of increased complications in this cohort with a view to improving outcomes.

SUBMITTER: Rehou S

PROVIDER: S-EPMC7865207 | biostudies-literature | 2017 Nov

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

The influence of substance misuse on clinical outcomes following burn.

Rehou Sarah S Mason Stephanie S MacDonald Jessie J Pinto Ruxandra R Jeschke Marc G MG

Burns : journal of the International Society for Burn Injuries 20170512 7

<h4>Introduction</h4>Ongoing increases in the prevalence of substance misuse among burn-injured patients necessitate a contemporary analysis of the association between substance misuse and clinical outcomes in burn-injured adults.<h4>Methods</h4>We conducted a retrospective cohort study of 1199 patients admitted to a regional burn center. History of substance misuse was derived from a prospective clinical registry and categorized as alcohol, illicit drug, or both. The primary outcome was hospita ...[more]

PMID: 28506508

Similar Datasets

Project description:Vitamin D deficiency is common among the general population. It is also observed in up to 76% of critically ill patients. Despite the high prevalence of hypovitaminosis D in critical illness, vitamin D is often overlooked by medical staff as the clinical implications and consequences of vitamin D deficiency in acute contexts remain to be fully understood. Vitamin D has a broad range of pleotropic effects on various processes and systems including the immune-inflammatory response. 1?,25-dihydroxyvitamin D (1,25(OH)2D), has been shown to promote a tolerogenic immune response limiting deleterious inflammatory effects, modulation of the innate immune system, and enhancement of anti-microbial peptides. Vitamin D deficiency is frequently observed in critically ill patients and has been related to extrinsic causes (i.e., limited sunlight exposure), magnitude of injury/illness, or the treatment started by medical doctors including fluid resuscitation. Low levels of vitamin D in critically ill patients have been associated with sepsis, organ failure, and mortality. Despite this, there are subpopulations of critical illness, such as burn patients, where the literature regarding vitamin D status and its influence on outcomes remain insufficient. Thermal injury results in damage to both burned and non-burned tissues, as well as induces an exaggerated and persistent immune-inflammatory and hypermetabolic response. In this review, we propose potential mechanisms in which burn injury affects the vitamin D status and summarizes current literature investigating the influence of vitamin D status on outcomes. In addition, we reviewed the literature and trials investigating vitamin D supplementation in critically ill patients and discuss the therapeutic potential of vitamin D supplementation in burn and critically ill patients. We also highlight current limitations of studies that have investigated vitamin D status and supplementation in critical illness. Thermal injury influences vitamin D status. More studies investigating vitamin D depletion in burn patients and its influence on prognosis, via standardized methodology, are required to reach definitive conclusions and influence clinical practice.

Project description:PurposeResearch consistently connects parental and youth substance misuse, yet less is known about the mechanisms driving this association among justice-involved youth. We examine whether harsh parenting is an explanatory mechanism for the association between parental substance use and parental mental health and youth substance use disorder in a sample of justice-involved youth.MethodsData were drawn from the Northwestern Juvenile Project, a large-scale longitudinal survey of mental health and substance misuse in a representative sample of youth in juvenile detention. Harsh parenting, child maltreatment, youth alcohol and cannabis use disorder, and parental substance misuse and mental health were assessed among 1,825 detained youth (35.95% female) at baseline, three-year follow-up, and four-year follow-up.ResultsAt baseline, over 80% of youth used alcohol and/or cannabis; at the four-year follow-up, 16.35% and 19.69% of the youth were diagnosed with alcohol and cannabis use disorder, respectively. More than 20% of youth reported their parent misused substances and 6.11% reported a parent had a severe mental health need. Black youth experienced significantly fewer types of harsh parenting compared to White youth. Multivariate path analyses revealed harsh parenting mediated the association between parental substance misuse and mental health on youth alcohol and cannabis use disorder. Harsh parenting that does not rise to the level of child maltreatment mediated the association between parental substance misuse and mental health on youth alcohol use disorder; in contrast, child maltreatment did not mediate these associations. Multigroup analyses revealed the effect of harsh parenting on youth alcohol and cannabis use disorder did not vary across sex or race-ethnic subgroups.ConclusionsHarsh parenting represents one mechanism for the intergenerational continuity of alcohol and cannabis misuse and should be regularly assessed for and addressed in juvenile justice settings.

Project description:Medication nonadherence after liver transplantation (LT) is associated with adverse clinical outcomes such as graft rejection and graft loss. Few studies have examined nonadherence and its impact on clinical outcomes in LT. The study objectives were (1) to evaluate medication understanding (with treatment knowledge and demonstrated regimen use scores) and medication adherence or nonadherence to entire regimens among LT recipients and (2) to examine associations of these exposures with clinical outcomes. We conducted a 2-site study of 105 recipients between 2011 and 2012 at 2 transplant centers in Chicago, IL and Atlanta, GA. Data were collected via detailed, in-person interviews and medical record reviews. Study participants were middle-aged and predominantly male; 15% of the sample had limited literacy. On average, patients were taking 11 medications [standard deviation (SD)?=?4], and 39% had undergone a medication change within the last month. The average scores for the entire medication regimen were 86% (SD?=?22%) for treatment knowledge and 78% (SD?=?22%) for demonstrated regimen use. The mean score for self-reported nonadherence to the entire regimen was 14% (SD?=?20%), whereas 32% of the patients were nonadherent according to tacrolimus levels. In multivariate analyses, lower income, less time since transplantation, a higher number of medications, and limited literacy were inversely associated with treatment knowledge scores (all P?<?0.05), whereas limited literacy was associated with nonadherence according to tacrolimus levels (P?<?0.05). In multivariate models, higher scores for treatment knowledge [incidence rate ratio (IRR)?=?0.85, 95% confidence interval (CI)?=?0.74-0.97] and demonstrated regimen use (IRR?=?0.87, 95% confidence interval?=?0.77-0.98) were independently associated with 15% and 13% reductions in the number of posttransplant rehospitalizations, respectively. Inadequate treatment knowledge and improper regimen use may be significant determinants of unintentional nonadherence among LT recipients and are associated with adverse clinical outcomes.

Project description:OBJECTIVES:Contingency management (CM) is a treatment for substance misuse that involves the provision of incentives. This review examines the hypothesis that adding another formal psychotherapy, such as cognitive-behavioural therapy (CBT) or motivational enhancement therapy (MET), to CM improves substance use outcomes at both treatment end and at post-treatment follow-up compared with CM only. DATA SOURCES:Searches were performed in December 2017 and July 2019 of seven electronic bibliographic databases (MEDLINE, PsycINFO, EMBASE, Scopus, Web of Science, CINAHL, PsycEXTRA), as well as online trial registries and EThoS, and were followed by reference list screening. ELIGIBILITY CRITERIA:Included studies were randomised controlled trials of adults (18-65) who were using illicit substances, alcohol or tobacco. Studies featured an experimental arm delivering CM combined with a structured evidence-based psychotherapeutic intervention and a CM-only arm. Studies published up to July 2019 were included. DATA EXTRACTION AND SYNTHESIS:The primary outcome was biometrically verified point prevalent abstinence (PPA) at treatment end. Secondary outcomes included biometrically verified PPA at post-treatment follow-up and self-reported days of use at treatment end and post-treatment follow-up. Pooled risk ratios for PPA outcomes and standardised mean differences for days of use were calculated using random effects models. Risk of bias was assessed using the Grading of Recommendations Assessment, Development and Evaluation. RESULTS:12 studies (n=1654) were included. The primary analysis found no evidence of a synergistic effect in PPA at treatment end (relative risk (RR) 0.97, 95% CI 0.85 to 1.09; p=0.57). Sensitivity analysis of studies featuring CBT/MET also found no evidence of an effect (RR 0.92; 95% CI 0.79 to 1.08; p=0.32). None of the secondary outcomes showed any evidence of benefit. CONCLUSION:The results of the meta-analyses found no evidence that combining CM with another intervention improves the short-term or long-term effects of CM treatment.

Project description:Background and Objectives: After burns, social reintegration is a primary long-term objective. At the same time, substance-abuse disorders are more common in burn patients. The aim of this study was to assess prevalence of substance abuse pre- and postburn as well as living situation and relationship status relative to patient-reported health-related quality of life (HRQoL). Patients and Methods: Burn survivors treated as inpatients between 1 January 2012 and 31 December 2019 were retrospectively identified. Collected clinical data included: age, gender, time since injury, burn extent (%TBSA), and substance abuse. Patient-reported living situation, relationship status, smoking habits, alcohol and drug consumption pre- and postburn as well as the SF-36 study were ascertained via telephone survey. Inductive statistical analysis comprised uni- and multivariate testing. A p < 0.05 was considered as statistically significant. Results: A total of 128 patients, 93 (72.7%) men, with a mean age of 40.0 ± 15.7 years were included. Mean TBSA was 9.2 ± 11.0% and significantly lower in women (p = 0.005). General health SF-36 scores were significantly lower in women (67.6 ± 29.8) than men (86.0 ± 20.8, p = 0.002). Smoking decreased from 38.8% pre- to 31.1% postburn. A significant reduction in alcohol consumption was noted over time (p = 0.019). The rate of never-drinkers was 18.0% pre- and 27.3% postburn. Drug abuse was rare both pre- (7.8%) and postburn (5.3%). Living situation remained stable. None of the participants depended on assisted living or lived in a care facility postburn. In total, 75.8% and 67.2% were in a relationship pre- and postburn. Patients with higher alcohol consumption postburn were significantly more often male (p = 0.013) and had higher SF-36 general health scores (p < 0.001). Conclusions: HRQoL is better in men than in women after burn injury. A slight decrease in substance abuse postburn was noted. The connection between HRQoL and substance abuse after burn injuries needs to be investigated further in the future.

Dataset Information

The influence of substance misuse on clinical outcomes following burn.

Introduction

Methods

Results

Conclusions

Publications

The influence of substance misuse on clinical outcomes following burn.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets