621 Discharge Survey of Burn Patients Reveals Concerns About Attending Follow up Appointments

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S165-S166
Author(s):  
Eve A Solomon ◽  
Elizabeth Phelan ◽  
Lilia G Tumbaga ◽  
Irina P Karashchuk ◽  
David G Greenhalgh ◽  
...  
Keyword(s):  
Drug Use ◽  
Social Worker ◽  
Illicit Drugs ◽  
Burn Injury ◽  
Great Distance ◽  
Living Situation ◽  
Improvement Project ◽  
Common Response ◽  
To Come

Abstract Introduction Follow-up appointments are important after a burn injury to minimize adverse sequelae. A retrospective study at our institution revealed that over 25% of patients never attend a follow-up appointment. Failure to follow-up was associated with homelessness, drug use, and distance to the clinic. The purpose of this study was to design and administer a survey prior to discharge that seeks to identify patient-perceived barriers to follow-up. Methods A multidisciplinary team consisting of a burn surgeon, medical student, discharge planner, and social worker developed an 18-question survey that examined areas that might influence following up in burn clinic. There were questions regarding transportation, living situation, motivation to return for follow-up, homelessness, drug use, and social determinants of health. As a quality improvement project the surveys were administered to patients discharged following a burn injury by either the discharge planner or social worker from September 2019 to July 2020. Statistical analysis included descriptive statistics of survey responses. Results There were 473 patients discharged during the study period. A total of 342 patients completed surveys (72.3% response rate). Most patients (208, 60.8%) were very confident that they would come to a follow-up appointment and stated they had no obstacles to keeping their appointment. The most common obstacles stated were: transportation (143, 41.8%), cost (100, 29.2%), and time off work/school (70, 20.5%). The planned mode of transportation to appointments was being driven by someone else in a personal car (234, 68.4%), the second most common response was that they were unsure of their transportation (29, 8.5%). Patients traveled a great distance to come to the clinic with 188 patients (55%) traveling more than one hour. The most frequent discharge location was the patient’s home (169, 49.4%), with the second most frequent being the home of a friend or family member (95, 27.8%). Sixty-two patients (18.1%) were homeless at the time of admission. When asked about their motivation for following up in clinic the most common response was concern about their injuries/healing (269, 78.7%). The most common levels of educational attainment were high school (149, 43.6%) and College (114, 33.3%). The most common employment status was unemployed (131, 38.3%) and 141 patients (41.2%) made less than $25,000 per year. With respect to substance use, 171 (50%) patients used alcohol, 151 (44.2%) patients smoked, and 82 (24%) patients used illicit drugs. Conclusions Many patients are motivated to come to their follow-up appointments but face significant difficulties in coming to appointments due to distance to the clinic, transportation, and cost issues.

Emergency Department Admission and Mortality Rate for Suicidal Behavior

Crisis ◽  
2014 ◽  
Vol 35 (6) ◽  
pp. 406-414 ◽  
Author(s):  
Raimondo Maria Pavarin ◽  
Angelo Fioritti ◽  
Francesca Fontana ◽  
Silvia Marani ◽  
Alessandra Paparelli ◽  
...  
Keyword(s):  
Emergency Department ◽  
Metropolitan Area ◽  
Suicidal Behavior ◽  
Mortality Risk ◽  
Illicit Drugs ◽  
Attempted Suicide ◽  
Cox Model ◽  
Emergency Department Admission ◽  
Completed Suicide

Background: The international literature reports that for every completed suicide there are between 8 and 22 visits to an Emergency Department (ED) for attempted suicide/suicidal behavior. Aims: To describe the characteristics of admission to emergency departments (EDs) for suicide-related presenting complaints in the metropolitan area of Bologna; to estimate the risk for all-cause mortality and for suicide; to identify the profiles of subjects most at risk. Method: Follow-up of patients admitted to the EDs of the metropolitan area of Bologna between January 2004 and December 2010 for attempted suicide. A Cox model was used to evaluate the association between sociodemographic variables and the general mortality risk. Results: We identified 505 cases of attempted suicide, which were more frequent for female subjects, over the weekend, and at night (8:00 p.m./8:00 a.m.). The most used suicide methods were psychotropic drugs, sharp or blunt objects, and jumping from high places. In this cohort, 3.6% of subjects completed suicide (4.5% of males vs. 2.9% of females), 2.3% within 1 year of the start of follow-up. The most common causes of death were drug use and hanging. In the multivariate analysis, those who used illicit drugs 24 hr prior to admission to the ED (hazard ratio [HR] = 3.46, 95% CI = 1.23–9.73) and patients who refused the treatment (HR = 6.74, 95% CI = 1.86–24.40) showed an increased mortality risk for suicide. Conclusion: Deliberate self-harm patients presenting to the ED who refuse treatment represent a specific target group for setting up dedicated prevention schemes.

Fire on the Mountain: Reinvigorating Legislative Measures to Quench the Flame of Illicit Drug Use in South Africa

2020 ◽  
Vol 3 (2) ◽  
pp. 15-29
Author(s):  
Sogo Angel Olofinbiyi ◽  
Thembelihle Mtambo
Keyword(s):  
South Africa ◽  
Drug Use ◽  
South African ◽  
Illicit Drugs ◽  
Illicit Drug ◽  
Illicit Drug Use ◽  
Critical Discussion ◽  
African Government ◽  
Clear Cut ◽  
Legislative Measures

South African societies have been characterized by the prolific incidence of illicit drug use in recent times.  The paper attempts to examine the legislations implemented on the use of illicit drugs in South Africa. The study adopts a review of the literature to identify and describe the most common illicit drugs used around South Africa communities, placing emphasis on the policies developed by the South African government in combating these situations. The research follows a critical   discussion on the issues associated with drug use, its causes, as well as its effects on humans and the environment. The study recommends relevant initiatives to combat all intricacies associated with drug use within the country. This approach will be appropriate in facilitating a clear-cut   understanding of the possible remedies to quench the burning flame of illicit drug use across a broad range of South African communities.

scholarly journals Does parental permissiveness toward cigarette smoking and alcohol use influence illicit drug use among adolescents? A longitudinal study in seven European countries

2021 ◽  
Author(s):  
Emina Mehanović ◽  
Federica Vigna-Taglianti ◽  
Fabrizio Faggiano ◽  
Maria Rosaria Galanti ◽  
Barbara Zunino ◽  
...  
Keyword(s):  
Alcohol Use ◽  
Drug Use ◽  
Cigarette Smoking ◽  
Longitudinal Data ◽  
Illicit Drug ◽  
Large Population ◽  
Illicit Drug Use ◽  
European Countries ◽  
The Impact

Abstract Purpose Adolescents’ perceptions of parental norms may influence their substance use. The relationship between parental norms toward cigarette and alcohol use, and the use of illicit substances among their adolescent children is not sufficiently investigated. The purpose of this study was to analyze this relationship, including gender differences, using longitudinal data from a large population-based study. Methods The present study analyzed longitudinal data from 3171 12- to 14-year-old students in 7 European countries allocated to the control arm of the European Drug Addiction Prevention trial. The impact of parental permissiveness toward cigarettes and alcohol use reported by the students at baseline on illicit drug use at 6-month follow-up was analyzed through multilevel logistic regression models, stratified by gender. Whether adolescents’ own use of cigarette and alcohol mediated the association between parental norms and illicit drug use was tested through mediation models. Results Parental permissive norms toward cigarette smoking and alcohol use at baseline predicted adolescents’ illicit drug use at follow-up. The association was stronger among boys than among girls and was mediated by adolescents’ own cigarette and alcohol use. Conclusion Perceived parental permissiveness toward the use of legal drugs predicted adolescents’ use of illicit drugs, especially among boys. Parents should be made aware of the importance of norm setting, and supported in conveying clear messages of disapproval of all substances.

scholarly journals Narratives of Change: Identity and Recognition Dynamics in the Process of Moving Away From a Life Dominated by Drug Use

2021 ◽  
pp. 009145092110270
Author(s):  
Inger Eide Robertson ◽  
Hildegunn Sagvaag ◽  
Lillian Bruland Selseng ◽  
Sverre Nesvaag
Keyword(s):  
Drug Use ◽  
Identity Formation ◽  
Recovery Process ◽  
Way Of Life ◽  
Positive Identity ◽  
The Social ◽  
Changing Practices ◽  
Struggle For Recognition ◽  
Depth Interviews

The concepts of identity and recovery capital are recognized as being an embedded part of moving away from a life dominated by drug use. However, the link between these two concepts and the effect of broader social structures, and the normative assumptions underpinning the condition of recovery, is less explored. This article focuses on the social practices of everyday life in the foreground of identity formation, meaning that “who I am” is an inseparable part of “what I do.” A narrative approach was employed to analyze qualitative follow-up data extracted from 48 in-depth interviews with 17 males and females with drug-using experience that were conducted posttreatment on three separate occasions over a period of 2.5 years. Theories of identity formation were employed to analyze the interdependent dynamic between social structure, persona and social resources, and way of life and identity. The analyses identified four narratives related to how people present themselves through the process of changing practices. Following the work of Honneth, we argue that the positive identity formation revealed in these narratives is best understood as a struggle for recognition via the principle of achievement. However, the participants’ self-narratives reflected cultural stories—specified as formula stories—of “normality,” “addiction,” and the “addict,” which work into the concepts of self and confine options of storying experiences during the recovery process. This study demonstrate that the process of recovery is culturally embedded and constitutes a process of adaption to conventional social positions and roles. We suggest challenging dominant discourses related to “addiction as a disease” and “normality” in order to prevent stigma related to drug use and recovery. In so doing, it may contribute to broaden conditions for identity (trans)formation for people in recovery.

scholarly journals Exploring Factors Associated with Functional Change and Predictors of Participation Improvement—A Two Years Follow-Up on People with Depression

2021 ◽  
Vol 18 (7) ◽  
pp. 3439
Author(s):  
Wen-Chou Chi ◽  
Chia-Feng Yen ◽  
Tsan-Hon Liou ◽  
Kwang-Hwa Chang ◽  
Hua-Fang Liao ◽  
...  
Keyword(s):  
Functional Status ◽  
Social Participation ◽  
Negative Relationship ◽  
General Function ◽  
Living Situation ◽  
Persons With Disabilities ◽  
Factors Associated ◽  
Whodas 2.0 ◽  
Household Activities

The purpose of this study is to understand the functional status distribution and to explore the factors associated with changes in functional status and social participation in people with depression using two-year follow-up data. Subjects were selected from the Taiwan Databank of Persons with Disabilities (TDPD) if they had an evaluation date between July 2012 and 31 December 2017. We used data for 1138 individuals with multiple evaluation records and who were diagnosed with depression. The WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) was the primary functional status measure. Other factors selected from the TDPD included social demographic data, living situation, employment status, economic status, and educational level. The results show scores in all dimensions of the WHODAS 2.0 declined over two years, especially in the domains of cognition, household activities, social participation, and total WHODAS 2.0 score. Aging groups showed poor recovery in cognition, getting along with others, and household activities. People living in suburban areas showed poorer recovery than people living in rural and urban areas in cognition, self-care, and general function (total score of WHODAS 2.0). Employment was also strongly associated with functional recovery in household activities, social participation, and general function. The original scores for cognition and getting along with others showed a significant negative relationship with social participation improvement. Our results can be used by policy makers to provide resources and conduct investigations, and by clinicians when making rehabilitation plans.

scholarly journals Healthcare cost associations of patients who use illicit drugs in Florida: a retrospective analysis

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Jessica L. Ryan ◽  
Veronica R. Rosa
Keyword(s):  
Drug Use ◽  
Patient Care ◽  
Healthcare Cost ◽  
Healthcare Costs ◽  
Illicit Drugs ◽  
Illicit Drug ◽  
Multiple Drug ◽  
Study Population ◽  
Multiple Drugs ◽  
Hospital Research

Abstract Background Illicit drug use increases visits to the hospital. Research is limited on the costs of these healthcare visits by illicit drug. Methods Florida’s Agency for Health Care Administration’s emergency department and inpatient datasets from 2016 to 2018 were analyzed. Adults who used an illicit drug were included in the study population resulting in 709,658 observations. Cost-to-charge ratios were used to estimate healthcare costs. Linear regression analyzed associations of illicit drugs with total healthcare cost. Results Total healthcare costs are estimated at $6.4 billion over the 3 year period. Medicare paid for the most patient care ($2.16 billion) with Medicaid and commercial insurance each estimated at $1.36 billion. Cocaine (9.25%) and multiple drug use (6.12%) increased the costs of an ED visit compared to a patient with cannabis SUD. Opioids (23.40%) and inhalants use (16.30%) increased the costs of inpatient compared to cannabis SUD. Conclusion Healthcare costs are high of patients with illicit drug SUD and poisoning, over half of which are paid for with tax payer dollars and to an unknown degree hospital write-offs. Injuries and illness of patients using cocaine and multiple drugs are associated with more expensive ED patient care and opioids and inhalants are associated with more expensive inpatient care.

Silent severe myocardial ischemia in a past illicit drug user imaged with myocardial perfusion scintigraphy

Perfusion ◽  
2021 ◽  
pp. 026765912110281
Author(s):  
Chrissa Sioka ◽  
Georgios Georgiou ◽  
Christos Katsouras ◽  
Konstantinos Pappas ◽  
Dimitris-Nikiforos Kiortsis ◽  
...  
Keyword(s):  
Drug Use ◽  
Myocardial Perfusion ◽  
Myocardial Ischemia ◽  
Illicit Drugs ◽  
Illicit Drug ◽  
Microvascular Dysfunction ◽  
Illicit Drug Use ◽  
Coronary Microvascular Dysfunction ◽  
Illicit Drug User ◽  
Cardiac Symptoms

Patients with illicit drug use may have deleterious acute and chronic cardiac effects. We present a case of a 42-year-old man, former alcohol and various illicit drugs user, who was admitted to the psychiatric unit for management of psychosis. Because of his previous drug and alcohol history, a cardiological evaluation was performed which revealed silent severe myocardial ischemia detected by myocardial perfusion imaging (MPI). The myocardial ischemia was attributed to coronary microvascular dysfunction, occurring several years after quitting the illicit drugs. This study highlights the potential myocardial ischemia that may occur in patients with previous alcohol and illicit drug use, and the role of MPI, a non-invasive test that can provide important information regarding the myocardial status of such patients, even without obvious cardiac symptoms or findings.

Follow up after burn injury is disturbingly low and linked with social factors

2021 ◽  
Author(s):  
Irina P Karashchuk ◽  
Eve A Solomon ◽  
David G Greenhalgh ◽  
Soman Sen ◽  
Tina L Palmieri ◽  
...  
Keyword(s):  
Social History ◽  
Drug Dependence ◽  
Burn Injury ◽  
Retrospective Chart Review ◽  
Burn Patients ◽  
Chi Square ◽  
Factors Associated ◽  
Ed Visits ◽  
Zip Code

Abstract For medical and social reasons, it is important that burn patients attend follow up appointments (FUAs). Our goal was to examine the factors leading to missed FUAs in burn patients. A retrospective chart review was conducted of adult patients admitted to the burn center from 2016-2018. Data collected included burn characteristics, social history, and zip code. Data analysis was conducted using chi-square, Wilcox Rank Sum tests, and multivariate regression models. A total of 878 patients were analyzed, with 224 (25.5%) failing to attend any FUAs and 492 (56.0%) missing at least one appointment (MA). Patients who did not attend any FUAs had smaller burns (4.5 (8)% vs. 6.5 (11)% median (inter quartile range)), traveled farther (70.2 (111.8) vs. 52.5 (76.7) miles), and were more likely to be homeless (22.8% vs. 6.9%) and have drug dependence (47.3% vs. 27.2%). Patients who had at least one MA were younger (42 (26) vs. 46 (28) years) and more likely to be homeless (17.5% vs. 2.6%) and have drug dependence (42.5% vs. 19.4%). On multivariate analysis, factors associated with never attending a FUA were: distance from hospital (odds ratio (OR) 1.004), burn size (OR 0.96), and homelessness (OR 0.33). Factors associated with missing at least one FUA : age (OR 0.99), drug dependence (OR 0.46), homelessness (OR 0.22), and ED visits (OR 0.56). A high percentage of patients fail to make any appointment following their injury and/or have at least one MA. Both FUAs and MAs are influenced by social determinants of health.

scholarly journals Shifting from Village-Based Networks to Locally Generated Networks: Undocumented Mexican Agricultural Workers Who Use/Used Hard Drugs

2017 ◽  
Vol 2017 ◽  
pp. 1-13
Author(s):  
Keith V. Bletzer
Keyword(s):  
United States ◽  
Drug Use ◽  
Illicit Drugs ◽  
The United States ◽  
Border Crossing ◽  
New Drugs ◽  
Agricultural Workers ◽  
Economic Success ◽  
Childhood Difficulties ◽  
Hard Drugs

Hardships that face transmigrants working in agriculture include the potential for drug use. Reliant on village-based networks that facilitate border crossing and developing a plan for a destination within this country, transmigrants who try new drugs/alcohol and/or continue on accustomed drugs/alcohol are facilitated in these endeavors through locally generated networks as alternative forms of access and support. Seven cases of undocumented men from Mexico are reviewed to show how use of illicit drugs is minimally affected by economic success and time in the United States, or village-based networks that first facilitated entry into this country. Prior conditions, especially childhood difficulties and search for socioeconomic autonomy, precipitate new and/or continuing drug use within the United States on this side of the border, where both forms of drug use are facilitated by locally generated networks.

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