Brenda Chabon

Risk Acts, Health Care, and Medical Adherence Among HIV+ Youths in Care over Time

The level and consistency of HIV-related sexual and substance-use risk acts, health status, and medical adherence were examined among 102 HIV+ youths aged 14 to 23 years (27% African American, 33% Latino). Over their lifetime, youths engaged in unprotected sexual acts with multiple partners (M = 284; Median = 44; consistent condom protection, 5%) and substance use (21% injecting drug use; 68% hard drugs). When current risk behaviors were assessed twice over two consecutive 3-month periods, almost one third had been sexually abstinent. Among youths who were currently sexually active, most had multiple sexual partners (M = 5.7, Time 1; 4.9, Time 2) and used condoms (72-77% sexual acts protected); most of the youths (63-64%) always used condoms. Use of alcohol (63%), marijuana (41%), hard drugs (36%), and injecting drugs (12%) was substantial. Youths were relatively healthy (M T cells = 521.4; 14% T cells < 200; 1.9 diseases and 3.7 physical symptoms in the previous 3 months); they attended about one third of their medical appointments. While all youths were linked to adolescent HIV programs, unhealthy behavior and risk acts remained common. More effective and intensive intervention appears required.

HIV and AIDS in adolescents

HIV infection in adolescents continues to challenge health providers, policymakers, and advocates for youth. There will be no relief from its complexities soon. Primary care providers are in a unique position to use effective HIV prevention and care interventions. Successful programs move beyond moralism to realism. They show a willingness to engage young people and their families in a sensitive dialogue about the needs of youthful sexual development. Youth at high risk for HIV should be identified and referred to comprehensive care and counseling as soon as possible. HIV-positive youth need intensive individual and group interventions to remain healthy and reduce transmission to others. To protect their patient population, health care providers will need to commit time and effort to making adolescents services visible, flexible, affordable, confidential, culturally appropriate, and universally available.

Prescribing thiamine to inpatients with alcohol use disorders: how well are we doing?

Objectives:Thiamine deficiency is a potentially dangerous sequela of alcohol use disorders (AUDs). European and British guidelines recommend administering high-dose parenteral thiamine 3 times daily to avoid consequences of thiamine deficiency such as Wernicke-Korsakoff syndrome (WKS), and suggest that traditional thiamine dosages are likely inadequate. Research into thiamine and WKS has lagged in the United States, and to date, no study has examined how thiamine is prescribed to inpatients with AUD in an American hospital. Methods:Thiamine prescribing data (amount, route, and frequency schedule) were collected for inpatients at a large, American, teaching hospital, who were referred to the addiction psychiatry service for AUD. Data were analyzed using Statistical Product and Service Solutions. Results:A total of 217 inpatients with AUD were included. A substantial percentage of them were not prescribed thiamine. Of those who were prescribed thiamine, nearly all were prescribed oral thiamine at traditional dosages, including high-risk patients. Conclusions:This is the first study to report on the prescribing of thiamine to inpatients with AUD at an American teaching hospital. It serves to confirm what many already suspected: that more education is needed to improve the diagnostic challenges of WKS, the detection of risk factors for WKS, and the adequate dosing of thiamine for prevention and treatment of WKS.

Development of a Substance Abuse Consultation and Referral Service in an Academic Medical Center: Challenges, Achievements and Dissemination

Approximately 25% of US hospital beds are occupied by individuals with active substance use disorders (SUD). Acute medical hospitalization provides an opportunity to address SUDs and provide patient-centered intervention and referral for treatment. Nationally, some hospitals have developed substance abuse consultation departments to improve the care of hospitalized substance users. In this paper we describe the Addiction Psychiatry Service (APS) in a large urban hospital which provides bed-side SUD consultation, screening, intervention and referral to treatment. APS utilizes the multiple disciplines of psychology, social work and medicine to integrate substance abuse services throughout the hospital and educate future generations of medical and psychology trainees. We conclude with how the APS service is informing the development of similar programs in other academic departments within our hospital and best practice recommendations to further disseminate this service model.

The Hospital-Based Consultation and Liaison Service

Psychosocial factors have a broad and substantial impact on patient presentation in the inpatient medical setting. Research clearly demonstrates that psychosocial factors play a crucial role in the etiology, pathophysiology, treatment, and clinical outcomes of numerous chronic and comorbid diseases as well as postsurgical outcomes and recovery. Given that psychiatric and behavioral symptoms can have a significant influence on chronic and acute illness, it is not surprising that inpatient medical settings have reported significant psychiatric issues in approximately 35 % of all inpatients. These psychiatric comorbidities can have negative consequences on medical outcomes as well as fiscal outcomes (e.g., increased length of stay and repeated readmission). Beyond clinical psychiatric diagnosis, the multiple stressors of the hospitalization can negatively impact the quality of life for even high-functioning patients. Unfortunately, these psychosocial factors are often poorly recognized and managed within the hospital setting. For example, less than 5 % of admissions across the hospital appear to receive a mental health consult, far less than the one third of patients estimated to have psychiatric comorbidity.