Edith Weiß-Gerlach

Value of ethyl glucuronide in plasma as a biomarker for recent alcohol consumption in the emergency room.

AIM This emergency department (ED) study compared the value of plasma ethyl glucuronide (EtG) testing with the information about alcohol consumption obtained using the standard alcohol biomarkers gamma-glutamyltransferase (GGT) and carbohydrate-deficient transferring (CDT) and the AUDIT questionnaire. METHODS Minimally injured and clinically non-intoxicated male patients (n = 81) admitted to an ED were screened regarding their alcohol consumption, using the computerized AUDIT questionnaire and a paper-and-pencil assessment including the type, amount and time of alcohol intake. Blood samples were collected for determination of ethanol, EtG (LC-MS) and GGT in plasma and %CDT in serum (Axis-Shield %CDT immunoassay). RESULTS Out of the 81 patients, 23 (28%) were positive (>/=8 points) on the AUDIT questionnaire. Only 3 (4%) showed a detectable ethanol concentration (range 0.01-0.07 g/L) but 31 (38%) showed a detectable EtG (0.16-39.5 mg/L). In four patients, EtG was detectable in plasma for >48 h after estimated completed elimination of ethanol. EtG was not correlated with the long-term biomarkers %CDT or GGT, or the AUDIT results, but with the time since estimated completed ethanol elimination. CONCLUSION EtG testing in blood was found useful in the ED as a way to detect recent drinking, even in cases of a negative ethanol test, and to confirm abstinence from alcohol. This sensitive and specific short-term biomarker provides valuable additional information about individual drinking habits and might also be helpful to identify an alcohol hangover.

Screening trauma patients with the alcohol use disorders identification test and biomarkers of alcohol use.

BACKGROUND Alcohol screening and brief interventions have been shown to reduce alcohol-related morbidity in injured patients. Use of self-report questionnaires such as the Alcohol Use Disorder Identification Test (AUDIT) is recommended as the optimum screening method. We hypothesized that the accuracy of screening is enhanced by combined use of the AUDIT and biomarkers of alcohol use in injured patients. METHODS The study was conducted in the emergency department of a large, urban, university hospital. Patients were evaluated with the AUDIT, and blood sampled to determine carbohydrate-deficient transferrin, gamma-glutamyl-transferase, and mean corpuscular volume. Alcohol problems were defined as presence of ICD-10 criteria for dependence or harmful use, or high-risk drinking according to World Health Organization criteria (weekly intake >420 g in males, >280 g in females). Screening accuracy was determined using Receiver Operating Characteristic curves. RESULTS There were 787 males and 446 females in the study. Median age was 33 years. The accuracy of the AUDIT was good to excellent, whereas all biomarkers performed only fairly to poorly in males, and even worse in females. At a specificity >0.80, sensitivity for all biomarkers was <0.43, whereas sensitivity for the AUDIT was 0.76 for males and 0.81 for females. The addition of biomarkers added little additional discriminatory information compared to use of the AUDIT alone. CONCLUSIONS Screening properties of the AUDIT are superior to %CDT, MCV, and GGT for detection of alcohol problems in injured patients and are not clinically significantly enhanced by the use of biomarkers.

Persistence of psychological distress in surgical patients with interest in psychotherapy: results of a 6-month follow-up.

Objectives This prospective observational study investigated whether self-reported psychological distress and alcohol use problems of surgical patients change between preoperative baseline assessment and postoperative 6-month follow-up examination. Patients with preoperative interest in psychotherapy were compared with patients without interest in psychotherapy. Methods A total of 1,157 consecutive patients from various surgical fields completed a set of psychiatric questionnaires preoperatively and at 6 months postoperatively, including Patient Health Questionnaire-4 (PHQ-4), Brief Symptom Inventory (BSI), Center for Epidemiologic Studies Depression Scale (CES-D), World Health Organization 5-item Well-Being Index (WHO-5), and Alcohol Use Disorder Identification Test (AUDIT). Additionally, patients were asked for their interest in psychotherapy. Repeated measure ANCOVA was used for primary data analysis. Results 16.7% of the patients were interested in psychotherapy. Compared to uninterested patients, they showed consistently higher distress at both baseline and month 6 regarding all of the assessed psychological measures (p’s between <0.001 and 0.003). At 6-month follow-up, neither substantial changes over time nor large time x group interactions were found. Results of ANCOVA’s controlling for demographic variables were confirmed by analyses of frequencies of clinically significant distress. Conclusion In surgical patients with interest in psychotherapy, there is a remarkable persistence of elevated self-reported general psychological distress, depression, anxiety, and alcohol use disorder symptoms over 6 months. This suggests high and chronic psychiatric comorbidity and a clear need for psychotherapeutic and psychiatric treatment rather than transient worries posed by facing surgery.

[The Post-Traumatic Stress Syndrome 14-Questions Inventory (PTSS-14) - Translation of the UK-PTSS-14 and validation of the German version].

BACKGROUND Hospitalization may represent a stressor that can lead to Posttraumatic stress disorder (PTSD). METHODS Translation of the UK-PTSS-14, conducted in accordance with ISPOR principles and validation with the PDS (86 patients). RESULTS The ROC analysis showed that the German version of PTSS-14 is a valid instrument with high sensitivity (82%) and specificity (92%) with the optimum cut-off point at 40 points. The translation process was authorized by the author of the UK-PTSS-14. CONCLUSION The validated German version of PTSS-14 is now ready for use as an efficient and reliable screening-tool for PTSD in a clinical setting.

Leichtverletzte Patienten einer innerstädtischen Rettungsstelle in Berlin

BACKGROUND The aim of this post hoc study was to evaluate the association of substance use disorders (SUD) and residential neighborhood affiliation in a group of patients with minor injuries presenting to an inner-city emergency room (ER) in Berlin. METHODS A total of 2,716 patients with minor injuries presenting to the ER were evaluated concerning alcohol use disorders (AUDIT, cut-off: males 8 points, females 5 points), smoking status, and illicit drug use in the past year. Information about residential area (zip code) and sociodemographics (paper-pencil questionnaire) were also obtained. RESULTS With respect to residential area, significant differences concerning SUD were identified: from the perspective of the inner-city ER, living close to the ER was associated with substance misuse. Here, alcohol use disorders (AUD), smokers, and illicit drug use were found more frequently compared to patients living in the periphery of the city. In addition, patients living close to the ER were more often unemployed, had a lower income, or were students. CONCLUSION There are differences in SUD with respect to residential area. However, in order to be able to draw reliable conclusions, an approach collecting representative data at the city district level as well as using a multicenter approach at the city ER level is necessary.

Kreißende mit Substanzkonsum – Bedeutung in der geburtshilflichen Anästhesie

Most of the female consumers of legal and illegal substances are of childbearing age. Occasional use, use disorder and addiction commonly devolve into each other. A lot of young women quit consuming when planning a family or at the latest with the knowledge of pregnancy. The ongoing substance abuse during pregnancy requires a coordinated interdisciplinary collaboration for a sufficient care of these highly complex and individual cases.

Patients with minor injuries in a Berlin inner-city emergency room: Substance misuse, residential area, and sociodemographics

BACKGROUND The aim of this post hoc study was to evaluate the association of substance use disorders (SUD) and residential neighborhood affiliation in a group of patients with minor injuries presenting to an inner-city emergency room (ER) in Berlin. METHODS A total of 2,716 patients with minor injuries presenting to the ER were evaluated concerning alcohol use disorders (AUDIT, cut-off: males 8 points, females 5 points), smoking status, and illicit drug use in the past year. Information about residential area (zip code) and sociodemographics (paper-pencil questionnaire) were also obtained. RESULTS With respect to residential area, significant differences concerning SUD were identified: from the perspective of the inner-city ER, living close to the ER was associated with substance misuse. Here, alcohol use disorders (AUD), smokers, and illicit drug use were found more frequently compared to patients living in the periphery of the city. In addition, patients living close to the ER were more often unemployed, had a lower income, or were students. CONCLUSION There are differences in SUD with respect to residential area. However, in order to be able to draw reliable conclusions, an approach collecting representative data at the city district level as well as using a multicenter approach at the city ER level is necessary.

Leichtverletzte Patienten einer innerstädtischen Rettungsstelle in Berlin@@@Patients with minor injuries in a Berlin inner-city emergency room: Substanzmissbrauch, Wohnbereich und Sozialstruktur@@@Substance misuse, residential area, and sociodemographics

BACKGROUND The aim of this post hoc study was to evaluate the association of substance use disorders (SUD) and residential neighborhood affiliation in a group of patients with minor injuries presenting to an inner-city emergency room (ER) in Berlin. METHODS A total of 2,716 patients with minor injuries presenting to the ER were evaluated concerning alcohol use disorders (AUDIT, cut-off: males 8 points, females 5 points), smoking status, and illicit drug use in the past year. Information about residential area (zip code) and sociodemographics (paper-pencil questionnaire) were also obtained. RESULTS With respect to residential area, significant differences concerning SUD were identified: from the perspective of the inner-city ER, living close to the ER was associated with substance misuse. Here, alcohol use disorders (AUD), smokers, and illicit drug use were found more frequently compared to patients living in the periphery of the city. In addition, patients living close to the ER were more often unemployed, had a lower income, or were students. CONCLUSION There are differences in SUD with respect to residential area. However, in order to be able to draw reliable conclusions, an approach collecting representative data at the city district level as well as using a multicenter approach at the city ER level is necessary.

Deutsche Suchtstiftung Matthias Gottschaldt - Wilhelm-Feuerlein-Preis - Effekt einer computergestützten Kurzberatung bei riskantem Alkoholkonsum nach einem Trauma

P atientinnen und Patienten mit einem riskanten bzw. gefährdenden Alkoholkonsum haben neben anderen Gesundheitsrisiken auch ein erhöhtes Risiko, Verletzungen aufgrund von Unfällen zu erleiden (1, 3–8, 10, 12–14). Riskanter Alkoholkonsum bedeutet nicht nur die Abhängigkeit oder den fortgesetzten Gebrauch, sondern beinhaltet auch einen Konsum wie Rauschtrinken bzw. ein erhöhter täglicher Alkoholkonsum, aus dem sich Gesundheitsrisiken ableiten (5, 8). Gemäß nationaler Empfehlungen der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (5, 8), die denen der „British Medical Association“ von 1995 entsprechen, beginnt ein riskanter Alkoholkonsum bei Männern bereits ab einer Trinkmenge von mehr als 30 g (z.B. ca. 0,75 Liter Bier) pro Tag und bei Frauen von mehr als 20 g (z.B. ca. 0,5 Liter Bier) pro Tag. Viele Patienten mit einem riskanten Alkoholkonsum verringern ihre Alkoholtrinkmenge nach einer Kurzintervention (1, 3–6, 8, 10, 11). Eine Kurzintervention bedeutet in diesem Zusammenhang ein nichtkonfrontatives Gespräch von 15 bis 40 Minuten Länge, das vornehmlich die Ambivalenz bezüglich des Alkoholkonsums evaluiert und akzeptiert. Ziel ist es, eine Änderung des gefährdenden Verhaltens herbeizuführen. Dabei wird versucht, die Motivation und die dem Patienten eigenen (autonomen) Möglichkeiten als wesentliches Element zu berücksichtigen bzw. die Motivation zur Veränderung aufzubauen. Durch eine solche Kurzintervention lassen sich erhöhte Risiken im Zusammenhang mit dem Alkoholkonsum – z.B. das Auftreten eines erneuten Unfalls, Gewalt, körperliche Erkrankungen, Krankenhausaufenthalte etc. – senken (1, 4, 6, 10, 11, 14). Eine erhebliche Anzahl von Patienten mit riskantem Alkoholkonsum wird in Rettungsstellen nach einem Unfall gesehen. Die Patienten sind zumeist jung sowie physisch, psychisch und sozial noch nicht beeinträchtigt. Sie haben wegen des alkoholbedingten erhöhten Verletzungsrisikos oftmals den ersten Kontakt mit dem Hilfesystem in Rettungsstellen oder Unfallstationen (3, 5, 6, 8, 10, 11, 14). Von sich aus wenden diese Patienten sich nur selten an suchtmittelspezifische Hilfeeinrichtungen. Nach einem Unfall ist bei diesen Patienten die Motivation jedoch erhöht, über eine Veränderung ihres gefährdenden Verhaltens nachzudenken. Allerdings sind Rettungsstellen gegenwärtig noch nicht hinreichend in der Lage, diesem Patientenkreis ein adäquates Beratungsangebot zu vermitteln (3, 6, 10). Die knapp bemessene Zeit in der Notfallversorgung und eine nicht ausreichende Ausbildung in suchtmedizinischer Gesprächsführung (z.B. „Motivational Interviewing“) werden dafür verantwortlich gemacht. Viele Patienten mit weniger schweren Rettungsstellenkontakte stellen eine gute Gelegenheit dar, bei verunfallten Patienten mit riskantem Alkoholkonsum verhaltensmodifizierende Interventionen durchzuführen. In dieser kontrolliert randomisierten Untersuchung an traumatisierten Patienten einer Rettungsstelle konnte gezeigt werden, dass es möglich ist, mittels gezielter Information und Feedback, beruhend auf einem computerisiert erfragten Risikoprofil, den Anteil von Patienten mit einem Risiko in Bezug auf den Alkoholkonsum signifikant zu senken: Von den Patienten (n = 1136) mit einem AUDIT-Punktwert von ≥ 5 (Screenpositiv) gaben initial 48% einen riskanten Alkoholkonsum nach den Kriterien der „British Medical Association“ (Männer mehr als 30g/d, Frauen > 20 g/d reiner Alkohol) an. In der 6-Monatskatamnese (n = 716) hatten signifikant weniger Patienten nach einer Intervention (21,7%) als Kontrollpatienten ohne Intervention (30,4%, p = 0,009) einen riskanten Alkoholkonsum nach den BMA-Kriterien. Dieser Effekt war nach 12 Monaten allerdings nur tendenziell nachweisbar.