A Hospital-based Managed Alcohol Program in a Canadian Setting.

OBJECTIVES: A managed alcohol program (MAP) is a harm reduction strategy that provides regularly, witnessed alcohol to individuals with a severe alcohol use disorder. Although community MAPs have positive outcomes, applicability to hospital settings is unknown. This study describes a hospital-based MAP, characterizes its participants, and evaluates outcomes. METHODS: A retrospective chart review of MAP participants was conducted at an academic hospital in Vancouver, Canada, between July 2016 and October 2017. Data included demographics, alcohol/substance use, alcohol withdrawal risk, and MAP indication. Outcomes after MAP initiation included the change in mean daily alcohol consumption and liver enzymes. RESULTS: Seventeen patients participated in 26 hospital admissions: 76% male, mean age of 54 years, daily consumption prehospitalization of a mean 14 alcohol standard drinks, 59% reported previous nonbeverage alcohol consumption, and 41% participated in a community MAP. Most participants were high risk for severe, complicated alcohol withdrawal and presented in moderate withdrawal. Continuation of community MAP was the most common indication for hospital-based MAP initiation (38%), followed by a history of leaving hospital against medical advice (35%) and hospital illicit alcohol use (15%). Hospital-based MAP resulted in a mean of 5 fewer alcohol standard drinks daily compared with preadmission ( P = 0.002; 95% confidence interval, 2-8) and improvement in liver enzymes, with few adverse events. CONCLUSIONS: Participation in a hospital-based MAP may be an effective safe approach to reduce harms for some individuals with severe alcohol use disorder. Further study is needed to understand who benefits most from hospital-MAP and potential benefits/harms following hospital discharge.

Exploring the experience of inpatients with severe alcohol use disorder on a managed alcohol program (MAP) at St. Paul's Hospital.

BACKGROUND: Managed alcohol programs are a harm reduction approach for people with severe alcohol use disorder that provide alcohol in a structured setting. We examined the patient experience of receiving alcohol after the implementation of a hospital-based managed alcohol program. METHODS: Using an interpretative descriptive methodology, we conducted interviews with five patients. The criteria for enrollment included continuation of community managed alcohol program or provision of alcohol for stabilization in hospital and ability to provide consent. RESULTS: Five themes emerged in the analysis: (1) Reasons for alcohol use highlighting factors leading to alcohol consumption; (2) I'm very appreciative indicating participant's perception of hospital-based managed alcohol program; (3) From just vibrating to calm and It's kinda like a pacifier for me recognizing the impact of hospital-based managed alcohol program on managing withdrawal and on psychological health; (4) I have no need to go anywhere at all demonstrating engagement in healthcare; and (5) Might be nice to have a selection for other people indicating the need for a broader selection of alcohol. CONCLUSIONS: This study helped to explore the effectiveness of a hospital-based managed alcohol program as experienced by the patients. Overall, participants had a positive experience on hospital-based managed alcohol program. Their perceptions can be used to inform implementation of managed alcohol programs in other hospital settings.

Exploring perceptions of stroke survivors and caregivers about secondary prevention: a longitudinal qualitative study.

Purpose: To explore the changes in perceived barriers and facilitators associated with participation in secondary prevention activities of stroke survivors and their caregivers over the early stroke recovery period.Method: We conducted two individual interviews (at 2 weeks and 6 months post-discharge) with stroke survivors and their family members. Using purposive sampling, participants were recruited from the stroke units of two acute care hospitals.Results: About 11 male and 8 female stroke survivors and nine caregivers participated in the study. Thematic analysis identified three themes. (1) "A soul searching experience" indicating that the stroke was anxiety provoking leading to a soul searching experience into exploring its causes to adopt a healthy lifestyle; (2) "Old habits die hard" revealing that stroke survivors encountered barriers to adopt healthy lifestyle changes; (3) "Making a fresh start" recognizing that participants were motivated to make their lifestyle healthier and most sustained some lifestyle changes over the past 6 months.Conclusion: Despite experiencing some barriers, stroke survivors adopted lifestyle changes transitioning through different stages of change. Stroke prevention education and interventions from experts would be helpful later in the rehabilitation phase (once at home) and adopting a patient-family centered approach may assist stroke survivors and their caregivers in the uptake of secondary stroke prevention activities.Implications for rehabilitationStroke is perceived as a soul searching experience by stroke survivors and their caregivers motivating them to enquire its causes and adopting lifestyle changes to prevent a future stroke.Despite experiencing some barriers, stroke survivors adopted lifestyle changes transitioning through different stages of change.Stroke prevention education and interventions from experts would be helpful later in the rehabilitation phase (once at home).Adopting a patient-family centered approach may assist stroke survivors and their caregivers in the uptake of secondary stroke prevention activities.

Determinants Influencing the Prestroke Health Behaviors and Cardiovascular Disease Risk of Stroke Patients: A Cross-Sectional Study.

BACKGROUND: Knowledge about stroke and stroke prevention may provide motivation to lead a healthy lifestyle to prevent stroke. The goal of this study is to quantify the knowledge of stroke and stroke prevention of patients with a recent stroke and its association with health behaviors and cardiovascular disease risk. METHODS: We conducted a prospective cross-sectional study utilizing consecutive stroke admissions at 2 hospitals in Vancouver, Canada. We included patients within 48-72 hours of admission. Stroke knowledge was measured prior to any hospital education. The Health-Promoting Lifestyle Profile II (HPLP II), a 52-item self-report scale was used to quantify health behavior for the week prior to the stroke. The cardiovascular risk score was calculated. Hierarchical multiple regression was used to assess the determinants of HPLP II and cardiovascular disease risk. RESULTS: We enrolled patients with primarily mild stroke (n = 100). The mean age of participants was 66.6 ± 13.6 years and 60% were male. The participants had poor knowledge of stroke symptoms and risk factors. In the first regression analysis, the final model explained 27% of the variance in health behavior (F (6, 93) = 5.69, p = <0.001) with only age and knowledge of risk factors as statistically significant variables. In the second regression analysis, the final model explained 15% of the variance in cardiovascular disease risk (F (7, 84) = 2.163, p = 0.046) with only physical activity remaining as a statistically significant variable. CONCLUSION: The findings would inform the development of novel programs to improve the knowledge and health behavior for prevention of stroke.

Effectiveness of interventions involving nurses in secondary stroke prevention: A systematic review and meta-analysis.

BACKGROUND AND PURPOSE: Among members of the health care team, nurses play a large role in actively engaging stroke survivors in secondary stroke prevention programs. This systematic review and meta-analysis examines the effectiveness of interventions in which nurses have a primary role on modification of risk factors among stroke survivors. METHODS: We systematically searched for randomized controlled trials in relevant databases investigating the role of nurses in secondary stroke prevention. Meta-analyses were conducted using Cochrane Review Manager Software. The mean pooled effect size, a 95% confidence interval (CI), and I-squared ( I2) for heterogeneity were calculated. RESULTS: Sixteen randomized controlled trials were included with a total of 3568 stroke and transient ischemic attack patients. After removing one outlier, the models demonstrated a statistically significant effect on reducing systolic blood pressure (SMD = -0.14 (95% CI = -0.23, -0.05), I2 = 0%; p = 0.002, six studies, n =1885) and diastolic blood pressure (SMD = -0.16 (95% CI = -0.27, -0.05), I2 = 0%; p = 0.003, four studies, n =1316). The interventions also significantly improved physical activity (five studies, n=1234), diet (three studies, n=425), medication adherence (two studies, n=270), and knowledge of risk factors (three studies, n=516). However, there was no effect on smoking cessation or reduction in use of alcohol. CONCLUSION: We found that interventions in which nurses had a primary role were effective on improving medical and behavioral risk factors, as well as knowledge of risk factors as part of secondary prevention of stroke.