Measurement of the major ignored burden of multiple myeloma, pernicious anaemia and of other haematological conditions on partners and family members: A cross-sectional study.

BACKGROUND: Having a haematological condition can adversely affect the quality of life (QoL) of family members/partners of patients. It is important to measure this often ignored burden in order to implement appropriate supportive interventions. OBJECTIVE: To measure current impact of haematological conditions on the QoL of family members/partners of patients, using the Family Reported Outcome Measure-16 (FROM-16). METHODS: A cross-sectional study, recruited online through patient support groups, involved UK family members/partners of people with haematological conditions completing the FROM-16. RESULTS: 183 family members/partners (mean age = 60.5 years, SD = 13.2; females = 62.8%) of patients (mean age = 64.1, SD = 12.8; females = 46.4%) with 12 haematological conditions completed the FROM-16. The FROM-16 mean total score was 14.0 (SD = 7.2), meaning 'a moderate effect on QoL'. The mean FROM-16 scores of family members of people with multiple myeloma (mean = 15.8, SD = 6.3, n = 99) and other haematological malignancies (mean = 13.9, SD = 7.8, n = 29) were higher than of people with pernicious anaemia (mean = 10.7, SD = 7.5, n = 47) and other non-malignant conditions (mean = 11, SD = 7.4, n = 56, p < .01). Over one third (36.1%, n = 183) of family members experienced a 'very large effect' (FROM-16 score>16) on their quality of life. CONCLUSIONS: Haematological conditions, in particular those of malignant type, impact the QoL of family members/partners of patients. Healthcare professionals can now, using FROM-16, identify those most affected and should consider how to provide appropriate holistic support within routine practice.

Mapping of Family Reported Outcome Measure (FROM-16) scores to EQ-5D: algorithm to calculate utility values.

OBJECTIVE: Although decision scientists and health economists encourage inclusion of family member/informal carer utility in health economic evaluation, there is a lack of suitable utility measures comparable to patient utility measures such those based on the EQ-5D. This study aims to predict EQ-5D-3L utility values from Family Reported Outcome Measure (FROM-16) scores, to allow the use of FROM-16 data in health economic evaluation when EQ-5D data is not available. METHODS: Data from 4228 family members/partners of patients recruited to an online cross-sectional study through 58 UK-based patient support groups, three research support platforms and Welsh social services departments were randomly divided five times into two groups, to derive and test a mapping model. Split-half cross-validation was employed, resulting in a total of ten multinomial logistic regression models. The Monte Carlo simulation procedure was used to generate predicted EQ-5D-3L responses, and utility scores were calculated and compared against observed values. Mean error and mean absolute error were calculated for all ten validation models. The final model algorithm was derived using the entire sample. RESULTS: The model was highly predictive, and its repeated fitting using multinomial logistic regression demonstrated a stable model. The mean differences between predicted and observed health utility estimates ranged from 0.005 to 0.029 across the ten modelling exercises, with an average overall difference of 0.015 (a 2.2% overestimate, not of clinical importance). CONCLUSIONS: The algorithm developed will enable researchers and decision scientists to calculate EQ-5D health utility estimates from FROM-16 scores, thus allowing the inclusion of the family impact of disease in health economic evaluation of medical interventions when EQ-5D data is not available.

Responsiveness and minimal important change of the Family Reported Outcome Measure (FROM-16).

BACKGROUND: The FROM-16 is a generic family quality of life (QoL) instrument that measures the QoL impact of patients' disease on their family members/partners. The study aimed to assess the responsiveness of FROM-16 to change and determine Minimal Important Change (MIC). METHODS: Responsiveness and MIC for FROM-16 were assessed prospectively with patients and their family members recruited from outpatient departments of the University Hospital Wales and University Hospital Llandough, Cardiff, United Kingdom. Patients completed the EQ-5D-3L and a global severity question (GSQ) online at baseline and at 3-month follow-up. Family members completed FROM-16 at baseline and a Global Rating of Change (GRC) in addition to FROM-16 at follow-up. Responsiveness was assessed using the distribution-based (effect size-ES, standardized response mean -SRM) and anchor-based (area under the receiver operating characteristics curve ROC-AUC) approaches and by testing hypotheses on expected correlation strength between FROM-16 change score and patient assessment tools (GSQ and EQ-5D). Cohen's criteria were used for assessing ES. The AUC ≥ 0.7 was considered a good measure of responsiveness. MIC was calculated using anchor-based (ROC analysis and adjusted predictive modelling) and distribution methods based on standard deviation (SD) and standard error of the measurement (SEM). RESULTS: Eighty-three patients with 15 different health conditions and their relatives completed baseline and follow-up questionnaires and were included in the responsiveness analysis. The mean FROM-16 change over 3 months = 1.43 (SD = 4.98). The mean patient EQ-5D change over 3 months = -0.059 (SD = 0.14). The responsiveness analysis showed that the FROM-16 was responsive to change (ES = 0.2, SRM = 0.3; p < 0.01). The ES and SRM of FROM-16 change score ranged from small (ES = 0.2; SRM = 0.3) for the distribution-based method to large (ES = 0.8, SRM = 0.85) for anchor-based methods. The AUC value was above 0.7, indicating good responsiveness. There was a significant positive correlation between the FROM-16 change scores and the patient's disease severity change scores (p < 0.001). The MIC analysis was based on data from 100 family members of 100 patients. The MIC value of 4 was suggested for FROM-16. CONCLUSIONS: The results of this study confirm the longitudinal validity of FROM-16 which refers to the degree to which an instrument is able to measure change in the construct to be measured. The results yield a MIC value of 4 for FROM-16. These psychometric attributes of the FROM-16 instrument are useful in both clinical research as well as clinical practice.

Variation of laparoscopic hernia repair in Scotland: a postcode lottery?

BACKGROUND AND PURPOSE: The laparoscopic approach is now recommended by NICE as the preferred technique for repair of bilateral and recurrent inguinal hernia and an accepted option for unilateral hernia. This study was set up to examine whether patients across Scotland had equal access to this method of treatment. METHODS: Information was collected on laparoscopic hernia repairs in adults at all acute general NHS hospitals in Scotland between the financial years 1997/8 and 2007/8. Private hospitals were excluded due to lack of data. The data were derived from SMR01 data of inpatient and daycase discharges from non-paediatric general acute NHS hospitals in Scotland as collected by the Information Services Division (ISD) of NHS National Services Scotland. FINDINGS: Of 6821 repairs in 2007/8, only 890 (13.0%) were performed laparoscopically, a small increase from 294 (4.5%) in 1997/8. The highest incidence of laparoscopic hernia repair in 2007/8 was in NHS Lothian, where 435 (41.1%) of all repairs were performed using the laparoscopic technique. Excluding NHS Lothian, the number of laparoscopic hernia repairs in the rest of Scotland showed a much smaller rise, from 184 (3.3%) to 455 (7.9%). NHS Lothian, (which has 20% of the Scottish population) performed 54.5% of laparoscopic repairs in Scotland between 1997/8 and 2007/8. In the most recent year available, 2007/8, 63.1% of bilateral primary, 53.7% of bilateral recurrent and 26.8% of unilateral recurrent hernia operations in Lothian were laparoscopic. This compares to only 9.9%, 7.0% and 7.1%, respectively, for other Scottish hospitals. CONCLUSIONS: Despite the fact that laparoscopic hernia repair has several proven advantages over open techniques, particularly in bilateral and recurrent hernias, activity remains at a low level in Scotland with the exception of NHS Lothian. In Scotland, laparoscopic techniques are not being used as recommended by NICE guidelines and there appears to be a "postcode lottery" in the provision of this method of treatment. Possible reasons are discussed and action plans are suggested.

Intraoperative cholangiography in modern surgical practice.

BACKGROUND/AIMS: The aim of this study was to assess the practice of performing intraoperative cholangiography (IOC) during laparoscopic cholecystectomy in a busy teaching hospital. METHODS: Data were obtained from a surgical database for patients who underwent laparoscopic cholecystectomy between January 2000 and December 2003. The findings of IOC and follow-up were analysed. RESULTS: 1,651 patients were included in the study. Of the 745 patients (45.1%) who underwent IOC, this was normal in 586 patients and abnormal in 68 patients. Of these 68 patients, 4 underwent immediate conversion to open common bile duct exploration. 33 patients underwent endoscopic retrograde cholangiopancreatography and 31 patients were observed. During a median follow-up period of 920 days (range 371-1,821), 5 of the 745 patients had retained stones. Two patients re-presented after a failed IOC while 5 of the 906 patients from the non-cholangiogram group returned with stones. Of the 1,651 patients, definite stones were identified in 1.5% patients. CONCLUSION: When the surgeon deemed that IOC was not required, very few subsequent problems were encountered. An observational policy with monitoring of the liver function tests may be appropriate to avoid unnecessary invasive interventions in patients with an abnormal IOC.

Recurrence after inguinal hernia repair at ten years by open darn, open mesh and TEP--no advantage with mesh.

BACKGROUND: Whilst mesh repair is now standard in inguinal hernia surgery, with the expectation of a reduction in recurrence rate, the incidence of recurrent hernias shows little evidence of decline. Long-term follow-up studies after hernia surgery are few. METHODS: 1361 patients underwent 1473 inguinal hernia repairs by open mesh, open sutured or total extraperitoneal (TEP) techniques with more than ten years' follow-up. FINDINGS: Recurrence rates after open mesh and open sutured repair were similar. There has been no benefit in terms of declining recurrence from the increasing use of mesh. There was a high rate of early recurrence after TEP due to learning curve effects. Late recurrence, occurring after two years was uncommon with all techniques, but was lowest after TEP, double the rate after open mesh and four times the rate after sutured repair. This may be due to mesh protecting the area of muscle weakness' with larger meshes conferring a greater long-term benefit. CONCLUSION: Our findings help to explain why there has been no significant fall in the incidence of recurrent inguinal hernias in national data sets and large scale audits, despite a widespread use of mesh.

Changing trends in surgery for acute appendicitis.

BACKGROUND: Laparoscopic appendicectomy (LA) offers faster recovery times and a reduced rate of wound infection compared with open appendicectomy (OA) but may be associated with more intra-abdominal abscesses. This study examines the changing trends in management of appendicitis in a regional setting during service reorganization and compares infective complication rates for each procedure. METHODS: Data were retrieved from the Lothian Surgical Audit database on 1824 patients treated for appendicitis by OA or LA during equal 31-month periods before and after service reorganization in August 2002. Outcome measures were duration of admission, recovery time from operation to discharge and reintervention for infective complications. Analysis was by intention to treat. RESULTS: The rate of LA in Lothian increased from 29.9 to 39.4 per cent (P < 0.001) after subspecialist service reorganization. Recovery time from operation to discharge was significantly shorter after LA than OA when results were stratified with respect to sex (mean 2.5 versus 4.4 days respectively in women, P < 0.001; 2.7 and 3.1 days in men, P = 0.023), timing of surgery (2.7 versus 3.3 days before subspecialization, P = 0.007; 2.5 versus 3.6 days after subspecialization, P < 0.001) and whether appendicitis was associated with peritoneal contamination (2.2 versus 3.0 days for uncontaminated surgery, P < 0.001; 4.3 versus 5.1 days for contaminated surgery, P = 0.060). Peritoneal contamination at primary operation was the only independent risk factor that predicted reintervention for infective complications. CONCLUSION: LA is associated with a shorter hospital stay from operation to discharge than OA, with no evidence of an increased rate of intra-abdominal infective complications.

Comparison of recurrence with lightweight composite polypropylene mesh and heavyweight mesh in laparoscopic totally extraperitoneal inguinal hernia repair: an audit of 1,232 repairs.

BACKGROUND: In Edinburgh a group of surgeons agreed to convert to a lightweight, composite mesh (Ultrapro-Ethicon) for totally extraperitoneal (TEP) inguinal hernia surgery. The aim of this study was to compare the outcome following the use of a new lightweight vs a standard heavyweight mesh during TEP hernia repair. METHODS: Patients undergoing TEP using lightweight (LWM) or heavyweight meshes (HWM) between March 2004 and March 2006 were identified from the Lothian Surgical Audit database. The patients who re-presented with recurrence of hernia were studied in greater detail. Date of re-attendance at a clinic with recurrence was used as a surrogate for date of recurrence. RESULTS: Two hundred and fifty one patients had 371 hernia repairs with LWM. A total of 16 (4.3%) recurred with a median follow-up of 14.5 months. A concurrent group of 326 patients had 425 repairs with standard mesh and have had 12 (2.82%) recurrences with a median follow-up of 22.4 months. A group of patients operated immediately prior to the introduction of LWM consisted of 328 patients who had 436 repairs using HWM, of whom 13 (2.98%) have recurred with a median follow-up of 43 months. Whilst there are no statistically significant differences in recurrence rates between these groups, we are concerned that the LWM group has the highest recurrence rate despite the shortest follow-up. CONCLUSION: In view of increased patient comfort, we continue to recommend LWM for laparoscopic inguinal hernia surgery but would recommend that, in larger hernias and possibly for all, the surgeon should improve mesh adhesion.

Adolescent neurocognitive development and impacts of substance use: Overview of the adolescent brain cognitive development (ABCD) baseline neurocognition battery.

Adolescence is characterized by numerous social, hormonal and physical changes, as well as a marked increase in risk-taking behaviors. Dual systems models attribute adolescent risk-taking to tensions between developing capacities for cognitive control and motivational strivings, which may peak at this time. A comprehensive understanding of neurocognitive development during the adolescent period is necessary to permit the distinction between premorbid vulnerabilities and consequences of behaviors such as substance use. Thus, the prospective assessment of cognitive development is fundamental to the aims of the newly launched Adolescent Brain and Cognitive Development (ABCD) Consortium. This paper details the rationale for ABC'lected measures of neurocognition, presents preliminary descriptive data on an initial sample of 2299 participants, and provides a context for how this large-scale project can inform our understanding of adolescent neurodevelopment.

Routine laparoscopic repair of primary unilateral inguinal hernias--a viable alternative in the day surgery unit?

UNLABELLED: In September 2004 the NICE institute revised its guidelines on the management of primary inguinal hernias to include laparoscopic repair of unilateral hernias. While published trials have confirmed the equal efficacy of the two approaches, it is not clear what impact a switch to laparoscopic repairs would have on resources and patient throughput in a Day Surgery Unit. METHOD: All elective hernia repairs performed in a one-year period were considered. Data were obtained from operation notes, discharge summaries and out-patient records. Operating times are routinely documented in theatre. RESULTS: Of the 351 operations studied, 150 were performed laparoscopically predominantly by an extraperitoneal (TEP)approach. Six required conversion to an open procedure. There was no significant difference in operating times, total theatre time or recovery room times between the two groups (51 min, 75 min and 34 min for the laparoscopic group and 53 min, 74 min and 31 min for the open repair group). Among the laparoscopic repair group there were 48 bilateral hernias and 20 recurrent hernias while 190 of the 201 open repairs were for primary unilateral hernias. Rates of overnight stay and immediate complications were similar between the groups though haematoma was more common following open repair (7 vs 2). CONCLUSIONS: There is no difference in theatre times, immediate complication rates or rates of overnight stay between open and laparoscopic repair of inguinal hernia. Routine laparoscopic repair of primary unilateral inguinal hernia is a viable alternative within the Day Surgery Unit.

Laparoscopic splenectomy is a better treatment for adult ITP than steroids--it should be used earlier in patient management. Conclusions of a ten-year follow-up study.

BACKGROUND: Laparoscopic splenectomy (LS) has rapidly become the preferred surgical treatment for immune thrombocytopaenic purpura (ITP). The aim of this study was to assess the long-term outcome of laparoscopic splenectomy for adult ITP performed in a single unit. METHODS: Between 1992 and 2002, 55 patients underwent LS for ITP refractory to medical therapy. These were performed by one surgeon. Long-term outcome data was obtained by case note review and telephone-based questionnaire. Complete remission was defined as a sustained platelet count of >100 x 10(9)/L without further requirement for medical therapy. RESULTS: Follow-up information was obtained for 40 (73%) out of 55 patients. Overall, 35 (88%) of 40 patients were in complete remission at five-year median follow-up. Five (13%) patients required continued steroid therapy despite LS. Seven (18%) patients reported bleeding problems, in particular bruising. Thirty-five (88%) of 40 patients considered their operation a success. Of these, 16 (46%) patients wished that the operation had been performed earlier in the course of their disease. CONCLUSIONS: This ten-year experience demonstrates that LS is safe, effective, and yields excellent long-term results for adult ITP, equivalent to results after open splenectomy. Patients' views suggest that laparoscopic splenectomy should be considered sooner in the management of adult ITP, reducing the duration and morbidity of medical treatment.

Emergency surgical care in Scotland.

The introduction of waiting list initiatives and targets has resulted in the concentration of resources in politically important medical disciplines. This has inevitably meant that other medical disciplines, many of which involve emergency or unplanned admissions, have diminished resources. We believe that both the scale of this problem and the number of emergency or unplanned admissions to Scottish hospitals are underestimated. An analysis of the surgical mortality in Scotland between April 2004 and March 2005 was undertaken and the prevalence of emergency and unplanned admissions in the different surgical disciplines in different areas of Scotland was calculated. It is apparent that about 40% of all surgical admissions in Scotland are emergency or unplanned admissions with about 70% being in general or orthopaedic surgery. About half of all admissions in neurosurgery, paediatric surgery, general surgery, orthopaedic surgery and cardiothoracic surgery are emergency or unplanned admissions. The numbers of emergency and unplanned admissions are much greater than is appreciated by many surgeons, managers and politicians. Recent changes in working hours, staffing levels and training have proved detrimental to the provision of good care for these patients. This situation is likely to worsen as the population ages and there are more emergency admissions. We believe that increasing centralisation is required in the major surgical disciplines if future problems are to be avoided.

Early results for new lightweight mesh in laparoscopic totally extra-peritoneal inguinal hernia repair.

Prosthetic mesh reinforcement is now routine in the management of inguinal hernia but can cause considerable pain and stiffness around the groin. The aim of this study was to compare the outcome after laparoscopic TEP inguinal repair using new lightweight or traditional heavyweight mesh performed in a single unit. Between November 2004 and March 2005, 113 patients underwent laparoscopic TEP inguinal repair using either lightweight (28 g/m(2)) or heavyweight (85 g/m(2)) mesh. Follow-up data was obtained using case note review and telephone-based questionnaire in April 2005. Follow-up information was obtained for 93 (83%) out of 113 patients. There was no difference between the two groups in the incidence of pain/discomfort at mean 3-month follow-up (45 vs 41%, Mann-Whitney U, P=0.641). However, there was a significant inverse correlation between the length of time since operation and severity of pain/discomfort in the lightweight group (P=0.001, Pearson test), suggesting a faster speed of recovery with lightweight mesh. Laparoscopic TEP inguinal hernia repair with lightweight mesh yields promising early results. Whilst there was no significant difference in pain or recurrence in the short term, post-operative pain scores improved earlier in patients with lightweight mesh compared to heavyweight mesh. This merits further study, with larger cohorts and longer follow-up, to determine the benefits of lightweight mesh.

Recurrence after totally extraperitoneal laparoscopic repair: implications for operative technique and surgical training.

BACKGROUND: The totally extraperitoneal (TEP) approach is increasingly favoured for inguinal hernia repair. The learning curve is slow with high, early recurrence rates but the exact cause of recurrence is unknown. OBJECTIVE: To determine the reasons for recurrence, identify the critical operative steps and examine the influence of surgical experience and training on results. PATIENTS AND METHODS: All patients undergoing TEP between 1993 and 2004 were included. Patients requiring re-operation for recurrence were identified and examined in detail. RESULTS: Eight surgical teams performed 1682 TEP repairs. Fifty five hernias recurred (3.27%) with a median follow-up of seven years (range 1-11 years). In six recurrences, the first repair was itself for recurrence and in 24, the initial repair was bilateral. The initial hernia was direct in 26 and indirect in 29 patients. These distributions were similar to a control sample. At re-operation, indirect recurrence was more common with 18 direct, and 37 indirect cases (P=0.020). At re-operation, when the original mesh could be identified (18 repairs), it appeared to have moved superiorly in 13 cases. Typically, recurrence occurred in 10% of a surgeon's first 20 cases, 4% of the next 60 cases and falling to below 2% thereafter. CONCLUSION: TEP repairs have a tendency for indirect recurrence even after direct repair. Meshes tend to migrate superiorly. Results suggest that recurrence occurs most often because of failure to fully expose the deep inguinal ring and/or to adequately spread the mesh inferiorly and laterally. We recommend particular attention be paid to these technical aspects. Acceptable results are obtainable after an experience of 20 cases but further improvement in results occurs as experience reaches 80 operations. With a large number of consultants having little or no experience in TEP surgery, there is an urgent need for 'hands-on' training courses so that all patients have access to TEP, particularly those with bilateral or recurrent inguinal herniae.

Totally extraperitoneal laparoscopic hernia repair in patients with previous lower abdominal surgery.

INTRODUCTION: Patients with lower abdominal scars are generally excluded from laparoscopic hernia repair due to the perceived technical difficulty and risk of visceral injury. This study examines the outcome of a series of patients who underwent totally extraperitoneal (TEP) inguinal hernia repair despite previous lower abdominal surgery. METHODS: Retrospective review of 47 consecutive patients who underwent TEP inguinal hernia repair in the presence of lower abdominal scars between 1993 and 2002. RESULTS: Thirty-five unilateral and 12 bilateral TEP hernia repairs were performed in the presence of 20 appendicectomy, 10 lower midline, 18 suprapubic and 5 paramedian incisions. Two cases were converted to open repair. There were no major complications and no early or late recurrences. Median operating time was 67.5 min and 83% of patients were managed as day cases. CONCLUSIONS: Totally extraperitoneal laparoscopic hernia repair can be carried out safely in the presence of scars from previous lower abdominal surgery.

Clinical needs assessment of middle and high school students following the 1995 Oklahoma City bombing.

OBJECTIVE: This clinical assessment was designed to identify middle and high school students in need of formal evaluation for posttraumatic response symptoms following the 1995 bombing of the Alfred P. Murrah Federal Building in Oklahoma City. METHOD: A clinical needs assessment instrument was developed and administered to grade 6 through 12 students 7 weeks after the bombing (N = 3,218). RESULTS: More than 40% of the students reported knowing someone injured, and more than one-third reported knowing someone killed in the blast. Posttraumatic stress symptoms at 7 weeks significantly correlated with gender, exposure through knowing someone injured or killed, and bomb-related television viewing. CONCLUSIONS: This study documents the intensity of community exposure to the bombing and the lingering symptoms of stress. The assessment was used in planning for clinical service delivery, training professional responders, and supporting funding requests.

Posttraumatic stress responses in bereaved children after the Oklahoma City bombing.

OBJECTIVE: To investigate the responses of middle and high school students exposed to the 1995 Oklahoma City bombing across a spectrum of loss. METHOD: A questionnaire measuring exposure, personal consequences, initial response, and current posttraumatic stress and other symptoms was administered to 3,218 students 7 weeks after the explosion. RESULTS: More than one third of the sample knew someone killed in the explosion. Bereaved youths were more likely than nonbereaved peers to report immediate symptoms of arousal and fear, changes in their home and school environment, and posttraumatic stress symptoms. Retrospective measures of initial arousal and fear predicted posttraumatic stress symptoms at 7 weeks. CONCLUSIONS: The results support the literature addressing the role of initial response in posttraumatic stress symptom development. The study raises concern about the impact of television, and traumatized youths' reactivity to it, in the aftermath of disaster.

Pretest expectancies and cognitive impairment in alcoholics.

Alcoholics' neurological deficits have been attributed to cognitive impairment associated with brain dysfunction. Because alcoholics perceive themselves as impaired in higher cognitive functions, we investigated the alternative hypothesis that their deficits are predicted by lowered expectancies for successful performance. Ss were 48 male, middle-aged Veterans Administration inpatient alcoholics and 36 community controls. Subjects completed a standard series of neuropsychological tests. Before taking each test, Ss were asked how well they expected to do on that test in relation to members of their community. As predicted, means for the overall measures of expectancies and performance were significantly lower for alcoholics than for control Ss. Although expectancies were significantly correlated with performance, regression analyses indicated they could not account for the obtained performance differences.

Spatial cognition in alcoholics: influence of concurrent abuse of other drugs.

Several tests of visuospatial cognition are known to be sensitive to chronic alcohol abuse, but the consequences of combined abuse of alcohol and other drugs on these measures in not known. To address this issue, groups that had abused only alcohol, alcohol and marijuana, or alcohol and multiple other drugs (Alc/Poly) were compared to community controls. Testing occurred after at least 3 weeks of treatment for the drug abusers. On all measures of visuospatial perception and construction and on all measures of visuospatial learning and memory, all groups of alcoholics were impaired relative to controls, but there were no significant differences among the groups that abused alcohol. By contrast, on all measures of geographical knowledge that required place localization, subjects in the Alc/Poly group were impaired while subjects who abused only alcohol or alcohol and marijuana performed as well as controls. Measures of alcohol consumption, mood or childhood or adult attention deficit were not consistently correlated with test performance.

Neuropsychological performance of recently abstinent alcoholics and cocaine abusers.

To examine possible influences of premorbid and comorbid factors on the neuropsychological test performance of recently abstinent (3-5 weeks) drug abusers, we studied 24 alcoholics, 23 cocaine abusers, and 22 healthy controls of comparable age and education. Both alcoholics and cocaine abusers performed significantly more poorly than controls on most measures of learning and memory, problem solving and abstraction and perceptual-motor speed, but the groups did not differ on the measure of sustained attention. Correlational analyses revealed no significant relationships between measures of childhood and residual hyperactivity and neuropsychological performance; scores on the Beck Depression Inventory were related only to performance on the Wisconsin Card Sorting Test. The findings indicate that abuse of cocaine or alcohol is associated with deficits on neuropsychological tests which cannot be attributed to specific premorbid or comorbid factors such as depression or childhood or residual attention deficit disorder.