Alcohol Misuse Screening Performance Improvement Initiative.

BACKGROUND: A trauma registry review of our trauma center's alcohol misuse screening compliance noted inconsistent screening and data collection methods, putting our American College of Surgeons trauma center reverification at risk for a deficiency. OBJECTIVE: The objective of this study was to evaluate an alcohol misuse screening improvement initiative on screening compliance in trauma patients. METHODS: This before and after analysis of a quality improvement initiative to improve alcohol misuse screening was conducted from 2019 to 2021 at a Southwestern U.S. Level II trauma center on admitted trauma patients aged 13 years and older. The multicomponent initiative included a change in the screening instrument and timing of application, implementing electronic medical record documentation screens, and educating staff. The primary outcome measure was screening adherence. RESULTS: A total of n = 4,734 patients were included in the study period. Alcohol misuse screening improved from 2.9% to 87.4% and remained sustained for over a year after the initiative's implementation. CONCLUSION: The performance improvement initiative improved the alcohol misuse screening process, resulting in consistent screenings exceeding the American College of Surgeons standards of 80% for verified trauma centers.

The buffering effect of social support on diabetes distress and depressive symptoms in adults with Type 1 and Type 2 diabetes.

BACKGROUND: Social support may buffer or decrease the negative effects of diabetes distress (DD) and depressive symptoms on diabetes outcomes. We assessed the buffering role of social support in the relationship between DD and self-care and depressive symptoms and self-care in adults with Type 1 (T1D) and Type 2 (T2D) diabetes. METHODS: Participants completed the Diabetes Distress Scale for T2D or T1D, the Patient Health Questionnaire-9, the Medical Outcomes Study Social Support Survey and the Self-Care Inventory-Revised. We conducted hierarchical multiple regression models using SPSS version 26.0. RESULTS: A total of 325 adults (median age = 40.5 years, 62.2% women, 86.5% White; 59.7% T2D, A1C = 59 ± 6 mmol/mol or 7.5 ± 1.6%; median duration = 11.0 years) participated. Greater social support buffered the negative effects of DD on self-care (R2 Δ = 0.015, p = 0.024) as well as depressive symptoms on self-care (R2 Δ = 0.024, p = 0.004) in participants with T1D and T2D. Both regression models recorded medium effect sizes (F2  = 0.220, F2  = 0.234 respectively). Social support subscale analyses showed tangible support (R2 Δ = 0.016, p = 0.018) and affectionate support (R2 Δ = 0.016, p = 0.020) buffered DD and self-care, and emotional support (R2 Δ = 0.015, p = 0.022), tangible support (R2 Δ = 0.020, p = 0.009), affectionate support (R2 Δ = 0.025, p = 0.004) and positive interaction support (R2 Δ = 0.017, p = 0.018) buffered depressive symptoms and self-care. CONCLUSIONS: Findings suggest that social support buffers the impact of DD and depressive symptoms on self-care in adults with T1D and T2D. Additional research is needed to confirm the buffering role of social support on DD and depressive symptoms. Greater understanding of these interactions may help improve clinical care and outcomes.