Alcohol screening questionnaires in women: a critical review.

OBJECTIVE: To describe the performance of alcohol screening questionnaires in female patients. DATA SOURCES: We searched MEDLINE from 1966 to July 1997 for alcoholism or alcohol-drinking and for CAGE, AUDIT, BMAST, TWEAK, T-ACE, MAST, SMAST, or SAAST; Citations Indexes for newer screening questionnaires and those without acronyms; and MEDLINE from 1996 to July 1997 for alcoholism or alcohol-drinking and screening. STUDY SELECTION AND DATA EXTRACTION: Reviewed studies presented data for women comparing brief alcohol screening questionnaires with valid criterion standards for heavy drinking (> or =2 drinks per day) or alcohol abuse or dependence in US general clinical populations. Sensitivities, specificities, and areas under receiver operating characteristic curves (AUROCs) were extracted. DATA SYNTHESIS: Thirteen articles (9 studies) were reviewed. The CAGE questionnaire had AUROCs of 0.84 to 0.92 for alcohol abuse and dependence in predominantly black populations of women, but using the traditional cut point of 2 or more resulted in low sensitivities (38%-50%) in predominantly white female populations. The TWEAK and Alcohol Use Disorders Identification Test (AUDIT) questionnaires had high AUROCs (0.87-0.93) for past-year alcohol abuse or dependence in black or white women, but had sensitivities less than 80% at traditional cut points. For detecting heavy drinking, the AUDIT questionnaire had AUROCs of at least 0.87 in female primary care patients. The TWEAK and T-ACE questionnaires had higher AUROCs (0.84-0.87) than the CAGE questionnaire (0.76-0.78) for detecting heavy drinking before pregnancy was recognized in black obstetric patients. CONCLUSIONS: The CAGE questionnaire was relatively insensitive in predominantly white female populations. The TWEAK and AUDIT questionnaires have performed adequately in black or white women, using lower cut points than usual.

How well can physicians estimate mortality in a medical intensive care unit?

The accuracies of physicians' predictions of mortality for 523 patients in a medical intensive care unit were compared with estimates derived from a logistic model. The model utilized a popular severity-of-illness measure, the APACHE II. Accuracy was assessed through its components resolution (discrimination) and calibration. Physicians could better discriminate survivors from nonsurvivors, as measured by the area under the receiver operating characteristic curve (0.89 for physicians vs 0.83 for APACHE II model, p less than 0.001) and by resolution (0.103 for physicians vs 0.130 for APACHE II model, p less than 0.001). Overall, the APACHE II model was better calibrated (0.003 for APACHE II vs 0.021 for physicians, p less than 0.001). While the APACHE II model was better calibrated in the central probability ranges, physicians could more accurately identify those most likely to die. Decisions on withholding or withdrawing treatment are being made daily in intensive care units based on physicians' subjective prognostic estimates. At least for experienced physicians at a major medical center, these estimates are comparable in accuracy to quantitative models.

Postgraduate pharmacy fellowships (1987-88).

During August and September 1987, the Brigham and Women's Hospital Pharmacy Services Department conducted its seventh annual nationwide survey of postgraduate pharmacy fellowships. There are 185 fellowships offered with 150 fellows at 53 sites.

The impact of age on utilization of intensive care resources.

The impact of age on admission practices and pattern of care were examined in 599 admissions to a medical intensive care unit (MICU) and 290 patients on the conventional medical care divisions of the same hospital. Four age groups were compared: under 55, 55 to 64, 65 to 74, and 75 years of age and over. Severity of illness and prior health were assessed using the Acute Physiology Score (APS) and the Chronic Health Evaluation (CHE) instruments. Resource utilization was assessed using the Therapeutic Intervention Scoring System (TISS) and hospital charges. Patients 65 years of age and over comprised 48% of the MICU sample. The distribution of CHE was different among the four groups. Twenty-one percent of patients under 55 years of age had no prior chronic illness, as compared to less than 8% of older patients. The APS at admission was similar for all age groups, as was admission, daily, and total TISS. Hospital survival declined with age from 85% to 70%, while the likelihood of being designated do not resuscitate (DNR) increased from 10% to 24%. Differences in hospital survival disappeared when controlling for severity of illness and prior health, but differences in DNR status did not. Still, elderly DNR patients received as much resources as younger DNR patients and this was more than non-DNR patients. The sample of patients treated on conventional medical divisions had age distribution similar to the MICU sample. There was some evidence that admission APS (median, 5, 5, 6, 6, respectively, P = .055) and maximum APS (median, 5, 5, 7, 8, respectively, P = .023) differed slightly across age groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Postgraduate pharmacy fellowships (1986-87)

During September and October 1986, the Brigham and Women's Hospital Pharmacy Services Department conducted its sixth annual nationwide survey of postgraduate pharmacy fellowships. There are 170 fellowships offered with 146 fellows at 44 sites.

A new method for reporting the sources of abnormal activities of lactate dehydrogenase in serum.

We have developed and tested a new method to increase the diagnostic usefulness of measurements of lactate dehydrogenase (LDH; EC 1.1.1.27) isoenzymes. The method estimates the separate contributions from enzymatically distinct organ clusters (e.g., heart/kidney/erythrocyte, liver/muscle, lung) to the total activity of LDH in serum. To test this method, we monitored serum LDH isoenzymes over the entire hospital course of 73 patients admitted to the intensive-care unit with chest pain, myocardial infarction, or serious hemodynamic disturbances. The organ-specific estimates provided useful information beyond measurements of the original isoenzymes. The sensitivity and specificity of this new method in detecting acute myocardial infarction, as well as concomitant disorders involving the liver or lung, are significantly greater than those of other diagnostic indices or pathologists' judgments. Serial plots of the organ-specific estimates may provide additional insight into evolving pathophysiological processes.

Postgraduate pharmacy fellowships (1985-86).

During August and September 1985, the Brigham & Women's Hospital Pharmacy Services Department conducted its fifth annual nationwide survey of postgraduate pharmacy fellowships. There are 115 fellowships offered with 89 fellows at 33 sites.

Postgraduate pharmacy fellowships (1984-85).

During July and August 1984, the Pharmacy Services Department of the Brigham and Women's Hospital conducted its fourth annual national mail questionnaire survey of postgraduate pharmacy fellowships. It was found that 91 fellowships are offered at 36 fellowship sites. Information regarding type of specialty fellowship, fellowship characteristics, fellowship location and contact person, and qualifications of applicants is presented.

Aggravation by propranolol of hyperglycaemic effect of hydrochlorothiazide in type II diabetics without alteration of insulin secretion.

14 hypertensive men with type II diabetes sequentially received, in random order, hydrochlorothiazide 50 mg twice a day, propranolol 80 mg twice a day, and both drugs in combination. The 3-week treatment periods were separated by a 1-week washout period. Hydrochlorothiazide significantly increased fasting glucose by 31% (p less than 0.05) and glycosylated haemoglobin (HbA1c) by 6.0% (p less than 0.10). A similar treatment period of propranolol 80 mg twice a day caused no significant increases. However, when both drugs were taken in combination, fasting glucose rose by 56% and HbA1c by 14.7% (p less than 0.01). The hyperglycaemic effect of hydrochlorothiazide and its potentiation by propranolol were independent of serum potassium and of endogenous insulin secretion as measured by urine C-peptide excretion. The combination of hydrochlorothiazide and propranolol thus seems to cause serious disturbances in glycaemic control in type II diabetics by mechanisms independent of insulin secretion.

Positions held by graduates of postgraduate pharmacy fellowship programs.

The Brigham and Women's Hospital Pharmacy Department conducted a survey to determine how recently trained (since 1981) postgraduate pharmacy fellows have been employed. We received responses to mailed survey questionnaires from 40 of 42 institutions or colleges offering a pharmacy fellowship. Survey results showed 117 pharmacists completed fellowships from 1981 through July 1984. Fifty percent (58/117) of all graduates are members of college of pharmacy faculty, 20 percent (24/117) are pharmacy staff specialists, and 12 percent (14/117) have pharmaceutical industry positions. The survey shows that the majority of fellowships completed are in pharmacokinetics, with clinical pharmacology and infectious disease a distant second and third, respectively. Postgraduate pharmacy fellowships are important to prepare pharmacists for faculty positions in clinical or pharmacy practice departments of colleges of pharmacy.

Postgraduate pharmacy fellowships (1983-1984).

During June and July 1983, the Pharmacy Services Department of the Brigham and Women's Hospital conducted its third annual national survey by mail questionnaire regarding postgraduate pharmacy fellowships. There was a total response of 76 percent to the questionnaire. Eighty-three fellowships are offered at 31 fellowship sites. Information regarding type of specialty fellowship, fellowship characteristics, fellowship location and contact person, and qualifications of applicants is reported.

Once-daily vs. continuous aminoglycoside dosing: efficacy and toxicity in animal and clinical studies of gentamicin, netilmicin, and tobramycin.

The dosing frequency of aminoglycoside antibiotics may alter efficacy and toxicity independent of total daily dose. Once-daily tobramycin dosing was compared with continuous infusion in three models of efficacy. Acute pneumonia due to Pseudomonas aeruginosa in guinea pigs responded better to once-daily dosing, and chronic pneumonia in rats and endocarditis in rabbits responded equally to both regimens. Dogs given gentamicin, tobramycin, or netilmicin once daily, with maximum serum concentrations of greater than 100 mg/liter, had less nephrotoxicity than dogs given continuous infusions. Tobramycin was given once daily or continuously to 52 patients with cystic fibrosis who in 10 days had no change in creatinine clearance or hearing despite maximum serum tobramycin concentrations of 40 mg/liter. Intermittent dosing of aminoglycosides, causing infrequent large maximum serum concentrations, may be less toxic and equally efficacious as frequent dosing.

Postgraduate pharmacy fellowships (1982-1983).

During June and July 1982, the Pharmacy Services Department of the Brigham and Women's Hospital conducted its second annual national survey by mail questionnaire regarding postgraduate pharmacy fellowships. There was a total response of 80 percent to the questionnaire. Sixty-three fellowships are offered at 25 fellowship sites. Information regarding type of specialty fellowship, fellowship characteristics, fellowship location and contact person, and qualifications of applicants is reported.