Addiction severity index composite scores as predictors for sexual-risk behaviors and drug-use behaviors in drug-using pregnant patients.

BACKGROUND: HIV sexual-risk and drug-use behavior predictors have been studied in non-pregnant but not pregnant drug-dependent populations. OBJECTIVE: Examine the ability of the ASI composite scores to predict HIV sexual- and drug-risk scores as well as the individual items of a modified version of the Risk Assessment Battery in drug-using pregnant women. METHODS: Pregnant women (N = 76) completing pretreatment ASI and HIV-risk questionnaires. RESULTS: The Legal composite score was the sole significant predictor of the sexual-risk score, with a 1 SD increase in the Legal composite score resulting in a 24% increase in sexual-risk, p < .001. The Medical, Drug, and Legal composite scores were each significant predictors of the drug-risk score, with a 1 SD increase resulting in a 31% decrease, and 121% and 73% increases, respectively, in drug-risk, all ps < .05. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: Drug-using pregnant women and their fetuses are vulnerable to the consequences of both sexual-risk behaviors and drug-use. The ASI may help screen such patients for HIV sexual-risk and drug-use behaviors as a first step in tailoring treatment to address these issues.

Substance Use and Psychosocial Functioning in a Sample of Liver Transplant Recipients with Alcohol-Related Liver Disease.

Despite the frequency of liver transplantation in alcoholic recipients, the burden of co-occurring psychosocial comorbidities remains poorly defined. METHODS: A survey study was conducted to examine demographic, substance use, mental health, and social support variables among liver transplant (LT) recipients with alcoholic liver disease (ALD) (LT-ALD: n  = 67). Survey completers (n = 67) were compared to a sample of liver transplant recipients without ALD (LT: n = 134). RESULTS: Survey participants (n  = 67) were predominately male, in their mid-fifties, and were retired or on disability. Alcohol consumption during the 6 months prior to transplant was reported by more than a third of participants. Alcohol consumption post-transplant was reported by 21.2% of respondents, with 4.5% of participants reporting "at-risk" levels of post-transplant alcohol use. Illicit drug use prior to transplant was reported by nearly half of participants (47.8%), and 16.4% reported illicit drug use post-transplant. Approximately half of the sample reported a history of cigarette smoking, and one-third of respondents (29.2%) reported current cigarette smoking. Participants frequently endorsed mental health symptoms consistent with moderate to severe depression (22.4%) and anxiety (17.9%). CONCLUSIONS: Despite relatively low rates of problematic alcohol use post-transplant, there is a significant burden of disability, substance use, and psychiatric symptomatology in this population.

Utilization of prealbumin as a nutritional parameter.

The response of prealbumin was compared to that of albumin and transferrin in 16 patients following 7 days of metabolic/nutritional support. Baseline values were compared to day 7 results to assess the degree of change. Prealbumin demonstrated a significant increase in the mean serum concentration (13.0 vs 19.6 mg/100 ml) in the presence of a positive nitrogen balance. Transferrin exhibited a similar significant response (168.8 vs 223.7 mg/100 ml). Albumin, body weight, and serum iron concentration did not change significantly during the 7-day period. Prealbumin effectively demonstrated an anabolic response in the study sample and could possibly be used as an early indicator of visceral protein anabolism in patients receiving metabolic/nutritional support.

A death with dignity in Oregon.

PURPOSE/OBJECTIVES: To inform readers about the Oregon Death With Dignity Act and present a compilation and summary of major arguments in debates regarding physician assistance in dying for the terminally ill. DATA SOURCES: Experience, medical records, the patient's physician and family, books, periodicals, legislative documents, and publications. DATA SYNTHESIS: The Oregon Death With Dignity Act became a legal option for terminally ill Oregon residents in October 1997. Persuasive psychological, theological, philosophical, and pragmatic arguments protest the Act as being irrational, immoral, contrary to medical ethics, and dangerous. Equally persuasive arguments advocate the Act as rational, moral, consistent with the practice of healing, and safe. CONCLUSIONS: Physician assistance in dying is a legal option for terminally ill patients in the State of Oregon. For such a practice to be "out of the closet," as well as legal, is novel. The debate about the appropriateness of this Act revolves around values and beliefs that are seasoned and cherished. IMPLICATIONS FOR NURSING PRACTICE: As the practice of the terminally ill requesting physician assistance to die moves into the realm of a rational patient choice and legal physician action, nurses increasingly will be faced with having to deal with their own beliefs, attitudes, and emotions regarding this issue. Nurses cannot hide behind glib responses, quick referals, institutional policies, or organizational standards to cover their own discomfort or confusion. They must discuss and formulate an understanding of healing and caring in situations that may challenge their core values.