Prevalence, detection, and treatment of alcoholism in hospitalized patients

Article Abstract:

As part of a program to improve the education of physicians in diagnosing and treating alcohol dependence and abuse, all new inpatients of The Johns Hopkins Hospital were screened for alcoholism. The prevalence of alcoholism by department was as follows: medicine, 25 percent; psychiatry, 30 percent; neurology, 19 percent; obstetrics-gynecology, 12.5 percent;and surgery, 23 percent. Detection rates by house staff and faculty physicians were found to be as low as less than 25 percent in surgery and gynecology and as high as over 50 percent in psychiatry. Physicians were less likely to identify as alcoholic patients those with higher incomes, more education, or private medical insurance. Women and patients who denied heavy alcohol intake were also less likely to be identified as alcoholic. Less than 50 percent of those patients diagnosed as alcoholic in the surgery and obstetrics-gynecology departments were put into treatment programs by their physician, while between 50 and 75 of those in medicine and neurology and 100 percent in psychiatry were placed in treatment programs. Patients were found to be more likely to change their drinking behavior upon specific recommendations from their physician. The results of the study are being incorporated into the medical education curriculum.

Methods, Evaluation, Diagnosis, Surveys, Medical screening, Health screening, Hospital patients, Diagnostic services

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The quality of mercy: caring for patients with 'Do Not Resuscitate' orders

Article Abstract:

Residents who have received extensive training in the ethical implications of Do Not Resuscitate (DNR) orders may provide better care to patients with DNR orders than residents who have not been so trained. DNR orders instruct physicians not to resuscitate hospitalized patients should they suffer a cardiac arrest. However, these patients should still be treated for other conditions that may arise during their hospitalization. At Johns Hopkins Hospital, these treatments are called Concurrent Care Concerns (CCC). Of 88 residents at Johns Hopkins, 22 were given six lectures on ethics (the limited intervention, or LI group) and 21 received more extensive training (the extensive intervention, or EI group). They attended the lectures and also participated in six conferences on DNR ethics, as well as discussing these issues during patient-care rounds. Both groups were compared to the residents who received no training in ethical issues. The medical records of all patients with a DNR order were reviewed before and after the training. After their training, residents in the EI group had listed more CCCs in the patients' charts than they had before training, and more than the other residents had at any time during the study.

Medical care, Quality management, Medical care quality, Study and teaching, Hospitalization, Medical ethics, Critically ill

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Knowledge, attitudes, and reported practices of medical students and house staff regarding the diagnosis and treatment of alcoholism

Article Abstract:

Physicians often fail to provide timely diagnosis and effective treatment for alcoholism because thet have inadequate skills and understanding to do so, and sometimes they have negative attitudes toward the disease. Over a period from 1986 to 1987, the medical students and house staff at Johns Hopkins self-administered a survey about their attitudes, skills, perceived role responsibility, knoweldge and practices regarding cases of alcoholism. Significant correlation was found between students' and staff's perceived role responsibility, confidence in skills amd screening and referral practices. Medical students perceived more of a responsibility for alcoholism screening than did the house staff. Medical students' association between skills and practice also strengthened with increased knowledge. The house staff tended to have more negative attitudes as well as lower confidence levels. The survey indicates that education of medical students and house staff regarding the serious chronic disease that alcoholism is can improve overall quality of care and the outcome of treatment.

Care and treatment, Medical students, Students, Beliefs, opinions and attitudes, Alcoholism treatment, Residents (Medicine), Interns (Medicine), Medical interns, Medical education, Johns Hopkins University. School of Medicine

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