Screening for hazardous alcohol use and dependence in psychiatric in-patients using the AUDIT questionnaire

The Alcohol Use Disorders Identification Test (AUDIT) has been used to screen for hazardous and harmful alcohol consumption among general hospital populations but not in psychiatric patients. Using the AUDIT, we assessed alcohol use in patients with four major types of psychiatric disorder, namely mood, adjustment, anxiety and psychotic disorders. Nine hundred and ninety consecutive admissions to the psychiatric units of two hospitals during a 12-month period underwent assessment. In each diagnostic group a high proportion of patients was alcohol-dependent. Among those with mood disorders 25.4% of men were alcohol-dependent, compared with 16.3% of women, while 34.5% of men with anxiety disorder were alcohol-dependent compared with 25.0% of women. Both gender differences were statistically significant. The differences were even greater for adjustment disorder (44.4% vs. 14.5%) and psychosis (29.2% and 4.2%, respectively). More men than women with anxiety disorder were classified as hazardous (24.1% vs. 11.7%) or harmful drinkers (13.8% vs. 3.3%), but for the other diagnostic groupings the percentages in these drinking categories were more nearly similar. Thus, there is a high rate of excessive alcohol consumption in people with psychiatric disorders, especially males. Such individuals may be particularly vulnerable to complications of alcohol misuse such as suicide and exacerbation of their disorder. The potential for decreased severity of psychiatric symptoms and a reduction in the number of hospital admissions following cessation or reduction in alcohol consumption is considerable. The AUDIT is a simple screening device for investigating alcohol use and dependence, and offers a means of initiating intervention in this population

Protocol for north of England and Scotland study of tonsillectomy and adeno-tonsillectomy in children (NESSTAC). A pragmatic randomised controlled trial comparing surgical intervention with conventional medical treatment in children with recurrent sore throats

BACKGROUND: Uncertainties surrounding the effectiveness and cost-effectiveness of childhood tonsillectomy for recurrent sore throat led the NHS Health Technology Assessment Programme to commission this research to evaluate the effectiveness and cost-effectiveness of tonsillectomy and adeno-tonsillectomy in comparison with standard non-surgical management in children aged under 16 with recurrent throat infections. The aim is to evaluate if tonsillectomy and adeno-tonsillectomy reduces the number of episodes of sore throats among children to a clinically significant extent. METHODS/DESIGN: A simple prospective pragmatic randomised controlled trial with economic analysis and prospective cohort study of non-trial participants comparing surgical intervention with conventional medical treatment. The treatment arm will receive tonsillectomy and adeno-tonsillectomy while in the control arm non-surgical conventional medical treatment only will be used. The primary outcome measure will be reported number of episodes of sore throat over two years with secondary outcomes measures of reported number of episodes of sore throat, otitis media and upper respiratory tract infection which invoke a GP consultation; reported number of symptom-free days; reported severity of sore throats and surgical and anaesthetic morbidity. The study will take place in five hospitals in the UK. The trial population will be 406 children aged 4–15 on their last birthday with recurrent sore throat referred by primary care to the 5 otolaryngology departments. The duration of the study is seven years (July 2001- July 2008). DISCUSSION: As with all pragmatic randomised controlled trials it is impossible to control the external environment in which the research is taking place. Since this trial began a number of factors have arisen which could affect the outcome including; a reduction in the incidence of respiratory tract infections, marked socio-economic differences in consultation rates, the results from the National Prospective Tonsillectomy Audit and the Government's waiting list initiatives