Com-BI-ne: preliminary results of a feasibility trial of brief intervention to improve alcohol consumption and comorbid outcomes in hypertensive or depressed primary care patients

Health outcomes are key to patients and clinicians, but trials of alcohol brief intervention (BI) tend to focus on behavioral outcomes, while those finding positive effects on physical- or mental-health outcomes generally lack power to show robust effects. To test the feasibility of a randomized controlled trial of BI for either hypertensive or depressed primary-care patients who drink alcohol above recommended levels, records at 25 English primary-care practices were searched for adult patients with risky drinking and comorbid hypertension or depression. Eligible patients were randomized to either a hypertension or depression arm, then to a control or intervention condition. They were screened for at-risk drinking using the Alcohol Use Disorders Identification Test (AUDIT). Consenting respondents scoring >7 on the AUDIT completed the Patient Health Questionnaire-9 (PHQ-9) (depression arm) or blood pressure measurement (hypertension arm) and received either BI or standard advice. At six-month follow-up, participants are again screened for alcohol use and comorbid condition. Seventeen practices (median adult patients, 7181; quartile 1, 5195, quartile 3, 8050) searched their databases. Fourteen percent of adult patients (median; quartile 1, 8.4%, quartile 3, 16.5%) drank above guidelines. Twenty percent of adult patients (median; quartile 1, 18.5%, quartile 3, 23.2%) were hypertensive, of which 5% (median; quartile 1, 3.9%, quartile 3, 5.3%) also drank heavily. Fourteen percent of adult patients had mild to moderate depression (median; quartile 1, 8.9%, quartile 3, 16.9%), of which 2% (median; quartile 1, 1.9%, quartile 3, 2.9%) also drank heavily. Of 2590 eligible patients, 633 (24%) completed the AUDIT. Thirty-five percent scored positively on the AUDIT in the hypertension arm, and 50% scored positively in the depression arm. Eighty patients were recruited to the hypertension arm, and recruitment to the depression arm is ongoing. Patients eligible for an RCT of BI for comorbid heavy drinking and hypertension or mild/moderate depression are identifiable in primary care records, though with variation among practices. Almost a quarter of these patients can be screened by mail for current alcohol use; more screen positively in the depression arm than in the hypertension arm. A trial in the hypertension arm seems most feasible

Intervention to reduce excessive alcohol consumption and improve comorbidity outcomes in hypertensive or depressed primary care patients: two parallel cluster randomized feasibility trials

Wilson, G. B. Wray, C. McGovern, R. Newbury-Birch, D. McColl, E. Crosland, A. Background Many primary care patients with raised blood pressure or depression drink potentially hazardous levels of alcohol. Brief interventions (BI) to reduce alcohol consumption may improve comorbid conditions and reduce the risk of future alcohol problems. However,research has not established their effectiveness in this patient population. This study aimed to establish the feasibility of definitive trials of BI to reduce excessive drinking in primary care patients with hypertension or mild to moderate depression. Methods Thirteen general practices in North East England were randomized to the intervention or control arm of one of two parallel pilot trials. Adult patients drinking excessively and diagnosed with hypertension or mild-to-moderate depression received the Alcohol Use Disorders Identification Test (AUDIT) by postal survey. Consenting respondents scoring more than 7 on AUDIT (score range 0 to 40) received brief alcohol consumption advice plus an information leaflet (intervention) or an information leaflet alone(control) with follow-up at six months. Measurements included the numbers of patients eligible, recruited, and retained, and the AUDIT score and systolic/diastolic blood pressure of each patient or the nine-item Patient Health Questionnaire (PHQ-9) score. Acceptability was assessed via practitioner feedback and patient willingness to be screened, recruited, and retained at follow-up. Results In the hypertension trial, 1709 of 33,813 adult patients(5.1%) were eligible and were surveyed. Among the eligible patients, 468 (27.4%) returned questionnaires; 166 (9.6% of those surveyed) screened positively on AUDIT and 83 (4.8% of those surveyed) were recruited (50.0% of positive screens). Sixty-seven cases (80.7% of recruited patients)completed follow-up at six months. In the depression trial, 1,044 of 73,146 adult patients(1.4%)were eligible and surveyed. Among these eligible patients, 215(20.6%)responded;104(10.0% of those surveyed)screened positively on AUDIT and 29 (2.8% of those surveyed) were recruited (27.9% of positive screens). Nineteen cases(65.5% of recruited patients)completed follow-up at six months. Conclusions Recruitment and retention rates were higher in the hypertension trial than in the depression trial. A full brief intervention trial appears feasible for primary care patients with hypertension who drink excessively. High AUDIT scores in the depression trial suggest the importance of alcohol intervention in this group. However, future work may require alternative screening and measurement procedures

Methods of electroencephalographic signal analysis for detection of small hidden changes

The aim of this study was to select and evaluate methods sensitive to reveal small hidden changes in the electroencephalographic (EEG) signal. Two original methods were considered

Urea Rebound Assessment Based on UV Absorbance in Spent Dialysate

The aim of the study was to examine the possibility of post-dialysis urea rebound assessment using UV-absorbance measurements in spent dialysate. Twenty-six patients on chronic three-times-a-week hemodialysis (HD) were studied in two separate studies. Double-beam spectrophotometer was used for the determination of UV absorbance in the collected spent dialysate samples. Also, on-line UV absorbance was monitored. The equilibrium concentration (C-eq) of urea at the end of the rebound phase was calculated based on urea concentration in blood and dialysate and UV absorbance in spent dialysate. Based on C-eq, urea rebound was expressed relative to urea concentration at the end of HD (R-1) and relative to the decrease in urea concentration during HD (R-2). Estimates based on UV-absorbance values in spent dialysate (R-1_a, R-2_a) slightly over assess postdialysis rebound compared with results based on the blood sample drawn 30 min after HD (R-1_30post, R-2_30post), but R-1_a and R-2_a presented greater consistency and accuracy compared with the estimates based on the intradialytic blood sample (R-1_b, R-2_b). In summary, the results show that it is possible to assess postdialysis urea rebound in blood based on UV-absorbance measurements in spent dialysate.</p