Alcohol screening in North Denmark Region hospitals:Frequency of screening and experiences of health professionals

Background: Alcohol consumption is a risk factor for disease, disability and death. Approximately 20% of all hospital admissions are alcohol related. In Denmark, hospitalised patients undergo systematic health risk screenings to establish preventive initiatives if the screening detects a risk. The frequency and usability of alcohol screening and health professionals’ experiences of the screening is unknown. Aim: To examine the frequency and usability of alcohol screening at North Denmark Region hospitals, as well as health professionals’ experiences of screening for alcohol. Methods: This study consisted of an initial audit of 120 patient records from medical and surgical units at four hospitals assessing information on alcohol screening. This was followed by six focus-group interviews with health professionals ( n = 20) regarding their experiences of conducting alcohol screening. Results: Among overall health screenings, screening for alcohol and tobacco smoking was performed most frequently (81.8% and 85%). Alcohol screening scored the lowest percentage for usability (67.7%). Hospital-based alcohol screening was perceived ambiguously leading to a schism between standardised alcohol screening and the individual needs of the patient. Health professionals described different patient types, each with their perceived needs, and screening was associated with taboo and reluctance to engage in alcohol screening of some patient groups. Conclusion: This study revealed factors that influence health professionals working with hospital-based alcohol screening. The variation in and complexity of alcohol screening suggests that screening practice is an ambiguous task that needs continuous reflection and development to ensure that health professionals are prepared for the task. </jats:sec

Association of lithium use with rate of out-of-hospital cardiac arrest in patients with bipolar disorder

Background: Lithium has been linked with induction of proarrythmic electrocardiographical changes. However, it is unclear whether lithium use is associated with an increased rate of cardiac arrest. We investigated the rate of out-of-hospital cardiac arrest associated with lithium exposure in a nationwide cohort of patients with bipolar disorder. Methods: Data from Danish registries was used to conduct a nationwide nested case-control study assessing the rate of out-of-hospital cardiac arrest associated with lithium exposure among 47,745 bipolar disorder patients from 2001 through 2015. 284 cases with out-of-hospital cardiac arrest were matched on age, sex, and age at first diagnosis of bipolar disorder with 1,386 controls. Rate analyses were performed using Cox regression. Results: Fewer cases than controls were exposed to lithium (24.3% vs. 34.9%, p&lt;.001). In adjusted analyses, lithium monotherapy was not significantly associated with increased rate of out-of-hospital cardiac arrest compared with no mood stabilizing treatment (Hazard ratio [HR] = 0.71 [95% CI, 0.46–1.10]), atypical antipsychotic monotherapy (HR = 0.69 [95% CI, 0.41–1.15]), and anticonvulsant monotherapy (HR = 1.37 [95% confidence interval [CI], 0.65–2.88]). Combination therapy with lithium plus one or more other mood stabilizers was not associated with increased rate of out-of-hospital cardiac arrest compared with combination therapy with two or more non-lithium mood stabilizers (HR = 0.58, [95% CI, 0.31–1.08]). Limitations: Possible residual confounding due to unmeasured variables. Lack of statistical power to detect weak associations. Conclusions: Lithium was not associated with increased rate of out-of-hospital cardiac arrest in bipolar disorder patients compared with other guideline-recommended mood stabilizing pharmacotherapy, nor compared with no mood stabilizer treatment.</p

Out-of-Hospital Cardiac Arrest in Patients With and Without Psychiatric Disorders:Differences in Use of Coronary Angiography, Coronary Revascularization, and Implantable Cardioverter-Defibrillator and Survival

Background Healthcare disparities for psychiatric patients are common. Whether these inequalities apply to postresuscitation management in out‐of‐hospital cardiac arrest (OHCA) is unknown. We investigated differences in in‐hospital cardiovascular procedures following OHCA between patients with and without psychiatric disorders. Methods and Results Using the Danish nationwide registries, we identified patients admitted to the hospital following OHCA of presumed cardiac cause (2001‐2015). Psychiatric disorders were identified using hospital diagnoses or redeemed prescriptions for psychotropic drugs. We calculated age‐ and sex‐standardized incidence rates and incidence rate ratios (IRRs) of cardiovascular procedures during post‐OHCA admission in patients with and without psychiatric disorders. Differences in 30‐day and 1‐year survival were assessed by multivariable logistic regression in the overall population and among 2‐day survivors who received acute coronary angiography (CAG). We included 7288 hospitalized patients who had experienced an OHCA: 1661 (22.8%) had a psychiatric disorder. Compared with patients without psychiatric disorders, patients with psychiatric disorders had lower standardized incidence rates for acute CAG (≤1 day post‐OHCA) (IRR, 0.51; 95% CI, 0.45–0.57), subacute CAG (2–30 days post‐OHCA) (IRR, 0.40; 95% CI, 0.30–0.52), and implantable cardioverter‐defibrillator implantation (IRR, 0.67; 95% CI, 0.48–0.95). Conversely, we did not detect differences in coronary revascularization among patients undergoing CAG (IRR, 1.11; 95% CI, 0.94–1.30). Patients with psychiatric disorders had lower survival even among 2‐day survivors who received acute CAG: (odds ratio of 30‐day survival, 0.68; 95% CI, 0.52–0.91; and 1‐year survival, 0.66; 95% CI, 0.50–0.88). Conclusions Psychiatric patients had a lower probability of receiving post‐OHCA CAG and implantable cardioverter‐defibrillator implantation compared with nonpsychiatric patients but the same probability of coronary revascularization among patients undergoing CAG. However, their survival was lower irrespective of angiographic procedures

Out-of-Hospital Cardiac Arrest in Patients With Psychiatric Disorders - Characteristics and Outcomes

Aims To investigate whether the recent improvements in pre-hospital cardiac arrest-management and survival following out-of-hospital cardiac arrest (OHCA) also apply to OHCA patients with psychiatric disorders. Methods We identified all adult Danish patients with OHCA of presumed cardiac cause, 2001–2015. Psychiatric disorders were defined by hospital diagnoses up to 10 years before OHCA and analyzed as one group as well as divided into five subgroups (schizophrenia-spectrum disorders, bipolar disorder, depression, substance-induced mental disorders, other psychiatric disorders). Association between psychiatric disorders and pre-hospital OHCA-characteristics and 30-day survival were assessed by multiple logistic regression. Results Of 27,523 OHCA-patients, 4772 (17.3%) had a psychiatric diagnosis. Patients with psychiatric disorders had lower odds of 30-day survival (0.37 95% confidence interval 0.32–0.43) compared with other OHCA-patients. Likewise, they had lower odds of witnessed status (0.75 CI 0.70–0.80), bystander cardiopulmonary resuscitation (CPR) (0.77 CI 0.72–0.83), shockable heart rhythm (0.37 95% CI, 0.33–0.40), and return of spontaneous circulation (ROSC) at hospital arrival (0.66 CI 0.59–0.72). Similar results were seen in all five psychiatric subgroups. The difference in 30-day survival between patients with and without psychiatric disorders increased in recent years: from 8.4% (CI 7.0–10.0%) in 2006 to 13.9% (CI 12.4–15.4%) in 2015 and from 7.0% (4.3–10.8%) in 2006 to 7.0% (CI 4.5–9.7%) in 2015, respectively. Conclusion Patients with psychiatric disorders have lower survival following OHCA compared to non-psychiatric patients and the gap between the two groups has widened over time

When Does the Family Govern the Family Firm?

We find that the controlling family holds both the chief executive officer and chair positions in 79% of Norwegian family firms. The family holds more governance positions when it owns large stakes in small, profitable, low-risk firms. This result suggests that the family trades off expected costs and benefits by conditioning participation intensity on observable firm characteristics. We find that the positive effect of performance on participation is twice as strong as the positive effect of participation on performance. The endogeneity of participation, therefore, should be carefully accounted for when analyzing the effect of family governance on the family firm’s behavior