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Nearly all patients included in this study had one or more health risk factors that could aggravate clinical outcomes. There is a significant need, and potential, for health-promoting interventions. Multi-factorial interventions may be frequently indicated and should be the subject of interventional studies.

BackgroundIn the everyday surgical life, staff may experience that patients with Alcohol Use Disorders (AUDs) seem reluctant to participate in alcohol intervention programs. The objective was therefore to assess acceptance of screening and intervention as well as adherence to the intervention program among emergency department (ED) and surgical patients with AUDs.MethodsA systematic literature search was followed by extraction of acceptance and adherence rates in ED and surgical patients. Numbers needed to screen (NNS) were calculated. Subgroup analyses were carried out based on different study characteristics.ResultsThe literature search revealed 33 relevant studies. Of these, 31 were randomized trials, 28 were conducted in EDs and 31 evaluated the effect of brief alcohol intervention. Follow-up was mainly conducted after six and/or twelve months.Four in five ED patients accepted alcohol screening and two in three accepted participation in intervention. In surgical patients, two in three accepted screening and the intervention acceptance rate was almost 100%. The adherence rate was above 60% for up to twelve months in both ED and surgical patients. The NNS to identify one eligible AUD patient and to get one eligible patient to accept participation in alcohol intervention varied from a few up to 70 patients.The rates did not differ between randomized and non-randomized trials, brief and intensive interventions or validated and self-reported alcohol consumption. Adherence rates were not affected by patients' group allocation and type of follow-up.ConclusionsMost emergency and surgical patients with AUD accept participation in alcohol screening and interventions and complete the intervention program.

BackgroundPatients with hazardous alcohol intake are overrepresented in emergency departments and surgical wards. These patients have an increased risk of postoperative complications with prolonged hospital stays and admissions to intensive care unit after surgery. In elective surgery, preoperative alcohol cessation interventions can reduce postoperative complications, but no studies have investigated the effect of alcohol cessation intervention at the time of acute fracture surgery. This protocol describes a randomised clinical trial that aims to evaluate the effect of a new gold standard programme for alcohol cessation intervention in the perioperative period regarding postoperative complications, alcohol intake and cost-effectiveness.Methods/DesignPatients with hazardous alcohol intake undergoing ankle fracture surgery will be recruited into the trial from multiple orthopaedic wards at university hospitals in Denmark, Sweden and Norway. Included patients will be randomly allocated to either standard care or the gold standard programme aimed at complete alcohol abstinence before, during and 6 weeks after surgery. It includes a structured patient education programme and weekly interventions meetings at the orthopaedic outpatient clinic. Furthermore, patients are provided with thiamine and B-vitamins, alcohol withdrawal prophylaxis and treatment, and disulfiram to support abstinence. Alcohol intake is biochemically validated (blood, urine and breath tests) at the weekly intervention meetings and follow-up visits. Follow-up assessments will be conducted 6 weeks and 3, 6, 9 and 12 months after surgery for all patients. The effect of the gold standard programme will be assessed comparing the outcome measures between the intervention and control group at each follow-up point.DiscussionThe study will provide new knowledge about how to prevent alcohol-related postoperative complications at the time of acute fracture surgery. If effective, the results will be a benefit for the clinical course, patients and society alike.Trial registrationThe protocol is registered in ClinicalTrials.gov (Id: NCT00986791).

Hospital admittances provide important opportunities for change, but hospital care is seen as fragmented and poorly communicated to the GPs. For shared responsibility and follow up, all participating agents, including the patient, must be sufficiently informed about what has happened and what will follow. For the patient, hospital admittance is usually brief, while the relationship with their GP is long term, even lifelong. GPs are therefore key partners for programme development.

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Background: High alcohol intake has been associated with increased risk of hospital admission, increased complication rates, and prolonged hospital stay. Thus, hospital admission may present a relevant opportunity for alcohol intervention. To understand the potential of alcohol interventions we need knowledge about patients' drinking patterns. The aim of this study was therefore to determine the drinking patterns in a Norwegian hospital population. Methods: A multicentre cross-sectional survey was carried out at three university hospitals. Patients were asked about alcohol intake one month prior to admission/outpatient treatment. The questionnaire included weekly alcohol intake calculated by frequency X quantity as well as episodes of binge drinking (drinking more than 5 AU during a single day). AUDIT-C was used to determine the frequency of patients having a hazardous drinking pattern during the 12 months prior to hospital treatment. Results: In total we assessed 2,932 patients for eligibility. A total of 2,350 patients fulfilled the inclusion criteria. We included 1,522 patients (65%) in the analyses. Six percent of the women and 11% of the men reported drinking more than the weekly limits of nine alcohol units (AU) for women and 14 AU for men. Fourteen percent of the women and 29% of the men reported binge drinking during the last month. The frequency of women scoring more or equal to 4 points on AUDIT-C was 20%. The frequency of men scoring more or equal to 5 points was 25%. Conclusion: Hazardous drinking among Norwegian hospital patients may be more prevalent than what has been reported for the Norwegian population in general. Binge drinking is the dominant drinking pattern.

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