Alcohol use disorder (AUD) screening is important but focused training with using AUDIT‐10 with counselling/mental health (MH) referral may be needed. We aimed to compare the effect of training on AUD screening/intervention in hepatology clinics in pre vs post‐training phases of a quality‐improvement initiative. Pre‐training encounters were evaluated for inquiry into AUD, AUDIT‐10 and MH referrals. Dedicated AUD‐related training was provided to hepatology providers and analyses repeated post‐training. Pre‐training (n = 378) and post‐training patients(n = 318) had similar demographics and disease characteristics. Post‐training there was higher inquiry about alcohol(92% vs 80%, P < .0001), counselling (82% vs 68%, P < .0001). This led to higher diagnosis of drinkers (49% vs 31%, P < .0001) of whom higher proportion had AUDIT‐10 administered(91% vs 34%, P < .0001) and referred to MH(29% vs 8%, P < .0001). On regression presumed alcohol‐related aetiology, younger age and post‐training period were associated with AUDIT‐10 administration. AUD‐focused training significantly improves rates of screening and MH referral for problem drinking in a hepatology clinic population.
The number of patients with implantable electronic cardiac devices is continuously increasing. As more pacemakers and implantable cardioverter-defibrillators (ICDs) are being placed, a basic understanding of some troubleshooting for devices is becoming essential. Loss of capture can be an emergent presentation for an unstable patient and can be encountered intermittently in hospitalized patients. There are many causes for a loss of capture, with the timing of the implant having a high correlation with certain causes over others. The most common acute cause just after the insertion procedure is lead dislodgement or malposition. In comparison, an increase in the required threshold promoting a loss of capture can happen after months to years of insertion of the pacemaker or ICD. This change can be due to a cardiomyopathy, fibrosis medications, metabolic imbalance, lead fracture, or an exit block. Loss of capture can also occur from external electrical stimuli and inappropriate pacemaker or ICD settings. Further, there are also potential noncardiac causes, such as medications, electrolyte imbalance, and acidemia. A knowledge of these factors is essential for health care providers, given the morbidity and mortality that can potentially be associated with device-related issues, especially in patients who are dependent on the included pacing function.
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