In the News

Staff awareness of stroke protocols, adverse events from supplements, and more.

Hospital staff shows low awareness of thrombolysis and in-hospital stroke protocols, study finds

Hospital staff's knowledge about treatment and protocols for in-hospital stroke was suboptimal, a recent survey at an Irish hospital found.

The study included 96 hospital staff members: 50% nurses, 18% allied health professionals, 9% doctors, 9% medical and nursing students, 7% support staff, 5% orderlies, and 2% administrators. Clinical staff made up 77% of the sample, and 31% were from stroke-related specialties. They were given a modified version of the Stroke Awareness Questionnaire to assess their knowledge of stroke symptoms, acute treatments, and hospital protocols for stroke treatment. Results appeared in the December 2015 Stroke.

The respondents showed adequate knowledge of stroke symptoms, the study authors found, with 92% naming at least 3 symptoms. Unilateral weakness was the most commonly named sign (93.8%), followed by slurred speech (90.6%) and facial weakness (87.5%). These symptoms are the ones advertised by public education campaigns, the authors noted, “suggesting that concerted efforts to educate the public using mass media may also impact those in healthcare facilities.” However, only 49% of the study population and 71% of those in stroke-related specialties named thrombolysis as an emergency stroke treatment. Similar proportions knew about the treatment window of 4.5 hours: 47.9% of the overall sample and 71% of the stroke-related specialties.

The researchers also investigated staff knowledge of the hospital's protocols for referral and assessment of patients who have a stroke or transient ischemic attack in the hospital. “Only 52% of general staff and 67% of stroke-related specialties indicated they were aware of hospital protocols for the management of [in-hospital stroke], and only 49% of general staff and 57% of stroke-related specialties would contact the on-call stroke team if stroke symptoms were suspected,” they noted.

The lack of knowledge observed in this study may contribute to previously observed shortcomings in treatment of in-hospital stroke, the authors said. The results aren't necessarily generalizable to other hospitals, the researchers acknowledged, but they do show the need for “routine, hospital-wide education and advertisement of code stroke procedures to all hospital staff.”

Adverse events from supplements bring 23,000 patients to ED each year, study finds

Dietary supplements could have caused an estimated 23,005 ED visits and 2,154 hospitalizations annually from 2004 through 2013, according to a recent analysis.

Using data from the 63 U.S. hospitals participating in the National Electronic Injury Surveillance System–Cooperative Adverse Drug Event Surveillance project, researchers analyzed 3,667 cases of ED visits for adverse events associated with dietary supplements. Results were published online on Oct. 15, 2015, by the New England Journal of Medicine.

Supplements included herbal or complementary nutritional products and micronutrients, but excluded products that are considered food or drink, such as energy drinks. Adverse events included adverse reactions, allergic reactions, excess doses, unsupervised ingestion by children, and other events, such as choking. ED visits involving intentional self-harm, drug abuse, therapeutic failures, nonadherence, or withdrawal were excluded, as were cases involving death on the way to the ED or after arrival.

From 2004 to 2005, the estimated number of annual ED visits for supplement-related adverse events was 20,517 (95% CI, 15,187 to 25,847), compared to 26,779 (95% CI, 21,703 to 31,854) from 2012 to 2013. After the researchers accounted for population increases, however, the number of ED visits for these adverse events did not significantly change during this period (P=0.09).

After excluding unsupervised ingestion by children—which accounted for about one-fifth of ED visits—researchers found that 65.9% of visits involved a single herbal or complementary nutritional product, compared to 31.8% involving a single micronutrient product. When unsupervised ingestion by children was discounted, a weight-loss product was implicated in 25.5% of ED visits and an energy product was implicated in 10% of visits.

About 28% of ED visits in the analysis involved patients between the ages of 20 and 34, and among this age group, weight-loss products were implicated in 2,661 (95% CI, 1,995 to 3,326) ED visits per year. Weight-loss or energy products were implicated in 71.8% (95% CI, 67.6% to 76.1%) of ED visits for cardiac symptoms, although about 90% of patients with palpitations, chest pain, or tachycardia were discharged from the ED.

For adults 65 and older, 3 micronutrients (iron, calcium, and potassium) were implicated in about 30% of ED visits, and swallowing problems caused nearly 40% of these visits. Older patients were more likely to be hospitalized than younger patients, with rates of 16% and 8.4%, respectively (P=0.003).

“Although the numbers of emergency department visits and hospitalizations were less than 5% of the numbers that have been reported for pharmaceutical products previously, dietary supplements are regulated and marketed under the presumption of safety,” the study's authors wrote. “These findings can help target interventions to reduce the risk of adverse events associated with the use of dietary supplements.”

They noted several limitations of their analysis, such as how it may underestimate the number of ED visits attributed to supplement-related adverse events because supplement use is underreported by patients, and physicians may not correctly link adverse symptoms to supplements. They also wrote that they did not collect data regarding food and drink products, such as energy drinks, and that the sample of hospitals was relatively small yet nationally representative.

Rates of substance abuse treatment remain low for opioid use disorders

Treatment rates remained low for individuals with opioid use disorders from 2004 to 2013, even as nonmedical use of opioid analgesics and heroin increased substantially during the same span, according to a study.

Researchers used data from the National Survey of Drug Use and Health, a nationally representative annual survey of individuals age 12 years or older, and in-person interviews to identify individuals with opioid abuse or dependence symptoms and to determine whether they received treatment for opioid use disorders in the prior 12 months. The sample was divided into two 5-year periods (2004–2008 and 2009-2013). In 2008, the Mental Health Parity and Addiction Equity Act took effect, requiring group health plans and health insurers to ensure that financial requirements (such as co-pays or deductibles) and treatment limitations (such as visit limits) for mental health or substance use disorders were no more restrictive than those applied to other medical benefits.

The study results appeared in a research letter in the Oct. 13, 2015, Journal of the American Medical Association.

There were 6,770 respondents with opioid use disorders. In an unadjusted analysis, the percentage of individuals with opioid use disorders receiving treatment was 16.6% in 2004-2008 and 21.5% in 2009-2013 (difference, 5.0 percentage points; 95% CI, 1.5 to 8.4 percentage points; P=0.005). Regression-adjusted rates were similar (18.8% in 2004-2008 vs. 19.7% in 2009-2013), and the difference was not statistically significant (0.8 percentage point; 95% CI, −2.3 to 4.0 percentage points; P=0.59).

The mean number of settings visited for treatment (such as a hospital, inpatient or outpatient clinic, ED, doctor's office, or jail) increased from 2.8 in 2004-2008 to 3.3 in 2009–2013 (difference, 0.5; 95% CI, 0.1 to 0.8; P=0.007). The most common setting in both periods was self-help groups, which did not significantly change.

Use of inpatient treatment increased from 37.5% in 2004–2008 to 51.9% in 2009-2013 (difference, 14.4 percentage points; 95% CI, 4.4 to 24.5 percentage points; P=0.005), and office-based treatment increased from 25.1% to 34.8% (difference, 9.7 percentage points; 95% CI, 0.5% to 18.8 percentage points; P=0.04). Adjusted treatment setting differences were consistent with unadjusted differences.

“Individuals in treatment received care in more settings, with the greatest increases in inpatient treatment and at physician's offices. Although physician's offices may provide access to buprenorphine, medication-assisted treatments are often unavailable in inpatient settings, which could hinder patient recovery,” the authors wrote.