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Strothmann B, Kraus L, Kriston L, Röhrig J, Scherbaum N, Buchholz A. Factorial, Construct, and Predictive Validity of the Motivation for Treatment Scale in Alcohol-Use Disorder Withdrawal Treatment. Eur Addict Res 2023; 29:375-384. [PMID: 38008078 DOI: 10.1159/000532066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 07/12/2023] [Indexed: 11/28/2023]
Abstract
INTRODUCTION The aim of the present study was to examine for the first time the factorial, construct, and predictive validity of the motivation for treatment (MfT) scale in a cohort of patients undergoing inpatient-qualified alcohol withdrawal treatment with the goal of referring patients to further treatment. The MfT scale has previously been evaluated in different settings of substance abuse treatment, revealing factorial ambiguity. To the best of our knowledge, the present study is the first study that conducted comprehensive factor analyses versus separate analyses of the factors conducted in prior studies in order to clarify the aforementioned factorial ambiguity. METHODS A total of 249 patients (mean age 45.2 years (SD = 10.3); 34.4% females) with alcohol dependence were assessed. Data were obtained from four inpatient clinics specialized in qualified alcohol withdrawal treatment in Germany. First, confirmatory factor analyses were carried out to examine the fit of the four models discussed in the literature. Second, an exploratory factor analysis was conducted. Correlations of the new factors with other motivational constructs and referral to a subsequent treatment were investigated as measures of construct and predictive validity. RESULTS None of the four models showed an acceptable fit to the data in confirmatory analyses. The exploratory analysis suggested to eliminate seven items because of inappropriate factor loadings and resulted in a shortened MfT scale, which consists of three factors based on 17 items. For the latent variables "problem recognition," "desire for help," and "treatment readiness," satisfactory composite reliability was found with 0.82, 0.80, and 0.78, respectively. Evidence for predictive validity was found in the correlation between "treatment readiness" and referral to a subsequent treatment. DISCUSSION/CONCLUSION The new shortened MfT scale exhibited remarkable parsimony, which is desirable in settings such as withdrawal treatment, where patients frequently are cognitively or physically impaired. Despite its briefness, construct and predictive validity were better than in the original version of the MfT scale. The factorial validity of the suggested scale needs to be corroborated in further research.
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Affiliation(s)
- Benjamin Strothmann
- Department of Medical Psychology, Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Ludwig Kraus
- IFT Institut für Therapieforschung, Munich, Germany
- Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Levente Kriston
- Department of Medical Psychology, Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Jeanette Röhrig
- Clinic for Addiction Medicine and Addictive Behaviour, Institute for Clinical Psychology, Medical Centre Stuttgart, Stuttgart, Germany
| | - Norbert Scherbaum
- LVR-Hospital Essen, Department of Addictive Behaviour and Addiction Medicine, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Angela Buchholz
- Department of Medical Psychology, Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
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End of life in the critically ill patient: evaluation of experience of end of life by caregivers (EOLE study). Ann Intensive Care 2021; 11:162. [PMID: 34825996 PMCID: PMC8626545 DOI: 10.1186/s13613-021-00944-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 10/25/2021] [Indexed: 11/28/2022] Open
Abstract
Background The death rate in intensive care units (ICUs) can reach 20%. More than half occurs after a decision of care withholding/withdrawal. We aimed at describing and evaluating the experience of ICU physicians and nurses involved in the end-of-life (EOL) procedure. Primary objective was the evaluation of the experience of EOL assessed by the CAESAR questionnaire. Secondary objectives were to describe factors associated with a low or high score and to examine the association between Numeric Analogic Scale and quality of EOL. Methods Consecutive adult patients deceased in 52 ICUs were included between April and June 2018. Characteristics of patients and caregivers, therapeutics and care involved after withdrawal were recorded. CAESAR score included 15 items, rated from 1 (traumatic experience) to 5 (comforting experience). The sum was rated from 15 to 75 (the highest, the best experience). Numeric Analogic Scale was rated from 0 (worst EOL) to 10 (optimal EOL). Results Five hundred and ten patients were included, 403 underwent decision of care withholding/withdrawal, and among them 362 underwent effective care withdrawal. Among the 510 patients, mean CAESAR score was 55/75 (± 6) for nurses and 62/75 (± 5) for physicians (P < 0.001). Mean Numeric Analogic Scale was 8 (± 2) for nurses and 8 (± 2) for physicians (P = 0.06). CAESAR score and Numeric Analogic Scale were significantly but weakly correlated. They were significantly higher for both nurses and physicians if the patient died after a decision of withholding/withdrawal. In multivariable analysis, among the 362 patients with effective care withdrawal, disagreement on the intensity of life support between caregivers, non-invasive ventilation and monitoring and blood tests the day of death were associated with lower score for nurses. For physicians, cardiopulmonary resuscitation the day of death was associated with lower score in multivariable analysis. Conclusion Experience of EOL was better in patients with withholding/withdrawal decision as compared to those without. Our results suggest that improvement of nurses’ participation in the end-of-life process, as well as less invasive care, would probably improve the experience of EOL for both nurses and physicians. Registration: ClinicalTrial.gov: NCT03392857. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-021-00944-z.
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Raabe FJ, Wagner E, Weiser J, Brechtel S, Popovic D, Adorjan K, Pogarell O, Hoch E, Koller G. Classical blood biomarkers identify patients with higher risk for relapse 6 months after alcohol withdrawal treatment. Eur Arch Psychiatry Clin Neurosci 2021; 271:891-902. [PMID: 32627047 PMCID: PMC8236027 DOI: 10.1007/s00406-020-01153-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/16/2020] [Indexed: 11/30/2022]
Abstract
This naturalistic study among patients with alcohol dependence examined whether routine blood biomarkers could help to identify patients with high risk for relapse after withdrawal treatment. In a longitudinal study with 6-month follow-up among 133 patients with alcohol dependence who received inpatient alcohol withdrawal treatment, we investigated the usefulness of routine blood biomarkers and clinical and sociodemographic factors for potential outcome prediction and risk stratification. Baseline routine blood biomarkers (gamma-glutamyl transferase [GGT], alanine aminotransferase [ALT/GPT], aspartate aminotransferase [AST/GOT], mean cell volume of erythrocytes [MCV]), and clinical and sociodemographic characteristics were recorded at admission. Standardized 6 months' follow-up assessed outcome variables continuous abstinence, days of continuous abstinence, daily alcohol consumption and current abstinence. The combined threshold criterion of an AST:ALT ratio > 1.00 and MCV > 90.0 fl helped to identify high-risk patients. They had lower abstinence rates (P = 0.001), higher rates of daily alcohol consumption (P < 0.001) and shorter periods of continuous abstinence (P = 0.027) compared with low-risk patients who did not meet the threshold criterion. Regression analysis confirmed our hypothesis that the combination criterion is an individual baseline variable that significantly predicted parts of the respective outcome variances. Routinely assessed indirect alcohol biomarkers help to identify patients with high risk for relapse after alcohol withdrawal treatment. Clinical decision algorithms to identify patients with high risk for relapse after alcohol withdrawal treatment could include classical blood biomarkers in addition to clinical and sociodemographic items.
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Affiliation(s)
- Florian J Raabe
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany.
- International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Kraepelinstrasse 2-10, 80804, Munich, Germany.
| | - Elias Wagner
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany
| | - Judith Weiser
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany
| | - Sarah Brechtel
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany
| | - David Popovic
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany
- International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Kraepelinstrasse 2-10, 80804, Munich, Germany
| | - Kristina Adorjan
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany
| | - Oliver Pogarell
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany
| | - Eva Hoch
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany
- Division of Clinical Psychology and Psychological Treatment, Department of Psychology, LMU Munich, Leopoldstrasse 13, 80802, Munich, Germany
| | - Gabriele Koller
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany
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Manthey J, Lindemann C, Verthein U, Frischknecht U, Kraus L, Reimer J, Grün A, Kiefer F, Schulte B, Rehm J. [Provision of healthcare for people with risky alcohol use and severe alcohol use disorders in the state of Bremen, Germany: demand and guideline concordance?]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63:122-130. [PMID: 31828370 DOI: 10.1007/s00103-019-03072-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Early detection of risky alcohol use and severe alcohol use disorders (AUDs) is crucial to avoid adverse health consequences. The German "Guidelines on Screening, Diagnosis and Treatment of Alcohol Use Disorders" recommend to routinely screen patients for hazardous alcohol use and to subsequently conduct brief interventions, for example in primary healthcare. For severe AUDs, provision of withdrawal treatment is recommended in inpatient settings if complications are anticipated. OBJECTIVES To estimate the proportion of people with hazardous alcohol use or severe AUDs receiving healthcare as stipulated by the guidelines. MATERIALS AND METHODS The prevalence of hazardous use (female ≥12 g; male ≥24 g) and severe AUDs (female ≥60 g; male ≥90 g) was estimated using per capita consumption of pure alcohol. Treatment rates were estimated using survey data (for hazardous use) and inpatient admissions (for severe AUDs). All estimates refer to the adult population (15 years or older) of the federal state of Bremen for 2016. RESULTS Physicians screened 2.9% of all people with hazardous alcohol use and conducted brief interventions with 1.4%. Among people with severe AUDs, 7.1% received inpatient treatment. Among people with severe AUDs who required inpatient treatment, 14.1% received withdrawal treatment in inpatient settings. Treatment rates below average were registered among 21- to 39-year-olds. CONCLUSIONS In Bremen, provision of guideline-conform healthcare for hazardous alcohol use and severe AUDs is insufficient, especially among 21- to 39-year-olds.
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Affiliation(s)
- Jakob Manthey
- Institut für Klinische Psychologie und Psychotherapie, TU Dresden, Chemnitzer Straße 46, 01187, Dresden, Deutschland. .,Zentrum für Interdisziplinäre Suchtforschung (ZIS), Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland.
| | - Christina Lindemann
- Zentrum für Interdisziplinäre Suchtforschung (ZIS), Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
| | - Uwe Verthein
- Zentrum für Interdisziplinäre Suchtforschung (ZIS), Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
| | - Ulrich Frischknecht
- Feuerlein Centrum für Translationale Suchtmedizin, Klinik für Abhängiges Verhalten und Suchtmedizin, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - Ludwig Kraus
- IFT Institut für Therapieforschung, München, Deutschland.,Department for Public Health Sciences, Stockholm University, Stockholm, Schweden.,Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Ungarn
| | - Jens Reimer
- Zentrum für Interdisziplinäre Suchtforschung (ZIS), Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland.,Gesundheit Nord, Bremen, Deutschland
| | | | - Falk Kiefer
- Feuerlein Centrum für Translationale Suchtmedizin, Klinik für Abhängiges Verhalten und Suchtmedizin, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - Bernd Schulte
- Zentrum für Interdisziplinäre Suchtforschung (ZIS), Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
| | - Jürgen Rehm
- Institut für Klinische Psychologie und Psychotherapie, TU Dresden, Chemnitzer Straße 46, 01187, Dresden, Deutschland.,Zentrum für Interdisziplinäre Suchtforschung (ZIS), Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Kanada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Kanada.,Department of Psychiatry, University of Toronto, Toronto, Kanada.,Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moskau, Russland
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