Ebook: Improving Usability, Safety and Patient Outcomes with Health Information Technology
Many physiologically active materials are removed from the bloodstream whether by metabolism or excretion at a rate proportional to the current concentration, so that they exhibit exponential decay with a characteristic halflife see pharmacokinetics. This is not true for alcohol, however.
Typical doses of alcohol actually saturate the enzymes' capacity, so that alcohol is removed from the bloodstream at an approximately constant rate. This rate varies considerably between individuals. Another sex based difference is in the elimination of alcohol. People under 25 [ citation needed ] , women  or with liver disease may process alcohol more slowly.
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Such persons have impaired acetaldehyde dehydrogenase , which causes acetaldehyde levels to peak higher, producing more severe hangovers and other effects such as flushing and tachycardia. Conversely, members of certain ethnicities that traditionally did not use alcoholic beverages have lower levels of alcohol dehydrogenases and thus "sober up" very slowly, but reach lower aldehyde concentrations and have milder hangovers. Rate of detoxification of alcohol can also be slowed by certain drugs which interfere with the action of alcohol dehydrogenases, notably aspirin , furfural which may be found in fusel alcohol , fumes of certain solvents , many heavy metals , and some pyrazole compounds.
Also suspected of having this effect are cimetidine Tagamet , ranitidine Zantac , and acetaminophen Tylenol paracetamol. Currently, the only known substance that can increase the rate of metabolism of alcohol is fructose. Fructose also increases false positives of high BAC ratio readings in anyone with proteinuria and hematuria, due to kidney-liver metabolism. Alcohol absorption can be slowed by ingesting alcohol on a full stomach. Alcohol absorption is slowed because the stomach sphincter closes in order to break down the food.
The alcohol cannot be absorbed through the stomach, thus cannot be absorbed until the sphincter is opened and the consumed alcohol can flow to the small intestine. Alcohol in carbonated beverages is absorbed faster than alcohol in non-carbonated drinks. Being under stress causes alcohol to metabolize faster. Retrograde extrapolation is the mathematical process by which someone's blood alcohol concentration at the time of driving is estimated by projecting backwards from a later chemical test.
This involves estimating the absorption and elimination of alcohol in the interim between driving and testing. The rate of elimination in the average person is commonly estimated at. Metabolism can be affected by numerous factors, including such things as body temperature, the type of alcoholic beverage consumed, and the amount and type of food consumed. In an increasing number of states, laws have been enacted to facilitate this speculative task: the blood alcohol content at the time of driving is legally presumed to be the same as when later tested.
There are usually time limits put on this presumption, commonly two or three hours, and the defendant is permitted to offer evidence to rebut this presumption. Forward extrapolation can also be attempted. If the amount of alcohol consumed is known, along with such variables as the weight and sex of the subject and period and rate of consumption, the blood alcohol level can be estimated by extrapolating forward.
From Wikipedia, the free encyclopedia. Metric of alcohol intoxication. See also: Short-term effects of alcohol consumption. Further information: Standard drink. See also: Binge drinking. Further information: Drunk driving law by country. This article needs additional citations for verification.
Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. BMC Public Health. Journal of Analytical Toxicology. April Retrieved La Presse. Ministry of Transport. Retrieved 2 July It came into effect beginning 14 November The penalties become even more severe at 0. January , retr. Above 0. Archived from the original on International Alliance for Responsible Drinking. Accessed on February 01, Federal Motor Carrier Safety Administration.
Archived from the original PDF on Driving Tests Resources. Br Med J. Buglass, ed. Chichester: Wiley.
Retrieved 6 July Recent Developments in Alcoholism. Journal of Pharmacology and Experimental Therapeutics. Retrieved 23 June Journal of Clinical Investigation.
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Scottish Medical Journal. Pawan, GL September The Proceedings of the Nutrition Society. The American Journal of Clinical Nutrition. Rawat, AK February Research Communications in Chemical Pathology and Pharmacology. Iber, FL September Archives of Internal Medicine.
Klinische Wochenschrift. The Journal of Pharmacology and Experimental Therapeutics. Alcohol and Alcoholism. Comptes Rendus Biologies. Archived from the original on 18 January When food is ingested, the pyloric valve at the bottom of the stomach will close in order to hold food in the stomach for digestion and thus keep the alcohol from reaching the small intestine. Stress causes the stomach to empty directly into the small intestine, where alcohol is absorbed even faster. Liquor mixed with soda or other bubbly drinks speeds up the passage of alcohol from the stomach to the small intestine, which increases the speed of absorption.
When deciding how to allocate case management staff and what types of professionals to engage with the PCPs, program leaders almost universally stressed the importance of flexibility in matching staff and resources to the needs and culture of each PCP. Hence, the number of case managers and whether they are shared among several PCPs or dedicated to just one PCP depends on the size of the practice, the types and roles of staff already employed in the practice, and the number of complex patients in the PCP panel see Table 2.
For example, CCA develops a staffing plan based on assessment of the patient mix, including the number of nursing-home-certifiable patients, ambulatory patients, and other characteristics. Some practices have such a large number of complex-needs patients who require intensive case management services that the regional network assigns one or more case managers directly to the practice. Case managers in all five programs strive to work with at least some local PCP leadership and staff in teams to share all relevant information about patient needs, preferences, and circumstances when developing care plans.
Several program leaders said they judge the success of their case managers or care coordinators by the degree to which they are accepted and integrated into the PCP. For example, CCA creates multidisciplinary teams, using its own clinical staff and that of the PCP to perform comprehensive health and social assessments, provide enhanced primary care, and develop individualized care plans.
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For patients who are eligible for nursing home care, a nurse practitioner often heads the team and has responsibility for first response and home visits. CCA also has team members specializing in geriatric social work, behavioral health care, and palliative care available for consultation. We employ and deploy resources, but it requires leadership from the practice and CCA program directors to ensure the CCA team is integrated into the practice.
They interact with the physicians and with the network staff and practice consultants to jointly determine what support or services are needed to lower inappropriate utilization.
We want the care management staff integrated into the team so that care managers are seen as an extension of the health care team. We push for full integration so that care managers can gain ready access to patient records and provide real-time consultations. The team-building process is not without tensions, however, and several programs noted the challenges of bringing disparate providers together.
For example, in Minnesota, community agencies that have long been providing case management to older adults and people with disabilities expressed concern that if the primary care practices participating in HCH are paid for care coordination, the community agencies will lose the funding they receive to coordinate care for these individuals. They should go out and see if there are existing programs like ours that they might engage with… [and] work with existing partners who are already working to tackle the problem.
In addition to providing case management staff, four of the five programs dedicated considerable resources to support practices by helping them reorganize workflow and systems, conducting home assessments, and providing tools to enhance PCP capacity to assure continuous access and ensure care coordination. Some also facilitated ready access to geriatrics or mental health consultation.
In exchange for these supports, most programs have corresponding requirements for participating PCPs, such as expectations regarding PCMH certification, health IT infrastructure, and participation in quality reviews. EHRs and other health IT are important tools for case management and care coordination. They enable teams to record and share information on many different aspects of patient needs and service use including: 1 results from needs assessments for different domains health, medications, home environment, social support, and family caregiver ; 2 referrals and results from lab and radiologic tests, specialty consults, and home health and other community-based care; 3 real-time monitoring of such critical events as hospital admissions and ER visits that trigger a need for follow up; 4 prompts and reminders regarding visits and preventive care; 5 decision-support tools for complex patient care, such as clinical care paths and guidelines; and 6 community resources lists.
These systems allow the program to readily access provider-level data on cost, utilization, and outcomes, which are then used to identify and direct services to high-need, high-cost users. The program Web site provides a list of low- and no-cost registries for PCPs to select. Unrelated to the program requirement, about 65 to 70 percent of all clinics in Minnesota already have an EHR system because State law requires clinics to meet health IT meaningful use criteria by Some clinics, however, do not use very advanced registry capabilities.
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Some practices use their registries to track referrals to social services; others do not. The other programs reported that their providers and care coordinators used separate electronic systems but consider information-sharing an essential part of each program. At Summa Health System, providers operating on separate EHR systems overcome interoperability barriers by taking notes on a single patient record and communicating via email, phone, fax, and alpha-page similar to text messaging.
At CHP and Summa Health System, case managers accompany clients to clinic visits and discuss relevant case history with the provider, helping to provide the information that would otherwise be lost between separate electronic systems. All of the programs emphasize quality improvement, and many use the EHR and data capabilities described above to report cost, quality, and utilization outcome measures to PCPs, program management, and patients Table 1.
They jointly identify areas to target for improvement and maintain a very collaborative approach toward practice improvement.