The total cholesterol to high-density lipoprotein cholesterol ratio predicts post-stroke depression: linear association and individualized risk nomogram.

One in nine hospitalized patients in the U.S. has a substance use disorder (SUD). While hospitals can be critical touchpoints for people with SUD, there are significant gaps in appropriately caring for this population during hospitalization. Hospitalized people with SUD experience stigma from staff, including viewing patients as violent and manipulative, which results in denying or delaying pain medication and shorter encounters with this patient population. Hospitals and healthcare workers often approach SUD care with a focus on abstinence, which can alienate patients, reduces engagement, and worsens health outcomes (including compromised patient-healthcare worker relationships, increased self-directed discharges, and incomplete treatment). Hospital-based harm reduction services are a powerful tool to improve outcomes for hospitalized patients with SUDs. The National Harm Reduction Coalition defines harm reduction as “a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use” that incorporates social justice and human rights. Harm reduction in the community, such as needle exchange programs and naloxone distribution, has helped patients with SUD reduce substance use, increased linkage to substance use treatment, and decreased fatal overdoses. Expanding harm reduction to hospital settings is gaining momentum and has been found to increase patient engagement and trust, increase uptake of overdose prevention services, increase access to harm reduction supplies among marginalized populations, and catalyze culture change, including reducing stigma for patients with SUD. One program in Portland, Oregon, developed a nurse-led hospital harm reduction intervention embedded in its addiction consult team, leveraging nurses’ central role in hospital care to normalize harm reduction within hospital settings. Another program in Boston, Massachusetts, integrated a community-based harm reduction program into the local safety-net hospital via a formal “in-reach collaboration”, where community harm reduction specialists worked alongside the hospital’s addiction consult team to provide harm reduction supplies to hospitalized patients. Several hospitals, including emergency departments across the country, have integrated take-home naloxone distribution for patients at risk of overdose. In August 2020, our safety-net hospital’s interprofessional Addiction Consult Team (ACT) launched a harm reduction program to provide education and substance use equipment to hospitalized people not seeking substance use abstinence. ACT members performed a needs assessment among hospitalized patients with SUD to determine if harm reduction supplies were needed and what education and supplies would be most helpful. The supplies are provided as harm reduction kits and include needles, syringes, pipes, fentanyl test strips, and foil. ACT members, most commonly substance use navigators, provide these kits to patients, tailoring them to individuals’ needs, and provide them alongside counseling and education at discharge. Our prior work describes the program’s launch, beneficial impacts, and challenges faced by hospital staff and patients.