Smita Das - Academia.edu (original) (raw)

Papers by Smita Das

Academic Psychiatry, 2016

Psychiatric Services, 2016

Individuals with behavioral health conditions (BHCs) smoke at high rates and have limited success... more Individuals with behavioral health conditions (BHCs) smoke at high rates and have limited success with quitting, despite impressive gains in recent decades in reducing the overall prevalence of smoking in the United States. This study examined smoking disparities among individuals with BHCs within an integrated health care delivery system with convenient access to tobacco treatments. The sample consisted of patients in an integrated health care delivery system in 2010-a group (N=155,733) with one or more of the five most prevalent BHCs (depressive disorders, anxiety disorders, substance use disorders, bipolar and related disorders, and attention-deficit hyperactivity disorder) and a group (N=155,733) without BHCs who were matched on age, sex, and medical home facility. The odds of smoking among patients with BHCs versus without BHCs were examined over four years using logistic regression generalized estimating equation models. Tobacco cessation medication utilization among a subset of smokers in 2010 was also examined. Although smoking prevalence decreased from 2010 to 2013 overall, the likelihood of smoking decreased significantly more slowly among patients with BHCs compared with patients without BHCs (p&amp;amp;amp;lt;.001), most notably among patients with substance use and bipolar and related disorders. Tobacco cessation medication use was low, and smokers with BHCs were more likely than smokers without BHCs to utilize these products (6.2% versus 3.6%, p&amp;amp;amp;lt;.001). Smoking decreased more slowly among individuals with BHCs compared with individuals without BHCs, even within an integrated health care system, highlighting the need to prioritize smoking cessation within specialty behavioral health treatment.

Current psychiatry reports, 2016

Tobacco use disorders (TUDs) continue to be overly represented in patients treated in mental heal... more Tobacco use disorders (TUDs) continue to be overly represented in patients treated in mental health and addiction treatment settings. It is the most common substance use disorder (SUD) and the leading cause of health disparities and increased morbidity/mortality amongst individuals with a psychiatric disorder. There are seven Food and Drug Administration (FDA) approved medications and excellent evidence-based psychosocial treatment interventions to use in TUD treatment. In the past few years, access to and use of other tobacco or nicotine emerging products are on the rise, including the highly publicized electronic cigarette (e-cigarette). There has also been a proliferation of technology-based interventions to support standard TUD treatment, including mobile apps and web-based interventions. These tools are easily accessed 24/7 to support outpatient treatment. This update will review the emerging products and counter-measure intervention technologies, including how clinicians can i...

Alcohol and alcoholism (Oxford, Oxfordshire), Jan 21, 2015

The prevalence of alcohol use disorders (AUDs) among hospitalized medically ill patients exceeds ... more The prevalence of alcohol use disorders (AUDs) among hospitalized medically ill patients exceeds 40%. Most AUD patients experience uncomplicated alcohol withdrawal syndrome (AWS), requiring only supportive medical intervention, while complicated AWS occurs in up to 20% of cases (i.e. seizures, delirium tremens). We aimed to prospectively test and validate the Prediction of Alcohol Withdrawal Severity Scale (PAWSS), a new tool to identify patients at risk for developing complicated AWS, in medically ill hospitalized patients. We prospectively considered all subjects hospitalized to selected general medicine and surgery units over a 12-month period. Participants were assessed independently and blindly on a daily basis with PAWSS, Clinical Institute Withdrawal Assessment-Alcohol, Revised (CIWA-Ar) and clinical monitoring throughout their admission to determine the presence and severity of AWS. Four hundred and three patients were enrolled in the study. Patients were grouped by PAWSS sc...

BMJ (Clinical research ed.), 2013

International Journal of Eating Disorders, 2005

Our objective was to develop a model to simultaneously prevent eating disorders and weight gain a... more Our objective was to develop a model to simultaneously prevent eating disorders and weight gain among female high school students. Of 188 female 10th graders enrolled in health classes, 174 elected to participate in the current study. They were assessed on-line and decided to participate in one of four interventions appropriate to their risk. The algorithm identified 111 no-risk (NR), 36 eating disorder risk (EDR), 16 overweight risk (OR), and 5 both risks. Fifty-six percent of the EDR and 50% of the OR groups elected to receive the recommended targeted curricula. Significant improvements in weight and shape concerns were observed in all groups. An Internet-delivered program can be used to assess risk and provide simultaneous universal and targeted interventions in classroom settings.

Nicotine & Tobacco Research, 2005

The present study aimed to determine whether tobacco use cessation rates observed in controlled t... more The present study aimed to determine whether tobacco use cessation rates observed in controlled trials of a hospital-based tobacco use cessation program could be replicated when the program was disseminated to a wide range of hospitals in a two-stage process including implementation and institutionalization phases. Using a nonrandomized, observational design, we recruited six hospitals to participate in the study. The research team helped implement the program during the first year of participation (implementation) and then withdrew from active involvement during the second year (institutionalization). The mean 6-month self-reported cessation rates were 26.3% (range = 17.6%-52.8%) for the implementation phase and 22.7% (range = 12.9%-48.2%) for the institutionalization phase. Hospitals with paid professionals providing the program had the best outcomes. Inpatient tobacco use cessation programs are feasible to implement and should target a 6-month self-reported cessation rate of at least 25%.

Journal of the American College of Surgeons, 2006

BACKGROUND: Both providers and payors bear the financial risk associated with complications of po... more BACKGROUND: Both providers and payors bear the financial risk associated with complications of poor quality care. But the stakeholder who bears the largest burden of this risk has a strong incentive to support quality improvement activities. The goal of the present study was to determine whether hospitals or payors incur a larger burden of increased hospital costs associated with complications. STUDY DESIGN: We merged clinical data for 1,008 surgical patients from the private sector National Surgical Quality Improvement Program to the internal cost-accounting database of a large university hospital. We then determined the marginal costs of surgical complications from the perspective of both hospitals (changes in profit and profit margin) and payors (increase in reimbursement paid to the hospital). In our analyses of cost and reimbursement, we adjusted for procedure complexity and patient characteristics using multivariate linear regression.

Echocardiography, 2010

Background: Methemoglobinemia is a recognized complication of topical anesthesia with benzocaine ... more Background: Methemoglobinemia is a recognized complication of topical anesthesia with benzocaine during transesophageal echocardiography (TEE). Though several risk factors have been described, the importance of individual factors is not known. We performed a retrospective study to identify determinants of the risk of methemoglobinemia. Materials and methods: All patients who underwent TEE with benzocaine topical anesthesia between June 2005 and June 2007 were included in this retrospective study. Results: Of the 886 patients who were included in the study, 140 had active infection (15.8%). The incidence of methemoglobinemia in this group was 2.9% (vs. 0%, P < 0.001). Compared to those without infection, patients in the active infection group were more likely to have a lower hemoglobin (P < 0.001), serum albumin level (P < 0.001), glomerular filtration rate less than 60 ml/min per 1.73 m 2 (P < 0.001), higher rates of dialysis (P < 0.001), a higher incidence of malignancy (P = 0.01), and increased use of acetaminophen and sulfa drugs (P < 0.001). However, multivariate logistic regression analysis did not identify any statistically significant covariates. Conclusion: In conclusion, patients with an active systemic infection who undergo TEE are at a higher risk of methemoglobinemia. However, none of the risk factors for methemoglobinemia including active infection reached statistical significance in the regression analysis which has to be interpreted with caution in view of the low event rate. (Echocardiography 2010;27:318-323)

Computers in Human Behavior, 2007

This investigation compared online and paper administration of self-report measures of weight and... more This investigation compared online and paper administration of self-report measures of weight and shape concerns, mood, weight and height. The former was designed as a screening instrument for adolescent students to determine risk for eating disorders. Participants were female sophomores (N = 74) from a San Francisco Bay area private high school. A counterbalanced designed was used to control for order effects. Four classes were randomly assigned to one of four conditions: (1) online-paper; (2) paper-online; (3) online-online; and (4) paperpaper. Participants completed self-report questionnaires twice, online and/or on paper, separated by 1 week. Agreement between online and paper assessment of weight and shape concerns and BMI ranged from 0.73 to 0.97 and 0.80 to 1.0, respectively. Agreement for positive mood ranged from 0.58 to 0.85 and negative mood from 0.59 to 0.82. Mean scores for weight and shape concerns and mood variables were significantly lower at the second testing. Online and paper assessment of weight and shape concerns was significantly correlated. However, there was a significant time effect. Mood was less stable and correlations between the two modes of self-report were less correlated. Online assessment may be beneficial and appropriate for many settings.

Clinical Pharmacology: Advances and Applications, 2010

Background: Beta1 (B 1 ) selective blockers have been widely used for the treatment of neurocardi... more Background: Beta1 (B 1 ) selective blockers have been widely used for the treatment of neurocardiogenic syncope though clinical trials have shown conflicting degrees of efficacy. Objective: To study the clinical efficacy of B 1 selective blockers compared to placebo in the treatment of neurocardiogenic syncope. Methods: Four placebo controlled randomized studies were identified after search of existing English language literature. Review Manager (RevMan version 5, Oxford, England) was used for statistical calculations. Both random and fixed effects models were used for analysis. Results: There was no demonstrable efficacy of B 1 blockers compared to placebo even after a pre-specified sensitivity analysis. There was a trend towards more adverse events in the beta blocker group compared to placebo (OR = 2.03 CI = 0.83-3.95, p = 0.12). Conclusion: There is no clinical evidence for justifying the use of B 1 selective blockers in the treatment of adult neurocardiogenic syncope. These agents may in fact lead to a higher rate of adverse events compared to placebo.

The purpose of this study was to evaluate a novel method of instituting quality improvement among... more The purpose of this study was to evaluate a novel method of instituting quality improvement among hospitals in the area of smoking cessation through publicizing poor performance. Smoking cessation was used as an indicator due to its impact on the health of our population, evidence base and also because of availability of data. The Joint