Multidimensionality of the Alcohol Withdrawal - Annotated Bibliography Example

Annotated bibliography Name Date Institution No. 1: Liu, J., Wang, N. (2013) Baclofen for alcohol withdrawal. Cochrane Database Syst Rev. 2013 Feb 28 Overview: The intention of the researchers was to assess the efficiency and safety of baclofen for alcohol-dependent patients with AW using Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar). Research Methods: The authors examined the Cochrane Central Register of Controlled Trials CINAHL EMBASE and MEDLINE in 1980 to October 2012. The authors use an all randomized measured clinical trials assessing baclofen contrasted with placebo or whichever type of treatment for patients with Alcohol Withdrawal Syndromes. Unrestrained, quasi-randomized trials were omitted. Reliability Findings: There were only validity findings Validity Findings: Validity was obtained as both parallel groups and cross-over designs were involved. 2 review authors autonomously evaluated references recovered for conceivable inclusion. All differences were determined by an autonomous person. The authors identified an aggregate of 113 references from all databases examined with an exception of duplicates. Strengths: Concerning the effectiveness, one research study indicated that both diazepam and baclofen expressively reduced the Clinical Institute Withdrawal Assessment of Alcohol Scale Revised (CIWA-Ar) score, without any substantial variance between the two interventions. Limitations: The articles examined are few as compared to the studies done in the particular field. Conclusions: The second research suggested that there was no substantial variance in CIWA-Ar score between placebo and baclofen but expressively reduced necessity on high dose benzodiazepines with baclofen paralleled to placebo. The proof for endorsing baclofen for AWS was inadequate. No. 2: Pittman, B., Gueorguieva, R., Krupitsky, E., Rudenko, A., Flannery, B., and Krystal, J.(2007).Multidimensionality of the Alcohol Withdrawal Symptom Checklist: a factoranalysis of the Alcohol Withdrawal Symptom Checklist and CIWA-Ar. Alcohol Clin Exp Res. 2007 Apr;31(4):612-8. Overview: The authors sought to evaluate the factor structure of two scales for gauging the extent of the alcohol withdrawal syndrome, the Alcohol Withdrawal Symptoms Checklist (AWSC), and the Clinical Institute Withdrawal Assessment-Alcohol, (CIWA-Ar). Research Methods: The authors opted to use alcohol-reliant adult male patients. Both measures of AWS were evaluated constantly throughout the first week of abstinence in the participants. An investigative factor analysis was applied to the data that was gathered at the onset of the study. Both measures of AWS were evaluated constantly throughout the first week of abstinence in the participants. Reliability Findings: The authors found out that 5 independent reasons accounted for 64% of total variance in the AWSC. 3 items, that is, stomach pain, illusions and confusion could not be involved in the examination because of inadequate variance. The 3 dimensions recognized for the CIWA-Ar were also shown by the ASWC. Total AWSC scores connected well with aggregate CIWA-Ar scores, supporting validity of the AWSC. Lower correspondences between aggregate CIWA-Ar and the 5 reasons indicated that the CIWA-Ar and AWSC reasons had discriminative value. Validity Findings: There were no validity findings in this study. Strenghts: The authors evaluated the abstinence in the patients, therefore, giving them more accurate findings. Limitation: Ensuring the validity of the findings would be a problem because of the difference of patients in the next similar study. Conclusions: The authors established that self-rated measures of AWS have an imperative role in supplementing observer-rated measures in medical and study settings. No. 3: Rappaport, D., Chuu. A., Hullett, C., Nematollahi, S., Teeple, M., Bhuyan, N., Honkanen, I, Adamas-Rappaport, J., and Sanders, A.(2013). Assessment of alcohol withdrawal in Native American patients utilizing the Clinical Institute Withdrawal Assessment of Alcohol Revised Scale. J Addict Med. 2013 May-Jun;7(3):196-9. Overview: The authors set out to examine the validity of the CIWA-Ar scale amongst Native American adult patients assessed for severe alcohol detoxification. Research Methods: The authors used case sequences of all participants assessed for alcohol withdrawal in an Acute Drug and Alcohol Detoxification hospital between June and April 2012. The CIWA-Ar scores were noted by qualified nurses on demonstration to Triage Department and after every two hours afterwards. A score of 10 or more showed that there was need for treatment and even admission. Age, blood alcohol levels, sex, pulse and blood pressure were noted on demonstration. Reliability Finding: It was noted that when participants were omitted from the research when other drug usage was seen by history. The connection of CIWA-Ar scores and ethnicity was matched using determination of variance. Validity Findings: The authors found out that Native Americans had constantly lower CIWA-Ar scores than other ethnic groups and lesser Native Americans required admission . Strenghts: The use of case sequencies significantly improved the validity of the results. Limitation: The research did not take into consideration the pertinent issue of ethnicity. Conclusions: It was concluded that the CIWA-Ar scale may undervalue the extent of alcohol withdrawal syndrome in some ethnic groups as noted earlier. No. 4: See, S., Nosal, S., Barr, W., Schiller, R. (2009).Implementation of a Symptom-Triggered Benzodiazepine Protocol for Alcohol Withdrawal in Family Medicine Inpatients. Hospital Pharmacy 44 (10) October 2009. Overview: The purpose of the research was to evaluate the application of symptom-triggered benzodiazepine therapy and assess the viability and results as compared with an earlier hospital standard of fixed-dose phenobarbital protocol for alcohol withdrawal on a family medicine service. Research Methods: The authors reviewed 46 records of patients. Adults suffering from alcohol withdrawal symptoms (AWS) were included in the study. These adults professed to be heavy daily drinkers and had a history of AWS and AWS-related seizures. Validity Findings: The validity of the study was proved with the Clinical Institute Withdrawal Assessment for Alcohol Scale, Revised (CIWA-Ar) that was used to assess the effect of personalized symptom-triggered therapy on result evaluation using symptom-triggered benzodiazepine therapy paralleled with the earlier hospital standard utilizing a fixed-dose phenobarbital protocol. Reliability Findings: 100% of the participants in the phenobarbital cluster needed drugs paralleled with 38% in the benzodiazepine group. 9.5% of the patients in the benzodiazepine group were decided to leave the hospital against the doctor’s advice while 36% of patients in the phenobarbital group left AMA. Strengths: The sample was large enough to draw reliability findings. Limitations: A small sample that was evidently unrepresentative was used. Conclusions: The results established that symptom-triggered therapy utilizing benzodiazepines occasioned better results than fixed-dosing phenobarbital. No. 5: Sarai, M., Tejani, A., Li, J., and Kuo, F.(2013). Magnesium for alcohol withdrawal. Cochrane Database Syst Rev. 2013 Jun 5. Overview: The authors set to evaluate the effects of magnesium in the treatment or prevention of alcohol withdrawal syndrome adults that were hospitalized. Research Methods: The authors delved into articles drawn from various journal websites and used a random or quasi random trials of magnesium used on adults that have been hospitalized. 4 trials that involved 317 patients met the inclusion criteria. Validity Findings: 3 trials studied oral magnesium (doses 12.5 mmol per day to 20 mmol per day). 1 trial studied parenteral magnesium in 24 hours. Every trial proved a high risk of bias in at least one area. Reliability Findings: There were substantial medical and procedural differences between trials. The authors found that no study that measured all of the stated primary results and met the goal of their review. One trial indicated medical signs of seizure and Clinical Institute Withdrawal Assessment for Alcohol scores were indicated. Strengths: A large number of cases were studied and this reveals the cogency of the study. Limitation: Patients that were treated with magnesium are very few and proof to back this practice is limited, and is often based on the contentious relationship between hypomagnesaemia and Alcohol Withdrawal Scales. Conclusions: The writers established that there was scant proof to establish whether magnesium was effective or injurious for the treatment or deterrence of alcohol withdrawal syndrome. No. 6: Bokhan A., Abolonin, F., Ankudinova É., Kurgak, I., and Mandel’ I.(2012). Use of remaxol in the combination therapy of post-withdrawal disorders in alcoholic patients with comorbid liver damage. Ter Arkh. 2012; 84(10):51-5. Overview: In this study, the authors set to evaluate the efficacy if Remaxol that is normally used to treat post-withdrawal disorders in alcoholic adults diagnosed with comorbid liver disorder. Research Methods: The extent of clinical parameters like anhedonia, pathological craving biochemical parameters were assessed in 120 patients (30 to 60 years). Validity Findings: Validity was drawn by dividing the patients into two distinct groups in which one group was given Remaxol while the other one took placebo. Reliability Findings: The reliability findings were that the drug initiated a speedy reduction in somato-automatic signs and significant reduction in affective strain and anxiety. The group of patients who received Remaxol exhibited noticeable signs of improvement in some biochemical parameters in accordance to the Clinical Institute Withdrawal Assessment of Alcohol Scale (CIWA-Ar). Strengths: The sample size was large enough to draw validity findings. Limitations: The central limitation of the research was the inaccuracies of the number of times the biochemical parameters were being administered. The affirmative changes prompted by Remaxol incorporated into the blend treatment are because of polymodal consequence of the drug on metabolic contrivances in the liver and the nervous system. Conclusions: The authors also stated that the double action encourages the amplified efficacy of treatment and remission. No. 7 Förg A., Hein, J., Volkmar, K., Winter, M., Richter, C., Heinz, A., and Müller, A.(2012). Efficacy and safety of pregabalin in the treatment of alcohol withdrawal syndrome: arandomized placebo-controlled trial. Alcohol Alcohol. 2012 Mar-Apr; 47(2):149-55. Overview: The authors set to collect preliminary data on the effectiveness and safety of Pregabalin in lessening the severity of alcohol withdrawal signs during the process of purification treatment in alcohol dependence. Research Methods: The authors used 42 alcohol dependent adults who exhibited alcohol withdrwal syndrome who were involved in the potential randomized double-blind placebo-controlled trial throughout adult alcohol purification. For 6 days, the patients were either given pregabalin or placebo in accordance to the stated dose program beginning with 300 mg/24hrs. Provisional on the score of the AWS Scale, diazepam was also given as a rescue medicine. Reliability Findings: The authors found out that both Pregabalin and placebo were good for the patients as they did not react adversely. Validity Findings: There were no validity findings. Strengths: The physiognomies of the sampel was very rich. Limitation: The main limitation to the study was that there was no statistically substantial dissimilarity that was detected comparing the total amount of additional diazepam medicine needed in the two study groups. Conclusions: Placebo and Pregabalin revealed comparable effectiveness in accordance to changes of scores of the AWSS, CIWA-Ar and neuropsychological scales. The occurrence of adversative events and drop-outs did not change between the both treatment groups. No. 8: Timary, D., de Sousa, D., Denoël, C., Hebborn, L., Derely, M., Desseilles, M., and Luminet O. (2013).The associations between self-consciousness, depressive state and craving to drink among alcohol dependent patients undergoing protracted withdrawal. PLoS One. 8(8). Overview: The authors’ main purpose was to establish how certain character traits affect the conncetion between depressing signs and craving. Research Methods: Trait self-consciousness was studied during a withdrawal as well as detoxification process. Craving, depressive state and trait SC were evaluated in alcohol-dependent inpatients (30 years and above) both at the commencement and end of protracted withdrawal during rehabilitation. Clinical Institute Withdrawal Assessment of Alcohol Scale, (CIWA-Ar) was used to determine the scores. Validity Findings: A substantial reduction in yearning and depressing symptoms was observed, while CIWA-Ar scores remained steady. There were also positive connections observed between yearning and depression. Reliability Findings: Regression evaluates showed that trait SC expressively moderated the effect of dejection on cravings for alcohol. Strengths: There was significant progress in the validity findings based on Trait SC as compared to previous research. Limitations: The study was performed on a somewhat small sample size and the yearning may have been assessed using other forms of measurements. Conclusions: During prolonged withdrawal, alcohol yearning reduced with the same level as depressing temperament. Depressing signs were linked to alcohol craving but only among participants with high CIWA-Ar scores. The outcomes indicate that metacognitive methods directed at SC could reduce craving, hence, avert future reversions. Critique assessment tool Clinical Institute Withdrawal Assessment for Alcohol Scale, Revised (CIWA-Ar) Alcohol abuse and dependence epitomizes grave medical issue across the world with key societal, relational and legal consequences. Reliance on alcohol is connected with both physical signs like the ability to tolerate and withdrawal, and communicative signs such as lessened control over alcohol and how often to take it. Clinical Institute Withdrawal Assessment for Alcohol Scale, Revised (CIWA-Ar) has been viewed as consistent, concise, straightforward and medically beneficial scale that is used to evaluate the severity of alcohol withdrawal, to observe reaction to treatment and to usage in studies. Carol et al explicate “The revised Clinical Institute Withdrawal Assessment for Alcohol scale (CIWA-Ar) is the tool used most widely for assessing alcohol withdrawal. It measures nine categories of symptoms on a scale of 0 to 7 and one symptom (clouding sensorium) on a scale of 0 to 4. Mild symptoms translate into a total score of less than 8, moderate symptoms 8 to15, and severe symptoms greater than 15. Patients who have a score of greater than or equal to 8 should receive drug therapy to treat their symptoms and reduce the risk of seizures and DT.” Shaw et al., (1981) advance that previous research studies occasioned in the progress of a trustworthy and corroborated 15-item scale that was initially known as the Clinical Institute Withdrawal Assessment for Alcohol. Authentication was realized by connection with universal ratings of doctors skilled in the assessment of patients with the alcohol withdrawal syndrome. Additionally, discrete items recorded by raters interrelated with more objective recordings. For instance, tremor rating interrelated with accelerometer measures (Zilm, 1979). Later, the 15-item CIWA-A scale could be condensed to the items which were more consistent and the medically relevant characteristics of alcohol withdrawal without a substantial loss of precision, the scale's efficacy and reception were also improved. This assessment tool is very important in the medical field because it has been proven to work very effectively. The CIWA-Ar can be adapted to evaluate and monitor the extent of a patient’s benzodiazepine withdrawal sings. It important to note that any medical practitioner can be able to read and remark about the score displayed by the CIWA-Ar. Alcohol withdrawal is a real medical diagnosis and the signs can be very problematic for the persons suffering from them. Delirium tremens are among the most precarious signs and can lead to death. However, they are not the only symptom and other signs comprise of unnecessary agitation, tremors, headaches, anxiety, chills, seizures and severe stomach aches. The purpose of safe alcohol detoxification is to detox patients off of liquor without subjecting them to long suffering, getting sicker or maybe die from withdrawal otherwise preventable signs and symptoms. The CIWA-Ar Scale for detoxification is very effective in ensuring that these hazardous things do not happen. Some drugs especially Benzodiazepines are important and effective at handling withdrawal signs. The purpose of this drug is to medicate and not over-medicate. In this endeavor, CIWA-Ar becomes very effective in ensuring the right dosages are administered and that there is no over-medication administered to the alcohol-dependent patients. At times alcohol withdrawal symptoms can be contained or treated without medicine or partially with and partially without medicine. The CIWA-Ar aids in figuring out which type of treatment strategy is essential for such types of patients. The CIWA-Ar is every so often used frequently during the primary withdrawal time occasionally every 2 to 4 hours since alcohol withdrawal signs can change quickly. In essence, CIWA-Ar allows care plans for treatment to adjust as required. In addition, individuals are sometimes advised to stay in the hospital when they are discovered to have a unique drinking problem that was initially unknown to the medical practitioners. This can be extremely dangerous since there is always a danger of administering drugs to patients erroneously. In this case the CIWA-Ar can be a very beneficial as general assessment tool even when the patient is not admitted in the hospital for alcoholism. The Clinical Institute Withdrawal Assessment for Alcohol Scale, Revised (CIWA-Ar) is also an effective tool for clinical assessment tool for quantifying alcohol withdrawal and an effective guide for determining the need for ancillary ‘rescue’ medication dosing. In a research study to establish the management of alcohol withdrawal in admitted alcohol-dependent patients, Eliot et al (2014) state, “Combined with the CIWA-AR score, the WTP identifies trends in the patient's condition and helps the nurse determine whether or not withdrawal symptoms require the p.r.n. use of medication. For example, a non-compromised patient with a CIWA-Ar of 7 and normal vital signs would require standard nursing support and reassurance with no medication intervention.” The CIWA-Ar regimen has been viewed to be effective with intermediate, short or benzodiazepines. It is also important to note that those patients with a known history of withdrawal seizures can be safely be treated with the CIWA-Ar assessment tool. Together with SAS, CIWA-AR can be used to evaluate the level of agitation and consciousness of a patient and be connected to medication. Richards, et al (2004) recognize the significance of evaluating the health risk status of alcoholics, and the signs for intercession. An extensive diversity of assessment instruments are in use to enable assessment and guarantee the consistency of the process. Therefore, the use of Clinical Institute Withdrawal Assessment for Alcohol Scale, Revised (CIWA-Ar) in hospitals is important as it helps nurses and doctors go about their prognosis as effectively. By implementing protocols based on the CIWA-Ar, nurses are directed to administer the prescribed medications. As the severity of the symptoms progresses, the medication dose increases. Nurses play a pivotal role in monitoring and scoring patients according to the protocol and administering medications as determined by the CIWA-Ar score. A consistent approach is necessary to successful patient outcomes. Lack of understanding about patients who have an addictive disorder can lead to a lack of objective judgment toward patients and their symptoms. It is therefore important to note that, Clinical Institute Withdrawal Assessment for Alcohol Scale, Revised (CIWA-Ar) is the most effective clinical assessment tool as it contributes a lot in ensuring the patients get the most appropriate care. References Bokhan A., Abolonin, F., Ankudinova É., Kurgak, I., and Mandel’ I.(2012). Use of remaxol in the combination therapy of post-withdrawal disorders in alcoholic patients with comorbid liver damage. Ter Arkh. 2012; 84(10):51-5 Elliott, D. Y., Geyer, C., Lionetti, T., & Doty, L. (April 01, 2014). Managing alcohol withdrawal in hospitalized patients. Nursing, 42, 4, 22-30. Förg A., Hein, J., Volkmar, K., Winter, M., Richter, C., Heinz, A., and Müller, A.(2012). Efficacy and safety of pregabalin in the treatment of alcohol withdrawal syndrome: a randomized placebo-controlled trial. Alcohol Alcohol. 2012 Mar-Apr; 47(2):149-55 Liu, J., Wang, N. (2013) Baclofen for alcohol withdrawal. Cochrane Database Syst Rev. 2013 Feb 28 Pittman, B., Gueorguieva, R., Krupitsky, E., Rudenko, A., Flannery, B., and Krystal, J.(2007).Multidimensionality of the Alcohol Withdrawal Symptom Checklist: a factor analysis of the Alcohol Withdrawal Symptom Checklist and CIWA-Ar. Alcohol Clin Exp Res. 2007 Apr;31(4):612-8. Puz, C. A., & Stokes, S. J. (September 01, 2005). Alcohol Withdrawal Syndrome: Assessment and Treatment with the Use of the Clinical Institute Withdrawal Assessment for Alcohol-Revised. Critical Care Nursing Clinics of North America, 17, 3, 297-304. Sandor, P. (1981) Development of optimal alcohol withdrawal tremor./£££ rrawiacnons; 5i dtreatment tactics for alcohol withdrawal. L Assessment ical Engineering, 26, pp. 3-10. Sarai, M., Tejani, A., Li, J., and Kuo, F.(2013). Magnesium for alcohol withdrawal. Cochrane Database Syst Rev. 2013 Jun 5. See, S., Nosal, S., Barr, W., Schiller, R. (2009).Implementation of a Symptom-Triggered Benzodiazepine Protocol for Alcohol Withdrawal in Family Medicine Inpatients. Hospital Pharmacy 44 (10) October 2009 Sullivan, J., Sykora, K., Schneiderman, J., Naranjo, C., and Sellers, F. Assessment of alcohol withdrawal: the revised Clinical Institute Withdrawal Assessment for Alcohol Scale. British Journal of Addiction 84:1353-1357, 1989. Rappaport, D., Chuu. A., Hullett, C., Nematollahi, S., Teeple, M., Bhuyan, N., Honkanen, I, Adamas-Rappaport, J., and Sanders, A.(2013). Assessment of alcohol withdrawal in Native American patients utilizing the Clinical Institute Withdrawal Assessment of Alcohol Revised Scale. J Addict Med. 2013 May-Jun;7(3):196-9. Richards, D. et al (2004) Quality monitoring of nurse telephone triage: pilot study. Journal of Advanced Nursing; 47: 5, 551–560 Read More