CIWA-AR CASE STUDY

We examined whether the protocol was warranted for the patients to whom it had been applied, as defined by the following criteria: The mean number of fixed-schedule doses received after CIWA-Ar scores were consistently below 10 was 3. Open in a separate window. Alcohol withdrawal syndrome AWS is characterized by varied symptoms that range from mild to severe intensity depending on several factors including the quantity, frequency and duration of alcohol intake, and the number of prior withdrawal episodes, as well as individual differences in the vulnerability [ 1 — 4 ]. There was no use of short acting benzodiazepines, which causes varying and rebound withdrawal symptoms across different time frame with its dosing and changing plasma concentration.

Hospital culture has changed in the years since the pre-protocol period, with a variety of new approaches to promote earlier discharge. Of the admissions reviewed, were included after application of the inclusion and exclusion criteria Table 1. Variables Mean SD Age The median duration of the hospital stay was 5. Median time from hospital admission to ordering of alcohol withdrawal protocol h. Admission with seizure or seizure disorder unrelated to alcohol withdrawal. To avoid bias in the results, these patients with early discontinuation were included in the analyses of secondary outcomes excluding total benzodiazepine dose and quality assurance outcomes.

British Journal of Psychiatry. The severity of withdrawal symptoms and appearance of complete sets of withdrawal symptoms at the 36th hour may have been influenced by plasma half-life of benzodiazepams being used for detoxification.

Factor Structure of CIWA-Ar in Alcohol Withdrawal

Clinical and Experimental Research. Assessment of alcohol withdrawal: Journal of Pharmacology and Experimental Therapeutics. Severity of alcohol withdrawal symptoms and the Tc polymorphism of the neuropeptide Y gene. Multidimensionality of the Alcohol Withdrawal Symptom Checklist: Alcohol withdrawal syndrome AWS is characterized by varied symptoms that range from mild to severe intensity depending on several factors including the quantity, frequency and duration of alcohol intake, and the number of prior withdrawal episodes, as well as individual differences in the vulnerability [ 1 — 4 ].

Ciwa-ag difference may be due to the time span of withdrawal on which data was collected. Not admitted to internal medicine service with minimum 24 h stay in hospital. Timing in Relation to Implementation of Protocol; N o. We had additional anxiety to this factor; hence, we share the name of this factor with Pittman et al.

  RACHMAN CASE STUDY OCD

ciwa-ar case study

Among them, the most commonly used observer-rated scale is the item clinical institute withdrawal assessment-alcohol, revised CIWA-Ar [ 10 ]. Presenting with delirium unrelated to alcohol withdrawal. Open in a separate window. Detailed physical cuwa-ar neurological examinations were done to exclude any comorbid general medical condition, comorbid other psychiatric disorder, and any other comorbid substance use disorders except caffeine and tobacco.

A cluster analytic study [ 8 ] identified three different symptoms clusters of alcohol withdrawal, namely, CNS excitation, adrenergic xtudy, and delirium. Ina retrospective chart analysis was conducted to evaluate the management of alcohol withdrawal in internal medicine patients at the study hospital Ingram S, Wilbur K, unpublished results.

Evaluation of an Alcohol Withdrawal Protocol and a Preprinted Order Set at a Tertiary Care Hospital

Because the protocol was implemented only on specific hospital wards and not in the emergency department, a delay from the time of admission to initiation and administration of the protocol was inevitable. Nonparametric statistics were chosen because the primary outcome variable, duration of benzodiazepine use, was not normally distributed.

Hence rating at the 24 hours of abstinence was considered as first rating. Implementation of an alcohol withdrawal protocol with a combination of fixed-schedule and symptom-triggered benzodiazepine dosing in a medical ward was associated with a shorter duration of benzodiazepine use and a lower incidence of severe complications of alcohol withdrawal.

ciwa-ar case study

This suggests that ratings on alcohol withdrawal symptoms on the very first day may miss certain set of symptoms, which appears on and around day two and are characterized by perceptual abnormality and delirium like picture.

The present study was carried out to explore the dimensionality of this scale in an attempt to identify a set of underlying factors that exist and can explain the interrelationships among various manifestations of acute alcohol withdrawal symptoms. Transferred off internal medicine service while receiving active treatment for withdrawal benzodiazepine dose within last 24 h.

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Evaluation of an Alcohol Withdrawal Protocol and a Preprinted Order Set at a Tertiary Care Hospital

N-methyl-D-aspartate glutamate receptors and alcoholism: The primary outcome was the duration of benzodiazepine treatment for alcohol withdrawal, defined as the time difference in hours between the first and last doses given in hospital, including doses given in the emergency department.

This factor may be a result of the practice of not using adrenergic medication on routine basis at our institute. It is known that autonomic arousal is an important mechanism in AWS; thus, other physiological measures and biological markers for objective assessment may be included in future studies. The authors alone are responsible for the content and writing of this paper.

For the clinical practice, it is advisable not to overdepend on rating scales and it must not replace a thorough clinical evaluation of the patient’s medical status in prediction of those at risk of severe alcohol withdrawal. Study sample includedonly male fulfilling ICD DCR World Health Organization [ 12 ] for alcohol dependence with currently withdrawal state, aged between 18 and 60 years, admitted within 24 hours of abstinence and patient himself or his guardian consenting for the study.

Factor Structure of CIWA-Ar in Alcohol Withdrawal

The averages of each rating of CIWA-Ar scores were computed to see the severity of withdrawal symptoms across time span of abstinence. Quality Assurance Outcomes Patterns of usage of the protocol in the post-protocol group were reviewed for quality assurance Table 5.

Strength of our study includes large sample size and not interfering with any medications or management strategies thus providing setting of casee conditions.

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