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Krcmarik KM, Hulley BJ, Huang J, Juang D, Cadman P, Urbiztondo C, Vo C, Vargas J, Motarjemi R, Moinizandi T, Kwan B. Assessment of a modified MINDS-based protocol for management of alcohol withdrawal syndrome on an inpatient medical service. Pharmacotherapy 2023; 43:1297-1306. [PMID: 37475509 DOI: 10.1002/phar.2855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/14/2023] [Accepted: 06/19/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVE To determine if a novel symptom-based alcohol withdrawal syndrome (AWS) protocol in a US Veterans cohort leads to significant clinical improvements in patient outcomes and safety. BACKGROUND Prior studies of AWS management, oftentimes using the revised version of the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) index, have demonstrated the effectiveness of symptom-triggered therapy for AWS. The Minnesota Detoxification Scale (MINDS) is an alternative to the CIWA-Ar index but remains unevaluated outside of the intensive care unit (ICU) setting. This study assesses outcomes in AWS management prior to and after the implementation of a novel MINDS-based AWS protocol (SDAWP) utilizing a revised MINDS index (MINDS-rev) in an inpatient medical ward setting. METHODS Retrospective cohort study including encounters prior to (n = 342) and after (n = 338) the implementation of the protocol. Pre- and post-protocol encounters were selected by combinations of diagnostic codes and charting elements. Outcome measures of AWS management were obtained in both groups. The primary endpoint was median total benzodiazepine exposure. Secondary outcomes included median length of hospitalization, median duration of benzodiazepine administration, and the incidence of complications. RESULTS The median total benzodiazepine exposure in the post-SDAWP group was significantly lower than the pre-SDAWP group (21.2 vs. 12.0 mg, p < 0.0001) and for a significantly shorter median duration of time (4.0 vs. 3.0 days, p < 0.0001). There was no significant difference in the median length of stay (4.0 vs. 4.0 days, p = 0.50). The incidence of delirium tremens (21 vs. 7, p = 0.01) and need for transfer to a higher level of care (33 vs. 12, p = 0.002) was significantly lower in the post-SDAWP group. CONCLUSION The SDAWP has provided significant improvements in AWS management in our institution and may potentially serve as a template for wider use in other inpatient settings.
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Affiliation(s)
- Kevin M Krcmarik
- Department of Internal Medicine, Section of Hospitalist Medicine, Jennifer Moreno Veterans Affairs Medical Center, San Diego, California, USA
| | - Benjamin J Hulley
- Department of Internal Medicine, Section of Hospitalist Medicine, Jennifer Moreno Veterans Affairs Medical Center, San Diego, California, USA
| | - Jiayi Huang
- Department of Pharmacy, Jennifer Moreno Veterans Affairs Medical Center, San Diego, California, USA
| | - Derek Juang
- Department of Internal Medicine, Section of Hospitalist Medicine, Jennifer Moreno Veterans Affairs Medical Center, San Diego, California, USA
| | - Peter Cadman
- Department of Internal Medicine, Section of Hospitalist Medicine, Jennifer Moreno Veterans Affairs Medical Center, San Diego, California, USA
| | - Charisma Urbiztondo
- Department of Pharmacy, Jennifer Moreno Veterans Affairs Medical Center, San Diego, California, USA
| | - Christine Vo
- Department of Pharmacy, Jennifer Moreno Veterans Affairs Medical Center, San Diego, California, USA
| | - Jaclyn Vargas
- Department of Internal Medicine, Section of Hospitalist Medicine, Jennifer Moreno Veterans Affairs Medical Center, San Diego, California, USA
| | - Ramin Motarjemi
- Department of Internal Medicine, Section of Hospitalist Medicine, Jennifer Moreno Veterans Affairs Medical Center, San Diego, California, USA
| | - Tarlan Moinizandi
- Department of Internal Medicine, Section of Hospitalist Medicine, Jennifer Moreno Veterans Affairs Medical Center, San Diego, California, USA
| | - Brian Kwan
- Department of Internal Medicine, Section of Hospitalist Medicine, Jennifer Moreno Veterans Affairs Medical Center, San Diego, California, USA
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Fenollal-Maldonado G, Brown D, Hoffman H, Kahlon C, Grossberg G. Alcohol Use Disorder in Older Adults. Clin Geriatr Med 2021; 38:1-22. [PMID: 34794695 DOI: 10.1016/j.cger.2021.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
As the number of older adults worldwide continues to grow, we observe a proportional growth of substance use. Despite the myriad of complications alcohol use disorder (AUD) has on the body with regards to organ systems and mental health, the topic has been underresearched in the older adult population. Thus, it is important to create awareness about the growing problem of AUD among older adults. In this way, we can mitigate the long-term complications and side effects observed with alcohol abuse in this vulnerable population.
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Affiliation(s)
- Gabriela Fenollal-Maldonado
- Department of Psychiatry and Behavioral Neuroscience, Division of Geriatric Psychiatry, St. Louis University School of Medicine, 1438 South Grand Boulevard, St Louis, MO 63104, US.
| | - Derek Brown
- Department of Psychiatry and Behavioral Neuroscience, Division of Geriatric Psychiatry, St. Louis University School of Medicine, 1438 South Grand Boulevard, St Louis, MO 63104, US
| | - Heidi Hoffman
- Saint Louis University School of Medicine, St. Louis University, 1438 South Grand Boulevard, St Louis, MO 63104, US
| | - Chanchal Kahlon
- Saint Louis University School of Medicine, St. Louis University, 1438 South Grand Boulevard, St Louis, MO 63104, US
| | - George Grossberg
- Department of Psychiatry and Behavioral Neuroscience, Division of Geriatric Psychiatry, St. Louis University School of Medicine, 1438 South Grand Boulevard, St Louis, MO 63104, USA
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Delirium Tremens in the Older Adult. J Neurosci Nurs 2020; 52:316-321. [PMID: 33156592 DOI: 10.1097/jnn.0000000000000543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Caring for patients experiencing alcohol withdrawal syndrome can be challenging. Patients 65 and older are at increased risk for alcohol withdrawal syndrome related complications. The higher prevalence of co-morbidities, including cognitive impairment, longer drinking history and greater sensitivity to alcohol withdrawal syndrome treatment are the result of decreased ability of the brain to adapt to stressors such as illness, trauma, or surgery. DELIRIUM TREMENS Symptoms may appear earlier from the last drink and present with a wide range of symptoms. The most effective interventions require high-quality nursing care delivery to prevent, decrease the severity and shorten the duration of delirium. NURSING IMPLICATIONS Strategies that help minimize these challenges starts with obtaining the patient's selfreport of their alcohol use history. Nurses should be diligent in their monitoring for signs of active alcohol withdrawal. Screening and assessment tools such as the Clinical Institute Withdrawal Assessment for Alcohol-Revised should guide pharmacological management. To support nurses in identifying delirium tremens, this manuscript seek to describe the underlying pathophysiology, key assessment components and nursing management of delirium tremens in the older adult.
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Kohli M, Charilaou P, Rousseau CP, Menezes R, Sanon M. Health care utilization in geriatric patients admitted with alcohol withdrawal from 2005 to 2014. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2020; 46:478-484. [PMID: 34780316 DOI: 10.1080/00952990.2020.1725539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 01/26/2020] [Accepted: 01/29/2020] [Indexed: 06/13/2023]
Abstract
BACKGROUND Alcohol-related and alcohol withdrawal (AW) hospitalizations are routinely underestimated in the geriatric population and can have a significant impact on healthcare resource utilization. OBJECTIVES To examine various patient-characteristics, hospitalization-outcomes, and prevalence of AW related-hospitalizations. METHODS In this retrospective study, we examined the objectives mentioned above over a 10-year period (2005 to 2014) using the Nationwide Inpatient Sample (NIS) in adults aged 65 years or older. National estimates of trends for AW prevalence and matched-regression analyses were conducted. RESULTS Increased prevalence of hospitalizations for AW was observed (148-cases-per-100,000-discharges in 2005 to 283-cases-per-100,000-discharges in 2014). Of the overall nationwide hospital admissions in patients aged 65 and older (128,111,787), 0.21% (264,786) with documented AW were identified. Of these, those of age 65-74 years accounted for 72.7% of admissions with the highest prevalence amongst males (males accounted for 74%, women 26%) and individuals of Caucasian ethnicity (79.9%).On comparing AW to Non-AW related-hospitalizations, patients admitted with AW had a higher median length of stay (five vs. four days), more significant functional decline with only 44.2% discharges being discharged home (vs. 47.2%) and 34.4% AW related discharges requiring discharge to skilled nursing facilities (vs. 28.5%). Higher hospitalization costs totaling $4,000 more on bivariate analysis were observed for the AW group. CONCLUSIONS The prevalence of admissions with AW has increased in the inpatient geriatric population, contributing to increased length of stay, higher hospitalization costs, and greater functional decline. Recognition of these findings and the development of programs supporting older adults with alcohol use disorder may improve patient outcomes.
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Affiliation(s)
- Maanit Kohli
- Division of Hospital Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Paris Charilaou
- Division of Gastroenterology & Hepatology, Saint Peter's University Hospital/Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Carl-Philippe Rousseau
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Martine Sanon
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Evaluation of a Symptom-triggered Protocol for Alcohol Withdrawal for Use in the Emergency Department, General Medical Wards, and Intensive Care Unit. J Psychiatr Pract 2019; 25:63-70. [PMID: 30633735 DOI: 10.1097/pra.0000000000000354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Alcohol withdrawal is common in hospitalized patients and symptom-triggered guidelines have been shown to reduce treatment duration, length of stay, and need for mechanical ventilation. OBJECTIVES To assess the feasibility of incorporating symptom-triggered alcohol withdrawal guidelines early in the hospital course and to evaluate outcomes of patients before and after implementation of the guidelines. METHODS This was a retrospective pre-post study of adult patients admitted from the emergency department to an urban, academic, tertiary care center. Subjects in the preguideline (PRE) group were given benzodiazepines in a nonprotocolized manner at the discretion of the treating physician, whereas subjects in the postguideline (POST) group were treated according to the alcohol withdrawal guidelines with treatment beginning in the emergency department. RESULTS The PRE group involved 113 admissions for severe alcohol withdrawal and the POST group involved 103 admissions for severe alcohol withdrawal. The median benzodiazepine dose per day, in milligrams of chlordiazepoxide, was higher in the POST group (100 mg in the PRE group vs. 141 mg in the POST group; P<0.02). A higher percentage of patients in the POST group were admitted to the intensive care unit (4.4% in the PRE group vs. 12.6% in the POST group; P=0.05); however, more patients in the PRE group than in the POST group received continuous intravenous sedation and mechanical ventilation, although the difference was not statistically significant (P=0.37 for both variables). There was no difference between the 2 groups in length of stay in the intensive care unit or hospital or discharge disposition. CONCLUSIONS Incorporating symptom-triggered guidelines for alcohol withdrawal early in the hospital course at a large medical center is feasible. This approach may result in increased benzodiazepine use, but it seems that it is safe and does not result in adverse outcomes.
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Abstract
This quality improvement project evaluates the effectiveness of implementing an evidence-based alcohol withdrawal protocol in an acute care setting. Patient outcomes, length of stay, and nurses' knowledge and satisfaction with care are compared pre- and postimplementation. Implementation resulted in significant reduction of restraint use, transfers to critical care, 1:1 observation, and length of stay, whereas no reduction was seen in rapid response calls. Nurses' knowledge post-alcohol withdrawal protocol education increased and satisfaction with patient care improved.
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Occurrence, Predictors, and Prognosis of Alcohol Withdrawal Syndrome and Delirium Tremens Following Traumatic Injury. Crit Care Med 2017; 45:867-874. [DOI: 10.1097/ccm.0000000000002371] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Wetterling T, Junghanns K. Substance Abuse in Older Psychiatric Inpatients. SUCHT-ZEITSCHRIFT FUR WISSENSCHAFT UND PRAXIS 2017. [DOI: 10.1024/0939-5911/a000476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Abstract. Aim: This study investigates the characteristics of older patients with substance abuse disorders admitted to a psychiatric department serving about 250.000 inhabitants. Methods: The clinical diagnoses were made according to ICD-10. The data of the patients with substance abuse were compared to a matched sample of psychiatric inpatients without substance abuse as well as to a group of former substance abusers with long-term abstinence. Results: 19.3 % of the 941 patients aged > 65 years showed current substance abuse, 9.4 % consumed alcohol, 7.9 % took benzodiazepines or z-drugs (zolpidem and zopiclone), and 7.0 % smoked tobacco. Multiple substance abuse was rather common (30.8 %). About 85 % of the substance abusers had psychiatric comorbidity, and about 30 % showed severe withdrawal symptoms. As with the rest of the patients, somatic multimorbidity was present in about 70 % of the substance abusers. Remarkable was the lower rate of dementia in current substance abusers. Conclusion: These results underscore that substance abuse is still a challenge in the psychiatric inpatient treatment of older people.
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Affiliation(s)
- Tilman Wetterling
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum Kaulsdorf, Berlin, Germany
| | - Klaus Junghanns
- Department of Psychiatry and Psychotherapy, University of Lübeck, Germany
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DiBartolo MC, Jarosinski JM. Alcohol Use Disorder in Older Adults: Challenges in Assessment and Treatment. Issues Ment Health Nurs 2017; 38:25-32. [PMID: 27936333 DOI: 10.1080/01612840.2016.1257076] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Alcohol use disorder (AUD) is a common, under-recognized, and under-treated health concern in older adults. Its prevalence is expected to reach unprecedented levels as the U.S. population ages; consequently, it is poised to place a significant burden on the healthcare system. Given the growing body of evidence regarding the patterns of use in this age group and the serious consequences of its misuse, it is critical that nurses and other healthcare providers assess for AUD in order to identify older adults in need of treatment. Yet, differences in symptom presentation, problems in isolating the symptoms of AUD from other healthcare complaints associated with aging, as well as the denial and fear of stigma that is especially pervasive in this age group, are major barriers to its identification and subsequent treatment. Furthermore, the lack of consistent use of evidence-based, age-specific screening instruments to identify those at risk is another significant obstacle to successful treatment. Healthcare providers in primary care are especially well-positioned to perform a systematic assessment utilizing appropriate instruments to identify AUD and initiate age-specific interventions, including the use of alcohol screening and brief interventions (ASBIs). The use of ASBIs, along with other targeted interventions such as mutual help groups (MHGs), such as Alcoholics Anonymous, can be key in encouraging insight, dismantling denial, and supporting treatment success, lifelong recovery, and overall quality of life in this vulnerable group.
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Affiliation(s)
- Mary C DiBartolo
- a Salisbury University , Department of Nursing , Salisbury , Maryland , USA
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Le Roux C, Tang Y, Drexler K. Alcohol and Opioid Use Disorder in Older Adults: Neglected and Treatable Illnesses. Curr Psychiatry Rep 2016; 18:87. [PMID: 27488204 DOI: 10.1007/s11920-016-0718-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The purpose of this article is to provide an overview of alcohol use disorder (AUD) and opioid use disorder (OUD) in older adults for general psychiatrists. The rapid growth of the geriatric population in the USA has wide-ranging implications as the baby boomer generation ages. Various types of substance use disorders (SUDs) are common in older adults, and they often take a greater toll on affected older adults than on younger adults. Due to multiple reasons, SUDs in older adults are often under-reported, under-detected, and under-treated. Older adults often use substances, which leads to various clinical problems. Space limitations prevents a comprehensive review; therefore, we primarily focus on alcohol use disorder and the problem of opioid use disorder, with more emphasis given to the latter, because the opioid use epidemic in the USA has gained much attention. We reviewed the literature on the topics, integrated across geriatric psychiatry, addiction psychiatry, research, and national trends. We discuss unique vulnerabilities of older adults to SUDs with regard to management of SUDs in older adults, medication-assisted treatment (MAT), and psychosocial treatments. We encourage general psychiatrists to raise their awareness of SUDs in older adults and to provide brief intervention or referral for further assessment.
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Affiliation(s)
- Christoffel Le Roux
- Atlanta VA Medical Center, Mental Health Service Line (116), 1670 Clairmont Road, Atlanta, GA, 30033, USA.,Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA
| | - Yilang Tang
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 12 Executive Park Drive NE, Atlanta, GA, 30329, USA
| | - Karen Drexler
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA. .,Addictive Disorders, VA Central Office, Washington, D.C., Atlanta VA Medical Center, Mental Health Service Line (116), 1670 Clairmont Road, Atlanta, GA, 30033, USA.
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Eberly ME, Lockwood AG, Lockwood S, Davis KW. Outcomes After Implementation of an Alcohol Withdrawal Protocol at a Single Institution. Hosp Pharm 2016; 51:752-758. [PMID: 27803505 DOI: 10.1310/hpj5109-752] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: There are varying dosing strategies for the administration of benzodiazepines in the setting of alcohol withdrawal. In October 2014, a symptom-based alcohol withdrawal protocol (AWP) using the Clinical Institute Withdrawal Assessment of Alcohol, Revised (CIWA-Ar) scale was implemented at one institution. Objective: To evaluate the safety and efficacy of the AWP. Methods: Retrospective chart review was completed, including patients receiving at least one dose of diazepam for alcohol withdrawal pre- and post-protocol. The primary outcome of this study was the average daily and cumulative dose of diazepam during hospital stay. Secondary outcomes included length of stay and occurrence of seizures or delirium tremens. Results: The average daily dose and the average cumulative dose of diazepam were significantly lower in the post-protocol group (5.4 vs 12.1 mg, p < .001; 35.0 vs 77.6 mg, p < .001, respectively). Length of stay was similar between groups (6.5 vs 6.4 days, p = .91), however, duration of benzodiazepine use was decreased in the post-protocol group (2.2 vs 4.7 days, p < .001). Despite using reduced doses of benzodiazepines, there was no increase in adverse events. Conclusions: The implementation of a symptom-based AWP using the CIWA-Ar scale was associated with a reduced average daily and cumulative dose of diazepam without any apparent safety issues.
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Dixit D, Endicott J, Burry L, Ramos L, Yeung SYA, Devabhakthuni S, Chan C, Tobia A, Bulloch MN. Management of Acute Alcohol Withdrawal Syndrome in Critically Ill Patients. Pharmacotherapy 2016; 36:797-822. [DOI: 10.1002/phar.1770] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Deepali Dixit
- Ernest Mario School of Pharmacy; Rutgers, The State University of New Jersey; Piscataway New Jersey
- Critical Care; Robert Wood Johnson University Hospital; New Brunswick New Jersey
| | | | - Lisa Burry
- Mt. Sinai Hospital; University of Toronto; Toronto Ontario Canada
| | - Liz Ramos
- New York-Presbyterian Weill Cornell Medical Center; New York New York
| | | | | | - Claire Chan
- Yale-New Haven Hospital; New Haven Connecticut
| | - Anthony Tobia
- Division of Psychiatry; Rutgers Robert Wood Johnson Medical School; New Brunswick New Jersey
| | - Marilyn N. Bulloch
- Harrison School of Pharmacy; Auburn University; Auburn Alabama
- Department of Internal Medicine; College of Community Health Sciences; University of Alabama; Tuscaloosa Alabama
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Bacon O, Robert S, VandenBerg A. Evaluating nursing satisfaction and utilization of the Clinical Institute Withdrawal Assessment for Alcohol, revised version (CIWA-Ar). Ment Health Clin 2016; 6:114-119. [PMID: 29955457 PMCID: PMC6007649 DOI: 10.9740/mhc.2016.05.114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction The Clinical Institute Withdrawal Assessment for Alcohol, revised version (CIWA-Ar), developed and validated for research, is used in our inpatient academic medical center. We sought to assess nursing satisfaction with the scale itself, training for using the scale, and nursing staff use of the CIWA-Ar. Methods A retrospective chart review included all patients with an order for CIWA-Ar between August 1, 2014, and September 30, 2014. Data collected included demographics, admitting diagnosis, vital signs, admission blood alcohol level, lorazepam total daily dose, and CIWA-Ar scores. Nursing staff was sent an anonymous, 26-question survey in January 2015. The survey collected demographics, training history, and recommendations for modifications to the CIWA-Ar. Results During the 2-month period, 274 patients had orders for CIWA-Ar, with 113 receiving at least one dose of lorazepam. Lorazepam was not given to 21% of patients when they scored >8 on the CIWA-Ar, whereas 71% of patients received a dose of lorazepam when they had a CIWA score <8. The survey was sent to 2011 clinical nurses, with 284 responses received (14% response rate). Only 36% of responding nurses felt adequately trained to administer the CIWA-Ar. Most nurses preferred on-the-job and online training methods. Discussion Nursing use of the CIWA-Ar could be optimized at this institution. Fewer than half of respondents reported feeling adequately training to administer the CIWA-Ar. Results will be used to improve training for nursing staff regarding scoring of the CIWA-Ar and administering lorazepam to treat alcohol withdrawal syndrome.
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Affiliation(s)
- Opal Bacon
- PGY-2 Psychiatric Pharmacy Resident, Medical University of South Carolina (MUSC) Medical Center, Charleston, South Carolina,
| | - Sophie Robert
- Clinical Pharmacy Specialist, MUSC Medical Center, Charleston, South Carolina
| | - Amy VandenBerg
- Clinical Pharmacy Specialist, MUSC Medical Center, Charleston, South Carolina
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Monte-Secades R, Rabuñal-Rey R, Guerrero-Sande H. Síndrome de abstinencia alcohólica en pacientes hospitalizados. Rev Clin Esp 2015; 215:107-16. [DOI: 10.1016/j.rce.2014.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 10/15/2014] [Accepted: 11/10/2014] [Indexed: 10/24/2022]
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Inpatient alcohol withdrawal syndrome. Rev Clin Esp 2015. [DOI: 10.1016/j.rceng.2014.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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