Implementing an Alcohol Withdrawal Protocol: A Quality Improvement Project.

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.

Alcohol use and congestive heart failure: incidence, importance, and approaches to improved history taking.

Alcohol use, abuse, and dependence have the potential to result in alcoholic cardiomyopathy (ACM). This distinct form of congestive heart failure (CHF) is responsible for 21-36% of all cases of nonischemic dilated cardiomyopathy in Western society. Without complete abstinence, the 4-year mortality for ACM approaches 50%. Therefore, accurate and detailed assessment of alcohol use in congestive heart failure is essential. The prevalence of problematic alcohol use is unrecognized by many clinicians. Clinical assessment of alcohol intake is often reduced to a simple question such as, "Do you drink?" Denial and minimization are hallmarks of alcohol abuse, with many individuals underreporting their use of alcohol. Clinicians can overcome these hurdles by implementing practical history taking measures to improve the accuracy of self-reported alcohol use. The data regarding the dangers of ongoing alcohol use in individuals with ACM make attempts to engage individuals in treatment to support abstinence essential. Suggestions for detailed and accurate assessment are discussed.

Symptom perception in CHF: (why mind matters).

Symptoms utilized in the clinical care of heart failure as markers of disease severity include, dyspnea, insomnia, low energy, fatigue, poor appetite, and diminished memory. This is despite the fact that physiologic variables such as cardiac ejection fraction and oxygen consumption do not accurately predict functional state in individuals with congestive heart failure (CHF). Distress (anxiety and depression) may amplify symptom complaints without associated physiologic aberration. Personality traits and psychiatric illness, such as mood, anxiety, and psychotic illnesses may also alter perception of somatic symptoms that are associated with this chronic illness. The impact of distress and its treatment on functional performance and CHF symptom reporting deserve additional attention. The need to screen for distress in all with serious symptomatic heart failure is certain.

Psychiatric assessment in transplantation

A implementaçäo da figura do doador presumido e as recentes mudanças na regulamentaçäo do transplante no Brasil iräo aumentar a disponibilidade de órgäos no país. O avanço no cuidado de doentes portadores de insuficiência grave de órgäos, por sua vez, irá aumentar a demanda por esses mesmos órgäos. Há considerável literatura apoiando o envolvimento de psiquiatras no processo de seleçäo dos candidatos ao transplante. Pesquisas mostram que fatores psicossociais influenciam na adesäo ao tratamento e, conseqüentemente, no prognóstico destes pacientes. A partir de uma revisäo da literatura existente, articula-se os componentes e lógicas de uma avaliaçäo psicossocial abrangente, propondo sua inserçäo na avaliaçäo pré-operatória dos pacientes para o recebimento de órgäo