RESUMO
BACKGROUND: Alcohol withdrawal delirium is the most serious manifestation of alcohol withdrawal. Evidence suggests that appropriate care improves mortality, but systematic reviews are unavailable. METHODS: Articles with original data on management of alcohol withdrawal delirium underwent structured review and meta-analysis. RESULTS: Meta-analysis of 9 prospective controlled trials demonstrated that sedative-hypnotic agents are more effective than neuroleptic agents in reducing duration of delirium and mortality, with a relative risk of death when using neuroleptic agents of 6.6. Statistically significant differences among various benzodiazepines and barbiturates were not found. No deaths were reported in 217 patients from trials using benzodiazepines or barbiturates. CONCLUSIONS: Control of agitation should be achieved using parenteral rapid-acting sedative-hypnotic agents that are cross-tolerant with alcohol. Adequate doses should be used to maintain light somnolence for the duration of delirium. Coupled with comprehensive supportive medical care, this approach is highly effective in preventing morbidity and mortality.
Assuntos
Delirium por Abstinência Alcoólica/tratamento farmacológico , Medicina Baseada em Evidências/normas , Delirium por Abstinência Alcoólica/economia , Antipsicóticos/economia , Antipsicóticos/normas , Antipsicóticos/uso terapêutico , Benzodiazepinas/economia , Benzodiazepinas/normas , Benzodiazepinas/uso terapêutico , Ensaios Clínicos Controlados como Assunto , Custos e Análise de Custo , Gerenciamento Clínico , Humanos , Metanálise como Assunto , Estudos Prospectivos , Agitação Psicomotora/tratamento farmacológico , Agitação Psicomotora/economiaRESUMO
The Drug Addiction Treatment Act of 2000 (DATA-2000) allows qualified physicians to treat opioid-dependent patients with schedule III-V medications, such as buprenorphine, in practices separate from licensed, accredited opioid treatment programs. Physicians may attain this qualification by completing 8-hours of training in treating opioid dependence. This paper describes the evaluation of a faculty development workshop designed to enhance teaching skills of small-group facilitators involved with DATA-2000 training sessions. This workshop coached the facilitators on their teaching roles in the DATA-2000 session through experiential practice of patient- case discussions related to treatment of opioid-dependence. Descriptive questionnaires evaluated the value of the workshop. Twenty-six facilitators participated in the workshops. Paired mean score responses for specific teaching skill abilities demonstrated statistically significant improvement in all categories. Evaluation of the DATA-2000 training session small-group facilitators was uniformly positive. This faculty development workshop was successful in improving teaching skills for our small-group faculty facilitators.
