Management of medically assisted withdrawal from alcohol in acute adult mental health and specialist addictions in-patient services: UK clinical audit findings.

BACKGROUND: Medically assisted alcohol withdrawal (MAAW) is increasingly undertaken on acute adult psychiatric wards. AIMS: Comparison of the quality of MAAW between acute adult wards and specialist addictions units in mental health services. METHOD: Clinical audit conducted by the Prescribing Observatory for Mental Health (POMH). Information on MAAW was collected from clinical records using a bespoke data collection tool. RESULTS: Forty-five National Health Service (NHS) mental health trusts/healthcare organisations submitted data relating to the treatment of 908 patients undergoing MAAW on an acute adult ward or psychiatric intensive care unit (PICU) and 347 admitted to a specialist NHS addictions unit. MAAW had been overseen by an addiction specialist in 33 (4%) of the patients on an acute adult ward/PICU. A comprehensive alcohol history, measurement of breath alcohol, full screening for Wernicke's encephalopathy, use of parenteral thiamine, prescription of medications for relapse prevention (such as acamprosate) and referral for specialist continuing care of alcohol-related problems following discharge were all more commonly documented when care was provided on a specialist unit or when there was specialist addictions management on an acute ward. CONCLUSIONS: The findings suggest that the quality of care provided for medically assisted withdrawal from alcohol, including the use of evidence-based interventions, is better when clinicians with specialist addictions training are involved. This has implications for future quality improvement in the provision of MAAW in acute adult mental health settings.

Wearable resistance sprint running is superior to training with no load for retaining performance in pre-season training for rugby athletes.

This study determined the effects of a six-week lower-limb wearable resistance training (WRT) intervention on sprint running time, velocity, and horizontal force-velocity mechanical variables. Twenty-two collegiate/semi-professional rugby athletes completed pre- and post-intervention testing of three maximal effort 30 m sprints. A radar device was used to measure sprint running velocity from which horizontal force-velocity mechanical profiling variables were calculated. All athletes completed two dedicated sprint training sessions a week for six-weeks during pre-season. The intervention (wearable resistance, WR) group completed the sessions with 1% body mass load attached to the left and right shanks (i.e. 0.50% body mass load on each limb), whilst the control group completed the same sessions unloaded. For the control group, all variables were found to detrain significantly (p ≤ 0.05) over the training period with large detraining effects (ES > 0.80) for theoretical maximal horizontal force, slope of the force-velocity profile, maximal ratio of force, index of force application, 5 and 10 m times. For the WR group, there were no significant changes to any recorded variables (all p > 0.05) and all effects of training were trivial or small (ES < 0.50). After adjustment for baseline differences, significant between group differences were found for all variables (large effects, ES > 0.80) except theoretical maximal velocity, 30 m time, and maximal velocity. The addition of light wearable resistance to sprint training during a six-week pre-season block enables the maintenance of sprint performance and mechanical output qualities that otherwise would detrain due to inadequate training frequencies.