Working Toward a Gold Standard: The Severity of Ethanol Withdrawal Scale (SEWS) Versus the Clinical Institute Withdrawal Assessment Alcohol Scale (CIWA-Ar).

AIM: Proving the Severity of Ethanol Withdrawal Scale (SEWS) significantly reduces Alcohol Withdrawal Syndrome (AWS) treatment Time on Medication Protocol (TOMP). METHOD: Head-to-head Quality Assurance outcome compared separate cohorts of SEWS or Clinical Institute Withdrawal Assessment Alcohol Scale, Revised (CIWA-Ar) data using Student's t and Wilcoxon tests. RESULTS: SEWS-driven treatment (n = 244) reduced TOMP to 2.2 days versus 3.4 days for CIWA-Ar (n = 137); P < 0.0001. CONCLUSION: The SEWS is the superior measure of AWS symptoms.

Alcoholism: diagnosis, prognosis, epidemiology, and burden of the disease.

To the clinician, alcoholism can appear as an amorphous entity that is confusing with respect to diagnosis, treatment prognosis, and the role of the health professional, despite its high incidence and associated morbidities and mortality when unrecognized or untreated. This chapter focuses on the clinical application of current knowledge, with the aim of being useful to the practitioner in working directly with patients for whom alcoholism may or may not be an already identified problem. It briefly reviews large-scale studies and then focuses on diagnosis and prognosis assessment and decision making. Also considered are current controversies in nomenclature and the chapter ends with an economic perspective with respect to healthcare and cost to society. As the introductory chapter, the goal is to provide a context of the scope of alcoholism and attendant problems for the rest of the chapters.

Clinical assessment of psychological adaptive mechanisms in medical settings.

The psychological adaptive mechanism (PAM) model for systematic clinical assessment can be applied in any human setting in which individuals adapt to the conditions of their lives. This report focuses on applying the PAM assessment technique to the stress and anxiety of physical illness. To do so, we must consider maturity of PAMs simultaneously in relation to the cognitive functioning of the brain as assessed either in the office or at bedside. After considering case examples to illustrate this application, the discussion proceeds to include larger patient groups to which clinical PAM assessment might be applied, with special reference to cognitive function. The report concludes with suggestions for further improvement of the PAM clinical recognition method as well as its current practical applicability as an acquired clinical skill designed for use in everyday practice.