[Health Care Organization - The New German S3-Guideline on Alcohol-Related Disorders and its Relevance for Health Care]. / Versorgungsorganisation ­ Die neue S3-Leitlinie Alkohol und ihre Bedeutung für die Versorgungspraxis.

BACKGROUND: Alcohol dependence is one of the most serious diseases of addiction in Germany. The new S3-guideline "Screening, Diagnostics and Treatment of Alcohol-Related Disorders" has been presented in 2015 and summarizes the present state of knowledge pertaining to the diagnosis and treatment of alcohol abuse and alcohol dependence. METHODS: This guideline was developed over four years within the framework of the Association of the Scientific Medical Societies in Germany (AWMF). The German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) and the German Society for Research and Therapy in Addiction (DG-Sucht) took the lead in the organization. More than 50 professional societies and associations and health organizations as well as more than 60 acknowledged experts were involved, including networks of self-help groups and relatives. The working group on "health care organization", whose results are presented here, was one out of thirteen working groups, focusing on the task how to implement the guideline under the basic conditions of the German health care system with its sectors and interfaces. RESULTS: For the chapter on "health care organization" 27 recommendations have been consented. Many of these have been prepared by the respective working groups. These recommendations cover areas such as screening, diagnostics and short interventions, detoxification and withdrawal as well as pharmacotherapy, physical complications and psychic comorbidity, medical rehabilitation and other forms of post-acute treatment, primary care by general practitioners, as well as specific target groups such as children and adolescents, (pregnant) women and the elderly, and, in addition, self-help approaches. CONCLUSION: For needs-based diagnostics and treatment of alcohol-related disorders, guideline-based recommendations for health care organization offer a framework for the cooperation and coordination of all health sectors and occupational groups, especially with respect to their interfaces. This includes the cooperation between the medical and the psychosocial system and stretches from harm reduction to social inclusion of people concerned. Particularly the field of rehabilitation with its explicit aims for participation relies heavily on such a cooperation.

T-wave response: a sensitive test for latent alcoholic polyneuropathy.

To date, the H-reflex is the most sensitive test to measure nerve conduction velocity in alcoholic polyneuropathy. Analogous to the H-reflex, we investigated the T-wave response from the soleus muscle using a hand-held reflex hammer. Twenty-four inpatients suffering from chronic alcoholism and 24 healthy volunteers were recruited. All probands had a careful neurological examination and were graded (PNP-classifications). The T- and H-reflexes were measured. In the clinical examination, only a few patients exhibited symptoms of alcoholic PNP. However, when the autonomic nervous system was also tested, 50% exhibited signs of alcoholic PNP. Both the T- and H-reflex responses were pathologically retarded, indicating latent alcoholic PNP in 60% of the patients. Thus the main finding in our study is the difference between clinical and electrophysiological examinations: only a few of the patients had neurological symptoms for alcoholic PNP but 14 patients (60%) exhibited a so-called latent, subclinical alcoholic PNP by showing delayed reflex latencies. Measuring the T-wave proved to be a simple and painless screening method for diagnosis and monitoring of alcoholic PNP. Among the clinical tests the best indicator for alcoholic PNP was the test for autonomous alcoholic PNP.