RESUMEN
While insecurity can affect students in any field of study, those studying to become nurses are particularly badly off. Receiving lower internship allowances than other students, depending on the region and not on the regional center for university and school works, they also have to deal with a very busy training program. Many of them then turn to temporary work, which allows them to earn what they need to continue learning their future profession. This situation should no longer exist in 2023: all students should be able to train under good conditions.
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Bachillerato en Enfermería , Estudiantes de Enfermería , Humanos , Aprendizaje , Universidades , EmpleoRESUMEN
Benzodiazepines (BZDs) are the first-line treatment of alcohol withdrawal. Comorbidity between benzodiazepine use disorder (BUD) and alcohol use disorders (AUD) is common. However, the risk factors are poorly characterized due to the paucity of available BUD screening tools. The present study aimed to rectify this by conducting an observational screening investigation for BUD in patients hospitalized for alcohol detoxification in a specialized unit. During a face-to-face interview, a short BUD screening tool, Echelle Cognitive d'Attachement aux benzodiazépines (ECAB), was administered to record recent patterns of BZD use, thereby allowing categorization of AUD patients as follows: non-BZD users, BZD users without BUD, and BUD (ECAB ≥6). Clinical and sociodemographic risk factors were identified and recorded during clinical assessment and were analyzed using nonparametric bivariate tests and multinomial regression for association with BUD, with p < 0.05 for significance. Of the 150 AUD patients, 23 (15%) had comorbid BUD. Several variables were associated with ECAB score, with their independence being verified using multinomial regression, with lower risk of BUD versus BZD use, when the initial prescriber was an addiction specialist compared with a psychiatrist or a general practitioner [odds ratio (OR) = 0.12, 95% confidence interval (CI) = 0.14-0.75]. A higher risk of BZD use versus no use was evident when comorbid psychiatric disorders were present (OR = 9.2, 95%CI = 1.3-65). Our findings raise clinicians' awareness that in patients hospitalized for alcohol detoxification, BUD is highly prevalent but not specifically related to psychiatric disorders. BUD can be effectively screened by utilization of the ECAB.
Asunto(s)
Alcoholismo , Síndrome de Abstinencia a Sustancias , Trastornos Relacionados con Sustancias , Humanos , Alcoholismo/diagnóstico , Alcoholismo/epidemiología , Alcoholismo/tratamiento farmacológico , Benzodiazepinas/efectos adversos , Síndrome de Abstinencia a Sustancias/tratamiento farmacológico , Prevalencia , Trastornos Relacionados con Sustancias/diagnóstico , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/terapia , HospitalizaciónRESUMEN
The disease progression of severe alcohol-related cognitive impairment (ARCI) is debated. The aim of this study was to compare the cognitive change of patients with severe ARCI in inpatient setting to that of patients with Alzheimer's disease (AD). Fifteen consecutive patients with severe ARCI were recruited between 2013 and 2015. They received inpatient detoxification, neurological assessment, and inpatient cognitive rehabilitation in specialized facilities. Twelve patients, with documented AD matched on sex and initial cognitive impairment severity, were selected. All have benefited from two neuropsychological assessments. The neurocognitive change was tested in both groups with pair-wised Wilcoxon tests. ARCI and AD patients' time course was compared with Mann-Whitney-Wilcoxon test. In ARCI group, first assessment occurred at 2.9 (± 2.2) months of abstinence and follow-up 6.5 (± 2.9) months later, the mean age was 56.5 (± 7.4) years, and 12 were men. In AD group, follow-up occurred at 12.8 (± 2.9) months (p < 10-3), the mean age was 72.3 (± 8.4) years (p < 10-3), and 10 were men. ARCI patients significantly improved on one executive function test (TMT-B; p < 0.05), while AD patients have worsened memory subtests on Free-and-Cued-Selective-Reminding Test (p < 0.05). These tests showed a statistically different change between severe ARCI and AD group (p < 0.05). Severe ARCI patients have improved in executive functioning, discernible on the TMT-B test, in specific care setting, including abstinence maintenance and rehabilitation. The disease progression was different from that observed in AD patients.
RESUMEN
BACKGROUND: The prevalence of cognitive impairment is high among alcohol-dependent patients. Although the clinical presentation of alcohol-related cognitive disorder (ARCD) may resemble that of Alzheimer's disease (AD), the prognosis and treatment of the 2 diseases are different. Cerebrospinal fluid (CSF) biomarkers (tau, phosphorylated tau, and amyloid ß) have high diagnostic accuracy in AD and are currently being used to discriminate between psychiatric disorders and AD, but are not used to diagnose ARCD. The aim of this study was to characterize CSF biomarkers in a homogeneous, cognitively impaired alcohol-dependent population. METHODS: This single-center study was conducted in an addiction medicine department of a Parisian Hospital. We selected patients with documented persistent cognitive impairment whose MoCA (Montreal Cognitive Assessment) score was below 24/30 after at least 1 month of documented inpatient abstinence from alcohol. We measured the CSF biomarkers (tau, phosphorylated tau, and amyloid ß 1-42 and 1-40) in 73 highly impaired alcohol-dependent patients (Alcohol Use Disorders Identification Test score over 11 for women and 12 for men) with. RESULTS: Patients' average age was 60 ± 9.1 years and 45 (61.6%) had a normal CSF profile, 8 (11.0%) had a typical CSF AD profile, and 20 (27.4%) had an intermediate CSF profile. CONCLUSIONS: This study revealed a high prevalence of AD in alcohol-dependent patients with persistent cognitive deficits and several anomalies in their CSF profiles. Thus, it is important to consider AD in the differential diagnosis of persistent cognitive deficits in patients with alcohol dependence and to use CSF biomarkers in addition to imaging and neuropsychological testing to evaluate alcohol-related cognitive impairment.
Asunto(s)
Alcoholismo/líquido cefalorraquídeo , Alcoholismo/epidemiología , Disfunción Cognitiva/líquido cefalorraquídeo , Disfunción Cognitiva/epidemiología , Anciano , Alcoholismo/diagnóstico , Enfermedad de Alzheimer/líquido cefalorraquídeo , Enfermedad de Alzheimer/diagnóstico , Enfermedad de Alzheimer/epidemiología , Biomarcadores/líquido cefalorraquídeo , Disfunción Cognitiva/diagnóstico , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Estado Nutricional/fisiología , Estudios RetrospectivosRESUMEN
Providing an on-site immediate diagnosis of Chronic Obstructive Pulmonary Disease (COPD) and lung age in tobacco smokers could be a motivational tool for smoking cessation. Our aim was to investigate the effects of an abnormal spirometry results on motivational change and subsequent smoking cessation. We conducted a retrospective analysis of smoking status after 3 months of tobacco counseling. Patients were recruited in an addiction outpatient center. Spirometry results were obtained with a portable device during the first visit. The sample was thus divided in 3 groups: COPD, subthreshold-group (no COPD but abnormal lung age) and normal spirometry. Among the three groups, we compared the immediate motivation change, difference in Q-MAT motivation scale score after minus before spirometry (Kruskal-Wallis test) and the smoking status after 3 months (Fisher test). We included 48 patients (37 males, median age 44 years, median cigarette-per-day 20). Spirometry results divided the sample in COPD (N = 13), subthreshold (N = 11) and normal group (N = 24). Mean Q-MAT score change after spirometry was different between groups (p = 0.019), greater in COPD (4.62 ± 3.38) than normal group (1.46 ± 3.11), and lower in patient with a co-occuring hazardous alcohol use (p = 7.6 × 10-3). Three-months smoking status was different between spirometry results groups (p = 0.0021). COPD (5/13, 38.5%) and subthreshold patients (6/10, 60.0%) had stopped more frequently than patients from the normal-group (2/22, 9.1%). The effect of immediate spirometry results on motivation to quit varies according to the screened pulmonary damages and hazardous alcohol use. It could be a useful tool in addiction treatment centers.
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Alcoholismo/rehabilitación , Pulmón/fisiopatología , Abuso de Marihuana/rehabilitación , Motivación , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Cese del Hábito de Fumar , Fumar Tabaco/fisiopatología , Adulto , Anciano , Alcoholismo/complicaciones , Femenino , Francia , Humanos , Masculino , Abuso de Marihuana/complicaciones , Tamizaje Masivo , Persona de Mediana Edad , Entrevista Motivacional , Educación del Paciente como Asunto , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Estudios Retrospectivos , Espirometría , Centros de Tratamiento de Abuso de Sustancias , Trastornos Relacionados con Sustancias/complicaciones , Trastornos Relacionados con Sustancias/rehabilitación , Fumar Tabaco/terapia , Adulto JovenRESUMEN
PURPOSE: Brain positron emission tomography using 18F-fluorodeoxyglucose (18FDG-PET) provides a metabolic assessment of brain function that is useful for differential diagnosis among several neurodegenerative diseases manifested by cognitive impairment (CI). The purpose of the study is to describe the pattern of 18FDG-PET abnormalities in patients with CI related to alcohol use disorder. METHODS: Patients admitted to the addiction medicine department of a university hospital in Paris between January 2017 and October 2018 with a confirmed diagnosis of alcohol-related cognitive impairment (ARCI) or Wernicke encephalopathy (WE) were included. Brain 18FDG-PET uptake was measured after at least 1 month of monitored abstinence from alcohol. Standardized uptake values were obtained for 13 regions of interest (ROI) and normalized to the pons. Individual patients' ROI Z-scores were calculated from healthy sex- and age-matched controls provided by Cortex ID software. RESULTS: Twenty-five patients were included in the analysis (20 males and 5 females; mean age 57.6 years (45-76 years old)). The group consisted of 19 ARCI and 6 WE cases. The mean hypometabolism was most severe in the prefrontal medial cortex (PFM) (- 2.80 (± 1.30)), the prefrontal lateral cortex (- 2.20 (± 1.35)), and the anterior cingulate cortex (- 2.24 (± 1.19)). Hypometabolism (Z-score < - 2) was most frequent in the PFM (72.0% of the sample, N = 18). Other regions were also affected (with 5.32/13 hypometabolic ROIs on average (SD = 4.16, range 0-13)). The Z-scores in the 13 ROIs did not differ significantly between the ARCI and WE patients (p ≥ 0.05). CONCLUSIONS: Predominant prefrontal and cingulate cortex hypometabolism was the most frequent brain 18FDG-PET pattern in our sample of patients with ARCI and WE.
Asunto(s)
Disfunción Cognitiva , Fluorodesoxiglucosa F18 , Anciano , Encéfalo/diagnóstico por imagen , Disfunción Cognitiva/complicaciones , Disfunción Cognitiva/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tomografía de Emisión de Positrones , Tomografía Computarizada por Rayos XRESUMEN
Benzodiazepines and Z-drugs have pharmacodynamic effects with tolerance that can occur quickly, after one week to one month of treatment and that concerns hypnotic and anxiolytic properties in particular. Old studies showed a real but poor short-term efficacy of benzodiazepines on anxiety and sleep disturbances. Long-term efficacy of benzodiazepines can be confused with the occurrence of rebound effect, discontinuation symptoms or relapse when the treatment is quitted; they contribute to an apparent efficacy, as well as the symptoms removal when treatment is re-initiated. Pharmacologic tolerance exists with respects to efficacy and side effects that decrease over time, in the first weeks of treatment. Its main associated characteristic is the occurrence of a severe withdrawal syndrome when treatment is quitted. To limit long-term treatments, it is relevant to target treatment initiation of benzodiazepines and to restrict indications and treatment duration. Addiction to benzodiazepines is frequent in patients treated for another addiction; it is associated with more frequent complications, in particular overdoses and suicide attempts. The use of benzodiazepines is necessary to prevent complications during alcohol or benzodiazepine withdrawal, but duration of treatment should be limited and dispensing should be supervised in patients with substance use disorders.
Asunto(s)
Trastornos de Ansiedad/tratamiento farmacológico , Benzodiazepinas/administración & dosificación , Trastornos del Inicio y del Mantenimiento del Sueño/tratamiento farmacológico , Trastornos de Ansiedad/sangre , Benzodiazepinas/efectos adversos , Benzodiazepinas/farmacocinética , Esquema de Medicación , Interacciones Farmacológicas/fisiología , Tolerancia a Medicamentos , Semivida , Humanos , Cuidados a Largo Plazo , Tasa de Depuración Metabólica/fisiología , Recurrencia , Trastornos del Inicio y del Mantenimiento del Sueño/sangre , Trastornos Relacionados con Sustancias/sangre , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/prevención & control , Resultado del TratamientoRESUMEN
Intranasal naloxone aims at preventing opioid overdose related deaths in active drug users. In France, it has been available since July 2016 through a temporary approval which requires a hospital-based pharmacy and a nominative registration of each patient. We present the characteristics of the first patients who could receive this prescription in our hospital-based addiction center and how they used naloxone during follow-up. Results favor a larger dispensing of naloxone. Patients' as well as peers' and families' education is needed.