進階搜尋


下載電子全文  
系統識別號 U0026-1002201423422900
論文名稱(中文) 實證為基礎之臨床指引更新:頭頸癌症皮瓣重建患者酒癮篩檢與處置
論文名稱(英文) Evidence-Based Guideline Renewal: Alcoholism Screening and Management for Head and Neck Cancer Patients Free Flap Reconstruction
校院名稱 成功大學
系所名稱(中) 護理學系
系所名稱(英) Department of Nursing
學年度 102
學期 1
出版年 103
研究生(中文) 王雅慧
研究生(英文) Ya-Hui Wang
學號 T26991080
學位類別 碩士
語文別 中文
論文頁數 108頁
口試委員 指導教授-黃美智
召集委員-蔡森田
口試委員-陳清惠
中文關鍵字 頭頸部癌症  皮瓣重建手術  酒癮篩檢與處置  實證照護指引 
英文關鍵字 Head and neck cancer patients  Free flap reconstruction  Alcoholism screening and management  Evidence-based guideline 
學科別分類
中文摘要 背景:
酒精濫用者容易發生口腔癌、食道癌、下咽癌及肝癌等,而頭頸癌症患者亦為酒精使用疾患之高危險群。為避免住院期間因停止飲酒而導致酒精戒斷症狀,無法配合醫療活動、發生非計畫性拔管、甚至威脅生命安全,南部某醫學中心耳鼻喉專科病房於2012年1月制訂並推展「頭頸癌症皮瓣重建患者酒癮篩檢與處置」之照護指引,執行滿一年後對此照護指引進行成效評值與更新。
目的:
(一)評值原始版「頭頸癌症皮瓣重建患者酒癮篩檢與處置」照護指引之成效;(二)以實證為基礎提出更新版,提供臨床參考使用,預防住院期間發生酒精戒斷症狀。
方法:
第一階段:採病歷回顧法,針對2012年1月至12月施行臨床照護指引期間之頭頸癌症曁皮瓣重建病患共48名,檢視醫護人員依循照護指引之執行率和完成率,及對於降低非計畫性拔管、酒精性譫妄發生率之成效。另輔以問卷調查醫護人員對於原照護指引之適用性及建議。第二階段:組成指引發展小組、分析現行照護指引及建構臨床問題、進行系統性文獻回顧與文獻評讀、撰擬臨床指引建議、邀請外部專家審核等步驟,最後提出更新版本。
結果:
第一階段:護理師依循照護指引之執行率為87.5%,完成率為95.2%;醫師之執行率為44.4%,完成率為0%。另比較耳鼻喉科病房於2011年(未施行照護指引)及2012年(施行照護指引)頭頸部癌症曁皮瓣重建病患之非計畫性拔管事件通報資料,2011年60位頭頸部癌症曁皮瓣重建手術病患中,出現3次因酒精性譫妄造成非計劃性拔管(5.0%)。2012年48位手術病患僅1人因酒精性譫妄而造成非計劃性拔管(2.1%);經採用無母數Mann-Whitney U 檢定分析,未達顯著差異(P=0.317),雖然2012年因譫妄造成非計劃性拔管之發生率有降低傾向,尚無法證實原版照護指引能降低酒精性譫妄造成的非計畫性拔管的發生率。
基於第一階段之評價結果而形成臨床問題,經過實證步驟及專家審核,更新「頭頸癌症皮瓣重建患者酒癮篩檢與處置」照護指引,其主要修正內容包括:(一)更新酒癮篩檢問卷評估工具,以具文化敏感度之華人酒癮篩檢問卷(C-CAGE)取代原酒癮篩檢問卷(CAGE),(二) 將酒精戒斷症狀篩檢提前至門診執行,並針對酒精使用疾患提前於門診開始給予BZD類藥物和維生素B群;(三)使用酒精戒斷症狀臨床評估量表(CIWA-Ar)評估戒斷程度,做為選擇藥物處置之依據。
結論:
更新版「頭頸癌症皮瓣重建患者酒癮篩檢與處置」照護指引,適用於臨床酒精戒斷症狀預防及處置,並提升醫護人員對酒精使用疾患之篩檢和評估之敏感度,避免酒精性譫妄造成的非計劃性拔管及手術後傷害,進而提升病人安全與醫療品質;後續則經由在職教育演講、宣傳,推薦給臨床使用。
英文摘要 Summary:Alcohol withdrawal syndrome (AWS) may cause life-threatening complications such as accidental self-extubation after major operation. An evidence-based guideline renewal toward alcoholism screening and management applicability to prevent AWS was completed in this study. The results might improve the sensitivity of medical personnel for screening and assessment to alcohol use disorders. It also improved the patient safety and decreased the occurrence of delirium during hospitalization.
Background:Alcohol consumption is strongly associated with the development of head and neck cancer, esophageal cancer and hepatoma. Patients with head and neck cancer have high prevalence rate of alcohol related disorders as well as alcohol withdrawal syndrome (AWS). To prevent the potential AWS hindering medical treatment, the clinical guideline of alcoholism screening and management of AWS for head and neck cancer patients with free flap reconstruction was conducted since January 2012 in the ward of ENT department of a medical center in southern Taiwan. The clinical guideline was evaluated and renewed after one year implementation.
Purpose:The purpose of this study is to evaluate the effects of the clinical guideline of alcoholism screening and management of AWS for head and neck cancer patients with free flap reconstruction (version 2012). Furthermore, an evidence-based renewal procedure were proceeded to revise the clinical guideline.
Methods:This study was undertaken in a two-phase research design:First phase: A retrospective review of medical records from 48 head and neck cancer patients with free flap reconstruction in 2012. To investigate the onset of alcohol delirium and the clinical appropriateness for the guideline, the nurses and the physicians in the ENT department were recruited to answer the questionnaire.
Second phase: An evidence-based renewal procedure were proceeded to revise the clinical guideline. The procedures included: establishment of the clinical guideline development group, the existing clinical guideline analysis, clinical problems construction, systematic review and critical appraisal the literatures. The external specialists were finally invited to recommend the clinical guideline writing and revision.
Results:
First phase:The implication rate of the clinical guideline was 87.5% by nurses and 44.4% by physicians. However, the complete rate of the clinical guideline was 95.2% and 0% respectively. In 2011, there were 60 head and neck cancer patients receiving major operation with free flap reconstruction. Three (5.0%) of them occurred accidental self-extubation due to alcohol delirium. The clinical guideline has been practiced in 2012, only 1(2.0%) of 48 head and neck cancer patients receiving major operation with free flap reconstruction encountered accidental self-extubation due to alcohol delirium. There was no statistical significance by Mann-Whitney U test (P = 0.317).
Second phase:
Based on the results of the first phase and aiming at the clinical problems, an evidence-based renewal procedure including auditing by the external specialists were proceeded to revise the clinical guideline. A renewal version includes: (A) Choose the C-CAGE, which has better Chinese cultural sensitivity, to replace CAGE for screening.(B)Shift the alcoholism screening from inpatient to outpatient clinics and provide the drug treatments with vitamin B complex and BZD.(C)Using CIWA-Ar to assess the patients’ alcoholism and risk of AWS during hospitalization.
Conclusion:
The clinical guideline renewal of alcoholism screening and management of AWS established from evidence-based can be applied to clinically for prevention of AWS. It also enhanced the sensitivity of medical personnel to detect and assess the alcohol use disorder earlier. Hopefully, it may decrease the alcohol delirium with unplanned extubation and improve patient safety. The experts also recommended that the guideline is appropriate for clinical practice and enhancing medical personnel capacity through in-service education and training to use the renewal guideline in clinical setting.
論文目次 中文摘要 I
Abstract III
致謝 V
目錄 VI
圖目錄 VIII
表目錄 VIII
第一章 緒論 1
第一節 研究動機和重要性 1
第二節 研究目的 5
第三節 名詞定義 6
第二章 文獻查證 8
第一節 酒癮篩檢評估工具 8
第二節 酒精性譫妄之相關因素和血液生物標誌 11
第三節 酒精戒斷症狀評估與處置 13
第四節 酒精使用患者介入治療-簡短諮詢 17
第五節 臨床照護指引發展介紹 18
第三章 研究方法 23
第一節 研究流程圖 24
第二節 頭頸癌症皮瓣重建患者酒癮篩檢與處置照護指引(原始版) 25
第三節 研究設計 27
第四節 研究工具 31
第五節 資料處理與分析方法 33
第六節 倫理考量 34
第四章 研究結果 35
第一節 病歷回顧紀錄查核資料分析 35
第二節 醫護人員指引適用性調查結果 43
第三節 頭頸癌症皮瓣重建患者酒癮篩檢與處置照護指引(更新版)55
第四節 專科專家審查結果 61
第五章 討論 66
第一節 更新版臨床照護指引之臨床應用性流程 66
第二節 酒精使用疾患之轉介 69
第三節 後續評值之宣傳、執行 70
第六章 結論和建議 71
第一節 結論 71
第二節 研究限制 72
第三節 未來研究方向 72
中文參考文獻 73
英文參考文獻 77
附件一 病歷回顧紀錄查核表 83
附件二 醫護人員指引適用性問卷調查表 87
附件三 專科專家照護指引審查表 93
附件四 比較酒癮篩檢問卷與華人酒癮篩檢問卷 104
附件五 酒精戒斷症狀臨床評估量表(CIWA-Ar) 105
附件六 同意人體研究證明書 107
參考文獻 American Psychiatric Association(2007)‧DSM-IV-TR精神疾病診斷準則手冊(孔繁鐘編譯)‧台北:合記。(原著出版於1999)
Bowker, R., Atkinson, M., Lakhanpaul, M., Armon, K., Macfaul, R., & Stephenson, T. (2009).如何撰寫臨床指引-從開始到完成‧(郭耿南總審閱),台北:台灣愛思唯爾。
方文芳、李欣岱、蘇千田、李芸霏、鐘國軒(2010)‧酒癮及酒精戒斷症候群‧家庭醫學與基層醫療,25(7),260-267。
方俊凱、劉珣瑛(2006)‧綜合醫院內外科住院病人飲酒問題之早期介入模式療效的追蹤:一年預後追蹤研究(研究計畫編號:DOH95-TD-M113937)‧台北市:行政院衛生署。
王宏銘(2009)‧頭頸部癌標靶治療的現在與展望‧取自http://sunbiotw.pixnet.net/blog/post/22076227
朱俊霖(2012)‧誰會是酒癮的人?~看酒癮的評估與診斷‧長庚醫訊,32(3),250-253。
行政院衛生署國民健康局(2009)‧國民健康訪問暨藥物濫用調查結果報告:藥物濫用調查‧取自http://nhis.nhri.org.tw/2009download.html
行政院衛生署國民健康局(2011)‧酒害防治‧取自http://www.doh.gov.tw/CHT2006/DM/DM2_p01.aspx?class_no=373&now_fod_list_no=11974&level_no=3&doc_no=81429
行政院衛生署國民健康局(2012)‧檳榔防治‧取自http://www.bhp.doh.gov.tw/BHPnet/Portal/Them.aspx?No=201109140001
吳晉祥、黃盈翔、張智仁(2007)‧老年人的預防性健康照護-從指引到臨床實務,台灣老年醫學雜誌,2(3),145-163。
吳麗芬(2002)‧內科住院老年人急性混亂發生率及相關因素之探討‧榮總護理,19(3),306-316。
宋惠娟、張淑敏(2006)‧臨床決策:實證實務的步驟‧志為護理,5(3),73-80。
李欣南、潘志泉(2003)‧譫妄及其治療‧台灣醫學,7(4),611-617。
李燕鳴、胡勝川(2004)‧急診醫療對酒後事故傷害防制的責任和機會,臺灣家庭醫學雜誌,14(2),63-70。
周繡玲(2006)‧臨床照護指引的發展方法‧腫瘤護理雜誌,11,5-14。
林志銘、林文苑(2012)‧台灣酒精性疾病死亡率之空間聚集分析‧台灣公共衛生雜誌,31(2),195-204。
洪千智(2003)‧酒精依賴程度對健康相關生活品質與醫療資源耗用的影響-以南投縣埔里地區為例(碩士論文)‧臺北:陽明大學醫務管理研究所。
國家衛生研究院(2004)‧飲酒的流行病學。台北市:國家衛生研究院。
國家衛生研究院(2004)‧過度飲酒行為之戒斷與預防。台北市:國家衛生研究院。
國家衛生研究院(2006)‧實證臨床指引平台‧取自http://ebpg.nhri.org.tw/Module/Content.aspx?catalog=95
張娟鳳(2001)‧短期諮商的效能因素與工作同盟之研究‧教育心理學報,32(2),71-102。
張啟宏、黃睦舜、高偉峰(2009)‧急診因酒精受傷患者的特性及酒精篩檢問題討論‧臺灣急診醫學會醫誌,11(4),7-13。
梁振翊、周肇茂、何佩珊、謝天渝、楊奕馨(2004)‧台灣地區飲酒盛行率調查報告‧臺灣口腔醫學衛生科學雜誌,20(2),91-104。
符芳蕙(2004)‧加護病房急性混亂發生率、相關因素及預後之探討(未發表的碩士論文)‧台北:國防醫學院。
莊雯、李欣南(2004)‧酒癮戒斷症候群之治療‧台灣醫學,8(3),425-4321。
許維素(2001)‧焦點解決短期治療介入創傷經驗的處理‧諮商與輔導,15-20。
郭千哲(2005)‧基層醫療診所的酒癮盛行率‧台灣精神醫學,19(2),137-147。
郭千哲、陳為堅、鄭泰安(1999)‧CAGE酗酒篩檢問卷在台灣基層醫療院所的跨文化效度測試‧中華公共衛生雜誌,18(2)87-94。
郭建宏、顏啟華、賴德仁(2008)‧老年人的酗酒問題‧基層醫學,23(10),314-31。
陳宏基(2012)‧殘缺可以彌補重建顯微手術的現在和未來‧中國醫訊,103,14-17。
陳杰峰、蔡宛真、邱文達 (2004)‧實證醫學於健康照護之應用‧臺灣醫學,8(2),235-240。
陳俊興、黃名琪、沈武典(2006)‧某綜合醫院問題性飲酒者之改變動機調查‧臺灣精神醫學,20(3),201-211。
陳喬琪(2009)‧成不成癮,大有問題‧台北:商務。
陳喬琪、葉英堃、胡海國、林式榖、李期才、王建哲、葉元麗(1987)‧一所綜合醫院住院病患之飲酒問題:酒精濫用與依賴之終生盛行率‧臺灣精神醫學,1(3),1166-1172。
彭子安、陳麗秋(2006)‧藥物與酒精戒斷的處理‧耕莘藥訊,第23期。取自http://www.cth.org.tw/08mail/medi_mail9502_01.pdf
湯夢彬、溫增光、孫曉光、劉明倫(2009)‧酒癮問題與治療‧家庭醫學與基層醫療,24(10),345-350。
黃名琪、陳俊興、余俊彥、喻劍飛、賴盈青、林式榖(2005)‧Reliability of the Chinese version of the revised clinical institute withdrawal assessment for alcohol scale‧臺灣精神醫學,19(3),250-254。
黃秀媚(2008)‧應用焦點解決短期諮商於藥物濫用之青少年‧學校衛生,53,57-71。
黃美園、蔡芸芳、李佳琳、陳日昌(2010)‧探討急診求治病患的危險性飲酒‧台灣急診醫學,12(2),27-33。
鄒鈺鈴(2008)‧護理人員對於病人飲酒問題之臨床實務探討(碩士論文)‧台北: 長庚大學護理學研究所。
劉家妤、邱麗櫻、呂佩珍(2006)‧提昇護理人員頭頸部顯微游離皮瓣重建術後照護認知之專案改善‧腫瘤護理雜誌,6(1), 29-41。
劉碧華、謝淑芬、章順仁、葛應欽(1994)‧五峰鄉原住民吸煙、喝酒及嚼食檳榔之盛行率及相關因素研究,高雄醫學科學雜誌,10,405-411。
蔡宗晃、鄭瑞隆、吳岳秀(2005)‧男性憂鬱、酒癮及暴力之相關性及評估‧亞洲家庭暴力與性侵害期刊,1(1),163-186。
賴彥輝、郭冠良、賴建仲、林光洋、黃惠娟、吳岱穎、劉乃萱(2008)‧檳榔與健康‧基層醫學,23(11),343-347。
顏銘漢、林可寰、薛文傑、陳俁榮、呂昭林(2011)‧容易忽略的併發症-酒精戒斷症候群,台灣醫界,54(11),8-14。
羅英毓、王森德、李芸霏、蘇千田(2010)‧口腔癌危險因子與癌前病變‧家庭醫學與基層醫療,25(8),310-317。 
Altieri, A., Bosetti, C., & Gallus, S. (2004). Wine, beer and spirits and risk of oral and pharyngeal cancer: A case-control study from Italy and Switzerland. Oral Oncology, 40, 904-909.
Amato, L., Minozzi, S., Vecchi, S., & Davoli, M. (2010). Benzodiazepines for alcohol withdrawal. Cochrane Database of Systematic Reviews, 17(3), CD005063. doi:10.1002/14651858.
Ambrose, M. L., Bowden, S.C., & Whelan. G. (2001). Thiamin treatment and working memory function of alcohol-dependent people: Preliminary findings. Alcoholism: Clinical and Experimental Research, 25, (1), 112-116.
Ang, C.D., Alviar, M. J. M., Dans, A. L., Bautista-Velez, G. G. P., Villaruz-Sulit, M. V. C., Tan, J. J., Co, H. U., Bautista, M. R. M., & Roxas, A. A. (2008). Vitamin B for treating peripheral neuropathy (review). The Cochrane Library, 4, 1-39.
Anton, R. F., Lieber, C., Tabakoff, B., & the CDTECT Study Group. (2002). Carbohydrate deficient transferrin and gamma-glutamyltransferase for the detection and monitoring of alcohol use: Results from a multisite study. Alcoholism: Clinical and Experimental Research, 26, 1215-1222.
Becker, H. C. (1998). Kindling in alcohol withdrawal. Alcohol Health Research World, 22(1), 25-33.
Bjarne, E., Klaus, L., Nete, H., Finn, Z., & Ulrik, B. (2011). Alcohol withdrawal syndrome: Symptom-triggered versus fixed-schedule treatment in an outpatient setting. Alcohol and Alcoholism , 46(3), 318-323.
Bradley, K. A., Rubinsky, A. D., Sun, H., Bryson, C. L., Bishop, M. J., Blough, D. K., & Kivlahan, D. R. (2011). Alcohol screening and risk of postoperative complications in male VA patients undergoing major non-cardiac surgery. Journal of General Internal Medicine, 26(2), 162-169.
Burkhart, C. S., Dell-Kuster, S., & Gamberini, M. (2010). Modifiable and nonmodifiable risk factors for postoperative delirium after cardiac surgery with cardiopulmonary bypass. Journal of Cardiothoracic and Vascular Anesthesia, 24, 555-559.
Campos, J., Roca, L., Gude, F., & Arturo Gonzalez-Quintela, A. (2011). Long-term mortality of patients admitted to the hospital with alcohol withdrawal syndrome. Alcoholism: Clinical and Experimental Research, 35(6), 1180-1186.
Centers for Disease Control and Prevention, CDC (2012). Alcohol and public health. Retrieved April 20, 2013, from http://www.cdc.gov/alcohol/fact-sheets/alcohol-use.htm.
Coffey, R., Kulisek, J., Tanda, R., & Chipps, E. (2011). Impact of the implementation of an alcohol withdrawal guideline on patients with burn injuries. Clinical Nurse Specialist, 25 (6), 286-293.
Cook, C., Brismee, J. M., Pietrobon, R., Sizer, P. J., Hegedus, E., & Riddle, D. L. (2010). Development of a quality checklist using delphi methods for prescriptive clinical prediction rules: The QUADCPR. Journal of Manipulative and Physiological Therapeutics, 33(1), 29-41.
Coulton, S., Watson, J., Bland, M., Drummond, C., Kaner, E., Godfrey, C., Hassey, A., & Gillian, T. (2008). The effectiveness and cost-effectiveness of opportunistic screening and stepped care interventions for older hazardous alcohol users in primary care (AESOPS): A randomised control trial protocol. BioMed Central Health Services Research, 8(129), 1-10.
Fineout-Overholt, E. & Johnston, L. (2005). Teaching EBP: Asking searchable, answerable clinical questions. Worldviews on Evidence-Based Nursing, 2, 157-160.
Gallivan, K. H., Reiter, D. (2001). Acute alcohol withdrawal and free flap mandibular reconstruction outcomes. Archives of Facial Plastic Surgery, 3, 264-266.
Hoffman, R. S., Weinhouse, G. L., Traub, S. J., & Grayzel, J. (2013). Management of moderate and severe alcohol withdrawal syndromes. UpToDate, Waltham (MA).
Holbrook, A. M., Crowther, R., & Lotter, A. (1999). Meta-analysis of benzodiazepine use in the treatment of acute alcohol withdrawal. Canadian Medical Association Journal, 160, 649-655.
Inouye, S. K. (2006). Delirium in older persons. New England Journal of Medicine, 354, 1157-1165.
Ko, Y.C., Huang, Y.L., Lee, C. H., Chen, M. J., Lin, L. M., & Tsai, C. C. (1995). Betel quid chewing, cigarette smoking and alcohol consumption related to oral cancer in Taiwan. Journal of Oral Pathology and Oral Medicine, 24, 450-453.
Koike, H., & Sobue, G. (2006). Alcoholic neuropathy. Current Opinion in Neurology, 19(5), 481-486.
Kuo, Y. R., Jeng, S. F., Lin, K. M., Hou, S. J., Su, C.Y., Chien, C.Y., Hsueh, K. L., & Huang, E.Y. (2008). Microsurgical tissue transfers for head and neck reconstruction in patients with alcohol-induced mental disorder. Annals of Surgical Oncology, 15(1), 371-377.
Lansford, C. D., Guerriero, C. H., Kocan, M. J., Turley, R., Groves, M. W., Bahl, V., & Teknos, T. N. (2008). Improved outcomes in patients with head and neck cancer using a standardized care protocol for postoperative alcohol withdrawal. Archives of Otolaryngology Head and Neck Surgery, 134(8), 865-872.
Litten, R, Z., Bradley, A. M., & Moss, H. B. (2010). Alcohol biomarkers in applied settings: Recent advances and future research opportunities. Alcoholism: Clinical and Experimental Research, 34, 955-967.
Mark, H. E., Jay, S., Barry, D., Steven H. W., Jeffrey, S., Bernard, E., & Marjorie, B. (2004). Strength of recommendation taxonomy (SORT): A patient-centered approach to grading evidence in the medical literature. American Family Physicians, 69 (3), 548-556.
McQueen, J., Howe, T. E., Allan, L., Mains, D., & Hardy, V. (2011). Brief interventions for heavy alcohol users admitted to general hospital wards. Cochrane Database of Systematic Reviews, 8. CD005191. doi: 10.1002/14651858.
National Institute for Health and Clinical Excellence. Alcohol-use disorders: Diagnosis and clinical management of alcohol-related physical complications. (Clinical guideline CG100.) 2010. http://guidance.nice.org.uk/CG100.
National Institute on Alcohol Abuse and Alcoholism. (2010). Alcohol and your health, Retrieved May 14, 2012, from http://www.niaaa.nih.gov/
Neumann, T., Helander, A., Dahl, H., Holzmann, T., Neuner, B., & Weiss-Gerlach, E. (2008). Value of ethyl glucuronide in plasma as a biomarker for recent alcohol consumption in the emergency room. Alcohol and Alcoholism, 43(4), 431-435.
Neyman, K. M., Gourin, C. G., & Terris, D. J. (2005). Alcohol withdrawal prophylaxis in patients undergoing surgical treatment of head and neck squamous cell carcinoma. The Laryngoscope, 115(5), 786-790.
Ntais, C., Pakos, E., & Kyzas, P. (2005). Benzodiazepines for alcohol withdrawal. Cochrane Database Systemaic Review, 20 (3), CD005063.
Oremus, M., Wolfson, C., Perrault, A., Demers, L., Momoli, F., & Moride, Y. (2001). Interrater reliability of the modified Jadad quality scale for systematic reviews of Alzheimer’s disease drug trials. Dementia and Geriatric Cognitive Disorders, 12(3), 232-236.
Parker, A. J., Marshall, E.J., & Ball, D. M. (2009). Diagnosis and management of alcohol use disorder. British Medical Journal, 336, 496-501.
Peters, T. J., Kotowicz, J., Nyka, W., Kozubski, W., Kuznetsov, V., Vanderbist, F., & Coffiner, M. (2006). Treatment of alcoholic polyneuropathy with vitamin b complex: A randomised controlled trial. Alcohol & Alcoholism, 41(6), 636-642.
Phillips, S., Haycock, C., & Boyle. D. (2006). Development of an alcohol withdrawal protocol: CNS collaborative exemplar. Clinical Nurse Specialist, 4 (20), 190-198.
Ragaisis, K. M. (2004). Alcohol screening in the acute hospital. Journal of Addictions Nursing, 15, 171-175.
Shah, S., Weed, H, G., He, X., Agrawal, A., Ozer, E & Schuller, D. E. (2012). Alcohol-related predictors of delirium after major head and neck cancer surgery. Archives of Otolaryngology Head and Neck Surgery, 138 (3), 266-271.
Sharpe, P. C. (2001). Biochemical detection and monitoring of alcohol abuse and abstinence. Annals of Clinical Biochemistry, 38 (6), 652-664.
Shaw, J. M., Kolesar, G. S., Sellers, E. M., Kaplan, H. L., & Sandor, P. (1981). Development of optimal treatment tactics for alcohol withdrawal assessment and effectiveness of supportive care. Journal of Clinical Psychopharmacology, 1(6), 382-387.
Siwek, J., Gourlay, M.L., Slawson, D. C., & Shaughnessy, A. F. (2002). How to write an evidence-based clinical review article. American Family Physician, 65, 251-258.
Spearing, N. (2007). Developing quality clinical practice guidelines. Australian Infection Control, 12(2), 48-54.
Stanley, K. M., Amabile, C. M., Simpson, K.N., Couillard, D., Norcross, E. D., & Worrall, C. L. (2003). Impact of an alcohol withdrawal syndrome practice guideline on surgical patient outcomes. Pharmacotherapy, 23(7), 843-854.
Stewart, S., Swain, S. (2012). NICE, Royal College of Physicians, London: Assessment and management of alcohol dependence and withdrawal in the acute hospital: Concise guidance. Clinical Medicine, 12 (3), 266-271.
Sullivan, J. T., Sykora, K., Schneiderman, J., Naranjo, C. A., & Sellers, E. M. (1989). Assessment of alcohol withdrawal: The revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar). British Medical Journal, 84(11), 1353-1357.
Talbot, P. A. (2011). Timing of efficacy of thiamine in Wernicke's disease in alcoholics at risk. Journal of Correctional Health Care, 17(1), 45-50.
Tsai, M.C., Tsai, Y. F., Chen, C.Y., & Liu, C.Y. (2005). Alcohol use disorders identification test (AUDIT): Establishment of cut-off scores in a hospitalized Chinese population. Alcoholism: Clinical and Experimental Research, 29, 53-57. doi: 10.1097/01.ALC.0000151986.96710.E0
Tsai, Y. F., Tsai, M. C., Lin, Y. P., Weng, C. E., Chou, Y. L., & Chen, C. Y. (2011). An alcohol training program improves Chinese nurses’ knowledge, self-efficacy, and practice: A randomized controlled trial. Alcoholism Clinical and Experimental Research, 3 (5), 976-983.
Weinfeld, A. B., Davison, S. P., Mason, A. C., Manders, E. K., & Russavage, J. M. (2000). Management of alcohol withdrawal in microvascular head and neck reconstruction. Journal of Reconstructive Microsurgery, 16, 201-206.
World Health Organization. (2009). Facts and figures: Alcohol. Available at:http://www.who.int/substance_abuse/facts/alcohol/en/index.html.
Wright, T., Myrick, H., Henderson, S., Peters, H., & Malcolm, R. (2006). Risk factors for delirium tremens: A retrospective chart review. The American Journal on Addictions, 15, 213-219.
論文全文使用權限
  • 同意授權校內瀏覽/列印電子全文服務,於2016-02-14起公開。
  • 同意授權校外瀏覽/列印電子全文服務,於2016-02-14起公開。


  • 如您有疑問,請聯絡圖書館
    聯絡電話:(06)2757575#65773
    聯絡E-mail:etds@email.ncku.edu.tw