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Critical Appraisal Topics Outline Title: Intramuscular high dose of thiamine treatment improves working memory function of alcohol-dependent people Clinical bottom line: Administering intramuscular high dose of thiamine, more than 200mg daily for a consecutive period of time, will significantly improve the working memory and cognitive function of alcohol-dependent people. Citation/s: Alcohol Clin Exp Res. 2001 Jan;25(1):112-6 Thiamin treatment and working memory function of alcohol-dependent people: preliminary findings Lead author's name and fax: Ambrose ML, Bowden SC, Whelan G. Clinical Scenario & PICO Question: 情境重點簡述:(與 PICO 有關的為主) P: 58 y/o man, chronic alcoholism with suspected chronic pancreatitis, delirium for 2 more months, ataxia(+), reduced consciousness(-), eye movement abnormalities(-) I/E: thiamine C: placebo O: cognitive function and improved neurological signs Type of Question: therapy Search Terms & Strategy: Database: Pubmed Key words & Search strategy: #4 Select 5 document(s) 00:29:35 5 #3 Search #1 OR #2 23:51:10 21 #2 Search (thiamine AND (korsakoff OR alcohol OR alcoholism )) AND systematic[sb] 23:50:22 14 #1 Search (thiamine AND (korsakoff OR alcohol OR alcoholism )) AND (randomized controlled trial[Publication Type] OR (randomized[Title/Abstract] AND controlled[Title/Abstract] AND trial[Title/Abstract])) 23:49:48 8 840975987 第 1 頁,共 3 頁 The Study: Level of Evidence: Ib Individual randomized control study, double-blind 169 participants were recruited and underwent a 4–5 day withdrawal regime with conservative management and any medications for sedation. Before group assignment and commencement of treatment, each subject was given a medical and neurological examination, including the Mini-Mental State Examination (MMSE). 43 of the initial sample did not complete treatment and assessment, and the final treatment groups differed in age and average daily ethanol consumption. Therefore, data from 19 participants were removed to equate treatment group means on the background variables of age, education, and drinking history without regard to treatment outcome data. Finally, 107 patients entered the study. Participants were assigned randomly in equal numbers to one of five treatment groups that received 5, 20, 50, 100, or 200 mg of intramuscular thiamin (as thiamin hydrochloride), once per day. All participants were blind to treatment dose and conformed to a DSM-IV diagnosis of alcohol dependence. On the third day of admission, all subjects were assessed individually on delayed alternation (DA) by a psychologist blind to treatment condition. The Evidence: 1. A significant difference between dosage groups in the number of trials taken to reach criterion [F(4,102) = 2.50, p = 0.047, f = 0.31]. A planned comparison between the 200 mg group and the mean of the other dosage groups was significant [t(104) =2.18, p = 0.031, d = 0.22] Comments: 1. The relatively small size of each treatment group, the high rate of non-completion, and the short duration of thiamin treatment, the results should be regarded as preliminary. 2. The pattern of results does not appear to reflect a simple stepwise dose-response relationship. 3. The heterogeneity of the treatment population in each sub-group is apparent that larger sample will facilitate good group-match under strict randomization. 4. The result of this study should generalize to other samples of alcohol-dependent people, due to broad subject selection criteria. 5. Our patient, who is alcohol-dependent without clinical triad of WKS, is compatible with the sample in this study. There is no problem in lowering down the level of evidence when applying the result of the study. 840975987 第 2 頁,共 3 頁 References: 1. Sechi G, Serra A. Lancet Neurol. 2007 May;6 (5):442-55. Wernicke's encephalopathy: new clinical settings and recent advances in diagnosis and management. 2. Day E, Bentham P, Callaghan R, Kuruvilla T, George S. Cochrane Database Syst Rev. 2004;(1):CD004033. Thiamine for Wernicke-Korsakoff Syndrome in people at risk from alcohol abuse. (LoE: 1a) 3. Jackson R, Teece S. Emerg Med J. 2004 Jul;21(4):501-2. Best evidence topic report. Oral or intravenous thiamine in the emergency department. 4. Kopelman MD. Br J Psychiatry. 1995 Feb;166 (2):154-73. The Korsakoff syndrome. Kill or Update By: Killed when 6/18/2009 科部會議名稱:「精神科 EBM style 期刊閱讀」 舉行日期時間: 12/18/2008, 1400-1500) 報告者:姓名:R1 陳濬廷 Code: 指導臨床教師:A 陳俊志 840975987 第 3 頁,共 3 頁 139302 Email: [email protected]