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      Patient education for alcohol cessation intervention at the time of acute fracture surgery: study protocol for a randomised clinical multi-centre trial on a gold standard programme (Scand-Ankle)

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          Patients with hazardous alcohol intake are overrepresented in emergency departments and surgical wards. These patients have an increased risk of postoperative complications with prolonged hospital stays and admissions to intensive care unit after surgery. In elective surgery, preoperative alcohol cessation interventions can reduce postoperative complications, but no studies have investigated the effect of alcohol cessation intervention at the time of acute fracture surgery. This protocol describes a randomised clinical trial that aims to evaluate the effect of a new gold standard programme for alcohol cessation intervention in the perioperative period regarding postoperative complications, alcohol intake and cost-effectiveness.


          Patients with hazardous alcohol intake undergoing ankle fracture surgery will be recruited into the trial from multiple orthopaedic wards at university hospitals in Denmark, Sweden and Norway. Included patients will be randomly allocated to either standard care or the gold standard programme aimed at complete alcohol abstinence before, during and 6 weeks after surgery. It includes a structured patient education programme and weekly interventions meetings at the orthopaedic outpatient clinic. Furthermore, patients are provided with thiamine and B-vitamins, alcohol withdrawal prophylaxis and treatment, and disulfiram to support abstinence. Alcohol intake is biochemically validated (blood, urine and breath tests) at the weekly intervention meetings and follow-up visits. Follow-up assessments will be conducted 6 weeks and 3, 6, 9 and 12 months after surgery for all patients. The effect of the gold standard programme will be assessed comparing the outcome measures between the intervention and control group at each follow-up point.


          The study will provide new knowledge about how to prevent alcohol-related postoperative complications at the time of acute fracture surgery. If effective, the results will be a benefit for the clinical course, patients and society alike.

          Trial registration

          The protocol is registered in (Id: NCT00986791).

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          Most cited references 47

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          Assessment of alcohol withdrawal: the revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar).

          A shortened 10-item scale for clinical quantitation of the severity of the alcohol withdrawal syndrome has been developed. This scale offers an increase in efficiency while at the same time retaining clinical usefulness, validity and reliability. It can be incorporated into the usual clinical care of patients undergoing alcohol withdrawal and into clinical drug trials of alcohol withdrawal.
            • Record: found
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            A scoring scale for symptom evaluation after ankle fracture.

             H Molander,  C Olerud (1983)
            A scoring system for evaluating symptoms after ankle fractures is presented. It is tested against (1) a linear analogue scale; (2) the limitation in range of motion in loaded dorsal extension; (3) the presence of osteoarthritis; and (4) the presence of dislocations on radiographs. It correlates well with these four parameters, which are considered to summarize the results after this type of injury, and is therefore considered to assess the symptoms in an objective way. The scoring system is recommended for scientific investigations, as even minor subjective differences in disability experienced by the patient are significantly separated. The use of this system will simplify the comparison of results presented by different authors.
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              Alcohol and public health

               R Room,  T F Babor,  J. Rehm (2005)

                Author and article information

                BMC Surg
                BMC Surg
                BMC Surgery
                BioMed Central (London )
                1 May 2015
                1 May 2015
                : 15
                [ ]WHO-CC, Clinical Health Promotion Centre, Bispebjerg/Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
                [ ]Clinical Health Promotion Centre, Department of Health Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
                [ ]Orthopedic Department, Hospital of Southern Jutland, University of Southern Denmark, Aabenraa, Denmark
                [ ]Alcohol and Drug Research Western Norway, Stavanger University Hospital, Stavanger, Norway
                [ ]Department of Orthopaedic Surgery, Bispebjerg/Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
                [ ]Department of Orthopaedic Surgery, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
                © Tønnesen et al.; licensee BioMed Central. 2015

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

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