NCEPOD – alcohol related liver disease care: ‘measuring the units’ 10 years on

The 2013 NCEPOD report ‘Measuring the Units’ reviewed the care of patients who died with alcohol-related liver disease (ArLD) in 2011. It highlighted that the care of patients who died of ArLD was less than good in more than 50% of cases reviewed. Given the ongoing concerns about the variation in outcomes of patients with ArLD, a Survey of the care of patients admitted to hospital with ArLD was commissioned by NCEPOD.All Acute Trusts in England, Wales and Northern Ireland were sent the Survey, which required completion based on Trust data and Lead Gastroenterologist/Hepatologist input. The questions covered numbers of admissions and mortality, alcohol screening and withdrawal management, the presence and constitution of an Alcohol Care Team (ACT), triage of decompensated ArLD patients to Gastroenterology/Hepatology and use of the BSG/BASL chronic liver disease care bundle, as well as escalation of care. In view of the impact of COVID-19, the Survey was sent round to Acute Trusts in January 2021 interrogating information from 2019.ResultsNCEPOD received responses from 145 Acute Trusts including District General Hospitals, regional Liver Units as well as Liver Transplant Units. This included 20,876 ArLD admissions and 2481 deaths in hospital, constituting 11.9% of admissions), with a wide variation in the numbers of reported admissions and deaths between Trusts. The use of symptom-triggered alcohol withdrawal scale (CIWA-Ar) was only 9.9% in the original report, but was employed on specific wards in 88.2% of Trusts in this Survey. The presence of a multidisciplinary ACT increased from 23.2% of Trusts in 2011 to 51.9%, although only 20% of Trusts responding had a Consultant Lead with dedicated sessions. 78% of Trusts stated that they triage patients with decompensated cirrhosis to a Gastroenterologist/Hepatologist and 70% of responding Trusts stated that they used BSG/BASL decompensated chronic liver disease care bundle. The responding clinician reported that it was subjectively more difficult to get patients with decompensated ArLD rather than other forms of cirrhosis into Critical Care in 28.3% of Trusts. Only 23% of ArLD patients who died had coded evidence of palliative care input.ConclusionsThis Survey compares specific aspects of care in patients with ArLD between 2011 and 2019 and indicates that there have been noteworthy improvements in certain areas of care provision, but also points to where attention is required in order to achieve consistent, high-quality care for this patient group, who have a high in-patient mortality.

A cohort study of duplicate faecal immunochemical testing in patients at risk of colorectal cancer from North-West England.

OBJECTIVES: We sought to investigate if duplicate faecal immunochemical testing (FIT) sampling improves the negative and positive predictive value of patients thought to be at risk of colorectal cancer (CRC). Specifically, we aimed to investigate whether the proportion of FIT-negative CRC missed by a single FIT test in symptomatic patients could be reduced by duplicate FIT testing. DESIGN: A retrospective service evaluation cohort study of the diagnostic accuracy of duplicate FIT testing. SETTING: Patients referred from primary care with suspected CRC to four secondary care trusts in North-West England. PARTICIPANTS: 28 622 patients over 18-years-old with lower gastrointestinal symptoms suggestive of CRC who completed two FIT samples. PRIMARY AND SECONDARY OUTCOME MEASURES: The performance of duplicate FIT for detecting CRC at a threshold of 10 µgHb/g. RESULTS: The sensitivity if either test was >10 µgHb/g was 0.978 (0.955-0.989), specificity was 0.662 (0.657-0.668), positive predictive value 0.031 (0.028-0.035) and negative predictive value 1.00 (0.999-1.00). Despite two-thirds of patients (18952) being negative following two tests, at this threshold only seven CRC were missed over a 26-month period. All seven patients had other high-risk features which should have prompted investigation. CONCLUSIONS: This study suggests that in routine NHS practice, a duplicate FIT sample strategy together with clinical evaluation for evidence of anaemia and weight loss is superior to a single FIT sample alone and would allow symptomatic patients to be managed in primary care without the need for urgent referral to secondary care for urgent colonic imaging.

Huddersfield Contemporary Music Festival 2020

‘There has always been a state of crisis’, we are told in Ziad Nawfal's wonderful introduction to the underground music scene in Beirut. That the corona restrictions comprise a rather different crisis to that of Lebanon's capital should be stressed, yet it will have been no easy task creating any kind of Huddersfield festival this year. That any event could occur at all is an achievement on the part of the festival team and the ensembles, musicians, broadcasters and composers with whom they work. Adaptation and renewal are a vital part of a new musicians’ toolkit, even if the pace of change can be bewildering.

The carbon footprint of a UK University during the COVID-19 lockdown.

The COVID-19 pandemic has provided a unique opportunity to compare the carbon intensity of higher education delivered on- and off-campus. This is attributed to governmental lockdown orders that have forced Universities to close their campuses, ban business travel and move all teaching and learning activities online. This study represents the first known attempt to compare the carbon footprint of a mid-sized UK University produced during the COVID-19 lockdown (April-June 2020) against that generated within the respective time period in previous years. Although the overall carbon footprint of the University decreased by almost 30% during the lockdown, the carbon intensity of online teaching and learning was found to be substantial and almost equal to that of staff and student commute in the pre-lockdown period. The study contributed to an emerging academic discourse on the carbon (dis)benefits of different models of higher education provision in the UK and beyond. The study suggested that policy and management decisions on transferring education online should carefully consider the carbon implications of this transfer.