An experience using historical hepatitis C data to Re-Engage: Possibilities and pitfalls during the COVID-19 pandemic.

OBJECTIVES: Public Health England (PHE) aims meet the WHO target to eliminate hepatitis C as a public health concern by 2030. One aspect of this strategy is to use historical surveillance data of anti-HCV positive patients identified by PHE to re-engage with offers of PCR testing and treatment if RNA-positive. Operational Delivery Networks (ODN), who deliver Hepatitis C treatment across 22 regions in England, are responsible for enacting this initiative. This study aims to evaluate the effectiveness of using this data with regional PCR results to re-engage HCV-infected persons in the West Midlands region of England. STUDY DESIGN: A longitudinal prospective study using historical surveillance data. METHODS: A dataset of historical anti-HCV positive antibody patients provided to the ODN by PHE was cross-referenced with HCV RNA data from 01/01/1996 to 01/01/2019 from five laboratories across the West Midlands. Letters were sent to the general practitioner and to the patients who were HCV RNA positive to invite them for repeat testing and treatment to achieve cure. RESULTS: From a dataset of 4540 anti-HCV antibody results, 31.7% (n=1440) had a PCR result: 48.1% (n=693) were PCR positive for HCV RNA. 693 letters were sent to GPs with responses from 14.2% (n=99). By May 2021, only 212 patient letters were sent (due to significant interruption by the COVID-19 pandemic) and 11.3% (n=24) replied, 17 presented for PCR testing and 4 were found to be viraemic. To date, one patient has achieved cure and three have completed treatment awaiting confirmation of cure. CONCLUSION: The use of historical anti-HCV antibody results can be used to successfully re-engage people into testing and treatment for hepatitis C, albeit with modest gains.

The effect of liver transplantation on fatigue in patients with primary biliary cirrhosis: a prospective study.

BACKGROUND & AIMS: The role of liver transplantation (LT) for the relief of fatigue in patients with primary biliary cirrhosis (PBC) is unclear, and while many centers exclude fatigue as an indication for transplantation, there have been no studies to prospectively evaluate the impact of LT on fatigue. We aimed at assessing the severity of fatigue in LT candidates with PBC and the impact of LT on fatigue. METHODS: In a prospective, longitudinal study, we used the PBC-40 questionnaire in 49 adult patients with PBC at listing and at 6, 12, and 24 months after LT and in two sex- and age-matched cohorts of community controls and non-transplanted PBC patients. Correlation analysis was used to assess the relationship between liver function and fatigue. ANOVA was used to compare the variation of fatigue score before and after LT. RESULTS: There was no correlation between MELD and fatigue before LT (r(2)=0.01). Overall, the fatigue score after LT was substantially lower than before LT, falling from 40.7 ± 11.4 pre-transplant to 27.7 ± 9.5, 28.7 ± 10.1, 26.2 ± 10.1 (p<0.0001) at 6, 12, and 24 months after LT, respectively. The same improvement of fatigue was observed in both low-MELD (<17) and high-MELD (≥ 17) patients. Improvement in fatigue was also evident in the comparison with a "non-transplant PBC" control group (31.1 ± 11.6, p=0.03). However, 44% of the total cohort, and 47% of those with low-MELD, for whom the probability of dying of LT may be higher than that of dying without LT, had moderate to severe fatigue (defined as a fatigue score ≥ 29) at two years after LT. Moreover, fatigue scores at two years were higher in the transplant PBC cohort compared to a cohort of community controls (17.8 ± 5.9, p<0.0001). CONCLUSIONS: Liver transplantation is associated with improvement in fatigue in patients with PBC. However, a substantial proportion of patients continue to suffer from significant fatigue after two years. Whether the improvement is enough to justify organ allocation in patients with fatigue alone, without liver failure, is still an open issue. Certainly, in the era of organ shortage, with many patients dying waiting for a graft, this may not represent the optimal use of donated deceased organs.

Liver transplantation for hepatic epithelioid hemangioendothelioma: a case series.

Epithelioid hemangioendothelioma is a rare soft-tissue tumor with unpredictable malignant potential. This type of tumor can occur in the liver but is very rare. Signs and symptoms are often nonspecific, and even if the problem is not misdiagnosed, arriving at a clear diagnosis can take some time. This article describes 3 patients who had very different signs and symptoms, all of whom were referred to a specialist center for liver transplantation in 1 year. All 3 patients proceeded to transplantation and made a good recovery. They have regular follow-up at the transplant center, and to date, no recurrence of hepatic epithelioid hemangioendothelioma has been seen in these 3 patients.

Development of an educational booklet for children of adult liver transplant recipients.

Educating family members of transplant recipients has long been recognized as an important factor in preparation for organ transplantation. This preparation may help the family come to terms with potential complications, the possibility of extended hospitalization, and the psychological changes that their loved ones might experience. Although education of a spouse or essential others may take place, children of an organ recipient may be unintentionally overlooked in the teaching process. This article describes how an educational booklet for children of adults undergoing liver transplantaion was developed and introduced into a liver transplant unit.

Modern Matrons: can they be easily identified by hospital patients?

The Modern Matron was introduced into hospital Trusts in April 2002 to improve the basics of patient care. They were to be easily identifiable, highly visible and authoritative figures. This article reports on a quantitative study done to ascertain if patients can identify the Modern Matron in one acute NHS Trust. A researcher-developed questionnaire was sent to 20 Modern Matrons and a different questionnaire was distributed to 72 randomly selected patients. The results demonstrated that only 5% of patients surveyed were able to correctly identify the Modern Matron by their uniform. This may be explained by the response from the Modern Matrons when asked how much time was spent with patients; 67% of their normal working day was taken up with management of staff, paperwork and meetings, leaving very little direct patient time.