New and Updated Cochrane Systematic Reviews

Alcoholic hepatitis is an acute manifestation of alcoholic liver disease with mortality as high as 40-50% in severe cases. Patients usually have a history of prolonged alcohol abuse with or without a known history of liver disease. Although there is significant range in severity at presentation, patients with severe alcoholic hepatitis typically present with anorexia, fatigue, fever, jaundice, and ascites. The use of either pentoxifylline or corticosteroids in those with severe disease (Maddrey's discriminate function >32) has significant mortality benefit. The addition of N-acetylcysteine to corticosteroids decreases the incidences of hepatorenal syndrome, infection, and short-term mortality, but does not appear to significantly affect 6-month mortality. Nutritional support with highcalorie, high-protein diet is recommended in all patients screening positive for malnutrition. Liver transplantation for a highly selected group of patients with severe alcoholic hepatitis may be an option in the future, but is not currently recommended or available at most transplant institutions. Publication type: Journal: Review Source: EMBASE 8.Title: Alcohol-related harm in the practice Citation: Practice Nursing, Jan 2015, vol. 26, no. 1, p. 10-15, 0964-9271 (January 2015) Author(s): Holloway, Aisha Abstract: Alcohol-related harm is a serious public health concern. Aisha Holloway explains how practice nurses can identify those at risk and deliver brief interventions to facilitate the change of alcohol consumption behaviour. [PUBLICATION] 24 references Source: BNI Full text: Available Practice Nursing at Practice Nursing 9.Title: Audit of the alcohol service provided to head and neck cancer patients within Mid-Yorkshire Hospitals NHS Trust Citation: British Journal of Oral and Maxillofacial Surgery, October 2014, vol./is. 52/8(e95), 0266-4356 (October 2014) Author(s): Suida M.I., Hoole J., Smith J., Jordan K., Andrews M., Mitchell D. Language: English Abstract: Introduction: Harmful drinking and alcohol dependence can cause many mental and physical health problems, and social problems. Following release of the NICE guidance on management of alcohol-use disorders, a new local pathway was developed to assess and manage patients classified as higher risk prior to treatment for head and neck cancer. This audit aims to evaluate our alcohol service to ensure patients are receiving appropriate care, treatment and advice in accordance to the NICE guidelines. Methods: Alcohol assessments are carried on all patients with a new diagnosis of head and neck cancer. This audit assessed whether all appropriate measures were completed for patients classified as a "higher risk drinker" according to the NICE guidance. Results Out of 45 patients, 100% were assessed, offered an assisted withdrawal program and were successfully withdrawn from alcohol prior to their planned treatment or surgery, with no related admissions, no incidence of post operative complications and significant cost reductions. Conclusions: Historically in our trust, patients classified as "higher risk drinkers" were admitted prior to treatment/ surgery for observation and potentially detoxification. The new local alcohol care pathway has allowed all relevant patients to be successfully withdrawn from alcohol prior to their planned treatment/surgery, in line with the NICE guidelines. Furthermore all patients requiring detoxification received their treatment at home, including the support and guidance required to be able to successfully withdraw Introduction: Harmful drinking and alcohol dependence can cause many mental and physical health problems, and social problems. Following release of the NICE guidance on management of alcohol-use disorders, a new local pathway was developed to assess and manage patients classified as higher risk prior to treatment for head and neck cancer. This audit aims to evaluate our alcohol service to ensure patients are receiving appropriate care, treatment and advice in accordance to the NICE guidelines. Methods: Alcohol assessments are carried on all patients with a new diagnosis of head and neck cancer. This audit assessed whether all appropriate measures were completed for patients classified as a "higher risk drinker" according to the NICE guidance. Results Out of 45 patients, 100% were assessed, offered an assisted withdrawal program and were successfully withdrawn from alcohol prior to their planned treatment or surgery, with no related admissions, no incidence of post operative complications and significant cost reductions. Conclusions: Historically in our trust, patients classified as "higher risk drinkers" were admitted prior to treatment/ surgery for observation and potentially detoxification. The new local alcohol care pathway has allowed all relevant patients to be successfully withdrawn from alcohol prior to their planned treatment/surgery, in line with the NICE guidelines. Furthermore all patients requiring detoxification received their treatment at home, including the support and guidance required to be able to successfully withdraw from alcohol, whilst still carrying out their normal daily activities. This has shown a cost saving to the trust of 144,580 in only one year. Publication type: Journal: Conference Abstract Source: EMBASE 10.Title: Benzodiazepines are the mainstay of treatment for acute alcohol withdrawal syndrome. Citation: Drugs & Therapy Perspectives, 01 November 2014, vol./is. 30/11(395-398), 11720360 Language: English Abstract: Benzodiazepines are first-line therapy for treatment of alcohol withdrawal syndrome (AWS). Longer acting benzodiazepines may provide a smoother withdrawal, while shorter-acting benzodiazepines may be preferred in patients who are elderly or have significant hepatic impairment. Front loading, fixed dose and symptom-triggered benzodiazepine dosing strategies may be used when treating moderate to severe AWS in the hospital setting. Other drugs may be appropriate as adjuncts to benzodiazepine therapy or in the treatment of mild to moderate AWS. Publication type: journal article Source: CINAHL 11.Title: Brief interventions for hazardous and harmful alcohol consumption in accident and emergency departments Citation: Frontiers in Psychiatry, 2014, vol./is. 5/OCT, 1664-0640 (2014) Author(s): Wojnar M., Jakubczyk A. Language: English Abstract: The prevalence of alcohol abuse among patients treated in accident and emergencydepartments (A&E) is considered substantial. This paper is a narrative review of studiesinvestigating the effectiveness of brief interventions (BI) for hazardous and harmful alcoholconsumption in A&E. A&E departments in hospitals (and other health care infrastructures)are commonly the place where serious consequences of alcohol drinking are seen and need tobe tackled, supporting the suggested theoretical usefulness of delivering brief interventions inthis environment. Available research shows that brief interventions (BI) may be considered avaluable technique for dealing with alcohol-related problems. However, it is suggested thatthe usefulness of BI may depend significantly on the target population to be dealt with. BIhave proved to be beneficial for male individuals and those patients who do not abuse otherpsychoactive substances. In contrast, evidence indicates that brief interventions in A&Esettings are not effective at all when dealing with men admitted as a consequence of aviolence-related event. In addition, some studies were unable to confirm the effectiveness ofBI in female population, in emergency setting. Studies investigating the association betweendrinking patterns and the effectiveness of brief interventions also present inconsistent results. Most studies assessing the effectiveness of BI in A&E settings only adopted a shortperspective (looking at the impact up to a maximum of twelve months after the BI wasdelivered). When assessing the effects of BI, both the amount of alcohol consumed as well asexpected reductions in alcohol consequences, such as injuries, can be taken into account. Evidence on the implementation of brief intervention in emergency departments remainsinconclusive as to whether there are clear benefits. A variety of outcome measures andassessing procedures were used in the different studies, which have investigated this topic. Publication type: Journal: Review Source: EMBASE 12.Title: Decompensated alcoholic liver disease intensive care prognosis: A district general hospital perspective Citation: Intensive Care Medicine, September 2014, vol./is. 40/1 SUPPL. 1(S31), 0342-4642 (September 2014) Author(s): McFarlane J.M., Mostert M., Rose B.O., Breeze R. Language: English Abstract: INTRODUCTION. The UK has seen a growing prevalence of alcoholic liver disease (ALD) over the last 25 years with worrying increases in <35 year olds [1]. Mortality rates for decompensated ALD admissions to ICU are commonly quoted at around 70 %, though the majority of studies represent tertiary care centres [2]. This guides all centres' views on prognosis. OBJECTIVES. We aim to evaluate if the ALD mortality in District General Hospitals (DGH) is comparable to current tertiary centre rates. METHODS. This retrospective study examines the 1 year mortality of decompensated ALD admissions to a DGH's ICU over 3 years, between November 2009 and November 2012. Only patients with decompensated ALD as their primary admission cause were included and were divided into three main presenting features: upper gastrointestinal bleed (UGIB); multiorgan failure (MOF)/sepsis and encephalopathy. Three main organ support factors were recorded for all patients: renal replacement therapy (RRT); mechanical ventilation (MV) and ionotropic support (IS). RESULTS. We identified 54 admissions to the 17 bed ICU with 5 multiple admissions. The median age was 54 years (IQR 47-61) with 4.1 % of admissions <35 years of age. Mean APACHE II and ICNARC scores were 18.4 (SD 7.5) and 22.4 (SD 10.3) respectively. Overall mortality rates were 30.6, 44.9, 55.1 and 57.1 % for ICU, hospital, 6 month and 12 month mortality respectively. UGIB represented the most common diagnosis at presentation (57.1 %). These patients had the lowest mean APACHE II score (17, SD 6.4) as well as the lowest hospital (35.7 %) and 12 month (42.9 %) mortality. Encephalopathic patients (14 %) had a mean APACHE II score of 20 (SD 5.5) and the lowest mean ICNARC (15.9, SD 4.7) scores with an ICU and 12 month mortality of 14 % rising to 71 % respectively. Patients presenting with MOF/ sepsis (29 %) had the highest mean APACHE II (20.4, SD 6) and ICNARC (25.8, SD 8.5) scores and also the highest ICU (50 %) and 12 month (79 %) mortality. 29 % of patients required no organ support, with a discharge survival of 71 %. MV represented the most common organ support (57 %), but carried the best prognosis for ICU and hospital mortality (39.3 % and 46.4 %, respectively). IS had the worst prognosis for ICU and hospital mortality (78.6 % and 85.7 %, respectively). For >2 organs supported, ICU and hospital mortality was 62.5 % and 68.8 % respectively. CONCLUSIONS. Our study indicates that DGH mortality in decompensated ALD is lower than current published tertiary care studies, whose patients may represent a select cohort [2]. Our findings suggest a review of current ALD predicted prognosis in DGHs, on which the burden of disease largely rests [2]. This is now increasingly relevant with research indicating the benefits of earlier transplant in ALD [3]. (Table Presented). Publication type: Journal: Conference Abstract Source: EMBASE 13.Title: Detecting alcohol problems in older adults: Can we do better? Citation: International Psychogeriatrics, November 2014, vol./is. 26/11(1755-1766), 1041-6102;1741-203X (15 Nov 2014) Author(s): Taylor C., Jones K.A., Dening T. Language: English Abstract: Alcohol problems in older adults aged 65 years or over, in the United Kingdom and internationally, have risen steadily over the past decade. These are a common but underdiagnosed and underrecognized problem. A UK survey in 2008 found that 21% of men and 10% of women aged 65 years and over reported drinking more than four and three units of alcohol respectively on at least one day per week (National Health Service Information Centre, 2010). A recent Royal College of Psychiatrists Report (2011) cited research that showed there has been a rise in the number drinking over weekly recommended limits by 60% in men and 100% in women between 1990 and 2006 with the number of people aged over 65 years requiring treatment for a substance misuse problem, set to more than double between 2001 and 2020, all of which points to a significant public health problem both now and in the future (National Health Service Information Centre, 2009). Publication type: Journal: Review Source: EMBASE 14.Title: Evaluating the impact of the alcohol act on off-trade alcohol sales: a natural experiment in Scotland. Citation: Addiction, 01 December 2014, vol./is. 109/12(2035-2043), 09652140 Author(s): Robinson, Mark, Geue, Claudia, Lewsey, James, Mackay, Daniel, McCartney, Gerry, Curnock, Esther, Beeston, Clare Language: English Abstract: Background and Aims A ban on multi-buy discounts of off-trade alcohol was introduced as part of the Alcohol Act in Scotland in October 2011. The aim of this study was to assess the impact of this legislation on alcohol sales, which provide the best indicator of population consumption. Design, Setting and Participants Interrupted timeseries regression was used to assess the impact of the Alcohol Act on alcohol sales among off-trade retailers in Scotland. Models accounted for underlying seasonal and secular trends and were adjusted for disposable income, alcohol prices and substitution effects. Data for off-trade retailers in England and Wales combined ( EW) provided a control group. Measurements Weekly data on the volume of pure alcohol sold by off-trade retailers in Scotland and EW between January 2009 and September 2012. Findings The introduction of the legislation was associated with a 2.6% (95% CI = −5.3 to 0.2%, P = 0.07) decrease in off-trade alcohol sales in Scotland, but not in EW (−0.5%, 95% CI = −4.6 to 3.9%, P = 0.83). A statistically significant reduction was observed in Scotland when EW sales were adjusted for in the analysis (−1.7%, 95% CI = −3.1 to −0.3%, P = 0.02). The decline in Scotland was driven by reduced off-trade sales of wine (−4.0%, 95% CI = −5.4 to −2.6%, P < 0.001) and pre-mixed beverages (−8.5%, 95% CI = −12.7 to −4.1%, P < 0.001). There were no associated changes in other drink types in Scotland, or in sales of any drink type in EW. Conclusions The introduction of the Alcohol Act in Scotland in 2011 was associated with a decrease in total off-trade alcohol sales in Scotland, largely driven by reduced off-trade wine sales. Publication type: journal article Source: CINAHL 15.Title: Favourite alcohol advertisements and binge drinking among adolescents: a cross-cultural cohort study. Citation: Addiction, 01 December 2014, vol./is. 109/12(2005-2015), 09652140 Author(s): Morgenstern, Matthis, Sargent, James D., Sweeting, Helen, Faggiano, Fabrizio, Mathis, Federica, Hanewinkel, Reiner Language: English Abstract: Aims To investigate the association between having a favourite alcohol advertisement and binge drinking among European adolescents. Design Data were obtained from a longitudinal observational study on relationships between smoking and drinking and film tobacco and alcohol exposures. Setting State-funded schools. Participants Baseline survey of 12 464 German, Italian, Polish and Scottish adolescents (mean age 13.5 years), of whom 10 259 (82%) were followed-up 12 months later. Measurements Pupils were asked the brand of their favourite alcohol advertisement at baseline. Multi-level mixed-effects logistic regressions assessed relationships between having a favourite alcohol advertisement ('alcohol marketing receptivity') and (i) binge drinking at baseline; and (ii) initiating binge drinking during follow-up among a subsample of 7438 baseline never binge drinkers. Findings Life-time binge drinking prevalence at baseline was 29.9% and 25.9% initiated binge drinking during follow-up. Almost one-third of the baseline sample (32.1%) and 22.6% of the follow-up sample of never-bingers named a branded favourite alcohol advertisement, with high between-country variation in brand named. After controlling for age, gender, family affluence, school performance, TV screen time, personality characteristics and drinking behaviour of peers, parents and siblings, alcohol marketing receptivity was related significantly to both binge drinking at baseline [adjusted odds ratio ( AOR) = 2.13, 95% confidence interval ( CI) = 1.92, 2.36] and binge drinking initiation in longitudinal analysis ( AOR = 1.45, 95% CI = 1.26, 1.66). There was no evidence for effect heterogeneity across countries. Conclusions Among European adolescents naming a favourite alcohol advertisement was associated with increased likelihood of initiating binge drinking during 1-year follow-up, suggesting a relationship between alcohol marketing receptivity and adolescent binge drinking. Publication type: journal article Source: CINAHL 16.Title: Health on the web: Randomised controlled trial of online screening and brief alcohol intervention delivered in a workplace setting Citation: PLoS ONE, November 2014, vol./is. 9/11, 1932-6203 (19 Nov 2014) Author(s): Khadjesari Z., Freemantle N., Linke S., Hunter R., Murray E. Language: English Abstract: Background: Alcohol misuse in England costs around 7.3 billion (US$12.2 billion) annually from lost productivity and absenteeism. Delivering brief alcohol interventions to employees as part of a health check may be acceptable, particularly with online delivery which can provide privacy for this stigmatised behaviour. Research to support this approach is limited and methodologically weak. The aim was to determine the effectiveness of online screening and personalised feedback on alcohol consumption, delivered in a workplace as part of a health check.Methods and Findings: This two-group online individually randomised controlled trial recruited employees from a UKbased private sector organisation (approx. 100,000 employees). 3,375 employees completed the online health check in the three week recruitment period. Of these, 1,330 (39%) scored five or more on the AUDIT-C (indicating alcohol misuse) and were randomised to receive personalised feedback on their alcohol intake, alongside feedback on other health behaviours (n = 659), or to receive feedback on all health behaviours except alcohol intake (n = 671). Participants were mostly male (75%), with a median age of 48 years and half were in managerial positions (55%). Median Body Mass Index was 26, 12% were smokers, median time undertaking moderate/vigorous physical activity a week was 173 minutes and median fruit and vegetable consumption was three portions a day. Eighty percent (n = 1,066) of participants completed follow-up questionnaires at three months. An intention to treat analysis found no difference between experimental groups for past week drinking (primary outcome) (5.6% increase associated with the intervention (95% CI-4.7% to 16.9%; p = .30)), AUDIT (measure of alcohol-related harm) and health utility (EQ-5D).Conclusions: There was no evidence to support the use of personalised feedback within an online health check for reducing alcohol consumption among employees in this organisation. Further research is needed on how to engage a larger proportion of employees in screening. Publication type: Journal: Article Source: EMBASE Full text: Available ProQuest at PLoS ONE Full text: Available ProQuest at PLoS One 17.Title: Health professionals' alcohol-related professional practices and the relationship between their personal alcohol attitudes and behavior and professional practices: A systematic review Citation: International Journal of Environmental Research and Public Health, December 2014, vol./is. 11/1(218-248), 1661-7827;1660-4601 (23 Dec 2013) Author(s): Bakhshi S., While A.E. Language: English Abstract: Health professionals' personal health behaviors have been found to be associated with their practices with patients in areas such as smoking, physical activity and weight management, but little is known in relation to alcohol use. This review has two related strands and aims to: (1) examine health professionals' alcohol-related health promotion practices; and (2) explore the relationship between health professionals' personal alcohol attitudes and behaviors, and their professional alcohol-related health promotion practices. A comprehensive literature search of the Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL, British Nursing Index, Web of Science, Scopus and Science Direct (2007-2013) identified 26 studies that met the inclusion criteria for Strand 1, out of which six were analyzed for Strand 2. The findings indicate that health professionals use a range of methods to aid patients who are high-risk alcohol users. Positive associations were reported between health professionals' alcohol-related health promotion activities and their personal attitudes towards alcohol (n = 2), and their personal alcohol use (n = 2). The findings have some important implications for professional education. Future research should focus on conducting well-designed studies with larger samples to enable us to draw firm conclusions and develop the evidence base. 2013 by the authors; licensee MDPI, Basel, Switzerland. Publication type: Journal: Review Source: EMBASE Full text: Available ProQuest at International Journal of Environmental Research and Public Health 18.Title: Helping elderly individuals address substance use Citation: Nursing & Residential Care, Oct 2014, vol. 16, no. 10, p. 586-590, 1465-9301 (October 2014) Author(s): Green, Danielle Abstract: This competence-based optional unit assesses the care worker's ability to support individuals with drug or alcohol problems in developing and reviewing their action plans. [PUBLICATION] 14 references Source: BNI Full text: Available Nursing & Residential Care at Nursing & residential care : the monthly journal for care assistants, nurses and managers working in health and social care 19.Title: Hospital admissions for alcoholic liver disease vary threefold across England. Citation: BMJ, 2014, vol./is. 349/(g5767), 0959-535X;1756-1833 (2014) Author(s): Kmietowicz Z Language: English Publication type: News Source: MEDLINE Full text: Available BMJ (Clinical research ed.) at The BMJ 20.Title: Impact of minimum price per unit of alcohol on patients with liver disease in the UK Citation: Clinical Medicine, Journal of the Royal College of Physicians of London, August 2014, vol./is. 14/4(396-403), 1470-2118;1473-4893 (01 Aug 2014) Author(s): Sheron N., Chilcott F., Matthews L., Challoner B., Thomas M. Language: English Abstract: The slow epidemic of liver disease in the UK over the past 30 years is a result of increased consumption of strong cheap alcohol. When we examined alcohol consumption in 404 subjects with a range of liver disease, we confirmed that patients with alcohol-related cirrhosis drank huge amounts of cheap alcohol, with a mean weekly consumption of 146 units in men and 142 in women at a median price of 33p/unit compared with 1.10 for low-risk drinkers. For the patients in our study, the impact of a minimum unit price of 50p/unit on spending on alcohol would be 200 times higher for patients with liver disease who were drinking at harmful levels than for low-risk drinkers. As a health policy, a minimum unit price for alcohol is exquisitely targeted at the heaviest drinkers, for whom the impact of alcohol-related illness is most devastating. Royal College of Physicians 2014. All rights reserved. Publication type: Journal: Article Source: EMBASE 21.Title: Industry Actors, Think Tanks, and Alcohol Policy in the United Kingdom. Citation: American Journal of Public Health, Aug 2014, vol. 104, no. 8, p. 1363-1369, 0090-0036 (August 2014) Author(s): Hawkins, Benjamin, McCambridge, Jim Abstract: Corporate actors seek to influence alcohol policies through various means, including attempts to shape the evidential content of policy debates. In this case study, we examined how SABMiller engaged the think tank Demos to produce reports on binge drinking, which were heavily promoted among policymakers at crucial stages in the development of the UK government's 2012 alcohol strategy. One key report coincided with other SABMiller-funded publications, advocating measures to enhance parenting as an alternative to minimum unit pricing. In this instance, the perceived independence of an influential think tank was used to promote industry interests in tactics similar to those of transnational tobacco corporations. This approach is in keeping with other alcohol industry efforts to marginalize the peer-reviewed literature. [PUBLICATION] 57 references Source: BNI Full text: Available EBSCOhost at American Journal of Public Health Full text: Available EBSCOhost at American Journal of Public Health Full text: Available EBSCOhost at American Journal of Public Health 22.Title: Long working hours and alcohol use: systematic review and meta-analysis of published studies and unpublished individual participant data. Citation: BMJ, 2015, vol./is. 350/(g7772), 0959-535X;1756-1833 (2015) Author(s): Virtanen M, Jokela M, Nyberg ST, Madsen IE, Lallukka T, Ahola K, Alfredsson L, Batty GD, Bjorner JB, Borritz M, Burr H, Casini A, Clays E, De Bacquer D, Dragano N, Erbel R, Ferrie JE, Fransson EI, Hamer M, Heikkila K, Jockel KH, Kittel F, Knutsson A, Koskenvuo M, Ladwig KH, Lunau T, Nielsen ML, Nordin M, Oksanen T, Pejtersen JH, Pentti J, Rugulies R, Salo P, Schupp J, Siegrist J, Singh-Manoux A, Steptoe A, Suominen SB, Theorell T, Vahtera J, Wagner GG, Westerholm PJ, Westerlund H, Kivimaki M Language: English Abstract: OBJECTIVE: To quantify the association between long working hours and alcohol use.DESIGN: Systematic review and meta-analysis of published studies and unpublished individual participant data.DATA SOURCES: A systematic search of PubMed and Embase databases in April 2014 for published studies, supplemented with manual searches. Unpublished individual participant data were obtained from 27 additional studies.REVIEW METHODS: The search strategy was designed to retrieve cross sectional and prospective studies of the association between long working hours and alcohol use. Summary estimates were obtained with random effects meta-analysis. Sources of heterogeneity were examined with meta-regression.RESULTS: Cross sectional analysis was based on 61 studies representing 333693 participants from 14 countries. Prospective analysis was based on 20 studies representing 100602 participants from nine countries. The pooled maximum adjusted odds ratio for the association between long working hours and alcohol use was 1.11 (95% confidence interval 1.05 to 1.18) in the cross sectional analysis of published and unpublished data. Odds ratio of new onset risky alcohol use was 1.12 (1.04 to 1.20) in the analysis of prospective published and unpublished data. In the 18 studies with individual participant data it was possible to assess the European Union Working Time Directive, which recommends an upper limit of 48 hours a week. Odds ratios of new onset risky alcohol use for those working 49-54 hours and >55 hours a week were 1.13 (1.02 to 1.26; adjusted difference in incidence 0.8 percentage points) and 1.12 (1.01 to 1.25; adjusted difference in incidence 0.7 percentage points), respectively, compared with working standard 35-40 hours (incidence of new onset risky alcohol use 6.2%). There was no difference in these associations between men and women or by age or socioeconomic groups, geographical regions, sample type (population based v occupational cohort), prevalence of risky alcohol use in the cohort, or sample attrition rate.CONCLUSIONS: Individuals whose working hours exceed standard recommendations are more likely to increase their alcohol use to levels that pose a health risk.Copyright Virtanen et al 2015. Publication type: Journal Article Source: MEDLINE Full text: Available BMJ (Clinical research ed.) at The BMJ 23.Title: Managing alcoholic liver disease Citation: Nursing, Nov 2014, vol. 44, no. 11, p. 30-40, 0360-4039 (November 2014) Author(s): Morrison, Dolores, Sgrillo, Justine, Daniels, Lauren H. Abstract: Morrison et al discuss the pathophysiology, incidence, and etiology of alcoholic liver disease (ALD), potential complications, medical and pharmacologic management, and nursing priorities. A serious consequence of chronic alcohol consumption, ALD poses complex medical and psychosocial challenges for the patient, family, and the healthcare team. ALD is a major cause of preventable liver disease in the US and worldwide. In 2003, 44% of deaths from liver disease in the US were attributed to alcohol. And in 2004, alcohol consumption was responsible for 3.8% of global mortality. Research indicates that women are twice as susceptible to hepatic damage from excess alcohol consumption. Compared with men, women are more prone to severe ALD even when consuming lower doses of alcohol. Explanations for gender disparities are linked to differences in alcohol absorption and metabolism. [PUBLICATION] 57 references Source: BNI Full text: Available Nursing at Nursing 24.Title: Multiple vitamin deficiencies in a patient with a history of chronic alcohol excess and self-neglect in the UK Citation: BMJ Case Reports, September 2014, vol./is. 2014/, 1757-790X (22 Sep 2014) Author(s): Dickson J.M., Naylor G., Colver G., Powers H.J., Masters P. Language: English Abstract: We report a case of inadequate diet (caused by extreme self-neglect and alcohol excess) which led to chronic severe deficiencies of vitamins A, D and E. At presentation the patient had widespread follicular hyperkeratosis of the skin, keratomalacia of both eyes and a severe cognitive impairment. He responded well to treatment including high dose parenteral vitamins, but lasting impairments in his vision and cognition have caused We report a case of inadequate diet (caused by extreme self-neglect and alcohol excess) which led to chronic severe deficiencies of vitamins A, D and E. At presentation the patient had widespread follicular hyperkeratosis of the skin, keratomalacia of both eyes and a severe cognitive impairment. He responded well to treatment including high dose parenteral vitamins, but lasting impairments in his vision and cognition have caused permanent disability. Copyright 2014 BMJ Publishing Group. All rights reserved. Publication type: Journal: Article Source: EMBASE 25.Title: Normative misperceptions about alcohol use in the general population of drinkers: A cross-sectional survey Citation: Addictive Behaviors, March 2015, vol./is. 42/(203-206), 0306-4603;1873-6327 (March 01, 2015) Author(s): Garnett C., Crane D., West R., Michie S., Brown J., Winstock A. Language: English Abstract: Introduction: Underestimating one's own alcohol consumption relative to others ('normative misperception') has been documented in some college student and heavy-alcohol using samples, and may contribute to excessive drinking. This study aimed to assess how far this phenomenon extends to alcohol users more generally in four English-speaking countries and if associations with socio-demographic and drinking variables exist. Methods: A cross-sectional online global survey (Global Drugs Survey-2012) was completed by 9820 people aged 18. + from Australia, Canada, the UK and US who had consumed alcohol in the last year. The survey included the AUDIT questionnaire (which assessed alcohol consumption, harmful drinking and alcohol dependence), socio-demographic assessment and a question assessing beliefs about how one's drinking compares with others. Associations were analysed by linear regression models. Results: Underestimation of own alcohol use relative to others occurred in 46.9% (95% CI: 45.9%, 47.9%) of respondents. 25.4% of participants at risk of alcohol dependence and 36.6% of harmful alcohol users believed their drinking to be average or less. Underestimation was more likely among those who were: younger (16-24; p<. 0.003), male (. p<. 0.001), from the UK (versus US; p<. 0.001), less well educated (. p=. 0.003), white (. p=. 0.035), and unemployed (versus employed; p<. 0.001). Conclusions: Underestimating one's own alcohol consumption relative to other drinkers is common in Australia, Canada, the UK and US, with a substantial minority of harmful drinkers believing their consumption to be at or below average. This normative misperception is greater in those who are younger, male, less well educated, unemployed, white, from the UK and high-risk drinkers. Publication type: Journal: Article Source: EMBASE 26.Title: Potential benefits of minimum unit pricing for alcohol versus a ban on below cost selling in England 2014: modelling study Citation: BMJ (Clinical Research Edition), Oct 2014, vol. 349, no. 7977, p. g5452., 0959-8138 (October 4, 2014) Author(s): Brennan, Alan, Meng, Yang, Holmes, John, Hill-McManus, Daniel, Meier, Petra S Abstract: Objective To evaluate the potential impact of two alcohol control policies under consideration in England: banning below cost selling of alcohol and minimum unit pricing. Design Modelling study using the Sheffield Alcohol Policy Model version 2.5. Setting England 2014-15. Population Adults and young people aged 16 or more, including subgroups of moderate, hazardous, and harmful drinkers. Interventions Policy to ban below cost selling, which means that the selling price to consumers could not be lower than tax payable on the product, compared with policies of minimum unit pricing at £0.40 (?0.57; $0.75), 45p, and 50p per unit (7.9 g/10 mL) of pure alcohol. Main outcome measures Changes in mean consumption in terms of units of alcohol, drinkers' expenditure, and reductions in deaths, illnesses, admissions to hospital, and quality adjusted life years. Results The proportion of the market affected is a key driver of impact, with just 0.7% of all units estimated to be sold below the duty plus value added tax threshold implied by a ban on below cost selling, compared with 23.2% of units for a 45p minimum unit price. Below cost selling is estimated to reduce harmful drinkers' mean annual consumption by just 0.08%, around 3 units per year, compared with 3.7% or 137 units per year for a 45p minimum unit price (an approximately 45 times greater effect). The ban on below cost selling has a small effect on population health saving an estimated 14 deaths and 500 admissions to hospital per annum. In contrast, a 45p minimum unit price is estimated to save 624 deaths and 23 700 hospital admissions. Most of the harm reductions (for example, 89% of estimated deaths saved per annum) are estimated to occur in the 5.3% of people who are harmful drinkers. Conclusions The ban on below cost selling, implemented in the England in May 2014, is estimated to have small effects on consumption and health harm. The previously announced policy of a minimum unit price, if set at expected levels between 40p and 50p per unit, is estimated to have an approximately 40-50 times greater effect. [PUBLICATION] 29 references Source: BNI Full text: Available BMJ at The BMJ Full text: Available BMJ at Salisbury District Hospital Healthcare Library 27.Title: Prenatal exposure to binge pattern of alcohol consumption: mental health and learning outcomes at age 11. Citation: European Child & Adolescent Psychiatry, 01 October 2014, vol./is. 23/10(891-899), 10188827 Author(s): Sayal, Kapil, Heron, Jon, Draper, Elizabeth, Alati, Rosa, Lewis, Sarah, Fraser, Robert, Barrow, Margaret, Golding, Jean, Emond, Alan, Davey Smith, George, Gray, Ron Language: English Abstract: The objective of the study is to investigate whether episodic binge pattern of alcohol consumption during pregnancy is independently associated with child mental health and academic outcomes. Using data from the prospective, population-based Avon Longitudinal Study of Parents and Children (ALSPAC), we investigated the associations between binge patterns of alcohol consumption during pregnancy (≥4 drinks per day) and child mental health [as rated by both parent ( n = 4,610) and teacher ( n = 4,274)] and academic outcomes [based on examination results ( n = 6,939)] at age 11 years. After adjusting for prenatal and postnatal risk factors, binge pattern of alcohol consumption (≥4 drinks in a day on at least one occasion) during pregnancy was associated with higher levels of mental health problems (especially hyperactivity/inattention) in girls at age 11 years, according to parental report. After disentangling binge-pattern and daily drinking, binge-pattern drinking was independently associated with teacher-rated hyperactivity/inattention and lower academic scores in both genders. Episodic drinking involving ≥4 drinks per day during pregnancy may increase risk for child mental health problems and lower academic attainment even if daily average levels of alcohol consumption are low. Episodic binge pattern of drinking appears to be a risk factor for these outcomes, especially hyperactivity and inattention problems, in the absence of daily drinking. Publication type: journal article Source: CINAHL 28.Title: Revisiting the rationale for social normative interventions in student drinking in a UK population. Citation: Addictive Behaviors, 01 December 2014, vol./is. 39/12(1823-1826), 03064603 Author(s): John, Bev, Alwyn, Tina Language: English Abstract: OBJECTIVES: Social normative re-education interventions are based on the premise that harmful student drinking is caused by misperceptions of campus drinking norms. They have become dominant despite little evidence for effectiveness, especially with heavy drinkers. The objective of this study was to explore the relative importance of social norms and other key cognitive constructs in predicting single occasion alcohol consumption in undergraduates. METHODS: DESIGN: A cross sectional survey design was utilised. SETTING: Three UK universities. PARTICIPANTS: 367 1st year undergraduate students. MEASURES: Frequency and quantity of alcohol consumed; hazardous drinking; descriptive and injunctive normative perceptions of alcohol consumption were measured at 3 proximal-distal levels. RESULTS: Participants in this study were drinking at much higher levels than previously reported (means of 20 units for males, 16 units for females on a single drinking occasion); 85% exceeded the UK government's definition of binge drinking of 8 units or more on a single occasion. Norm perceptions, which form the basis of social normative interventions, were not significant predictors of individual consumption. Cognitive appraisal of oneself as a drinker and volitional behavioural control on drinking occasions are the most important constructs in predicting heavy drinking in this sample of UK undergraduate students. The model that emerges explains 40% of the variance in single occasion consumption. CONCLUSIONS: Students are consuming levels of alcohol that will result in accumulative harm if unchecked. This study provides an explanation as to why social normative interventions are not effective. An alternative focus for reducing alcohol consumption in UK undergraduates is suggested. Publication type: journal article