Treatment of Alcohol Related Liver Disease (ARLD) by Acute Trusts in Wessex shows that the number of liver disease admissions are increasing each year in the region. In 2015, 37% of liver disease admissions across Wessex had an alcohol-specific condition coded, though one trust reported 45%. Patients diagnosed with ARLD have greater mortality, more admissions, and longer lengths of stay than non-ARLD patients. There is variation between trusts in percentages of admissions coded as ARLD, lengths of stay, and costs. Estimates suggest improving early diagnosis and management of ARLD patients could save £10-13.3 million per year across the six acute trusts in the region.
Integrated Treatment for ARLD: making it happen, 2nd February 2017, Presenta...Health Innovation Wessex
This document summarizes evidence on reducing alcohol-related harm, particularly liver disease. It discusses international patterns of alcohol consumption and harm, highlighting groups that consume the most alcohol and are most at risk of harm. The evidence shows policies that effectively reduce harm include increasing alcohol taxes and prices, limiting availability and marketing. However, non-regulatory approaches alone are less effective. Public support for regulation is growing. Reducing consumption can have rapid health benefits, even for cirrhosis. The alcohol industry should have no role in policy-making given its vested interests.
Integrated Treatment for ARLD: making it happen, 2nd February 2017 Presentat...Health Innovation Wessex
This document summarizes alcohol-related liver disease (ARLD) on the Isle of Wight, including current services and barriers to improvement. It finds that 36% of liver disease admissions have an alcohol-specific condition, and 47% of ARLD patients die in the hospital. An audit revealed opportunities to improve alcohol screening and referrals to treatment. Moving forward, plans include developing an integrated alcohol service between hospitals and community clinics, universal screening in emergency departments and pharmacies, and re-auditing outcomes. The main barrier is startup costs to establish hospital and community treatment teams.
Integrated Treatment for ARLD: Making it happen, 2 February 2017 Presentation...Health Innovation Wessex
The document summarizes audits of patients admitted with liver disease to St. Mary's Hospital on the Isle of Wight in 2015 and 2016. The initial 2015 audit found that 36% of liver disease admissions were alcohol-related, yet screening and referral processes for harmful alcohol use were lacking. A repeat 2016 audit showed improvements in screening and documentation, with 92% of patients asked about alcohol and 36% completing an alcohol screening tool. However, rates of referral for harmful drinking remained low. The document outlines plans to establish an integrated alcohol service across hospital and community settings on the Isle of Wight to further improve identification and support of patients with alcohol-related liver disease.
Integrated Treatment for ARLD: Making it happen, 2 February 2017 Presentation...Health Innovation Wessex
The James Lind Alliance brings together patients, caregivers, and clinicians to identify and prioritize the top 10 unanswered questions about particular health areas like alcohol-related liver disease, to help ensure research funders are aware of the issues that matter most. A priority setting partnership was established for alcohol-related liver disease, where a survey and workshop were held to identify the most important unanswered questions agreed upon by patients, caregivers, and health professionals dealing with this issue. The top 5 questions focused on ways to help people stop drinking, delivering healthcare education about risks, models of community-based care, experiences of patients, and how attitudes of healthcare professionals
Service Innovation - UHS Pharmacy an Opportunity to Increase the Coverage of ...Health Innovation Wessex
Getting To Grips with Alcohol 2016
Presentation Slides
Service Innovation - UHS Pharmacy an opportunity to increase the coverage of identification and brief advice
Jacqueline Swabe and Lindsay Steel
Integrated Treatment for ARLD: making it happen, 2nd February 2017, Presenta...Health Innovation Wessex
This document summarizes evidence on reducing alcohol-related harm, particularly liver disease. It discusses international patterns of alcohol consumption and harm, highlighting groups that consume the most alcohol and are most at risk of harm. The evidence shows policies that effectively reduce harm include increasing alcohol taxes and prices, limiting availability and marketing. However, non-regulatory approaches alone are less effective. Public support for regulation is growing. Reducing consumption can have rapid health benefits, even for cirrhosis. The alcohol industry should have no role in policy-making given its vested interests.
Integrated Treatment for ARLD: making it happen, 2nd February 2017 Presentat...Health Innovation Wessex
This document summarizes alcohol-related liver disease (ARLD) on the Isle of Wight, including current services and barriers to improvement. It finds that 36% of liver disease admissions have an alcohol-specific condition, and 47% of ARLD patients die in the hospital. An audit revealed opportunities to improve alcohol screening and referrals to treatment. Moving forward, plans include developing an integrated alcohol service between hospitals and community clinics, universal screening in emergency departments and pharmacies, and re-auditing outcomes. The main barrier is startup costs to establish hospital and community treatment teams.
Integrated Treatment for ARLD: Making it happen, 2 February 2017 Presentation...Health Innovation Wessex
The document summarizes audits of patients admitted with liver disease to St. Mary's Hospital on the Isle of Wight in 2015 and 2016. The initial 2015 audit found that 36% of liver disease admissions were alcohol-related, yet screening and referral processes for harmful alcohol use were lacking. A repeat 2016 audit showed improvements in screening and documentation, with 92% of patients asked about alcohol and 36% completing an alcohol screening tool. However, rates of referral for harmful drinking remained low. The document outlines plans to establish an integrated alcohol service across hospital and community settings on the Isle of Wight to further improve identification and support of patients with alcohol-related liver disease.
Integrated Treatment for ARLD: Making it happen, 2 February 2017 Presentation...Health Innovation Wessex
The James Lind Alliance brings together patients, caregivers, and clinicians to identify and prioritize the top 10 unanswered questions about particular health areas like alcohol-related liver disease, to help ensure research funders are aware of the issues that matter most. A priority setting partnership was established for alcohol-related liver disease, where a survey and workshop were held to identify the most important unanswered questions agreed upon by patients, caregivers, and health professionals dealing with this issue. The top 5 questions focused on ways to help people stop drinking, delivering healthcare education about risks, models of community-based care, experiences of patients, and how attitudes of healthcare professionals
Service Innovation - UHS Pharmacy an Opportunity to Increase the Coverage of ...Health Innovation Wessex
Getting To Grips with Alcohol 2016
Presentation Slides
Service Innovation - UHS Pharmacy an opportunity to increase the coverage of identification and brief advice
Jacqueline Swabe and Lindsay Steel
Improving the Physical health care of people with mental ill health: Cardiovascular health of people with serious mental illness National Learning Network Event 29th April 2015.
Main Slide: NHS IQ CVD SMI LNE 29 April 2015 slides - 1-152
BREAKOUT 1_PATIENT VOICE slides 153-161
BREAKOUT 2a_IMPROVING CARDIOVASCULAR CARE FOR PEOPLE WITH SMI - slides 162-188
BREAKOUT 2b_UCLP PROGRAMME ON CVDSMI - slides 188-195
BREAKOUT 3_PHYSICAL ACTIVITY IN MENTAL HEALTH - slides 196-212
BREAKOUT 4_REASONS FOR TEWVS SUCCESS - slides 213-225
BREAKOUT 5_ PHYSICAL HEALTH AND WELLBEING - slides 226-243
BREAKOUT 6_SHAPE - slides 244-271
BREAKOUT 7_SCREENING FOR CARDIOMETABOLIC RISK FACTORS - slides 272 -296
This document discusses integrated treatment approaches for alcohol-related liver disease. It covers the progression of alcoholic liver disease, from fatty liver to cirrhosis. It recommends cost-effective public health policies to reduce alcohol consumption such as taxes, licensing restrictions, and limits on advertising. It emphasizes the importance of early detection of liver disease through screening programs. For patients with alcoholic hepatitis, it discusses treatments including corticosteroids and pentoxifylline, and highlights risks of infection from corticosteroid use. It also stresses the importance of nutrition supplementation in treatment. Prognostic scores are discussed to help predict outcomes and determine appropriate care.
Homeless Health Needs Assessment - Tim Elwell-Sutton & Jonathan FokIan Brown
The document summarizes a homeless health needs assessment conducted in Essex, England. It found that over 2,800 people were estimated to be homeless, with the majority being male, white, and from the UK. The assessment surveyed 152 homeless individuals, finding high rates of physical and mental health issues. Two-thirds reported symptoms of stress, anxiety, and depression, while many used drugs or alcohol to cope. Recommendations included improving access to services, integrating mental health support, and conducting regular needs assessments. The assessment confirmed global findings on health problems faced by the homeless population.
This study assessed blood donation patterns and motivators in Acholi sub-region of Uganda. The results showed that only 41.8% of the required blood was being collected, with fluctuations corresponding to school holidays. There was no significant trend in quantities donated over four years. Nearly half of blood was discarded due to hepatitis B and C. Motivators for donation included health status screening and altruism, while lack of time and fears were demotivating factors. The researchers recommend strategies to retain donors and explore alternatives to voluntary donation to improve collection rates.
This grant proposal aims to improve cardiovascular health in the Nashville community by increasing public awareness of hypertension risks. It notes that blood pressure control is one of the poorest controlled risk factors nationally and is not projected to improve greatly. Over 15% of hypertensive adults in Nashville do not take medication, and the presenter's patients have an average systolic blood pressure of 130 mmHg, above recommendations. The $5,000 grant would fund public outreach at local events to educate all age groups, especially those over 40, about blood pressure risks through tents, posters, and radio ads. The project's effectiveness will be evaluated after one year by comparing patients' risk scores and blood pressures to initial data.
Think Kidneys: Raising the profile of AKI in EnglandRenal Association
The document discusses the Think Kidneys program in England, which aims to raise awareness of acute kidney injury (AKI) and improve care. The program has established data flows to allow audit and quality improvement, provided education to clinicians and patients about AKI, and supported leaders in prioritizing AKI care. An evaluation found the program delivered national frameworks to guide action, raised the profile of AKI, and supported other improvement initiatives. The objectives of establishing better data, education, and championing have been met.
Developing and implementing clinical standards for seven day servicesNHS Improving Quality
Celia Ingham Clark National Director: Reducing Premature Mortality. Slides from Celia's presentation from the 7 Day Services events West Midlands 11th June and East Midlands 12th June 2014
The document provides a summary of a survey conducted in June 2018 at five entry-exit checkpoints along the line of contact in eastern Ukraine. The following key points were reported:
- Most respondents were female elderly residents of non-government controlled areas who cross the checkpoints quarterly to access pensions and services.
- Travel to government-controlled areas was mostly to address documents issues and withdrawals, while travel to non-government areas was to visit relatives and check property.
- Crossing times averaged 2-3 hours, with the longest waits at Maiorske checkpoint. Conditions were most difficult at Stanytsia Luhanska due to a one-hour walk between checkpoints.
- Main concerns included long
National Diabetes Registry Report 2013-2019: Update of Key FindingsArunah Chandran
This presentation is the update of key findings from the second National Diabetes Registry (NDR) report since the establishment of the registry in Malaysia. It is intended to share the data contained within the NDR for clinicians, public
health specialists and researchers and all those who are interested in the clinical management of diabetes
Accelerating Primary Care Abstract 2014 V9Nikki Davis
The AHPCN CR program was developed to improve access to cardiac rehabilitation services for residents in rural Alberta and increase participation rates, as prior to 2012 only 3% of cardiac patients from the region utilized the program in Edmonton despite 48% of cardiac patients living rurally. The program has grown from serving 12 participants weekly in 2012 to 30 participants weekly by 2015, offering both supervised exercise and educational classes delivered by a multidisciplinary team. Referrals have increased each year since the program began from rural hospitals, cardiac programs, and local physicians to better serve residents and support secondary prevention of heart disease.
The PURE study followed over 200,000 participants from 27 countries over 9.5 years. It found that cardiovascular disease (CVD) is the leading cause of death globally and in low-income countries, while cancer deaths are more common in many high-income countries. Modifiable risk factors like hypertension, diet, tobacco use, and physical activity explain around 70% of the risk of CVD and mortality. Hypertension has the largest impact on CVD risk. The importance of other factors like air pollution, education, and grip strength have been previously underappreciated, especially in low-income countries. Reducing CVD and mortality will require modifying major risk factors through low-cost interventions and improving healthcare, education, and reducing indoor
Diabetic eye screening 1 April 2015 to 31 March 2016 data slide setMike Harris
This document provides charts and data to support the annual NHS Diabetic Eye Screening Programme report for the period of April 1, 2015 to March 31, 2016. It includes information on eligible patients, screening outcomes, referrals to eye hospitals, and notes on data quality for individual screening services. Definitions of key terms and codes for the 90 screening services across England are also provided.
This document summarizes substance abuse issues faced in emergency departments. It notes that substance abuse patients are frequent emergency department users who require significant resources. Over 5 million emergency department visits annually are related to drugs, including 2.5 million specifically for drug abuse or misuse. Prescription opioid abuse and overdoses have risen dramatically in recent years. New CDC guidelines aim to curb opioid prescribing practices to help address this crisis. Emergency physicians are on the front lines of this issue and see the consequences of opioid addiction firsthand.
Diagnose-prescribing survey in general practiceTHL
1) The document describes a study that surveyed management of common infections in primary care practices in Sweden, Latvia, and Lithuania.
2) The study recruited primary care doctors and practices through convenience sampling and had them complete a protocol for patients presenting with infections over one week.
3) Results showed that Swedish patients tended to be older and wait longer with symptoms, while Latvia and Lithuania prescribed more amoxicillin and macrolides, and Sweden used more penicillin V and doxycycline.
12 things we learnt about drug and alcohol treatment in Wales in 2014-15Andrew Brown
The document summarizes key statistics from the Welsh National Database for Substance Misuse about drug and alcohol treatment in Wales in 2014-2015. Some of the main findings include: referrals were highest among those aged 25-34 for both males and females; the most common sources of referrals were GPs, self-referrals, and criminal justice; cannabis and alcohol were the most common problematic substances; the number of people in treatment increased slightly from 2013-2014; and the most common treatment types delivered were psychosocial interventions, brief interventions, and harm reduction.
Record of NHS Screening e-learning completionMike Harris
This document records Jonathan Waldheim's completion of various e-learning modules related to NHS screening programmes. It shows the dates that modules within different screening program topics were completed, including antenatal and newborn screening, sickle cell and thalassaemia screening, newborn blood spot screening, fetal anomaly scanning, nuchal translucency screening, sickle cell and thalassaemia laboratory techniques, newborn hearing screening, newborn and infant physical examination, abdominal aortic aneurysm screening, and 18-20 week fetal anomaly ultrasound scanning. The document provides details on over 50 individual e-learning modules and the dates they were completed from 2014 to 2017.
This document summarizes a research study evaluating the impact of cash transfer programs for older adults in Yucatan, Mexico. The study phased a program providing $550 pesos per month to adults over age 70 into three towns, with treatment and control groups. Surveys measuring health indicators were administered before and after to evaluate impacts on health, nutrition, and well-being. Preliminary results suggest the cash transfers improved food availability and medical care usage, while decreasing hunger and reliance on family support. More frequent monthly payments were also found to more effectively alleviate poverty compared to bi-monthly payments. Future analysis will evaluate cost-effectiveness and additional health interventions.
Integrated Treatment for ARLD: Making it happen, 2 February 2017, Presentatio...Health Innovation Wessex
The Clinical Research Network Wessex (CRN Wessex) provides study support services across six divisions to facilitate NIHR portfolio research. CRN Wessex is part of the NIHR family of organizations and works to support clinical research studies through resources like research nurses, clinical trials assistants, study coordinators, and support services in pharmacy, pathology, and radiology. For more information, contact the CRN Wessex study support team.
This document provides an assignment for an insurance and risk management course. It contains 6 questions related to topics like price risk, elements of life insurance organizations, doctrines of indemnity and subrogation, evidence and claims notices, insurance marketing mix, and benefits of reinsurance. Students are instructed to answer each question in approximately 400 words. The assignment is worth 60 total marks. It provides students an opportunity to demonstrate their understanding of key insurance concepts.
Improving the Physical health care of people with mental ill health: Cardiovascular health of people with serious mental illness National Learning Network Event 29th April 2015.
Main Slide: NHS IQ CVD SMI LNE 29 April 2015 slides - 1-152
BREAKOUT 1_PATIENT VOICE slides 153-161
BREAKOUT 2a_IMPROVING CARDIOVASCULAR CARE FOR PEOPLE WITH SMI - slides 162-188
BREAKOUT 2b_UCLP PROGRAMME ON CVDSMI - slides 188-195
BREAKOUT 3_PHYSICAL ACTIVITY IN MENTAL HEALTH - slides 196-212
BREAKOUT 4_REASONS FOR TEWVS SUCCESS - slides 213-225
BREAKOUT 5_ PHYSICAL HEALTH AND WELLBEING - slides 226-243
BREAKOUT 6_SHAPE - slides 244-271
BREAKOUT 7_SCREENING FOR CARDIOMETABOLIC RISK FACTORS - slides 272 -296
This document discusses integrated treatment approaches for alcohol-related liver disease. It covers the progression of alcoholic liver disease, from fatty liver to cirrhosis. It recommends cost-effective public health policies to reduce alcohol consumption such as taxes, licensing restrictions, and limits on advertising. It emphasizes the importance of early detection of liver disease through screening programs. For patients with alcoholic hepatitis, it discusses treatments including corticosteroids and pentoxifylline, and highlights risks of infection from corticosteroid use. It also stresses the importance of nutrition supplementation in treatment. Prognostic scores are discussed to help predict outcomes and determine appropriate care.
Homeless Health Needs Assessment - Tim Elwell-Sutton & Jonathan FokIan Brown
The document summarizes a homeless health needs assessment conducted in Essex, England. It found that over 2,800 people were estimated to be homeless, with the majority being male, white, and from the UK. The assessment surveyed 152 homeless individuals, finding high rates of physical and mental health issues. Two-thirds reported symptoms of stress, anxiety, and depression, while many used drugs or alcohol to cope. Recommendations included improving access to services, integrating mental health support, and conducting regular needs assessments. The assessment confirmed global findings on health problems faced by the homeless population.
This study assessed blood donation patterns and motivators in Acholi sub-region of Uganda. The results showed that only 41.8% of the required blood was being collected, with fluctuations corresponding to school holidays. There was no significant trend in quantities donated over four years. Nearly half of blood was discarded due to hepatitis B and C. Motivators for donation included health status screening and altruism, while lack of time and fears were demotivating factors. The researchers recommend strategies to retain donors and explore alternatives to voluntary donation to improve collection rates.
This grant proposal aims to improve cardiovascular health in the Nashville community by increasing public awareness of hypertension risks. It notes that blood pressure control is one of the poorest controlled risk factors nationally and is not projected to improve greatly. Over 15% of hypertensive adults in Nashville do not take medication, and the presenter's patients have an average systolic blood pressure of 130 mmHg, above recommendations. The $5,000 grant would fund public outreach at local events to educate all age groups, especially those over 40, about blood pressure risks through tents, posters, and radio ads. The project's effectiveness will be evaluated after one year by comparing patients' risk scores and blood pressures to initial data.
Think Kidneys: Raising the profile of AKI in EnglandRenal Association
The document discusses the Think Kidneys program in England, which aims to raise awareness of acute kidney injury (AKI) and improve care. The program has established data flows to allow audit and quality improvement, provided education to clinicians and patients about AKI, and supported leaders in prioritizing AKI care. An evaluation found the program delivered national frameworks to guide action, raised the profile of AKI, and supported other improvement initiatives. The objectives of establishing better data, education, and championing have been met.
Developing and implementing clinical standards for seven day servicesNHS Improving Quality
Celia Ingham Clark National Director: Reducing Premature Mortality. Slides from Celia's presentation from the 7 Day Services events West Midlands 11th June and East Midlands 12th June 2014
The document provides a summary of a survey conducted in June 2018 at five entry-exit checkpoints along the line of contact in eastern Ukraine. The following key points were reported:
- Most respondents were female elderly residents of non-government controlled areas who cross the checkpoints quarterly to access pensions and services.
- Travel to government-controlled areas was mostly to address documents issues and withdrawals, while travel to non-government areas was to visit relatives and check property.
- Crossing times averaged 2-3 hours, with the longest waits at Maiorske checkpoint. Conditions were most difficult at Stanytsia Luhanska due to a one-hour walk between checkpoints.
- Main concerns included long
National Diabetes Registry Report 2013-2019: Update of Key FindingsArunah Chandran
This presentation is the update of key findings from the second National Diabetes Registry (NDR) report since the establishment of the registry in Malaysia. It is intended to share the data contained within the NDR for clinicians, public
health specialists and researchers and all those who are interested in the clinical management of diabetes
Accelerating Primary Care Abstract 2014 V9Nikki Davis
The AHPCN CR program was developed to improve access to cardiac rehabilitation services for residents in rural Alberta and increase participation rates, as prior to 2012 only 3% of cardiac patients from the region utilized the program in Edmonton despite 48% of cardiac patients living rurally. The program has grown from serving 12 participants weekly in 2012 to 30 participants weekly by 2015, offering both supervised exercise and educational classes delivered by a multidisciplinary team. Referrals have increased each year since the program began from rural hospitals, cardiac programs, and local physicians to better serve residents and support secondary prevention of heart disease.
The PURE study followed over 200,000 participants from 27 countries over 9.5 years. It found that cardiovascular disease (CVD) is the leading cause of death globally and in low-income countries, while cancer deaths are more common in many high-income countries. Modifiable risk factors like hypertension, diet, tobacco use, and physical activity explain around 70% of the risk of CVD and mortality. Hypertension has the largest impact on CVD risk. The importance of other factors like air pollution, education, and grip strength have been previously underappreciated, especially in low-income countries. Reducing CVD and mortality will require modifying major risk factors through low-cost interventions and improving healthcare, education, and reducing indoor
Diabetic eye screening 1 April 2015 to 31 March 2016 data slide setMike Harris
This document provides charts and data to support the annual NHS Diabetic Eye Screening Programme report for the period of April 1, 2015 to March 31, 2016. It includes information on eligible patients, screening outcomes, referrals to eye hospitals, and notes on data quality for individual screening services. Definitions of key terms and codes for the 90 screening services across England are also provided.
This document summarizes substance abuse issues faced in emergency departments. It notes that substance abuse patients are frequent emergency department users who require significant resources. Over 5 million emergency department visits annually are related to drugs, including 2.5 million specifically for drug abuse or misuse. Prescription opioid abuse and overdoses have risen dramatically in recent years. New CDC guidelines aim to curb opioid prescribing practices to help address this crisis. Emergency physicians are on the front lines of this issue and see the consequences of opioid addiction firsthand.
Diagnose-prescribing survey in general practiceTHL
1) The document describes a study that surveyed management of common infections in primary care practices in Sweden, Latvia, and Lithuania.
2) The study recruited primary care doctors and practices through convenience sampling and had them complete a protocol for patients presenting with infections over one week.
3) Results showed that Swedish patients tended to be older and wait longer with symptoms, while Latvia and Lithuania prescribed more amoxicillin and macrolides, and Sweden used more penicillin V and doxycycline.
12 things we learnt about drug and alcohol treatment in Wales in 2014-15Andrew Brown
The document summarizes key statistics from the Welsh National Database for Substance Misuse about drug and alcohol treatment in Wales in 2014-2015. Some of the main findings include: referrals were highest among those aged 25-34 for both males and females; the most common sources of referrals were GPs, self-referrals, and criminal justice; cannabis and alcohol were the most common problematic substances; the number of people in treatment increased slightly from 2013-2014; and the most common treatment types delivered were psychosocial interventions, brief interventions, and harm reduction.
Record of NHS Screening e-learning completionMike Harris
This document records Jonathan Waldheim's completion of various e-learning modules related to NHS screening programmes. It shows the dates that modules within different screening program topics were completed, including antenatal and newborn screening, sickle cell and thalassaemia screening, newborn blood spot screening, fetal anomaly scanning, nuchal translucency screening, sickle cell and thalassaemia laboratory techniques, newborn hearing screening, newborn and infant physical examination, abdominal aortic aneurysm screening, and 18-20 week fetal anomaly ultrasound scanning. The document provides details on over 50 individual e-learning modules and the dates they were completed from 2014 to 2017.
This document summarizes a research study evaluating the impact of cash transfer programs for older adults in Yucatan, Mexico. The study phased a program providing $550 pesos per month to adults over age 70 into three towns, with treatment and control groups. Surveys measuring health indicators were administered before and after to evaluate impacts on health, nutrition, and well-being. Preliminary results suggest the cash transfers improved food availability and medical care usage, while decreasing hunger and reliance on family support. More frequent monthly payments were also found to more effectively alleviate poverty compared to bi-monthly payments. Future analysis will evaluate cost-effectiveness and additional health interventions.
Integrated Treatment for ARLD: Making it happen, 2 February 2017, Presentatio...Health Innovation Wessex
The Clinical Research Network Wessex (CRN Wessex) provides study support services across six divisions to facilitate NIHR portfolio research. CRN Wessex is part of the NIHR family of organizations and works to support clinical research studies through resources like research nurses, clinical trials assistants, study coordinators, and support services in pharmacy, pathology, and radiology. For more information, contact the CRN Wessex study support team.
This document provides an assignment for an insurance and risk management course. It contains 6 questions related to topics like price risk, elements of life insurance organizations, doctrines of indemnity and subrogation, evidence and claims notices, insurance marketing mix, and benefits of reinsurance. Students are instructed to answer each question in approximately 400 words. The assignment is worth 60 total marks. It provides students an opportunity to demonstrate their understanding of key insurance concepts.
Este documento describe la transformada de Fourier, una transformación matemática que convierte señales entre el dominio del tiempo y el dominio de la frecuencia. Explica que la transformada de Fourier descompone una función en sus componentes de frecuencia, de manera similar a como el oído humano percibe el sonido. También incluye las propiedades básicas y definiciones matemáticas de la transformada de Fourier y la transformada inversa. Finalmente, presenta algunos ejemplos de cálculo de la transformada de Fourier para funciones simples.
What Happens When You Donate Your Career to ScienceThea Boodhoo
New giant dinosaurs. Mountain ranges on Pluto. Gravity waves from other galaxies. We live in a golden age for scientific discovery, and it’s hard not to wonder, as we pry ourselves away from Mars panoramas back into the earth-bound corporate things waiting in our other browser tabs, what it would be like if we’d gone into that science field we really like instead.
Thea Boodhoo was a run-of-the-mill content strategist at an admittedly pretty great ad agency, who also found inspiration in the discoveries of science. She thought, “Surely scientists need content strategists. They must. Right?” And she set off on a journey that took her into the depths of time, the insides of a dead pigeon, and the far, exotic reaches of New Jersey, Utah, and academia.
Now she’s ready to share what she learned about the reality of modern science, what it’s like working with scientists, how she overcame the hurdles of being an outsider, and how you, too, can apply your skills as a creative professional to science projects where they are, truly, needed. Without having to dissect a pigeon.
CLARIN Centro-K-español forma parte de la infraestructura europea CLARIN, Common Language Resources and Technology Infrastructure. Su objetivo es ofrecer los conocimientos y experiencia de los tres grupos que inicialmente lo componen en la utilización de tecnología para la investigación en humanidades y ciencias sociales.
This document provides information about an assignment for the subject Management and Organizational Development. It includes 6 questions related to organizational development, goal setting, learning organizations, downsizing, and initiating organizational learning. Students are to answer each question in approximately 400 words. Questions address topics such as defining organizational development, reasons for resistance to change, characteristics of OD interventions, advantages and disadvantages of goal setting, attributes of learning organizations, types and effects of downsizing, and steps for initiating organizational learning. Students can purchase solved assignments for Rs. 125 each by emailing subjects4u@gmail.com or calling 09882243490.
The document provides a budget for equipment rental and purchases for a film project, including a camera, boom microphone, audio mixer, tripod, lighting, grip equipment, and accessories such as a book, scarf, teddy bear, and storage box. It lists the item, source for rental or purchase, number of rental days, and price for each item. The total budget appears to be for equipment and purchases for a 3 week film shoot.
trabajo engel escobar , transformada de fourrierLuiz Casanova
El documento habla sobre las series de Fourier y su historia. Explica que las series de Fourier pueden expresar cualquier función periódica como una suma de senos y cosenos del mismo periodo. Además, menciona que los Babilonios usaron una forma primitiva de las series de Fourier para predecir eventos celestiales y que la historia moderna comenzó con D'Alembert y su tratado sobre las oscilaciones de las cuerdas del violín. Finalmente, introduce brevemente que la transformada de Fourier puede simplificar el estudio de la solución de ciertas ecu
Ahmad Reza Khawar - Midterm Assignment SIBM Feb 2016Reza Khawar
This document provides an analysis of entering the Turkish market for Netflix. It examines the macroenvironmental factors through a PESTAL analysis and SWOT framework. Some key points include:
- Turkey has over 44 million broadband subscribers providing a large potential market for Netflix.
- Entering the market could impact DVD/CD rental companies but also provides opportunities to hire local workers.
- Netflix will face competition from other streaming services and need to differentiate with local language dubbing/subtitling and customer service.
- Strengths include Netflix's brand and subscriber base while weaknesses are cultural/language differences.
- Opportunities exist in high internet availability and demand for streaming, while threats include social restrictions and competitors
Ensayos sobre el aprendizaje aporta una visión esclarecedora sobre como se debería entender el aprendizaje.
La cuestión puede abordarse de forma dual o de forma binaria. En este ensayo abordamos las implicaciones de tomar uno u otro enfoque, además resaltamos la importancia de la comprensión conceptual para la compresión operativa
Open Trip Pulau Harapan, Kepulauan Seribu UtaraTour de Java
Dokumen ini memberikan informasi tentang wisata gabungan ke Pulau Harapan dan pulau-pulau kecil lainnya di Kepulauan Seribu. Wisata ini memberikan kesempatan untuk menikmati matahari terbit dan terbenam, menjelajahi beberapa pulau, menyelam untuk melihat keindahan bawah laut, serta mengunjungi taman penyu dengan biaya Rp. 370.000 per orang yang termasuk transportasi, akomodasi, makanan, dan aktivitas.
The Zen Buddhist Temple in Ann Arbor, Michigan is hosting a two-day workshop on September 3-4, 2016 to explore the intersection of mindfulness and social justice. The workshop will be led by Dawn Haney and Katie Loncke from the Buddhist Peace Fellowship and will combine discussion, reflection, and training in areas like political-spiritual messaging and compassionate confrontation. The goal is to strengthen spiritual activist strategies and build coalitions in Southeast Michigan to address issues like economic inequality, racial discrimination, and environmental injustice. The workshop will provide accommodations and meals for out-of-town participants.
Rozarina Md Yusof Howton has extensive education and experience in various areas of science including medical physics, bioengineering, data science, and teaching. She holds a Master's degree in Medical Physics and Bioengineering from University College London and has undertaken continuing education in machine learning, programming, and languages. Her experience includes work as a private tutor, data analyst, science teacher, finance intern, and postgraduate research using optical tomography for imaging the neonatal brain. She has published papers and presented research at conferences on this topic.
Este documento presenta una aplicación móvil para gestionar el abono de transporte público, evitando olvidos como dejar de recargar la tarjeta o que caduque el saldo. La app permitiría llevar la tarjeta en el móvil, recargar directamente y contaría con un plano del transporte público y alarmas para cuando el saldo esté a punto de caducar. El público objetivo son personas de 16 a más de 60 años.
Treatment of Alcohol Related Liver Disease (ARLD) by Acute Trusts in Wessex shows that ARLD admissions are increasing each year across the region. In 2015, 37-46% of Liver Disease admissions across different trusts were for alcohol-specific conditions. Patients admitted with ARLD are on average younger, more likely to be male, have greater numbers of admissions, longer lengths of stay, and increased mortality compared to other Liver Disease patients. Estimates indicate that improving patient management could save £12.9-£17.2 million per year in the region through earlier diagnosis and intervention for ARLD.
This report examined the association between renal failure admissions (RFA) to hospitals in Victoria, Australia and socioeconomic disadvantage across 79 local government areas from 2011-2014. The results showed that RFA rates varied inversely with socioeconomic disadvantage and the most disadvantaged areas had RFA rates 2.4 times higher than the least disadvantaged areas. Areas with high RFA rates also had high rates of other conditions like heart failure and COPD. The variations in RFA rates likely reflect factors like access to adequate care, delayed referral to nephrology services, and lack of understanding about the disease among patients. Addressing chronic kidney disease and renal failure remains a public health challenge.
NHS Atlas of Variation in Healthcare for People with Liver Diseaserightcare
This document summarizes key findings from an atlas of variation in healthcare for people with liver disease in England. It finds significant variations in outcomes like emergency admissions, chronic liver disease mortality, and liver cancer mortality across different localities. It also identifies variations in processes of care like rates of transplantation, hepatitis C testing, obesity rates, and use of day-case surgery. The variations are likely due to differences in risk factors, service configuration, and adherence to clinical guidance across areas. Addressing unwarranted variations could improve outcomes and reduce costs for people with liver disease.
This study aims to evaluate the right lobe liver diameter to albumin ratio as a non-invasive marker for predicting esophageal varices in cirrhotic patients. Esophageal variceal bleeding is a serious complication of cirrhosis with high mortality. Currently, repeated endoscopy is required for screening but it is invasive and costly. The study will measure right lobe liver diameter and albumin levels via ultrasound and blood tests in cirrhotic patients and compare the ratio to presence and size of varices found on endoscopy. If shown to accurately predict varices, the ratio could offer a cheaper, non-invasive alternative to repeated endoscopy for screening high-risk cirrhotic patients.
Dr Debbie Lowe - The future of innovation in AF and stroke preventionInnovation Agency
Presentation by Dr Debbie Lowe, Clinical Lead - Stroke, Getting It Right The First Time: Getting it right first time at The future of innovation in AF and stroke prevention in the NWC, 27 June 2018, Haydock Park Racecourse
The document discusses guidelines for blood donor selection and criteria. It covers several topics:
1. Donor questionnaires are used to assess donor health and safety and reduce infection risk. Questionnaires should be simple, unambiguous, and available in local languages.
2. Effective donor education informs donors about health conditions that would make them unsuitable and screening tests performed. It should be made clear there is no discrimination in selection.
3. Infrastructure and facilities for donor selection should provide privacy, confidentiality, and a pleasant atmosphere to encourage donation and reduce anxiety.
This document summarizes the results of a national audit on lower gastrointestinal bleeding (LGIB) in the UK. It found that over 2528 patients were included from 139 hospitals. Key findings include that 26.7% of patients received red blood cell transfusions, but many transfusions may have been inappropriate. Nearly half of patients had no inpatient investigations to identify the bleeding source. Access to lower GI endoscopy and interventional radiology varied between hospitals. The audit recommendations focus on improving investigation of patients, guidelines for transfusion and management of anticoagulants, and increasing access to key services including interventional radiology.
This document analyzes the impact of sepsis on conditions targeted by the Hospital Readmissions Reduction Program (HRRP). It finds that sepsis increases risks for several HRRP conditions like acute myocardial infarction (AMI), congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and pneumonia. Patients with sepsis and AMI have high mortality (28%) and case mix index (3.4). Sepsis combined with COPD or pneumonia poses the greatest risks, including higher odds of other HRRP conditions. The document recommends focus on less severe sepsis cases to prevent progression.
- The study aimed to determine the prevalence of peripheral vascular disease (PVD) in patients with chronic kidney disease (CKD) using ankle brachial index (ABI) measurements.
- ABI was measured on 72 CKD patients, and 20 patients (27.8%) had an ABI <0.9 indicating PVD.
- PVD prevalence was highest (34.7%) in patients with stage 5 CKD. Overall, the study found a significant prevalence of PVD among CKD patients based on ABI measurements.
Interesting things about alcohol and other drugs - April 2017Andrew Brown
One in a regular series of slide sets on interesting data about alcohol and other drugs (and the wider issues to do with multiple needs) from a UK perspective.
This document summarizes key findings from The NHS Atlas of Variation in Healthcare for People with Diabetes:
- There is significant variation across England in the processes and outcomes of diabetes care provided by Primary Care Trusts (PCTs), with some PCTs performing much better or worse than others.
- Over 60% of people with Type 1 diabetes and almost half of people with Type 2 diabetes did not receive all nine basic care processes for managing their condition.
- Prescribing costs for diabetes treatments have risen 41% since 2005/06 and now account for over 8% of primary care prescribing costs.
- There is up to a 10-fold variation between PCTs in providing recommended
Interesting things about alcohol and other drugs - May 2017Andrew Brown
One in a regular series of slide sets on interesting data about alcohol and other drugs (and the wider issues to do with multiple needs) from a UK perspective.
This document summarizes a systematic review of 17 cases of cardiovascular events associated with energy drink consumption. Most cases involved teenagers and young adults consuming energy drinks in large quantities over a short period of time, often mixed with alcohol. While causality cannot be determined, the review found that heavy energy drink consumption was implicated in several cases. The document calls for further research to better understand risks, as well as improved labeling and warnings regarding energy drink consumption among vulnerable groups.
This document summarizes a systematic review of 17 cases of cardiovascular events associated with energy drink consumption. Most cases involved teenagers and young adults consuming energy drinks in large quantities over a short period of time, often mixed with alcohol. While causality cannot be determined, the review found that heavy energy drink consumption was implicated in several cases. The document calls for further research to better understand risks, as well as improved labeling and warnings regarding energy drink consumption among vulnerable groups.
The rapid increase in energy drink (ED) consumption has stimulated growing public concern with adverse events related to ED consumption.
The US Substance Abuse Services and Mental Health Administration has reported that over a 4-year period from 2007 to 2011, emergency department visits related to EDs more than doubled to >20,000 visits annually.
Most of the adverse effects and toxicities associated with EDs have been attributed to the high caffeine content of EDs.
B743SG - The Social Context of Health Care Provision and Delivery - Coronary...Mike Dunn
Coronary heart disease (CHD) is a major cause of death in Derby, England. Rates of CHD in Derby are higher than the national average and are significantly impacted by socioeconomic factors. Local policies aim to address CHD through the "Livewell" program, which provides personalized support to improve lifestyle behaviors and access to health resources. The program focuses on high-risk areas and bringing services directly to communities. National policies also target CVD through initiatives aimed at early detection, treatment, and prevention across demographic groups.
This document analyzes hospital performance on sepsis in Pennsylvania. It finds that from 2012-2014, the average sepsis mortality rate in PA hospitals decreased from 26.8% to 22.7%, and total sepsis admissions and deaths increased. Hospitals were grouped by size and region, finding variations in mortality rates and deaths. Analysis of additional data found the average length of stay was most highly correlated with mortality. A case study compares two large hospitals, finding one with lower mortality and length of stay implemented best practices for early sepsis diagnosis and intervention.
The study found that patients who received aminoglycoside treatment for perioperative cardiac surgery had a substantially higher risk of requiring postoperative dialysis, and this risk was independent of dose size and number. Some findings, such as the disappearance of risk when adjusting for confounding factors in endocarditis patients, were unexpected. Clinicians should be aware of the increased risk of postoperative dialysis associated with aminoglycoside use in cardiac surgery patients.
The Health Innovation Network Polypharmacy Programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Reducing opioid prescribing, can be viewed here.
For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/
Pharmacist Interventions and Medication Reviews at Care Homes - Improving Med...Health Innovation Wessex
The Health Innovation Network Polypharmacy Programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Pharmacist Interventions and Medication Reviews at Care Homes - Improving Medication Safety and Patient Outcomes, can be viewed here.
For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/
The Health Innovation Network Polypharmacy Programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, SBAR Patient Engagement Tool, can be viewed here.
For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/
The Health Innovation Network Polypharmacy Programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Reducing medication related falls risk in patients with severe frailty, can be viewed here.
For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/
The Health Innovation Network Polypharmacy Programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Assessing the outcomes of structured medication reviews, can be viewed here.
For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/
The Health Innovation Network Polypharmacy Programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Polypharmacy SMR reviews in outpatient bone health clinics, can be viewed here.
For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/
Polypharmacy reviews of asthma and COPD patients over 65 and 10 or more medic...Health Innovation Wessex
The Health Innovation Network Polypharmacy Programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Polypharmacy reviews of asthma and COPD patients over 65 and 10 or more medicines, can be viewed here.
For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/
Evaluating the impact of a specialist frailty multidisciplinary team pathway ...Health Innovation Wessex
The Health Innovation Network Polypharmacy Programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Evaluating the impact of a specialist frailty multidisciplinary team pathway with clinical pharmacist involvement, can be viewed here.
For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/
Genome UK – State of the nation by Professor Dame Sue Hill, Chief Scientific Officer for England and NHS Genomics Programme Senior Responsible Officer.
Pharmacogenomics into practice - stroke services and a systems approach by Dr Richard Marigold, Consultant Stroke Physician and NIHR Hyperacute Stroke Research Centre Lead, University Hospital Southampton NHS Foundation Trust
To evaluate the benefits of Structured Medication Reviews in elderly Chinese ...Health Innovation Wessex
The Health Innovation Network Polypharmacy programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, To evaluate the benefits of Structured Medication Reviews in elderly Chinese patients, can be viewed here.
For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/
The Health Innovation Network Polypharmacy programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary,
Review of patients on high dose opioids at Living Well PCN, can be viewed here.
For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/
The Health Innovation Network Polypharmacy programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Re-establishing autonomy in elderly frail patients, can be viewed here.
For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/
The Health Innovation Network Polypharmacy programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Improving Medication Reviews using the NO TEARS Tool, can be viewed here.
For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/
Improving care in County Durham under the STOMP agenda - A 5 year review.pdfHealth Innovation Wessex
The Health Innovation Network Polypharmacy programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Improving care in County Durham under the STOMP agenda - A 5 year review, can be viewed here.
For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/
Impact of an EMIS search to prioritise care home residents for a pharmacist l...Health Innovation Wessex
The Health Innovation Network Polypharmacy programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Impact of an EMIS search to prioritise care home residents for a pharmacist led medication review, can be viewed here.
For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/
The Health Innovation Network Polypharmacy programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Identifying Orthostatic Hypotension caused by Medication, can be viewed here.
For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/
Digital Health in India_Health Informatics Trained Manpower _DrDevTaneja_15.0...DrDevTaneja1
Digital India will need a big trained army of Health Informatics educated & trained manpower in India.
Presently, generalist IT manpower does most of the work in the healthcare industry in India. Academic Health Informatics education is not readily available at school & health university level or IT education institutions in India.
We look into the evolution of health informatics and its applications in the healthcare industry.
HIMMS TIGER resources are available to assist Health Informatics education.
Indian Health universities, IT Education institutions, and the healthcare industry must proactively collaborate to start health informatics courses on a big scale. An advocacy push from various stakeholders is also needed for this goal.
Health informatics has huge employment potential and provides a big business opportunity for the healthcare industry. A big pool of trained health informatics manpower can lead to product & service innovations on a global scale in India.
The Importance of Black Women Understanding the Chemicals in Their Personal C...bkling
Certain chemicals, such as phthalates and parabens, can disrupt the body's hormones and have significant effects on health. According to data, hormone-related health issues such as uterine fibroids, infertility, early puberty and more aggressive forms of breast and endometrial cancers disproportionately affect Black women. Our guest speaker, Jasmine A. McDonald, PhD, an Assistant Professor in the Department of Epidemiology at Columbia University in New York City, discusses the scientific reasons why Black women should pay attention to specific chemicals in their personal care products, like hair care, and ways to minimize their exposure.
At Malayali Kerala Spa Ajman we providing the top quality massage services for our customers.
Our massage center prioritizes efficiency to ensure a quality massage experience for our clients at Malayali Kerala Spa Ajman. We offer a convenient appointment system and precise massage services.
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Research, Monitoring and Evaluation, in Public Healthaghedogodday
This is a presentation on the overview of the role of monitoring and evaluation in public health. It describes the various components and how a robust M&E system can possitively impact the results or effectiveness of a public health intervention.
VEDANTA AIR AMBULANCE SERVICES IN REWA AT A COST-EFFECTIVE PRICE.pdfVedanta A
Air Ambulance Services In Rewa works in close coordination with ground-based emergency services, including local Emergency Medical Services, fire departments, and law enforcement agencies.
More@: https://tinyurl.com/2shrryhx
More@: https://tinyurl.com/5n8h3wp8
Health Tech Market Intelligence Prelim Questions -Gokul Rangarajan
The Ultimate Guide to Setting up Market Research in Health Tech part -1
How to effectively start market research in the health tech industry by defining objectives, crafting problem statements, selecting methods, identifying data collection sources, and setting clear timelines. This guide covers all the preliminary steps needed to lay a strong foundation for your research.
This lays foundation of scoping research project what are the
Before embarking on a research project, especially one aimed at scoping and defining parameters like the one described for health tech IT, several crucial considerations should be addressed. Here’s a comprehensive guide covering key aspects to ensure a well-structured and successful research initiative:
1. Define Research Objectives and Scope
Clear Objectives: Define specific goals such as understanding market needs, identifying new opportunities, assessing risks, or refining pricing strategies.
Scope Definition: Clearly outline the boundaries of the research in terms of geographical focus, target demographics (e.g., age, socio-economic status), and industry sectors (e.g., healthcare IT).
3. Review Existing Literature and Resources
Literature Review: Conduct a thorough review of existing research, market reports, and relevant literature to build foundational knowledge.
Gap Analysis: Identify gaps in existing knowledge or areas where further exploration is needed.
4. Select Research Methodology and Tools
Methodological Approach: Choose appropriate research methods such as surveys, interviews, focus groups, or data analytics.
Tools and Resources: Select tools like Google Forms for surveys, analytics platforms (e.g., SimilarWeb, Statista), and expert consultations.
5. Ethical Considerations and Compliance
Ethical Approval: Ensure compliance with ethical guidelines for research involving human subjects.
Data Privacy: Implement measures to protect participant confidentiality and adhere to data protection regulations (e.g., GDPR, HIPAA).
6. Budget and Resource Allocation
Resource Planning: Allocate resources including time, budget, and personnel required for each phase of the research.
Contingency Planning: Anticipate and plan for unforeseen challenges or adjustments to the research plan.
7. Develop Research Instruments
Survey Design: Create well-structured surveys using tools like Google Forms to gather quantitative data.
Interview and Focus Group Guides: Prepare detailed scripts and discussion points for qualitative data collection.
8. Sampling Strategy
Sampling Design: Define the sampling frame, size, and method (e.g., random sampling, stratified sampling) to ensure representation of target demographics.
Participant Recruitment: Plan recruitment strategies to reach and engage the intended participant groups effectively.
9. Data Collection and Analysis Plan
Data Collection: Implement methods for data gathering, ensuring consistency and validity.
Analysis Techniques: Decide on analytical approaches (e.g., statistical
The facial nerve, also known as cranial nerve VII, is one of the 12 cranial nerves originating from the brain. It's a mixed nerve, meaning it contains both sensory and motor fibres, and it plays a crucial role in controlling various facial muscles, as well as conveying sensory information from the taste buds on the anterior two-thirds of the tongue.
Cyclothymia Test: Diagnosing, Symptoms, Treatment, and Impact | The Lifescien...The Lifesciences Magazine
The cyclothymia test is a pivotal tool in the diagnostic process. It helps clinicians assess the presence and severity of symptoms associated with cyclothymia.
NURSING MANAGEMENT OF PATIENT WITH EMPHYSEMA .PPTblessyjannu21
Prepared by Prof. BLESSY THOMAS, VICE PRINCIPAL, FNCON, SPN.
Emphysema is a disease condition of respiratory system.
Emphysema is an abnormal permanent enlargement of the air spaces distal to terminal bronchioles, accompanied by destruction of their walls and without obvious fibrosis.
Emphysema of lung is defined as hyper inflation of the lung ais spaces due to obstruction of non respiratory bronchioles as due to loss of elasticity of alveoli.
It is a type of chronic obstructive
pulmonary disease.
It is a progressive disease of lungs.
Satisfying Spa Massage Experience at Just 99 AED - Malayali Kerala Spa AjmanMalayali Kerala Spa Ajman
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For the most result-oriented Russian Spa treatment in Ajman, visit our Massage Center. Our Russian therapists are skilled in various techniques to address health concerns. Our body-to-body massage is efficient due to individualized care and high-grade massage oils.
Simple Steps to Make Her Choose You Every DayLucas Smith
Simple Steps to Make Her Choose You Every Day" and unlock the secrets to building a strong, lasting relationship. This comprehensive guide takes you on a journey to self-improvement, enhancing your communication and emotional skills, ensuring that your partner chooses you without hesitation. Forget about complications and start applying easy, straightforward steps that make her see you as the ideal person she can't live without. Gain the key to her heart and enjoy a relationship filled with love and mutual respect. This isn't just a book; it's an investment in your happiness and the happiness of your partner
At Malayali Kerala Spa Ajman, Full Service includes individualized care for every client. We specifically design each massage session for the individual needs of the client. Our therapists are always willing to adjust the treatments based on the client's instruction and feedback. This guarantees that every client receives the treatment they expect.
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1. Treatment of Alcohol Related Liver Disease
(ARLD) by Acute Trusts in Wessex
A report for Wessex AHSN ‘Reducing Harm from Alcohol’ Programme
Dr Brad Keogh
Centre for Implementation Science
brad.keogh@soton.ac.uk
@KeoghData
Wessex AHSN alcohol programme clinical leads: Dr Julia Sinclair & Dr Leonie Grellier
Wessex AHSN senior programme manager: Kathy Wallis alcohol@wessexahsn.net
2. Contents
• Introduction & key findings: Pages 3-5
• Headline figures & trends over time: pages 6-9
• Patient survival, demographics, repeat attendances & length of stay: pages 10-13
• Variation across Wessex Acute Trusts: pages 14-18
• Variation across Wessex CCGs: pages 19-20
• Estimations of cost avoidance from earlier intervention: pages 21-25
• What must YOU do now? pages 26-28
• Appendix A: Data limitations page 29
• Appendix B: Liver Disease ICD-10 codes pages 30-32
• Appendix C: Alcohol-specific ICD-10 codes page 33
• Appendix D: Estimating early intervention cost avoidance
in Wessex pages 34-40
2
3. Key findings in Wessex
Data from the 6 Acute NHS Trusts in Wessex shows:
• The number of Liver Disease admissions are increasing each year
• In 2015: Across Wessex an average of 37% of Liver Disease admissions were for
alcohol-specific conditions, this increased to 45% at one Acute Trust
• Alcohol Related Liver Disease (ARLD) patients are on average 10 years younger
and more likely to be male
• The probability of death for an ARLD diagnosed patient 3-years after diagnosis is
45%, compared with 26% for a non-ARLD patient*
• ARLD patients have a greater number of admissions and longer lengths of stay
than other Liver Disease patients
• An audit from Hampshire Hospitals Foundation Trust suggests that at least an
additional 13% of Liver Disease admissions have alcohol use disorders but are not
coded as such. Further audits are being completed at other Trusts across Wessex
• It is estimated that improving patient management in Acute Trust settings could
save at least £10m-£13.3m per year** across the 6 Acute Trusts
* Figures based on Trust recorded data only, hence probability of death may be under-reported here
**Range determined by ARLD diagnosis either 1 or 2 years earlier3
4. Development of regional Wessex acute
Liver Disease (LD) database
• 6 Wessex Acute Trusts have contributed admissions data to a regional Wessex
database
• The database comprises all LD admissions Jan 2011 - Dec 2015: ~25,000 admission
episodes with over 350 data fields for each admission (~9 million elements)
• As well as this report there are individual reports available for each Trust/CCG
Wessex
Liver
Disease
database
The Royal
Bournemouth and
Christchurch
Hospitals NHS
Foundation Trust
Portsmouth
Hospitals NHS
Trust
University Hospital
Southampton NHS
Foundation TrustPoole Hospital NHS
Foundation Trust
Hampshire
Hospitals NHS
Foundation Trust
Isle of Wight NHS
Trust
4
5. This data does not include:
• Any hospital admission where Liver Disease is not coded
(even if present)
• Any admission occurring outside of the 6 Acute Trusts
ARLD and alcohol-specific admissions are under-
estimated where:
• Patients have not been screened for alcohol
• Patients screened but not coded in Trust electronic records
• Patients where ARLD is obscured by obesity-related Liver
Disease
5
6. Headline numbers: Wessex (6 Acute Trusts)
• During Jan 2011 – Dec 2015:
– There were 21,400 LD admissions
– There were over 9,100 ARLD admissions (from 4,150 ARLD patients)
– On average there were ~660 new diagnoses of ARLD per year
– 42% of all LD admissions had an alcohol-specific condition recorded
– 84% of all LD admissions were emergency
• Between Jan-Dec 2015:
– There were 3,960 LD patients
• Who had 5,200 admissions
• Of which 1,900 were alcohol-specific admissions
• There were 1,260 LD patients who had at least one admission for an alcohol-specific
condition
– Of the LD patients there were 1,000 patients diagnosed with ARLD
• Who had 1,600 admissions
• Using 17,500 bed days
• At a PbR cost of over £4,440,000*
Definitions of admissions:
LD: patient with Liver Disease diagnosis
ARLD: patient with Alcohol-Related
Liver Disease diagnosis
Alcohol-specific: admission with ARLD
or other alcohol diagnosed conditions
For full definitions see Appendix A
* Cost may be under-reported by up to 10%, as some admissions could not be assigned to a HRG tariff
6
7. Key Narrative
In 2015 in Wessex 37% of LD
admissions were coded with
an alcohol-specific condition.
In 2015 in Wessex 31% of LD
admissions were coded with
ARLD.
A HHFT audit suggests that up
to an additional 13% of Liver
Disease admissions have
alcohol use disorders but are
not coded as such.
37% of Liver Disease
admissions were for
alcohol-specific
conditions31%
6%
63%
Proportion of Liver Disease admissions
ARLD or alcohol-specific in Wessex
7
8. Numbers of Liver Disease admissions
in Wessex over time
Key Narrative
In Wessex there were over 5000
LD admissions in 2015 and the
no. of LD admissions have
increased over time (49%
between 2011-15).
The number of ARLD admissions
have remained similar over time.
However the total no. of alcohol-
specific admissions (‘ARLD’ and
‘other alcohol’) have increased
by 16% between 2011-15.
42% of all LD admissions
between 2011-2015 were
alcohol-specific.
A HHFT audit suggests that up
to an additional 13% of Liver
Disease admissions have
alcohol use disorders but are
not coded as such.
Alcohol-specific
admissions (ARLD and
‘other alcohol’) have
increased by 16%
(2011-15)
No. of Liver Disease
admissions are
increasing each year
8
9. Admission coding by Liver Disease
code in Wessex (final K-code of spell)
Key Narrative
When considering the final LD
diagnosis recorded in the
hospital spell:
Between 2011-2015 there has
been significant increase
(190%) in ‘Non-alcoholic fatty
liver disease’ (NAFLD) and
‘Non-alcoholic steatohepatitis’
(NASH) diagnosed admissions.
Over this time there has also
been an increase of 46% in the
number of ‘other LD’
admissions.
These changes are most likely
to be due to the increase in
obesity. The impact of
obesity on Liver
Disease admissions
9
10. Impact of alcohol on Liver Disease
(2012 cohort)
• 2,303 patients were admitted for LD for the first time in 2012
• Over 4 years (2012-2015) these patients had:
– 3,951 Admissions
– 974 Deaths (42% died)
• A comparison of those with an ARLD diagnosis and those without is
shown below over the 4 year period:
ARLD Non-ARLD
665 Patients (29% of cohort)
1,758 Admissions (44% of cohort admissions)
2 Admissions per patient on average (median)
309 Deaths (46% died)
1,638 Patients (61% of cohort)
2,193 Admissions (56% of cohort admissions)
1 Admissions per patient on average (median)
665 Deaths (41% died)
6.5% of LD patients not diagnosed with ARLD
had at least 1 alcohol-specific admissionARLD patients have a
greater number of
admissions on average
than other Liver Disease
patients10
11. ARLD patient demographics in Wessex
(2012 cohort)
Key Narrative
Patients admitted with an ARLD code are on average younger than
those without (median age: 57yrs compared with 67yrs).
Patients admitted with an ARLD code are more likely to be male (68%
of ARLD group) that those without (50% male in non-ARLD group).
ARLD patients are
on average younger
and more likely to
be male
11
12. Liver Disease survival in Wessex:
2012 cohort, ages 46-65 years
Key Narrative
Based on those admitted for
the first time with a LD
diagnosis in 2012 (age 45-65):
The probability of a LD patient
surviving after first diagnosis
(of any LD) in Wessex is much
lower for those who have
ARLD diagnosed.
Within 3years of first LD
diagnosis the probability of
death for an ARLD diagnosed
patient is 45%, compared with
26% for a non-ARLD patient.
Note: deaths only include
those recorded on Trust data
systems.
There is increased
mortality in patients
diagnosed with
ARLD
12
13. Liver disease Length of Stay in Wessex
(46-65 yrs)
Key Narrative
When comparing the most
common ARLD age group (46-
65yrs) difference in length of
stay (LOS) is greater on
average by 2 days (6 days
rather than 4). Longer LOS are
also seen in the 26-45, 66-75
& 76-85yrs age groups.
There are likely to be
undiagnosed ARLD patients in
the non-ARLD group, hence
the difference in LOS may be
even greater than that shown
here.
ARLD patients have
greater lengths of
stay than other Liver
Disease patients
13
14. Trust variation: number of Liver Disease
admissions at Trusts across Wessex
Key Narrative
Number of admissions varied
between Trusts in 2015. There
were almost 1,800 LD
admissions at University
Hospital Southampton FT in
2015.
There were over 800
admissions for ARLD at
University Hospital
Southampton FT and
Portsmouth Hospitals Trust in
2015.
A HHFT audit suggests that up
to an additional 13% of LD
admissions could be coded
with alcohol if correctly
written in notes.
There were over 800
admissions for ARLD
at the two biggest
Trusts in 201514
15. Trust variation: % of Liver Disease
admissions coded with ARLD/alcohol
Key Narrative
In 2015 the percentage of LD
admissions coded with ARLD
varied by Trusts between 23-
39%.
The percentage of LD
admissions coded with
alcohol-specific conditions
(‘ARLD’ + ‘other alcohol’)
varied by Trust between 30-
45%.
Up to 45% of Liver
Disease admissions
at some Trusts were
alcohol-specific
15
16. Trust variation: HRG spend for alcohol Liver
Disease admissions across Wessex
Key Narrative
Cost for each admission were
calculated using PbR tariffs.
Note: not all admissions could
have a PbR tariff attached.
Therefore approximately 10% of
admission costs are not accounted
for. Poole HFT did not provide HRG
data and so no costs are
presented.
ARLD admission costs in 2015 for
the 5 Trusts totalled almost £4.5
million. The two largest Trusts
account for over £2.5 million of
this.
The two largest Trusts have a
higher proportion of cost
associated with LD admissions with
alcohol-specific conditions than
the other Trusts.
ARLD admission costs
in 2015 for the 5
Trusts totalled almost
£4.5 million
16
17. Trust variation: admission breakdown
by final Liver Disease diagnosis
Key Narrative
When comparing the last LD
diagnosis code of each
admission spell in 2015:
The proportion of ARLD
diagnoses varied by 17-33%
between Trusts.
The proportion of
NAFLD/NASH diagnoses varied
by 13-37% between Trusts.
Smaller Trusts are observed to
have a greater proportion of
admissions with a final ARLD
diagnosis.
The largest Trust had 60% of
LD admissions neither
classified as ARLD or
NAFLD/NASH.
17
18. Trust variation: LOS for (ages 46-65yrs)
Key Narrative
There is variation in LOS for
both ARLD and non-ARLD
groups between Trusts.
Median LOS varies between 4-
5 days for non-ARLD
diagnosed patients and 5-6
days for ARLD diagnosed
patients.
HHFT and UHS have the
longest LOS in Wessex for
ARLD patients.
Bournemouth and
Christchurch FT has on average
the lowest LOS for both ARLD
and non-ARLD groups.
Length of Stay is
greater for ARLD
admissions across all
Trusts in Wessex18
19. CCG variation: number of Liver Disease
admissions from CCGs across Wessex
Key Narrative
Note: CCG data only includes
the admissions to the 6 Acute
NHS Trusts submitting data.
Hence this may not provide a
complete picture for each
CCG.
West Hants, Dorset and
Southampton CCGs have the
greatest numbers of Liver
Disease admissions to the 6
NHS Trusts for which data was
collected.
19
20. CCG variation: % of Liver Disease
admissions coded with ARLD/alcohol
Key Narrative
In 2015 the percentage of LD
admissions coded with ARLD
varied by CCG between 26-
42%.
The percentage of LD
admissions coded with
alcohol-specific conditions
(‘ARLD’ + ‘other alcohol’)
varied by CCG between 31-
48%.
Up to 48% of Liver
Disease admissions
from some CCGs
were alcohol-specific
20
21. Estimating early intervention cost
avoidance in Wessex
• Nuffield Trust report on “Alcohol-specific
activity in hospitals in England” (published Dec
2015) showed:
– rising burden of alcohol on A&E departments
(attendance rates doubled between 2008/09-
2013/14)
– highlighted the possibility for earlier
intervention: ¾ of those diagnosed with ARLD
during 2009/2010 had contact with hospital
services the year before diagnosis.
Source:
http://www.nuffieldtrust.org.uk/node/448321
22. £-
£1,000,000
£2,000,000
£3,000,000
£4,000,000
£5,000,000
£6,000,000
£7,000,000
£8,000,000
-4 -3 -2 -1 1 2 3 4
Year from ARLD diagnosis
Estimated (1year) early intervention cost avoidance in Wessex
Current cost Early intervention cost Cost avoided
Estimating early intervention cost
avoidance in Wessex: current cost
Key Narrative
The Nuffield Trust report
showed the average number of:
elective admissions, emergency
admissions, A&E attendances
and outpatient appointments for
ARLD patients before and after
first ARLD diagnosis.
There are ~660 new ARLD
diagnoses in Wessex each year
and the costs of acute treatment
for the cohort were estimated
using National Schedule of
Reference Costs (year 2014-15).
An annual mortality rate of
14.3% is used, as found from the
Wessex Trust data examined.
The estimated annual cost of
treatment for all ARLD patients
at the 6 Acute Trusts is £19.5m.
The estimated annual cost of
treatment for all ARLD
patients at the 6 Acute Trusts
is £19.5m
Current 1st
ARLD diagnosis
For further detail
on the method for
the estimated
cost avoidance
see Appendix D
22
23. £-
£1,000,000
£2,000,000
£3,000,000
£4,000,000
£5,000,000
£6,000,000
£7,000,000
£8,000,000
-4 -3 -2 -1 1 2 3 4
Year from ARLD diagnosis
Estimated (1year) early intervention cost avoidance in Wessex
Current cost Early intervention cost Cost avoided
Estimating early intervention cost
avoidance in Wessex: new cost
Key Narrative
Assuming earlier intervention
prior to current first ARLD
diagnosis (and a reduction in
annual mortality rate), the
subsequent reduction in
elective admissions,
emergency admissions and
A&E attendances (but not
outpatient appointments)
would result in a reduced cost
of managing the patient
cohort each year after the
earlier diagnosis.
If diagnosis of ARLD patients is
brought forward by 1 year the
new estimated annual cost of
treatment is £9.4m. Bringing
this forward by 2 years the
estimated cost is £6.2m.
New 1st ARLD
diagnosis
By improving the management of
patients in Acute Trust settings the
treatment cost of ARLD patients is
estimated to be between £6.2m -
£9.4m per year
Current 1st
ARLD diagnosis
For further detail
on the method for
the estimated
cost avoidance
see Appendix D
23
24. £-
£1,000,000
£2,000,000
£3,000,000
£4,000,000
£5,000,000
£6,000,000
£7,000,000
£8,000,000
-4 -3 -2 -1 1 2 3 4
Year from ARLD diagnosis
Estimated (1year) early intervention cost avoidance in Wessex
Current cost Early intervention cost Cost avoided
Estimating early intervention cost
avoidance in Wessex: cost avoided
Key Narrative
If diagnosis of ARLD patients is
brought forward (by either 1
or 2 years) the estimated cost
avoidance at the 6 Acute
Trusts is between £10m-
£13.3m per year respectively.
Note: this is likely an under
estimate as the figures only
include hospitalised costs;
costs in additional care
settings could further increase
the potential costs avoided.
Early intervention requires
mandatory alcohol screening
and referrals to alcohol care
team. The cost of an alcohol
team is approximately £150k
annually per Trust.
By improving the management of
patients in the 6 Acute Trust
settings it is estimated that a cost
avoidance of £10-13.3m per year
is possible
For further detail
on the method for
the estimated
cost avoidance
see Appendix D
Current 1st
ARLD diagnosis
New 1st ARLD
diagnosis
24
25. -£2,000,000
£0
£2,000,000
£4,000,000
£6,000,000
£8,000,000
£10,000,000
£12,000,000
£14,000,000
£16,000,000
1 year earlier 2 years earlier
Breakdown of earlier intervention cost avoidance
A&E attendances
Elective admissions
Emergency admissions
Outpatient appointments
Estimating early intervention cost avoidance in
Wessex: where are costs avoided? For further detail
on the method for
the estimated
cost avoidance
see Appendix DKey Narrative
The estimated cost savings
from intervening either 1 or 2
years earlier are broken down
opposite.
The largest estimated cost
avoidance is from emergency
admissions (contributing ~68%
of cost avoidance), followed
by elective admissions
(contributing ~28%).
An increase in cost is expected
from outpatient appointments
(due to the increased patient
survival). This cost is relatively
small in comparison and is
included in the estimated cost
avoidance quoted.
1 year earlier 2 years earlier
Elective admissions £2,914,200 £3,709,900
Emergency admissions £6,738,800 £9,193,600
Outpatient appointments -£77,300 -£77,300
A&E attendances £441,100 £441,100
Total £10,020,000 £13,270,000
~68% of cost
avoidance will be
in emergency
admissions
25
26. What must you do for an effective
ARLD pathway?
26
For Providers:
1. Implement a Trust alcohol strategy
2. Find an alcohol champion at executive level
3. Designate a board metric for Alcohol
• e.g. NICE Alcohol Quality Standard
4. Mandatory alcohol screening and referral to alcohol team
• A Trust alcohol team costs around £150k per annum and consists of:
0.1-0.2 FTE hospital clinical lead
2.0 FTE specialist nurses (one band 7 & one band 5 - mix of MHN and
RGN)
1.0 FTE band 3 for alcohol screening
1.0 FTE admin/pathway co-ordinator (for co-ordination and data)
For Commissioners:
1. Commission an alcohol pathway that supports earlier
intervention
2. Ensure that routine monitoring systems are in place
to track implementation of the new pathway
27. Wessex AHSN can offer you:
The Wessex AHSN have developed a toolkit to assist Trusts to
implement system wide changes to how patients with ARLD
are identified and managed within current resources.
This includes:
• an audit protocol
• implementation pack
• training resources
• access to Trust data
…to benchmark their organisation and monitor changes.
For more information please contact:
alcohol@wessexahsn.net
27
28. Contacts & Acknowledgements
With thanks to:
• Dr Julia Sinclair
• Dr Leonie Grellier
• Cathy Rule
• Kathy Wallis
• Prof Paul Roderick
• Dr Harriet Gordon
• Dr Richard Aspinall
• Dr Safa Al-Shamma
• Dr Nick Sharer
• Matt Winker
• Caroline Powell
• Bill Gillespie
Data and analysis produced by:
Dr Brad Keogh
brad.keogh@soton.ac.uk
@KeoghData
Wessex Centre for Implementation
Science
Faculty of Health Sciences
University of Southampton
WessexCIS@soton.ac.uk
@WessexCIS
On behalf of Wessex Academic
Health Science Network:
alcohol@wessexahsn.net
@WessexAHSN
28
29. Appendix A: Data definitions &
limitations
Definitions:
• Liver Disease (LD) admissions were identified as: any admission with an ICD-10 diagnosis starting
with ‘K7’ (anywhere within episode). See Appendix B for full list.
• Alcohol Related Liver Disease (ARLD) admissions were identified as: any admission with an ICD-10
diagnosis starting with ‘K70’ (anywhere within episode)
• Alcohol-specific LD admissions were identified with the same methodology as in the Local Alcohol
Profiles England produced by PHE: any LD admission with an ICD-10 diagnosis within the list seen in
Appendix C (anywhere within episode)
Limitations:
• Records are not linked between Trusts, hence the same patient may receive treatment at multiple
Trusts but will be recorded as a separate individual within this dataset and corresponding analyses
• Any calculation involving a death involves only the deaths recorded on the Trust database (i.e. some
deaths outside of the hospital may not be recorded)
• Although in some analyses patients are separated into ARLD/non-ARLD groups it is likely that there
will always be patients in the non-ARLD group who in fact have not yet been diagnosed with ARLD
• PbR costs are not presented for one Trust as insufficient data was provided to calculate this. Of the
admissions with suitable data 10% of the admissions could not have a PbR cost calculated (hence
estimates of the total cost could be around 10% smaller than presented)
29
30. Appendix B: ICD-10 Liver Disease diagnosis codes (1/3)
ICD-10 code Description
K70 Alcoholic liver disease
K70.0 Alcoholic fatty liver
K70.1 Alcoholic hepatitis
K70.2 Alcoholic fibrosis and sclerosis of liver
K70.3 Alcoholic cirrhosis of liver
K70.4 Alcoholic hepatic failure
K70.9 Alcoholic liver disease, unspecified
K71 Toxic liver disease
K71.0 Toxic liver disease with cholestasis
K71.1 Toxic liver disease with hepatic necrosis
K71.2 Toxic liver disease with acute hepatitis
K71.3 Toxic liver disease with chronic persistent hepatitis
K71.4 Toxic liver disease with chronic lobular hepatitis
K71.5 Toxic liver disease with chronic active hepatitis
K71.6 Toxic liver disease with hepatitis, not elsewhere classified
K71.7 Toxic liver disease with fibrosis and cirrhosis of liver
K71.8 Toxic liver disease with other disorders of liver
K71.9 Toxic liver disease, unspecified
K72 Hepatic failure, not elsewhere classified
K72.0 Acute and subacute hepatic failure
K72.1 Chronic hepatic failure
K72.9 Hepatic failure, unspecified
Source: WHO ICD-10 classifications
http://apps.who.int/classifications/icd10/browse/2016/en#/K70-K7730
31. Appendix B: ICD-10 Liver Disease diagnosis codes (2/3)
ICD-10 code Description
K73 Chronic hepatitis, not elsewhere classified
K73.0 Chronic persistent hepatitis, not elsewhere classified
K73.1 Chronic lobular hepatitis, not elsewhere classified
K73.2 Chronic active hepatitis, not elsewhere classified
K73.8 Other chronic hepatitis, not elsewhere classified
K73.9 Chronic hepatitis, unspecified
K74 Fibrosis and cirrhosis of liver
K74.0 Hepatic fibrosis
K74.1 Hepatic sclerosis
K74.2 Hepatic fibrosis with hepatic sclerosis
K74.3 Primary biliary cirrhosis
K74.4 Secondary biliary cirrhosis
K74.5 Biliary cirrhosis, unspecified
K74.6 Other and unspecified cirrhosis of liver
K75 Other inflammatory liver diseases
K75.1 Phlebitis of portal vein
K75.2 Nonspecific reactive hepatitis
K75.3 Granulomatous hepatitis, not elsewhere classified
K75.4 Autoimmune hepatitis
K75.8 Other specified inflammatory liver diseases: Nonalcoholic steatohepatitis [NASH]
K75.9 Inflammatory liver disease, unspecified
Source: WHO ICD-10 classifications
http://apps.who.int/classifications/icd10/browse/2016/en#/K70-K7731
32. Appendix B: ICD-10 Liver Disease diagnosis codes (3/3)
ICD-10 code Description
K76 Other diseases of liver
K76.0 Fatty (change of) liver, not elsewhere classified (Non-alcoholic fatty liver disease [NAFLD])
K76.1 Chronic passive congestion of liver
K76.2 Central haemorrhagic necrosis of liver
K76.3 Infarction of liver
K76.4 Peliosis hepatis
K76.5 Hepatic veno-occlusive disease
K76.6 Portal hypertension
K76.7 Hepatorenal syndrome
K76.8 Other specified diseases of liver
K76.9 Liver disease, unspecified
K77* Liver disorders in diseases classified elsewhere
K77.0* Liver disorders in infectious and parasitic diseases classified elsewhere
K77.8* Liver disorders in other diseases classified elsewhere
Source: WHO ICD-10 classifications
http://apps.who.int/classifications/icd10/browse/2016/en#/K70-K7732
33. Appendix C: Wholly alcohol attributable ICD-10 codes used to
define alcohol-specific inpatient activity (alcohol-specific
conditions)
ICD-10 code Description
E24.4 Alcohol-induced pseudo-Cushing’s syndrome
F10 Mental and behavioural disorders due to alcohol
G31.2 Degeneration of nervous system due to alcohol
G62.1 Alcoholic polyneuropathy
G72.1 Alcoholic myopathy
I42.6 Alcoholic cardiomyopathy
K29.2 Alcoholic gastritis
K70 Alcoholic liver disease
K85.2 Alcohol-induced acute pancreatitis
K86.0 Alcohol-induced chronic pancreatitis
Q86.0 Foetal alcohol syndrome (dysmorphic)
R78.0 Excess alcohol blood levels
T51.0 Ethanol poisoning
T51.1 Methanol poisoning
T51.9 Toxic effect of alcohol, unspecified
X45 Accidental poisoning by and exposure to alcohol
X65 Intentional self-poisoning by and exposure to alcohol, undetermined intent
Y15 Poisoning by and exposure to alcohol, undetermined intent
Y90 Evidence of alcohol involvement determined by blood alcohol content
Y91 Evidence of alcohol involvement determined by level of intoxication
Source: PHE England Local Alcohol Profiles User Guide
http://fingertips.phe.org.uk/profile/local-alcohol-profiles33
34. Appendix D: Estimating early intervention cost
avoidance in Wessex (1/7)
Introduction
The estimation of ‘early intervention cost avoidance in Wessex’ was calculated using
data from a variety of sources:
• Wessex AHSN Acute Liver Disease database
• “Alcohol-specific activity in hospitals in England” (2015), Nuffield Trust report
• NHS reference costs 2014 to 2015*
• “The Epidemiology of Alcoholic Liver Disease” (2004), Mann R.E., Smart, R.G. &
Govoni, R., Publication from the National Institute on Alcohol Abuse and
Alcoholism
The method and assumptions made in the calculations are outlined in this appendix.
The inputs and assumptions within the cost estimation model are summarised in the
following slide with further detail surrounding the method following. All cost
estimates are at 2014/15 values.
34 *Available here: https://www.gov.uk/government/collections/nhs-reference-costs
35. ‘New cost’ model inputs
Appendix D: Estimating early intervention cost
avoidance in Wessex (2/7)
‘Current cost’ model inputs
Model input Value Source/comments
Initial size of ARLD cohort
660 (Wessex),
varies by Trust
Source: Wessex AHSN Acute Liver Disease database (2011-2015). Data showed ~660 patients each
year between 2011-15 were newly diagnosed with ARLD in Wessex.
Annual mortality rate
Fixed annual rate of
14.3%
Source: as above. Annual rate calculated from the 4-year survival probability (54%) of ARLD
patients who had first ARLD diagnosis in 2012. Note: deaths only include those recorded on Trust
data systems.
Average additional utilisation
rate of secondary care services
by ARLD patients: 4-years
before and after ARLD diagnosis
Rates vary based
on year from ARLD
diagnosis (values in
Appendix D: 3/7)
Source: “Alcohol-specific activity in hospitals in England” (2015), Nuffield Trust report
Average cost of: elective
admissions, emergency
admissions, A&E attendances
and outpatient appointments
Fixed cost based on
2014/15 prices
(values in
Appendix D: 5/7)
Source: NHS reference costs 2014 to 2015
Model input Value Source/comments
Initial size of ARLD cohort
660 (Wessex), varies
by Trust
Source: Wessex AHSN Acute Liver Disease database (2011-2015). Data showed ~660 patients
each year between 2011-15 were newly diagnosed with ARLD in Wessex.
Annual mortality rate
Fixed annual rate of
2.1%
Source: “The Epidemiology of Alcoholic Liver Disease” (2004), Mann R.E., Smart, R.G. & Govoni,
R., Publication from the National Institute on Alcohol Abuse and Alcoholism. Annual rate
calculated from the 5-year survival probability (90%) of those with cirrhosis who stop drinking.
Average additional utilisation
rate of secondary care services
by ARLD patients: 4-years
before and after ARLD diagnosis
Rates vary based on
year from ARLD
diagnosis (values in
Appendix D: 3/7)
Source: “Alcohol-specific activity in hospitals in England” (2015), Nuffield Trust report.
Modifications to the additional utilisation rates, reported by the Nuffield Trust, were made with
the assumption that earlier diagnosis will lead to an earlier reduction in additional utilisation
rates.
Average cost of: elective
admissions, emergency
admissions, A&E attendances
and outpatient appointments
Fixed cost based on
2014/15 prices
(values in
Appendix D: 5/7)
Source: NHS reference costs 2014 to 2015
35
36. 0.00
1.00
2.00
3.00
4.00
-4 -3 -2 -1 1 2 3 4
Averageadditionalactivityper
patient
Years from ARLD diagnosis
'New cost' additional ARLD patient activity
0.00
1.00
2.00
3.00
4.00
-4 -3 -2 -1 1 2 3 4
Averageadditionalactivityper
patient
Years from ARLD diagnosis
'Current cost' additional ARLD patient activity
Appendix D: Estimating early intervention cost
avoidance in Wessex (3/7)
Additional hospital usage of ARLD patients
The average hospital activity for ARLD diagnosed patients (above that of the average population) was taken
from the Nuffield Trust Report (2015). This showed the average: elective admissions, emergency admissions,
A&E attendances and outpatient appointments for ARLD patients before and after their first ARLD diagnosis. A
summary of the additional activity as an ‘age, sex & deprivation standardised rate per capita’ is shown below
(left). The ‘current cost’ estimates are based on this additional hospital utilisation rate. An assumption that
earlier diagnosis will lead to a reduction in: elective admissions, emergency admissions and A&E attendances
(but not outpatient appointments) is used. An annual reduction in the activity rate of 33% is assumed. The
altered additional hospital utilisation (for diagnosis 1 year earlier) is shown below (right). This hospital
utilisation is used for the ‘new cost’ estimations.
36
37. Appendix D: Estimating early intervention cost
avoidance in Wessex (4/7)
Number of new diagnoses per year & mortality assumptions
The number of the newly diagnosed Wessex ARLD patients was identified from the Wessex AHSN Liver Disease
database. There are ~660 new ARLD diagnoses at the 6 Acute Trusts in Wessex each year (2011-2015). The
Wessex Trust data examined showed a 4-year survival rate of 54% (equal to an annual mortality rate of 14.3%).
This survival rate is calculated only from the deaths known to the Trusts. This was used in the estimation of the
‘current cost’.
Mann et al (2004) states the 5-year survival rate of cirrhosis patients who stop drinking as 90% (equal to an
annual mortality rate of 2.1%). This value is used to estimate the cohort size in the ‘new cost’ estimation. This is
thought to be a ‘best case’ survival rate and hence will produce a more conservative estimate of the possible
cost avoidance (a smaller cohort being alive will result in lower service utilisation). The summary of the
estimated cohort changes over time is shown in the table below.
37
38. Appendix D: Estimating early intervention cost
avoidance in Wessex (5/7)
Estimating additional hospital activity of ARLD patients and costs associated
The total additional hospital activity was calculated from the average additional activity rate multiplied by the
number of patients alive in each year. The total cost of treatment was then calculated using average National
Schedule of Reference Costs (Year: 2014/15) for: elective admissions, emergency admissions, A&E attendances
and outpatient appointments. Costs used are shown in the table (right).
This was completed for the ‘current cost’ and ‘new cost’, which were
then compared to give an estimated ‘cost avoidance’. The summary
table of calculations is given in the following slide.
Average cost calculations: National schedule of reference costs
The reference costs are: the average unit cost to the NHS of providing secondary healthcare to NHS patients
and are used to set prices for NHS-funded services in England.
The calculated average elective and non-elective admission costs were weighted by activity after the exclusion
of tariff costs for: Labour and delivery incl. C-sections, Neonatal, Paediatric & Under 18 years. Non-elective
long-stay and non-elective short-stay costs were weighted by activity in order to calculate an average
emergency admission cost.
The average costs for A&E attendances and outpatient appointments were not weighted by activity. No
exclusions were made to the A&E tariffs. The average cost for outpatient appointments was calculated from the
hepatology treatment function only.
38
39. Appendix D: Estimating early intervention cost
avoidance in Wessex (6/7)
The tabulated hospital activity and costs for the cohort, in the four years prior and the four
years following ARLD diagnosis, are summarised below. In this example the ‘new cost’ is based
on the 1-year earlier diagnosis of patients.
39
40. Appendix D: Estimating early intervention cost
avoidance in Wessex (7/7)
The total: ‘current cost’, ‘new cost’ and ‘cost avoided’ estimations for the cohort over the 8 years
is given in the table below for the assumption of diagnosing patients both 1-year and 2-years
earlier.
These values are the same as the annual cost if all ARLD patients (not just a single cohort) at the 6
Acute Trusts in Wessex were managed in the same way. It is therefore estimated that across the 6
Acute Trusts there is a potential cost avoidance of between £10m - £13.3m per year through
the earlier diagnosis and management of ARLD patients.
Note: this is likely to be an under estimate of total cost as the figures only include hospitalised
costs; reduced costs in additional care settings could further increase the potential costs avoided
with earlier diagnosis.
40