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21. Drug and Alcohol Abuse amongst Anaesthetists - Guidance on Identification and Management 2

of a T rust alcohol and substance 30 abuse policy Appendix 4:Identifying unsafe drinking habits 35 © The Association of Anaesthetists of Great Britain & Ireland 201 13 1. Summary The vast majority of anaesthetists will be unaffected by substance abuse, but for those few that are affected the consequences can be devastating both for them and for their patients. Drug and alcohol abuse is a problem for some anaesthetists, as it is in the general population. Drug abuse is more common than alcohol abuse (...) on cognitive performance and are associated with cognitive failures at work. This may have implications for the care of patients and the health and safety of an employee and his/her colleagues. 1.1 Alcohol and substance abuse related problems at work are defined as: • any drinking of alcohol • any use of illicit non-prescribed drugs • any misuse of prescribed drugs • any use of any other substance of abuse, e.g. solvents that has the potential to interfere with an employee’s functioning and performance

2011 Association of Anaesthetists of GB and Ireland

22. Hepatic, lipid and genetic factors associated with obesity: crosstalk with alcohol dependence? Full Text available with Trip Pro

Hepatic, lipid and genetic factors associated with obesity: crosstalk with alcohol dependence? Alcohol dependence represents a leading cause of mortality and morbidity. Understanding the variables that contribute to this diagnosis and its severity is critical. An overlap between factors that may predispose people to become obese and those that may increase the risk of alcohol dependence may exist. However, data in the literature are not conclusive. Therefore, this study aimed to identify (...) the association between alcohol dependence and obesity-related factors, including biochemical and genetic factors.In a case-control study with 829 participants, factors involved with metabolism and obesity were assessed, including biochemical lipid and liver markers, and the fat mass and obesity-associated (FTO) single nucleotide polymorphism (SNP) rs8050136.Increased triglycerides, having one or two minor A alleles for rs8050136 and being a smoker were associated with increased risk of alcohol dependence

2016 The world journal of biological psychiatry : the official journal of the World Federation of Societies of Biological Psychiatry

23. Predicting Low-Risk for Sustained Alcohol Use After Early Liver Transplant for Acute Alcoholic Hepatitis: The SALT Score. (Abstract)

Predicting Low-Risk for Sustained Alcohol Use After Early Liver Transplant for Acute Alcoholic Hepatitis: The SALT Score. Early liver transplant (LT) for alcohol-associated disease (i.e., without a specific sobriety period) is controversial but increasingly used. Using the multicenter American Consortium of Early Liver Transplantation for Alcoholic Hepatitis (ACCELERATE-AH) cohort, we aimed to develop a predictive tool to identify patients pretransplant with low risk for sustained alcohol use (...) posttransplant to inform selection of candidates for early LT. We included consecutive ACCELERATE-AH LT recipients between 2012 and 2017. All had clinically diagnosed severe alcoholic hepatitis (AH), no prior diagnosis of liver disease or AH, and underwent LT without a specific sobriety period. Logistic and Cox regression, classification and regression trees (CARTs), and least absolute shrinkage and selection operator (LASSO) regression were used to identify variables associated with sustained alcohol use

2018 Hepatology

24. Controlled Attenuation Parameter And Alcoholic Hepatic Steatosis: Diagnostic Accuracy and Role Of Alcohol Detoxification. Full Text available with Trip Pro

Controlled Attenuation Parameter And Alcoholic Hepatic Steatosis: Diagnostic Accuracy and Role Of Alcohol Detoxification. Controlled attenuation parameter (CAP) is a novel non-invasive measure of hepatic steatosis, but it has not been evaluated in alcoholic liver disease. Therefore, we aimed to validate CAP for the assessment of biopsy-verified alcoholic steatosis and to study the effect of alcohol detoxification on CAP.This was a cross-sectional biopsy-controlled diagnostic study in four (...) (interquartile range 4-6) for detoxification, CAP decreased by 32 ± 47 dB/m (p <0.001). Body mass index predicted higher CAP in both cohorts, irrespective of drinking pattern. Obese patients with body mass index ≥30 kg/m2 had a significantly higher CAP, which did not decrease significantly during detoxification.CAP has a good diagnostic accuracy for diagnosing severe alcoholic liver steatosis and can be used to rule in any steatosis. In non-obese but not in obese, patients, CAP rapidly declines after alcohol

2018 Journal of Hepatology

25. Assessment of the risk of alcohol relapse following liver transplantation for alcoholic hepatitis using a meta-analysis approach. (Abstract)

Assessment of the risk of alcohol relapse following liver transplantation for alcoholic hepatitis using a meta-analysis approach. 29505845 2019 05 01 2019 05 01 1600-0641 68 6 2018 06 Journal of hepatology J. Hepatol. Assessment of the risk of alcohol relapse following liver transplantation for alcoholic hepatitis using a meta-analysis approach. 1322-1323 S0168-8278(18)30142-9 10.1016/j.jhep.2018.02.020 Deltenre Pierre P Department of Gastroenterology, Hepatopancreatology, and Digestive (...) 03 02 Netherlands J Hepatol 8503886 0168-8278 3K9958V90M Ethanol IM J Hepatol. 2018 Mar;68(3):380-382 29175244 J Hepatol. 2018 Jun;68(6):1323 29505846 Alcohol Abstinence Ethanol Hepatitis, Alcoholic Humans Liver Transplantation Recurrence 2018 02 01 2018 02 04 2018 3 6 6 0 2019 5 2 6 0 2018 3 6 6 0 ppublish 29505845 S0168-8278(18)30142-9 10.1016/j.jhep.2018.02.020

2018 Journal of Hepatology

26. Reply to: "Assessment of the risk of alcohol relapse following liver transplantation for alcoholic hepatitis using a meta-analysis approach". (Abstract)

Reply to: "Assessment of the risk of alcohol relapse following liver transplantation for alcoholic hepatitis using a meta-analysis approach". 29505846 2019 05 01 2019 05 01 1600-0641 68 6 2018 06 Journal of hepatology J. Hepatol. Reply to: "Assessment of the risk of alcohol relapse following liver transplantation for alcoholic hepatitis using a meta-analysis approach". 1323 S0168-8278(18)30141-7 10.1016/j.jhep.2018.02.019 Luther Jay J Gastrointestinal Unit, Massachusetts General Hospital (...) , Harvard Medical School, Boston, MA, USA. Electronic address: Jluther1@mgh.harvard.edu. Dienstag Jules L JL Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: jdienstag@partners.org. eng Letter Comment 2018 03 02 Netherlands J Hepatol 8503886 0168-8278 3K9958V90M Ethanol IM J Hepatol. 2018 Mar;68(3):380-382 29175244 J Hepatol. 2018 Jun;68(6):1322-1323 29505845 Alcohol Abstinence Ethanol Hepatitis, Alcoholic Humans Liver Transplantation

2018 Journal of Hepatology

27. Long-term prognostic value of the FibroTest in patients with non-alcoholic fatty liver disease, compared to chronic hepatitis C, B, and alcoholic liver disease. Full Text available with Trip Pro

Long-term prognostic value of the FibroTest in patients with non-alcoholic fatty liver disease, compared to chronic hepatitis C, B, and alcoholic liver disease. Although the FibroTest has been validated as a biomarker to determine the stage of fibrosis in non-alcoholic fatty liver disease (NAFLD) with results similar to those in chronic hepatitis C (CHC), B (CHB), and alcoholic liver disease (ALD), it has not yet been confirmed for the prediction of liver-related death.To validate the 10-year

2018 Alimentary Pharmacology & Therapeutics

28. Correction: Alcohol-related changes in the intestinal microbiome influence neutrophil infiltration, inflammation and steatosis in early alcoholic hepatitis in mice. Full Text available with Trip Pro

Correction: Alcohol-related changes in the intestinal microbiome influence neutrophil infiltration, inflammation and steatosis in early alcoholic hepatitis in mice. [This corrects the article DOI: 10.1371/journal.pone.0174544.].

2017 PLoS ONE

29. Alcohol-related changes in the intestinal microbiome influence neutrophil infiltration, inflammation and steatosis in early alcoholic hepatitis in mice. Full Text available with Trip Pro

protein monocyte chemoattractant protein-1 (MCP-1) were also reduced in antibiotic-treated alcohol-fed mice. Alcohol-induced hepatic steatosis measured by Oil-Red O staining was significantly reduced in antibiotic treated mice. Genes regulating lipid production and storage were also altered by alcohol and antibiotic treatment. Interestingly, antibiotic treatment did not protect from alcohol-induced increases in serum aminotransferases (ALT/AST).Our data indicate that acute-on-chronic alcohol feeding (...) Alcohol-related changes in the intestinal microbiome influence neutrophil infiltration, inflammation and steatosis in early alcoholic hepatitis in mice. Alcohol-induced intestinal dysbiosis disrupts homeostatic gut-liver axis function and is essential in the development of alcoholic liver disease. Here, we investigate changes in enteric microbiome composition in a model of early alcoholic steatohepatitis and dissect the pathogenic role of intestinal microbes in alcohol-induced liver

2017 PLoS ONE

30. Two drug treatments for severe alcoholic hepatitis do not improve survival rates Full Text available with Trip Pro

as bleeding and sepsis are common complications of severe alcoholic hepatitis. Serious side effects were common in this trial, affecting nearly one in two participants. This study found that the overall mortality was high and more needs to be done to promote abstinence from alcohol in this group of people with severe disease. Management of alcohol abuse or dependence is warranted in all people with alcoholic hepatitis. Also, new treatments are needed. Citation Thursz MR, Richardson P, Allison M et al. . N (...) were common in this trial, affecting nearly one in two participants. This study found that the overall mortality was high and more needs to be done to promote abstinence from alcohol in this group of people with severe disease. Management of alcohol abuse or dependence is warranted in all people with alcoholic hepatitis. Also, new treatments are needed. Citation Thursz MR, Richardson P, Allison M et al. . N Engl J Med. 2015;372(17):1619-28. This project was funded by the National Institute

2018 NIHR Dissemination Centre

31. Overview of chronic alcohol use

disorders, 5th ed., (DSM-5). Washington, DC: American Psychiatric Publishing; 2013. and as harmful use of alcohol and alcohol dependence in the ICD-10. World Health Organization. International statistical classification of diseases and related health problems. 10th ed. Geneva, Switzerland: WHO; 2016. http://www.who.int/classifications/icd/en/ The syndrome occurs in alcohol abusers as a result of decrease or cessation of alcohol drinking, resulting in the blood alcohol levels below the level to which (...) in the Western world are chronic hepatitis C and alcoholic liver disease, followed by non-alcoholic fatty liver disease (steatohepatitis) and chronic hepatitis B. The main complications of cirrhosis are related to the development of liver insufficiency and portal hypertension, and include ascites, variceal haemorrhage, jaundice, portosystemic encephalopathy, hepatorenal and hepatopulmonary syndromes, and the development of hepatocellular carcinoma. A rare syndrome defined by a rapid decline in hepatic

2018 BMJ Best Practice

32. Alcoholic liver disease

bleeding, ascites, coagulopathy, hepatic encephalopathy, and liver cancer. Definition Alcoholic liver disease (ALD) has 3 stages of liver damage: fatty liver (steatosis), alcoholic hepatitis (inflammation and necrosis), and alcoholic liver cirrhosis. All are caused by chronic heavy alcohol ingestion. History and exam presence of risk factors abdominal pain hepatomegaly haematemesis and melaena venous collaterals splenomegaly hepatic mass jaundice palmar erythema cutaneous telangiectasia asterixis (...) Alcoholic liver disease Alcoholic liver disease - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Alcoholic liver disease Last reviewed: February 2019 Last updated: May 2018 Summary Accounts for 3.3 million deaths annually worldwide. Caused by chronic heavy alcohol ingestion. About 40 to 80 g/day in men and 20 to 40 g/day in women for 10 to 12 years is sufficient to cause liver damage in the absence of other liver

2018 BMJ Best Practice

33. Overview of chronic alcohol use

disorders, 5th ed., (DSM-5). Washington, DC: American Psychiatric Publishing; 2013. and as harmful use of alcohol and alcohol dependence in the ICD-10. World Health Organization. International statistical classification of diseases and related health problems. 10th ed. Geneva, Switzerland: WHO; 2016. http://www.who.int/classifications/icd/en/ The syndrome occurs in alcohol abusers as a result of decrease or cessation of alcohol drinking, resulting in the blood alcohol levels below the level to which (...) in the Western world are chronic hepatitis C and alcoholic liver disease, followed by non-alcoholic fatty liver disease (steatohepatitis) and chronic hepatitis B. The main complications of cirrhosis are related to the development of liver insufficiency and portal hypertension, and include ascites, variceal haemorrhage, jaundice, portosystemic encephalopathy, hepatorenal and hepatopulmonary syndromes, and the development of hepatocellular carcinoma. A rare syndrome defined by a rapid decline in hepatic

2018 BMJ Best Practice

34. When a liver transplant recipient goes back to alcohol abuse: Should we be more selective? Full Text available with Trip Pro

When a liver transplant recipient goes back to alcohol abuse: Should we be more selective? Alcoholic liver disease (ALD) is one of the most common indications for liver transplantation (LT). However, it has always remained as a complicated topic from both medical and ethical grounds, as it is seen for many a "self-inflicted disease". Over the years, the survival rate of transplanted patients has significantly improved. The allocation system and the inclusion criteria for LT has also undergone (...) some modifications. Early LT for acute alcoholic hepatitis has been subject to recent clinical studies with encouraging results in highly selected patients. We have learned from studies the importance of a multidisciplinary evaluation of candidates for LT. Complete abstinence should be attempted to overcome addiction issues and to allow spontaneous liver recovery. Risk factors for relapse include the presence of anxiety or depressive disorder, short duration of sobriety pre-LT and lack of social

2016 World Journal of Gastroenterology

35. Transient elastography for diagnosis of stages of hepatic fibrosis and cirrhosis in people with alcoholic liver disease. Full Text available with Trip Pro

Transient elastography for diagnosis of stages of hepatic fibrosis and cirrhosis in people with alcoholic liver disease. The presence and progression of hepatic (liver) fibrosis into cirrhosis is a prognostic variable having impact on survival in people with alcoholic liver disease. Liver biopsy, although an invasive method, is the recommended 'reference standard' for diagnosis and staging of hepatic fibrosis in people with liver diseases. Transient elastography is a non-invasive method (...) for assessing and staging hepatic fibrosis.To determine the diagnostic accuracy of transient elastography for diagnosis and staging hepatic fibrosis in people with alcoholic liver disease when compared with liver biopsy. To identify the optimal cut-off values for differentiating the five stages of hepatic fibrosis.The Cochrane Hepato-Biliary Group Controlled and Diagnostic Test Accuracy Studies Registers, The Cochrane Library, MEDLINE (OvidSP), EMBASE (OvidSP), and the Science Citation Index Expanded (last

2015 Cochrane

36. Impact of hepatitis C virus infection on the risk of death of alcohol-dependent patients. (Abstract)

Impact of hepatitis C virus infection on the risk of death of alcohol-dependent patients. Hepatitis C virus (HCV) infection is frequent among patients with alcohol use disorders. We aimed to analyse the impact of HCV infection on survival of patients seeking treatment for alcohol use. This was a longitudinal study in a cohort of patients who abused alcohol recruited in two detoxification units. Socio-demographic and alcohol use characteristics, liver function tests for the assessment of alcohol (...) -related liver disease and HCV and HIV infection serologies were obtained at admission. Patients were followed until December 2008; causes of death were ascertained through clinical records and death registry. Cox models were used to analyse predictors of death. A total of 675 patients (79.7% men) were admitted; age at admission was 43.5 years (IQR: 37.9-50.2 years), duration of alcohol abuse was 18 years (IQR: 11-24 years), and median alcohol consumption was 200 g/day (IQR: 120-275 g/day

2015 Journal of viral hepatitis

37. Baseline urine metabolic phenotype in patients with severe alcoholic hepatitis and its association with outcome Full Text available with Trip Pro

Baseline urine metabolic phenotype in patients with severe alcoholic hepatitis and its association with outcome Severe alcoholic hepatitis (SAH) has a high mortality rate, and corticosteroid therapy is effective in 60% patients. This study aimed to investigate a baseline metabolic phenotype that could help stratify patients not likely to respond to steroid therapy and to have an unfavorable outcome. Baseline urine metabolome was studied in patients with SAH using ultra-high performance liquid

2018 Hepatology communications

38. Can we reliably predict response to corticosteroid treatment in severe alcoholic hepatitis? Full Text available with Trip Pro

Can we reliably predict response to corticosteroid treatment in severe alcoholic hepatitis? 29881814 2018 11 14 2471-254X 2 6 2018 Jun Hepatology communications Hepatol Commun Can we reliably predict response to corticosteroid treatment in severe alcoholic hepatitis? 625-627 10.1002/hep4.1191 Chokshi Shilpa S Chief Scientific Officer Institute of Hepatology Foundation for Liver Research London United Kingdom. eng Editorial 2018 04 27 United States Hepatol Commun 101695860 2471-254X 2018 03 29

2018 Hepatology communications

39. What is the excess cost/use of health and social resources related to alcohol?

and indirect, health, and societal. • Service utilisation – treatment, hospitalisation, accident and emergency attendance, ambulance call outs, outpatient visits, social services. • Injury - road accidents, assault, falls. • Fetal Alcohol Spectrum Disorders (FASD). • Health and wellbeing – illness, child welfare, carers, dependents. • Impact of problem drinking on family and the community. • Productivity losses – absence, unemployment. Costs Only 15 papers (1, 2, 7, 10-21) gave actual costs, some (...) ? KLS Evidence Briefing 19/07/18 https://masshealthpolicyforum.brandeis.edu/forums/Documents/FINAL-SEN- IssueBrief_For-Print.pdf 35. Mortimer D, Segal L 2006. Economic evaluation of interventions for problem drinking and alcohol dependence: Do within-family external effects make a difference? Alcohol and Alcoholism 41(1) 92-8. Available: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=psy c5&AN=2006-00560-014 36. Balsa AI, French MT 2012. The impact of parental drinking

2018 Public Health England - Evidence Briefings

40. What is the most accurate and cost-effective direct test (ELF test, hyaluronic acid, P3NP, Fibroscan or ARFI elastography) for detecting and staging liver fibrosis and/or cirrhosis in patients with diagnosed or suspected non-alcoholic fatty liver disease,

connective tissue caused by repeated liver injury from metabolic dysfunction, alcohol abuse, viral hepatitis or autoimmune disease 2 . Cirrhosis: end-stage liver disease characterised by nodules of liver tissue surrounded by advanced fibrosis and consequent liver dysfunction 3 . Extendedly dominated (a term used in health economics): an extendedly dominated strategy has an incremental cost-effectiveness ratio (ICER) higher than that of the next most effective strategy; therefore an extendedly dominated (...) fibrosis and cirrhosis 6 . The most common chronic liver diseases associated with liver fibrosis and cirrhosis are non-alcoholic fatty liver disease (NAFLD), alcohol-related liver disease and viral hepatitis. Much of the morbidity and mortality associated with chronic liver disease occurs in those patients who also have advanced liver fibrosis or cirrhosis 7 . Liver fibrosis is a progressive condition where excess connective tissue builds up in the liver causing scarring and loss of liver function 6

2018 Evidence Notes from Healthcare Improvement Scotland

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