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Take a look at a selection of our recent media coverage:

New treatment guidelines for alcohol dependence subject to UK-wide consultation

20th October 2023

A consultation on UK-wide guidelines for the clinical treatment of harmful drinking and alcohol dependence has been launched by the Department of Health and Social Care (DHSC).

Developed in partnership with the UKs devolved administrations, the guidelines include advice for alcohol care in acute hospitals as well as other settings such as primary care, community health services and the criminal justice system.

Patients with alcohol use disorder present to acute hospitals with a wide range of primary diagnoses and the presence of alcohol use disorder may not always be obvious to the patient or to clinical staff, the guidance states.

It therefore emphasises the need for hospitals to have staff with appropriate skills to identify alcohol use disorders, assess risk and provide specialist treatment interventions.

The importance of implementing a system for identifying health risk from alcohol and gauging the severity of alcohol use disorder among all hospital inpatients is also highlighted as this may impact a patients treatment, recovery and risk of complications.

The guidelines also outline key factors in dealing with acute or medically assisted alcohol withdrawal, managing associated complications and treating patients with co-occurring physical and mental health conditions, including those in crisis.

The need for a seamless transition to ongoing treatment in mental health and community services when discharged is also detailed, with integrated planning identified as a priority to ensure effective wrap-around care.

According to the DHSC, the main aim of the guidelines is to develop a ‘clearer consensus’ on good practice and how to implement NICE-recommended interventions.

The consultation will be open for eight weeks, inviting views from people working in alcohol treatment, the wider health and care sector and those with lived experience of alcohol dependence across the UK.

Neil O’Brien, minister for public health, said: ’This consultation will help us develop guidance to ensure alcohol treatment services are of consistently high quality, providing stronger pathways to recovery for those in need of treatment for alcohol dependence.’

In May, ministers were accused of not taking alcohol harm seriously enough after a new report revealed that over the last two decades the number of alcohol-related deaths rose by 89% and was continuing to rise sharply since the start of the pandemic.

Despite this, the report found that a ‘staggering’ 82% of dependent drinkers were not in treatment despite success rates of 60% and evidence that treatment delivers £3 of benefit for every £1 invested.

A version of this story was originally published by our sister publication Nursing in Practice.

Guideline discordant antibiotic prescribing for ED patients with severe CAP increases mortality

7th October 2021

The presence of guideline discordant antibiotic prescribing for ED patients with severe CAP has been found to increase 30-day mortality.

Community-acquired pneumonia (CAP) is an infection acquired in the community, i.e., outside of a hospital setting. The worldwide incidence of community-acquired pneumonia has been estimated to vary between 1.5 to 14 cases per 1000 person-years. Mortality rates for CAP are very low (< 2%) for patients treated in the community but increase among those hospitalised (5 – 20%) and are higher still (up to 50%) for patients who are admitted to intensive care. Treatment of CAP involves the use of empirical antibiotics and several guidelines exist for the management of CAP. Moreover, evidence suggests that guideline-concordant prescribing for CAP is associated with improved health outcomes and lower resource use in adults. But to what extent would guideline discordant antibiotic prescribing impact on health outcomes and mortality?

This was the question posed by a team from the Department of Emergency Medicine, Seoul National University Bundang Hospital, Republic of Korea. The team undertook a retrospective analysis of adult patients with severe CAP, hospitalised in the emergency department (ED) after the diagnosis of severe CAP, defined by the 2007, Infectious Diseases Society of America/American Thoracic Society guidelines. For the treatment of severe CAP, the guidelines recommend a beta-lactam antibiotic plus either a macrolide or fluoroquinolone. Among penicillin allergic patients, a respiratory fluoroquinolone plus aztreonam is recommended. Data on prescribing , together with demographic and co-morbidity information were obtained from hospital medical records. Patients were then categorised as either being prescribed guideline concordant antibiotics or guideline discordant antibiotics. Propensity score matching was used to reduce selection bias and 30-day survival was estimated with logistic regression.

Findings

A total of 630 patients were included, of whom 179 (28.4%) died within 30 days of being hospitalised. After propensity matching, a total of 255 individuals were included in each group with an approximate age of 75 years (66% male). After propensity matching, guideline discordant prescribing was significantly associated with 30-day mortality (hazard ratio, HR = 1.43, 95% CI 1.05 – 1.93, p = 0.022). In addition, 30-day mortality was found to be lower in the guideline concordant group (23.9% vs 33.3%, concordant vs discordant, p = 0.024).

Commenting on these findings, the authors noted that 43% of patients were prescribed guideline discordant antibiotics for severe CAP and concluded that this was independently associated with 30-day survival.

Citation

Hyun KS et al. Antibiotic prescription consistent with guidelines in emergency department is associated with 30-day survival in severe community-acquired pneumonia. BMC Emerg Med 2021.

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