British Liver Trust

P. Newsome, R. Cramb, S. Davison, J. Dillon, M. Foulerton, E. Godfrey, R. Hall, Ulrike Harrower, M. Hudson, A. Langford, A. Mackie, R. Mitchell-Thain, K. Sennett, N. Sheron, J. Verne, Martine Walmsley, A. Yeoman

These updated guidelines on the management of abnormal liver blood tests have been commissioned by the Clinical Services and Standards Committee (CSSC) of the British Society of Gastroenterology (BSG) under the auspices of the liver section of the BSG. The original guidelines, which this document supersedes, were written in 2000 and have undergone extensive revision by members of the Guidelines Development Group (GDG). The GDG comprises representatives from patient/carer groups (British Liver Trust, Liver4life, PBC Foundation and PSC Support), elected members of the BSG liver section (including representatives from Scotland and Wales), British Association for the Study of the Liver (BASL), Specialist Advisory Committee in Clinical Biochemistry/Royal College of Pathology and Association for Clinical Biochemistry, British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN), Public Health England (implementation and screening), Royal College of General Practice, British Society of Gastrointestinal and Abdominal Radiologists (BSGAR) and Society of Acute Medicine. The quality of evidence and grading of recommendations was appraised using the AGREE II tool. These guidelines deal specifically with the management of abnormal liver blood tests in children and adults in both primary and secondary care under the following subheadings: (1) What constitutes an abnormal liver blood test? (2) What constitutes a standard liver blood test panel? (3) When should liver blood tests be checked? (4) Does the extent and duration of abnormal liver blood tests determine subsequent investigation? (5) Response to abnormal liver blood tests. They are not designed to deal with the management of the underlying liver disease.

R. Parker, Michael Allison, Seonaid Anderson, Richard Aspinall, Sara Bardell, V. Bains, Ryan M Buchanan, L. Corless, I. Davidson, Pauline Dundas, Jeff Fernandez, Ewan H Forrest, Erica Forster, D. Freshwater, R. Gailer, R. Goldin, Vanessa Hebditch, S. Hood, Arron Jones, Victoria Lavers, D. Lindsay, James B Maurice, Joanne McDonagh, Sarah Morgan, Tania Nurun, C. Oldroyd, E. Oxley, Sally Pannifex, G. Parsons, Thomas Phillips, Nicole Rainford, Neil Rajoriya, Paul Richardson, J. Ryan, J. Sayer, Mandy Smith, Ankur Srivastava, E. Stennett, J. Towey, R. Vaziri, I. Webzell, Andrew Wellstead, Ashwin D. Dhanda, S. Masson

Objective Alcohol-related liver disease (ALD) is the most common cause of liver-related ill health and liver-related deaths in the UK, and deaths from ALD have doubled in the last decade. The management of ALD requires treatment of both liver disease and alcohol use; this necessitates effective and constructive multidisciplinary working. To support this, we have developed quality standard recommendations for the management of ALD, based on evidence and consensus expert opinion, with the aim of improving patient care. Design A multidisciplinary group of experts from the British Association for the Study of the Liver and British Society of Gastroenterology ALD Special Interest Group developed the quality standards, with input from the British Liver Trust and patient representatives. Results The standards cover three broad themes: the recognition and diagnosis of people with ALD in primary care and the liver outpatient clinic; the management of acutely decompensated ALD including acute alcohol-related hepatitis and the posthospital care of people with advanced liver disease due to ALD. Draft quality standards were initially developed by smaller working groups and then an anonymous modified Delphi voting process was conducted by the entire group to assess the level of agreement with each statement. Statements were included when agreement was 85% or greater. Twenty-four quality standards were produced from this process which support best practice. From the final list of statements, a smaller number of auditable key performance indicators were selected to allow services to benchmark their practice and an audit tool provided. Conclusion It is hoped that services will review their practice against these recommendations and key performance indicators and institute service development where needed to improve the care of patients with ALD.

E. Kaner, D. Newbury-Birch, L. Avery, N. Brown, K. Jackson, H. Mason

Gwenllian Collin, Oliver Turner, V. Luthra

Developing psychotherapeutic competencies is an essential part of psychiatric training. All Core Trainees at Leeds and York Partnership NHS Foundation Trust (LYPFT) saw a patient for psychodynamic psychotherapy until 2020. Due to the pandemic, all face‐to‐face appointments at the LYPFT Medical Psychotherapy Service were paused from March 2020. Patients could choose whether to continue therapy remotely or defer therapy. Supervision was also moved to a remote format. Face‐to‐face therapy sessions resumed from August 2020, with new infection control procedures. This project aimed to establish doctors' experience of training in delivering psychodynamic psychotherapy at LYPFT during the pandemic. A two‐step methodology was used: an online survey including qualitative and quantitative analysis of the impact of the pandemic;and semi‐structured interviews with thematic analysis. The online survey had a response rate of 68%. Four patients deferred therapy;the mean deferral length was two months. Ten respondents had sessions cancelled due to infection/self‐isolation. Thirteen respondents (commencing therapy pre‐pandemic) delivered therapy face‐to‐face (without personal protective equipment [PPE]). During the pandemic five respondents delivered therapy via phone, six face‐to‐face with PPE. Thirteen were concerned about attaining psychotherapy competencies. Thematic analysis of the interviews identified three main themes (with subthemes). Challenges of delivering therapy during the pandemic were identified, as well as areas of good practice and opportunities. [ FROM AUTHOR] Copyright of British Journal of Psychotherapy is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

J. Worsfold, Vanessa Hebditch, S. Ryder

IntroductionFor patients with chronic liver disease, thrombocytopenia is a common complication that impacts on management of cirrhosis and has implications for planned surgical/diagnostic procedures due to an increased risk of bleeding. Platelet transfusion (PT) has been the standard of care for management of thrombocytopenia. There is a need to better understand the views and experiences of UK patients with advanced disease and how their condition, and requirements for PT, affect quality of life.MethodThe British Liver Trust (BLT) undertook a patient survey between December 2020 and February 2021. Patients were invited to participate via BLT channels (monthly newsletter;patient support groups) answering 30 questions (anonymously) via the Survey Monkey platform. The survey was conducted independently by the BLT, supported by an educational grant from Shionogi.ResultsA total of 121 patients completed the survey. Alcohol related liver disease was the most commonly reported primary liver disease (28%);63% of respondents were female;73% were aged over 45 years, and 51% have been told they may require a liver transplant in the future. A large proportion (69%) of patients reported that liver disease sometimes affects their ability to think clearly. Half of responders recorded having to take time off work for liver-related hospital appointments;40% travel > 25 miles to their liver centre/hospital for routine appointments, and 55% said that the COVID-19 pandemic had led to procedures related to their liver disease being cancelled. Many patients (62%) reported that healthcare professionals (HCPs) have difficulties inserting a needle into a vein and 40% noted that they have needed a dental extraction since being diagnosed. Almost a third (30%) have required a PT at some time, and of those, 70% had to stay in hospital the night before the PT. Patients reported that the reasons for needing a PT were typically well-explained. Among recipients of PT, 42% said they felt unwell during or post the PT. Following completion of the survey, 33 patients provided consent for voluntary follow-up and supplementary questions from the BLT.ConclusionsA survey of patients with chronic liver disease highlights that the COVID-19 pandemic has impacted on and delayed planned procedures, and identifies that both chronic liver disease, and the requirement for PT, pose a burden to patients that may adversely affect quality of life.