Medical staff struggle to spot problem drinking in their patients unless they are already intoxicated, according to research by the University of Leicester.
The work led by Dr Alex J Mitchell, consultant at Leicestershire Partnership NHS Trust and honorary senior lecturer at the University, reveals that clinical staff often overlook alcohol problems in their patients when they do not present intoxicated.
In a new study involving 20,000 patients assessed for alcohol problems by medical staff, all clinicians struggled to detect alcohol problems whether or not patients volunteered information regarding their drinking.
1 in 4 of the adult population in England (33% of men and 16% of women) consumes alcohol in a way that is potentially harmful to their health and 6% of men are alcohol dependent (Pilling et al, 2011). 1 in 6 primary care patients have an alcohol use disorder or are alcohol dependent.
General practitioners (GPs) identified 40% of problem drinkers, hospital doctors identified 50% of problem drinkers and mental health specialists recognised 55% of problem drinkers. Clinicians correctly recorded a diagnosis in the case-notes for only 1 in 3 people who had an alcohol problem. Only alcohol intoxication was accurately identified. A&E clinicians were able to correctly detect patients with alcohol intoxication in 9 out of 10 patients. In research studies where patients admitted to a drinking problem by self report, the same rates of under-detection occurred.
Assessing for alcohol problems in patients using a short questionnaire is recommended by the UK Primary Care Service Framework and NICE but not widely implemented by clinicians.
Dr Alex Mitchell said: ‘This study highlights that clinical identification of alcohol problems is challenging in busy clinical environments. When clinicians try and spot alcohol problems they often miss patients who have serious alcohol problems but who are not currently intoxicated. Further they can misidentify about 5% of

The study explains why certain patients develop severe infections after chemotherapy and points to ways of averting this side-effect
Cancer chemotherapy can be a life-saver, but it is fraught with severe side effects, among them an increased risk of infection. Until now, the major criterion for assessing this risk has been the blood cell count: if the number of white blood cells falls below a critical threshold, the risk of infection is thought to be high. A new model built by Weizmann Institute mathematicians in collaboration with physicians from the Meir Medical Center in Kfar Saba and from the Hoffmann-La Roche research center in Basel, Switzerland, suggests that for proper risk assessment, it is essential to evaluate not only the quantity of these blood cells, but also their quality, which varies from one person to another.
This research may represent an important step in the emerging field of personalised medicine, leading to a more individualised approach to chemotherapy. In particular, better precautions might need to be taken to prevent infection in high-risk patients whereas those at a low risk could be spared unnecessary preventive treatments.

The study brought together the expertise of researchers from such diverse disciplines as applied mathematics, electrical engineering, oncology, immunology and paediatrics.
The new model reveals how the immune system functions under conditions of neutropenia

On World Mental Health Day (10 October), WHO has called for an end to the stigmatisation of depression and other mental disorders and for better access to treatment for all people who need it.
Globally, more than 350 million people have depression, a mental disorder that prevents people from functioning well. But because of the stigma that is often still attached to depression, many fail to acknowledge that they are ill and do not seek treatment.
Depression is different from usual mood fluctuations. Depression induces a sustained feeling of sadness for two weeks or more and interferes with the ability to function at work, school or home. Effective treatments include psychosocial treatment and medication. The active involvement of depressed people and those who are close to them in addressing depression is key. The first step is to recognise the depression and reach out for support. The earlier the treatment begins, the more effective it is.
‘We have some highly effective treatments for depression. Unfortunately, fewer than half of the people who have depression receive the care they need. In fact in many countries this is less than 10%,’ says Dr Shekhar Saxena, Director of the Department for Mental Health and Substance Abuse. ‘This is why WHO is supporting countries in fighting stigma as a key activity to increasing access to treatment.’
Cultural attitudes and lack of proper understanding of the condition contribute to a reluctance to seek help for depression.
WHO estimates suggest that depression is common in all regions of the world. A recent study supported by WHO revealed that around 5% of people in the community had depression during the last year.
Depression results from a complex interaction of social, psychological and biological factors. There is a relationship between depression and physical health, for example cardiovascular disease can lead to depression and vice versa. Up to one in five women who give birth experience post-partum depression.
In addition, circumstances such as economic pressures, unemployment, disasters, and conflict can also increase the risk of the disorder. At its worst, depression can lead to suicide. Tragically almost one million people commit suicide every year and a large proportion of them had experienced depression.
WHO assists governments in including treatment of depression in their basic health care packages. Through WHO

Five million ‘test tube babies’ have now been born around the world, according to research presented at a conference of fertility experts. Delegates hailed it as a ‘remarkable milestone’ for fertility treatments.
The first test tube baby, Louise Brown, was born in the UK in July 1978. Her mother Leslie Brown died last month.
However, delegates at the conference in Turkey warned couples not to use fertility treatment as an ‘insurance policy’ if they delayed parenthood.
The International Committee for Monitoring Assisted Reproductive Technologies (Icmart) presented its latest data on children born to infertile parents at the European Society of Human Reproduction and Embryology conference.
It said official figures up to 2008, plus three years of estimates, put the total number of test tube babies born at five million.
Icmart chairman Dr David Adamson said: ‘This technology has been highly successful in treating infertile patients. Millions of families with children have been created, thereby reducing the burden of infertility.
IVF success rates (based on figures for 2008)
33.1% for women under 35
27.2% for women aged 35-37
19.3% for women aged 38-39
12.5% for women aged 40-42
‘The technology has improved greatly over the years to increase pregnancy rates.’
About 1.5 million cycles of IVF, and similar techniques, are performed every year, resulting in 350,000 babies, Icmart said.
Stuart Lavery, a consultant gynaecologist and director of IVF at Hammersmith Hospital, said: ‘IVF is now part of the mainstream, it is no longer something couples are ashamed of.’
However, he cautioned that the great success of assisted reproduction techniques should not lull people into thinking they could wait to have children.
‘The subtext is that if people delay childbirth they may view IVF as an insurance policy that they can access at any stage.
‘Unfortunately the facts still suggest that IVF success rates in women as they get older are not fantastic.’
Dr Allan Pacey, senior lecturer in andrology at the University of Sheffield, said: ‘I think it’s significant that we’ve got to five million. It’s far more socially acceptable than it has been over the last 10 or 20 years.
‘One word of warning, we should make sure that couples understand that IVF isn’t a guaranteed solution and if they’re in a position to have their children earlier in life then they should try and do that.
‘IVF really is something that should be preserved for those people who really need it.’ BBC

The Society for Healthcare Epidemiology of America (SHEA) and Centers for Disease Control and Prevention (CDC) have each released new tools and information to help track deadly healthcare-associated infections (HAIs) in nursing homes and other long-term care settings. Potentially deadly HAIs strike volumes of nursing home residents each year, with best estimates suggesting that up to 2.8 million infections can occur in this population annually.
An expert panel published updated infection definitions and guidance that provides uniform criteria for nursing homes and other long-term care facilities to track and monitor HAIs. The updated surveillance definitions, co-ordinated by SHEA’s Long-Term Care Special Interest Group, incorporate evidence published over the past two decades, with definitions for norovirus gastroenteritis and Clostridium difficile infections added and more specific definitions for urinary tract infections included.
In parallel, CDC’s National Healthcare Safety Network (NHSN) released a new tracking component, allowing nursing homes and other long term care facilities to monitor HAIs. The newly published guidance serves as the foundation of the new NHSN component. When facilities track infections, they can identify problems, implement prevention measures, and monitor progress toward stopping infections. State and local health officials can also use the system to monitor the impact of regional prevention efforts. On the national level, data entered into NHSN will gauge progress toward national infection prevention goals.
‘The unsettling truth is that our best estimates of healthcare-associated infections in long-term care facilities, such as nursing homes, most likely understate the true problem,’ said Nimalie Stone, M.D., a lead author of the guidance and a medical epidemiologist at the Centers for Disease Control and Prevention (CDC). ‘Clinicians in nursing homes cannot prevent healthcare-associated infections unless they know where and how they are occurring. Tracking infections within facilities is the first step toward prevention and ultimately saves lives.’
The new NHSN component allows nursing homes and other long term care facilities to track Clostridium difficile (a deadly diarrhoeal infection), drug-resistant infections such as methicillin-resistant Staphylococcus aureus (MRSA), urinary tract infections, and healthcare worker adherence to basic infection control procedures including hand hygiene and glove use.
‘With the rising number of individuals receiving more complex medical care in nursing homes, these new tools provide a needed means for these resource-limited care settings to help track and monitor their facility’s infections using criteria that reflect the care they provide and the patients they see,’ said Suzanne Bradley, MD, a co-author of the paper and editor-in-chief of Infection Control and Hospital Epidemiology. EurekAlert