Cause Of Death In England Research Articles

Hypertension: a PCN Clinical Pharmacist‐led intervention

Cardiovascular disease (CVD) remains the second most common cause of death in England, after dementia and Alzheimer disease, causing a quarter of all deaths. Hypertension is the largest single known risk factor for CVD; however, as the condition rarely has noticeable symptoms, an estimated 4.2 million people in England are walking around with undiagnosed hypertension. This article presents how one primary care network (PCN), Nottingham West, is working in new ways to make a difference to the health of their local population about hypertension.

Impact of Frailty on Symptom Burden in Chronic Obstructive Pulmonary Disease.

Chronic obstructive pulmonary disease (COPD), the sixth leading cause of death in the United States in 2022 and the third leading cause of death in England and Wales in 2022, is associated with high symptom burden, particularly dyspnoea. Frailty is a complex clinical syndrome associated with an increased vulnerability to adverse health outcomes. The aim of this review was to explore the current evidence of the influence of frailty on symptoms in patients with a confirmed diagnosis of COPD according to GOLD guidelines. Fourteen studies report a positive association between frailty and symptoms, including dyspnoea, assessed with the COPD Assessment Test (CAT) and the modified Medical Research Council (mMRC) scale. Data were analysed in a pooled a random-effects meta-analysis of mean differences (MDs). There was an association between COPD patients living with frailty and increased CAT score versus COPD patients without frailty [pooled SMD, 1.79 (95% CI 0.72-2.87); I2 = 99%]. A lower association was found between frailty and dyspnoea measured by the mMRC scale versus COPD patients without frailty [pooled SMD, 1.91 (95% CI 1.15-2.66); I2 = 98%]. The prevalence of frailty ranged from 8.8% to 82% and that of pre-frailty from 30.4% to 73.7% in people living with COPD. The available evidence supports the role of frailty in worsening symptom burden in COPD patients living with frailty. The review shows that frailty is common in patients with COPD. Future research is needed to have further details related to the data from CAT to improve our knowledge of the frailty impact in this population.

Mortality from leading cancers in districts of England from 2002 to 2019: a population-based, spatiotemporal study

Cancers are the leading cause of death in England. We aimed to estimate trends in mortality from leading cancers from 2002 to 2019 for the 314 districts in England. We did a high-resolution spatiotemporal analysis of vital registration data from the UK Office for National Statistics using data on all deaths from the ten leading cancers in England from 2002 to 2019. We used a Bayesian hierarchical model to obtain robust estimates of age-specific and cause-specific death rates. We used life table methods to calculate the primary outcome, the unconditional probability of dying between birth and age 80 years by sex, cancer cause of death, local district, and year. We reported Spearman rank correlations between the probability of dying from a cancer and district-level poverty in 2019. In 2019, the probability of dying from a cancer before age 80 years ranged from 0·10 (95% credible interval [CrI] 0·10-0·11) to 0·17 (0·16-0·18) for women and from 0·12 (0·12-0·13) to 0·22 (0·21-0·23) for men. Variation in the probability of dying was largest for lung cancer among women, being 3·7 times (95% CrI 3·2-4·4) higher in the district with the highest probability than in the district with the lowest probability; and for stomach cancer for men, being 3·2 times (2·6-4·1) higher in the district with the highest probability than in the one with the lowest probability. The variation in the probability of dying was smallest across districts for lymphoma and multiple myeloma (95% CrI 1·2 times [1·1-1·4] higher in the district with the highest probability than the lowest probability for women and 1·2 times [1·0-1·4] for men), and leukaemia (1·1 times [1·0-1·4] for women and 1·2 times [1·0-1·5] for men). The Spearman rank correlation between probability of dying from a cancer and district poverty was 0·74 (95% CrI 0·72-0·76) for women and 0·79 (0·78-0·81) for men. From 2002 to 2019, the overall probability of dying from a cancer declined in all districts: the reductions ranged from 6·6% (95% CrI 0·3-13·1) to 30·1% (25·6-34·5) for women and from 12·8% (7·1-18·8) to 36·7% (32·2-41·2) for men. However, there were increases in mortality for liver cancer among men, lung cancer and corpus uteri cancer among women, and pancreatic cancer in both sexes in some or all districts with posterior probability greater than 0·80. Cancers with modifiable risk factors and potential for screening for precancerous lesions had heterogeneous trends and the greatest geographical inequality. To reduce these inequalities, factors affecting both incidence and survival need to be addressed at the local level. Wellcome Trust, Imperial College London, UK Medical Research Council, and the National Institute of Health Research.

Patient journey and costs through a brain health clinic compared with a memory clinic: a costing study

BackgroundDementia and Alzheimer's disease are the leading cause of death in England, with prevalence estimated to rise with an ageing population. 2021 cost estimates were £25 billion, rising to an estimated £47 billion in 2050. Brain health clinics (BHC) offer patients with memory concerns access to higher quality memory assessment and imaging than memory clinics, which are the usual care. BHCs aim to offer patients a more accurate and timely diagnosis, resulting in more specific treatment options. BHCs also offer patients the opportunity to take part in research. We aimed to compare the cost of a patient journey through a BHC and a memory clinic as part of an evaluation of the BHC model. MethodsFor this costing study, we consulted staff from one BHC and one memory clinic in the south of England in March 2023, to identify the patient journey and estimate clinical and research resources, time, and costs. We estimated personnel costs using time-per-task estimations multiplied by staff salary and verified with full-time-equivalent estimations for clinical and research tasks overall. BHC costs included both the BHC appointment and a follow-up appointment of reduced duration at the memory clinic. Memory clinic costs included a memory clinic appointment of normal duration. We estimated costs for both clinical (memory clinics and BHC) and research (BHC) tasks (not shown here). FindingsBHC costs were 3·5 times more expensive (£1428) than memory clinic costs (£414). Approximately 150 patients are seen in BHCs yearly (total cost £214 200) compared with 600 patients seen in memory clinics yearly (total cost £248 400). BHC patients re-entering the memory clinic pathway required shorter appointments, thus offering cost savings of £230 per appointment in the memory clinic. InterpretationBHC costs were higher due to a lower throughput of patients and higher cost of high-quality imaging and assessment compared with memory clinics. However, these costs might prove to provide value for money when considering the gains in quality of life for patients and carers. Future work is planned to gather further outcome data to understand the added value of BHCs. Limitations include only assessing costs for one BHC and one memory clinic; further cost estimates are preferrable. FundingNone.

The use of cardiovascular modes of death in the office of national statistics mortality statistics

Abstract Funding Acknowledgements: Type of funding sources: Other. Main funding source(s): Cardiac Risk in the Young The office for national statistics (ONS) holds a record of all causes of death in England and Wales according to the International Classification of Diseases 10th Revision. In some cases, a mode of death, such as arrhythmia, may be given. We aimed to quantify the proportion of cardiovascular deaths being coded as a mechanism of death from the ONS. We analysed the ONS records from 2013 – 2021. There were 4,852,897 deaths overall, of which, 836,741 (17.24%) were cardiovascular. Of these, 103,160 (12.33%) were labelled as mechanisms and 35,784 (4.28%) were nonspecific causes. The most common modes being used were arrhythmia (56,291 (6.7%)) and heart failure (46787 (5.6%)). The most common nonspecific codes being used were myocardial degeneration (12,192 (1.46%)), unascertained (10,605 (1.27%)) and cardiomegaly (6,573 (0.79%)). Modes of death as opposed to causes of death are being used in a notable proportion of cardiac deaths and this is increasing. Modes of death do not aid in screening of blood relatives for inherited cardiac conditions. Causes should be listed as an underlying disease process such as ischaemic heart disease (IHD) or hypertrophic cardiomyopathy. This enables screening to be focussed on specific diseases. The use of a mode of death as opposed to a specific disease should prompt a referral for autopsy. ICD-11 has coding for SADS and arrhythmogenic cardiomyopathy (ACM) and our findings highlight the importance of the transition to this update to allow accurate establishment of the burden of disease of these two important genetic conditions.

Cholesterol: how to measure and how to treat

Raised lipid levels are a significant risk factor for cardiovascular disease. Alison Pottle provides an overview of how these are measured and the lifestyle measures and medications that can be used to reduce risk in these patients Cardiovascular disease (CVD) is the leading cause of death in England and Wales. Raised lipid levels are a significant risk factor for CVD. Lipids are a heterogeneous group of substances which include cholesterol, triglycerides, lipoproteins and apolipoproteins. The link between increased lipid levels and atherosclerosis was first established in the early 1900s. Numerous clinical studies have demonstrated the critical role of low density lipoproteins and other cholesterol-rich apolipoprotein-B containing lipoproteins in atherosclerotic plaque formation and the subsequent risk of CVD events. There is now clear indication that the lower the achieved LDL levels, the lower the risk of CVD. Multiple interventions including changes in lifestyle together with the use of lipid-lowering therapies may be required to achieve desired lipid levels, and practice nurses can play a key role in this. This article will discuss how cholesterol levels are measured and the treatment strategies now available.

A qualitative exploration of the views of paramedics regarding the identification of cardiovascular risk factors in the pre-hospital environment.

Cardiovascular disease remains the most prominent cause of death in England. Healthcare professionals have been encouraged to identify cardiovascular risk factors (CVRFs). The aim of this study was to explore how paramedics contribute to the identification of CVRFs in the pre-hospital setting, through their role, behaviours and practice. The study took place within the North East Ambulance Service NHS Foundation Trust supported by a National Institute for Health Research clinical research internship. A qualitative approach was used, and a single focus group was conducted. The study recruited participants through advertising for volunteers and purposive sampling. The themes that arose from the focus group allowed the initial exploration of the views of paramedics in relation to role, behaviour and practice in identifying CVRFs. A single focus group with five paramedics was conducted in June 2021. Two central themes emerged: education/health promotion and fear/anxiety. Participants agreed that their role in this area centred around patient education. Participants' behaviours and practice were adversely affected through fear of complaints, fear of hypocrisy and feeling a lack of support from the ambulance service. Participants felt that further training and subsequent indemnity from complaints would improve the likelihood of more direct patient education. Support from the ambulance service to improve employees' own health and well-being was also a key topic of discussion. The study explored the views of a small sample of paramedics on this topic. Patient education was felt to be part of a paramedic's role; however, barriers were identified that prevent paramedics from carrying out this role. Further research is needed to explore these barriers further.

Introducing multi-component cardiovascular health screening into existing Abdominal Aortic Aneurysm (AAA) screening programmes in the UK: a qualitative study of programme staff views

BackgroundCardiovascular disease is a major contributor to poor health in the UK and the leading cause of death in England. Peripheral arterial disease and high blood pressure are conditions that identify individuals at high cardiovascular disease risk, likely to benefit from cardiovascular risk management. Both conditions remain considerably underdiagnosed and untreated. The National Health Service abdominal aortic aneurysm (AAA) screening programmes represent an opportunity to screen for these conditions with potentially minimal additional effort or cost. We explored AAA screening programme staff views on the proposed introduction of such additional screening within AAA screening.MethodsNine focus groups and seven follow-on interviews were undertaken with 38 AAA screening staff. Our study methods were oriented broadly towards a grounded theory methodology, and data were analysed using thematic analysis.ResultsThree themes were identified: (i) ‘Perceptions of patient experience and health-related outcomes’, (ii) ‘Opportunities and challenges for programme staff’, and (iii) ‘Maintaining and improving programme standards’. Staff talked about the high uptake of AAA screening, staff experience and skills in their role, and the programme’s high quality standards as both opportunities and potential challenges linked to the proposed additions to AAA screening. While positive about the potential to improve patients’ health outcomes, participants had questions about the practicalities of incorporating additional procedures within their time- and resource-constrained context, and how this may reconfigure work processes, roles and relationships.ConclusionsThe proposed additions to the programme require taking staff’s views into account. Key areas that need to be addressed relate to ensuring follow-up support for patients, clarity around staff responsibilities, and availability of sufficient resources for the programme.

The rising tide of dementia deaths: triangulation of data from three routine data sources using the Clinical Practice Research Datalink

BackgroundDementia is currently the leading certified underlying cause of death in England. We assess how dementia recording on Office for National Statistics death certificates (ONS) corresponded to recording in general practice records (GP) and Hospital Episode Statistics (HES).MethodsRetrospective study of deaths (2001-15) in 153 English General Practices contributing to the Clinical Practice Research Datalink, with linked ONS and HES records.ResultsOf 207,068 total deaths from any cause, 19,627 mentioned dementia on the death certificate with 10,253 as underlying cause; steady increases occurred from 2001 to 2015 (any mention 5.3 to 15.4 %, underlying cause 2.7 to 10 %). Including all data sources, recording of any dementia increased from 13.2 to 28.6 %. In 2015, only 53.8 % of people dying with dementia had dementia recorded on their death certificates. Among deaths mentioning dementia on the death certificate, the recording of a prior diagnosis of dementia in GP and HES rose markedly over the same period. In 2001, only 76.3 % had a prior diagnosis in GP and/or HES records; by 2015 this had risen to 95.7 %. However, over the same period the percentage of all deaths with dementia recorded in GP or HES but not mentioned on the death certificate rose from 7.9 to 13.3 %.ConclusionsDementia recording in all data sources increased between 2001 and 2015. By 2015 the vast majority of deaths mentioning dementia had supporting evidence in primary and/or secondary care. However, death certificates were still providing an inadequate picture of the number of people dying with dementia.

Advance care planning and decision-making in dementia care: a literature review.

Dementia is the leading cause of death in England and Wales, but traditionally it has not been considered a terminal or life-limiting condition. As a result, little significance may be placed on advance care planning (ACP) for people with dementia. Evidence suggests that most patients with advanced dementia have often not been given an opportunity to complete an advance care plan and have not had conversations with their families about their wishes and preferences at the end of life. This article reports on a literature review that aimed to explore the evidence on the introduction of ACP in achieving preferred place of care or death for people living with dementia, and reducing carer burden. The literature review found that ACP discussions have several benefits for people with dementia and their family carers, but that various factors can support or hinder such discussions. It concludes that these people and their families need to plan for end of life and suggests that ACP can increase the likelihood of achieving their preferred place of care and death and reducing decisional burden for carers.

Invasive meningococcal disease: Timing and cause of death in England, 2008–2015

Neisseria meningitidis is a major cause of bacterial meningitis and septicaemia, with death often occurring rapidly after onset of the first symptoms. Later death can also occur, but may be due to other causes, such as underlying comorbidities. The study aimed to assess the timing and cause of death in patients with invasive meningococcal disease (IMD) prior to the introduction of two new meningococcal immunisation programmes in England. Public Health England (PHE) conducts IMD surveillance in England through its national meningococcal reference unit. Laboratory-confirmed IMD cases diagnosed during 2008-2015 were linked to weekly and annual electronic death registration records as well as the Patient Demographic Service (PDS) database. Overall, 6734 of 6808 (99%) laboratory-confirmed IMD cases matched to PDS, including 668 fatalities. Of these, 667 linked to an annual death registration record compared to 405 reports linked to weekly death registrations. In total, 429/667 (64%) of all deaths and 428/502 (85%) of IMD-related deaths occurred within one day of diagnosis. In total, 498/667 (75%) deaths had occured by 30 days after IMD diagnosis and 98% (490/498) of these were IMD-related. Serogroup B contributed to 64% (323/502) of IMD-related deaths, followed by serogroup W (84/502, 17%) and serogroup Y (70/502, 14%). Deaths occurring after 30 days were less likely to be IMD-related, mainly amongst ≥65 year-olds, with malignancy, chronic respiratory and cardiac conditions predominating. Most IMD-related deaths occurred within a day of diagnosis and nearly all IMD-related deaths occurred within 30 days of diagnosis. The rapidity of death highlights the importance of prevention through vaccination.

PRIMEtime CE: a multistate life table model for estimating the cost-effectiveness of interventions affecting diet and physical activity

BackgroundNon-communicable diseases are the leading cause of death in England, and poor diet and physical inactivity are two of the principle behavioural risk factors. In the context of increasingly constrained financial resources, decision makers in England need to be able to compare the potential costs and health outcomes of different public health policies aimed at improving these risk factors in order to know where to invest so that they can maximise population health. This paper describes PRIMEtime CE, a multistate life table cost-effectiveness model that can directly compare interventions affecting multiple disease outcomes.MethodsThe multistate life table model, PRIMEtime Cost Effectiveness (PRIMEtime CE), is developed from the Preventable Risk Integrated ModEl (PRIME) and the PRIMEtime model. PRIMEtime CE uses routinely available data to estimate how changing diet and physical activity in England affects morbidity and mortality from heart disease, stroke, diabetes, liver disease, and cancers either directly or via raised blood pressure, cholesterol, and body weight.ResultsModel outcomes are change in quality adjusted life years, and change in English National Health Service and social care costs.ConclusionThis paper describes PRIMEtime CE and highlights its main strengths and limitations. The model can be used to compare any number of public policies affecting diet and physical activity, allowing decision makers to understand how they can maximise population health with limited financial resources.

The Impact of Sociodemographic Factors and Emergency Admissions on the Place of Death of Gynecological Cancer Patients in England: An Analysis of a National Mortality-Hospital Episode Statistics-Linked Data Set.

The aim of this study was to develop a predictive model for risk of death in hospital for gynecological cancer patients specifically examining the impact of sociodemographic factors and emergency admissions to inform patient choice in place of death. The model was based on data from 71,269 women with gynecological cancer as underlying cause of death in England, January 1, 2000, to July 1, 2012, in a national Hospital Episode Statistics-Office for National Statistics database. Two thousand eight hundred eight deaths were used for validation of the model. Logistic regression identified independent predictors of a hospital death: adjusting for year of death, age group, income deprivation quintile, Strategic Health Authority, gynecological cancer site, and number of elective and emergency hospital admissions and respective total durations of stay. Forty-three percent of deaths from gynecological cancer occurred in hospital. The variables significantly predicting death in hospital were less recent year of death (odds ratio [OR], 0.93; P < 0.001), increasing age (OR, 1.17; P < 0.001), increasing deprivation (OR, 1.06; P < 0. 001), increasing frequency and length of elective and emergency admissions (P < 0.001). The model correctly identified 73% of hospital deaths with a sensitivity of 75% and a specificity of 72%. The areas under the receiver operating curve were 0.78 for the predictive model and 0.71 for the validation data set. Each subsequent emergency admission in the last month of life increased the odds of death in hospital by 2.4 times (OR, 2.38; P < 0.001). Hospital deaths were significantly lower in all other regions compared with London. The model predicted a 16% reduction of deaths in hospital if 50% of emergency hospital admissions in the last month of life could be avoided by better community care. Our findings could enable identification of patients at risk of dying in hospital to ensure greater patient choice for place of death.

Offline: Time to act on minimum unit pricing of alcohol

Offline: Time to act on minimum unit pricing of alcohol

Advanced nurse practitioner-led abdominal therapeutic paracentesis.

Liver disease is a common cause of death in England and Wales, and ascites is associated with a 50% mortality rate. Most patients who present with ascites have underlying liver cirrhosis, and often require therapeutic paracentesis for symptomatic relief. This article describes a competency framework that was developed to enable advanced nurse practitioners to perform therapeutic paracentesis in an ambulatory care unit.

Epidemiology and outcomes from out-of-hospital cardiac arrests in England

IntroductionThis study reports the epidemiology and outcomes from out-of-hospital cardiac arrest (OHCA) in England during 2014. MethodsProspective observational study from the national OHCA registry. The incidence, demographic and outcomes of patients who were treated for an OHCA between 1st January 2014 and 31st December 2014 in 10 English ambulance service (EMS) regions, serving a population of almost 54 million, are reported in accordance with Utstein recommendations. Results28,729 OHCA cases of EMS treated cardiac arrests were reported (53 per 100,000 of resident population). The mean age was 68.6 (SD=19.6) years and 41.3% were female. Most (83%) occurred in a place of residence, 52.7% were witnessed by either the EMS or a bystander. In non-EMS witnessed cases, 55.2% received bystander CPR whilst public access defibrillation was used rarely (2.3%). Cardiac aetiology was the leading cause of cardiac arrest (60.9%). The initial rhythm was asystole in 42.4% of all cases and was shockable (VF or pVT) in 20.6%. Return of spontaneous circulation at hospital transfer was evident in 25.8% (n=6302) and survival to hospital discharge was 7.9%. ConclusionCardiac arrest is an important cause of death in England. With less than one in ten patients surviving, there is scope to improve outcomes. Survival rates were highest amongst those who received bystander CPR and public access defibrillation.

Sex differentials in phthisis mortality in England and Wales, 1861–1870

In the mid-nineteenth century phthisis, or pulmonary tuberculosis, was the single most important cause of death in England and Wales. It was widely distributed geographically though some areas were worse affected than others. This paper explores aspects of the geography of phthisis mortality in England in the second half of the nineteenth century, with particular attention to the sex differential in mortality from this cause. Phthisis is often thought of as a disease of young women, and throughout much of England and Wales, especially in agricultural areas, women aged between 15 and 40 years were especially vulnerable. However the sex ratio of deaths from phthisis varied greatly from place to place and, in some places where phthisis was prevalent, men rather than young women were at the greatest risk of death. Phthisis mortality was sufficiently important that the geography of the overall sex differential in mortality was to a considerable extent determined by the geography of the sex differential in phthisis mortality. Where phthisis mortality disadvantaged females, the overall sex differential between male and female mortality was small or even negative; where phthisis mortality disadvantaged males, the overall sex differential was large. The paper then considers explanations of geographical variations in the sex differential in phthisis mortality. It is not clear that these are best explained by a ‘bargaining-nutrition’ account which holds that young women in poor households were especially vulnerable to mortality from phthisis because their weak intra-household bargaining position compromised their nutritional status. Other factors, such as the return migration to their native areas of out-migrants who became sick with the disease, and working conditions, especially for females, may have been more important. The final part of the paper considers the implications of the results for explanations of the decline of phthisis mortality between 1860 and 1900.

The potential impact of new national guidance on primary prevention of cardiovascular disease in people living with HIV.

IntroductionCardiovascular disease (CVD) is the leading cause of death in England and Wales. As people living with HIV (PLWH) age, proactive management of CVD risk factors is crucial. The long-awaited draft guidelines for CVD from the National Institute of Clinical Excellence (NICE) propose lipid modification (with statins) and lifestyle modification for 40–74 year olds with >10% (previously >20%) 10-year risk of CVD using QRISK2. We currently use Framingham so compared 3 CVD risk calculators in our cohort and analyzed the impact of a change in CVD threshold on the proportion of our patients who would need intervention.Materials and MethodsFramingham, QRISK2 and JBS3 cardiovascular risk calculators were compared in a group of randomly selected patients. Then, to analyze the impact of a change in primary prevention threshold on our cohort, we interrogated a prospectively collected database to identify all individuals who had a documented Framingham risk assessment and applied the current/proposed thresholds accordingly. We performed the same analysis for the three calculator subgroup (recalculating Framingham risk). Finally we surveyed HIV services in England & Wales regarding their choice of calculator.ResultsWe compared the 3 CVD risk calculators in 100 patients, see Table 1.In terms of eligibility for primary prevention 20.9% (916/4383) had documented Framingham risk assessment as part of routine care. Using a 20% threshold, 8.8% (81/916) would require intervention, increasing to 35.2% (322/916) with a threshold for intervention of 10%. Restricting analysis to the 100 patients to whom we applied all three calculators resulted in the following proportion requiring intervention with a 20%/10% threshold, respectively: Framingham 28%/76%, QRISK2 20%/53%, JBS3 15%/42% (four patients were excluded due to incomplete data).ConclusionsReducing the threshold for cardiovascular preventative measures to 10% vastly increases the number of patients requiring primary intervention, from two- to fourfold depending on risk calculator used. This may have significant implications, including cost, drug–drug interactions and patient experience, that HIV physicians and general practitioners will need to address, ideally in a coordinated and patient-focused manner.

Impact of a cancer of unknown primary (CUP) service on end-of-life planning for patients with metastatic cancer.

66 Background: Cancer of Unknown Primary (CUP) is the 4th most common cause of cancer death in England and Wales. [(Office for National Statistics, Mortality Statistics: Deaths registered in England and Wales. http://www.ons.gov.uk/ons/search/index.html?newquery=series+dr (accessed 1/7/14).] Patients with CUP have poor outcomes secondary to delayed, inappropriate investigations and poor treatment response. In line with NICE guidance [(NICE guidelines: CG 104 (July 2010).]. Metastatic malignant disease of unknown primary: diagnosis and management of metastatic malignant disease of unknown primary.) a CUP service was set-up at the Royal Free in June 2012. This analysis assessed its impact on patients diagnosed with metastatic cancer who were not fit for active treatment. Methods: Clinical notes were reviewed for all admissions with an imaging-based diagnosis of metastatic cancer. A retrospective analysis (January-April 2009) was compared to prospective data following the launch of the CUP service (June-December 2012). Results: The notes of 9 patients (2009) and 15 patients (2012) were compared (see table). Age and length of stay (LOS) were analysed using t-test, other data were compared using chi-squared test. All patients were reviewed by Oncology and Palliative Care teams. There was a significant reduction in mean LOS (6.7 days, 18.6 days p&lt;0.004) and the number who died in hospital (7%, 67% p&lt;0.002) with only one patient not dying in his preferred place. Conclusions: Prompt assessment by the CUP service facilitates early input from Oncology and Palliative Care teams resulting in reduced LOS and fewer deaths in hospital in keeping with the agenda of the End of Life Care Strategy [(End of Life Care Strategy: Promoting high quality care for all adults at the end of life (July 2008). DOH (England).]. [Table: see text]

PWE-134 Overview Of Efficacy And Cost Effectiveness Of Nurse Led Day Case Abdominal Paracentesis Service At Gloucestershire Hospital Nhs Foundation Trust

IntroductionLiver disease is the fifth most common cause of death in England and Wales1 and is one of the important causes of acute hospital admissions. Ascites is a common complication...