Dominion: Examining the Subject of Power in Tolkien

The discussion of power and one’s use of it in literature is far from a novel one. This is especially so regarding how one uses power to rule others. Two notable and conflicting ways to rule are using one’s power over the ruled, to keep control of them, and using one’s power for the ruled, by helping and supporting them. The clash between these two can be seen as early as the first book of the Jewish and Christian bibles, wherein God gives humans “dominion over…all the earth, and over every creeping thing that creepeth upon the earth,” asking them to “replenish the earth, and subdue it” (King James Bible, Genesis 1:26, 28). By asking humankind to both subdue and replenish, God is asking them to use both the previously noted ways to rule: to dominate and to aid. This naturally creates a conflict about how to balance these techniques in order to rule correctly. This disagreement between these two is seen elsewhere in literature, and no more so than in J.R.R. Tolkien’s fictional universe

The impact on hospital resource utilisation of treatment of hepatic encephalopathy with rifaximin-α

BACKGROUND & AIMS: Rifaximin-α reduces the risk of recurrence of overt hepatic encephalopathy. However, there remain concerns regarding the financial cost of the drug. We aimed to study the impact of treatment with rifaximin-α on healthcare resource utilisation using data from seven UK liver treatment centres. METHODS: All seven centres agreed a standardised data set and data characterising clinical, demographic and emergency hospital admissions were collected retrospectively for the time periods 3, 6 and 12 months before and following initiation of rifaximin-α. Admission rates and hospital length of stay before and during therapy were compared. Costs of admissions and drug acquisition were estimated using published sources. Multivariate analyses were carried out to assess the relative impact of various factors on hospital length of stay. RESULTS: Data were available from 326 patients. Following the commencement of rifaximin, the total hospital length of stay reduced by an estimated 31-53%, equating to a reduction in inpatient costs of between £4858 and £6607 per year. Taking into account drug costs of £3379 for 1-year treatment with rifaximin-α, there was an estimated annual mean saving of £1480-£3228 per patient. CONCLUSIONS: Initiation of treatment with rifaximin-α was associated with a marked reduction in the number of hospital admissions and hospital length of stay. These data suggest that treatment of patients with rifaximin-α for hepatic encephalopathy was generally cost saving

New metrics for the Lancet Standing Commission on Liver Disease in the UK

Health Polic

Alcohol care teams: where are we now?

Alcohol consumption affects the risks of approximately 230 three-digit disease and injury codes in the International Statistical Classification of Diseases and Related Health Problems-10th Revision. The United Nations Sustainable Development Goals comprise 17 challenging goals with 169 targets, which the 193 Member States aim to achieve by 2030. Action to reduce the harmful use of alcohol, especially addressing global health inequalities, will contribute to achieving many of the health-related goals and targets. Alcohol care teams, mainly developed in acute UK hospitals, reduce acute hospital admissions, readmissions and mortality, improve the quality and efficiency of alcohol care, and have 11 key evidence-based, cost-effective and aspirational components. A clinician-led, multidisciplinary team, with integrated alcohol treatment pathways across primary, secondary and community care, coordinated alcohol policies for emergency departments and acute medical units, a 7-day alcohol specialist nurse service, addiction and liaison psychiatry services, an alcohol assertive outreach team, and consultant hepatologists and gastroenterologists with liver disease expertise facilitate collaborative, multidisciplinary, person-centred care. Quality metrics, national indicators, audit, workforce planning, training and accreditation support research and education of the public and healthcare professionals. Hospitals should collaborate with local authorities, public health, clinical commissioning groups, patients and key stakeholders to develop and disseminate cost-effective prevention and treatment strategies. Globally, alcohol care teams can support the achievement of the United Nations Sustainable Development Goals, and should be advocated and implemented through the WHO global alcohol strategy. This requires collaborative care planning by key stakeholders, a skilled workforce, targeted financial resources and dedicated political commitment