News

The Advisory Committee on Clinical Excellence Awards (ACCEA) opened the 2018 awards round on Tuesday 13th February. The final closing date for applications to the ACCEA is 17:00 on Thursday 12th April.

Application for BASL support
If you would like to apply for BASL support, please complete and submit a copy of your ACCEA Application Form to BASL, along with any other supplementary CVQs as detailed below:

• Supplementary CV Questionnaire: Research & Innovation Assessment
• Supplementary CV Questionnaire: Teaching & Training Assessment
• Supplementary CV Questionnaire: Medical Leadership & Managing a High Quality Service Assessment.

Please be aware that there is a maximum number of supplementary forms that can be completed at each National Level: Bronze and Silver applicants: 1 and Gold applicants: 2. These forms are optional and it is for the applicant to decide whether using them will increase chances of success.

Full application guidance can be found on the ACCEA website including the use of the Supplementary Forms by clicking here.

In addition BASL requires a short piece to accompany your application stating why you feel you should be supported by BASL.

The deadline for applying for BASL support is 17:00 on Friday 16th March 2018.

All applications must go through the ACCEA on line system, should you need a downloadable form to send to BASL these can be found on the ACCEA website by clicking here.

Eligibility
As in previous years BASL are able to support colleagues directly by nomination for national Gold, Silver and Bronze awards. As a specialist society, BASL cannot make nominations for Platinum awards; this must be done through the applicant’s University/Research Body and Universities UK. BASL can however provide a citation to support an application for a Platinum award.

To apply for BASL support, please follow the steps below:

1. Send a completed ACCEA Application Form, along with a short piece as to why you feel you should be supported by BASL, to the BASL Secretariat, Judy.Hawksworth@execbs.com by 17:00 on Friday 16th March 2018.

Please understand that in fairness to all applicants, late submissions will not be considered.

2. All applicants are asked to provide the name of an individual who could write a supporting citation when submitting their application to BASL. ACCEA regard the citations provided in support of individuals as giving added value to the process. The citation MAY be stronger if it comes from outside ones institution.

3. You must submit your own application to ACCEA online by their deadline 17:00 on Thursday 12th April 2018. This is your own responsibility.
https://www.gov.uk/government/organisations/advisory-committee-on-clinical-excellence-awards .

4. If you are in receipt of BASL support then BASL will upload your citation. You must ensure that your application is uploaded to the ACCEA website at least one week before the deadline - 17:00 on Thursday 5th April 2018, so that BASL has sufficient time to upload your citations onto your application on the ACCEA website.

Alcohol Health Alliance - Policy and Advocacy Manager 

For the Alcohol Health Alliance UK based at the Institute of Alcohol Studies
Salary £35,000 per year including London weighting
Fixed 24-month contract

A copy of the Job Description and details on how to apply can be downloaded here:  Download Job Description policy manager AHA Feb 2018 with interview dates.pdf

Or viewed on the AHA website: http://ahauk.org/aha-vacancy-policy-advocacy-manager/ .

Apply for this role

To apply for this role, please send a CV and cover letter outlining how you meet the criteria to Kellie Donaldson at kdonaldson@ias.org.uk .

The deadline for applications is 5pm Friday 23rd February 2018.

First interviews will be held on Wednesday 7th March 2018 and successful candidates will be invited back for final interviews on Monday 19th March 2018.

Clinical Research Associate in Hepatology (Autoimmune Liver Disease)
Salary: £28,641 - £48,123 per annum
Closing date: 2 March 2018

Applications are invited for the post of Clinical Research Associate based in the Institute of Cellular Medicine (ICM) at Newcastle University, to pursue a programme of research in liver disease with a particular focus on Autoimmune Liver Disease. You will benefit from working in a group with an international reputation for its research and clinical practice in liver disease and from close interaction with the Stratified Medicine, Biomarkers and Therapeutics and Inflammation, Immunology and Immunotherapy themes in ICM. You will also be appointed an Honorary Registrar at Newcastle upon Tyne Hospitals NHS Foundation Trust contributing to specialist liver clinics and taking part in the out of hours tertiary liver unit on call rota. This will give you tertiary liver unit experience.

You will be expected to have some experience with audit and/or research and to be undertaking or completed higher specialist training in gastroenterology/hepatology. The key attribute, however, is enthusiasm to realise the opportunities offered by the post.

You must be in possession of MRCP or equivalent, with a valid full GMC Registration to eligible to apply.

This is a 2 year post with the potential to extend to a third year.

Those interested are strongly encouraged to contact either: Professor David Jones, email: david.jones@ncl.ac.uk or Dr Jess Dyson, e-mail: Jessica.Dyson@nuth.nhs.uk to discuss the post.

To apply, please visit the Newcastle University vacancies website.  
Ref: A109780R

Government and the alcohol industry are failing to provide drinkers with the information they need to make the right choices about alcohol – both for themselves and for their children.

New figures released show that only 16% people are aware of the weekly alcohol guidelines, 2 years after the guidelines were announced.

They also reveal that parents are not equipped with the right information to keep their children safe from alcohol harm, with fewer than 1 in 20 aware of the official advice on children’s drinking.

The figures come from the Alcohol Health Alliance UK (AHA), who surveyed the UK public on their attitudes to alcohol in September 2017.

The low-risk weekly drinking guideline for adults is 14 units a week – around 6 pints of 4% beer, or 6 medium glasses of wine. This guideline was announced by the UK’s Chief Medical Officers in January 2016.

For children, the official advice is that an alcohol-free childhood is best, due to evidence of a wide range of short term and long term harms linked to children’s drinking.

In England, the Chief Medical Officer says that if children do try alcohol, they should be at least 15 years old, and be in a supervised environment.

The recommendation that an alcohol-free childhood free is best is based on the fact that young people are physically unable to tolerate alcohol as well as adults, and young people who drink are more likely to engage in unsafe sex, try drugs, and fall behind in school.

In addition, the younger someone starts drinking, the more likely they are to develop a problem with alcohol when they are older.

This goes against the commonly held view that allowing children to drink at home at a young age will teach them to be responsible drinkers when they are adults. The AHA survey found that this view was common, with 6 in 10 people agreeing that children who drink at home will ‘know how to handle their drink when they’re older’, and that children who drink in moderation at home ‘are less likely to binge on their own.’

Whilst awareness of the alcohol guidelines for both adults and children is low, the AHA’s survey found that there is an appetite among the public for greater information on the risks linked with drinking, with high levels of support for the inclusion of warning messages on alcohol labels.

Eight out of 10 people want alcohol labels to include the weekly guidelines, and a warning that exceeding the guidelines can damage your health.

80% of people also want labels to include a warning that alcohol is linked with cancer. Alcohol is known to be linked with at least seven types of cancer, and has been classed as a class 1 carcinogen, along with tobacco, by the UN-linked International Agency for Research on Cancer. The alcohol industry has been found to mislead the public on this link, by denying or distracting away from it*, and industry bodies recently lobbied successfully in Canada to have a trial of cancer labels on alcohol products halted.

Commenting on the results of the AHA’s polling, Professor Sir Ian Gilmore, chair of the AHA, said that more should be done to ensure the guidelines for both adults and children are communicated to the public. He said:

‘It is really disappointing that only 16% of the public are aware of the alcohol guidelines for adults, and that fewer than 1 in 20 are aware of the advice around children’s drinking. The public have the right to know the Chief Medical Officers’ guidelines, so that they are empowered to make informed choices about their drinking. The same applies to parents, who want to do the right thing by their children and deserve to be informed of the Chief Medical Officers’ guidance on children and alcohol.

‘It is clear from our polling that the public want to be informed of the risks linked with alcohol, including the link with cancer, and that they want to see clear warning information on alcohol labels about the drinking guidelines and the risks of drinking at levels above these guidelines.

‘To this end, the government should introduce mandatory labelling of all alcoholic products, to ensure that the public and parents are fully informed about the risks.

‘In addition, the government should develop national information campaigns, informing the public and parents of the guidelines for both adults and children.’

Commenting on the survey’s findings around alcohol and cancer, Caroline Moye, Head of World Cancer Research Fund UK (WCRF UK), said:
‘AHA’s new research shows a clear public call for alcohol product labels to carry a warning about the link between alcohol and cancer, and the Government should put these warning labels in place. Government cannot leave the communication of cancer risks to the alcohol industry.

‘For anyone who drinks alcohol, we recommend they stay within the weekly guideline of 14 units a week, though abstaining from alcohol altogether will reduce their cancer risk even more. We have many tips for cutting down on alcohol, including drinking out of smaller glasses, diluting drinks such as swapping pints for a spritzer and aiming to keep at least a few days each week alcohol-free. People can get more information about our Cancer Prevention Recommendations at https://www.wcrf-uk.org/uk/preventing-cancer/cancer-prevention-recommendations.' 

The AHA’s polling was carried out in September 2017. 2,000 people across the UK (1,671 in England, 165 in Scotland, 110 in Wales and 54 in Northern Ireland) were surveyed on the AHA’s behalf by the national polling company OnePoll, and the results were then weighted to ensure they are nationally representative.

OnePoll works according to the Market Research Society’s code of conduct. This code helped ensure, for example, that none of the survey questions could be considered as leading.

Key statistics from the polling include:
- Only 16% of people are aware of the low-risk weekly drinking guideline of 14 units
- Only 3% of people are aware of the guidance that an alcohol-free childhood is best
- Only 10% of people mention cancer when asked which diseases and illnesses are linked to alcohol
- 81% believe the weekly guidelines should appear on alcohol labels
- 78% believe labels should include a warning that exceeding the guidelines can damage your health
- 77% of people support a cancer warning on alcohol product labels
- 73% believe labels should include calorie information
- 55% of people believe that ‘providing children with alcohol in a supervised situation will ensure that they know how to handle drinking when they’re older’.
- 57% of people believe that ‘children that drink alcohol in moderation with their own family are less likely to binge on their own’.
- 77% of people believe that the UK has an ‘unhealthy’ relationship with alcohol
- 52% think that the government is not doing enough to tackle the problems with alcohol in society

The Alcohol Health Alliance UK (AHA) is a group of over 50 organisations including the Royal College of Physicians, Royal College of GPs, British Medical Association, Alcohol Concern and the Institute of Alcohol Studies. 

For further information, please contact Matt Chorley, the AHA’s Policy and Communications Officer, at matt.chorley@rcplondon.ac.uk  or on 0203 075 1726.

The BASL Annual Meeting 2017 was held between 20th to 22nd September on the Warwick University Campus with a splendid evening of dinner and jousting at Warwick Castle. Here we summarise some clinical highlights from the meeting.

In the Wednesday transplant section, Andrew Holt and Kerry Webb discussed individualisation of transplant assessment for patients with alcohol related liver disease, outlining guidelines which move away from the ‘six month rule’ of pre-transplantation abstinence and aim to provide uniformity of care amongst transplant units to avoid a perceived geographical variation in access to liver transplantation for this indication. The severe alcoholic hepatitis pilot was discussed by Ewen Forrest, who updated the group on the failure to recruit any patients to the pilot, but also stressed the lack of a robust statistical model to predict transplant need in this cohort.

In the field of stem cell transplantation, Fotis Sampaziotis presented his novel study demonstrating applicability of human derived stem cells to successfully populate a bioengineered mouse bile duct in vivo. Peter Friend delivered the Williams-Calne Lecture, which was a state of the art update on the current and future role of organ reperfusion preservation techniques in improving outcomes after liver transplant.

On Thursday morning, Ian Fellows’ erudite lecture highlighted the important role of sarcopenia in prognostication for patients with cirrhosis (perhaps best measured on the L3 slice of a non-contrast abdominal CT). He emphasised that patients with end stage chronic liver disease are invariably malnourished and require nutritional and dietetic support with high protein, high calorie supplementation ‘little and often’.

Tariq Iqbal presented data on a causal association between dysbiosis and liver disease in mouse models, thus highlighting potential novel therapeutic approaches in the field. Sotiris Mastoridis showed that exosomal MiRNA profiles may provide prognostic information in the field of acute liver failure. Gwilym Webb’s study of the epidemiological profile of autoimmune liver disease in the UK identified an interesting association between latitude and prevalence. Julia Verne presented the 2nd atlas of variation in risk factors and healthcare for liver disease in England. This forms an important reference document for all involved in hepatology service provision (https://fingertips.phe.org.uk/profile/atlas-of-variation).

Intrahepatic cholangiocarcinoma continues to confer a poor prognosis. Ali Yousuf presented a systematic review of the application of loco-regional therapies for inoperable disease. The SIRCCA trial is an international study comparing standard therapy versus selective internal radiation therapy (SIRT) for Inoperable disease and is open to recruitment in the UK.

George Mells, speaking on behalf of the UKPBC group, proposed a predictive model for identifying non-responders to ursodeoxycholic acid using pre-treatment parameters. The British Liver Trust Lecture given by Mary Ramsey outlined the economic and political hurdles which were overcome to provide the recently rolled out universal childhood hepatitis B vaccination programme in the UK. Tion Lim presented two cases of steroid resistant AIH which showed treatment response to interleukin-2 therapy that merits further evaluation in larger studies. The afternoon’s highlight was John O’ Grady’s Ralph Wright Lecture in which he emphasized the over-reliance on the p-value in the medical literature. He discussed the syndrome of “acute on chronic liver failure”, the contents of which he lays out in the October 2017 issue of Liver Transplantation.

Friday morning turned to case presentations. Lauren Johansen and Marianne Samyn presented the case of a young boy with juvenile PSC, highlighting the autoimmune element of the disease and the challenges of immune suppression management. Nowlan Selvapatt and Shahid Khan’s case led to a discussion of biomarker development in the field of cholangiocarcinoma and the need for larger studies in the field. Geoff Dusheiko and Shirin Demma expertly interweaved case and case discussion of a patient with active HDV, stressing the importance of universal HDV testing for patients with HBsAg seropositivity. Charlotte Grant and John Iredale discussed fibrosis regression in liver disease, exemplified by a case of recompensation after alcohol cessation and venesection in a patient with haemochromatosis and ARLD cirrhosis. Kris Bennett and Guru Aithal’s case led to a discussion of MRI in assessing for portal venous haemodynamics.

There were a number of noteworthy posters. Amongst these, Jayaswal showed that SVR12 is associated with reduction in liver fibroinflammation as assessed by MRI. Sherman demonstrated the potential value of combining ARFI and a “spleen-platelet/portal vein Doppler score” to predict clinically significant portal hypertension. Verne observed that the rate of cirrhosis related hospital admissions has more than doubled in the last ten years and that there was a high degree of variation in admission rates for paracentesis and oesophageal varices across different CCGs in England. Kamarajah showed that paired liver stiffness measurement compared favourably with paired liver biopsies in determining fibrosis progression for patients with NAFLD in Malaysia. Warburton demonstrated a complex biliary microbiome in “normal” human bile. Srivastava showed comparable liver transplant survival data between patients managed in a non-transplant and transplant liver centres in the UK. Delvincourt highlighted the role of self-expanding metal stents in the management of early post-transplant anastomotic biliary strictures. Campbell described the benefits of a shared palliative care liver pathway for the management of advanced liver disease in a hospice setting. Marra showed that 8-weeks of therapy with sofosbuvir/velpatasvir for patients with G3 HCV and advanced fibrosis achieved a 95% SVR.

Will Gelson
Consultant Hepatologist

Saqib Mumtaz
Hepatology Specialist Trainee