Pill burden and health-related quality of life across dialysis modalities: a multimodal assessment using KDQOL-36 and eQ-5D-5L.

Alcohol Use Disorder (AUD) may lead to alcohol-related presentations to acute healthcare services, with conditions such as alcohol withdrawal syndrome (AWS) and alcohol related seizures, or presentations associated with chronic alcohol-related ill health, for example decompensation of alcohol related liver disease, or acute pancreatitis. As a result, patients with AUD often form part of high intensity healthcare service user populations. At a population level, nearly 6% of all hospital admissions in England were due to an alcohol-related diagnosis or a had an alcohol-related condition directly contributing to their admission [,]. Furthermore, alcohol-specific deaths rose by 63.8% between 2006 and 2023 [], and alcohol related hospital admissions in 2023–2024 cost in excess of £351 million/year [] in England. An estimated 5% of adults in England []) consume alcohol at harmful levels (seven UK units (8 g of absolute ethanol = 1 UK unit) or more on drinking days, or > 35units per week []). The Institute of Alcohol Studies predict, that left unaddressed these changes in consumption may lead to an extra 14,7982 additional cases of alcohol-related diseases, 9,914 additional premature deaths and a cost to the UK National Health Service (NHS) of an additional £1.2 billion in England by 2035 []. AWS reflects the rapid onset of a range of symptoms, behaviours and psychological features following sudden and unplanned cessation of the consumption of alcohol in an individual who is physically dependent on alcohol []. Symptoms range from agitation, tremor, sweating, fast heart rates to disorientation, hallucinations and seizures. Of those presenting to hospital with alcohol dependence, around 30% may develop AWS []. Furthermore, 1.7% and 1.66% of patients on general medical and surgical wards in the UK are assigned an ICD code for AWS or AWS with delirium, respectively []. Among hospitalised patients (<60 years), AWS is as common, or more common, than complications of other long-term conditions, including diabetes and hypertension []. The majority of AWS cases can be successfully managed using benzodiazepines (BZPs) []. Some (up to 23% []), particularly those who are severely physically dependent on alcohol, require escalating doses of BZPs or the use of adjunct medications such as phenobarbital, baclofen or clonidine [,]. As such, they may be considered refractory to standard approaches []. Large doses of BZPs can cause excessive and delayed sedation, and other pharmacological medications for AWS management are limited by a lack of high-quality evidence surrounding their efficacy [] or require a level of monitoring only available in high dependency settings. As such, many patients presenting to hospital with AWS who experience severe AWS are admitted for extended periods [], exposed to additional medication-associated side-effects, intubation or invasive blood-pressure monitoring, and require high dependency or intensive care []. Medicinal ethanol may represent an alternative treatment option in the management of patients who are severely physically dependent on alcohol, and not responding effectively to standard medicines whilst also avoiding some of the adverse side effects of other adjuncts [,]. We have recently reviewed the current evidence-base surrounding the use of medicinal ethanol for AWS. We found that whilst the evidence was largely of poor quality, and from a heterogenous group of study designs, it was as effective in the majority of studies as alternative treatments []. Furthermore, when we reviewed the prescribing practices relating to medicinal ethanol for AWS within an acute UK NHS healthcare trust we found that whilst the majority of AWS presentations are successfully treated using standard approaches (BZPs), a minority (∼5-10%) of patients are managed using oral ethanol (provided as UK unit measures of 37.5%ABV vodka, diluted in fruit juice). This approach is typically reserved for patients who 1) have a history of alcohol consumption consistent with severe physical dependence (>25 units/day for women, >30 units/day for men), or 2) have a history of AWS related seizures/delirium tremens, or 3) are known to the Alcohol Care Team (ACT) to experience difficult to manage AWS. Among this group, oral ethanol led to a reduction in the requirement for unplanned admission to the Trust when compared with BZPs [], was not associated with an increased occurrence of subsequent alcohol related re-presentations or admissions at follow-up [], led to effective symptom control measured with the CIWA-Ar tool, and was well received by service users []. Since these publications, Panneerselvam et al. (2025) reported effective implementation and positive patient outcomes of a monitored therapeutic alcohol administration programme in a perioperative setting [].