The why and wherefore of hepatic encephalopathy.

Hepatic encephalopathy is a common neuropsychiatric abnormality, which complicates the course of patients with liver disease. It was probably first described by Hippocrates over 2000 years ago, who said that "those whose madness arises from phlegm are quiet and neither shout nor make a disturbance, while those whose madness arises from bile shout, play tricks and will not keep still, but are always up to some mischief ". He was presumably describing the differences between patients with pneumonia and acute liver failure.

An identification and brief advice programme for low-risk alcohol consumption in an acute medical setting: an implementation study.

Objectives: To implement an identification and brief advice (IBA) intervention to detect low-risk/hazardous alcohol consumption.

Design: Implementation was guided through the use of quality improvement tools and training.

Setting: This study was conducted over an 18-month period from April 2010 to September 2011 on a 42-bed acute medical unit at a central London acute hospital.