Evaluating the Safety and Outcomes of Oesophagogastroduodenoscopy in Elderly Patients Presenting With Acute Upper Gastrointestinal Bleeding.

AIMS: In the absence of evidence-based guidelines regarding the safety and appropriateness of emergency endoscopy in elderly, co-morbid and frail patients, we aimed to find clinical outcomes in elderly patients who have undergone gastroscopy following an acute upper gastrointestinal bleeding (UGIB). METHODS: We carried out a retrospective observational study of patients aged 70 years and older who had undergone emergency oesophagogastroduodenoscopy (OGD) at the Royal Sussex County Hospital, Brighton, United Kingdom, between May 2020 and January 2022. Data collected for analysis included Glasgow-Blatchford score, age, gender, endoscopic findings, endoscopic treatments, immediate complications, 90-day complications, 30-day and 90-day survival, length of hospital stay and re-bleeding. RESULTS: A total of 248 study participants were categorised into two groups: age 70-79 years (n=102) and ≥80 years (n=146). Melaena (n=226, 91%, p=0.0001) was the commonest indication for emergency OGD in both groups, with the majority of patients presenting with a Glasgow-Blatchford score of ≥1 (n=200, 80.6%, p=0.2). Endoscopy findings were normal in 26.4% (n=27) of those 70-79 years and 32% (n=47) of those ≥80 years (p=0.01). Duodenal ulcer, oesophagitis and gastric ulcer were the commonest abnormal findings (n=50, 20%; n=29, 11.7%; and n=28, 11.3%, respectively). Of the participants, 93.8% (n=212) had no immediate complications. Bleeding and hypotension occurred in 2.7% (n=6) and 2% (n=5) of patients, respectively. At 90 days post-procedure, 83.3% (n=85) of those 70-79 years and 67.8% (n=99) of those ≥80 years had survived (p=0.180). CONCLUSIONS: We conclude that OGD is largely a safe procedure in older adults with acute UGIB; however, the high proportion of OGDs with normal findings reinforces the importance of careful selection of patients.

Computed tomography coronary angiography: Diagnostic yield and downstream testing.

BACKGROUND: The UK National Institute for Health and Care Excellence (NICE) updated its guidelines on stable chest pain in 2016 and recommended computed tomography coronary angiography (CTCA) as first line investigation for all patients with new onset symptoms. We implemented the guideline and audited downstream testing. METHODS: We undertook a retrospective search of the local radiology database from January 2017 to May 2018. RESULTS: Six-hundred and fifty-two patients underwent CTCA (mean age of 55 years, 330 were male). Thirty-four patients were found to have severe coronary artery disease (CAD), with 30 undergoing invasive coronary angiography (ICA) which confirmed severe CAD in 22, a yield of 73%.Fifty-eight patients were found to have moderate CAD on CTCA with 36 referred for ICA, of which, 33 attended and 18 were found to have severe CAD. Eighteen were referred for imaging stress tests and one was positive. The total yield of severe CAD at ICA was 55%. The majority of patients had normal coronary arteries. CONCLUSIONS: CTCA was an effective rule-out test for most patients. In patients that went on to have ICA, the overall yield of severe CAD was relatively high. This compares well with our previous audit applying the NICE 2010 guidelines which recommended ICA for all high probability patients wherein the yield of severe CAD was 30%.

A systematic review and meta-analysis of 'Systems for Social Processes' in eating disorders.

Social and emotional problems have been implicated in the development and maintenance of eating disorders (ED). This paper reviews the facets of social processing in ED according to the NIMH Research and Domain Criteria (NIMH RDoC) 'Systems for Social Processes' framework. Embase, Medline, PsycInfo and Web of Science were searched for peer-reviewed articles published by March 2013. One-hundred and fifty four studies measuring constructs of: attachment, social communication, perception and understanding of self and others, and social dominance in people with ED, were identified. Eleven meta-analyses were performed, they showed evidence that people with ED had attachment insecurity (d=1.31), perceived low parental care (d=.51), appraised high parental overprotection (d=0.29), impaired facial emotion recognition (d=.44) and facial communication (d=2.10), increased facial avoidance (d=.52), reduced agency (d=.39), negative self-evaluation (d=2.27), alexithymia (d=.66), poor understanding of mental states (d=1.07) and sensitivity to social dominance (d=1.08). There is less evidence for problems with production and reception of non-facial communication, animacy and action.