Alcohol-related emergency department admissions in an elderly population.

OBJECTIVE: Alcohol abuse remains a major health concern. This study aimed to describe the characteristics of alcohol-related emergency department (ED) admissions in an elderly population. METHODS: Between 1 September 2013 and 31 August 2014, we retrospectively analyzed patient charts of patients admitted with a blood alcohol concentration (BAC) of at least 0.5 g/L to the EDs of all five hospitals in two distinct areas. We focused on the population ≥65 years, divided in three subgroups (65-74, 75-84 and ≥85, respectively) and compared them to the 55-64 year group. RESULTS: Of the 3918 included patients 645 (16.5%) were between 55 and 64, and 406 (10.4%) were ≥65 years (65-74: 267, 6.8%; 75-84: 128, 3.3%; ≥85: 11, 0.3%). The male-to-female ratio ranged between 2.1:1 and 2.7:1. BACs decreased with increasing age. In all age groups the majority of patients (71.0-77.8%) were transported by emergency medical services. The chief presenting complaint was trauma and its relative importance increased with age. Contextual factors consisted mostly of chronic abuse (43.1-57.8%). Most frequently patients could be discharged within 24 h, although hospital admission rates increased with age. CONCLUSION: Our study shows that alcohol-related ED admissions in the elderly are common, but less frequent than in younger age groups. More (preferentially prospective) studies are needed to give more insight in the living environment, prescription medication, socioeconomic cost, etc. Nonetheless, it is clear that a national action plan should be developed to tackle the alcohol abuse problem in all age groups.

Video-recording consultations for educational purposes in out-of-hours primary care: patients and physicians are willing to participate.

Background Video-recordings of consultations are used by general practitioner (GP) trainees to enable reflection on aspects of knowledge, skills and attitudes. Typically, these recordings are made during office hours in general practice, but little is known about using video-recording during out of hours (OOH) care, which is an important and distinct part of a GP's work. To be able to record consultations during OOH care (i.e. at the emergency department (ED) and at the General Practitioner Cooperative (GPC)), patients must be willing to cooperate and give informed consent. Therefore, it was of interest to investigate potential barriers in these OOH settings. Methods A questionnaire on demographics and attitudes regarding consent was administered to patients and physicians at the ED and at the GPC in Sint-Niklaas, Belgium. Results A total of 346 questionnaires were completed, 23 by physicians and 323 by patients. A majority of the patients (225/286 (79%)) would consent to video-recording the consultation, without physical examination. Almost all physicians (21/23) would agree to participate. Overall, 85% (260/323) of the patients agree when only the doctor was being recorded. Patients were neutral in recording in 79% (88/224) at the GPC and 57% (56/99) at the ED. Shyness or embarrassment was present in 32% (71/224), and 28% (28/99) at the GPC and ED, respectively. We did not find any significant differences in giving consent or feelings between patients at the GPC and ED. Conclusion A vast majority of both patients and physicians would consent to video-recording their consultation in OOH primary care settings (GPC and ED), with possible concerns about privacy, shame and discomfort.

An Exceptional Case of Diabetic Ketoacidosis.

We present a case of diabetic ketoacidosis, known as one of the most serious metabolic complications of diabetes. We were confronted with rapid neurological deterioration and unseen glycaemic values, which reached almost 110 mmol/L, subsequently resulting in hyperkalaemia and life-threatening dysrhythmias. This is the first reported live case with such high values of blood glucose and a favourable outcome.

Assessment of renal function in recently admitted critically ill patients with normal serum creatinine.

BACKGROUND: Detection of renal dysfunction is important in critically ill patients, and in daily practice, serum creatinine is used most often. Other tools allowing the evaluation of renal function are the Cockcroft-Gault and MDRD (Modification of Diet in Renal Disease) equations. These parameters may, however, not be optimal for critically ill patients. The present study evaluated the value of a single serum creatinine measurement, within normal limits, and three commonly used prediction equations for assessment of glomerular function (Cockcroft-Gault, MDRD and the simplified MDRD formula), compared with creatinine clearance (Ccr) measured on a 1 h urine collection in an intensive care unit (ICU) population. METHODS: This was a prospective observational study. A total of 28 adult patients with a serum creatinine <1.5 mg/dl, within the first week of ICU admission, were included in the study. Renal function was assessed with serum creatinine, timed 1 h urinary Ccr, and the Cockcroft-Gault, MDRD and simplified MDRD equations. RESULTS: Serum creatinine was in the normal range in all patients. Despite this, measured urinary Ccr was <80 ml/min/1.73 m2 in 13 patients (46.4%), and <60 ml/min/1.73 m2 in seven patients (25%). Urinary creatinine levels were low, especially in patients with low Ccr, suggesting a depressed production of creatinine caused by pronounced muscle loss. Regression analysis and Bland-Altman plots revealed that neither the Cockcroft-Gault formula nor the MDRD equations were specific enough for assessment of renal function. CONCLUSIONS: In recently admitted critically ill patients with normal serum creatinine, serum creatinine had a low sensitivity for detection of renal dysfunction. Furthermore, the Cockcroft-Gault and MDRD equations were not adequate in assessing renal function.