Scientific Research

Introduction

Geriatric and general medical wards have nationally been troubled with an ever increasing patient population requiring carer support at home and a widespread shortage of those able to deliver it. This pilot project aimed to assess patient understanding of the care they were awaiting, their understanding of the reason for ongoing hospitalisation and their satisfaction with the care on discharge. We aimed to improve patient understanding with the use of a patient information leaflet (PIL).

Method

Patients identified during multi-disciplinary team meetings at two district general and one community hospitals as being medically fit for discharge and awaiting care at home were questioned. Those lacking capacity for the discussion were excluded. Approximately half questioned were given a PIL detailing the scope of a domiciliary care package. Patients discharged home were followed up via telephone.

Results

Twenty nine patients were questioned. 21% of patients died before follow up and 14% were excluded due to direct care home admission. Only 59% were discharged home. Two thirds had received domiciliary care previously. Good awareness that wait for care was hindering discharge (76%) but poor understanding of scope of carers. 21% believed care call duration was limitless, 28% expected their home to be cleaned and 31% believed they chose the timing of care calls. All happy with care received at home. Poor recall of information on PIL.

Conclusion

Prolonged periods waiting for care is associated with high mortality and institutionalisation rates. Awareness of the discharge process and scope of care could be improved but PIL unlikely to be a sufficient method for such complex matters. For those discharged, patient satisfaction of the care received is high. Further research is required.

Introduction

Perioperative geriatrics is an emerging specialty with immense importance to all medical and surgical specialties. Only a small number of papers have been published on the topic. A bibliometric analysis is used to identify themes and trends in current research and practice. Objectives To identify and describe research topics relating to perioperative geriatrics.

Methods

Thompson Reuters Web of Science indexing database was searched for all manuscripts relating to perioperative geriatrics. Of these, the top 100 were subcategorised into manuscript type, age, theme, specialty, journal and citation rate.

Results

The highest cited article was by Bhandari et al with 294 citations. The highest citation rate was achieved by Partridge et al, 23.75 citations/year. Across the series, the mean number of citations was 50.41 (range 294-12). The highest number of manuscripts were published between 2010-19 (n=55), with 70% of manuscripts published in journals with impact factor < 5. The specialty with the highest number of publications was orthopaedics (n=36), followed by cardio-thoracics (n=15). Most articles focussed on surgical management of geriatrics patients, followed by anaesthetic management.

Conclusion

This is the first bibliometric analysis of the top 100 most cited papers in perioperative geriatrics. Only 395 papers were returned, indicating that this needs to be further researched as a topic. Key themes identified were surgical management and anaesthetic treatment. Key Words Bibliometric analysis, literature review, geriatrics, perioperative

Introduction

Parkinson’s Disease is the second most common neurogenerative disorder and has a pervasive effect on health-related quality of life. There is increasing evidence of the importance of the endocannabinoid system in pre-clinical models of disease. However, there is a paucity of clinical evidence on cannabis-based medicinal products (CBMPs) in Parkinson’s Disease. This study presents a preliminary analysis of those with Parkinson’s Disease enrolled in the UK Medical Cannabis Registry (UKMCR). Method Patients prescribed CBMPs for Parkinson’s Disease symptoms for longer than one month were identified from the UKMCR. The primary outcomes were changes from baseline in Parkinson's Disease Questionnaire-39 (PDQ-39), Generalised Anxiety Disorder-7 (GAD-7), Single-Item Sleep Quality Scale (SQS), and EQ-5D-5L scales at one month. p<0.050 was defined as statistically significant.

Results

Thirty-four patients were identified from the UKMCR that met the inclusion criteria. Twenty (58.82%) patients were male, and the mean age was 66.76 ± 11.60 years. The median Charlson co-morbidity index score was 5.00 (IQR: 3.00-6.00). There was a significant improvement at one month follow up in the EQ-5D-5L index value, as well as the pain and discomfort, and usual activities domains (p<0.050). There was no significant change at one month in the PDQ-39, GAD-7 or SQS measures (p>0.050). Twelve adverse events were reported by two (5.88%) participants. The majority of adverse events were mild (n=7; 20.59%) or moderate (n=3; 8.82%). There were no life-threatening adverse events.

Conclusions

This preliminary analysis demonstrates a possible association with improved general health-related quality of life secondary to improvements in the ability to perform usual activities, as well as pain in those with Parkinson’s Disease. Moreover, the results suggest that CBMPs are well-tolerated in the first month of treatment. However, this must be interpreted with caution considering the small sample size, length of follow-up and the limitations of observational study design.

Introduction

As we face a 7th wave of Covid in our geriatric wards, we as caregivers are exhausted and find it increasingly difficult to repeat these isolation measures again and again. We are aware of the importance of avoiding clusters but it is mostly the elderly who are positive for Sars-Cov-2 and hospitalised. Fortunately the virus no longer kills, but nevertheless has enormous deleterious consequences on the mental health of our elderly.

Methods

To expose the practical consequences of clinical cases experienced during these successive waves of Sars-Cov-2 and make a review of the literature concerning this theme.

Results

The patients with moderate to severe cognitive disorders almost all presented a confused state and lost autonomy during their period of isolation. After more than 2 years, it can be stated that these patients really suffered from this quarantine for sometimes 14 days or more. Behavioural disorders increased, patients who were paranoid increased their disorders The families also suffered as well as the geriatric carers who had all the difficulties to take care of these patients in a global way with all the paramedics and stimulations that we usually bring them.

Conclusions

The consequences of this forced isolation, whether in hospital in an acute unit, at home or in a nursing home, has had and will have serious consequences on the mental well-being of our seniors. If we "have to live with these successive mutations", should we not think about not isolating our elderly patients in such a deleterious way? Ethical considerations must be analysed as much as public Health. We must also be careful not to increase "ageism" in this period of pandemic.

^{References R.Manca et al,Front.Psychiatry,2020,D.Piette et al, Louvain Medical ,2021,B.Meisner et al,Canadian Journal on Aging,2020}

Pancreatic cancer represents one of the most prothrombotic neoplasms secondary to high tumoral expression of tissue factor, cytokine release, activation of leukocytes and hypofibrinolysis. Studies have shown that the incidence of thrombotic complications can reach up to 36%.

We present a case of an 84-year-old male patient who was admitted onto the Geriatrics ward with a 3-day history of sudden-onset dyspnoea, productive cough, pallor, and general malaise. Admission blood revealed microcytic anaemia (Hb 91 g/L), neutrophilic leukocytosis (WCC 29.9 x 10^9/L, Neut 26.9 x10^9/L) and elevated C-reactive protein (211 mg/L). Despite high clinical suspicion of pneumonia, chest X-ray did not demonstrate any pathology.

On day 2 of admission, D-dimer was requested, and the critical result of 3500 ng/mL was noted. Patient was immediately commenced on anticoagulation therapy and urgent CT-PA demonstrated the presence of a pulmonary embolus in a posterior sub-segmental artery of the right lower lobe.

On day 3, patient manifested left-sided lower limb weakness along with reduced sensation to light touch up to the left knee. Patient did not demonstrate cortical symptoms. Urgent CT-Head revealed hypodensity in the right parietal region suggestive of acute ischaemic infarction.

On day 5, patient reported pain and swelling of the left calf. Physical examination rendered high suspicion of left deep vein thrombosis with calf circumferential difference of 4cm (Left 34cm, Right 30cm) and significant tenderness on palpation. In light of three consecutive thromboembolic events within 5-day course of admission, suspicion of cancer-associated thrombosis was established. Urgent CT-AP was conducted, 5cm carcinoma at the tail of the pancreas with extensive hepatic, splenic and adrenal metastatic disease. The following case warrants attention from the clinicians as unprovoked pulmonary embolism should prompt investigation for potential underlying malignancy.

Furthermore, it highlights the malignancy-induced hypercoagulability and risk of cancer-associated thrombosis, particularly in the context of pancreatic carcinoma.