Time for the BGS to help in Africa?

Richard Walker is a Consultant Geriatrician at North Tyneside General Hospital, and Honorary Professor of Ageing and International Health at Newcastle University. He has a research interest in non-communicable diseases in sub-Saharan Africa (SSA) and is Associate International Director for SSA for the Royal College of Physicians, London. He is the Clinical Lead for the Northumbria / Kilimanjaro Christian Medical Centre health link and Chair of the Movement Disorders Society African Task Force. In this blog article he discusses the growing challenge of ageing in Africa.

The ageing population in Africa is exploding. In Nigeria alone, for example, there are now more than 6 million people aged over 65 years. Despite this, worryingly, services are particularly ill prepared to meet the needs of this group. Compounding this challenge is the fact that there’s a real lack of Geriatrics’ teaching in undergraduate medical curricula in SSA. Furthermore, we found that there’s very few ‘Geriatricians’ in SSA outside South Africa, with most countries having none at all. Continue reading

Spring Speakers Series: Assessing memory and thinking in stroke – it’s confusing

Dr Terry Quinn (Joint Stroke Association / CSO Senior Clinical Lecturer) has a clinical and research interest in post stroke cognitive decline. Supported by a Stroke Association Priority Program Grant he is pursuing a portfolio of work themed around how to assess cognition and mood in the Acute Stroke Unit. Terry will be sharing some of the findings from this and other work at the BGS Spring Meeting in Newcastle as part of a themed session on dementia. Terry tweets about all things cognitive @DrTerryQuinn and in his role as Coordinating editor of the Cochrane Dementia Group @cochraneDCIG

Specialist societies, clinical guidelines and audit standards all encourage us to assess cognition when patients present with stroke. Intuitively this seems like a sensible idea. We know that patients fear problems with memory and thinking more than they fear physical disability and we know that cognitive problems are extremely common in the post stroke period. What is less clear is how we should assess cognition in stroke. Continue reading

Researchers find key to stroke survival

nurseThe number of trained nurses available to treat patients immediately after a stroke is the most reliable health services predictor of survival according to research from the University of Aberdeen and University of East Anglia published in Age & Ageing.

Having the optimal number of trained nurses available to look after patients in an acute stroke unit was consistently found to be the best predictor of survival from stroke – after personal health factors were accounted for, such as age, stroke severity and blood pressure.

The study found that just one additional trained nurse per ten beds could reduce the chance of death after thirty days by up to twenty-eight per cent, and after one year by up to twelve per cent. Continue reading

Do studies of the weekend effect really allow for differences in illness severity?

For nearly 15 years from 1997 until 2011, David Barer and his stroke team colleagues kept a prospective register of all patients admitted to hospital in Gateshead with suspected acute stroke. This was used mainly for research but also allowed independent checks to be made on the official figures from the coding department, providing useful insights into diagnostic uncertainties, the reasons for coding errors and day-to-day and year-on-year changes in the numbers and clinical characteristics of stroke admissions.  In this study he analyses whether the apparent excess mortality among patients admitted at weekends might be due to differences in stroke severity or other factors which cannot be measured in studies relying on routine administrative data.

strokeThe long-rumoured but now notorious “weekend effect” recently received the seal of scientific respectability from two huge studies, analysing routine data on 20 million hospital admissions (and 1/2 million deaths) in England and Wales. They found a 10-15% increase in the risk of dying in the first month after weekend, compared with weekday admissions, even after adjusting for differences in overall “sickness levels” by sophisticated modelling of diagnostic and administrative data.  The authors of the larger study even included non-emergency admissions, despite the obvious imbalance between weekdays and weekends, arguing that their risk model could “explain” most of the mortality variation.  Continue reading

Inaugural BGS Eastern Region Geriatric SpR Research & Audit Presentation Day

Katie Honney obtained her MBBS BSc (Hons) at University College London. She completed her foundation and core training in the eastern deanery and is currently working at the Queen Elizabeth Hospital, King’s Lynn, as a specialty registrar in geriatric medicine.

cambridgeOn the 24th June 2016 the inaugural BGS Eastern Region Geriatric SpR Research & Audit Presentation Day took place at NAPP Pharmaceuticals, Cambridge Science Park. The wealth of excellent research and audit work conducted by trainees within the region prompted the need for an opportunity in which this work could be shared among colleagues.

The day commenced with an informative presentation from Prof John Potter relating to blood pressure control and cognitive function. Prof. Potter told the audience about the rising prevalence of hypertension with age, as well as discussing how cognitive impairment is associated with the extremes of blood pressure. Continue reading

The push to improve stroke services

14599057094_556c720cf5_oAdhi Vedamurthy is a consultant geriatrician with a special interest in stroke, and Chair of the BGS Wales Council.

It was a typical Monday morning in a district general hospital. Loads of elderly medical patients had spent the night in the emergency department waiting for a bed. About a dozen ambulances were outside the hospital unable to offload patients.

I had just done a third of my ward round with the foundation year one doctor when the bleep went off. A patient with potential need for thrombolysis had just arrived. Apart from the stroke nurse, there was no other suitable senior doctor available to assess the patient.

I abandon the ward round to assess the patient, organise the scan, push the trolley with the stroke nurse to take the patient to the stroke unit and initiate thrombolysis. This takes nearly an hour. During this time, the patients on the ward are still waiting for my assessment and management plan. Two discharges get delayed and a few scans were not booked on time and they had to wait for another day.

This scenario is very common in many hospitals where geriatricians have more than one role. Time is of the essence when treating stroke patients, but this comes at a cost if commissioners do not invest to improve services and expect existing services to stretch. This also applies to therapy services who are asked to prioritise stroke patients.

To meet targets, a patient with a suspected stroke (many do not have a stroke) must get a bed in a stroke unit within four hours. But it seems entirely acceptable for patients with heart failure, pneumonia, a fall, delirium, etc., who have far higher mortality, to spend hours on a trolley in the emergency department.

There is no argument that acute stroke is an emergency and should be treated accordingly. However this should not come at the expense of other services in geriatric medicine.

A majority of geriatricians in Wales felt that an improvement seen in stroke services has come at the cost of compromising services in geriatric medicine.

Is this the case in the other devolved nations? I would love to hear your views.

Treating dysphagia: understanding the need for training

5328790665_b4a675915d_oHelen Willis is a Dietitian at Wiltshire Farm Foods: in this blog she looks at caring for older people with dysphagia, and the importance of proper training

It is often the case that with such a media and governmental focus on health issues such as obesity, other nutritional issues get pushed aside and given little focus. One example is the very common swallowing condition, dysphagia.

Continue reading

Making difficult decisions about the benefits and risks of thrombolysis treatment

Dr Aoife De Brun is a Research Associate at the Institute of Health & Society at Newcastle Universityshutterstock_114405178

An online survey investigating factors that influence clinical decision-making regarding intravenous thrombolysis for patients with acute ischaemic stroke has been launched. The project is funded by the NIHR Health Service and Delivery Research Programme and is led by researchers from Newcastle University.

We are recruiting clinicians who are involved in making the final decision regarding thrombolysis for patients with acute ischemic stroke.  By understanding how clinicians make difficult trade-offs between the potential benefits and risks of thrombolysis, we can design strategies to better support risk communication, consent and decision-making with patients in clinical practice. Continue reading

A new look at case reports in Age and Ageing journal

David Stott is Professor of Geriatric Medicine at the Institute of Cardiovascular and Medical Sciences at the University of Glasgow and is Editor in Chief for Age and Ageing journal. Here he introduces two case reports from the latest issue of the journal.Web

The inclusion of case reports in Age and Ageing emphasises the clinical focus of the journal. Typically they illustrate either classic presentations of uncommon diseases or unusual presentations or aspects of common diseases in older people. At their best case reports provide a blueprint for high-quality clinical decision making and health care in ‘tricky’ cases. They often carry general lessons that can be learned from specific challenging circumstances. Case reports are generally valued by our readers, providing clinical education and giving balance to the journal’s content.

In the current issue of the journal we report a case of an unusual infection causing acute neurological deterioration (a stroke mimic), and of a rare but treatable disease, Anti-N-Methyl-D-Aspartate (NMDA) receptor encephalopathy. In both these cases failure to make the diagnosis would likely have carried catastrophic consequences.

In this issue we have a new development, adding a short expert commentary by Tom Hughes (from Cardiff) to the case reports which places them in a wider context, helping to bring the implications of the cases to the fore. Continue reading

Website Review: www.strokeeducation.co.uk

Website Review: www.strokeeducation.co.uk

Website:strokeeducation.co.uk Informative/E-learning

Target Audience: Hospital Doctors, Jnr Doctors, GPs, Allied health Professionals, Medical Students, General Public

Validity:  Written by and based around a hyper-acute stroke course run by Dr D O’Kane [Clinical Stroke Lead and Honorary Senior Clinical Lecturer]. It is accompanied by relevant references and a thorough literature review. Continue reading