Outcomes of de-prescribing proton pump inhibitors during acute admissions in a general medical unit: a pilot study.

The study describes the feasibility and short-to-medium-term efficacy of an evidence-based proton pump inhibitor (PPI) de-prescribing initiative undertaken as part of routine clinical care during acute admissions in a general medical unit. Of the 44 (median (IQR) age 75.5 (13.

Diagnosis and Management of Supine and Nocturnal Hypertension in Orthostatic Hypotension: A Review.

The prevalence of supine and nocturnal hypertension (S-N-HT) is high among patients with orthostatic hypotension (OH), especially in those who have a neurogenic aetiology. The evidence suggests that S-N-HT exacerbates OH, although it is unclear whether pharmacologic treatment of S-N-HT will improve OH. S-N-HT has also been associated with target organ damage.

Prevalence and predictors of inappropriate dosing of direct oral anticoagulants.

Background: Information on inappropriate dosing of direct oral anticoagulants (DOACs) is scarce in the Australian context.

Aim: To describe the prevalence and potential predictors of inappropriate dosing of DOACs.

Methods: Patients who received DOACs during admission under a general medical unit over a 2-year period (from January 2017 to December 2018) were retrospectively studied.

Normocalcaemic primary hyperparathyroidism: is nephrolithiasis more common than osteoporosis?

Background: Normocalcaemic primary hyperparathyroidism (NPHPT) is often under-recognised in clinical practice.

Aim: To determine the prevalence and clinical significance of NPHPT in an unselected sample in an acute hospital setting.

Methods: Patients aged >18 years who had measurement of an elevated serum parathyroid hormone (PTH ≥ 7 pmol/L) during 12 months from 1 January 2017 to 31 December 2017 were retrospectively studied.

Predictors of bleeding in patients receiving direct oral anticoagulants.

Background: The predictors of clinically significant bleeding events (CSBE) associated with direct oral anticoagulants (DOAC) are poorly characterised in the literature.

Aim: To determine the incidence and predictors of CSBE in patients receiving DOAC.

Methods: Patients who received DOAC during admission to a general medical unit over a 2-year period were retrospectively studied.

Masked Hypertension: A Systematic Review.

Background: Masked phenomenon, Masked Hypertension (MHT) and Masked Uncontrolled Hypertension (MUCH) is a well-defined clinical entity. However, many aspects of MHT/MUCH remain unclear.

Methods: We systematically reviewed the published literature on MHT/MUCH from 1 January 2000 to 31 June 2018 with a particular focus on epidemiology, clinical significance, evaluation and management.

The Role of Older Age in Normocytic Anaemia in Type 2 Diabetes Mellitus.

Background: Older age has a significant association with anaemia. However, this has not been adequately investigated in the context of specific comorbidities such as Type 2 Diabetes Mellitus (T2DM).

Objectives: To investigate the role of age in Normocytic Anaemia (NCA) and the adverse outcomes of NCA in T2DM.

Ambulatory Blood Pressure Monitoring in Type 2 Diabetes Mellitus: A Cross-sectional Study.

Background: Ambulatory blood pressure (ABP) monitoring in type 2 diabetes (T2DM) is not yet routine in clinical practice.

Objectives: To quantify abnormal ABP patterns and their associations with diabetic complications, and to assess the reliability of office blood pressure (OBP) for assessing BP in T2DM.

Methods: In a cross-sectional study, eligible patients with T2DM underwent OBP and 24- hour ABP measurements under standardized conditions and screening for diabetic complications.

Enablers and barriers to the use of antibiotic guidelines in the assessment and treatment of community-acquired pneumonia-A qualitative study of clinicians' perspectives.

Background: Community-acquired pneumonia (CAP) is a common condition and a number of guidelines have been developed for its assessment and treatment. Adherence to guidelines by clinicians varies and particularly the prescribing of antibiotics often remains suboptimal.

Objective: The aim of this study was to elucidate potential barriers and enablers to the adherence to antibiotic guidelines by clinicians treating CAP in an Australian hospital.

In-hospital Falls in Older Patients: The Risk Factors and The Role of Hyponatraemia.

Background: Hyponatraemia has been associated with increased falls risk. However, this has not been adequately investigated in the context of In-Hospital Falls (IHFs).

Objectives: To determine the potential risk factors for IHFs, particularly the role of hyponatraemia.

Orthostatic hypotension: pathophysiology, assessment, treatment and the paradox of supine hypertension.

Both hypertension and orthostatic hypotension (OH) are strongly age-associated and are common management problems in older people. However, unlike hypertension, management of OH has unique challenges with few well-established treatments. Not infrequently, they both coexist, further compounding the management.

Chronic idiopathic normocytic anaemia in older people: the risk factors and the role of age-associated renal impairment.

Objectives: To characterise the risk factors for chronic idiopathic normocytic anaemia (CINA) in older people, particularly the role of age-associated renal impairment.

Methods: Patients aged ≥65 years admitted to a medical unit over 12 months were assessed. Those with secondary causes of anaemia including chronic kidney disease (CKD) were excluded.

The clinical utility of ambulatory blood pressure monitoring (ABPM): a review.

The current evidence suggests that ambulatory blood pressure monitoring (ABPM) should be an integral part of the diagnosis and management of hypertension. However, its uptake in routine clinical practice has been variable. This paper reviews the current evidence for the role of ABPM in clinical practice, including in hypotensive disorders and in specific comorbidities.

Hip fracture risk factors and the discriminability of hip fracture risk vary by age: a case-control study.

Aims: To determine the important risk factors for hip fracture and the discriminability of hip fracture risk in different age cohorts (≤80 years, >80 years).

Methods: Consecutive admissions of hip fracture over 24 months in those aged >60 years, and an age- and sex-matched control derived from admissions under a medical unit were prospectively assessed. The risk factors and the discriminabilty of hip fracture risk by age were investigated for each sex in univariate and multivariate models.

The prevalence of Neurally Mediated Syncope in older patients presenting with unexplained falls.

Aims: To determine the prevalence and clinical significance of carotid sinus syndrome (CSS) and vasovagal syncope (VVS), the two common types of Neurally Mediated Syncope (NMS), in a cohort of older patients with unexplained falls.

Methods: Patients presenting with unexplained and accidental falls were identified from 200 consecutive admissions of falls in patients aged 65 years and older admitted to the Rapid Assessment Medical Unit (RAMU) in a teaching hospital. A sample of unexplained and accidental fallers underwent carotid sinus massage (CSM) and tilt table testing (TTT) as per a standardised protocol.

Efficacy and safety of oral continuous low-dose versus short-term high-dose vitamin D: a prospective randomised trial conducted in a clinical setting.

Objective: To compare the efficacy and safety of a 10-day, high-dose v a 3-month, continuous low-dose oral cholecalciferol course in a vitamin D deficient population. The primary end points were the change in serum 25-hydroxyvitamin D (25(OH)D) concentrations at 3 months and the development of hypercalcaemia and hypercalciuria.

Design, Setting And Participants: Fifty-nine vitamin D deficient inpatients (serum 25(OH)D < or = 50 nmol/L) were enrolled in a prospective, randomised, open-label trial.

Pitfalls in managing falls.

Falls are common in the elderly and one of the most common reasons for older people to seek medical help. To illustrate the diagnostic dilemmas of this common clinical problem, we present a case study of a woman with a history of recurrent falls.

Osteoporotic fractures and vitamin D deficiency.

A caucasian woman aged 79 years, with a history of hypertension, hyperlipidaemia, and osteoarthritis, was referred for assessment of osteoporosis and generalised musculoskeletal pain after surgery for a right midshaft femoral fracture. Further history revealed she had suffered nonspecific musculoskeletal pain, particularly of the pelvic girdle, and unsteady gait for many weeks, but denied suffering any falls. She had limited mobility due to osteoarthritis of both knees.

A case of intravascular lymphomatosis (IVL) presenting as polyneuropathy.

Intravascular lymphomatosis (IVL) is a rare, yet important, cause of a variety of unexplained neurological syndromes. In this clinical context, the only clue to the diagnosis may be a significantly raised plasma lactate dehydrogenase (LDH) on a background of clinical features of a systemic illness.