C. Capet

Clinical Presentation of Hypernatremia in Elderly Patients: A Case Control Study

OBJECTIVES: To assess early clinical signs and their prognostic value in elderly patients with hypernatremia.

Impact of recommendations on crushing medications in geriatrics: from prescription to administration

The practice of crushing drugs is very common in geriatric units. In 2009 a first study, performed in all geriatric units of a university hospital, showed that numerous errors were made during prescription, preparation and administration. The aim of this second prospective study was to assess the impact of regional and national recommendations in the same geriatric units. A survey of 719 patients (85.3 ± 6.7 years) was performed in 2013. For each patient who received crushed drugs, we recorded the reason the drugs were crushed, pharmacological classes, galenic presentations and the technique used for preparation and administration. Results were compared to the previous study. The number of patients receiving drugs after crushing was significantly lower than in the previous study (22.9% vs. 32.3%, P < 0.001). The number of crushed drugs was lower too (594 per 165 patients vs. 966 per 224 patients (P < 0.01). The main indication for crushing drugs remained swallowing disorders. The dosage form prevented crushing in 24.9% of drugs (vs. 42.0% in 2009, P < 0.001), but the drugs generally remained crushed all together. A mortar was used less often (38.6% vs. 92.6%, P < 0.001), with preference for individual‐specific cups (56.1%). Mortars were more often cleaned between each patient (56.0% vs. 11.6%). The vehicle was more often neutral (water 88.5% vs. 5.7%, P < 0.001). This second study shows that regional and national recommendations have led to an overall improvement of practices for crushing drugs. Technical improvements are still possible, in association with appropriate pharmacological studies.

PURPLE URINE BAGS: A GERIATRIC PRESENTATION OF LOWER URINARY TRACT INFECTION

Critical to the program’s philosophy and operations is the maintenance of a network of personal relationships. The community workers know the patients in their own homes, know their neighbors and friends, and know the surrounding community. (Some patients are so attached to particular workers that special planning for vacations is necessary.) The workers regularly visit the outpatient clinic, where they know the nurses, physicians, and pharmacists, all of whom may pause to discuss how best to address a particular diffi-

Does age influence the gastric emptying of solids

TO THE EDITOR: I am happy to clarify my position on first trimester ERCP for Dr. Cohen et al., and anyone else I may have “confused” (1). My statement that “ERCP is easy in early pregnancy” would have been more eloquently conveyed as “shielding the fetus from radiation during ERCP is technically easiest in the first trimester” (when the uterine fundus is still in the pelvis). My colleagues seem to be proscribing first trimester ERCP altogether, which I believe is wrong. I was careful in my commentary to stress the importance of only using ERCP in pregnancy when the circumstances indicate that it is the safest and most effective way to manage a problem. I have personally performed three first trimester ERCPs with sphincterotomy and stone removal for cholangitis: in each case, dosimeters revealed negligible radiation exposure to the fetus, which was well shielded by a lead apron covering most of the mother’s abdomen. There were no complications and three healthy babies were delivered at term. Each mother underwent interval cholecystectomy in the postpartum period. Historically, surgeons have been taught to avoid opening the abdomen during the first trimester because of the well documented risk of fetal loss. There are no data to suggest that ERCP carries equivalent risk. The greatest danger posed to the first trimester fetus by ERCP is that of severe pancreatitis. So far, no case of severe maternal pancreatitis resulting from ERCP during pregnancy has been reported. Obviously, that risk exists and must be considered whenever ERCP is being contemplated in a pregnant woman. Dr. Cohen and his colleagues can take comfort from the fact that of 15 ERCPs that I have personally performed in pregnant women, only three (20%) have been in the first trimester. So, this should be a rare dilemma for most endoscopists.

Antiplatelet drugs in the elderly: prescriptions often inappropriate and reduced tolerance by associated diseases and drugs.

To assess the conditions of prescriptions and tolerance of antiplatelet drugs (APD) in the elderly and to detail the parameters that influence the tolerance of these drugs. Prospective survey in a Department of Geriatric Medicine. Two hundred nineteen patients 70 years and older treated with one or two APD prior to admission were included during 7 months in 2008. We recorded the type of APD, associated diseases, main associated or co‐prescribed drugs which could interact with APD and the bleeding adverse events including cutaneous bleeding. The mean age of the 219 patients was 84.5 ± 6.7 years (70–101 years), women 59.4%. Among patients 64.8% received aspirin (mainly 75 mg), 28.3% received clopidogrel and 6.8% received their combination; 16.9% of prescriptions were off‐label; 51.6% of patients had an associated disease and/or an associated drug which could have increased risk of bleeding event. Among the patients who received a gastric‐protective drug, the prescription followed the recommendations of the French Health Authority in 38.9%. We recorded bleeding events in 24.2% of patients at admission and in 18.3% of patients during the hospitalization. Bleeding events were significantly more frequent in patients treated with aspirin than clopidogrel (40.8 vs. 24.2%, P < 0.05) and/or with an associated drug (OR = 2.36, 95% CI 1.34–4.14, P < 0.01) and/or an associated disease (OR = 1.22, 95% CI 1.01–3.42, P < 0.05). APD treatment was stopped in 28.8% of patients, mainly because lack of indication or bleeding adverse events. Off‐label prescriptions of APD were not rare in the elderly, and adverse events are frequent. The results of this preliminary study evoke that medical situations at increased risk of bleeding are perhaps insufficiently evaluated, either in case of prescription of associated drugs with increased bleeding risk or during the follow‐up of patients with associated diseases. Cutaneous bleeding events should be more taken into account in prospective studies.