Background. Dizziness, syncope, and falls are common occurrences in elderly people. Neurocardiovascular investigation units aim to detect those patients who fall due to disturbances of blood pressure control or cardia...
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Background. Dizziness, syncope, and falls are common occurrences in elderly people. Neurocardiovascular investigation units aim to detect those patients who fall due to disturbances of blood pressure control or cardiac conduction. Specialist units have a high diagnostic yield in the investigation of these problems. Dues this translate to less specialized centers? We report on the diagnostic findings of a district general hospital neurocardiovascular investigation unit. Methods. A total of 120 consecutive patients over the age of 65 presenting to a single geriatrician a ere assessed. After a full history and physical examination, patients underwent neurocardiovascular investigation: blood pressure and heart rate response to active stand, carotid sinus massage, and 30-minute head-up tilt. Results. The 120 patients assessed had a mean age of 78 years (range 66-94 years);in this group, 85 were women. Of these patients, 23% presented with falls, 14% with blackouts, and 30% with dizziness. The remaining 33% had overlap of symptoms. Neurocardiovascular investigations produced a diagnosis in 57% of the patients: 22% had cardioinhibitory carotid sinus syndrome (CSS);15% had vasodepressor CSS;29% had orthostatic hypotension: and 3% had vasovagal syncope. Thirteen percent had more than one neurocardiovascular abnormality and 18% had benign positional vertigo. Five patients had postural instability causing falls. Hyperventilation syndrome, aortic stenosis, dysrhythmia, cervical spondylosis, and epilepsy each accounted for one case. Seventeen percent of the subjects remained undiagnosed after integrated neurocardiovascular assessment. Conclusion. Management of falls requires access to neurocardiovascular assessment. It is feasible to provide such a service in the district general hospital setting, with a comparable diagnostic yield to tertiary referral centers.
Effective clinical practice in a hospital needs current knowledge together with the skills and right attitude;these should be applied continuously. Failure of this system can be due to ignorance or arrogance. We attem...
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Effective clinical practice in a hospital needs current knowledge together with the skills and right attitude;these should be applied continuously. Failure of this system can be due to ignorance or arrogance. We attempted to correct these deficiencies by formulating a set of policies which were enforced from 1962 to 1983. The policies related to the following: intensive care (including asthma, nutrition and organ donation), drug prescribing and resuscitation. We believe that these rules improved patient care and the standards of training;the prescribing policy also saved money. (C) 1998 John Wiley & Sons, Ltd.
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