Can usual gait speed be used as a prognostic factor for early palliative care identification in hospitalized older patients? A prospective study on two different wards

Background Timely palliative care in frail older persons remains challenging. Scales to identify older patients at risk of functional decline already exist. However, factors to predict short term mortality in older hospitalized patients are scarce. Methods In this prospective study, we recruited patients of 75 years and older at the department of cardiology and geriatrics. The usual gait speed measurement closest to discharge was chosen. We used the risk of dying within 1 year as parameter for starting palliative care. ROC curves were used to determine the best cut-off value of usual gait speed to predict one-year mortality. Time to event analyses were assessed by COX regression. Results On the acute geriatric ward (n = 60), patients were older and more frail (assessed by Katz and iADL) in comparison to patients on the cardiology ward (n = 82); one-year mortality was respectively 27 and 15% (p = 0.069). AUC on the acute geriatric ward was 0.748 (p = 0.006). The best cut-off value was 0.42 m/s with a sensitivity and specificity of 0.857 and 0.643. Slow walkers died earlier than faster walkers (HR 7.456, p = 0.011), after correction for age and sex. On the cardiology ward, AUC was 0.560 (p = 0.563); no significant association was found between usual gait speed and survival time. Conclusions Usual gait speed may be a valuable prognostic factor to identify patients at risk for one-year mortality on the acute geriatric ward but not on the cardiology ward

Posterieur reversibel encefalopathiesyndroom als oorzaak van veranderd bewustzijn : een diagnostische uitdaging

Het posterieur reversibel encefalopathiesyndroom (PRES) is een meestal goedaardige hersenaandoening die gepaard gaat met hoofdpijn, convulsies, verwardheid en visusstoornissen. Dit artikel beschrijft een casus van een 82-jarige vrouw met PRES als gevolg van een ontregelde arteriële hypertensie. De patiënte bood zich in het ziekenhuis aan met een veranderd bewustzijn en een corticale blindheid. Op de MRI zag men het typische beeld van een vasogeen oedeem occipitaal. Na de behandeling van de hypertensie en de epilepsie klaarden zowel het klinische als het radiografische beeld volledig op. Het belang van een vroegtijdige diagnosestelling wordt benadrukt en de onderliggende pathogenese en de differentiaaldiagnose worden besproken

An Exceptional Case of Diabetic Ketoacidosis

We present a case of diabetic ketoacidosis, known as one of the most serious metabolic complications of diabetes. We were confronted with rapid neurological deterioration and unseen glycaemic values, which reached almost 110 mmol/L, subsequently resulting in hyperkalaemia and life-threatening dysrhythmias. This is the first reported live case with such high values of blood glucose and a favourable outcome

Clinical and radiological factors associated with erosive radiographic progression in hand osteoarthritis

SummaryObjectiveTo identify prognostic factors of erosive progression in hand osteoarthritis (OA).MethodOne hundred and fifty-four patients with hand OA were selected from an earlier cohort. X-rays, clinical and demographic data at baseline were present. All patients were seen for a follow-up between January and March 2014. Interphalangeal (IP) finger joints were scored on both radiographs using the anatomical scoring system. Radiographic progression was defined as a joint progressing from at least one anatomical phase, excluding the progression from a ‘Normal’ to ‘Stationary’ phase. Odds ratios (OR) and 95% confidence intervals (95% CI) of potential clinical and radiographic prognostic factors were calculated on joint, hand and patient level with a generalized estimating equation (GEE) model.ResultsRadiographic progression, including progression from ‘N’ to ‘S’ phase, was present in 1014 of 2750 joints (36.9%) after a mean follow-up of 5.8 years. On joint level, the following clinical factors were associated with radiographic progression (OR [95% CI]): presence of pain (1.48 [1.01–2.15]), tenderness (2.18 [1.56–3.05]), and soft tissue swelling (2.56 [1.54–4.24]). The following radiographic variables were significantly associated with erosive progression: presence of ‘J’ (16.74 [9.09–30.83]) and ‘E’ phase (76.34 [42.17–138.23]). On hand and patient level, soft tissue swelling, ‘J’ and ‘E’ phase were retained as prognostic factors.ConclusionPain, tenderness, soft tissue swelling, ‘J’ and ‘E’ phase were significantly associated with erosive progression in hand OA. These prognostic factors should be confirmed in further studies and considered when selecting patients for therapeutic trials with potential disease-modifying osteoarthritis drugs (DMODs)

An Exceptional Case of Diabetic Ketoacidosis

We present a case of diabetic ketoacidosis, known as one of the most serious metabolic complications of diabetes. We were confronted with rapid neurological deterioration and unseen glycaemic values, which reached almost 110 mmol/L, subsequently resulting in hyperkalaemia and life-threatening dysrhythmias. This is the first reported live case with such high values of blood glucose and a favourable outcome