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Abstract
BACKGROUND Chronic subdural haematoma (CSDH) is a condition predominantly affecting the elderly. We reported an incidence of 8.2 per 100 000 per year in people above the age of 65 in 2002. AIM Since recent studies have demonstrated a higher incidence, we repeated our study to estimate the current incidence of CSDH amongst people above the age of 65 in North Wales. DESIGN We used radiological reports to identify patients with CSDH over a 1-year period. METHODS We collected data on demographics, clinical presentations, indications for brain imaging, drug history and 30-day outcome from the case notes and electronic records. RESULTS The population of North Wales was 687 937 of which 138 325 (20%) were above 65. There were 66 cases of CSDH giving an incidence of 48 per 100 000 per year. Mean age was 81 and there were 32 males and 34 females. Falls and confusion were the commonest indications to request a CT scan (90%). Other indications were drowsiness (9%) and focal neurological deficit (4%). 17 were on antiplatelets and 20 were on warfarin. Ten underwent surgical intervention. At 30 days 28 were discharged, 22 were still in hospital and 16 died. CONCLUSION The incidence of CSDH is much higher than previously reported. Reasons include a low threshold for imaging patients with recurrent falls and confusion, increasing use of anti-thrombotics and ageing population. In many older patients CSDH is a marker of underlying co-morbidities rather than a primary event.
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Affiliation(s)
- V Adhiyaman
- From the Glan Clwyd Hospital, Rhyl, LL18 5UJ, UK
| | | | - F Irshad
- From the Glan Clwyd Hospital, Rhyl, LL18 5UJ, UK
| | - D Curran
- Wrexham Maelor Hospital, Wrexham, UK
| | - S Abraham
- Wrexham Maelor Hospital, Wrexham, UK
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Sajjad K, Shandilya S, Adhiyaman V. Is it time to replace the bleeper system with smart phones? Clin Med (Lond) 2012; 12:400. [PMID: 22930898 PMCID: PMC4952142 DOI: 10.7861/clinmedicine.12-4-400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Swaro A, Adhiyaman V. Autopsy in older medical patients: concordance in ante- and post-mortem findings and changing trends. J R Coll Physicians Edinb 2011; 40:205-8. [PMID: 21127759 DOI: 10.4997/jrcpe.2010.304] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Despite modern diagnostics, the discordance between ante- and post-mortem diagnoses is still around 25%, reiterating the need for high post-mortem rates. In our study, 3.5% had class I errors that, had they been detected during life, would or might have affected short-term outcome. Another 14% had major errors, conditions recorded as primary cause of death that were clinically missed or unrecorded but would not have affected the outcome. There has been an unexplained decline in hospital post mortems and more than a third of UK autopsies are now performed under the instruction of the relevant Coroner's office. The UK Coroners' system is currently under judicial and administrative review to improve the speed of and reduce the need for post-mortem analysis.
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Affiliation(s)
- A Swaro
- Glan Clwyd Hospital, Rhyl, UK
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Adhiyaman V, Adhiyaman S. [Transient ischemic attacks]. Praxis (Bern 1994) 2009; 98:1091-1092. [PMID: 19774517 DOI: 10.1024/1661-8157.98.19.1091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- V Adhiyaman
- Glan Clwyd Hospital, Rhyl, Denbighshire, The Laurels Surgery, Flint, Flintshire CH6 5AF.
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Affiliation(s)
- V Adhiyaman
- Department of Geriatric Medicine, Glan Clwyd District Hospital, Rhyl, Denbighshire, UK.
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Affiliation(s)
- V Adhiyaman
- Department of Geriatric Medicine, Glan Clwyd Hospital, Rhyl, UK.
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Ganeshram KN, Adhiyaman V, Meara RJ. Higher level gait disorders. Age Ageing 2004; 33:206. [PMID: 14960444 DOI: 10.1093/ageing/afh043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Adhiyaman V. Horizons in Medicine (number 13). J R Soc Med 2002. [DOI: 10.1258/jrsm.95.10.522-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Adhiyaman V. Horizons in Medicine (Number 13). Med Chir Trans 2002. [DOI: 10.1177/014107680209501019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- V Adhiyaman
- Department of Geriatric Medicine, Glan Clwyd Hospital, Rhyl, Denbighshire LL18 5UJ, UK
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Abstract
Chronic subdural haematoma is predominantly a disease of the elderly. It usually follows a minor trauma. A history of direct trauma to the head is absent in up to half the cases. The common manifestations are altered mental state and focal neurological deficit. Neurological state at the time of diagnosis is the most important prognostic factor. Morbidity and mortality is higher in the elderly but outcome is good in patients who undergo neurosurgical intervention.
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Affiliation(s)
- V Adhiyaman
- Department of Geriatric Medicine, Glan Clwyd District General Hospital, Rhyl.
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Adhiyaman V, Asghar M, Oke A, White AD, Shah IU. Nephrotoxicity in the elderly due to co-prescription of angiotensin converting enzyme inhibitors and nonsteroidal anti-inflammatory drugs. J R Soc Med 2001; 94:512-4. [PMID: 11581344 PMCID: PMC1282204 DOI: 10.1177/014107680109401005] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Both angiotensin converting enzyme inhibitors and nonsteroidal anti-inflammatory drugs can lead to functional renal insufficiency. In an observational study we assessed the frequency of this adverse effect in patients aged over 75 years receiving these drugs in combination. In one year, out of 1500 patients whose records were screened, 12 were prescribed this combination. 2 developed acute renal failure, of whom one died and the other recovered after discontinuation of both drugs. 4 patients showed deterioration in renal function, which returned to normal after one of the drugs was stopped. Renal function remained stable in 6 patients: patients with deterioration in renal function were older and more likely to be on diuretics. This drug combination is commonly nephrotoxic in the elderly and should be avoided, especially in those taking diuretics.
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Affiliation(s)
- V Adhiyaman
- Department of Geriatric Medicine, Wrexham Maelor Hospital, Wrexham LL13 7TD, Wales, UK
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Affiliation(s)
- V Adhiyaman
- Withybush General Hospital, Haverfordwest, Pembrokeshire SA61 2PZ
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Adhiyaman V, Froese S, Vaishnavi A, Cowell R. Broad complex tachycardia: a diagnostic dilemma. Postgrad Med J 2000; 76:802A. [PMID: 11085782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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Adhiyaman V, Froese S, Vaishnavi A, Cowell R. Broad complex tachycardia: a diagnostic dilemma. Postgrad Med J 2000. [DOI: 10.1136/pgmj.76.902.798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Adhiyaman V, Froese S, Vaishnavi A, Cowell R. Broad complex tachycardia: a diagnostic dilemma. Postgrad Med J 2000; 76:798, 803-4. [PMID: 11085776 PMCID: PMC1741838 DOI: 10.1136/pmj.76.902.798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- V Adhiyaman
- Withybush General Hospital, Haverfordwest, Dyfed SA61 2PZ, UK
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Adhiyaman V, Oke A, Aziz K, White AD. Progressive heart block in active rheumatoid arthritis. Int J Clin Pract 2000; 54:544-5. [PMID: 11198736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
A 68-year-old woman presented with active rheumatoid arthritis (RA) and severe extra-articular manifestations. During the course of her treatment, her electrocardiogram (ECG) transformed from normal sinus rhythm to left bundle branch block and finally to complete heart block (CHB). Investigations ruled out an ischaemic event. A permanent pacemaker was inserted due to the symptoms of heart failure and she made an uneventful recovery. CHB in RA is probably a marker of severity of the disease.
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Affiliation(s)
- V Adhiyaman
- Department of Geriatric Medicine, Wrexham Maelor Hospital, Wrexham, UK
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Adhiyaman V, Oke A, White AD, Shah IU. Diagnoses in discharge communications: how far are they reliable? Int J Clin Pract 2000; 54:457-8. [PMID: 11070571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
To discover whether general practitioners are correctly notified of a patient's final diagnosis following hospital discharge, an observational study was undertaken in a district general hospital. The final diagnosis was compared with the diagnosis documented in the discharge summary and the take-home prescription. Two hundred discharges were studied. Only 163 (81%) discharge summaries and 138 (69%) take-home prescriptions had the correct diagnosis; 24 (12%) take-home prescriptions did not have any diagnosis at all. In some cases the diagnosis differed between the discharge summaries and the take-home prescriptions. Only in 122 (61%) cases was the final diagnosis correctly documented in both instances. Communication regarding diagnosis in discharge letters is less than adequate. Every effort should be made to improve this.
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Affiliation(s)
- V Adhiyaman
- Department of Geriatric Medicine, Wrexham Maelor Hospital, Clwyd, UK
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Adhiyaman V, Asghar M, White AD. Colonic perforation associated with slow-release diclofenac sodium. Int J Clin Pract 2000; 54:338-9. [PMID: 10954963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
Upper gastrointestinal tract complications due to non-steroidal anti-inflammatory drugs are well recognised. However, adverse effects on large intestinal mucosa are less common and less well recognised, even though they carry a significant morbidity and mortality. Here we report a case of colonic perforation in a healthy woman without any underlying colonic pathology associated with ingestion of slow release diclofenac sodium.
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Affiliation(s)
- V Adhiyaman
- Department of Geriatric Medicine, Wrexham Maelor Hospital, Wrexham, Clwyd, UK
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Affiliation(s)
- V Adhiyaman
- Withybush General Hospital, Haverfordwest, Pembrokeshire SA61 2PZ
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Abstract
Most patients with atrial fibrillation should be considered for antithrombotic therapy. In a retrospective survey we investigated practice in two hospitals. For patients at high risk, established guidelines recommend warfarin, or aspirin if anticoagulants are contraindicated; for those at medium risk, either may be used. Of 156 with atrial fibrillation (acute, chronic or paroxysmal), 119 were at high risk, mean age 79 years. According to the guidelines, 89 of these were suitable for anticoagulation but only 49 (55%) received warfarin; 27 received aspirin and 13 neither. Of 27 patients at medium risk (mean age 70 years), 6 were not prescribed any antithrombotic therapy. This survey indicates that guidelines on antithrombotic therapy are commonly disregarded and that, in particular, warfarin is underutilized in the group for whom it is most indicated.
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Affiliation(s)
- V Adhiyaman
- Department of Geriatric Medicine, Wrexham Maelor Hospital, UK
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