ABSTRACT
BACKGROUND: Orthostatic hypotension (OH) is common in Parkinson's disease (PD), but the relation between the results of orthostatic blood pressure tests and orthostatic symptoms in daily life is not clear. METHODS: We performed a cross-sectional study in an incident nontertiary care cohort of PD patients with additional recruitment of PD patients from our own outpatient clinic. We recruited sex- and age-matched controls. All participants underwent orthostatic blood pressure tests using continuous blood pressure measurements. Orthostatic symptoms experienced in daily life were assessed using autonomic symptom questionnaires (SCOPA-AUT and COMPASS-31). RESULTS: A total of 83 PD patients and 35 controls were included. Mean patient age was 69.2 years (standard deviation [SD]: 10.0). Mean disease duration was 6.6 years (SD, 0.8). The estimated prevalence of OH in PD was 24.1% (95% confidence interval: 16.2-34.3). There was no significant difference between PD patients with and without OH regarding reported daily orthostatic symptoms. Alternative OH criteria did not substantially improve this. CONCLUSIONS: Perceived orthostatic symptoms in daily life have no clear association with the results of a single orthostatic blood pressure test. Better diagnostic strategies are needed.
ABSTRACT
The Dutch legislator has adopted the point of view that people with diabetes and hypoglycaemia unawareness are unfit for driving a motor vehicle because hypoglycaemia unawareness carries with it an unacceptable risk for traffic accidents. There is no legal obligation for people in possession of a driving license to report changes to their state of health such as the appearance of hypoglycaemia unawareness. We argue that patients with newly diagnosed diabetes should inform the Driving Test Organisation about changes to their health status for moral reasons, and for reasons of judicial liability. This subject should be included in patient education, as should be strategies to minimise the risk of hypoglycaemia. In exceptional cases, the physician may opt to breech medical confidentiality and report the presence of hypoglycaemia unawareness in order to avert immediate, severe danger.
Subject(s)
Accidents, Traffic , Automobile Driving , Awareness , Hypoglycemia/complications , HumansABSTRACT
The carotid sinus syndrome and carotid sinus hypersensitivity (CSH) are closely related disorders. The first is characterized by syncope triggered by manipulation of the carotid sinus in daily life (e.g. shaving). According to the current European Society of Cardiology guidelines, CSH is diagnosed when carotid sinus massage elicits ≥3 s asystole, a fall in systolic blood pressure of ≥50 mmHg, or both, with symptoms. The question is, however, whether symptoms can be expected when these criteria are met. Although they are widely accepted, we will show that their basis is primarily in arbitrary clinical observations and that in the original publications the link between classification and clinical symptoms was often dubious. The current criteria for CSH are thus too sensitive, explaining the reported high prevalence of CSH in the general older population. The review will conclude with suggesting a stricter set of criteria for CSH that should be evaluated in future studies.
Subject(s)
Carotid Sinus/physiopathology , Syncope/diagnosis , Syncope/physiopathology , Blood Pressure/physiology , Electrocardiography , Guidelines as Topic , Humans , Hypotension/etiology , Hypotension/physiopathology , Syncope/complicationsABSTRACT
In-hospital adult cardiopulmonary resuscitation is successful in only approximately 20% of cases and may result in permanent neurological damage. Two reasons justify not commencing resuscitation: either the patient does not want to be resuscitated, or resuscitation is considered medically futile by the doctor. This subject should be discussed timely with all chronically ill patients who are likely to be admitted to hospital, preferably in the outpatient clinic setting, and results must be communicated with all doctors involved (e.g. general practitioners). Here we describe 3 cases that demonstrate the need to discuss possible restrictions on cardiopulmonary resuscitation with all chronically ill patients, regardless of their age. The first was a 45-year-old HIV-positive male with chronic clinical depression who refused ICU care, the second a 75-year-old patient whose initial 'do no resuscitate' order was reversed based on the wishes of her daughter and the third a 45-year-old female with sickle cell disease who expressed a sustained wish not to be treated in the ICU or to be resuscitated.
