A comparative analysis of the Irish post-graduate geriatric medicine training scheme with the European post-graduate curriculum in geriatric medicine.

PURPOSE: Minimum training recommendations to become a specialist geriatrician in the EU have been published and in this study we compared these recommendations with content from the post-graduate training scheme in Geriatric Medicine in Ireland. METHODS: We examined the content of didactic study-day lectures delivered during Geriatric medicine training in Ireland. We compared how both the formal Irish curriculum and the content of the study days match up with the 36 items that are identified as core knowledge content areas. RESULTS: The Irish geriatric medicine curriculum outlined that 30 of the 36 knowledge areas from the European curriculum should be covered. Formal teaching was delivered on 33 of the 36 knowledge components that are outlined in the European curriculum. 24 of 36 topics were covered at least twice. CONCLUSION: There was a high concordance between the content of the Irish and European post-graduate curriculum in Geriatric medicine.

Severe brachial plexopathy secondary to shingles (herpes zoster).

Varicella zoster reactivation ("shingles" or "herpes zoster") usually presents as a self-limiting, unilateral, dermatomal vesicular rash in older adults. We present the case of a 73 year-old woman with unilateral brachial plexopathy, an unusual but debilitating complication of shingles. Despite treatment with intravenous acyclovir and immunoglobulin she had a marked residual motor paresis that required an upper limb rehabilitation program after discharge.

The accuracy of anatomical landmarks for locating the carotid sinus.

BACKGROUND: carotid sinus massage (CSM) is a valuable clinical test for carotid sinus syndrome (CSS) and relies on accurately locating the carotid sinus (CS). OBJECTIVE: in this study, we sought to examine the accuracy of using anatomical landmarks for locating the CS. METHODS: consecutive patients (n = 20) were recruited prospectively. Two clinicians, trained in CSM, were asked to locate the CS using anatomical landmarks. A point on the skin overlying the CS was then marked by a vascular technician using ultrasound. Accuracy of techniques was compared using intra-class correlation coefficients and Bland-Altman statistics. RESULTS: anatomical landmarks underestimated the CS location by 1.5 ± 1.3 cm. Error extremes ranged from 4 cm below to 2 cm above CS using anatomical landmarks. A moderate correlation between ultrasound and anatomical landmarks was found, r = 0.371 (P = 0.031). CONCLUSION: this is the first study to characterise the accuracy of standard anatomical landmarks used in CSM. Results suggest that the point of maximal pulsation has the lowest associated error. Future work should examine CSM yield across this and a range of other methodological factors.

Amnesia for loss of consciousness is common in vasovagal syncope.

AIMS: The aim of this study was to determine the prevalence of amnesia for loss of consciousness (A-LOC) in those who have a history suggestive of vasovagal syncope (VVS) and who develop syncope on head-up tilt (HUT) table testing. Furthermore, we wished to determine if A-LOC is an age-dependent phenomenon in VVS and whether haemodynamic parameters on tilting can predict for A-LOC. METHODS AND RESULTS: Patients were recruited in a dedicated syncope unit and underwent neurocardiovascular evaluation as indicated under European Society of Cardiology guidelines to illicit a diagnosis of VVS. A set protocol of questioning occurred following induced syncope to determine the presence of A-LOC. The prevalence of A-LOC following syncope on tilting was 28% (44/159). Forty-two per cent of those≥60 years of age vs. 20%<60 years of age experienced amnesia post-induced syncope (P=0.003). However, regression analysis did not show age to be an independent predictor for A-LOC. Blood pressure change between those without amnesia and those with amnesia showed no significant difference (P=0.687). There was a significant difference in heart rate response; those experiencing amnesia had reduced bradycardic response on HUT compared with those without amnesia (P=0.001). CONCLUSION: Amnesia for loss of consciousness is common in VVS. Although more prevalent, it is not unique to older age-groups. Absence of syncope associated bradycardia during HUT testing predicts for A-LOC.

Developing strategies for the prevention, detection and management of elder abuse: the Irish experience.

It is only within the past two decades that elder abuse has received governmental attention in Ireland. There had been little awareness, and no structures in place to tackle this problem prior to this. Media highlighting of particular cases, and an exploratory study undertaken in 1998, prompted the setting up of a governmental working group on elder abuse. Unique to this group was the trialling of a proposed system in two pilot sites. This allowed for recommendations based on actual practice, and has lead to the adoption of a network of elder abuse caseworkers, among other recommendations.