BackgroundThis study's aim was to investigate an association between outcome from in-hospital cardiopulmonary resuscitation (CPR) and increasing burden of comorbidities and frailty. Methods Retrospective analysis of prospectively collected data from contemporaneous patient notes and electronic records of all patients who suffered an in-hospital cardiac arrest between 1 April 2017 and 31 March 2018 in a hospital that includes a tertiary cardiology department. Results A total of 113 patient records were assessed. Patient frailty was assessed based on calculation of Rockwood clinical frailty score (CFS) and comorbidity assessment based on Charlson comorbidity index (CCI). A linear correlation has been identified between increasing CCI and reduced survival(ANOVA = p<0.001) and rates of return of spontaneous circulation (ROSC) (ANOVA = 0.013). No patients with a CFS above 6 survived to 1 year. A linear correlation was identified between increasing CFS and reduced probability of ROSC (ANOVA p=0.002), survival to discharge (ANOVA p=0.003) and 1 year (ANOVA p=0.001). ConclusionOur findings suggest an association between increasing patient multimorbidity and frailty and poorer outcome post cardiac arrest.

Caregivers identified three key relationship needs whilst caregiving for a PWD at EOL: i) the need for connection and intimacy at the EOL (including opportunities for forgiveness and rebuilding relationships); ii) the need to find joy and positivity and iii) the need to say goodbye.Additionally, many caregivers reported the benefits of sharing experiences with other caregivers; it fostered a sense of solidarity, normalised the experience and offered validation from peers. Caregivers found emotional security in setting boundaries, building relationships with staff and having confidence in staff expertise. The need for caregivers to feel a sense of control during the EOL period was also identified. Role recognition in the form of both acknowledgement of caregiving duties and defining an identity outside the caregiving role were fundamental relationship needs. Conclusion Caregivers wanted to feel listened to, primarily as advocates for PWD but also to validate their caregiving role and recognise the intimate knowledge that they have acquired whilst caregiving for a PWD at EOL.

Mirtazapine is a commonly used drug indicated for the treatment of severe depression. It works as a presynaptic α₂-adrenoreceptor antagonist that increases central noradrenergic and serotonergic neurotransmission, and it is metabolized by the p450 cytochrome oxidase system. There is evidence within the literature to suggest a link between antidepressants and increased liver enzymes, although case reports demonstrating a link between mirtazapine specifically and steatosis are sparse. Here, we present a case of mirtazapine-induced steatosis in a 48-year-old office worker. She presented with painless jaundice of 2 days duration and generalized lethargy and peripheral edema present for 3 weeks beforehand. Extensive investigations were undertaken to identify the cause of her jaundice but no biochemical, blood-borne, or anatomical cause could be found. Mirtazapine was subsequently stopped, and her liver function, both clinically and biochemically, improved rapidly. She made a full recovery after discontinuation of her mirtazapine.
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Table 2 Action documented by clinician in response to a 'MUST' score of !1

<b><i>Introduction:</i></b> Significant variation exists in the prevalence of home haemodialysis (HHD) among UK renal centres. Our centre has a HHD prevalence of 2%, and we aimed to study how many patients who chose HHD as their preferred mode of renal replacement therapy (RRT) went on to receive this treatment and the barriers to starting this treatment. <b><i>Methods:</i></b> A retrospective single-centre analysis of electronic medical records for all patients who chose HHD at the time of RRT education was performed, and data were collected on patient demographics, comorbidity, frailty, RRT events, and barriers to HHD. <b><i>Results:</i></b> 116 patients chose HHD as their preferred mode of RRT between 2006 and 2018. Of these patients, 93 required RRT, but only 28 patients ever received HHD. No statistical difference was identified between those patients who only received unit haemodialysis (UHD) and those who went onto receive HHD with respect to age, gender, comorbidity, frailty, and socioeconomic deprivation. Patient choice, change in clinical condition, transplantation, home environment, vascular access problems, and training delays were identified as reasons patients did not start HHD. No documented reason could be found in 9 patients with a breakdown of communication between clinics and peripheral dialysis units attributed as a significant contributor in some of these patients. Of the 26 patients who started HHD after UHD, 19 did so within 1 year of starting UHD. <b><i>Conclusion:</i></b> Most patients who choose HHD do not receive HHD. Many patients never start HHD because of potentially reversible barriers including inadequate communication among clinicians about patient choices, patients changing their minds once in a dialysis unit, and inadequate timely training support.