ObjectivesThe concept of this review is to examine and quantify the reporting of parameters of dose (duration, speed, head excursion) and dosage (daily and weekly frequency, duration) for gaze stabilisation exercises and to report on outcome measures used to assess change in gaze stabilisation following intervention. This review includes any population completing gaze stabilisation exercises.DesignScoping review.MethodsWe searched key terms in the following databases: PubMed, CINAHL, Scopus and Cochrane. Two researchers reviewed titles, abstracts and full-text articles for inclusion. Data retrieved included: patient diagnosis, specific interventions provided, dose and dosage of gaze stabilisation interventions and outcome measures.ResultsFrom the initial 1609 results, 138 studies were included. Data extraction revealed that only 13 studies (9.4%) reported all parameters of dose and dosage. Most studies used other interventions in addition to gaze stabilisation exercises. Half of the studies did not use a clinical or instrumented outcome measure of gaze stability, using only patient-reported outcome measures. Clinical tests of gaze stability were used in 21.1% of studies, and instrumented measures of gaze stability were used in 14.7% of studies.ConclusionsFull reporting of the dose and dosage of gaze stabilisation interventions is infrequent, impairing the ability to translate current evidence into clinical care. Most studies did not use a clinical or instrumented measure of gaze stabilisation as outcome measures, questioning the validity of intervention effects. Improved reporting and use of outcome measures are necessary to establish optimal intervention parameters for those with gaze stability impairments.

LessonAn 86-year-old Latvian gentleman presented with worsening heart failure two months after a previous hospital admission. Admission medication included diuretics, angiotensin converting enzyme inhibitor and spironolactone. It was felt that the diuretic dose was suboptimal and the diuretic load was increased. Symptoms settled and he was discharged with a fourweek supply of medications. Clinic follow up was booked one month post discharge. At the clinic appointment he was hypotensive and renal function had deteriorated. Discussion with the patient and relatives suggested that a number of communication problems had conspired to create a situation in which adherence to the medication regimen was impossible, precipitating the most recent hospital admission.The patient did not have a telephone installed at his house which meant that he was unable to speak directly to his general practitioner (GP) or local pharmacy to obtain a repeat prescription. As English was not his first language he found it difficult to explain the problem without help from his relatives. His ongoing symptoms prevented him visiting the practice to address the situation. The lack of a repeat prescription, as opposed to suboptimal diuretic dose, had precipitated the admission. As this had not been appreciated, the diuretic dose had been escalated unnecessarily, causing hypotension and a deterioration in renal function. Explanation of the situation to the GP and local pharmacy enabled a weekly delivery of a dossette box to the patient's house and symptom control was achieved. CommentAround 25% of all patients do not adhere well to prescribed medication. 1 Prescription of three or more medications, medications prescribed by more than one doctor, living alone, and cognitive decline are risk factors for non-adherence to medication in elderly patients. In the elderly population the medications most likely to be associated with non-adherence are hypnotics, analgesics, diuretics and bronchodilators. 2 A meta-analysis of medication adherence published in 2006 suggested the mortality of patients with good adherence to be approximately half that of patients with poor adherence. 3 The definition of 'good' adherence varied between studies, ranging from >66% to >95%. A caveat to the association of adherence and reduced mortality is the possibility of the 'healthy adherer' effect, whereby adherence may act as a surrogate marker for overall healthy behaviour.Diuretic therapy is an essential part of the medication regimen of the majority of patients with heart failure. Diuretics reduce morbidity and hospitalisation lesson of the month Medication adherence in heart failureBarriers to successful medication adherence exist and poor adherence is common. Recurrent admission with chronic conditions should prompt a detailed enquiry into medication adherence.