In critically ill patients, chronic pre-morbid hyperglycemia increases the risk of hypoglycemia and modifies the association between acute hypoglycemia and mortality.

No abstract

No abstract

Introduction Alcohol use disorder (AUD) in older adults is increasingly common, under-recognised and under-treated within acute hospitals. Methods Consecutive patients seen by the Alcohol Care Team (ACT) at an acute NHS trust between January-April 2021 were invited to take part in a service evaluation. Baseline demographic and clinical data was collected in addition to community alcohol service referrals for all patients. For older adults (>64years), Older People’s Mental Health (OPMH) referral and hospital use data (ED attendances and admissions) in the 12 months prior/post index admission were also collected. Results Of 280 patients seen by the ACT during the 3-month period, 87 (31%) were older adults and 75% were male. Older adults resided in more affluent neighbourhoods compared to patients under 65 (p = 0.002). Referral to community alcohol services was predicted by younger age (p<0.001), medically assisted withdrawal during admission (MAW) (p <0.001) and scoring as possibly alcohol dependent (p= 0.006) on the Alcohol Use Disorder Identification Test (AUDIT) screening tool. In binary multivariate logistic regression considering age, sex, MAW and AUDIT category, referral onto alcohol services remained highly significant for age, with older adults less likely to be referred (odds ratio 0.029, CI: 0.007 to 0.125, p<0.001). In older adults drinking at higher risk/possibly dependent levels, only 4.3% (n=2/47) were referred to alcohol services compared to 66.2% (n = 96/145) in under 65s. Older adults were more often signposted or not referred due to confirmed/perceived cognitive impairment. No significant difference in use of hospital services was found for the 12 months after the index admission. Conclusions Older adults are less likely to be referred to community alcohol services, despite evidence they are drinking at higher risk/dependent levels. Further exploration into the reasons behind this is required to help inform development of appropriate pathways and services for this patient group.

BACKGROUND During emergence of general anaesthesia, hypertension and tachycardia caused by tracheal extubation may lead to serious complications during craniotomies. This study was designed to assess the effect of magnesium sulphate on these cardiovascular responses during extubation following craniotomies under general anaesthesia.