usually require more guidance in interpreting the data they receive than in selecting the investigations their patients require. The omission from some of the chapters of adequate information about normal ranges, not to mention the absence of a discussion of which data are normally distributed and which are not, must limit the book's general appeal. All clinicians will be pleased to find that the necessity of interpreting electrophysiological findings in the clinical context is properly stressed throughout. Whilst clinical neurophysiology is likely to continue to complement modern imaging techniques for some time to come it is clear that its ultimate contribution to clinical management will probably emphasize the functional as opposed to the structural abnormalities which it can demonstrate. These portents are well discussed in relation to computerisation of EEG and evoked potentials, and all too briefly in chapters dealing with central nervous system disorders and event related potentials. For the clinical neurophysiologist, often practising in relative isolation, there is an abundance of thoughtprovoking information and probably some invaluable refresher material as well. There are a few surprises, such as the definition of supramaximal stimulation. The statement that somatosensory evoked potentials give a higher yield than visual evoked potentials in the diagnosis of multiple sclerosis surely requires some qualification. There may also be a few UK readers unaware that evoked potential recording in theatre costs 700 dollars per case. This is an excellent book, beautifully produced, and no department of clinical neurophysiology should be without one.

https://pmj.bmj.com/content/postgradmedj/64/749/253.2.full.pdf

Jeffcoate's Principles of Gynaecology

Purpose of reviewHeart failure is a major chronic illness with no definitive cure. With improving healthcare and with an aging population in many countries, heart failure has become a common disease of the elderly. Pharmacological management of heart failure in the elderly remains a challenge. The s

Management of heart failure in the elderly.

Increasing age is an established prognostic determinant in chronic heart failure (HF). Diabetes often complicates HF in its course and appears to worsen HF prognosis. A differential impact of diabetes depending on patients’ age was not yet studied. We evaluated the impact of diabetes in the mortality of HF patients according to their age.
 We studied a cohort of chronic ambulatory HF patients prospectively recruited. Patients were on optimized evidence-based therapy, and they were excluded if on renal replacement therapy or if they had any therapy modification or hospitalizations in the previous 2 months. Patients were followed for up to 5 years; all-cause mortality was analyzed. Mortality predictors were assessed using a Cox regression. Analysis was stratified according to patient’s age: cutoff 75 years. Multivariate models were built. Interaction between diabetes and age was formally tested.
 We studied 283 chronic HF patients; mean age was 69 years and 70.3% were male; 58.0% had severe systolic dysfunction; 105 (37.1%) were diabetic. In patients with less than 75 years, the coexistence of diabetes predicted a multivariate adjusted 1.98 (95% CI 1.13–3.46) 5-year death risk while in older patients (≥ 75 years) no significant association was reported. Age interacted with the prognostic impact of diabetes, p for interaction = 0.04.
 The prognostic impact of diabetes in chronic HF depends on patient’s age. In patients < 75 years, the coexistence of diabetes predicts an almost double risk of 5-year mortality; no such association exists in patients with 75 years or above. Diabetes predicts mortality only in younger HF patients.

Age affects the prognostic impact of diabetes in chronic heart failure

BACKGROUND The multidimensional prognostic index (MPI) is a validated tool for prognostic stratification in acute and chronic setting of geriatric patients. However, only few data are available on patients with cardiovascular diseases. AIM To evaluate the potential role of MPI as predictor of 1-year and long-term outcome in ultra-octogenarians patients hospitalized for cardiovascular diseases. METHODS AND RESULTS We conducted a prospective study on 216 patients (mean age 85 ± 4 years) hospitalized for cardiovascular disease enrolled from September 2011 to February 2014 in both Cardiology and Internal Medicine Departments. The mean follow-up was 33 ± 7 months. The primary end-point was 1-year all-cause mortality. In addition, 3-year all-cause mortality was also assessed in the overall cohort and outcome prediction was then evaluated separately in patients with a primary diagnosis of heart failure and acute coronary syndrome. At admission, 53% of patients had a MPI-1 low risk, 34% had a MPI-2 moderate risk and 13% had a MPI-3 high risk (13%). Internal medicine inpatients had worse risk profile and higher MPI risk class than patients admitted to the cardiovascular department. Fifty-four patients (25%) experienced the primary end-point. In the multivariate logistic regression model MPI score [hazard ratio (HR) 1.83, 95% confidence interval (CI) 1.23-2.71, P = 0.003], serum creatinine (HR 1.32, 95% CI 1.13-1.54, P < 0.001) and serum albumin (HR 0.43, 95% CI, P = 0.04) were independent predictors of 1-year mortality. The area under the receiver operating characteristic combining the MPI score with serum creatinine and albumin was 0.83 (CI 0.15-0.59, P < 0.001). CONCLUSION In ultra-octogenarian inpatients hospitalized for cardiovascular disease, MPI score independently predicts a poorer outcome. An integrated model including MPI, serum creatinine and albumine might aid the prognostic stratification of hospitalized elderly populations.

Outcome of the multidimensional prognostic index in ultra-octogenarian patients hospitalized for cardiovascular diseases.

Posture, Mobility, and 30-day Hospital Readmission in Older Adults with Heart Failure

Heart failure commonly occurs in the elderly age group. Treatment mainly centres on the use of digoxin and diuretics. In intractable heart failure other agents ie inotropic agents and vasodilators may be considered. Routine maintenance on diuretic and digoxin should not be encouraged. A conscious effort to tail off these medication is needed.

Heart failure in the elderly.

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Heart failure in the elderly.