Hip protector use amongst older hospital inpatients: compliance and functional consequences.

Carotid sinus massage – How safe is it? SIR—Carotid sinus massage (CSM) is a useful diagnostic tool in the investigation of unexplained falls and syncope [1]. Despite the increased use of CSM, concerns persist regarding its safety particularly in older patients. The principal concern relates to the development of neurological events secondary to CSM. The likelihood of performing CSM over atheromatous carotid arteries is higher in older patients with the increased theoretical risk of precipitating an anoxic event or profound haemodynamic changes sufficient to cause a permanent neurological deficit. To date, four major studies [2–5] have reviewed the incidence of neurological complications following CSM. Reported neurological complication rates ranged from 0.17% [4] to 1.0% [5]. Cardiac complications including ventricular [6, 7] and atrial arrhythmias [8] have previously been described only rarely. Data on CSM complications are available from only three centres worldwide, with 79.5% of these patients being from two centres. It is unclear whether CSM complication rates observed at these centres are comparable with those found elsewhere. Whether differences in patient risk factors account for the apparent 5-to 6-fold variation in complication rates described in these studies is also unclear. This knowledge is important if physicians are to provide meaningful information to their patients and obtain informed consent for the procedure. Computerised data on CSM studies performed at King's College Hospital (KCH) (London, UK) and Mid-Western Regional Hospital (MWRH) (Limerick, Ireland) were pro-A specific field existed in both the databases for operators to record complications arising from CSM as they occurred. The absence of complications was not specifically documented in the KCH database. Data from both databases were collated in a single Excel spreadsheet and further analysed by the author. Patients were referred from a wide variety of sources including hospital consultants, the Accident and Emergency departments as well as from general practitioners. Indications for CSM were recurrent unexplained falls or syncope together with a clinical suspicion that carotid sinus syndrome may be the underlying diagnosis. Contraindications to CSM were the presence of a carotid bruit, a known carotid stenosis >50%, a history of myocardial infarction or stroke within the preceding 3 months or a history of ven-tricular arrhythmias or symptomatic bradyarrhythmias [3]. All patients gave informed consent prior to CSM. Longitudinal massage was applied for 5 s over the point of maximal carotid impulse on the right and then the left carotid artery. A minimum of 30 s …