A standardised method of medication review and deprescribing may significantly reduce medication burden in a cohort of older hospitalised patients.

Our findings imply that there remains considerable uncertainty about appropriate prescribing and dosing of NOAC, particularly in patients with impaired renal function. We recommend judicious prescribing and regular monitoring of renal function in patients at high risk of complications from NOAC therapy.

Deciding which head-injured patients should be transferred to a neurosurgical unit can be difficult. Traditional criteria emphasise the development of deteriorating responsiveness but lead to delayed diagnosis and to avoidable mortality and morbidity. To discover if a more liberal admission policy improved results a study was conducted analysing data collected prospectively from 683 patients who had a traumatic intracranial haematoma evacuated in the Glasgow neurosurgical unit between 1974 and 1980. In the first four years, before the change in policy, mortality was 38% but decreased to 29% afterwards. This reflected a reduction in the proportion of patients who talked after injury but who deteriorated into coma before operation-that is, 31 % before the change in policy, 16% afterwards.If the potential benefits of CT scanning in the management of head injuries are to be realised patients must be scanned sooner than in the past. This will usually mean that more patients should go to a neurosurgical unit and that simple criteria for transfer should be established.

Aims To determine the proportion of older medical patients who have an adverse drug event (ADE) during admission to hospital and assess the association with hospital length of stay (LOS). Methods A retrospective evaluation of eligible patients, aged greater than 65 years, consecutively admitted to a medical ward at the Royal Brisbane and Women's Hospital, Australia. Patient medication charts, medical notes and laboratory results were reviewed using an ADE trigger tool to identify potential ADEs during admission. A clinical panel examined and confirmed any true ADEs and the corresponding causative agents. LOS was compared between patients who did and did not have an ADE. Results A total of 164 patients were recruited over 30 days. The trigger tool identified a total of 69 triggers from 40 patients (24.3%) with a potential ADE during admission, of which 12 patients (7.3%) had a true ADE. The main drug categories implicated included cardiovascular, anti‐infective and haematological agents. The group of patients with an ADE had a longer median (25th, 75th percentile) LOS when compared to patients without an ADE: 6.5 (3.75, 11) versus 4 (2, 7) days (p = 0.043). Conclusion Approximately 7% of older in‐patients experience an ADE, which has a significant association with an increase in their LOS. To minimise patient harm, undesirable high‐risk drugs should be avoided and vigilant monitoring must occur if they need to be prescribed. An adequately powered, multi‐site study is required and preventative strategies should be further explored.

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