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67 HCPs took part in this survey. Of these 19% (13) were

Consultant Physicians,18% (12) were Pharmacists and the rest 63% (42)

were trainees in Medicine. 37% (25) routinely ask patients about HM

use. The commonest reasons for not asking were


t remember to

ask (33%;21) and lack of knowledge about herbal medicines (20%, 13).

The commonest herbal medicines that HCPs had come across were

Ginseng (54%,36), Gingko Biloba (49%, 33) and garlic (48%, 32). 40%

(27) were aware that Gingko improves memory whilst 64% (43) felt

that St John

s Wort can cause transplant rejection in patients on

cyclosporine. Only a fifth of HCPs recognised the potential drug

interaction between Gingko biloba and clopidogrel whilst 48%(32)

recognised that garlic and 25%(17) recognised that Gingko Biloba had

antiplatelet activity. Only 3% (2) of responders rated their knowledge

as very good and good.


Our findings suggest that HCPs knowledge about HM

is poor. We need to ensure that education about common herbal

medicines is provided as part of multidisciplinary teaching pro-

grammes and that we improve HCPs awareness of where to access

relevant information about HM.


Development of lidocaine patch guidelines for short term use

A. Mackett, R. Berry.

Cambridge Universities Hospitals NHS Trust, United



Local consensus supports lidocaine patch use in older

patients as adjunctive therapy for fractures and acute back pain. Local

primary care guidelines restrict use based on insufficient evidence

for neuropathic pain.


Literature review For fractures and back pain there is a

paucity of quality evidence. In non-randomised, open-label trials there

is a 50% reduction in back pain [1,2]. In rib fractures a randomised-

controlled trial demonstrated significant and persistent reductions in

pain after 5 days [3]. Audit 71 patients were prescribed lidocaine

patches in 7 months (40


, 31


). Indications: 45%

fractures, 25% back pain, 30% other. 61 patients previously failed trials

of other analgesics due to side effects (SE) (26%) or inefficacy (75%).

Overall 55% had documented improvement in pain with lidocaine


59% were fracture and 56% back pain patients. 23% of

patients experienced significant improvement in mobility and

engagement with the therapists.


Lidocaine patches are relatively expensive in comparison

to other analgesia [4] but may improve management of localised

musculoskeletal pain especially in groups at risk of SE from other

agents e.g. elderly patients and those at risk of falls [5]. Patch use may

facilitate early mobilisation and potentially reduce length of stay thus

offsetting the cost of the patches. Guidelines to support short term use

in hospital and community have been developed. Recommendations

Trial patch for 10 days. 24 hour removal. If pain returns repeat once.

If pain returns again refer back to initiating team.


1. Galer BS, Gammaitoni AR, Oleka N, Jensen MP, Argoff CE: Use of

the lidocaine patch 5% in reducing intensity of various pain qualities

reported by patients with low-back pain.

Curr Med Res Opin


20(Suppl 2): S5


2. Argoff CE, Galer BS, Jensen MP, Oleka N, Gammaitoni AR:

Effectiveness of the lidocaine patch 5% on pain qualities in three

chronic pain states: assessment with the Neuropathic Pain Scale.

Curr Med Res Opin

2004, 20(Suppl 2): S21


3. Cheng Y-J: Lidocaine skin patch (Lidopat


5%) is effective in the

treatment of traumatic rib fractures: a prospective double-blinded

and vehicle-controlled study.

Med Princ Pract

2016, 25: 36


4. HSCB letter Northern Ireland Lidocaine Plaster (Versatis



Recommendations for Primary and Secondary Care in Non-

Specialist settings. November 2013.

5. Pirmohamed M, James S, Meakin S

et al.

Adverse drug reactions

as cause of admission to hospital: prospective analysis of 18 820


British Medical Journal

2004; 329(7456): 15



Prevalence of preventive cardiovascular medication use in nursing

home residents with short life expectancy. The SHELTER Study

A. Malek Makan


, H. van Hout


, G. Onder


, R. van Marum





University Medical Centre, Amsterdam,


Amaris Zorggroep, Hilversum,

The Netherlands;


Universita Cattolica del Sacro Cuoro, Rome, Italy;


Department of Geriatric Medicine, Jeroen Bosch Hospital,

s-Hertogenbosch, The Netherlands


In nursing home (NH) residents with a very short life

expectancy, the benefits of preventive cardiovascular medication

maintenance are questionable.


To assess the prevalence of four classes of preventive

cardiovascular medication (PCM) in nursing home residents.


A 12 months prospective cohort study was conducted in 57

NH in 8 countries (Czech Republic, England, Finland, France, Germany,

Italy, The Netherlands, Israel). We assessed the prevalence at first

measurement of 4 classes of PCM: oral anticoagulants (OAC), platelet

aggregation inhibitor (PAI), antihypertensive (AHT), and lipid modi-

fying agent (LMA), in older (60+) residents with valid medication

assessments. The PCM prevalence was compared across the length of

stay (short < 60 days, mid, long >12 months), mortality risk as defined

by CHESS > 3 (Changes in Health, End-Stage Disease, Signs, and

Symptoms Scale), and cognitive impairment by CPS > 2 (cognitive

performance scale).


Of the 3759 eligible residents, 2175 (57.9%) used at least 1 or

more PCMs. The prevalence of the four groups of PCM: OAC, PAI, AHT

and LMAwas 5.6%, 34.9%, 35.7%, and 10.4% respectively. PCM use was

lower in long stay residents versus mid stay: 56.0% vs. 62.7%, in

cognitively impaired residents (47.1% vs 67%), and in residents with a

high mortality risk (47.4% vs 58.6%).


Although the prevalence of PCM use was lower in long

stay, cognitively impaired residents, and persons with a high mortality

risk, there seems to be room for deprescribing.


Keywords: Cardiovascular disease; medication; Cognitive

impairment; Nursing home resident; Shelter study.


Metformin-associated lactic acidosis in the very old: reflexions

about a case report

L. Marques.

Unidade Universitária de Geriatria, Faculdade de Medicina

da Universidade de Lisboa, Hospital Beatriz Ângelo


Metformin is first line therapy for type2 diabetes.

Metformin-associated lactic acidosis (MALA) is rare, but has 50%

mortality rate. MALA risk factors are renal impairment and a

secondary event like cirrhosis, sepsis or hypoperfusion. Metformin

contraindications include moderate to severe renal dysfunction,

hepatic insufficiency and circulatory dysfunction. Very elderly patients

are a risk group for metformin treatment. Case Report A 96 year old

male, autonomous, was admitted to an emergency department in

shock. He had medical history of type2 diabetes, essential hyper-

tension and mild cognitive impairment. He was medicated with

metformin, furosemide and ramipril. On admission he was unrespon-

sive, had immensurable arterial blood pressure, respiratory rate was

29 per minute and had ventricular escape rhythm. Atropine was

administered with response. Objective analysis revealed severe lactic

acidosis with pH 7,01 and lactate >130 mg/dL, acute renal failure and

no elevated inflammatory parameters. Patient was started on

antibiotics and resuscitation with crystalloid fluids with clinical

benefit. MALA was admitted. He was putted under renal dialysis

with progressive correction of lactic acidosis and renal function

recovery. After 5 dialysis sessions the patient recovered from renal

insufficiency and was discharged 14 days after hospital admission.

Metformin and furosemide were removed from his prescription. The

patient remains alive and autonomous a month after hospital


Poster presentations / European Geriatric Medicine 7S1 (2016) S29