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A survey on physicians’ knowledge and attitudes toward clinical use of opioids in nursing home facilities in The Netherlands
S176
9th congress of the EUGMS / European Geriatric Medicine 4 (2013) S142–S216
Conclusions.– In this representative older population, treatment with melatonin did not improve incidence of delirium. Our findings do support the use of preoperative melatonin to decrease the prevalence of longer lasting delirium in vulnerable older hip fracture patients. http://dx.doi.org/10.1016/j.eurger.2013.07.586 P519
Blood lowering medications are not related to orthostatic hypotension
tion 44 vs. 45%) and the 12 co-morbidities belonging to CHADS2 and/or HEMORR2HAGES scores (excepted of course for reduced platelet function: 100 vs. 45%). Stroke risk was similar in AP and AC patients (7.1 ± 3.5 vs. 7.0 ± 3.3%/year). Severe bleeding risk was slightly higher in AP than in AC (3.2 ± 0.3 vs. 2.8 ± 0.7%/year), but similar when no point was given for AP in HEMORR2HAGES score. Conclusions.– No clinical reason justifies withholding anticoagulation in older patients with atrial fibrillation and high stroke risk. When prescribing long-term anticoagulation, clinicians may withdraw antiplatelet therapy in patients without recent ischemic event or stenting to reduce their bleeding risk.
B. Boland , D. Kajungu , N. Speybroek , F. Vaillant Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
http://dx.doi.org/10.1016/j.eurger.2013.07.588
Introduction.– Orthostatic hypotension (OH) in geriatric patients is often considered to be related to blood lowering medications (BLM). We tested the hypothesis that this might not be the case. Methods.– OH (≥ 20/10 mmHg decrease in systolic/diastolic blood pressure) was screened in 100 older inpatients (85 ± 5 years, 59% women) able to stand up (3 minutes) during the first two days after admission in an academic geriatric ward. We analyzed the use of BLM (ACE/angiotensin inhibitors, calcium channel blockers, -blockers, diuretics, ␣1-blockers, central ␣-agonists, nitrates) and expressed their dosage with the number of defined daily dose (DDD). Results.– No difference in BLM was observed between 33 patients with OH and 67 patients without OH in terms of use (73 vs. 85%), number (1.76 vs. 1.57 drugs) or mean dosage (1.8 vs. 1.7 DDD). No statistical difference was found at the drug level between patients with and those without OH (ACE/angiotensin inhibitors 42 vs. 42%; calcium channel blockers 24 vs. 24%; -blockers 48 vs. 37%; diuretics 30 vs. 30%; ␣1-blockers 12 vs. 6%, nitrates 9 vs. 6%; central ␣-agonists 3 vs. 1%). OH prevalence was 30% in the 80 patients receiving BLM and 45% in the 20 other patients (P = 0.31). OH prevalence was not associated with BLM number (Odds Ratio 1.09 per unit of DDD increase, 95% CI: 0.8–1.5, P = 0.57), nor with their dosage (Odds Ratio 1.04, 95% CI: 0.8–1.3, P = 0.74). Conclusion.– This study found no evidence nor trend for an association between orthostatic hypotension and blood lowering medications in geriatric inpatients.
The impact of pharmaceutical care on non-adherence in elderly polypharmacy patients
http://dx.doi.org/10.1016/j.eurger.2013.07.587 P520
Anticoagulation should be started in older patients with atrial fibrillation B. Boland , O. Dalleur , F. Maes , C. Scavée , S. Henrard Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium Introduction.– Older patients with atrial fibrillation and recommendation for anticoagulation (AC) often receive no AC but antiplatelet therapy (AP). We studied whether such an antithrombotic strategy is explained by a higher bleeding risk and/or a lower stroke risk in patients on AP only than in patients on AC. Methods.– Cross-sectional study in a teaching hospital (2008–2010, when AC was achieved using VKAntagonism). Inclusion criteria were older age (≥ 75 years), atrial fibrillation, recommended AC (CHADS2 ≥ 2), comprehensive geriatric assessment, and antithrombotic treatment upon admission (VKAntagonist and/or AP). Risks of AF-associated stroke and AC-associated bleeding were predicted using respectively CHADS2 and HEMORR2HAGES scores; the latter was adapted (×0.30) to predict severe bleeding (intracranial or fatal). Results.– AP only (n = 233) and AC (n = 389) patients were similar in demographics (85 ± 5 vs. 84 ± 5 years; nursing home 21 vs. 17%), geriatric syndromes (cognitive impairment 32 vs. 32%; malnutri-
P521
C. Olesen , P. Harbig , I. Barat , E.M. Damsgaard Department of Geriatric, Aarhus University Hospital, Aarhus, Denmark Introduction.– Elderly polypharmacy patients have an increased risk of medication non-adherence. Our aim was to study the impact of home-based pharmaceutical care on non-adherence to drugs used by elderly polypharmacy patients. Methods.– A randomised controlled trial with two arms (pharmaceutical care and control) was designed as part of an adherence study. It comprised 630 patients, living in Aarhus, Denmark, aged 65+ years, and using > 5 drugs without caretaker assistance. The intervention group received pharmaceutical care consisting of one visit and three telephone calls by a pharmacist during one year. Non-adherence was measured by pill count. A person was categorised as non-adherent if the mean non-adherence rate for all drugs consumed was < 80%. Impact of pharmaceutical care on nonadherence was analysed by a 2 × 2 table. Results.– In the final analyses 517 patients were included. Reasons for dropout were equal in the two groups except for more dropouts in the pharmaceutical care group, due to lack of interest. The median age was 74 years, 52% were females. The median adherence rate was 95%. Eleven percent in the pharmaceutical care group were non-adherent compared to ten in the control group (Odds ratio 1.14; 95% confidence interval 0.65–2.00). Conclusion.– There was no difference between patients receiving pharmaceutical care and those who did not. So we conclude that pharmaceutical care to elderly polypharmacy patients as described in our setting has no significant impact on adherence. However, pill counts may have increased adherence rate in both groups allowing little room for further improvement. http://dx.doi.org/10.1016/j.eurger.2013.07.589 P522
A survey on physicians’ knowledge and attitudes toward clinical use of opioids in nursing home facilities in The Netherlands C. Griffioen , S. Kouwenhoven , E. Willems Leiden University Medical Center, Leiden, The Netherlands Introduction.– Undertreatment of pain in vulnerable elderly living in long term care facilities is a common problem in elderly care medicine. Studies have shown that opiophobia contributes to insufficient pain management. Opiophobia and its related factors have not yet been studied in The Netherlands. The objective of this study was to measure the degree of knowledge of opioids of elderly care physicians (ECPs) and of physicians
9th congress of the EUGMS / European Geriatric Medicine 4 (2013) S142–S216
specializing in elderly care medicine in Dutch nursing homes and to determine factors that may influence clinical use of opioids in these facilities. Design.– A self-reported questionnaire was designed and distributed among ECPs (also those in training) via email, regional symposia and on all three academic training faculties for elderly care medicine. Results.– Three hundred and eighty-six ECPs and ECPs in training responded. The internal consistency (Cronbach’s alpha) of the questionnaire was 0.75. The highest knowledge scores were achieved by ECPs. Those who felt their knowledge of opioids was poor scored lower than those who felt their knowledge was good. Three main barriers in clinical use of opioids were identified: – patients’ reluctance to take opioids (82.7%); – unknown degree of pain (78.8.%); – pain of unknown origin (51.6%). Conclusion.– The factors identified in this study may provide valuable information for better pain management of vulnerable elderly living in a long term care facility: patient information about the pros and cons of opioids are heavily needed, next to tools for better clinical assessment of pain in a multi-morbidity population. http://dx.doi.org/10.1016/j.eurger.2013.07.590 P523
A comparison on medical and pharmacy sudents’ knowledge and skills on pharmacology and pharmacotherapy after graduating their Bachelor’s Degree C.J.P.W. Keijsers , J.R.B.J. Brouwers , D.J. de Wildt , E.J.F.M. Custers , O.T.J. ten Cate , P.A.F. Jansen University Medical Center Utrecht, Utrecht, The Netherlands Introduction.– Collaboration of pharmacists and physicians for medication reviews has increased interest over the years. The aim is to study if pharmacy and medical students differ on pharmacology and pharmacotherapy (P&P) knowledge and skills. Methods.– A cross-sectional design was used to test P&P knowledge in pharmacy and medical master students both from a PBL-based curriculum. A fifty question standardized formative assessment on bachelors’ level knowledge and skills was developed, containing the 3 domains. The assessment was validated on concurrent validity by an expert panel. Internal consistency was calculated with Guttman Labda. Mean scores in percentages per group on the domains and subdomains of the assessment were compared with use of an unpaired t-test and an ANCOVA. Results.– A total of 602 students were included (451 medical, 151 pharmacy students; period August 2010–July 2012, response rate 80.8% overall). On basic knowledge pharmacy students outscored the medical students (77.0% vs 68.2%, P 0.000, ␦ 0.88), on skills the medical students outscored the pharmacy students (68.6% vs 50.7%, P 0.000, ␦ 0.57). For case-based knowledge differences were in favor of the pharmacy students (73.8% vs 72.2%, P 0.007, ␦ 0.15). Conclusion.– Pharmacy master students outscored medical master students on basic knowledge on pharmacology. On case based knowledge differences were significant, but too small to be relevant. On skills medical students outscored pharmacy students. It is likely that both students’ knowledge can complement each other. Therefore, collaborations on the level of education can be useful. http://dx.doi.org/10.1016/j.eurger.2013.07.591 P524
Benzodiazepines dependence in elderly people over 65 years old C.M. Sarabia , C. Castanedo University of Cantabria, Santander, Spain
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Objective.– The aim was to describe and compare sociodemographic and clinical features related to the prescription and benzodiazepines (BDZ) use in old people with and without dependence to these drugs in a nursing home in Santander, Spain. Method.– A total of 53 patients were recruited. Diagnosis of BDZ dependence was obtained with the SCID-I Interview, the severity of depression and anxiety symptoms were evaluated through the Montgomery & Asberg Scale (MADRS) and the Hamilton Anxiety Scale, respectively. Results.– No significant differences were found between patients with and without BDZ dependence in terms of social and demographic characteristics and medical comorbidity. The mean age of BDZ use onset and the time of consumption were 60.2 years and 587.3 weeks, respectively. Significant differences were found between groups in terms of BDZ consumption features. Patients with BDZ dependence exhibited more drug seeking behavior, more abandonment of daily activities, and more tolerance and abstinence symptoms. Patients with BDZ dependence exhibited more prominent symptoms of anxiety and depression than patients without BDZ dependence. Also, these patients had a poorer cognitive performance and lower psychosocial functioning. Conclusions.– BDZ dependence is a complex phenomenon related to the severity of depressive and anxiety symptoms. Sociodemographic characteristics in this sample were not related to the presence of BDZ dependence; nevertheless, it has been reported that the female gender and the presence of chronic pain are risk. http://dx.doi.org/10.1016/j.eurger.2013.07.592 P525
Diagnosis of frailty in older adults C.M. Sarabia , C. Castanedo , B. Torres University of Cantabria, Santander, Spain Objectives.– To make a diagnosis of frailty in an older adult population living in an urban area in Cantabria, Spain. Methods.– An observational, descriptive and cross-sectional study was conducted in a population aged over 60 years in 2012. The universe of older people was made up of 329 persons. For estimating the fragility prevalence, the Geriatric Scale of Functional Assessment was applied to all the elderly included in the study and they were then classified as frail and non-frail according to the present Cuban criteria. The collected information served to make a database for the analysis through frequency distributions basically. Results.– Of the studied older people, 47.9% were identified as frail. It was found that the prevailing frailty criterion was consumption of many drugs (29.5%) and that the relative risk of frailty in female elder is 1.06 higher than the male older person, that is to say, the frailty condition was associated to the feminine sex. Conclusions.– Frailty in older people is a highly prevalent condition in the Santander’s people, in which the consumption of many drugs has great incidence. http://dx.doi.org/10.1016/j.eurger.2013.07.593 P526
Rhabdomyolysis after amiodarone therapy D. Schmidt a,b , H. Topp a,b , M. Gogol a,b Krankenhaus Lindenbrunn Coppenbruegge, Coppenbrügge, Germany b Sana Klinikum Hameln Pyrmont Hameln, Hameln, Germany a
Introduction.– Rhabdomyolysis is a rare but serious complication of diseases and drug therapy leading to muscle weakness and ADL dependence. Methods.– We present a case of a 76-year-old male entering our rehabilitation department after 4 weeks of in-hospital treatment for severe rhabdomyolysis. After a ventricular tachycardia by
9th congress of the EUGMS / European Geriatric Medicine 4 (2013) S142–S216
Conclusions.– In this representative older population, treatment with melatonin did not improve incidence of delirium. Our findings do support the use of preoperative melatonin to decrease the prevalence of longer lasting delirium in vulnerable older hip fracture patients. http://dx.doi.org/10.1016/j.eurger.2013.07.586 P519
Blood lowering medications are not related to orthostatic hypotension
tion 44 vs. 45%) and the 12 co-morbidities belonging to CHADS2 and/or HEMORR2HAGES scores (excepted of course for reduced platelet function: 100 vs. 45%). Stroke risk was similar in AP and AC patients (7.1 ± 3.5 vs. 7.0 ± 3.3%/year). Severe bleeding risk was slightly higher in AP than in AC (3.2 ± 0.3 vs. 2.8 ± 0.7%/year), but similar when no point was given for AP in HEMORR2HAGES score. Conclusions.– No clinical reason justifies withholding anticoagulation in older patients with atrial fibrillation and high stroke risk. When prescribing long-term anticoagulation, clinicians may withdraw antiplatelet therapy in patients without recent ischemic event or stenting to reduce their bleeding risk.
B. Boland , D. Kajungu , N. Speybroek , F. Vaillant Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
http://dx.doi.org/10.1016/j.eurger.2013.07.588
Introduction.– Orthostatic hypotension (OH) in geriatric patients is often considered to be related to blood lowering medications (BLM). We tested the hypothesis that this might not be the case. Methods.– OH (≥ 20/10 mmHg decrease in systolic/diastolic blood pressure) was screened in 100 older inpatients (85 ± 5 years, 59% women) able to stand up (3 minutes) during the first two days after admission in an academic geriatric ward. We analyzed the use of BLM (ACE/angiotensin inhibitors, calcium channel blockers, -blockers, diuretics, ␣1-blockers, central ␣-agonists, nitrates) and expressed their dosage with the number of defined daily dose (DDD). Results.– No difference in BLM was observed between 33 patients with OH and 67 patients without OH in terms of use (73 vs. 85%), number (1.76 vs. 1.57 drugs) or mean dosage (1.8 vs. 1.7 DDD). No statistical difference was found at the drug level between patients with and those without OH (ACE/angiotensin inhibitors 42 vs. 42%; calcium channel blockers 24 vs. 24%; -blockers 48 vs. 37%; diuretics 30 vs. 30%; ␣1-blockers 12 vs. 6%, nitrates 9 vs. 6%; central ␣-agonists 3 vs. 1%). OH prevalence was 30% in the 80 patients receiving BLM and 45% in the 20 other patients (P = 0.31). OH prevalence was not associated with BLM number (Odds Ratio 1.09 per unit of DDD increase, 95% CI: 0.8–1.5, P = 0.57), nor with their dosage (Odds Ratio 1.04, 95% CI: 0.8–1.3, P = 0.74). Conclusion.– This study found no evidence nor trend for an association between orthostatic hypotension and blood lowering medications in geriatric inpatients.
The impact of pharmaceutical care on non-adherence in elderly polypharmacy patients
http://dx.doi.org/10.1016/j.eurger.2013.07.587 P520
Anticoagulation should be started in older patients with atrial fibrillation B. Boland , O. Dalleur , F. Maes , C. Scavée , S. Henrard Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium Introduction.– Older patients with atrial fibrillation and recommendation for anticoagulation (AC) often receive no AC but antiplatelet therapy (AP). We studied whether such an antithrombotic strategy is explained by a higher bleeding risk and/or a lower stroke risk in patients on AP only than in patients on AC. Methods.– Cross-sectional study in a teaching hospital (2008–2010, when AC was achieved using VKAntagonism). Inclusion criteria were older age (≥ 75 years), atrial fibrillation, recommended AC (CHADS2 ≥ 2), comprehensive geriatric assessment, and antithrombotic treatment upon admission (VKAntagonist and/or AP). Risks of AF-associated stroke and AC-associated bleeding were predicted using respectively CHADS2 and HEMORR2HAGES scores; the latter was adapted (×0.30) to predict severe bleeding (intracranial or fatal). Results.– AP only (n = 233) and AC (n = 389) patients were similar in demographics (85 ± 5 vs. 84 ± 5 years; nursing home 21 vs. 17%), geriatric syndromes (cognitive impairment 32 vs. 32%; malnutri-
P521
C. Olesen , P. Harbig , I. Barat , E.M. Damsgaard Department of Geriatric, Aarhus University Hospital, Aarhus, Denmark Introduction.– Elderly polypharmacy patients have an increased risk of medication non-adherence. Our aim was to study the impact of home-based pharmaceutical care on non-adherence to drugs used by elderly polypharmacy patients. Methods.– A randomised controlled trial with two arms (pharmaceutical care and control) was designed as part of an adherence study. It comprised 630 patients, living in Aarhus, Denmark, aged 65+ years, and using > 5 drugs without caretaker assistance. The intervention group received pharmaceutical care consisting of one visit and three telephone calls by a pharmacist during one year. Non-adherence was measured by pill count. A person was categorised as non-adherent if the mean non-adherence rate for all drugs consumed was < 80%. Impact of pharmaceutical care on nonadherence was analysed by a 2 × 2 table. Results.– In the final analyses 517 patients were included. Reasons for dropout were equal in the two groups except for more dropouts in the pharmaceutical care group, due to lack of interest. The median age was 74 years, 52% were females. The median adherence rate was 95%. Eleven percent in the pharmaceutical care group were non-adherent compared to ten in the control group (Odds ratio 1.14; 95% confidence interval 0.65–2.00). Conclusion.– There was no difference between patients receiving pharmaceutical care and those who did not. So we conclude that pharmaceutical care to elderly polypharmacy patients as described in our setting has no significant impact on adherence. However, pill counts may have increased adherence rate in both groups allowing little room for further improvement. http://dx.doi.org/10.1016/j.eurger.2013.07.589 P522
A survey on physicians’ knowledge and attitudes toward clinical use of opioids in nursing home facilities in The Netherlands C. Griffioen , S. Kouwenhoven , E. Willems Leiden University Medical Center, Leiden, The Netherlands Introduction.– Undertreatment of pain in vulnerable elderly living in long term care facilities is a common problem in elderly care medicine. Studies have shown that opiophobia contributes to insufficient pain management. Opiophobia and its related factors have not yet been studied in The Netherlands. The objective of this study was to measure the degree of knowledge of opioids of elderly care physicians (ECPs) and of physicians
9th congress of the EUGMS / European Geriatric Medicine 4 (2013) S142–S216
specializing in elderly care medicine in Dutch nursing homes and to determine factors that may influence clinical use of opioids in these facilities. Design.– A self-reported questionnaire was designed and distributed among ECPs (also those in training) via email, regional symposia and on all three academic training faculties for elderly care medicine. Results.– Three hundred and eighty-six ECPs and ECPs in training responded. The internal consistency (Cronbach’s alpha) of the questionnaire was 0.75. The highest knowledge scores were achieved by ECPs. Those who felt their knowledge of opioids was poor scored lower than those who felt their knowledge was good. Three main barriers in clinical use of opioids were identified: – patients’ reluctance to take opioids (82.7%); – unknown degree of pain (78.8.%); – pain of unknown origin (51.6%). Conclusion.– The factors identified in this study may provide valuable information for better pain management of vulnerable elderly living in a long term care facility: patient information about the pros and cons of opioids are heavily needed, next to tools for better clinical assessment of pain in a multi-morbidity population. http://dx.doi.org/10.1016/j.eurger.2013.07.590 P523
A comparison on medical and pharmacy sudents’ knowledge and skills on pharmacology and pharmacotherapy after graduating their Bachelor’s Degree C.J.P.W. Keijsers , J.R.B.J. Brouwers , D.J. de Wildt , E.J.F.M. Custers , O.T.J. ten Cate , P.A.F. Jansen University Medical Center Utrecht, Utrecht, The Netherlands Introduction.– Collaboration of pharmacists and physicians for medication reviews has increased interest over the years. The aim is to study if pharmacy and medical students differ on pharmacology and pharmacotherapy (P&P) knowledge and skills. Methods.– A cross-sectional design was used to test P&P knowledge in pharmacy and medical master students both from a PBL-based curriculum. A fifty question standardized formative assessment on bachelors’ level knowledge and skills was developed, containing the 3 domains. The assessment was validated on concurrent validity by an expert panel. Internal consistency was calculated with Guttman Labda. Mean scores in percentages per group on the domains and subdomains of the assessment were compared with use of an unpaired t-test and an ANCOVA. Results.– A total of 602 students were included (451 medical, 151 pharmacy students; period August 2010–July 2012, response rate 80.8% overall). On basic knowledge pharmacy students outscored the medical students (77.0% vs 68.2%, P 0.000, ␦ 0.88), on skills the medical students outscored the pharmacy students (68.6% vs 50.7%, P 0.000, ␦ 0.57). For case-based knowledge differences were in favor of the pharmacy students (73.8% vs 72.2%, P 0.007, ␦ 0.15). Conclusion.– Pharmacy master students outscored medical master students on basic knowledge on pharmacology. On case based knowledge differences were significant, but too small to be relevant. On skills medical students outscored pharmacy students. It is likely that both students’ knowledge can complement each other. Therefore, collaborations on the level of education can be useful. http://dx.doi.org/10.1016/j.eurger.2013.07.591 P524
Benzodiazepines dependence in elderly people over 65 years old C.M. Sarabia , C. Castanedo University of Cantabria, Santander, Spain
S177
Objective.– The aim was to describe and compare sociodemographic and clinical features related to the prescription and benzodiazepines (BDZ) use in old people with and without dependence to these drugs in a nursing home in Santander, Spain. Method.– A total of 53 patients were recruited. Diagnosis of BDZ dependence was obtained with the SCID-I Interview, the severity of depression and anxiety symptoms were evaluated through the Montgomery & Asberg Scale (MADRS) and the Hamilton Anxiety Scale, respectively. Results.– No significant differences were found between patients with and without BDZ dependence in terms of social and demographic characteristics and medical comorbidity. The mean age of BDZ use onset and the time of consumption were 60.2 years and 587.3 weeks, respectively. Significant differences were found between groups in terms of BDZ consumption features. Patients with BDZ dependence exhibited more drug seeking behavior, more abandonment of daily activities, and more tolerance and abstinence symptoms. Patients with BDZ dependence exhibited more prominent symptoms of anxiety and depression than patients without BDZ dependence. Also, these patients had a poorer cognitive performance and lower psychosocial functioning. Conclusions.– BDZ dependence is a complex phenomenon related to the severity of depressive and anxiety symptoms. Sociodemographic characteristics in this sample were not related to the presence of BDZ dependence; nevertheless, it has been reported that the female gender and the presence of chronic pain are risk. http://dx.doi.org/10.1016/j.eurger.2013.07.592 P525
Diagnosis of frailty in older adults C.M. Sarabia , C. Castanedo , B. Torres University of Cantabria, Santander, Spain Objectives.– To make a diagnosis of frailty in an older adult population living in an urban area in Cantabria, Spain. Methods.– An observational, descriptive and cross-sectional study was conducted in a population aged over 60 years in 2012. The universe of older people was made up of 329 persons. For estimating the fragility prevalence, the Geriatric Scale of Functional Assessment was applied to all the elderly included in the study and they were then classified as frail and non-frail according to the present Cuban criteria. The collected information served to make a database for the analysis through frequency distributions basically. Results.– Of the studied older people, 47.9% were identified as frail. It was found that the prevailing frailty criterion was consumption of many drugs (29.5%) and that the relative risk of frailty in female elder is 1.06 higher than the male older person, that is to say, the frailty condition was associated to the feminine sex. Conclusions.– Frailty in older people is a highly prevalent condition in the Santander’s people, in which the consumption of many drugs has great incidence. http://dx.doi.org/10.1016/j.eurger.2013.07.593 P526
Rhabdomyolysis after amiodarone therapy D. Schmidt a,b , H. Topp a,b , M. Gogol a,b Krankenhaus Lindenbrunn Coppenbruegge, Coppenbrügge, Germany b Sana Klinikum Hameln Pyrmont Hameln, Hameln, Germany a
Introduction.– Rhabdomyolysis is a rare but serious complication of diseases and drug therapy leading to muscle weakness and ADL dependence. Methods.– We present a case of a 76-year-old male entering our rehabilitation department after 4 weeks of in-hospital treatment for severe rhabdomyolysis. After a ventricular tachycardia by