Orthostatic hypotension: clinical review and case study

Transient loss of consciousness (TLOC) accounts for 3% of all attendance in emergency departments within the UK. More than 90% of TLOC presentations are due to epileptic seizures, psychogenic seizures or syncope. However, in England and Wales in 2002, it was estimated that 92000 patients were incorrectly diagnosed with epilepsy, at an additional annual cost to the NHS of up to £189 million. This article will reflect on the case study of a 54-year-old female patient who presented with a possible TLOC, and had a background of long-term depression. Differential diagnoses will be discussed, but the article will focus on orthostatic hypotension. Being diagnosed with this condition is independently associated with an increased risk of all-cause mortality. Causes of orthostatic hypotension and the pathophysiology behind the condition will be discussed, highlighting the importance of obtaining an accurate clinical history. This is extremely pertinent if a patient collapses in an NHS setting and this is witnessed by nurses because they can contribute to the history of the type of collapse, to aid diagnosis and correct treatment. In addition, nurses have a valuable role to play in highlighting polypharmacy to doctors, and non-medical prescribers, as a contributing factor to orthostatic hypotension is polypharmacy. It is therefore important to accurately distinguish TLOC aetiology, not only to provide appropriate management, but to also identify patients at risk of morbidity/mortality related to underlying disease.N/

The social dimensions of a river’s environmental quality assessment

International audienceIntegrated water resources management, promoted in developed countries, obliges to integrate social aspects with hydrological and ecological dimensions when assessing river quality. To better understand these social aspects, we propose a mixed-method to study public perceptions of an impounded river. Since the 1930s, the management of the Ain river (France) has been challenged by conflicts about the river's quality. We surveyed (using interviews and mental maps) various stakeholders along the river. The results based on textual and content analysis show variations in the public's perceptions according to the residence area, practices, and the degree of emotional attachment to the river. The assessment of environmental quality needs to take into account different types of knowledge, sometimes conflicting, that reveal and shape the variety of waterscapes which compose the Ain River. The social dimensions highlight integrated water management's inherent complexity by considering the river basin as a place to live and by involving multiple stakeholders