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Lartigau M, Barateau M, Rosé M, Petricã N, Salles N. Pressure ulcer prevention devices in the management of older patients at risk after hospital discharge: an SNDS study. J Wound Care 2023; 32:clxxi-clxxx. [PMID: 37703220 DOI: 10.12968/jowc.2023.32.sup9a.clxxi] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
OBJECTIVE Our aim was to measure the effectiveness of home healthcare pressure ulcer (PU) prevention devices (PUPDs) for at-risk patients after hospital discharge in France. METHOD We conducted a retrospective analysis of PU-associated hospitalisations based on the French medico-administrative database (Système National des Données de Santé, SNDS), which covers the entire French population. All adults >70 years of age, hospitalised from 1 July to 31 December 2015, and equipped with a medical bed at home, were included. Follow-up was for a maximum of 18 months. Propensity score matching allowed the comparison of PUPD equipped and non-equipped groups (No-PUPD), considering sociodemographic characteristics and other factors. RESULTS The study included 43,078 patients. Of this population, 54% were PUPD patients and 46% No-PUPD. After matching, PUPD patients had significantly fewer PUs than No-PUPD patients (5.5% versus 8.9%, respectively; p<0.001). The adoption of PUPD reduced by 39% the risk of a PU in hospital. Patients equipped within the first 30 days at home after hospitalisation had fewer PUs than those equipped later (4.8% versus 5.9%, respectively). The estimated PUPD use costs represented 1% of total healthcare expenditure per patient during the study period. CONCLUSION The study results demonstrated the effectiveness of the adoption of mattress toppers or prevention mattresses in reducing PU occurrence in patients aged >70 years of age. A short delay in PUPD delivery appeared to have a real impact in the medical setting. Future research on a larger population might provide more evidence on the appropriate support and timeframe to choose based on risk assessment.
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Affiliation(s)
- Marion Lartigau
- Department of Clinical Gerontology, University Hospital, Bordeaux, 33000 France
| | - Martine Barateau
- Department of Clinical Gerontology, University Hospital, Bordeaux, 33000 France
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Lartigau M, Ouattara E, Tumiotto C, Wodrich H, Busson L, Trimoulet P, Thiel E, Nouzille M, Dubos M, Lafon ME, Gilleron V, Dehail P, Salles N, Malvy D. Post-vaccination SARS-cov-2 infection in nursing home residents, Bordeaux, France. J Clin Virol 2022; 149:105134. [PMID: 35313222 PMCID: PMC8923035 DOI: 10.1016/j.jcv.2022.105134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/08/2022] [Accepted: 03/14/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To describe COVID-19 breakthrough infections in two nursing homes (NHs) sites of active COVID-19 clusters despite optimal vaccination coverage. METHODS A cross-sectional study was conducted in two NHs of south-western France, following the investigation of COVID-19 clusters (February-March 2021). SARS-CoV-2-confirmed infection was defined by positive RT-PCR. Antibodies neutralization capacities were tested in a subgroup of fully-vaccinated and seropositive-residents. RESULTS Of the 152 residents, 66% were female with median age 87 years (IQR: 80.0-90.2). Overall, 132 (87%) residents received 2 doses of vaccine, 14 (9%) one dose and 6 (4%) were unvaccinated. Forty-seven (31%) residents had confirmed infection (45 (98%) with variant 20I/501Y.V1). All 6 non-vaccinated residents, 4 /14 who had one dose and 37/132 that had two doses, were infected. Of the 39 residents reporting symptoms, 12 and 3 presented severe and critical disease, respectively. One resident with a confirmed infection died. Infected-residents had a median anti-S IgG titre of 19 116.0 (IQR: 3 028.0-39 681.8 AU/mL), 19 times higher than that of non-infected vaccinated persons (1,207.0; IQR: 494.0-2,782.0). In the subgroup of 19 residents tested for neutralizing antibodies, the neutralizing titre (50%) was strongly positively correlated with the anti-S IgG titre (correlation coefficient = 0.83), and 1.5 times higher for the infected than non-infected residents [5.9 (IQR: 5.3-6.9) vs. 3.6 (2.9-3.8)]. CONCLUSION Institutionalized elderly persons who undergo breakthrough infection develop higher titres of anti-S IgGs, which are strongly correlated with the neutralizing capacity of the antibodies. These results advocate for additional vaccine doses in this population.
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Affiliation(s)
- Marion Lartigau
- Department of Clinical Gerontology, University Hospital Centre Bordeaux, Bordeaux, France
| | - Eric Ouattara
- Medical Information Department, Medical information Analysis and Coordination Unit (UCAIM-DIM), University Hospital Centre Bordeaux, Bordeaux, France.
| | - Camille Tumiotto
- Virology Laboratory, University Hospital Centre Bordeaux, Bordeaux, France; CNRS UMR5234, Fundamental Microbiology and Pathogenicity, University Hospital Centre Bordeaux, Bordeaux, France
| | - Harald Wodrich
- CNRS UMR5234, Fundamental Microbiology and Pathogenicity, University Hospital Centre Bordeaux, Bordeaux, France
| | - Laurent Busson
- Virology Laboratory, University Hospital Centre Bordeaux, Bordeaux, France
| | - Pascale Trimoulet
- Virology Laboratory, University Hospital Centre Bordeaux, Bordeaux, France
| | - Elise Thiel
- Department of Clinical Gerontology, University Hospital Centre Bordeaux, Bordeaux, France
| | - Mahissata Nouzille
- Department of Clinical Gerontology, University Hospital Centre Bordeaux, Bordeaux, France
| | - Maria Dubos
- Department of Clinical Gerontology, University Hospital Centre Bordeaux, Bordeaux, France
| | - Marie-Edith Lafon
- Virology Laboratory, University Hospital Centre Bordeaux, Bordeaux, France; CNRS UMR5234, Fundamental Microbiology and Pathogenicity, University Hospital Centre Bordeaux, Bordeaux, France
| | - Véronique Gilleron
- Medical Information Department, Medical information Analysis and Coordination Unit (UCAIM-DIM), University Hospital Centre Bordeaux, Bordeaux, France; Inserm U1219 / Bordeaux Population Health Research Center, Population Health trAnslational Research (PHARes), Universty of Bordeaux, Bordeaux, France
| | - Patrick Dehail
- Inserm U1219 / IRD, University Hospital Centre Bordeaux, Bordeaux, France; Nouvelle-Aquitaine Regional Health Agency, Bordeaux, France
| | - Nathalie Salles
- Department of Clinical Gerontology, University Hospital Centre Bordeaux, Bordeaux, France.
| | - Denis Malvy
- Department of Infectious Diseases and Tropical Medicine, Division of Tropical Medicine and Clinical International Health, University Hospital Centre Bordeaux, Bordeaux, France; Inserm U1219 / IRD, University Hospital Centre Bordeaux, Bordeaux, France
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