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Visade F, Beuscart JB, Norberciak L, Deschasse G, Babykina G. New horizons in the analysis of hospital readmissions of older adults. Aging Clin Exp Res 2023; 35:2267-2270. [PMID: 37515712 DOI: 10.1007/s40520-023-02514-8] [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] [Received: 05/15/2023] [Accepted: 07/19/2023] [Indexed: 07/31/2023]
Abstract
This short communication highlights analytical methods that can be usefully applied to the problem of hospital readmissions of older adults. The limitations of the models currently used in studies of hospital readmissions are described. In summary, analyses of hospital readmissions face two important methodological and statistical problems not accounted for by these currently used statistical models: the potential recurrence of readmissions, and death, a terminal event which absorbs the readmission process. Not addressing the issue raised by recurrent events and terminal event generates biased estimates. We discuss an approach for the analysis of hospital readmission risk and death in the same framework. Understanding the features of this kind of approaches is essential at a time when high-quality data on hospital readmission in older patients are becoming available to a large number of researchers. Models adapted for the analysis of recurrent and terminal events are presented, and their application to studies of hospital readmission are explained, with reference to two cohorts of several thousand older individuals.
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Affiliation(s)
- Fabien Visade
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000, Lille, France.
- Department of Geriatrics, Lille Catholic Hospitals, 59000, Lille, France.
| | - Jean-Baptiste Beuscart
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000, Lille, France
| | - Laurène Norberciak
- Research Department, Biostatistics, Lille Catholic Hospitals, 59000, Lille, France
| | - Guillaume Deschasse
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000, Lille, France
- Department of Geriatrics, CHU Amiens-Picardie, 80054, Amiens, France
| | - Genia Babykina
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000, Lille, France
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Pascart T, Robinet P, Ottaviani S, Leroy R, Segaud N, Pacaud A, Grandjean A, Luraschi H, Rabin T, Deplanque X, Maciejasz P, Visade F, Mackowiak A, Baclet N, Maréchaux S, Lefebvre A, Budzik JF, Bardin T, Richette P, Norberciak L, Ducoulombier V, Houvenagel E. Evaluating the safety and short-term equivalence of colchicine versus prednisone in older patients with acute calcium pyrophosphate crystal arthritis (COLCHICORT): an open-label, multicentre, randomised trial. Lancet Rheumatol 2023; 5:e523-e531. [PMID: 38251496 DOI: 10.1016/s2665-9913(23)00165-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/07/2023] [Accepted: 06/13/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Acute calcium pyrophosphate crystal arthritis causes intense joint pain mainly affecting older people. Because guidance and evidence remain scarce, management of this disease relies on expert opinion. We therefore aimed to compare the safety and short-term equivalence of low-dose colchicine with oral prednisone in older patients with acute calcium pyrophosphate crystal arthritis. METHODS We did an open-label, multicentre, randomised, trial (COLCHICORT) at six hospitals in Paris and northern France. We enrolled patients who were admitted to hospital who were 65 years or older and who presented with acute calcium pyrophosphate crystal arthritis with a symptom duration of less than 36 h. Diagnosis of calcium pyrophosphate crystal arthritis was made by the identification of calcium pyrophosphate crystals on synovial fluid analysis or typical clinical presentation (onset of joint pain and swelling). Key exclusion criteria included absence of calcium pyrophosphate crystals on synovial fluid analysis or a history of gout. Participants were randomly allocated (1:1), using a centralised electronic treatment group allocation module, to receive either colchicine 1·5 mg on day 1 and 1 mg on day 2 (ie, the colchicine group) or oral prednisone 30 mg on days 1 and 2 (ie, the prednisone group). The primary outcome was change in joint pain (measured by visual analogue scale [VAS] from 0 mm to 100 mm) at 24 h. Equivalence was determined whether the 95% CI of the between-group difference at 24 h was within the -13 mm to +13 mm margin in the per-protocol analysis. Adverse events were recorded using the National Cancer Institute Common Terminology Criteria for Adverse Events (version 4.0). This trial is completed and is registered with ClinicalTrials.gov, NCT03128905. FINDINGS Between Feb 5, 2018, and May 7, 2022, 111 patients who were admitted to hospital were randomly assigned (57 [51%] to the colchicine group and 54 [49%] to the prednisone group). 95 (86%) of 111 patients were included in the per-protocol analysis (49 [52%] in the colchicine group and 46 [48%] in the prednisone group). The median age was 88·0 years (IQR 82·0-91·0) and 69 (73%) of 95 participants were women and 26 (27%) were men. Acute calcium pyrophosphate crystal arthritis affected mainly the knee in 46 (48%) of 95 participants, the wrist in 19 (20%), and the ankle in 12 (13%). Pain VAS at baseline was 68 mm (SD 17). At 24 h, change in pain VAS was -36 mm (SD 32) in the colchicine group and -38 mm (SD 23) in the prednisone group. The between-group difference in change in pain VAS at 24 h was -1 mm (95% CI -12 to 10), showing equivalence between the two drugs. In the colchicine group, 12 (22%) of 55 patients had diarrhoea, one (2%) had hypertension, and none had hyperglycaemia. In the prednisone group, three (6%) of 54 had diarrhoea, six (11%) had hypertension, and three (6%) had hyperglycaemia. No deaths occurred in the colchicine group; two deaths occurred in the prednisone group, which were deemed unrelated to prednisone (one due to infectious valvular endocarditis leading to heart failure, and one due to a stroke). INTERPRETATION Colchicine and prednisone exhibit equivalent short-term efficacy for the treatment of acute calcium pyrophosphate crystal arthritis, with different safety profiles in the older population. FUNDING French Inter-regional Hospital Program of Clinical Research.
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Affiliation(s)
- Tristan Pascart
- Department of Rheumatology, Hôpital Saint-Philibert, Université Catholique de Lille, Lomme, France.
| | - Pierre Robinet
- Department of Geriatrics, Hôpital Saint-Philibert, Université Catholique de Lille, Lomme, France
| | | | - Rémi Leroy
- Department of Rheumatology, Centre Hospitalier de Dunkerque, Dunkirk, France
| | - Nicolas Segaud
- Department of Internal Medicine, Centre Hospitalier d'Armentières, Armentières, France
| | - Aurore Pacaud
- Department of Rheumatology, Hôpital Saint-Philibert, Université Catholique de Lille, Lomme, France
| | - Agathe Grandjean
- Department of Rheumatology, Hôpital Saint-Philibert, Université Catholique de Lille, Lomme, France
| | - Hélène Luraschi
- Department of Rheumatology, Hôpital Saint-Vincent-de-Paul, Université Catholique de Lille, Lille, France
| | - Thibault Rabin
- Department of Rheumatology, Hôpital Saint-Philibert, Université Catholique de Lille, Lomme, France
| | - Xavier Deplanque
- Department of Geriatrics, Hôpital Saint-Vincent-de-Paul, Université Catholique de Lille, Lille, France
| | - Pierre Maciejasz
- Department of Geriatrics, Hôpital Saint-Vincent-de-Paul, Université Catholique de Lille, Lille, France
| | - Fabien Visade
- Department of Geriatrics, Hôpital Saint-Philibert, Université Catholique de Lille, Lomme, France
| | - Alexandre Mackowiak
- Department of Neurology, Hôpital Saint-Philibert, Université Catholique de Lille, Lomme, France
| | - Nicolas Baclet
- Department of Internal Medicine, Hôpital Saint-Vincent-de-Paul, Université Catholique de Lille, Lille, France
| | - Sylvestre Maréchaux
- Department of Cardiology, Hôpital Saint-Philibert, Université Catholique de Lille, Lomme, France
| | - Antoine Lefebvre
- Department of Pharmacy, Hôpital Saint-Philibert, Université Catholique de Lille, Lomme, France
| | - Jean-François Budzik
- Department of Radiology, Hôpital Saint-Philibert, Université Catholique de Lille, Lomme, France
| | - Thomas Bardin
- Department of Rheumatology, Hôpital Lariboisière APHP Paris Nord, INSERM, UMR 1132, Bioscar, Paris, France
| | - Pascal Richette
- Department of Rheumatology, Hôpital Lariboisière APHP Paris Nord, INSERM, UMR 1132, Bioscar, Paris, France
| | - Laurène Norberciak
- Research Department-Biostatistics and Methodology, Hôpital Saint-Philibert, Université Catholique de Lille, Lomme, France
| | - Vincent Ducoulombier
- Department of Rheumatology, Hôpital Saint-Philibert, Université Catholique de Lille, Lomme, France
| | - Eric Houvenagel
- Department of Rheumatology, Hôpital Saint-Philibert, Université Catholique de Lille, Lomme, France
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Komenan K, Bouveret P, Delecluse C, Robinet P, Puisieux F, Visade F. A Qualitative Analysis of the Optimal Discharge Summary: Effective Communication of Medication Changes for Older Patients. J Appl Gerontol 2023; 42:871-878. [PMID: 36514276 DOI: 10.1177/07334648221145847] [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: 12/15/2022] Open
Abstract
Background: The importance of the discharge summary (DS) is well recognized. The format to be used is also important, but this aspect has not yet been studied in the literature. The purpose of this work was to establish a DS format for older patients that ensures effective communication with general practitioners (GPs). Methods: This study was based on the grounded theory approach to qualitative analysis. Data was collected from GPs during semi-structured and directive interviews. Results: Semi-structured interviews were conducted with 12 GPs and directive interviews with 39 GPs. A consensus was reached on one DS version providing selected information items such as trends in laboratory results (rising/falling) and information about planned drug withdrawals or specialist consultations. Conclusion: This work led to a consensus on the most appropriate format for the DS for older patients returning home. Its use in routine practice is needed to confirm its reception by GPs.
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Affiliation(s)
- Ked Komenan
- General Medicine Department, 27023University of Lille, Lille, France
| | - Perrine Bouveret
- Department of Geriatrics, Lille Catholic Hospitals, Lille, France
| | - Céline Delecluse
- Department of Geriatrics, Lille Catholic Hospitals, Lille, France
| | - Pierre Robinet
- Department of Geriatrics, Lille Catholic Hospitals, Lille, France
| | | | - Fabien Visade
- Department of Geriatrics, Lille Catholic Hospitals, Lille, France
- University Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, France
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Deschasse G, Drumez E, Visade F, Charpentier A, Delecluse C, Loggia G, Lescure P, Attier-Żmudka J, Bloch J, Gaxatte C, Bloch F, Puisieux F, Beuscart JB. Factors Associated with Transfer from an Acute Geriatric Unit to a Post-Acute Care Facility among Community-Dwelling Patients: Results from the DAMAGE Cohort. Clin Interv Aging 2022; 17:1821-1832. [DOI: 10.2147/cia.s370562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 09/14/2022] [Indexed: 12/13/2022] Open
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Deschasse G, Charpentier A, Prodhomme C, Genin M, Delecluse C, Gaxatte C, Gérard C, Bukor Z, Devulde P, Couvreur LA, Bloch F, Puisieux F, Visade F, Beuscart JB. Transition to Comfort Care Only and End-of-Life Trajectories in an Acute Geriatric Unit: A Secondary Analysis of the DAMAGE Cohort. J Am Med Dir Assoc 2022; 23:1492-1498. [DOI: 10.1016/j.jamda.2022.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/11/2022] [Accepted: 04/24/2022] [Indexed: 10/18/2022]
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Visade F, Babykina G, Puisieux F, Bloch F, Charpentier A, Delecluse C, Loggia G, Lescure P, Attier-Żmudka J, Gaxatte C, Deschasse G, Beuscart JB. Risk Factors for Hospital Readmission and Death After Discharge of Older Adults from Acute Geriatric Units: Taking the Rank of Admission into Account. Clin Interv Aging 2021; 16:1931-1941. [PMID: 34744433 PMCID: PMC8565893 DOI: 10.2147/cia.s327486] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/15/2021] [Indexed: 11/23/2022] Open
Abstract
Objective To analyze the impact of the number of hospital readmissions on the risks of further hospital readmission and death after adjustment for a range of risk factors. Methods We performed a multicentre prospective study of the DAMAGE cohort in the Hauts-de-France region of France. Patients aged 75 and over hospitalized initially in an acute geriatric unit (AGU) were included and followed up for 12 months. The risk of hospital readmission was analyzed using a Cox model, and its extension for recurrent events and the risk of death were analyzed using a Cox model for time-dependent variables. Results A total of 3081 patients were included (mean (SD) age: 86.4 (5.5)). In the multivariate analysis, the relative risk (95% confidence interval [CI]) of hospital readmission rose progressively to 2.66 (1.44; 5.14), and the risk of death rose to 2.01 (1.23; 3.32) after five hospital admissions, relative to a patient with no hospital readmissions. The number of hospital readmissions during the follow-up period was the primary risk factor and the best predictor of the risk of hospital readmission and the risk of death. Conclusion Hospital readmission is the primary risk factor for further hospital readmissions and for death in older subjects discharged from an AGU.
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Affiliation(s)
- Fabien Visade
- University Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, F-59000, France.,Geriatrics Department, Lille Catholic Hospitals, Lille, F-59000, France
| | - Genia Babykina
- University Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, F-59000, France
| | | | - Frédéric Bloch
- Department of Geriatrics, CHU Amiens-Picardie, Amiens, F-80054, France.,Laboratory of Functional Neurosciences EA 4559, University of Picardie - Jules-Verne, Amiens, France
| | | | - Céline Delecluse
- Geriatrics Department, Lille Catholic Hospitals, Lille, F-59000, France
| | - Gilles Loggia
- UNICAEN, INSERM, COMETE, Normandie Univ, Caen, France.,Department of Geriatrics, Normandie Univ, UNICAEN, CHU de Caen Normandie, Caen, France
| | - Pascale Lescure
- Department of Geriatrics, Normandie Univ, UNICAEN, CHU de Caen Normandie, Caen, France
| | - Jadwiga Attier-Żmudka
- Geriatric Department, General Hospital of Saint-Quentin, Saint-Quentin, France.,CHIMERE EA 7516 Head and Neck Research Group, Jules Verne University, Amiens, France
| | - Cédric Gaxatte
- Department of Geriatrics, CHU Lille, Lille, F-59000, France
| | - Guillaume Deschasse
- University Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, F-59000, France.,Department of Geriatrics, CHU Amiens-Picardie, Amiens, F-80054, France
| | - Jean-Baptiste Beuscart
- University Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, F-59000, France.,Department of Geriatrics, CHU Lille, Lille, F-59000, France
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Deschasse G, Bloch F, Drumez E, Charpentier A, Visade F, Delecluse C, Loggia G, Lescure P, Attier-Żmudka J, Bloch J, Gaxatte C, Van Den Berghe W, Puisieux F, Beuscart JB. Development of a predictive score for mortality at 3- and 12-month after discharge from an acute geriatric unit as a trigger for advanced care planning. J Gerontol A Biol Sci Med Sci 2021; 77:1665-1672. [PMID: 34375411 DOI: 10.1093/gerona/glab217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There is a need for a mortality score that can be used to trigger advanced care planning among older patients discharged from acute geriatric units (AGUs). OBJECTIVE To develop a prognostic score for 3- and 12-month mortality after discharge from an AGU, based on a comprehensive geriatric assessment, in-hospital events, and the exclusion of patients already receiving palliative care. METHODS DAMAGE is a French multicentre, prospective, cohort study. The broad inclusion criteria ensured that the cohort is representative of patients treated in an AGU. The DAMAGE participants underwent a comprehensive geriatric assessment, a daily clinical check-up, and follow-up visits 3 and 12 months after discharge. Multivariable logistic regression models were used to develop a prognostic score for the derivation and validation subsets. RESULTS 3509 patients were assessed and 3112 were included. The patient population was very older and frail or dependant, with a high proportion of deaths at 3 months (n=455, 14.8%) and at 12 months (n=1014, 33%). The score predicted an individual risk of mortality ranging from 1% to 80% at 3 months and between 5% and 93% at 12 months, with an area under the receiving operator characteristic curve in the validation cohort of 0.728 at 3 months and 0.733 at 12 months. CONCLUSIONS Our score predicted a broad range of risks of death after discharge from the AGU. Having this information at the time of hospital discharge might trigger a discussion on advanced care planning and end-of-life care with very old, frail patients.
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Affiliation(s)
- Guillaume Deschasse
- CHU Amiens-Picardie, Department of Geriatrics, Amiens, France.,Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, France
| | - Frédéric Bloch
- CHU Amiens-Picardie, Department of Geriatrics, Amiens, France
| | - Elodie Drumez
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, France.,CHU Lille, Department of Biostatistics, Lille, France
| | | | - Fabien Visade
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, France.,Lille Catholic Hospitals, Geriatrics Department, Lille, France
| | | | - Gilles Loggia
- Normandie Univ, UNICAEN, INSERM, COMETE, Caen, France.,Department of Geriatrics, Normandie Univ, UNICAEN, CHU de Caen Normandie, Caen, France
| | - Pascale Lescure
- Department of Geriatrics, Normandie Univ, UNICAEN, CHU de Caen Normandie, Caen, France
| | - Jadwiga Attier-Żmudka
- Geriatric department, General Hospital of Saint-Quentin, Saint-Quentin, France.,CHIMERE EA 7516 team research, Jules Verne University, Amiens, France
| | | | | | | | | | - Jean-Baptiste Beuscart
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, France.,CHU Lille, Department of Geriatrics, Lille, France
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Visade F, Deschasse G, Devulder P, Di Martino C, Loggia G, Prodhomme C, Beuscart JB. Terms used by physicians when deciding to withhold treatment for older patients not having received palliative care in an acute geriatric care unit. Eur Geriatr Med 2021; 13:101-107. [PMID: 34282526 DOI: 10.1007/s41999-021-00542-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 07/10/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE There are no guidelines or consensus statements on the terms to be used when discussing withholding of treatment for patients in acute geriatric care units and who have not received palliative care. The objective of the present study was to analyze the terms used in medical records to refer to the withholding of treatment for patients who died in an acute geriatric care unit and did not receive palliative care. METHODS We conducted an ambispective multicentre cohort study based on the DAMAGE study. Data on 53 patients who died in the acute geriatric care unit and who had not received palliative care were extracted from medical records. The verbatims referring to the withholding of treatment were analyzed in terms of keywords and then key concepts, as defined by several reviewers in a consensus-based approach. RESULTS The mean age of the patients was 86.4 years, 34.1% were male. Terms referring to the withholding of treatment were found for 25 of the 53 patients (47.2%). Most of the decisions on the withholding of treatment were recorded in the week following admission to the acute geriatric care unit. Our analysis of the terms identified 11 key concepts: treatment limitation, no resuscitation, withholding diagnostic procedures, justification of care, ethical considerations, disease progression, uncertainty, the patient's wishes, the family's wishes, patient's comfort, and collegiality. The terms used to describe key concepts varied markedly from one physician to another. CONCLUSION Decisions about the withholding of treatment are frequently noted in the medical records of patients who die in the acute geriatric care unit without having received palliative care. The broad variety of key concepts and differences in the choice of words highlight the need for standardized terms.
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Affiliation(s)
- Fabien Visade
- Univ. Lille, CHU Lille, ULR 2694-METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, F-59000, Lille, France. .,Department of Geriatrics, Lille Catholic Hospitals, F-59160, Lille, France.
| | - G Deschasse
- Univ. Lille, CHU Lille, ULR 2694-METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, F-59000, Lille, France.,Department of Geriatrics, Amiens University Hospital, F-80054, Amiens, France
| | - P Devulder
- Univ. Lille, CHU Lille, ULR 2694-METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, F-59000, Lille, France.,Department of Geriatrics, Lille Catholic Hospitals, F-59160, Lille, France
| | - C Di Martino
- Univ. Lille, CHU Lille, ULR 2694-METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, F-59000, Lille, France
| | - G Loggia
- Normandie Univ, UNICAEN, INSERM, COMETE, 14033, Caen, France.,Department of Geriatrics, Normandie Univ, UNICAEN, CHU de Caen Normandie, 14033, Caen, France
| | - C Prodhomme
- Palliative Care Unit, Univ. Lille, CHU Lille, F-59000, Lille, France.,ETHICS (Experiment, Transhumanism, Human Interactions, Care and Society), EA 7446, Lille Catholic University, 59800, Lille, France
| | - J B Beuscart
- Univ. Lille, CHU Lille, ULR 2694-METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, F-59000, Lille, France
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9
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Visade F, Lefebvre A, Floret E, Decaudin B, Puisieux F, Delecluse C, Beuscart JB. Proposition of a structured list of information items to be transmitted to primary caregivers after in-hospital medication optimization: a qualitative study. Acta Clin Belg 2021; 76:184-189. [PMID: 31787034 DOI: 10.1080/17843286.2019.1699689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background and objective: Defective transmission of drug information during the transition from hospital to home care are causes of adverse drug reactions in older patients. We aimed to reach a consensus concerning information about changes in treatment to be transmitted to primary caregivers when an older patient is discharged from hospital.Methods: A qualitative focus group study was conducted with general practitioners, geriatricians, community pharmacists, and hospital pharmacists providing care for older patients. Four steps were used to reach a focus group consensus: 1) presentation of the purpose of the focus group; 2) generation and enumeration of ideas; 3) sharing opinions about these ideas; 4) voting to create a list of ranked items. The process involved three focus groups.Results: A consensus was reached on ten items: indication for continued, discontinued, newly introduced or changed treatments and their duration; reasons for discontinuing drugs or introducing new drugs; information about re-evaluating treatments; reasons for hospital stay, significant elements and diagnosis at discharge; administrative information concerning the patient; the name of the primary care physician, and the discharging hospital unit and the physician(s) in charge; known allergies, information about liver and kidney failure; main adverse effects to monitor; date of latest blood tests; hospital admission/discharge dates.Conclusion: The consensus on the list of information items concerning changes in the treatment should be used by hospital physicians and pharmacists to ensure safe patient discharge.
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Affiliation(s)
- Fabien Visade
- Geriatrics Department, Lille Catholic Hospitals, University of Lille, Lomme, France
- Univ. Lille, EA2694 - Evaluation des Technologies de Santé et des Pratiques Médicales, F-59000 Lille, France
| | - Antoine Lefebvre
- Department of Pharmacy, Lille Catholic Hospitals, University of Lille, Lomme, France
| | - Emmanuel Floret
- Department of Pharmacy, Lille Catholic Hospitals, University of Lille, Lomme, France
| | - Bertrand Decaudin
- Univ. Lille, EA 7365-GRITA-Groupe de Recherche sur les formes Injectables et les Technologies Associées, Lille, France
- CHU Lille, Department of pharmacology, F-59000 Lille, France
| | - François Puisieux
- CHU Lille, Department of pharmacology, F-59000 Lille, France
- CHU Lille, Department of Geriatrics, F-59000 Lille, France
| | - Céline Delecluse
- Geriatrics Department, Lille Catholic Hospitals, University of Lille, Lomme, France
| | - Jean-Baptiste Beuscart
- Univ. Lille, EA2694 - Evaluation des Technologies de Santé et des Pratiques Médicales, F-59000 Lille, France
- CHU Lille, Department of Geriatrics, F-59000 Lille, France
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Visade F, Babykina G, Lamer A, Defebvre MM, Verloop D, Ficheur G, Genin M, Puisieux F, Beuscart JB. Importance of previous hospital stays on the risk of hospital re-admission in older adults: a real-life analysis of the PAERPA study population. Age Ageing 2021; 50:141-146. [PMID: 32687169 DOI: 10.1093/ageing/afaa139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/14/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND consideration of the first hospital re-admission only and failure to take account of previous hospital stays, which are the two significant limitations when studying risk factors for hospital re-admission. The objective of the study was to use appropriate statistical models to analyse the impact of previous hospital stays on the risk of hospital re-admission among older patients. METHODS an exhaustive analysis of hospital discharge and health insurance data for a cohort of patients participating in the PAERPA ('Care Pathways for Elderly People at Risk of Loss of Personal Independence') project in the Hauts de France region of France. All patients aged 75 or over were included. All data on hospital re-admissions via the emergency department were extracted. The risk of unplanned hospital re-admission was estimated by applying a semiparametric frailty model, the risk of death by applying a time-dependent semiparametric Cox regression model. RESULTS a total of 24,500 patients (median [interquartile range] age: 81 [77-85]) were included between 1 January 2015 and 31 December 2017. In a multivariate analysis, the relative risk (95% confidence interval [CI]) of hospital re-admission rose progressively from 1.8 (1.7-1.9) after one previous hospital stay to 3.0 (2.6-3.5) after five previous hospital stays. The relative risk [95%CI] of death rose slowly from 1.1 (1.07-1.11) after one previous hospital stay to 1.3 (1.1-1.5) after five previous hospital stays. CONCLUSION analyses of the risk of hospital re-admission in older adults must take account of the number of previous hospital stays. The risk of death should also be analysed.
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Affiliation(s)
- Fabien Visade
- University of Lille, EA2694—Evaluation des Technologies de Santé et des Pratiques Médicales, Lille F-59000, France
- Department of Geriatrics, Lille Catholic Hospitals, University of Lille, Lomme F-59160, France
| | - Genia Babykina
- University of Lille, EA2694—Evaluation des Technologies de Santé et des Pratiques Médicales, Lille F-59000, France
| | - Antoine Lamer
- University of Lille, EA2694—Evaluation des Technologies de Santé et des Pratiques Médicales, Lille F-59000, France
| | | | | | - Grégoire Ficheur
- University of Lille, EA2694—Evaluation des Technologies de Santé et des Pratiques Médicales, Lille F-59000, France
| | - Michael Genin
- University of Lille, EA2694—Evaluation des Technologies de Santé et des Pratiques Médicales, Lille F-59000, France
| | - François Puisieux
- University of Lille, EA2694—Evaluation des Technologies de Santé et des Pratiques Médicales, Lille F-59000, France
| | - Jean-Baptiste Beuscart
- University of Lille, EA2694—Evaluation des Technologies de Santé et des Pratiques Médicales, Lille F-59000, France
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Castier S, Preda C, Puisieux F, Beuscart JB, Mahmoudi R, Visade F. Association between anticholinergic burden and hospital readmission in older patients: a prospective analysis. Hosp Pract (1995) 2020; 49:104-109. [PMID: 33040637 DOI: 10.1080/21548331.2020.1835264] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Despite known adverse effects of anticholinergic (AC) medication, little work has been devoted to the impact of high anticholinergic burden on the rate of hospital readmission. The purpose of this study was to analyze prospectively the link between high AC burden and the rate of all-cause thirty-day hospital readmission in older people. STUDY DESIGN This was a prospective non-interventional study conducted from January to August 2019 in one acute-care geriatric ward. All hospital stays of patients aged at least 75 years who were discharged to their home were included in the analysis. AC burden was determined from discharge prescriptions using the Anticholinergic Drug Scale (ADS) and the Anticholinergic Risk Scale (ARS), and defined as high if ≥3. RESULTS The analysis concerned 350 hospital stays. Median patient age was 88 years (interquartile interval 84-91). In a multivariate analysis, the risk of hospital readmission within 30 days was not increased for patients with high AC burden (ADS≥3): odds ratio 1.16 [95% confidence interval 0.56-2.37], compared to a patient whose anticholinergic burden was not high. CONCLUSION Unlike retrospective studies on this issue, the findings of our prospective analysis do not support a higher risk of hospital admission within 30 days for older people with high AC burden as assessed from their discharge prescriptions.
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Affiliation(s)
- Sophie Castier
- Geriatrics Department, Lille Catholic Hospitals, Lille, France
| | - Cristian Preda
- Laboratory of Mathematics Paul Painlevé, UMR CNRS, University of Lille, Lille, France.,Lille Catholic Hospitals, Biostatistics Department - Delegation for Clinical Research and Innovation, Lille Catholic University, Lille, France
| | - François Puisieux
- ULR 2694-METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, University Lille, CHU Lille, Lille, France
| | - Jean-Baptiste Beuscart
- ULR 2694-METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, University Lille, CHU Lille, Lille, France
| | - Rachid Mahmoudi
- Department of Geriatrics and Internal Medicine, Maison Blanche Hospital, Reims University Hospitals, Reims, France.,Faculty of Medicine, University of Reims Champagne-Ardenne, Reims, France
| | - Fabien Visade
- Geriatrics Department, Lille Catholic Hospitals, Lille, France.,ULR 2694-METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, University Lille, CHU Lille, Lille, France
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12
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Al Zallouha M, Landkocz Y, Méausoone C, Ledoux F, Visade F, Cazier F, Martin PJ, Borgie M, Vitagliano JJ, Trémolet G, Cailliez JC, Gosset P, Courcot D, Billet S. A prospective pilot study of the T-lymphocyte response to fine particulate matter exposure. J Appl Toxicol 2020; 40:619-630. [PMID: 31975422 DOI: 10.1002/jat.3932] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Exposure to air pollution is associated with increased morbidity and mortality. Once the fine atmospheric particulate matter (FP) is inhaled, some of its compounds can pass through the lungs and reach the bloodstream where they can come into contact with immune cells. Exposure to FP particularly affects sensitive populations such as the elderly. Aging affects the immune system, making the elderly more vulnerable. The project aims to determine the effects of FP exposure on human T cells while looking for biomarkers associated with exposure. Blood samples from 95 healthy subjects in three different age groups (20-30, 45-55 and 70-85 years) were collected to determine a potential age effect. T lymphocytes were isolated to be exposed ex vivo for 72 hours to 45 μg/mL of FP collected in Dunkirk and chemically characterized. Overexpression of the CYP1A1, CYP1B1 and CYP2S1 genes was therefore measured after exposure of the T cells to FP. These genes code for enzymes known to be involved in the metabolic activation of organic compounds such as polycyclic aromatic hydrocarbons detected in the FP sample. T-cell profiling allowed us to suggest a mixed T-helper 1/2 profile caused by exposure to FP. With regard to the influence of age, we have observed differences in the expression of certain genes, as well as an increase in interleukin-4 and -13 concentrations in the elderly. These results showed that exposure of T lymphocytes to FP causes effects on both transcriptomic and cytokine secretion levels.
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Affiliation(s)
- Margueritta Al Zallouha
- EA 4492 - UCEIV - Unité de Chimie Environnementale et Interactions sur le Vivant, Université du Littoral Côte d'Opale, SFR Condorcet FR CNRS 3417, Dunkerque, France
| | - Yann Landkocz
- EA 4492 - UCEIV - Unité de Chimie Environnementale et Interactions sur le Vivant, Université du Littoral Côte d'Opale, SFR Condorcet FR CNRS 3417, Dunkerque, France
| | - Clémence Méausoone
- EA 4492 - UCEIV - Unité de Chimie Environnementale et Interactions sur le Vivant, Université du Littoral Côte d'Opale, SFR Condorcet FR CNRS 3417, Dunkerque, France
| | - Fréderic Ledoux
- EA 4492 - UCEIV - Unité de Chimie Environnementale et Interactions sur le Vivant, Université du Littoral Côte d'Opale, SFR Condorcet FR CNRS 3417, Dunkerque, France
| | - Fabien Visade
- Service de gériatrie, Groupement des Hôpitaux de l'Institut Catholique de Lille, Lille, France
| | - Fabrice Cazier
- Centre Commun de Mesures, Université Littoral Côte d'Opale, Dunkerque, France
| | - Perrine J Martin
- EA 4492 - UCEIV - Unité de Chimie Environnementale et Interactions sur le Vivant, Université du Littoral Côte d'Opale, SFR Condorcet FR CNRS 3417, Dunkerque, France
| | - Mireille Borgie
- EA 4492 - UCEIV - Unité de Chimie Environnementale et Interactions sur le Vivant, Université du Littoral Côte d'Opale, SFR Condorcet FR CNRS 3417, Dunkerque, France
| | - Jean-Jacques Vitagliano
- Direction de la Recherche Médicale, Groupement des Hôpitaux de l'Institut Catholique de Lille, Lille, France
| | - Gauthier Trémolet
- EA 4492 - UCEIV - Unité de Chimie Environnementale et Interactions sur le Vivant, Université du Littoral Côte d'Opale, SFR Condorcet FR CNRS 3417, Dunkerque, France
| | | | - Pierre Gosset
- Service d'Anatomie pathologique, Groupement des Hôpitaux de l'Institut Catholique de Lille, Lille, France
| | - Dominique Courcot
- EA 4492 - UCEIV - Unité de Chimie Environnementale et Interactions sur le Vivant, Université du Littoral Côte d'Opale, SFR Condorcet FR CNRS 3417, Dunkerque, France
| | - Sylvain Billet
- EA 4492 - UCEIV - Unité de Chimie Environnementale et Interactions sur le Vivant, Université du Littoral Côte d'Opale, SFR Condorcet FR CNRS 3417, Dunkerque, France
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