Rôle de la leptine systémique sur l'expression et l'activité du transporteur intestinal d'oligopeptides pept-1 (évaluation in vivo et in vitro)

CHATENAY M.-PARIS 11-BU Pharma. (920192101) / SudocSudocFranceF

Safety of Elderly Fallers: Identifying Associated Risk Factors for 30-Day Unplanned Readmissions Using a Clinical Data Warehouse

International audienceBackground: Hospital readmissions are a major problem in the older people as they are frequent, costly, and life-threatening. Falls among older adults are the leading cause of injury, deaths, and emergency department visits for trauma.Objective: The main objective was to determine risk factors associated with a 30-day readmission after index hospital admission for fall-related injuries.Methods: A retrospective nested case-control study was conducted. Data from elderly patients initially hospitalized for fall-related injuries in 2019, in 11 of the Greater Paris University Hospitals and discharged home, were retrieved from the clinical data warehouse. Cases were admission of elderly patients who subsequently experienced a readmission within 30 days after discharge from the index admission. Controls were admission of elderly patients who were not readmitted to hospital.Results: Among 670 eligible index admissions, 127 (18.9%) were followed by readmission within 30 days after discharge. After multivariate analysis, men sex (odds ratio [OR] = 2.29, 95% confidence interval [CI] = 1.45–3.61), abnormal concentration of C-reactive protein, and anemia (OR = 2.22, 95% CI = 1.28–3.85; OR = 1.85, 95% CI = 1.11–3.11, respectively) were associated with a higher risk of readmission. Oppositely, having a traumatic injury at index admission decreased this risk (OR = 0.47, 95% CI = 0.28–0.81).Conclusions: Reducing early unplanned readmission is crucial, especially in elderly patients susceptible to falls. Our results indicate that the probability of unplanned readmission is higher for patients with specific characteristics that should be taken into consideration in interventions designed to reduce this burden

Which Potentially Inappropriate Medications list can detect patients at risk of readmissions in the older adult population admitted for Falls? An observational multicentre study using a clinical data warehouse Running heading: Potentially Inappropriate Medications and Readmissions • Authors

International audienceObjective Hospital readmissions are common in the older adult population and potentially inappropriate medications are known to be involved in these readmissions. Several lists of potentially inappropriate medications have been published in diverse countries in order to adapt the lists to local specificities. Among them, the Beers Criteria® were first published in 1991 in the USA, followed by the French Laroche list, the Norwegian NORGEP criteria, the German PRISCUS list, the the Austrian consensus panel listand the European list, EU-7. The main objective was to detect which potentially inappropriate medications list can better detect hospital readmissions within 30 days in the older adult population hospitalized for fall related injuries. Methods A multicenter observational retrospective cohort study was conducted. Data from older patients initially hospitalized for falls in 2019 and discharged home, were retrieved from the clinical data warehouse. Exposure to potentially inappropriate medications was classified according to the six lists mentioned above. Results After adjustments using propensity score matching, taking a potentially inappropriate medication as per Laroche and PRISCUS lists was associated with a 30-day hospital readmission with an OR of 1.58 (95 % CI [1.06-2.37]) and 1.68 (95 % CI [1.13-2.50]) respectively while the other 4 studied lists showed no association with readmissions. Conclusion Our study evidenced that not all lists published allow the accurate prediction of hospital readmissions to the same extent. We found that Laroche and PRISCUS lists were associated with increased 30day all-cause hospital readmissions after an index admission with a FRI. The local ethic committee approved the study protocol (number CER-2020-79)

Risk scores identifying elderly inpatients at risk of 30-day unplanned readmission and accident and emergency department visit: a systematic review

International audienceObjectives : The aim of this systematic review was to describe and analyse the performance statistics of validated risk scores identifying elderly inpatients at risk of early unplanned readmission.Data sources : We identified potentially eligible studies by searching MEDLINE, EMBASE, COCHRANE and Web of Science. Our search was restricted to original studies, between 1966 and 2018.Eligibility criteria : Original studies, which internally or externally validated the clinical scores of hospital readmissions in elderly inpatients.Data extraction and synthesis : A data extraction grid based on Strengthening the Reporting of Observational Studies in Epidemiology and Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis statements was developed and completed by two reviewers to collect general data. The same process was used to extract metrological data of the selected scores.Quality assessment of the included studies : Assessment of the quality and risk of bias in individual studies was performed by two reviewers, using the validated Effective Public Health Practice Project quality assessment tool.Participants : Elderly inpatients discharged to home from hospital or returning home after an accident and emergency department visit.Results : A total of 12 studies and five different scores were included in the review. The five scores present area under the receiving operating characteristic curve between 0.445 and 0.69. Identification of Senior At Risk (ISAR) and Triage  Risk Screening Tool (TRST) scores were the more frequently validated scores with ISAR being more sensitive and TRST more specific.Conclusions : The TRST and ISAR scores have been extensively studied and validated. The choice of the most suitable score relies on available patient data, patient characteristics and the foreseen clinical care intervention. In order to pair the intervention with the appropriate clinical score, further studies of external validation of clinical scores, identifying elderly patients at risk of early unplanned readmission, are needed

Pharmacists' role in antimicrobial stewardship and relationship with antibiotic consumption in hospitals: An observational multicentre study

International audienceOBJECTIVES:Antimicrobial stewardship (AMS) teams around the world include pharmacists; however, their impact is relatively unknown. This study aimed to explore the relationship between pharmacists' actions and antibiotic consumption.METHODS:Hospital pharmacists involved in the French antibiotic consumption surveillance network (ATB-Raisin) were invited to participate in a retrospective observational multicentre study. Collected data were: the previous year's (2016) antibiotic consumption expressed in daily defined dose per 1000 patient-days; AMS measures, including pharmacist-specific actions; and use of a computerised prescription order entry (CPOE) system. Associations between antibiotic consumption and AMS measures were assessed by linear regression, after adjustment for hospital activities.RESULTS:Annual data for 2016 from 77 hospitals (7260000 bed-days in 24000 beds) were analysed. Pharmacists were involved in AMS programs in 73% of hospitals, and were the antibiotic advisor in 25%. Pharmaceutical review of prescriptions was organised in almost all hospitals (97%). The univariable analysis identified five measures associated with lower overall antibiotic consumption: CPOE use (if >80% of prescriptions or 100%), pharmaceutical review (if >80% of beds or 100%) and the antibiotic advisor being a pharmacist (P=0.04, P=0.004 and P=0.003, respectively). In the multivariable analysis, two explanatory variables were significantly and independently associated with a lower overall antibiotic consumption: the antibiotic advisor being a pharmacist and a pharmaceutical review covering all beds (-19.9% [-31.6%; -8.1%], P=0.002 and -18.3% [-34.0%; -2.6%], P=0.03, respectively).CONCLUSIONS:Antibiotic consumption was lower when the antibiotic advisor was a pharmacist and when the pharmaceutical team reviewed all prescriptions. These results highlight that actions initiated by pharmacists have a positive impact and should be supported

A systematic review of regulatory and educational interventions to reduce the burden associated with the prescriptions of sedative-hypnotics in adults treated for sleep disorders

<div><p>Background</p><p>The burden of Sedative-Hypnotics (SHs) has been known since the 1980s. Yet, their consumption remains high. A systematic review of the literature should help to assess efficient interventions to improve the appropriate use of SHs in sleep disorders.</p><p>Objectives</p><p>To identify and assess regulatory and educational interventions designed to improve the appropriate use of SHs for insomnia treatment.</p><p>Methods</p><p>We conducted a systematic review of the literature according to PRISMA guidelines. A systematic search covering the period 1980–2015 was carried out in Medline, Web of Science, Embase and PsycInfo. We included studies reporting the implementation of regulatory or educational strategies directed towards patients and/or healthcare professionals to improve the appropriate use of SHs to treat insomnia in the community, hospitals and nursing homes.</p><p>Results</p><p>Thirty-one studies were included: 23 assessed educational interventions (recommendations by mail/email, computer alerts, meetings, mass media campaigns, prescription profile), 8 assessed regulatory interventions (prescription rule restriction, end of reimbursement). The most recent was implemented in 2009. Restrictive prescription rules were effective to reduce the consumption of targeted SHs but led to a switch to other non-recommended SHs. Among educational interventions, only 3 studies out of 7 reported positive results of mono-faceted interventions; whereas, 13 out of the 16 multi-faceted interventions were reported as efficient: particularly, the active involvement of healthcare professionals and patients and the spread of information through mass media were successful. The risk of bias was high for 24 studies (mainly due to the design), moderate for 3 studies and weak for 4 studies.</p><p>Conclusion</p><p>Educational multifaceted studies are presented as the most efficient. But further better designed studies are needed to make evidence-based results more generalizable.</p></div