Women in the middle: An observational study of a generation story in Alzheimer disease in France.
Huvent-Grelle, D.; Boulanger, E.; Beuscart, J.; Martin, T.; Podvin, J.; and Puisieux, F.
European Geriatric Medicine, 6(2): 124–127. 2015.
doi
link
bibtex
abstract
@article{huvent-grelle_women_2015,
title = {Women in the middle: {An} observational study of a generation story in {Alzheimer} disease in {France}},
volume = {6},
shorttitle = {Women in the middle},
doi = {10.1016/j.eurger.2014.10.001},
abstract = {Background: It is well known that informal care giving for Alzheimer patients can be a burden and may result in caregivers' distress and stress. Caring for a person with Alzheimer's disease (AD) is a difficult task, which can become overwhelming. Their caregivers need attention as well. Objectives: The present study examines the socio-demographic characteristics and the quality of health and life of the sandwich grandparent generation (SGP) caregivers defined as providing care to both old demented parents and young grandchildren. Study design: Multicentric, prospective and observational study over a one-year period. Setting: Eleven voluntary Memory Clinics across the North of France. Participants: Voluntary SGP caregivers recruited in Memory Clinics who completed an oral questionnaire, during an interview one to one with a physician. Results: A vast majority of our SGP caregivers were women, mean age 59 years, married, retired, described in the literature as "women in the middle", felling stressed and not sleeping well in more than half of the cases. They had three grandchildren, mean age 7 years. The AD patient, mean age 86-yearsold, was most frequently the caregiver's mother. Many SGPs had been providing their help for 5 years or even longer. Nevertheless, the SGPs considered themselves satisfied about their health, and said they had a good quality of life. Conclusion: Although SGP women caregivers reported high levels of perceived burden, they considered that their health and quality of life were good. © 2015 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.},
number = {2},
journal = {European Geriatric Medicine},
author = {Huvent-Grelle, D. and Boulanger, E. and Beuscart, J.B. and Martin, T. and Podvin, J. and Puisieux, F.},
year = {2015},
keywords = {Alzheimer disease, Caregiver burden, Caregiving},
pages = {124--127},
}
Background: It is well known that informal care giving for Alzheimer patients can be a burden and may result in caregivers' distress and stress. Caring for a person with Alzheimer's disease (AD) is a difficult task, which can become overwhelming. Their caregivers need attention as well. Objectives: The present study examines the socio-demographic characteristics and the quality of health and life of the sandwich grandparent generation (SGP) caregivers defined as providing care to both old demented parents and young grandchildren. Study design: Multicentric, prospective and observational study over a one-year period. Setting: Eleven voluntary Memory Clinics across the North of France. Participants: Voluntary SGP caregivers recruited in Memory Clinics who completed an oral questionnaire, during an interview one to one with a physician. Results: A vast majority of our SGP caregivers were women, mean age 59 years, married, retired, described in the literature as "women in the middle", felling stressed and not sleeping well in more than half of the cases. They had three grandchildren, mean age 7 years. The AD patient, mean age 86-yearsold, was most frequently the caregiver's mother. Many SGPs had been providing their help for 5 years or even longer. Nevertheless, the SGPs considered themselves satisfied about their health, and said they had a good quality of life. Conclusion: Although SGP women caregivers reported high levels of perceived burden, they considered that their health and quality of life were good. © 2015 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.
Management of recurrent falls in hypertensive elderly.
Puisieux, F.; Boulanger, E.; and Beuscart, J.
Archives des Maladies du Coeur et des Vaisseaux - Pratique, 2015(242): 8–13. 2015.
doi
link
bibtex
abstract
@article{puisieux_management_2015,
title = {Management of recurrent falls in hypertensive elderly},
volume = {2015},
shorttitle = {Prise en charge des chutes répétées chez l'hypertendu âgé},
doi = {10.1038/jhh.2013.82},
abstract = {Among people aged 65 years or over, two thirds have hypertension (HTA) and one third fall each year. These conditions frequently coexist in the same patient, and each carries a risk for functional decline or mortality. The majority of falls result from interactions between multiple predisposing and precipitating factors. Orthostatic hypotension is recognized as a risk factor of falling. Although antihypertensive treatment may contribute to orthostatic hypotension, data from studies suggest that the link between HTA, antihypertensive medication, orthostatic hypotension and falls is more complex than expected. The treatment of HTA is crucial for the prevention of stroke and heart failure even in the frail old person at high risk for falling, but represents in this group of patients a challenge in terms of safety and quality of life. Confirmation of the diagnosis with 24-hour ambulatory blood pressure monitoring or BP monitoring at home is important. Cautious drug prescription, with adapted blood pressure targets, avoiding too intensive treatments, is important for treatment adequacy and safety. Cardiologists must pay greater attention to fall risk in older adults with HTA in an effort to prevent falls and injurious falls. © 2015 Elsevier Masson SAS. All rights reserved.},
number = {242},
journal = {Archives des Maladies du Coeur et des Vaisseaux - Pratique},
author = {Puisieux, F. and Boulanger, E. and Beuscart, J.-B.},
year = {2015},
pages = {8--13},
}
Among people aged 65 years or over, two thirds have hypertension (HTA) and one third fall each year. These conditions frequently coexist in the same patient, and each carries a risk for functional decline or mortality. The majority of falls result from interactions between multiple predisposing and precipitating factors. Orthostatic hypotension is recognized as a risk factor of falling. Although antihypertensive treatment may contribute to orthostatic hypotension, data from studies suggest that the link between HTA, antihypertensive medication, orthostatic hypotension and falls is more complex than expected. The treatment of HTA is crucial for the prevention of stroke and heart failure even in the frail old person at high risk for falling, but represents in this group of patients a challenge in terms of safety and quality of life. Confirmation of the diagnosis with 24-hour ambulatory blood pressure monitoring or BP monitoring at home is important. Cautious drug prescription, with adapted blood pressure targets, avoiding too intensive treatments, is important for treatment adequacy and safety. Cardiologists must pay greater attention to fall risk in older adults with HTA in an effort to prevent falls and injurious falls. © 2015 Elsevier Masson SAS. All rights reserved.
Evaluation of compliance with recommendations of prevention of thromboembolism in atrial fibrillation in the elderly, by data reuse of electronic health records.
Ferret, L.; Beuscart, J.; Ficheur, G.; Beuscart, R.; Luyckx, M.; and Chazard, E.
Studies in Health Technology and Informatics, 210: 394–398. 2015.
link
bibtex
abstract
@article{ferret_evaluation_2015,
title = {Evaluation of compliance with recommendations of prevention of thromboembolism in atrial fibrillation in the elderly, by data reuse of electronic health records},
volume = {210},
issn = {0926-9630},
abstract = {Under-prescription of anticoagulants in the elderly with atrial fibrillation (AF) has been described in several studies, showing that only 15 to 44\% of them receive anticoagulants. However, the European Society of Cardiology recommendations state that anticoagulants should be systematically prescribed. In case of refusal of the treatment by the patient, a platelet aggregation inhibitor should be prescribed in monotherapy or bitherapy according to the HAS-BLED bleeding risk score. In all the cases the patient should receive an antithrombotic treatment. In this work we observe the adequacy of prescription practices to the recommendations for AF in the elderly by data reuse on a monocentric observational retrospective cohort. Data of a 222 beds French community hospital were extracted for the year 2013. The patients aged over 75 years and presenting AF were selected. The HAS-BLED score was calculated and the consistency of the prescriptions with the recommendations of the European Society of Cardiology was verified. Then the compliance rate to the recommendations was calculated. The rules detected 433 patients with AF and aged over 75 years. From those patients, 45\% received an anticoagulant, 32.1\% received platelet aggregation inhibitors and 22.9\% did not receive any antithrombotic treatment. When a platelet aggregation inhibitor was prescribed the recommendation for bitherapy was not followed in 97\% of the cases. The compliance rate to the recommendations was 47.8\%. This work highlights a major problem of quality of the prescriptions in the hospital field and shows how data reuse can help describing this type of issues.},
language = {eng},
journal = {Studies in Health Technology and Informatics},
author = {Ferret, Laurie and Beuscart, Jean-Baptiste and Ficheur, Grégoire and Beuscart, Régis and Luyckx, Michel and Chazard, Emmanuel},
year = {2015},
pmid = {25991173},
pages = {394--398},
}
Under-prescription of anticoagulants in the elderly with atrial fibrillation (AF) has been described in several studies, showing that only 15 to 44% of them receive anticoagulants. However, the European Society of Cardiology recommendations state that anticoagulants should be systematically prescribed. In case of refusal of the treatment by the patient, a platelet aggregation inhibitor should be prescribed in monotherapy or bitherapy according to the HAS-BLED bleeding risk score. In all the cases the patient should receive an antithrombotic treatment. In this work we observe the adequacy of prescription practices to the recommendations for AF in the elderly by data reuse on a monocentric observational retrospective cohort. Data of a 222 beds French community hospital were extracted for the year 2013. The patients aged over 75 years and presenting AF were selected. The HAS-BLED score was calculated and the consistency of the prescriptions with the recommendations of the European Society of Cardiology was verified. Then the compliance rate to the recommendations was calculated. The rules detected 433 patients with AF and aged over 75 years. From those patients, 45% received an anticoagulant, 32.1% received platelet aggregation inhibitors and 22.9% did not receive any antithrombotic treatment. When a platelet aggregation inhibitor was prescribed the recommendation for bitherapy was not followed in 97% of the cases. The compliance rate to the recommendations was 47.8%. This work highlights a major problem of quality of the prescriptions in the hospital field and shows how data reuse can help describing this type of issues.
Acrylamide induces accelerated endothelial aging in a human cell model.
Sellier, C.; Boulanger, E.; Maladry, F.; Tessier, F. J.; Lorenzi, R.; Nevière, R.; Desreumaux, P.; Beuscart, J.; Puisieux, F.; and Grossin, N.
Food and Chemical Toxicology: An International Journal Published for the British Industrial Biological Research Association, 83: 140–145. September 2015.
doi
link
bibtex
abstract
@article{sellier_acrylamide_2015,
title = {Acrylamide induces accelerated endothelial aging in a human cell model},
volume = {83},
issn = {1873-6351},
doi = {10.1016/j.fct.2015.05.021},
abstract = {Acrylamide (AAM) has been recently discovered in food as a Maillard reaction product. AAM and glycidamide (GA), its metabolite, have been described as probably carcinogenic to humans. It is widely established that senescence and carcinogenicity are closely related. In vitro, endothelial aging is characterized by replicative senescence in which primary cells in culture lose their ability to divide. Our objective was to assess the effects of AAM and GA on human endothelial cell senescence. Human umbilical vein endothelial cells (HUVECs) cultured in vitro were used as model. HUVECs were cultured over 3 months with AAM or GA (1, 10 or 100 μM) until growth arrest. To analyze senescence, β-galactosidase activity and telomere length of HUVECs were measured by cytometry and semi-quantitative PCR, respectively. At all tested concentrations, AAM or GA reduced cell population doubling compared to the control condition (p {\textless} 0.001). β-galactosidase activity in endothelial cells was increased when exposed to AAM (≥10 μM) or GA (≥1 μM) (p {\textless} 0.05). AAM (≥10 μM) or GA (100 μM) accelerated telomere shortening in HUVECs (p {\textless} 0.05). In conclusion, in vitro chronic exposure to AAM or GA at low concentrations induces accelerated senescence. This result suggests that an exposure to AAM might contribute to endothelial aging.},
language = {eng},
journal = {Food and Chemical Toxicology: An International Journal Published for the British Industrial Biological Research Association},
author = {Sellier, Cyril and Boulanger, Eric and Maladry, François and Tessier, Frédéric J. and Lorenzi, Rodrigo and Nevière, Rémi and Desreumaux, Pierre and Beuscart, Jean-Baptiste and Puisieux, François and Grossin, Nicolas},
month = sep,
year = {2015},
pmid = {26070502},
keywords = {Acrylamide, Endothelial cell, Hayflick's limit, Senescence, Telomere length shortening},
pages = {140--145},
}
Acrylamide (AAM) has been recently discovered in food as a Maillard reaction product. AAM and glycidamide (GA), its metabolite, have been described as probably carcinogenic to humans. It is widely established that senescence and carcinogenicity are closely related. In vitro, endothelial aging is characterized by replicative senescence in which primary cells in culture lose their ability to divide. Our objective was to assess the effects of AAM and GA on human endothelial cell senescence. Human umbilical vein endothelial cells (HUVECs) cultured in vitro were used as model. HUVECs were cultured over 3 months with AAM or GA (1, 10 or 100 μM) until growth arrest. To analyze senescence, β-galactosidase activity and telomere length of HUVECs were measured by cytometry and semi-quantitative PCR, respectively. At all tested concentrations, AAM or GA reduced cell population doubling compared to the control condition (p \textless 0.001). β-galactosidase activity in endothelial cells was increased when exposed to AAM (≥10 μM) or GA (≥1 μM) (p \textless 0.05). AAM (≥10 μM) or GA (100 μM) accelerated telomere shortening in HUVECs (p \textless 0.05). In conclusion, in vitro chronic exposure to AAM or GA at low concentrations induces accelerated senescence. This result suggests that an exposure to AAM might contribute to endothelial aging.
Development of a risk stratification algorithm to improve patient-centered care and decision making for incident elderly patients with end-stage renal disease.
Couchoud, C. G.; Beuscart, J. R.; Aldigier, J.; Brunet, P. J.; Moranne, O. P.; and REIN registry
Kidney International, 88(5): 1178–1186. November 2015.
doi
link
bibtex
abstract
@article{couchoud_development_2015,
title = {Development of a risk stratification algorithm to improve patient-centered care and decision making for incident elderly patients with end-stage renal disease},
volume = {88},
issn = {1523-1755},
doi = {10.1038/ki.2015.245},
abstract = {A significant number of elderly patients die during their first 3 months of dialysis. Because dialysis can impair the quality of both life and death, a personalized care plan based on both early prognosis and patient choices is required. We developed a prognostic screening tool to identify older patients in need of specific care based on a multidisciplinary approach. Our study included 24,348 patients aged 75 years and older from the French national renal epidemiology and information network (REIN) registry who began dialysis between 1 January 2005 and 30 September 2012. Our primary outcome was overall mortality during the first 3 months of renal replacement therapy. Multivariate logistic regression was used to construct a scoring system in a random half of the cohort (training set). This score, which included age, gender, specific comorbidities, albumin levels, and mobility, was then applied to the other half (validation set). In all, 2548 patients died during the first 3 months after dialysis initiation, 22\% after dialysis withdrawal. Three risk groups were identified: low risk (score under 12 points, 3-month expected mortality under 20\%), intermediate risk (score from 12 to 16, mortality between 20 and 40\%, 9.5\% of patients) and high risk (score 17 or more, mortality over 40\%, 2.5\% of patients). We developed a decision-making process that classifies patients according to their risk of early death in view of their potentially imminent need for supportive care or treatment.},
language = {eng},
number = {5},
journal = {Kidney International},
author = {Couchoud, Cécile G. and Beuscart, Jean-Baptiste R. and Aldigier, Jean-Claude and Brunet, Philippe J. and Moranne, Olivier P. and {REIN registry}},
month = nov,
year = {2015},
pmid = {26331408},
pages = {1178--1186},
}
A significant number of elderly patients die during their first 3 months of dialysis. Because dialysis can impair the quality of both life and death, a personalized care plan based on both early prognosis and patient choices is required. We developed a prognostic screening tool to identify older patients in need of specific care based on a multidisciplinary approach. Our study included 24,348 patients aged 75 years and older from the French national renal epidemiology and information network (REIN) registry who began dialysis between 1 January 2005 and 30 September 2012. Our primary outcome was overall mortality during the first 3 months of renal replacement therapy. Multivariate logistic regression was used to construct a scoring system in a random half of the cohort (training set). This score, which included age, gender, specific comorbidities, albumin levels, and mobility, was then applied to the other half (validation set). In all, 2548 patients died during the first 3 months after dialysis initiation, 22% after dialysis withdrawal. Three risk groups were identified: low risk (score under 12 points, 3-month expected mortality under 20%), intermediate risk (score from 12 to 16, mortality between 20 and 40%, 9.5% of patients) and high risk (score 17 or more, mortality over 40%, 2.5% of patients). We developed a decision-making process that classifies patients according to their risk of early death in view of their potentially imminent need for supportive care or treatment.
“Women in the middle”: An observational study of a generation story in Alzheimer disease in France.
Huvent-Grelle, D.; Boulanger, E.; Beuscart, J. B.; Martin, T.; Podvin, J.; and Puisieux, F.
European Geriatric Medicine, 6(2): 124–127. 2015.
![“Women in the middle”: An observational study of a generation story in Alzheimer disease in France [link]](//bibbase.org/img/filetypes/link.svg "Paper")
Paper
doi
link
bibtex
abstract
@article{huvent-grelle_women_2015-1,
title = {“{Women} in the middle”: {An} observational study of a generation story in {Alzheimer} disease in {France}},
volume = {6},
issn = {1878-7649},
shorttitle = {“{Women} in the middle”},
url = {http://www.sciencedirect.com/science/article/pii/S1878764914002307},
doi = {10.1016/j.eurger.2014.10.001},
abstract = {Background
It is well known that informal care giving for Alzheimer patients can be a burden and may result in caregivers’ distress and stress. Caring for a person with Alzheimer's disease (AD) is a difficult task, which can become overwhelming. Their caregivers need attention as well.
Objectives
The present study examines the socio-demographic characteristics and the quality of health and life of the sandwich grandparent generation (SGP) caregivers defined as providing care to both old demented parents and young grandchildren.
Study design
Multicentric, prospective and observational study over a one-year period.
Setting
Eleven voluntary Memory Clinics across the North of France.
Participants
Voluntary SGP caregivers recruited in Memory Clinics who completed an oral questionnaire, during an interview one to one with a physician.
Results
A vast majority of our SGP caregivers were women, mean age 59 years, married, retired, described in the literature as “women in the middle”, felling stressed and not sleeping well in more than half of the cases. They had three grandchildren, mean age 7 years. The AD patient, mean age 86-years-old, was most frequently the caregiver's mother. Many SGPs had been providing their help for 5 years or even longer. Nevertheless, the SGPs considered themselves satisfied about their health, and said they had a good quality of life.
Conclusion
Although SGP women caregivers reported high levels of perceived burden, they considered that their health and quality of life were good.},
number = {2},
urldate = {2016-03-01},
journal = {European Geriatric Medicine},
author = {Huvent-Grelle, D. and Boulanger, E. and Beuscart, J. B. and Martin, T. and Podvin, J. and Puisieux, F.},
year = {2015},
keywords = {Alzheimer Disease, Caregiver burden, Caregiving},
pages = {124--127},
}
Background It is well known that informal care giving for Alzheimer patients can be a burden and may result in caregivers’ distress and stress. Caring for a person with Alzheimer's disease (AD) is a difficult task, which can become overwhelming. Their caregivers need attention as well. Objectives The present study examines the socio-demographic characteristics and the quality of health and life of the sandwich grandparent generation (SGP) caregivers defined as providing care to both old demented parents and young grandchildren. Study design Multicentric, prospective and observational study over a one-year period. Setting Eleven voluntary Memory Clinics across the North of France. Participants Voluntary SGP caregivers recruited in Memory Clinics who completed an oral questionnaire, during an interview one to one with a physician. Results A vast majority of our SGP caregivers were women, mean age 59 years, married, retired, described in the literature as “women in the middle”, felling stressed and not sleeping well in more than half of the cases. They had three grandchildren, mean age 7 years. The AD patient, mean age 86-years-old, was most frequently the caregiver's mother. Many SGPs had been providing their help for 5 years or even longer. Nevertheless, the SGPs considered themselves satisfied about their health, and said they had a good quality of life. Conclusion Although SGP women caregivers reported high levels of perceived burden, they considered that their health and quality of life were good.
Prise en charge des chutes répétées chez l’hypertendu âgé.
Puisieux, F.; Boulanger, E.; and Beuscart, J. -.
Archives des Maladies du Coeur et des Vaisseaux - Pratique, 2015(242): 8–13. November 2015.
Paper
doi
link
bibtex
abstract
@article{puisieux_prise_2015,
title = {Prise en charge des chutes répétées chez l’hypertendu âgé},
volume = {2015},
issn = {1261-694X},
url = {http://www.sciencedirect.com/science/article/pii/S1261694X15000498},
doi = {10.1016/j.amcp.2015.09.011},
abstract = {Résumé
Parmi les personnes de 65 ans et plus, deux tiers sont hypertendus et un tiers tombe chaque année. Hypertension artérielle (HTA) et chutes coexistent fréquemment chez un même patient, portant chacun un risque de déclin fonctionnel et de mortalité. La majorité des chutes résultent de l’interaction de multiples facteurs prédisposants et précipitants. L’hypotension orthostatique est reconnue comme un facteur de risque de chute. Bien que les traitements antihypertenseurs puissent contribuer à l’hypotension orthostatique, les études suggèrent que les liens unissant HTA, médicaments antihypertenseurs, hypotension orthostatique et chutes sont plus complexes qu’attendu. Le traitement de l’HTA est bénéfique pour la prévention des accidents vasculaires cérébraux et l’insuffisance cardiaque même chez les sujets âgés fragiles à haut risque de chutes, mais représente dans ce groupe de patients un challenge en termes de sécurité et de qualité de vie. La confirmation du diagnostic par une mesure ambulatoire de la pression artérielle est indispensable. La prescription doit être prudente, avec des objectifs tensionnels raisonnables, en évitant des traitements trop intensifs. Les cardiologues doivent prêter plus d’attention au risque de chute de leurs patients âgés hypertendus dans le but de prévenir le risque de chute et de chute grave.
Summary
Among people aged 65 years or over, two thirds have hypertension (HTA) and one third fall each year. These conditions frequently coexist in the same patient, and each carries a risk for functional decline or mortality. The majority of falls result from interactions between multiple predisposing and precipitating factors. Orthostatic hypotension is recognized as a risk factor of falling. Although antihypertensive treatment may contribute to orthostatic hypotension, data from studies suggest that the link between HTA, antihypertensive medication, orthostatic hypotension and falls is more complex than expected. The treatment of HTA is crucial for the prevention of stroke and heart failure even in the frail old person at high risk for falling, but represents in this group of patients a challenge in terms of safety and quality of life. Confirmation of the diagnosis with 24-hour ambulatory blood pressure monitoring or BP monitoring at home is important. Cautious drug prescription, with adapted blood pressure targets, avoiding too intensive treatments, is important for treatment adequacy and safety. Cardiologists must pay greater attention to fall risk in older adults with HTA in an effort to prevent falls and injurious falls.},
number = {242},
urldate = {2016-03-01},
journal = {Archives des Maladies du Coeur et des Vaisseaux - Pratique},
author = {Puisieux, F. and Boulanger, E. and Beuscart, J. -B.},
month = nov,
year = {2015},
pages = {8--13},
}
Résumé Parmi les personnes de 65 ans et plus, deux tiers sont hypertendus et un tiers tombe chaque année. Hypertension artérielle (HTA) et chutes coexistent fréquemment chez un même patient, portant chacun un risque de déclin fonctionnel et de mortalité. La majorité des chutes résultent de l’interaction de multiples facteurs prédisposants et précipitants. L’hypotension orthostatique est reconnue comme un facteur de risque de chute. Bien que les traitements antihypertenseurs puissent contribuer à l’hypotension orthostatique, les études suggèrent que les liens unissant HTA, médicaments antihypertenseurs, hypotension orthostatique et chutes sont plus complexes qu’attendu. Le traitement de l’HTA est bénéfique pour la prévention des accidents vasculaires cérébraux et l’insuffisance cardiaque même chez les sujets âgés fragiles à haut risque de chutes, mais représente dans ce groupe de patients un challenge en termes de sécurité et de qualité de vie. La confirmation du diagnostic par une mesure ambulatoire de la pression artérielle est indispensable. La prescription doit être prudente, avec des objectifs tensionnels raisonnables, en évitant des traitements trop intensifs. Les cardiologues doivent prêter plus d’attention au risque de chute de leurs patients âgés hypertendus dans le but de prévenir le risque de chute et de chute grave. Summary Among people aged 65 years or over, two thirds have hypertension (HTA) and one third fall each year. These conditions frequently coexist in the same patient, and each carries a risk for functional decline or mortality. The majority of falls result from interactions between multiple predisposing and precipitating factors. Orthostatic hypotension is recognized as a risk factor of falling. Although antihypertensive treatment may contribute to orthostatic hypotension, data from studies suggest that the link between HTA, antihypertensive medication, orthostatic hypotension and falls is more complex than expected. The treatment of HTA is crucial for the prevention of stroke and heart failure even in the frail old person at high risk for falling, but represents in this group of patients a challenge in terms of safety and quality of life. Confirmation of the diagnosis with 24-hour ambulatory blood pressure monitoring or BP monitoring at home is important. Cautious drug prescription, with adapted blood pressure targets, avoiding too intensive treatments, is important for treatment adequacy and safety. Cardiologists must pay greater attention to fall risk in older adults with HTA in an effort to prevent falls and injurious falls.
Medication Review: Human Factors Study Aiming at Helping an Acute Geriatric Unit to Sustain and Systematize the Process.
Wawrzyniak, C.; Beuscart-Zephir, M.; Marcilly, R.; Douze, L.; Beuscart, J.; Lecoutre, D.; Puisieux, F.; and Pelayo, S.
Studies in Health Technology and Informatics, 218: 80–85. 2015.
link
bibtex
abstract
@article{wawrzyniak_medication_2015,
title = {Medication {Review}: {Human} {Factors} {Study} {Aiming} at {Helping} an {Acute} {Geriatric} {Unit} to {Sustain} and {Systematize} the {Process}},
volume = {218},
issn = {0926-9630},
shorttitle = {Medication {Review}},
abstract = {BACKGROUND: Medication Review (MRev) has been implemented in many hospitals to improve patient safety and well-being. However, it seems sometimes difficult to implement, maintain and systematize this process, especially when key-elements are absent. This study focuses on the analysis of a MRev process implemented in an Acute Geriatric Unit (AGU) which, at the time of the study, had no Computerized Physician Order Entry (CPOE) and no sufficient staff to - normally - support the process.
OBJECTIVE: This study describes the MRev process as existing in the AGU with a particular focus on the preparatory MRev meeting phase and presents our recommendations to maintain and optimize it.
METHODS: Human Factor experts have collected and analyzed data during MRev process by interviews, shadowing observations and video recording from April to October 2014 at Lille University Hospital.
RESULTS: MRev process consists of three phases (meeting preparation, MRev meeting and patient discharge) and includes seven main tasks for which actors, documented supports, outcomes and difficulties are identified. Although allocating a fulltime pharmacist for the AGU would solve several problems, the main realistic recommendations concern training for junior and senior actors according to their roles and the improvement of some tasks processes.
CONCLUSION: Despite less than optimal conditions as compared to those recommended by the literature, the observed AGU performs an efficient review based on well designed tools and processes.},
language = {eng},
journal = {Studies in Health Technology and Informatics},
author = {Wawrzyniak, Clément and Beuscart-Zephir, Marie-Catherine and Marcilly, Romaric and Douze, Laura and Beuscart, Jean-Baptiste and Lecoutre, Dominique and Puisieux, François and Pelayo, Sylvia},
year = {2015},
pmid = {26262531},
pages = {80--85},
}
BACKGROUND: Medication Review (MRev) has been implemented in many hospitals to improve patient safety and well-being. However, it seems sometimes difficult to implement, maintain and systematize this process, especially when key-elements are absent. This study focuses on the analysis of a MRev process implemented in an Acute Geriatric Unit (AGU) which, at the time of the study, had no Computerized Physician Order Entry (CPOE) and no sufficient staff to - normally - support the process. OBJECTIVE: This study describes the MRev process as existing in the AGU with a particular focus on the preparatory MRev meeting phase and presents our recommendations to maintain and optimize it. METHODS: Human Factor experts have collected and analyzed data during MRev process by interviews, shadowing observations and video recording from April to October 2014 at Lille University Hospital. RESULTS: MRev process consists of three phases (meeting preparation, MRev meeting and patient discharge) and includes seven main tasks for which actors, documented supports, outcomes and difficulties are identified. Although allocating a fulltime pharmacist for the AGU would solve several problems, the main realistic recommendations concern training for junior and senior actors according to their roles and the improvement of some tasks processes. CONCLUSION: Despite less than optimal conditions as compared to those recommended by the literature, the observed AGU performs an efficient review based on well designed tools and processes.
Registration on the renal transplantation waiting list and mortality on dialysis: an analysis of the French REIN registry using a multi-state model.
Beuscart, J.; Pagniez, D.; Boulanger, E.; and Duhamel, A.
Journal of Epidemiology / Japan Epidemiological Association, 25(2): 133–141. 2015.
doi
link
bibtex
abstract
@article{beuscart_registration_2015,
title = {Registration on the renal transplantation waiting list and mortality on dialysis: an analysis of the {French} {REIN} registry using a multi-state model},
volume = {25},
issn = {1349-9092},
shorttitle = {Registration on the renal transplantation waiting list and mortality on dialysis},
doi = {10.2188/jea.JE20130193},
abstract = {BACKGROUND: Access to the renal transplantation (RT) waiting list depends on factors related to lower mortality rates and often occurs after dialysis initiation. The aim of the study was to use a flexible regression model to determine if registration on the RT waiting list is associated with mortality on dialysis, independent of the comorbidities associated with such registration.
METHODS: Data from the French REIN registry on 7138 incident hemodialysis (HD) patients were analyzed. A multi-state model including four states ('HD, not wait-listed', 'HD, wait-listed', 'death', and 'RT') was used to estimate the effect of being wait-listed on the probability of death.
RESULTS: During the study, 1392 (19.5\%) patients were wait-listed. Of the 2954 deaths observed in the entire cohort during follow-up, 2921 (98.9\%) were observed in the not wait-listed group compared with only 33 (1.1\%) in the wait-listed group. In the multivariable analysis, the adjusted hazard ratio for death associated with non-registration on the waiting list was 3.52 (95\% CI, 1.70-7.30). The risk factors for death identified for not wait-listed patients were not found to be significant risk factors for wait-listed patients, with the exception of age.
CONCLUSIONS: The use of a multi-state model allowed a flexible analysis of mortality on dialysis. Patients who were not wait-listed had a much higher risk of death, regardless of co-morbidities associated with being wait-listed, and did not share the same risk factors of death as wait-listed patients. Registration on the waiting list should therefore be taken into account in survival analysis of patients on dialysis.},
language = {eng},
number = {2},
journal = {Journal of Epidemiology / Japan Epidemiological Association},
author = {Beuscart, Jean-Baptiste and Pagniez, Dominique and Boulanger, Eric and Duhamel, Alain},
year = {2015},
pmid = {25721069},
pmcid = {PMC4310874},
pages = {133--141},
}
BACKGROUND: Access to the renal transplantation (RT) waiting list depends on factors related to lower mortality rates and often occurs after dialysis initiation. The aim of the study was to use a flexible regression model to determine if registration on the RT waiting list is associated with mortality on dialysis, independent of the comorbidities associated with such registration. METHODS: Data from the French REIN registry on 7138 incident hemodialysis (HD) patients were analyzed. A multi-state model including four states ('HD, not wait-listed', 'HD, wait-listed', 'death', and 'RT') was used to estimate the effect of being wait-listed on the probability of death. RESULTS: During the study, 1392 (19.5%) patients were wait-listed. Of the 2954 deaths observed in the entire cohort during follow-up, 2921 (98.9%) were observed in the not wait-listed group compared with only 33 (1.1%) in the wait-listed group. In the multivariable analysis, the adjusted hazard ratio for death associated with non-registration on the waiting list was 3.52 (95% CI, 1.70-7.30). The risk factors for death identified for not wait-listed patients were not found to be significant risk factors for wait-listed patients, with the exception of age. CONCLUSIONS: The use of a multi-state model allowed a flexible analysis of mortality on dialysis. Patients who were not wait-listed had a much higher risk of death, regardless of co-morbidities associated with being wait-listed, and did not share the same risk factors of death as wait-listed patients. Registration on the waiting list should therefore be taken into account in survival analysis of patients on dialysis.
Dietary CML-enriched protein induces functional arterial aging in a RAGE-dependent manner in mice.
Grossin, N.; Auger, F.; Niquet-Leridon, C.; Durieux, N.; Montaigne, D.; Schmidt, A. M.; Susen, S.; Jacolot, P.; Beuscart, J.; Tessier, F. J.; and Boulanger, E.
Molecular Nutrition & Food Research. February 2015.
doi
link
bibtex
abstract
@article{grossin_dietary_2015,
title = {Dietary {CML}-enriched protein induces functional arterial aging in a {RAGE}-dependent manner in mice},
issn = {1613-4133},
doi = {10.1002/mnfr.201400643},
abstract = {SCOPE:: Advanced glycation end-products (AGEs) are endogenously produced and are present in food. N(ε) -carboxymethyllysine (CML) is an endothelial activator via the receptor for AGEs (RAGE) and is a major dietary AGE. This work investigated the effects of a CML-enriched diet and RAGE involvement in aortic aging in mice.
METHODS AND RESULTS:: After 9 months of a control diet or CML-enriched diets (50, 100 or 200μgCML /g of food), endothelium-dependent relaxation (EDR), RAGE, vascular cell adhesion molecule-1 (VCAM-1) and sirtuin-1 (SIRT1) expression, pulse wave velocity (PWV) and elastin disruption were measured in aortas of wild-type or RAGE(-/-) male C57BL/6 mice. Compared to the control diet, EDR was reduced in the wild-type mice fed the CML-enriched diet (200μgCML /g) (66.8±12.26 vs 94.3±2.6\%, p{\textless}0.01). RAGE and VCAM-1 (p{\textless}0.05) expression were increased in the aortic wall. RAGE(-/-) mice were protected against CML-enriched diet-induced endothelial dysfunction. Compared to control diet, the CML-enriched diet (200μgCML /g) increased the aortic PWV (86.6±41.1 vs 251.4±41.1cm/s, p{\textless}0.05) in wild-type animals. Elastin disruption was found to a greater extent in the CML-fed mice (p{\textless}0.05). RAGE(-/-) mice fed the CML-enriched diet were protected from aortic stiffening.
CONCLUSION:: Chronic CML ingestion induced endothelial dysfunction and arterial stiffness and aging in a RAGE dependent manner. This article is protected by copyright. All rights reserved.},
language = {ENG},
journal = {Molecular Nutrition \& Food Research},
author = {Grossin, Nicolas and Auger, Florent and Niquet-Leridon, Céline and Durieux, Nicolas and Montaigne, David and Schmidt, Ann Marie and Susen, Sophie and Jacolot, Philippe and Beuscart, Jean-Baptiste and Tessier, Frédéric J. and Boulanger, Eric},
month = feb,
year = {2015},
pmid = {25655894},
}
SCOPE:: Advanced glycation end-products (AGEs) are endogenously produced and are present in food. N(ε) -carboxymethyllysine (CML) is an endothelial activator via the receptor for AGEs (RAGE) and is a major dietary AGE. This work investigated the effects of a CML-enriched diet and RAGE involvement in aortic aging in mice. METHODS AND RESULTS:: After 9 months of a control diet or CML-enriched diets (50, 100 or 200μgCML /g of food), endothelium-dependent relaxation (EDR), RAGE, vascular cell adhesion molecule-1 (VCAM-1) and sirtuin-1 (SIRT1) expression, pulse wave velocity (PWV) and elastin disruption were measured in aortas of wild-type or RAGE(-/-) male C57BL/6 mice. Compared to the control diet, EDR was reduced in the wild-type mice fed the CML-enriched diet (200μgCML /g) (66.8±12.26 vs 94.3±2.6%, p\textless0.01). RAGE and VCAM-1 (p\textless0.05) expression were increased in the aortic wall. RAGE(-/-) mice were protected against CML-enriched diet-induced endothelial dysfunction. Compared to control diet, the CML-enriched diet (200μgCML /g) increased the aortic PWV (86.6±41.1 vs 251.4±41.1cm/s, p\textless0.05) in wild-type animals. Elastin disruption was found to a greater extent in the CML-fed mice (p\textless0.05). RAGE(-/-) mice fed the CML-enriched diet were protected from aortic stiffening. CONCLUSION:: Chronic CML ingestion induced endothelial dysfunction and arterial stiffness and aging in a RAGE dependent manner. This article is protected by copyright. All rights reserved.
Systematic skin examination in an acute geriatric unit: skin cancer prevalence.
Templier, C.; Boulanger, E.; Boumbar, Y.; Puisieux, F.; Dziwniel, V.; Mortier, L.; and Beuscart, J. B.
Clinical and Experimental Dermatology. January 2015.
doi
link
bibtex
abstract
@article{templier_systematic_2015,
title = {Systematic skin examination in an acute geriatric unit: skin cancer prevalence},
issn = {1365-2230},
shorttitle = {Systematic skin examination in an acute geriatric unit},
doi = {10.1111/ced.12562},
abstract = {BACKGROUND: Ageing is a determining factor in skin cancer, but the incidence and prevalence of skin cancer in elderly patients are not known.
AIM: To determine the prevalence of skin cancers in elderly patients and to assess their associated geriatric syndromes.
METHODS: Between January and April 2013, all consecutive incident patients hospitalized in the Acute Geriatric Unit of Lille University Hospital underwent a geriatric assessment and a systematic dermatological examination. A biopsy was taken whenever there was any lesion with suspicion of malignancy.
RESULTS: In total, 204 patients (mean age 85.4 years) were included, and 16 cutaneous biopsies were taken from 15 patients. Histological examination confirmed skin cancer in 11 biopsies from 10 patients: 9 basal cell carcinomas, 1 squamous cell carcinoma (SCC) and 1 malignant lentigo. The prevalence of skin cancer was 4.9\%. The geriatric assessment revealed severe geriatric syndromes in the 10 patients with skin cancer: severe dependence (8/10), possible cognitive impairment (10/10), and moderate or severe malnutrition (5/10).
CONCLUSIONS: The prevalence of skin cancer is high in frail elderly patients. The association of severe geriatric syndromes suggests that close collaboration between geriatricians and dermatologists is essential to optimize the treatment of skin carcinoma in elderly patients.},
language = {ENG},
journal = {Clinical and Experimental Dermatology},
author = {Templier, C. and Boulanger, E. and Boumbar, Y. and Puisieux, F. and Dziwniel, V. and Mortier, L. and Beuscart, J. B.},
month = jan,
year = {2015},
pmid = {25623526},
}
BACKGROUND: Ageing is a determining factor in skin cancer, but the incidence and prevalence of skin cancer in elderly patients are not known. AIM: To determine the prevalence of skin cancers in elderly patients and to assess their associated geriatric syndromes. METHODS: Between January and April 2013, all consecutive incident patients hospitalized in the Acute Geriatric Unit of Lille University Hospital underwent a geriatric assessment and a systematic dermatological examination. A biopsy was taken whenever there was any lesion with suspicion of malignancy. RESULTS: In total, 204 patients (mean age 85.4 years) were included, and 16 cutaneous biopsies were taken from 15 patients. Histological examination confirmed skin cancer in 11 biopsies from 10 patients: 9 basal cell carcinomas, 1 squamous cell carcinoma (SCC) and 1 malignant lentigo. The prevalence of skin cancer was 4.9%. The geriatric assessment revealed severe geriatric syndromes in the 10 patients with skin cancer: severe dependence (8/10), possible cognitive impairment (10/10), and moderate or severe malnutrition (5/10). CONCLUSIONS: The prevalence of skin cancer is high in frail elderly patients. The association of severe geriatric syndromes suggests that close collaboration between geriatricians and dermatologists is essential to optimize the treatment of skin carcinoma in elderly patients.
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