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1. Managing hypertension in frail oldest-old—The role of guideline use by general practitioners from 29 countries

Author

Roulet, C., Rozsnyai, Z., Jungo, K.T., Ploeg, M.A. van der, Floriani, C., Kurpas, D., Vinker, S., Pestic, S.K., Petrazzuoli, F., Hoffmann, K., Viegas, R.P.A., Mallen, C., Tatsioni, A., Maisonneuve, H., Collins, C., Lingner, H., Tsopra, R., Mueller, Y., Poortvliet, R.K.E., Gussekloo, J., Streit, S., University of Bern, Leiden University Medical Center (LUMC), Wrocław Medical University, Tel Aviv University [Tel Aviv], University of Tuzla, Lund University [Lund], Medizinische Universität Wien = Medical University of Vienna, NOVA Medical School - Faculdade de Ciências Médicas (NMS), Universidade Nova de Lisboa = NOVA University Lisbon (NOVA), Keele University [Keele], University of Ioannina, Université de Genève = University of Geneva (UNIGE), Irish College of General Practitioners [Dublin, Irlande] (ICGP), Hannover Medical School [Hannover] (MHH), Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Lausanne = University of Lausanne (UNIL), Leiden University, NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM), Bodescot, Myriam, University of Wrocław [Poland] (UWr), Tel Aviv University (TAU), Univerzitet u Tuzli [Tuzla, Bosnie-Herzégovine], Centre de Recherche des Cordeliers (CRC (UMR_S_1138 / U1138)), École pratique des hautes études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Cité (UPCité), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Prof. Streit’s research was supported by grants (P2BEP3_165353) from the Swiss National Science Foundation (SNF) and the Gottfried and Julia Bangerter-Rhyner Foundation, Switzerland. Christian Mallen is funded by the NIHR Collaborations for Leadership in Applied Health Research and Care West Midlands, the NIHR SPCR and a NIHR Research Professorship in General Practice, (NIHR-RP-2014-04-026)., University of Geneva [Switzerland], Sciences de l’information au service de la médecine personnalisée = Information Sciences to support Personalized Medicine [CRC], Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université de Paris (UP)-École pratique des hautes études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université de Paris (UP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Université de Lausanne (UNIL), and Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Cité (UPCité)-École pratique des hautes études (EPHE)

Subjects
Medical Doctors, Health Care Providers, [SDV]Life Sciences [q-bio], Blood Pressure, Cardiovascular Medicine, Vascular Medicine, MESH: Hypertension, Geographical Locations, MESH: Aged, 80 and over, MESH: Practice Guidelines as Topic, RA0421, Medicine and Health Sciences, Medical Personnel, Aged, 80 and over, MESH: Aged, Frailty, [SDV.MHEP.GEG] Life Sciences [q-bio]/Human health and pathology/Geriatry and gerontology, Agricultural and Biological Sciences(all), [SDV.MHEP.GEG]Life Sciences [q-bio]/Human health and pathology/Geriatry and gerontology, MESH: Clinical Decision-Making, Drugs, MESH: Blood Pressure, 3. Good health, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, MESH: General Practitioners, Europe, Professions, Cardiovascular Diseases, Hypertension, Practice Guidelines as Topic, Medicine, [SDV.IB]Life Sciences [q-bio]/Bioengineering, Research Article, Frail Elderly, Science, Clinical Decision-Making, education, 610 Medicine & health, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, SDG 3 - Good Health and Well-being, General Practitioners, 360 Social problems & social services, Physicians, Humans, General, Aged, Pharmacology, [SDV.IB] Life Sciences [q-bio]/Bioengineering, Treatment Guidelines, Health Care Policy, MESH: Humans, Biochemistry, Genetics and Molecular Biology(all), MESH: Frail Elderly, R1, Health Care, Geriatrics, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, People and Places, Population Groupings, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, RA, Antihypertensives
Abstract

BackgroundThe best management of hypertension in frail oldest-old (≥80 years of age) remains unclear and we still lack guidelines that provide specific recommendations. Our study aims to investigate guideline use in general practitioners (GPs) and to examine if guideline use relates to different decisions when managing hypertension in frail oldest-old.Design/settingCross-sectional study among currently active GPs from 29 countries using a case-vignettes survey.MethodsGPs participated in a survey with case-vignettes of frail oldest-olds varying in systolic blood pressure (SBP) levels and cardiovascular disease (CVD). GPs from 26 European countries and from Brazil, Israel and New Zealand were invited. We compared the percentage of GPs reporting using guidelines per country and further stratified on the most frequently mentioned guidelines. To adjust for patient characteristics (SBP, CVD and GPs' sex, years of experience, prevalence of oldest-old and location of their practice), we used a mixed-effects regression model accounting for clustering within countries.ResultsOverall, 2,543 GPs from 29 countries were included. 59.4% of them reported to use guidelines. Higher guideline use was found in female (p = 0.031) and less-experienced GPs (pConclusionMany GPs reported using guidelines to manage hypertension in frail oldest-old patients, however guideline users did not decide differently from non-users concerning hypertension treatment decisions. Instead of focusing on the fact if GPs use guidelines or not, we as a scientific community should put an emphasis on what guidelines suggest in frail and oldest-old patients.

Published
2020
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2. Potentially inappropriate medication and attitudes of older adults towards deprescribing

Author

Achterhof, A.B., Rozsnyai, Z., Reeve, E., Jungo, K.T., Floriani, C., Poortvliet, R.K.E., Rodondi, N., Gussekloo, J., and Streit, S.

Subjects
Male, Questionnaires, Patients, Epidemiology, Health Care Providers, Science, Social Sciences, 610 Medicine & health, Comorbidity, Research and Analysis Methods, Deprescriptions, Elderly, Adverse Reactions, Psychological Attitudes, 360 Social problems & social services, Physicians, hemic and lymphatic diseases, Medicine and Health Sciences, Humans, Psychology, Adults, Medical Personnel, Potentially Inappropriate Medication List, Aged, Aged, 80 and over, Pharmacology, Survey Research, Biology and Life Sciences, Patient Acceptance of Health Care, Health Care, Professions, Cross-Sectional Studies, Geriatrics, Age Groups, Research Design, Medical Risk Factors, People and Places, Polypharmacy, Medicine, Female, Population Groupings, Self Report, Attitude to Health, Research Article
Abstract

IntroductionMultimorbidity and polypharmacy are current challenges when caring for the older population. Both have led to an increase of potentially inappropriate medication (PIM), illustrating the need to assess patients' attitudes towards deprescribing. We aimed to assess the prevalence of PIM use and whether this was associated with patient factors and willingness to deprescribe.MethodWe analysed data from the LESS Study, a cross-sectional study on self-reported medication and on barriers and enablers towards the willingness to deprescribe (rPATD questionnaire). The survey was conducted among multimorbid (≥3 chronic conditions) participants ≥70 years with polypharmacy (≥5 long-term medications). A subset of the Beers 2019 criteria was applied for the assessment of medication appropriateness.ResultsData from 300 patients were analysed. The mean age was 79.1 years (SD 5.7). 53% had at least one PIM (men: 47.8%%, women: 60.4%%; p = 0.007). A higher number of medications was associated with PIM use (p = 0.002). We found high willingness to deprescribe in both participants with and without PIM. Willingness to deprescribe was not associated with PIM use (p = 0.25), nor number of PIMs (p = 0.81).ConclusionThe willingness of older adults with polypharmacy towards deprescribing was not associated with PIM use in this study. These results suggest that patients may not be aware if they are taking PIMs. This implies the need for raising patients' awareness about PIMs through education, especially in females, in order to implement deprescribing in daily practice.

Published
2020
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3. 'Ab initio' calculations on a novel mode for storing and releasing electrons via C-C bond formation and cleavage

Author

Cambi, R., Nottoli, R., Rosi, M., Sgamellotti, A., and Floriani, C.

Subjects
Nickel compounds -- Research, Scission (Chemistry) -- Research, Chemical bonds -- Research, Chemistry
Abstract

Ab initio Hartree-Fock and Moller-Plesset calculations are performed on the reduction chemistry of (Ni(salophen)). Results show that no oxidation state change follows the addition of two electrons to the system because no localized-on-nickel and low-energy orbitals are present to accomodate them. Instead, the two electrons form a new C-C bond which can be broken to give the original product. Moreover, the Ni2+ functions as a shield among the negative charges of the ligand during the redox reaction.

Published
1992

4. Thyroid Hormone Therapy for Older Adults with Subclinical Hypothyroidism

Author

Stott, D.J., Rodondi, N., Kearney, P.M., Ford, I., Westendorp, R.G.J., Mooijaart, S.P., Sattar, N., Aubert, C.E., Aujesky, D., Bauer, D.C., Baumgartner, C., Blum, M.R., Browne, J.P., Byrne, S., Collet, T.H., Dekkers, O.M., Elzen, W.P.J. den, Puy, R.S. du, Ellis, G., Feller, M., Floriani, C., Hendry, K., Hurley, C., Jukema, J.W., Kean, S., Kelly, M., Krebs, D., Langhorne, P., McCarthy, G., McCarthy, V., McConnachie, A., McDade, M., Messow, M., O'Flynn, A., O'Riordan, D., Poortvliet, R.K.E., Quinn, T.J., Russell, A., Sinnott, C., Smit, J.W.A., Dorland, H.A. van, Walsh, K.A., Walsh, E.K., Watt, T., Wilson, R., Gussekloo, J., TRUST Study Grp, Sinnott, Carol [0000-0002-8620-7461], and Apollo - University of Cambridge Repository

Subjects
Male, endocrine system, medicine.medical_specialty, Pediatrics, endocrine system diseases, medicine.medical_treatment, Levothyroxine, Thyrotropin, General Medicine, 030209 endocrinology & metabolism, Reference range, 610 Medicine & health, 030204 cardiovascular system & hematology, Placebo, law.invention, Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18], 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, Double-Blind Method, Hypothyroidism, law, 360 Social problems & social services, Subclinical hypothyroidism, medicine, Humans, Treatment Failure, Fatigue, Subclinical infection, Aged, Aged, 80 and over, Intention-to-treat analysis, business.industry, Thyroid, R1, 3. Good health, Intention to Treat Analysis, Clinical trial, Thyroxine, medicine.anatomical_structure, Physical therapy, Quality of Life, Female, Hormone therapy, business, hormones, hormone substitutes, and hormone antagonists, medicine.drug
Abstract

Item does not contain fulltext BACKGROUND: The use of levothyroxine to treat subclinical hypothyroidism is controversial. We aimed to determine whether levothyroxine provided clinical benefits in older persons with this condition. METHODS: We conducted a double-blind, randomized, placebo-controlled, parallel-group trial involving 737 adults who were at least 65 years of age and who had persisting subclinical hypothyroidism (thyrotropin level, 4.60 to 19.99 mIU per liter; free thyroxine level within the reference range). A total of 368 patients were assigned to receive levothyroxine (at a starting dose of 50 mug daily, or 25 mug if the body weight was

Published
2017
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5. Thyroid function tests in the reference range and fracture: Individual participant analysis of prospective cohorts

Author

Aubert, C.E. (Carole E.), Floriani, C. (Carmen), Bauer, D.C. (Douglas), B.R. da Costa (Bruno), Segna, D. (Daniel), Blum, M.R. (Manuel), Collet, T.-H. (Tinh-Hai), Fink, H.A. (Howard A.), Cappola, A.R. (Anne), Syrogiannouli, L. (Lamprini), Peeters, R.P. (Robin), Asvold, B.O. (Bjorn O.), Elzen, W.P.J. (Wendy) den, Luben, R.N. (Robert), Bremner, A. (Alexandra), Gogakos, A. (Apostolos), Eastell, R. (Richard), Kearney, P.M. (Patricia M.), Hoff, M. (Mari), Le Blanc, E. (Erin), Ceresini, G. (Graziano), Rivadeneira, F. (Fernando), Uitterlinden, A.G. (André), Khaw, K.T., Langhammer, A. (Arnulf), Stott, D.J. (David. J.), Westendorp, R.G.J. (Rudi), Ferrucci, L. (Luigi), Williams, G. (Graham), Gussekloo, J. (Jacobijn), Walsh, J.P. (John), Aujesky, D. (Drahomir), Rodondi, N. (Nicolas), Aubert, C.E. (Carole E.), Floriani, C. (Carmen), Bauer, D.C. (Douglas), B.R. da Costa (Bruno), Segna, D. (Daniel), Blum, M.R. (Manuel), Collet, T.-H. (Tinh-Hai), Fink, H.A. (Howard A.), Cappola, A.R. (Anne), Syrogiannouli, L. (Lamprini), Peeters, R.P. (Robin), Asvold, B.O. (Bjorn O.), Elzen, W.P.J. (Wendy) den, Luben, R.N. (Robert), Bremner, A. (Alexandra), Gogakos, A. (Apostolos), Eastell, R. (Richard), Kearney, P.M. (Patricia M.), Hoff, M. (Mari), Le Blanc, E. (Erin), Ceresini, G. (Graziano), Rivadeneira, F. (Fernando), Uitterlinden, A.G. (André), Khaw, K.T., Langhammer, A. (Arnulf), Stott, D.J. (David. J.), Westendorp, R.G.J. (Rudi), Ferrucci, L. (Luigi), Williams, G. (Graham), Gussekloo, J. (Jacobijn), Walsh, J.P. (John), Aujesky, D. (Drahomir), and Rodondi, N. (Nicolas)

Abstract

Context: Hyperthyroidism is associated with increased fracture risk, but it is not clear if lower thyroid-stimulating hormone (TSH) and higher free thyroxine (FT4) in euthyroid individuals are associated with fracture risk. Objective: To evaluate the association of TSH and FT4 with incident fractures in euthyroid individuals. Design: Individual participant data analysis. Setting: Thirteen prospective cohort studies with baseline examinations between 1981 and 2002. Participants: Adults with baseline TSH 0.45 to 4.49 mIU/L. Main Outcome Measures: Primary outcome was incident hip fracture. Secondary outcomes were any, nonvertebral, and vertebral fractures. Results were presented as hazard ratios (HRs) with 95% confidence interval (CI) adjusted for age and sex. For clinical relevance, we studied TSH according to five categories: 0.45 to 0.99 mIU/L; 1.00 to 1.49 mIU/L; 1.50 to 2.49 mIU/L; 2.50 to 3.49 mIU/L; and 3.50 to 4.49 mIU/L (reference). FT4 was assessed as study-specific standard deviation increase, because assays varied between cohorts. Results: During 659,059 person-years, 2,565 out of 56,835 participants had hip fracture (4.5%; 12 studies with data on hip fracture). The pooled adjusted HR (95% CI) for hip fracture was 1.25 (1.05 to 1.49) for TSH 0.45 to 0.99 mIU/L, 1.19 (1.01 to 1.41) for TSH 1.00 to 1.49 mIU/L, 1.09 (0.93 to 1.28) for TSH 1.50 to 2.49 mIU/L, and 1.12 (0.94 to 1.33) for TSH 2.50 to 3.49 mIU/L (P for trend = 0.004). Hip fracture was also associated with FT4 [HR (95% CI) 1.22 (1.11 to 1.35) per one standard deviation increase in FT4]. FT4 only was associated with any and nonvertebral fractures. Results remained similar in sensitivity analyses. Conclusions: Among euthyroid adults, lower TSH and higher FT4 are associated with an increased risk of hip fracture. These findings may help refine the definition of optimal ranges of thyroid function tests.

Published
2017
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7. Development and validation of a standardised method to identify drug-related hospital admissions in older people

Author

UCL - SSS/LDRI - Louvain Drug Research Institute, UCL - (MGD) Département de pharmacie, UCL - (SLuc) Service de gériatrie, UCL - (SLuc) Département de pharmacie, Thevelin, Stefanie, Spinewine, Anne, Boland, B, Beuscart, JB, Marien, S, Vaillant, F, Cullinan, S, Donzé, J, Floriani, C, Schneider, C, Vondeling, A, Wilting, I, Jansen, P, O'Mahony, D, Rodondi, N, Dalleur, Olivia, UCL - SSS/LDRI - Louvain Drug Research Institute, UCL - (MGD) Département de pharmacie, UCL - (SLuc) Service de gériatrie, UCL - (SLuc) Département de pharmacie, Thevelin, Stefanie, Spinewine, Anne, Boland, B, Beuscart, JB, Marien, S, Vaillant, F, Cullinan, S, Donzé, J, Floriani, C, Schneider, C, Vondeling, A, Wilting, I, Jansen, P, O'Mahony, D, Rodondi, N, and Dalleur, Olivia

Published
2016

48. ChemInform Abstract: cis‐ and trans‐Dichloro Derivatives of Six‐ and Seven‐Coordinate Zirconium and Hafnium Bonded to Quadridentate Schiff‐Base Ligands. Crystal Structures of (Zr(acen)Cl2(thf)), (M(salphen)Cl2(thf))·0.5thf, (M(acen)Cl2), (M: Zr or Hf), and (Zr(msal)Cl2) (acen: N,N′‐ethylenebis(acetylacetoneiminate), salphen: N,N′‐o‐phenylenebis(salicylideneiminate), msal: N‐methylsalicylideneiminate, and thf: tetrahydrofuran).

Author

CORAZZA, F., primary, SOLARI, E., additional, FLORIANI, C., additional, CHIESI‐VILLA, A., additional, and GUASTINI, C., additional

Published
1990
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