Search

Introduction The prescription of psychotropic drugs to older patients in a hospital setting has not been extensively characterized. The objective was to describe the inappropriate co-prescriptions of psychotropic drugs in hospitalized patients aged 75 and over. Methods By analysing the medical database from 222-bed general hospital in France, we reviewed a total of 11,929 stays of at least 3 days by patients aged 75 and over. Prescriptions and co-prescriptions of psychotropic drugs were identified automatically. Anticholinergic drugs with sedative effects were considered as psychotropic drugs. An expert review was performed for stays with the co-prescription of three or more psychotropic drugs to identify inappropriate co-prescriptions. Results Administration of a psychotropic drug was identified in 5475 stays (45.9% of the total number of stays), of which 1526 (12.8% of the total) featured at least one co-prescription. Co-prescriptions of three or more psychotropic drugs for at least 3 days were identified in 374 stays (3.1% of the total). Most of these co-prescriptions ( n =334; 89.2%) were considered inappropriate because of the combination of at least two drugs from the same psychotropic class ( n =269), the absence of a clear indication for a psychotropic drug ( n =173) and a history of falls ( n =86). However, the co-prescriptions were maintained after hospital discharge in 77.4% of cases. Conclusion The co-prescriptions of psychotropic drugs should be re-evaluated in older hospitalized patients.

Background The consequences of an incident delirium (ID) are multiple and severe among the hospitalized elderly patients. Many medications are recognized risk factors for delirium. The aim of this study was to determine the incidence of ID in an acute geriatric unit and to assess the role of iatrogenic factors among the precipitating factors of ID. Methods The study included 369 consecutive incident patients who were admitted in our Acute Geriatric Unit between January and April 2013. Delirium was diagnosed with the Confusion Assessment Method on a daily basis. The Naranjo criteria were used to determine iatrogenic causes of the ID. Results During the study, 34 (9.2%) patients exhibited 35 ID. A multifactorial origin was found in 26 (75%) of these ID. A therapeutic change likely to promote an ID was found for 11 of these ID. According to the criteria of Naranjo, seven (20%) of these ID were likely to have iatrogenic origins. Only one of these seven ID was caused exclusively by iatrogenic factors. Medication was less frequently implicated as a precipitating factor of ID than metabolic factors ( n =33; 94.4%), sources of discomfort ( n =29; 82.8%), or acute medical problems ( n =30; 85.7%). Conclusion The incidence of ID was about 10% in our acute geriatric unit. Iatrogenic factors were implicated in only one out of five ID and they were not among the three most common precipitating factors of ID.

Drug-induced hyperkalemia is a frequent and severe complication in the hospital setting. Other risk factors may also induce hyperkalemia but the combination of drugs and precipitating factors has not been extensively studied. The aim was to identify drug-induced hyperkalemia events in hospitalized older patients and to describe their combinations with precipitating factors. Two experts independently analyzed retrospective data of patients aged 75 years or more. Experts identified 471 hyperkalemia events and concluded that 379 (80.5%) were induced by drugs. The cause was multifactorial (i.e., at least one drug with a precipitating factor) in 300 (79.2%) of the 379 drug-induced hyperkalemia. Most of the drug-induced hyperkalemia events were avoidable (79.9%)-mainly because of the multifactorial cause (e.g., dosage adaptation during acute kidney injury). Drug-induced hyperkalemia events are frequently combined with precipitating factors in hospitalized older patients and their prevention should focus on these combinations.

International audience; A better understanding of “patient pathway” thanks to data analysis can lead to better treatments for patients. The ClinMine project, supported by the The French National Research Agency (ANR), aims at proposing, from various case studies, algorithmic and statistical models able to handle this type of pathway data, focusing primarily on hospital data. This article presents two of these case studies, focusing on the integration of temporal data within analysis. First, the hypothesis that some aspects of the patient pathway can be described, even predicted, from the management process of the hospital medical mail is studied. Therefore a specific functional data analysis is driven, and several types of patients have been detected. The second case study deals with the detection of profiles through a biclustering of the patients. The difficulty to simultaneously deal with heterogeneous data, including temporal data is exposed and a method is proposed. Results on real data show the effectiveness of the proposed method.

Background: The significant risk of adverse events following medical procedures supports a clinical epidemiological approach based on the analyses of collections of electronic medical records. Data analytical tools might help clinical epidemiologists develop more appropriate case-crossover designs for monitoring patient safety. Objective: To develop and assess the methodological quality of an interactive tool for use by clinical epidemiologists to systematically design case-crossover analyses of large electronic medical records databases. Material and Methods: We developed IT-CARES, an analytical tool implementing case-crossover design, to explore the association between exposures and outcomes. The exposures and outcomes are defined by clinical epidemiologists via lists of codes entered via a user interface screen. We tested IT-CARES on data from the French national inpatient stay database, which documents diagnoses and medical procedures for 170 million inpatient stays between 2007 and 2013. We compared the results of our analysis with reference data from the literature on thromboembolic risk after delivery and bleeding risk after total hip replacement. Results: IT-CARES provides a user interface with 3 columns: (i) the outcome criteria in the left-hand column, (ii) the exposure criteria in the right-hand column, and (iii) the estimated risk (odds ratios, presented in both graphical and tabular formats) in the middle column. The estimated odds ratios were consistent with the reference literature data. Discussion: IT-CARES may enhance patient safety by facilitating clinical epidemiological studies of adverse events following medical procedures. The tool’s usability must be evaluated and improved in further research.

Introduction L’analyse des opinions spontanement exprimees sur Internet permet d’apprecier l’acceptabilite des politiques preventives, en complement de l’approche classique par questionnaire. L’objectif de ce travail est d’analyser les opinions concernant la vaccination contre les papillomavirus humains (HPV), exprimees par les internautes sur le forum de discussions en ligne du site d’information en sante Doctissimo ® . Methode Les donnees correspondent aux 14 742 messages, regroupes en 234 sujets traitant de la vaccination anti-HPV, publies entre le 23 novembre 2006 et le 5 janvier 2014. La grille d’analyse regroupe les arguments exprimes par les internautes pour justifier leurs opinions vis-a-vis du vaccin. Ces arguments sont classes en trois items : securite, efficacite et perceptions. La portee du contenu d’un message est appreciee grâce au nombre de vues. Plus de 45 % des messages sont informatifs (6634 messages). Chaque message est vu en moyenne 3625 fois. Resultats L’opinion exprimee est soit positive (44 %), soit negative (45 %), soit neutre (11 %). Les opinions negatives sont passees de 29 % des avis exprimes en 2006 a 44 % en 2013 en atteignant un pic a 56 % en 2011. Les arguments avances par les « anti-vaccinaux » font le plus souvent appel a la securite vaccinale (42 % versus 31 %, p −15 ) et aux perceptions vis-a-vis du vaccin (40 % versus 31 %, p −10 ) ; ceux exprimes par les « pro-vaccinaux » se rapportent a l’efficacite du vaccin (38 % versus 18 %, p −15 ). Conclusion Cette etude montre la possibilite de structurer l’information contenue dans les forums de discussion afin d’analyser l’opinion des internautes concernant la vaccination ainsi que son evolution au cours du temps.