University Hospitals of Reims

Witry-lès-Reims, France

University Hospitals of Reims

Witry-lès-Reims, France
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Wolak A.,University of Reims Champagne Ardenne | Wolak A.,University Hospitals of Reims | Jolly D.,University of Reims Champagne Ardenne | Jolly D.,University Hospitals of Reims | And 16 more authors.
European Geriatric Medicine | Year: 2010

Aim: The aim of this study was to discuss about the Dementia Quality of Life (DQoL) psychometric properties and the contributions stemming from the French language version. Methods: To assess the psychometric properties of the French language DQoL transcultural validation, 155 patients with mild to moderate dementia (Mini Mental State Examination score ≥ 10) were recruited in seven French-speaking hospitals. Feasibility and acceptability were assessed by the time required to complete the questionnaire, the rate of refusal to participate, and the rates of abandon or non-response. Internal consistency and test-retest reliability were assessed respectively by Cronbach's alpha coefficient and Intraclass Correlation Coefficient. The discriminant validity was tested by evaluating the influence of severity of cognitive decline, dependence, existence of depression or behavioural troubles, as well as caregiver burden. Results: Of the 155 eligible patients, 46 patients (29.7%) failed the screening procedure but completed the questionnaire nonetheless. The remaining 109 patients had an average age of 81 ± 6 years, average Mini Mental State Examination (MMSE) score was 20.8 ± 4.4. No patient refused to participate or abandoned. The French DQoL showed acceptable internal consistency (Cronbach's alpha ranging from 0.70 to 0.87) and good reliability (Intraclass Correlation Coefficient [ICC]: 0.96-1.00). Cognitive status, humour and behavioural troubles had an impact on Quality of Life (QoL), whereas dependence and caregiver burden did not. Psychometric properties did not differ for the group who passed the screening test (n = 109) and for the whole population (n = 155). Conclusion: The French-language version of DQoL showed comparable psychometric properties to the original version. According to our findings, all patients with mild to moderate dementia can undergo evaluation with the French adaptation of the DQoL. We suggest transforming the screening procedure into a training step. © 2010 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.

Zhao H.,University of Reims Champagne Ardenne | Novella J.-L.,University of Reims Champagne Ardenne | Novella J.-L.,University Hospitals of Reims | Drame M.,University of Reims Champagne Ardenne | And 15 more authors.
Dementia and Geriatric Cognitive Disorders | Year: 2012

Objective: The aim of this study was to identify the factors associated with differences between how Alzheimer's disease (AD) patients and their caregivers rate the patient's health-related quality of life (QoL). Methods: Cross-sectional, multicentre study. Patients were 65 years or more, suffering from mild to moderate AD, native French speakers, with a main caregiver. Interrater agreement of the QoL-AD was assessed using the intraclass coefficient. A generalised linear model was used to identify factors related to the difference in health-related QoL scores between patients and their caregivers. Results: The 122 patients of the study were 82 ± 6 years old and mainly women (69%). Independent factors related to the difference between patients and caregivers were: Mini Mental State Exam score (β = 0.32; 95% CI = 0.05-0.59); instrumental activities of daily living score (β = -0.61; 95% CI = -1.14 to -0.07); total Neuropsychiatric Inventory score (β = 0.10; 95% CI = 0.05-0.59), and Zarit's burden score (β = 0.09; 95% CI = 0.01-0.17). Conclusion: Practitioners must take into account the trend towards underestimation when health-related QoL is rated by caregivers or proxies. Copyright © 2012 S. Karger AG.

Lang P.-O.,University of Geneva | Lang P.-O.,University of Reims Champagne Ardenne | Zekry D.,University of Geneva | Michel J.-P.,University of Geneva | And 8 more authors.
Journal of Nutrition, Health and Aging | Year: 2010

Background: Dementia is a serious, chronic, and costly public health problem. Prior studies have described dementia as increasing length of hospital stay, but so far no explanations have been proposed. Methods: To identify early markers for prolonged hospital stay in demented elderly inpatients, 178 communitydwelling or institutionalized subjects aged 75+, hospitalized through an emergency department in 9 teaching hospitals in France, were analyzed. Prolonged hospital stays were defined according a limit adjusted for Diagnosis Related Group. All patients underwent a comprehensive geriatric assessment at admission. Logistic regression multifactorial mixed model was performed. Center effect was considered as a random effect. Results: Of the 178 stays, 52 were prolonged. Most concerned community-dwelling patients (86%). Multifactor analysis demonstrated that demographic variables had no influence on the length of stay, while diagnosis of delirium (OR 2.31; 95% CI 1.77-2.91), walking difficulties (OR 1.94; 95% CI 1.62-2.43) and report by the informal caregiver of moderate or severe burden (OR 1.52; 95% CI 1.19-1.86) or low social quality-of-life score (OR 1.25; 95% CI 1.03-1.40), according to the Zarit's Burden Inventory short scale (12 items) and the Duke's Health Profile respectively, were identified as early markers for prolonged hospital stays. Conclusion: At the time of the rising incidence of cognitive disorders, these results suggest that preventive approaches might be possible. In a hospital setting as well as in a community-dwelling population, more specific, specialized and coordinated care, using the expertise of multiple disciplines appears as a probable effective measure to limit prolonged hospital stay. Such approaches require (i) clear patient-oriented goal definition, (ii) understanding and appreciation of roles among various health care and social disciplines and, (iii) cooperation between partners in patient's management. However, the cost-and health-effectiveness of such approaches should be evaluated.

Godard-Sebillotte C.,McGill University | Drame M.,University of Reims Champagne Ardenne | Drame M.,University Hospitals of Reims | Basileu T.,Martinique General Hospital | And 2 more authors.
Quality of Life Research | Year: 2016

Purpose: To determine whether self-rated health is a prognostic factor of six-week mortality, independently of other known objective prognostic factors. Methods: The SAFMA study was a prospective cohort, which recruited patients from the University Hospital of Martinique Acute Care for Elders unit (French West Indies) from January to June 2012. Patients aged 75 or older and hospitalized for an acute condition were eligible. The outcome was time to death within the six-week follow-up. The main explanatory variable was self-rated health. Sociodemographic and clinical characteristics were considered as covariates. Cox’s proportional hazards model was used. Results: The mean age of the 223 patients included was 85.1 ± 5.5 years. Six-week mortality rate was 14.8 %; none were lost to follow-up. In total, 123 claimed “very good to good” health, and 100 “medium to very poor” health. Self-rated health was the only independent prognostic factor associated with 6-week mortality (hazard ratio 2.61; 95 % confidence interval 1.18–5.77; p = .02), when adjusting for known prognostic factors such as age, dimensions of the comprehensive geriatric assessment and comorbidity burden. Conclusion: The association between self-rated health and short-term mortality could have implications for clinical practice, particularly in helping in the estimation of prognosis in acute care setting. © 2016 Springer International Publishing Switzerland

Lang P.O.,University of Geneva | Lang P.O.,University of Reims Champagne Ardenne | Hasso Y.,University of Geneva | Drame M.,University of Reims Champagne Ardenne | And 5 more authors.
Age and Ageing | Year: 2010

Objective: The study aimed to determine the prevalence of and risk factors for inappropriate prescribing (IP) and prescribing omission (PO) in elderly with mental co-morbidities. Participants: one hundred fifty consecutive inpatients with mental co-morbidities hospitalised for acute medical illness (mean age 80 ± 9, 70% of women) were considered for the study. Measurements: IP and PO were prospectively indentified according to STOPP/START criteria at hospital admission. Results: over 95% were taking ≥1 medication (median = 7) which amounted to 1,137 prescriptions. The prevalence of IP was 77% and PO was 65%. The most frequent encountered IP concerned drugs adversely affecting fallers (25%) and anti-aggregants therapy without atherosclerosis (14%). PO concerned antidepressants with moderate/severe depression (20%) and calcium-vitamin D supplementation (18%). Independent predictors for IP were increased number of concomitant drugs (odds ratio [OR] 1.54, 95% confidence interval [CI] 1.13-1.89), being cognitively impaired (OR 1.83, 95% CI 1.55-2.24), and having fallen in the preceding 3 months (OR 2.03, 95% CI 1.52-2.61) or hospitalised in the preceding year (OR 1.09, 95% CI 1.02-1.23). Concerning PO, psychiatric disorder (OR 1.64, 95% CI 1.42-2.01) and increase level of co-morbidities (OR 1.79, 95% CI 1.48-1.99) were identified. Living in an institutional setting was a predictive maker for both IP (OR 1.45, 95% CI 1.27-1.74) and PO (OR 1.67, 95% CI 1.32-1.91). Conclusion: IP and PO were highly prevalent raising the need of a greater health literacy concerning geriatric conditions in non-geriatrician practitioners who care elderly as well as in the community, in hospital and institutional settings for improving quality and safety in prescribing medication. © The Author 2010. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email:

Girre V.,University Pierre and Marie Curie | Arkoub H.,University Pierre and Marie Curie | Puts M.T.E.,University of Toronto | Vantelon C.,University Pierre and Marie Curie | And 3 more authors.
Critical Reviews in Oncology/Hematology | Year: 2011

Introduction: Drug interaction constitutes a major challenge in elderly cancer patients. This study investigated the number and types of medications patients and potential drug interactions in these patients. Methods: Treatments received by 105 cancer outpatients aged ≥70 years were analyzed using the French Thesaurus to identify drug-drug interactions according to four levels: contraindication, concomitant use not recommended, concomitant medications requiring precautions and concomitant medications to be taken into account. Results: The mean number of medications per patient was 4.7 (range: 0-14). Among 97 patients taking ≥2 drugs, 45 potential interactions were identified, occurring in 32 patients. No contraindication, 2 cases of concomitant use not recommended, 9 cases requiring precautions (20%) and 34 cases of concomitant medications to be taken into account were identified. Drug interactions caused respiratory distress and increased bleeding risk. Conclusion: Drug interactions are common in the elderly, but almost half of interactions were moderate. © 2010 Elsevier Ireland Ltd.

Cazaubon Y.,University of Lyon | Cazaubon Y.,University Hospitals of Reims | Cazaubon Y.,CNRS Biometry and Evolutionary Biology Laboratory | Bourguignon L.,University of Lyon | And 7 more authors.
Fundamental and Clinical Pharmacology | Year: 2015

The aim of this work was to define the optimal dosage (OD) of ciprofloxacin in order to prevent the emergence of bacterial resistance of Pseudomonas aeruginosa in a geriatric population with a bloodstream infection. A thousand pharmacokinetic profiles were simulated with a ciprofloxacin pharmacokinetic model from the literature. Three dosing regimens were tested for five days: once daily (QD), twice daily (BID), and thrice daily (TID). First of all, effective dosages (ED) of ciprofloxacin were defined as those achieving a target AUC24/MIC ≥ 125. Then, these ED were simulated in order to calculate the percentage of time spent within the mutant selection window (TMSW) and to select optimal dosage (OD) defined as those achieving TMSW ≤ 20%. Based on the AUC24/MIC, for low MICs (0.125 μg/mL), all dosing regimens recommended by French guidelines were effective. For intermediate MICs (0.25 and 0.5 μg/mL), simulated doses higher than those recommended were needed to achieve the efficacy target. About prevention of resistance for low MICs, dosages recommended were only effective in patients with creatinine clearance (CLCR) ≥ 60 mL/min. For intermediate MICs, dosages higher than recommended were needed to achieve the optimality target. This study shows that current ciprofloxacin dosing guidelines have not been optimized to prevent the emergence of bacterial resistance, especially in geriatric patients with mild to severe renal impairment. To achieve both efficacy and prevention of resistance, ciprofloxacin dosages greater than those recommended would be needed. Tolerance of such higher doses needs to be evaluated in clinical studies. © 2015 Société Française de Pharmacologie et de Thérapeutique.

Dhaussy G.,University of Reims Champagne Ardenne | Drame M.,University of Reims Champagne Ardenne | Drame M.,University Hospitals of Reims | Jolly D.,University of Reims Champagne Ardenne | And 12 more authors.
Journal of the American Medical Directors Association | Year: 2012

Objectives: To assess whether health-related quality of life is an independent prognostic factor for mortality or nursing home placement in frail elderly patients. Design: A prospective, multicenter study with a 12-month follow-up. Setting: Nine French hospitals. Participants: A total of 1306 patients aged 75 and older hospitalized through an emergency department. Measurements: Data obtained from sociodemographic characteristics, Comprehensive Geriatric Assessment and the Duke Health Profile (DHP) were used into a Cox model to identify prognostic variables for 12-month mortality and institutionalization. Results: Crude mortality and nursing home placement rates were 34.1% (n = 445) and 16.1% (n = 210), respectively. Independent prognostic factors identified for mortality were: Comorbidity level (moderate: hazard ratio [HR] [95% confidence interval (CI)] = 1.40 [1.09-1.78]; severe: 2.70 [1.63-4.46]), dependence for activities of daily living (1.68 [1.06-2.67]), pressure sore risk (1.49 [1.16-1.90]), risk of malnutrition (2.09 [1.46-3.00]), delirium (2.25 [1.75-2.90]), and 10-point increase in the DHP perceived health score (0.96 [0.93-0.99]). Independent prognostic factors identified for nursing home placement were the following: living alone at home (1.82 [1.30-2.55]), having 2 children or more (0.71 [0.51-0.99]), dependence for activities of daily living (2.48 [1.39-4.44]), dementia (1.93 [1.39-2.69]), unplanned hospital readmission during follow-up (2.05 [1.45-2.91]), and 10-point increase in the DHP social health score (0.90 [0.83-0.99]). Balance troubles and risk of malnutrition were no more significant when adjusted for the DHP scores and other clinical variables. Conclusion: The perceived health and social health scores of the DHP were independent prognostic factors of survival and nursing home placement among hospitalized elderly patients, respectively. When associated with Comprehensive Geriatric Assessment, they could help screen frail patients to set up as early as possible targeted interventions to restore/maintain modifiable prognostic factors, such as nutritional status, functional ability, and social support. © 2012 American Medical Directors Association, Inc.

Wolak-Thierry A.,University of Reims Champagne Ardenne | Wolak-Thierry A.,University Hospitals of Reims | Novella J.-L.,University of Reims Champagne Ardenne | Novella J.-L.,University Hospitals of Reims | And 8 more authors.
Aging and Mental Health | Year: 2015

Objective: The Dementia Quality of Life (DQoL) and the Quality of Life in Alzheimer's Disease (QoL-AD) are the two most widely used dementia-specific QoL instruments in the world. We aimed to compare the psychometric properties of these two instruments and identify which is most adapted to use in geriatric consultations.Methods: To evaluate the psychometric properties of the French language validation of DQoL and QoL-AD, 123 patients aged 65 years and over suffering from AD (Mini Mental State Examination score ≥10) were recruited in seven French hospitals and one Switzerland hospital. The DQoL comprises 29 items, ranked on a five-point Likert scale and measuring five QoL domains: self-esteem, positive affect, negative affect, feeling of belonging and sense of aesthetics. The QoL-AD contains 13 items giving an overall score ranging from 13 to 52 and evaluating the domains of interpersonal relationships, financial difficulties, physical condition, memory, mood and overall health.Results: Both questionnaires showed adequate reproducibility at 2 weeks interval (intra-class correlation coefficient >0.80), good internal consistency (Cronbach's alpha coefficient >0.70) and good convergent validity with the general health dimension of the Duke Health Profile. The time required to complete the QoL-AD was significantly shorter (p < 0.0001). DQoL had better discriminant capacity (with at least one dimension significant for each subgroup of severity of cognitive decline, dependency, presence of depression or behavioural disorders).Conclusions: For quick evaluation of QoL during consultations in geriatric care, the QoL-AD is preferable, whereas for the purposes of research and more in-depth evaluation, the DQoL is more suitable. © 2014 Taylor & Francis.

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