Frailty assessment in critically ill older adults: a narrative review.

Frailty, a condition that was first defined 20 years ago, is now assessed via multiple different tools. The Frailty Phenotype was initially used to identify a population of "pre-frail" and "frail" older adults, so as to prevent falls, loss of mobility, and hospitalizations. A different definition of frailty, via the Clinical Frailty Scale, is now actively used in critical care situations to evaluate over 65 year-old patients, whether it be for Intensive Care Unit (ICU) admissions, limitation of life-sustaining treatments or prognostication. Confusion remains when mentioning "frailty" in older adults, as to which tools are used, and what the impact or the bias of using these tools might be. In addition, it is essential to clarify which tools are appropriate in medical emergencies. In this review, we clarify various concepts and differences between frailty, functional autonomy and comorbidities; then focus on the current use of frailty scales in critically ill older adults. Finally, we discuss the benefits and risks of using standardized scales to describe patients, and suggest ways to maintain a complex, three-dimensional, patient evaluation, despite time constraints. Frailty in the ICU is common, involving around 40% of patients over 75. The most commonly used scale is the Clinical Frailty Scale (CFS), a rapid substitute for Comprehensive Geriatric Assessment (CGA). Significant associations exist between the CFS-scale and both short and long-term mortality, as well as long-term outcomes, such as loss of functional ability and being discharged home. The CFS became a mainstream tool newly used for triage during the Covid-19 pandemic, in response to the pressure on healthcare systems. It was found to be significantly associated with in-hospital mortality. The improper use of scales may lead to hastened decision-making, especially when there are strains on healthcare resources or time-constraints. Being aware of theses biases is essential to facilitate older adults' access to equitable decision-making regarding critical care. The aim is to help counteract assessments which may be abridged by time and organisational constraints.

[Physical activity and chronic illness, a theoretical framework]. / Comprendre l'activité physique dans la maladie chronique : proposition d'un cadre théorique d'analyse.

The positive effects of adapted physical activity (PA) in patients with chronic illness are scientifically recognized, and PA promotion is part and parcel of public policy. In this context, one task in public health research consists in improving knowledge of PA practice in persons with chronic illnesses. As a complement to studies evaluating the importance of various determinants of PA practice, qualitative research is called for. In this framework, the present article will propose a theoretical analytical framework for study of PA in chronic illness. It will be built around two key concepts, namely the "standards of life" drawn from the notion of health in the philosophy of Georges Canguilhem and the "illness trajectory" drawn from the interactionist sociology of Anselm Strauss. We will attempt to improve understanding of the important yet frangible "labor" of patients at work in transformation of their habits and life standards involving PA professionals.

Ab initio study of the elastic properties of single and polycrystal TiO(2), ZrO(2) and HfO(2) in the cotunnite structure.

In this work, we study theoretically the elastic properties of the orthorhombic (Pnma) high-pressure phase of IV-B group oxides: titania, zirconia and hafnia. By means of the self-consistent SIESTA code, pseudopotentials, density functional theory in the LDA and GGA approximations, the total energies, hydrostatic pressures and stress tensor components are calculated. From the stress-strain relationships, in the linear regime, the elastic constants C(ij) are determined. Derived elastic constants, such as bulk, Young's and shear modulus, Poisson coefficient and brittle/ductile behavior are estimated with the polycrystalline approach, using Voigt-Reuss-Hill theories. We have found that C(11), C(22) and C(33) elastic constants of hafnia and zirconia show increased strength with respect to the experimental values of the normal phase, P 2(1)/c. A similar situation applies to titania if these constants are compared with its normal phase, rutile. However, shear elastic constants C(44), C(55) and C(66) are similar to the values found in the normal phase. This fact increases the compound anisotropy as well as its ductile behavior. The dependence of unit-cell volumes under hydrostatic pressures is also analyzed. P-V data, fitted to third-order Birch-Murnaghan equations of state, provide the bulk modulus B(0) and its pressure derivatives B'(0). In this case, LDA estimations show good agreement with respect to recent measured bulk moduli of ZrO(2) and HfO(2). Thermo-acoustic properties, e.g. the propagation speed of transverse, longitudinal elastic waves together with associated Debye temperatures, are also estimated.

[Benchmarks for evaluating health care networks]. / Repères pour l'évaluation des réseaux de soin.

The implementation of health care networks is accompanied by a certain number of changes in professional practices. At the heart of the economic, organisational, and political stakes, new questions are posed, especially in terms of evaluation. It is true that no matter what the level of evaluation, it is essential today to rely on the support of existing information systems to develop methodologies and to better describe the produced effects, in economic terms and health outcomes, but also from a more qualitative point of view, in terms of public satisfaction and benefits to clients. Laying down some reference points for evaluating health care networks can only contribute to developing new strategies for showing their effectiveness and efficiency and learning from this experimentation.

[Situation and role of local structures of hospital ethics: s survey of Hospital Public Care in Paris]. / La place et le rôle de structures locales d'éthique à l'hôpital: une enquête à l'Assistance Publique Hôpitaux de Paris.

This article presents the main results of a survey carried out among the local structures for hospital ethics of the Public Assistance sector of the Hospitals of Paris. The results show that the situation of these structures has completely transformed itself since the law of 1988 on human research. Only four ethics committees subsist out of the 16 university-hospital committees that existed in 1991. Seven new structures have been created since 1994, which are open to all categories of personnel and within which doctors are a minority. The four ethics committees provide almost no decision making opinions anymore and are, like the new groups, fora for discussion, reflection, or even information on issues of hospital ethics. Almost none of these structures has an official mission. This situation presents the question of the role that a local ethics structure can hold within a hospital.

[Cardiac surgery in France (supply, service and needs response): a national survey]. / La chirurgie cardiaque en France (offre, activité et réponse aux besoins): une enquête nationale.

This paper describes the results of a national study of the 70 french cardiac surgery units. This study was required by the ministry of health in order to prepare the planning process of cardiac surgery in France. Results concerning the year 1994 show important regional variations of resources among the country. The number of interventions has increased three fold in 15 years (from 13,000 to 38,000 a year). The share of the different indications are constant (coronaropathy: 53%; valvulopathy: 36%; congenital: 8%). Patient flows across french regions represent 15% of the interventions. Regional intervention rates per capita range from 45 to more than 80 for 100,000 inhabitants. French cardiac surgery is, in fact, organized at a multiregional level and the regional intervention rates are not correlated with mortality or demographic rates.

[Epidemiology of Crohn disease in Public Assistance-Hospitals in Paris. Data of hospitalizations 1981-1992]. / Epidémiologie de la maladie de Crohn à l'Assistance Publique-Hôpitaux de Paris. Données d'hospitalisation 1981-1992.

OBJECTIVES: The aim of this study was to describe the epidemiological features of hospitalizations for Crohn's disease in Public Hospitals of Paris ("Assistance Publique-Hôpitaux de Paris") between 1981 and 1992. METHODS: Data concerning hospital stays were obtained from the OTARIE file, containing for each hospitalization descriptive data about the patient (including sex, birth date and locality, residence locality) and the hospital (including the identity of hospital department, the route of admission into the department and discharge from the department, the main medical diagnosis). RESULTS: There was a 2.5-fold increase of the number of hospital stays for Crohn's disease from the beginning to the end of the study period. Concomitantly, the women/men sex-ratio increased from 0.99 to 1.39. The rate of hospital stays lasting less than 24 hours increased at the end of the study period, reaching 10.6% in 1992. Among the patients born out of the area of Paris, there was a significantly higher proportion of patients native from the North of France. CONCLUSION: The prominent epidemiological features concerning the hospital stays for Crohn's disease in Public Hospitals of Paris between 1981 and 1992 were: a) a 2.5-fold increase of the number of patients hospitalized per year between 1981 and 1992; b) a concomitant increase of the sex-ratio in favour of women; c) the existence of a significant higher proportion of patients originary from the North of France.