ABSTRACT
BACKGROUND: Hospitalization for worsening/acute heart failure is increasing in France, and limited data are available on referral/discharge modalities. AIM: To evaluate patients' journeys before and after hospitalization for this condition. METHODS: On 1 day per week, between October 2014 and February 2015, this observational study enrolled 260 consecutive patients with acute/worsening heart failure in all 10 departments of cardiology and four of the departments of geriatrics in the Greater Paris University Hospitals. RESULTS: First medical contact was an emergency unit in 45% of cases, a general practitioner in 16% of cases, an emergency medical ambulance in 13% of cases and a cardiologist in 13% of cases; 78% of patients were admitted directly after first medical contact. In-hospital stay was 13.2±11.3 days; intensive care unit stay (38% of the population) was 6.4±5 days. In-hospital mortality was 2.7%. Overall, 63% of patients were discharged home, whereas 21% were transferred to rehabilitation units. A post-discharge outpatient visit was made by only 72% of patients within 3 months (after a mean of 45±28 days). Only 53% of outpatient appointments were with a cardiologist. CONCLUSION: Emergency departments, ambulances and general practitioners are the main points of entry before hospitalization for acute/worsening heart failure. Home discharge occurs in two of three cases. Time to first patient post-discharge visit is delayed. Therefore, actions to improve the patient journey should target primary care physicians and emergency structures, and efforts should be made to reduce the time to the first visit after discharge.
Subject(s)
Cardiology Service, Hospital , Critical Pathways , Geriatrics , Heart Failure/therapy , Hospital Departments , Hospitals, University , Aged , Aged, 80 and over , Ambulances , Ambulatory Care , Emergency Service, Hospital , Female , General Practice , Heart Failure/diagnosis , Heart Failure/mortality , Humans , Intensive Care Units , Length of Stay , Male , Middle Aged , Paris , Patient Admission , Patient Discharge , Patient Transfer , Prospective Studies , Risk Factors , Time Factors , Treatment OutcomeABSTRACT
OBJECTIVE: To examine the diagnostic ability of the Lawton Instrumental Activities Daily Living (IADLs) scale and the Activities Daily Living (ADLs) scale as a sensitive tool to Alzheimer's disease (AD) in community-dwelling elderly people. DESIGN: In an old age memory outpatient center, among patients with a clinical diagnosis of AD dementia or no dementia supported by at least 6 months of follow-up, we looked back at the baseline Lawton IADL scale (short version IADL-4 item), ADL scale, Mini-Mental State Examination (MMSE), and Montreal Cognitive Assessment (MOCA) values. RESULTS: There were 109 patients with AD and 53 nondemented individuals (81.4 ± 4.6 years). The sensitivity of ADL scale or IADL-4 item or the MMSE was low (52%-57%). The most efficient AD classification used both the IADLs-4 item and the MOCA with a threshold score of 20. Besides age and memory scores, the main correlates of IADLs scale or ADLs scale were executive, neuropsychiatric, vascular, and extrapyramidal scores. CONCLUSION: Our results suggest that the Lawton IADLs-4 item scale and ADLs scale lack sensitivity to AD dementia in elderly people and support a better sensitivity of MOCA rather than MMSE and IADLs-4 item/ADLs at the expense of specificity.
Subject(s)
Alzheimer Disease/diagnosis , Dementia/diagnosis , Surveys and Questionnaires/standards , Activities of Daily Living , Aged , Aged, 80 and over , Alzheimer Disease/psychology , Dementia/psychology , Female , Follow-Up Studies , Humans , Male , Memory , Neuropsychological Tests , Reproducibility of Results , Sensitivity and SpecificitySubject(s)
Alzheimer Disease/diagnosis , Electroencephalography/statistics & numerical data , Epilepsy/diagnosis , Frontotemporal Dementia/diagnosis , Guideline Adherence/statistics & numerical data , Medical Audit , Aged , Aged, 80 and over , Electroencephalography/standards , Female , France , Geriatrics/standards , Geriatrics/statistics & numerical data , Guideline Adherence/standards , Hospitals, Special/standards , Hospitals, Special/statistics & numerical data , Humans , Male , Unnecessary Procedures/statistics & numerical data , Utilization ReviewABSTRACT
OBJECTIVES: To prospectively evaluate a management approach to bacteriuria including advice from an infectious diseases consultant (IDC) in geriatric inpatients. DESIGN: Prospective study from July 1, 2003, to June 30, 2004. SETTING: A 205-bed geriatric university-affiliated hospital. PARTICIPANTS: Consecutive hospitalized patients with positive urine cultures. INTERVENTION: The hospital's infection control department developed recommendations about antimicrobial use for bacteriuria, which were discussed at staff meetings. Treatments for bacteriuria prescribed by ward physicians were reviewed by an IDC, who suggested changes where appropriate. Physicians were free to follow or to disregard the IDC's suggestions. MEASUREMENTS: Patients with positive urine cultures (UC) were classified as having asymptomatic bacteriuria (AB), urinary tract infection (UTI) or pyelonephritis (PN). Prescribed and actual treatments were compared. RESULTS: Of 252 consecutive positive UCs in 181 patients, 124 (49%) were classified as AB, 88 (35%) as UTI, and 38 (15%) as PN; 2 cases of prostatitis were excluded. The total number of prescribed antimicrobial days before IDC advice was 729 and the actual number (after IDC advice) was 577, for a 152-day (21%) reduction. Most of the reduction was generated by shortening the treatment duration. CONCLUSION: Intervention of an IDC resulted in reduced antimicrobial use in older inpatients with bacteriuria.
