[Multidisciplinary Team Meeting dedicated to geriatric oncology: Decisions and four month follow-up]. / RCP dédiée à l'onco-gériatrie : décisions et suivi à quatre mois.

INTRODUCTION: MTDM dedicated to geriatric oncology are held at the E. Herriot hospital in Lyon. They bring together oncologist and geriatrician to optimize, through their complementary expertise, the care plan for elderly cancer patients. The aim is to demonstrate the value of these MTDMs and to describe the follow-up of oncological and geriatric recommendations. METHODS: This is a descriptive, prospective, non-interventional study analyzing the MTDMs dedicated to patients over 70years old with cancer. All patients underwent a comprehensive geriatric assessment (CGA) with a four-month follow-up. RESULTS: One hundred twenty-one patients were included with a G8 score≤14 (93 %), a slightly diminishing independence ADL<6 (36%) and IADL<4 (42%). The median CIRS-G is eight with on average, three geriatric syndromes/patient. Most cancers are non-metastatic. When oncological treatment is recommended (80 %), it is mostly curative (58 %). Geriatric recommendations were made for 75 % of patients. At four months, four patients were lost to follow-up and 34 died. No significant change in the dependency level was found. In 75 % of cases, at least one geriatric recommendation were followed and 77 % of oncological recommendations. CONCLUSION: The recommendations could be followed at four months; they were carried out in a comparable way whether they were oncological or geriatric. These MTDMs specializing in geriatric oncology appear to be beneficial in the geriatric oncology decision-making process. It is important to continue and strengthen this co-management.

Combining high-resolution contact data with virological data to investigate influenza transmission in a tertiary care hospital.

OBJECTIVE: Contact patterns and microbiological data contribute to a detailed understanding of infectious disease transmission. We explored the automated collection of high-resolution contact data by wearable sensors combined with virological data to investigate influenza transmission among patients and healthcare workers in a geriatric unit. DESIGN: Proof-of-concept observational study. Detailed information on contact patterns were collected by wearable sensors over 12 days. Systematic nasopharyngeal swabs were taken, analyzed for influenza A and B viruses by real-time polymerase chain reaction, and cultured for phylogenetic analysis. SETTING: An acute-care geriatric unit in a tertiary care hospital. PARTICIPANTS: Patients, nurses, and medical doctors. RESULTS: A total of 18,765 contacts were recorded among 37 patients, 32 nurses, and 15 medical doctors. Most contacts occurred between nurses or between a nurse and a patient. Fifteen individuals had influenza A (H3N2). Among these, 11 study participants were positive at the beginning of the study or at admission, and 3 patients and 1 nurse acquired laboratory-confirmed influenza during the study. Infectious medical doctors and nurses were identified as potential sources of hospital-acquired influenza (HA-Flu) for patients, and infectious patients were identified as likely sources for nurses. Only 1 potential transmission between nurses was observed. CONCLUSIONS: Combining high-resolution contact data and virological data allowed us to identify a potential transmission route in each possible case of HA-Flu. This promising method should be applied for longer periods in larger populations, with more complete use of phylogenetic analyses, for a better understanding of influenza transmission dynamics in a hospital setting.

Five years of hospital based surveillance of influenza-like illness and influenza in a short-stay geriatric unit.

BACKGROUND: Data on influenza in the healthcare setting are often based on retrospective investigations of outbreaks and a few studies described influenza during several consecutive seasons.The aim of the present work is to report data on influenza like illness (ILI) and influenza from 5-year prospective surveillance in a short-stay geriatrics unit. FINDINGS: A short stay geriatrics unit underwent 5 years of ILI surveillance from November 2004 to March 2009, with the aim of describing ILI in a non-outbreak context. The study was proposed to patients who presented ILI, defined as fever >37.8°C or cough or sore throat. Among 1,353 admitted patients, 115 presented an ILI, and 34 had hospital-acquired ILI (HA-ILI). Influenza was confirmed in 23 patients, 13 of whom had been vaccinated. Overall attack rates were 2.78% and 0.02% for HA-ILI and HA-confirmed influenza respectively, during the 5 seasons. CONCLUSIONS: This 5-year surveillance study supports the notion that influenza infections are common in hospitals, mostly impacting the elderly hospitalized in short-stay units. It highlights the need for appropriate control measures to prevent HA-ILI in geriatric units and protect elderly patients.

Estimating potential infection transmission routes in hospital wards using wearable proximity sensors.

BACKGROUND: Contacts between patients, patients and health care workers (HCWs) and among HCWs represent one of the important routes of transmission of hospital-acquired infections (HAI). A detailed description and quantification of contacts in hospitals provides key information for HAIs epidemiology and for the design and validation of control measures. METHODS AND FINDINGS: We used wearable sensors to detect close-range interactions ("contacts") between individuals in the geriatric unit of a university hospital. Contact events were measured with a spatial resolution of about 1.5 meters and a temporal resolution of 20 seconds. The study included 46 HCWs and 29 patients and lasted for 4 days and 4 nights. 14,037 contacts were recorded overall, 94.1% of which during daytime. The number and duration of contacts varied between mornings, afternoons and nights, and contact matrices describing the mixing patterns between HCW and patients were built for each time period. Contact patterns were qualitatively similar from one day to the next. 38% of the contacts occurred between pairs of HCWs and 6 HCWs accounted for 42% of all the contacts including at least one patient, suggesting a population of individuals who could potentially act as super-spreaders. CONCLUSIONS: Wearable sensors represent a novel tool for the measurement of contact patterns in hospitals. The collected data can provide information on important aspects that impact the spreading patterns of infectious diseases, such as the strong heterogeneity of contact numbers and durations across individuals, the variability in the number of contacts during a day, and the fraction of repeated contacts across days. This variability is however associated with a marked statistical stability of contact and mixing patterns across days. Our results highlight the need for such measurement efforts in order to correctly inform mathematical models of HAIs and use them to inform the design and evaluation of prevention strategies.