A Qualitative Analysis of the Optimal Discharge Summary: Effective Communication of Medication Changes for Older Patients.

Background: The importance of the discharge summary (DS) is well recognized. The format to be used is also important, but this aspect has not yet been studied in the literature. The purpose of this work was to establish a DS format for older patients that ensures effective communication with general practitioners (GPs). Methods: This study was based on the grounded theory approach to qualitative analysis. Data was collected from GPs during semi-structured and directive interviews. Results: Semi-structured interviews were conducted with 12 GPs and directive interviews with 39 GPs. A consensus was reached on one DS version providing selected information items such as trends in laboratory results (rising/falling) and information about planned drug withdrawals or specialist consultations. Conclusion: This work led to a consensus on the most appropriate format for the DS for older patients returning home. Its use in routine practice is needed to confirm its reception by GPs.

Evaluating the safety and short-term equivalence of colchicine versus prednisone in older patients with acute calcium pyrophosphate crystal arthritis (COLCHICORT): an open-label, multicentre, randomised trial.

BACKGROUND: Acute calcium pyrophosphate crystal arthritis causes intense joint pain mainly affecting older people. Because guidance and evidence remain scarce, management of this disease relies on expert opinion. We therefore aimed to compare the safety and short-term equivalence of low-dose colchicine with oral prednisone in older patients with acute calcium pyrophosphate crystal arthritis. METHODS: We did an open-label, multicentre, randomised, trial (COLCHICORT) at six hospitals in Paris and northern France. We enrolled patients who were admitted to hospital who were 65 years or older and who presented with acute calcium pyrophosphate crystal arthritis with a symptom duration of less than 36 h. Diagnosis of calcium pyrophosphate crystal arthritis was made by the identification of calcium pyrophosphate crystals on synovial fluid analysis or typical clinical presentation (onset of joint pain and swelling). Key exclusion criteria included absence of calcium pyrophosphate crystals on synovial fluid analysis or a history of gout. Participants were randomly allocated (1:1), using a centralised electronic treatment group allocation module, to receive either colchicine 1·5 mg on day 1 and 1 mg on day 2 (ie, the colchicine group) or oral prednisone 30 mg on days 1 and 2 (ie, the prednisone group). The primary outcome was change in joint pain (measured by visual analogue scale [VAS] from 0 mm to 100 mm) at 24 h. Equivalence was determined whether the 95% CI of the between-group difference at 24 h was within the -13 mm to +13 mm margin in the per-protocol analysis. Adverse events were recorded using the National Cancer Institute Common Terminology Criteria for Adverse Events (version 4.0). This trial is completed and is registered with ClinicalTrials.gov, NCT03128905. FINDINGS: Between Feb 5, 2018, and May 7, 2022, 111 patients who were admitted to hospital were randomly assigned (57 [51%] to the colchicine group and 54 [49%] to the prednisone group). 95 (86%) of 111 patients were included in the per-protocol analysis (49 [52%] in the colchicine group and 46 [48%] in the prednisone group). The median age was 88·0 years (IQR 82·0-91·0) and 69 (73%) of 95 participants were women and 26 (27%) were men. Acute calcium pyrophosphate crystal arthritis affected mainly the knee in 46 (48%) of 95 participants, the wrist in 19 (20%), and the ankle in 12 (13%). Pain VAS at baseline was 68 mm (SD 17). At 24 h, change in pain VAS was -36 mm (SD 32) in the colchicine group and -38 mm (SD 23) in the prednisone group. The between-group difference in change in pain VAS at 24 h was -1 mm (95% CI -12 to 10), showing equivalence between the two drugs. In the colchicine group, 12 (22%) of 55 patients had diarrhoea, one (2%) had hypertension, and none had hyperglycaemia. In the prednisone group, three (6%) of 54 had diarrhoea, six (11%) had hypertension, and three (6%) had hyperglycaemia. No deaths occurred in the colchicine group; two deaths occurred in the prednisone group, which were deemed unrelated to prednisone (one due to infectious valvular endocarditis leading to heart failure, and one due to a stroke). INTERPRETATION: Colchicine and prednisone exhibit equivalent short-term efficacy for the treatment of acute calcium pyrophosphate crystal arthritis, with different safety profiles in the older population. FUNDING: French Inter-regional Hospital Program of Clinical Research.

[French geriatric day hospitals managing falls]. / Les hôpitaux de jour gériatriques français prenant en charge les chutes.

INTRODUCTION: Falling is a serious hazard for the elderly that may lead to severe injury, loss of independence, and death. The aim of the study was to describe the resources devoted by French geriatric day hospitals for the assessment and care of elderly fallers, by differentiating medicine day hospitals and rehabilitation day hospitals. METHOD: Department heads listed in the directory of the Association for the Promotion of the Day Hospitals for Elderly people (APHJPA) were contacted by email and invited to answer a questionnaire online. RESULTS: Among the 162 doctors contacted, 135 filled in the questionnaire (82.3%). Care of fallers was an important activity for responding departments. However, it represented less than 20% of the total activity for 80% of respondents. It involved the systematic or occasional participation of numerous medical and paramedical personnel. The majority of teams systematically performed complementary investigations in all fallers. Primary care physicians requested one half of all day hospitalization. A standardized file was used by 55 to 64.3% of respondents, while computerized files were still not widely used. Home assessment was proposed by only 17 medicine day hospitals. 85% of rehabilitation day hospitals proposed a personalized care project, spread out over several sessions, associated with educational intervention. One half of respondents carried out a preliminary consultation and/or a follow-up consultation. CONCLUSION: Although the fall was not the leading activity in terms of volume of geriatric day hospitals, the majority of these units devoted considerable resources to this activity and ensures personalized evaluation and care of elderly fallers.