Evaluation of a mobile team dedicated to behavioural disorders as recommended by the Alzheimer Cooperative Valuation in Europe joint action: observational cohort study.

BACKGROUND AND PURPOSE: Preventing behavioural crises appears to be crucial to promote quality of life of the patient-caregiver dyad, to reduce inappropriate hospitalizations and to delay institutionalization. The Alzheimer Cooperative Valuation in Europe promotes mobile care to prevent patients from severe behavioural and psychological symptoms in dementia. This study assessed the potential efficacy of a mobile team for Alzheimer's disease on hospitalization sparing and behavioural disorder reduction. METHODS: A cohort study was set up from 1 January 2012 to 31 December 2013 by the Clinical and Research Memory Centre of Lyon (France). It included patients with behavioural and psychological symptoms living at home or in a nursing home. An interview explored the alternative patient pathways used by general practitioners (GPs) if the mobile team had not existed (hospitalization sparing). The Neuropsychiatry Inventory score was assessed at inclusion and 30 days later. The sample included 424 consecutive patients with Alzheimer's disease or related disorders and behavioural disorders at any cognitive and functional stage of the disease, taken in charge by the mobile team. RESULTS: Amongst the 424 patients (84.0 ± 7.2 years), 220 (51.9%) hospitalizations were considered by their GPs and 181 (82.3%) were avoided. The Neuropsychiatric Inventory score declined after mobile team intervention (45.8-29.9, P < 0.001). Sleep and appetite disorders, endangered situation and caregiver burnout were associated with higher risk of hospitalization at 30 days. CONCLUSIONS: The mobile team for Alzheimer's disease allows a high proportion of hospitalizations related to behavioural disorders to be avoided and may help to reduce behavioural disorders.

[Lumbar puncture practice in case of hemorrhagic or ischemic risk: a national opinion survey]. / Enquête d'opinions sur la pratique de la ponction lombaire non urgente chez des patients à risque hémorragiques/thrombotiques.

CONTEXT: Lumbar puncture (LP) is a common medical procedure for which no valid consensus exists in situations of hemorrhagic or thrombotic risk. The aim of this study was to identify the opinion-guided practices of LP at a national level. METHODS: A national opinion survey on Internet. An anonymous questionnaire of 19 questions collecting information about the LP practice for patients with hemorrhagic or thrombotic risks. RESULTS: We sent 632 e-mails with the link of the survey and obtained 211 responses in six weeks. None of the responses was unanimous for any of the 13 different clinical situations proposed. Six practices were reported as adopted by the majority of participants, six by more than one-third. Reports of practices were highly variable, particularly for the minimum platelets count accepted, for the management of patients taking two antiplatelet agents or newer anticoagulant agents. DISCUSSION AND CONCLUSION: These results underline the heterogeneity of practices and the lack of recommendations. The establishment of a clear consensus in this area seems essential to guide practices in the future. In order to increase the representativeness of our responses, the survey is still going on online and will be open for all practitioners who wish to participate (http://www.surveymonkey.com/s/hemopl).

[Role of clinical pharmacist in the therapeutical optimization in geriatric outpatient hospital]. / Place du pharmacien clinicien dans l'optimisation thérapeutique en hôpital de jour gériatrique.

SETTING: Cares in outpatient hospital for elderly patients is a period of interest for multidisciplinary reassessment and pharmaceutical care of the prescription. The objective is to present the implementation of the pharmaceutical care activity at the outpatient hospital. METHODS: Between August and October 2011, elderly patients hospitalized in the outpatient hospital for a brief appraisal had a pharmaceutical care. The clinician introduced pharmaceutical reviews in the synthesis letter for general practitioner. An analysis of the activity was carried out over 3 months. RESULTS: A pharmaceutical care had been realized for 67 patients, mean age of 81.7 years. Among medical related problems identified, 39.6% were for potentially unnecessary medication. A stop was proposed for 44% of pharmaceutical interventions. A total of 91 pharmaceutical interventions and 13 recommendations were made and 34% of patients had potentially inappropriate medication. CONCLUSION: According to the objective to reduce the therapeutics contributing to the iatrogenesis, this approach allowed us to undertake a multidisciplinary collaboration oriented toward the relay between hospital and city cares.

[Effectiveness of a cognitive-behavioral unit on behavioral and psychological symptoms of dementia]. / Efficacité d'une unité cognitivo-comportementale sur les symptômes psychologiques et comportementaux des démences.

INTRODUCTION: Cognitive-behavioral units (CBUs) have been created in the context of the national Alzheimer plan 2008/2012 for the management of behavioral disorders of patients suffering from Alzheimer's disease or related diseases. The Alzheimer plan promotes the evaluation of these units through the observation of the evolution of behavioral and psychological symptoms of dementia (BPSD). The aim of this study was to assess the effects of the memory center of Lyon (hospices civils de Lyon) CBU on BPSD. PATIENTS: The neuropsychiatric inventory (NPI) was rated by the patients' caregiver (NPI-F) at admission to the CBU and 2 weeks after the discharge. The NPI was also rated by the nursing staff (NPI-NS) 3 days after admission in the CBU and at discharge. RESULTS: All patients admitted in the CBU between July and October 2001 were included in the study for a total of 28 patients. A significant reduction of NPI-F scores between admission (58.93 ± 24.8) and 2 weeks after the discharge (27.07 ± 19.70) (P<0.0001) was observed. Improvement was specifically observed for delusions, agitation, depression, anxiety, disinhibition and aberrant motor activity symptoms. No significant changes were found on NPI-NS scores. CONCLUSION: This study discloses benefits of CBUs in terms of BPSD reduction in patients 2 weeks after CBU discharge. These units have the potential to achieve their principal objective of reducing behavioral problems.