Initial and long-term evaluation of patients with Alzheimer's after hospitalization in cognitive and behavioural units: the EVITAL study design.

BACKGROUND: Alzheimer's disease and related disorders are characterized by cognitive impairment associated with behavioral and psychological symptoms of dementia. These symptoms have significant consequences for both the patient and his family environment. While risk factors for behavioral disorders have been identified in several studies, few studies have focused on the evolution of these disorders. Moreover, it is important to identify factors linked to the long-term evolution of behavioral disorders, as well as patients' and caregivers' quality of life. Our purpose is to present the methodology of the EVITAL study, which primary objective is to determine the factors associated with the evolution of behavioral disorders among patients with Alzheimer's disease and related disorders during the year following their hospitalization in cognitive and behavioral units. Secondary objectives were 1) to assess the factors related to the evolution of behavioral disorders during hospitalization in cognitive and behavioral units; 2) to identify the factors linked to patients' and caregivers' quality of life, as well as caregivers' burden; 3) to assess the factors associated with rehospitalization of the patients for behavioral disorders in the year following their hospitalization in cognitive and behavioral units. METHOD/DESIGN: A multicenter, prospective cohort of patients with Alzheimer's disease and related disorders as well as behavioral disorders who are hospitalized in cognitive and behavioral units. The patients will be included in the study for a period of 24 months and followed-up for 12 months. Socio-demographic and environmental data, behavioral disorders, medications, patients and caregivers quality of life as well as caregivers burden will be assessed throughout hospitalization in cognitive and behavioral units. Follow-up will be performed at months 3, 6 and 12 after hospitalization. Socio-demographic and environmental data, behavioral disorders, medications, patients and caregivers quality of life, unplanned rehospitalization as well as caregivers burden will also be assessed at each follow-up interview. DISCUSSION: The present study should help better identify the factors associated with reduction or stabilization of the behavioral and psychological symptoms of dementia in patients with Alzheimer's disease. It could therefore help clinicians to better manage these symptoms. TRIAL REGISTRATION: Clinical Trials NCT01901263. Registered July 9, 2013.

Assessing respiratory epidemic potential in French hospitals through collection of close contact data (April-June 2020).

The transmission risk of SARS-CoV-2 within hospitals can exceed that in the general community because of more frequent close proximity interactions (CPIs). However, epidemic risk across wards is still poorly described. We measured CPIs directly using wearable sensors given to all present in a clinical ward over a 36-h period, across 15 wards in three hospitals in April-June 2020. Data were collected from 2114 participants and combined with a simple transmission model describing the arrival of a single index case to the ward to estimate the risk of an outbreak. Estimated epidemic risk ranged four-fold, from 0.12 secondary infections per day in an adult emergency to 0.49 per day in general paediatrics. The risk presented by an index case in a patient varied 20-fold across wards. Using simulation, we assessed the potential impact on outbreak risk of targeting the most connected individuals for prevention. We found that targeting those with the highest cumulative contact hours was most impactful (20% reduction for 5% of the population targeted), and on average resources were better spent targeting patients. This study reveals patterns of interactions between individuals in hospital during a pandemic and opens new routes for research into airborne nosocomial risk.

A quick access to information on influenza burden and prevention in Lyon university hospital: A prospective QR code-based information campaign in 2022-2023.

BACKGROUND: Influenza vaccines are effective in decreasing hospitalizations and mortality related to influenza and its complications. However, the Vaccine Coverage Rate of influenza remains low and multifaceted efforts are required to improve it. The aim of this study was to assess the impact on influenza vaccine perception using a digital tool among outpatients and health care workers (HCWs). METHODS: A study was performed among outpatients and the HCWs of 23 hospital departments from 4 hospitals affiliated to Lyon university Hospitals (France), between October 2022 and February 2023. By scanning QR (Quick Response) codes, displayed on posters for patients, their companions, as well as in the letters sent to HCWs, users accessed anonymously to a web-application (ELEFIGHT®), which provided information on influenza and invited them to initiate a discussion on influenza prevention with their physicians during the consultation. Patients were also invited to complete a questionnaire regarding their perception of influenza vaccination before and after reading the information on ELEFIGHT®. The retention rate (RR = proportion of people who remain on the page for >2 s), the conversion rate (CR = proportion of people who click on the "Call-To-Action" button) and the absolute variation (difference in the perception before/after) and relative variation (absolute change as a percentage of the initial perception) in perception regarding influenza vaccination before and after consulting the application were calculated. RESULTS: 3791 scans were performed by 3298 patients and/or their companions with a RR of 52% and a CR of 55.1% and 253 scans by 221 HCWs with a RR of 71.2% and a CR of 115.3%. Participants spent an average of 47 s on the application. The questionnaire on influenza vaccination perception was completed by 1533 participants (46.5%); 1390 (90.7%) maintained the same position (neutral, favorable or unfavorable) on this vaccination before and after consulting the application. The relative variations in favor of vaccination were + 7.2% (unfavorable then favorable) and + 19.8% (neutral then favorable). CONCLUSION: This study suggests that a facilitated direct access to medical information through QR codes disseminated in health settings can help nudge people to foster their awareness of influenza and its prevention. Future deployments in a similar context or to other populations could be envisaged. Other vaccine-preventable and/or chronic diseases could also be the target of similar projects as part of public health programs.

A cross-sectional study to evaluate hypovitaminosis C prevalence and risk factors in an acute geriatric unit in Lyon, France: the HYPO-VIT-C protocol.

INTRODUCTION: Vitamin C is an essential micronutrient playing crucial roles in human biology. Hypovitaminosis C is defined by a plasmatic ascorbemia below 23 µmol/L and is associated with numerous outcomes such as cardiovascular diseases, cancers or neurocognitive disorders. Numerous risk factors are common among older adults making them particularly susceptible to hypovitaminosis C. These risk factors include reduced vitamin intakes, higher vitamin metabolism related to polypathology, and iatrogeny because of polypharmacy. However, the precise prevalence of hypovitaminosis C and its risk factors are poorly documented within the geriatric population.A better knowledge of hypovitaminosis C prevalence and risk factor may lead to improving the vitamin C status among older people and prevent its consequences. METHOD AND ANALYSIS: To answer these questions, we designed a monocentric cross-sectional study in a population of older hospitalised patients in Lyon, France. A sample size of 385 patients was needed to estimate hypovitaminosis C prevalence. The study was proposed to all eligible patient aged more than 75 years old entering the participating acute geriatric unit. The plasmatic vitamin C status was systematically assessed for participating patients, and variables part of the medical and geriatric evaluation were collected. For patients with severe vitamin C depletion, an oral supplementation and a follow-up phone call were organised to ensure treatment completion and tolerance. ETHICS AND DISSEMINATION: The protocol has been approved by an independent national ethics committee and meets the methodological requirements. Final outcomes will be published in a peer-reviewed journal and disseminated through conferences. TRIAL REGISTRATION NUMBER: NCT05668663.

Patient influenza vaccination reduces the risk of hospital-acquired influenza: An incident test negative-case control study in Lyon university hospital, France (2004-2020).

BACKGROUND: Literature is limited on the impact of patient vaccination on the risk of hospital-acquired influenza (HAI). This test negative case-control study nested in a surveillance program aimed at evaluating the effectiveness of influenza vaccination in reducing the risk of HAI in hospitalized patients during 15 influenza seasons (2004-05 to 2019-20). METHODS: HAI cases were those who developed influenza like illness (ILI) symptoms at least 72 h after hospitalization and had a positive reverse transcriptase-polymerase chain reaction (RT-PCR). Controls were those with ILI symptoms and a negative RT-PCR test. A nasal swab as well as socio-demographic, clinical data and information on influenza vaccination were collected. RESULTS: Of the 296 patients included, 67 were confirmed HAI cases. Influenza vaccine coverage was significantly higher among controls compared to HAI cases (p = 0.002). The risk of HAI was reduced by almost 60 % in vaccinated patients. CONCLUSIONS: A better control of HAI can be achieved by vaccinating hospitalized patients.

Study of a tool supporting the link between community and hospital care: a six-month study of a geriatric hotline.

The growing elderly population and their overlapping conditions require more specialised care. The difficulties accessing scheduled hospital admissions often lead to visits to accident and emergency departments (A&E), which can have a harmful effect on these patients. The French Regional Health Agency (ARS) has developed geriatric hotlines in certain geriatric departments. An analysis of the populations concerned will allow adjustments to be made to this system in order to improve care pathways for the elderly and to better meet the needs of general practitioners. This is a descriptive, retrospective, monocentric epidemiological study conducted between February and July 2017. The caller, the reason for the call, the general practitioner's request, the demographic and geriatric characteristics of the patients and the response provided were described. Calls were mainly made by general practitioners, in 72.8% of the cases, for acute conditions. Access to hospital admission accounted for 69.6% of the requests, while a home assessment accounted for 16% of requests. Fifty-five per cent of the patients were admitted to hospital and 75% of them were admitted directly to the geriatric department. Twenty-one per cent of requests for hospital admission received other treatment. The average age of the patients was 86, with a majority of patients being poly-medicated, having multiple pathologies and also more neurocognitive disorders than the general population. Guidance is provided in 30% of the calls, improving the care pathway of these elderly patients. The time to response and to hospital admission is short, thus favouring direct access to hospital departments. The main independent risk factor for hospital admission was the presence of acute illness. This link between community and hospital care seems to respond to the principal requests of general practitioners, i.e. hospitalisation for acute conditions. It is beneficial for the management of these patients who are at risk of decompensation. Coordination and communication between the different players involved in community and hospital care must continue to develop to improve the care pathway of these complex geriatric patients.

[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.

Using ELEFIGHT® QR Codes for Quick Access to Information on Influenza Burden and Prevention: A Pilot Study in Lyon University Hospital.

(1) Background: The Vaccine Coverage Rate of influenza remains low and omnichannel efforts are required to improve it. The objective was to evaluate the feasibility and outcomes of a QR Code nudging system in outpatient departments. (2) Methods: The study was performed in 6 departments ensuring ambulatory activities in a French university Hospital between November and December 2021. By scanning QR codes, users accessed anonymously to the ELEFIGHT® web app, which provides medical information on influenza and invites them to initiate a discussion about influenza prevention with their physicians during the consultation. (3) Results: 351 people made 529 scans with an average reading time of 1 min and 4 s and a conversion rate of 32%, i.e., people willing to engage in a discussion. (4) Conclusions: The study suggests that direct access to medical information through QR codes in hospitals might help nudge people to raise their awareness and trigger their action on influenza prevention.

[Study of a tool supporting the community-hospital link, the Central Hospital Group's geriatric hotline, over a period of 6 months]. / Étude d'un outil favorisant le lien ville-hôpital : la hotline gériatrique du Groupement Hospitalier Centre, sur une durée de 6 mois.

The increasing elderly population and their overlapping conditions require more specialised care. The difficulties accessing scheduled hospital admission lead to visits to Accident and Emergency Department (A&E), which have a harmful effect on these patients. The Regional Health Agency (ARS) has developed geriatric hotlines in all geriatric sectors. An analysis of the population concerned will allow changes to be made to this system in order to improve the care pathway for the elderly and to better meet the needs of the general practitioners. This was a descriptive, retrospective, monocentric epidemiological study conducted from February to July 2017. The applicant, reason for the call, the general practioner's request, the demographic and geriatric characteristics of the patients, the response provided were described. The calls were mainly made by the general practitioners, in 72.8% of the cases, for acute conditions. Access to hospital admission accounted for 69.6% of the requests, a home assessment, 16 %. Fifty-five per cent of the patients were admitted to hospital, 75 % of them directly in geriatrics. Twenty-one per cent of the requests for hospital admission received other treatment. The average age was 86 years, with a majority of patients being poly-medicated, having multiple pathologies and also more neurocognitive disorders than the general population. Guidance is provided in 30 % of the calls, improving the care pathway of these elderly patients. The time to response and to hospital admission is short, thus favouring direct access to hospital departments. The main independent risk factor for hospital admission was the presence of acute illness. This community-hospital link seems to answer the principal request of GPs, i.e. hospitalization in acute condition. It is beneficial for the management of these patient at risk of decompensation. Coordination and communication between the different community-hospital players must continue to develop to improve the care pathway of these complex geriatric patients.

Factors Associated with Clostridioides (Clostridium) Difficile Infection and Colonization: Ongoing Prospective Cohort Study in a French University Hospital.

INTRODUCTION: Clostridioides (Clostridium) difficile can be isolated from stool in 3% of healthy adults and in at least 10% of asymptomatic hospitalized patients. C. difficile, the most common cause of hospital-acquired infectious diarrhea in the developed world, has re-emerged in recent years with increasing incidence and severity. In an effort to reduce the spread of the pathogen, published recommendations suggest isolation and contact precautions for patients suffering from C. difficile infection (CDI). However, asymptomatic colonized patients are not targeted by infection control policies, and active surveillance for colonization is not routinely performed. Moreover, given the current changes in the epidemiology of CDI, particularly the emergence of new virulent strains either in the hospital or community settings, there is a need for identification of factors associated with colonization by C. difficile and CDI. Methods and analysis: We are carrying out a prospective, observational, cohort study in Edouard Herriot Hospital, Hospices Civils de Lyon, a 900-bed university hospital in Lyon, France. All consecutive adult patients admitted on selected units are eligible to participate in the study. Stool samples or rectal swabs for C. difficile testing are obtained on admission, every 3-5 days during hospitalization, at the onset of diarrhea (if applicable), and at discharge. Descriptive and logistic regression analyses will be completed to mainly estimate the proportion of asymptomatic colonization at admission, and to evaluate differences between factors associated with colonization and those related to CDI. Ethics: The study is conducted in accordance with the ethical principles of the Declaration of Helsinki, French law, and the Good Clinical Practice guidelines. The study protocol design was approved by the participating units, the ethics committee and the hospital institutional review board (Comité de protection des personnes et Comission Nationale de l'Informatique et des Libertés; N°: 00009118). Dissemination: The results of this study will be disseminated by presenting the findings locally at each participating ward, as well as national and international scientific meetings. Findings will be shared with interested national societies crafting guidelines in CDI.

Acceptability and perception of the herpes zoster vaccine in the 65 and over population: A French observational study.

The aim of the study was to evaluate the acceptability and to describe the perception of vaccination against herpes zoster (HZ) for outpatients and hospitalized patients in Lyon, France, aged 65 years and over. An observational study was based on a questionnaire completed from a face-to-face interview from January 2018 to March 2019. Volunteer outpatients who attended private medical laboratories or who were hospitalized in the geriatric department, or who were at the ambulatory medical clinic for a consultation were asked to participate. A total of 907 individuals were interviewed, with a mean age of 75.8 years. A large majority 87.6% (795) knew about HZ and 68.9% (625) would agree to be vaccinated against HZ if they had risk factors. The participants had knowledge of HZ as a disease but vaccine awareness is still lacking among the general public.

One-Year Evolution of Behavioral and Psychological Symptoms of Dementia in Patients Initially Hospitalized in Cognitive Behavioral Units: The EVITAL Prospective Cohort.

BACKGROUND: The 2008-2012 French Alzheimer's Plan has provided hospital Cognitive and Behavioral Units (CBU) to improve the management of patients with productive behavioral and psychological symptoms of dementia (BPSD). Little is known concerning the behavioral outcome of these patients after discharge. OBJECTIVE: The present study investigated the long-term evolution of BPSD over one year after CBU discharge. METHODS: The EVITAL cohort included 221 participants admitted to the CBUs of 3 French hospitals. BPSD were collected using the Neuropsychiatric Inventory (NPI) at admission and 3, 6, and 12 months after hospitalization. The global NPI score evolution was assessed using a linear mixed-effect model. A four-factor model of the NPI including behavioral dyscontrol, psychosis, mood, and agitation subscores was also analyzed. RESULTS: Our analysis focused on 148 patients followed up during 12 months and evaluated at each visit. The global NPI score was 48.5 (SD 21.7) at baseline, 28.8 (SD 18.7) at 3-month, 23.2 (SD 16.4) at 6-month and 20.9 (SD 15.9) at 12-month follow-up. The score significantly decreased from baseline to follow-up (F = 109.3 p < 0.0001). Moreover, the decrease was observed for each NPI subscores. The Clinical Dementia Rating (CDR) scale score was significantly linked to the baseline NPI score (t = 2.76, p = 0.009). Conversely, the NPI decline was observed whatever the CDR level. CONCLUSION: The present study showed a decrease in the global NPI score and all its subscores during the year following the CBU hospitalization, regardless of the initial CDR score.

Contacts between health care workers and patients in a short-stay geriatric unit during the peak of a seasonal influenza epidemic compared with a nonepidemic period.

BACKGROUND: Patterns of contacts between health care workers and patients during seasonal epidemics are unknown. Our study objective was to compare the number and duration of contacts between health care workers and patients during a nonepidemic period versus a community influenza epidemic, and to identify supercontactors. METHODS: Our observational study was conducted in a short-stay geriatric unit of a university hospital. Contacts between individuals were recorded by active radio frequency identification devices. Contact patterns were compared between 2 periods according to contact number and duration. Each care period lasted 5 days in the nonepidemic and influenza epidemic periods. RESULTS: The study included 21 medical doctors, 43 nurses, and 56 patients. In total, 3,200 contacts (61.4%; 152,700 seconds) were recorded during the nonepidemic period, with 2,013 contacts (38.6%; 92,740 seconds) in the epidemic period (P = .007). More cumulative contacts occurred during the nonepidemic period between nurses and patients (n = 2,638 [82%] vs n = 1,599 [79%]), but not between patients (n = 56 [18%] vs n = 414 [21%]). Contact duration between nurses and patients lasted longer during the nonepidemic period (P = .04). During the epidemic period, 6 nurses (15%) considered to be supercontactors accounted for 44.3% of the total number of contacts with patients. CONCLUSION: The pattern of contacts between individuals differed according to the presence or not of the community influenza peak that might have influenced the risk of nosocomial influenza.

[Effect of a non-pharmacological intervention, Voix d'Or(®), on behavior disturbances in Alzheimer disease and associated disorders]. / Effet d'une intervention non médicamenteuse, Voix d'Or(®), sur les troubles du comportement dans la maladie d'Alzheimer ou une maladie apparentée.

An innovative non-pharmacological intervention called Voix d'Or(®) (Golden Voice) was proposed in the Cognitive behavioral unit (CBU) of the Memory center at the Hospices civils in Lyon. Voix d'Or(®) offers eight sound activities disseminated via an audio device based on different approaches sociotherapeutic (music therapy, reminiscence, relaxation, reorientation in reality). The aim of this study was to test the effects of the Voix d'Or(®) program on behavioral and psychological symptoms of dementia (BPSD) in patients with Alzheimer's disease hospitalized in the CBU. Twenty four patients with agitation and/or apathy and/or anxiety and/or depression were included. Patients were randomly selected in the intervention group exposed to Voix d'Or versus a control group exposed to usual occupational activities. Patients were assessed before (T0) and after (T1) the intervention period. Several variables were measured: frequency and severity of behavioral disorders, anxiety, depression, agitation and apathy. A significant improvement of anxiety level between T0 and T1was observed in the group with Voix d'Or(®) compared to the control group. This study suggests that this non-pharmacological intervention may be beneficial on anxiety in patients with Alzheimer's disease.

[Experience of a care pathway for psychological and behavioral symptoms of dementia]. / Expérience d'un parcours de soins des symptômes psychologiques et comportementaux des démences.

Behavioral and psychological symptoms of dementia (BPSD) are present in more than eighty percent of patients, resulting in a significant decrease of quality of life of patients and caregivers. To provide the most appropriate and early response to behavioral disorders, a specific care pathway, unique in France, has been created within the Memory Center at the Hospices Civils of Lyon. It includes a consultation "Behavior" aimed to intervention and guidance, a Cognitive-Behavioral Unit for pharmacological and non-pharmacological interventions in a comprehensive care of the patient during 3 to 4 weeks, and an Alzheimer's disease mobile team, which can assess the BPSD in the patient's living environment at home or in nursing homes, appraise drug treatments and environment, and give training for caregivers. This care pathway is aimed to provide individualized and early care for behavioral crises secondary prevention, taking into account the psychological, neuropsychological and somatic context of the behavioral disorders occurrence.