Impact of care pathway for nursing home residents treated for cancer: ONCO-EHPAD study.

PURPOSE: Few data are known about cancer management in frail nursing home residents. METHODS: Objective of our prospective, interventional study was to set up in the Marseille area, a care pathway for nursing homes residents with a suspected cancer. It combined cancer diagnosis procedures and comprehensive geriatric assessment (CGA), both made in our geriatric oncology outpatient unit, before oncologic advice for treatment decision. In standard care, CGA is carried out after therapeutic decision, to determine whether the planned treatment is compatible with the patient's frailties. CGA and quality of life were performed at enrolment and at 6 months. This study was registered in ClinicalTrials.gov (NCT03103659). RESULTS: Between April 2017 and March 2020, 48 residents from 38 nursing homes were included: 24 had the care pathway (PP), and 24 the standard care (NPP). Six were excluded (no cancer). PP had more frailties than NPP. All PP and 75% of NPP had outpatient care. Curative treatment was given to 77% of NPP (including chemotherapy in 10 cases), and 25% of PP (surgery, radiotherapy, hormone therapy). A majority of PP (75%) had supportive care. At 6 months, 16 patients died (11 NPP, 5 PP). Quality of life evolution was available for 11 PP and 7NPP: it showed stability in PP and degradation in NPP. CONCLUSION: Even if part of residents were too frail to get curative treatment, the care pathway enabled them to benefit from oncologic advice and appropriate supportive care while preserving their quality of life. Further investigations are needed to confirm these findings.

The creation and implementation of advanced practice nursing in France: Experiences from the field.

AIM: This paper describes the characteristics of the new advanced practice nursing roles in France, as well as their challenges and perspectives, and compares the French model with the recommendations of the International Council of Nurses. BACKGROUND: Advanced practice nursing is particularly well established in English-speaking countries. Since 2018, France has become the second French-speaking region to legalize and regulate advanced practice nurses. SOURCE OF EVIDENCE: The International Council of Nurses and French government websites, and scientific databases (PubMed, CINALH, Cochrane Library) were explored. Feedback from French nursing academics was also requested. DISCUSSION: The advanced practice nursing model in France is described according to the scope and conditions of professional practice. The educational program leads to a State diploma with master's degree, which it is mandatory to be a registered nurse. Remuneration depends on the sector of practice in the public hospital, primary care or private sector. Although there is no national strategy for the implementation of advanced practice nursing roles, research projects are being initiated to guide and evaluate the practice. Based on concordance analysis with the recommendations of the International Council of Nurses, the French advanced practice nursing model appears to be similar to the nurse practitioner model. CONCLUSION: Adjustments in the scope of practice and education can be expected as the implementation of these roles is evaluated. IMPLICATIONS FOR NURSING PRACTICE: This is a historical evolution of the nursing profession in France, for which communication with patients and healthcare professionals is essential. IMPLICATIONS FOR NURSING POLICY: The implementation of advanced practice nursing roles in clinical settings requires the development of national strategies to support initiatives and ensure the sustainability of these roles.

[Telemedicine and drug iatrogenesis in nursing homes]. / Télémédecine et iatrogénie médicamenteuse en Ehpad.

Inappropriate drug prescribing is an avoidable cause of adverse drug events, sources of an increase in morbimortality, excess spending and a decrease in quality of life. Many actions exist to improve prescribing quality and to secure the medication circuit in nursing homes. As part of the deployment of telemedicine, the benefit of a medico-pharmaceutical tele-expertise system for medication is evident.

Effect of frailty on unplanned readmission in older adults: A systematic review.

BACKGROUND: Frailty and hospital readmissions are two major problems for older people because of their impact on health, quality of life and healthcare systems. The aims of this study were to investigate the relationship between frailty and unplanned readmissions at 30, 90, 180 days and 1 year in hospitalised older people, and to identify the most relevant tools for assessing readmission risk in different clinical settings to facilitate systematic identification of this high-risk population by healthcare professionals. METHOD: This review was based on a systematic search of the MEDLINE, EMBASE and SCIENCEDIRECT databases for articles published between January 2011 and December 2021 that examined the association between frailty and unplanned readmission in hospitalised adults aged 65 years and over using identified validated tools. RESULTS: 44 eligible studies out of 1362 were included in a descriptive analysis. Sixteen countries were represented with older adults hospitalised in medical, surgical, post-acute care and rehabilitation, and emergency departments. Up to 84.5% of frail older adults had an unplanned readmission. Of the 21 tools identified, the Hospital Frailty Risk Score (HFRS), the Frailty Index (FI), its derivatives, the Clinical Frailty Scale (CFS) and the Fried model were the most widely used and relevant tools for identifying the association between frailty and unplanned readmission. CONCLUSION: Frailty is widely associated with readmission risk in older adults. The HFRS, FI, CFS and Fried model appear to be the most commonly used tools to assess frailty and prevent unplanned readmissions.

[Tagravpa: Help table and grid for identifying the risk of aggravation and early rehospitalization of elderly persons 75 years and older referred to emergency departments and/or hospitalized in care units]. / Tagravpa : Tableau d'aide et grille de repérage du risque d'aggravation et de réhospitalisation précoce des personnes âgées de 75 ans et plus adressées aux urgences et/ou hospitalisées dans les unités de soins.

People aged 75 and over, frail or dependent are the most frequently hospitalized, particularly via the emergency department, and are sometimes readmitted to hospital less than a month after their discharge. Article 70 of the 2012 social security financing act has set up experiments aimed at improving the care pathway for the elderly. In this context, Marseille University Hospital has developed a table of help and grid for identifying the risk of aggravation of the elderly (Tagravpa). Comprising nine medical-psycho-social items, the grid enables the identification of the risk of aggravation to which is associated a score for identifying the risk of early re-hospitalization for the modeling of care pathways. A study was conducted in two departments. In cardiology for readmission at 1 month the results showed a grid positivity threshold of 6 for sensitivity measured at 56,6% (95% CI: 22,7-84,7) and specificity of 61,5% (95% CI: 40,7-79,1). In Emergency Department the results showed a positivity threshold of 4 for sensitivity at 83,3% (95% CI: 57,7-95,6) and specificity at 45,5% (95% CI: 36,8-54,3). This grid, called TAGRAVPA appears as a simple tool for identifying the risk of early re-hospitalization. It is applicable in a hospital environment, whatever the department and allows the initiation of an adapted path for the elderly person hospitalized or returning home from the emergency department.