Discharge of newborns with risk factors of severe hyperbilirubinemia: description of a hospital at home-based care monitoring and phototherapy.

Neonatal jaundice is common and associated with delay in hospital discharge and risk of neurological sequelae if not treated. The objectives of the study were to report on our experience of the monitoring and treatment of neonatal jaundice in a home care setting and its feasibility and safety for neonates with high risk of severe hyperbilirubinemia. The 2-year study has been led in the greater Paris University Hospital At Home (Assistance Publique-Hôpitaux de Paris). The device of the intervention was the Bilicocoon® Bag, a light-emitting diode sleeping bag worn by the neonate when the total serum bilirubin value exceeds intensive phototherapy threshold, according to the guidelines from the American Academy of Pediatrics. One hundred and thirty-nine neonates had participated in the intervention and 39 (28%) were treated by phototherapy at home, as continuation of inpatient phototherapy or started at home. Seventy-five percent of the sample had more than two risk factors for development of severe hyperbilirubinemia. Twenty five percent of the cohort who received phototherapy at home had lower gestational age (p < 0.014) and had younger age at discharge from maternity (p < 0.09). Median length of stay in hospital at home was 5 days. Two patients needed readmission in conventional hospital (1%) for less than 24 h. In multivariate model, the length of stay decreased with the higher gestational age (p < 0.001) and increased significantly with the older age at discharge, the birth weight < 10th percentile, and a treatment by phototherapy at home.    Conclusion: Hospital at home, which is a whole strategy using an effective and convenient phototherapy device combined with a specialized medical follow-up, could be an alternative to conventional hospitalization for neonates at high risk of severe jaundice. The maternity discharge is facilitated, the mother-infant bonding can be promoted, and the risk of conventional rehospitalization is minimal, while guaranteeing the safety of this specific care. What is Known: • Managing neonatal jaundice is provided in conventional hospital with phototherapy. • Neonatal jaundice increases the risk of prolonged hospitalization or readmission. What is New: • Phototherapy is feasible in hospital at home for neonates with high risk of severe hyperbilirubinemia. • The care pathway of neonates from conventional hospital to hospital at home is described.

Treatment for multiple myeloma in hospital at home: clinical characteristics and patient care pathways.

While most patients receive anticancer injection in a conventional hospital, some are treated in hospital at home. Given the lack of data, we seek to determine the clinical characteristics and care pathways of patients benefiting from hospital at home (HAH) for anticancer injection. A longitudinal scheme was conducted about patients with multiple myeloma (MM) starting bortezomib-based regimens in HAH in 2015 with a follow-up to September 2019. 154 patients received bortezomib at home with a mean age of 70.6 years, 72.7% over 65y-old and, a median Karnofsky Performans Status of 70. One-third of the elderly lived alone, 16.1% required domestic help. After a 24-month follow-up, 77.9% of patients were alive. The median overall survival was not reached at 4 years. Between 42.1% and 48.1% of patients returned to HAH for a new line of treatment. Patients were mainly independent and "fit." The involvement of HAH was achieved without safety issues nor compromise long-term outcomes. However, the real-world patterns highlighted that only a small proportion of patients returned to HAH for a new treatment line.

Complicated hospitalization due to influenza: results from the Global Hospital Influenza Network for the 2017-2018 season.

BACKGROUND: Since 2011, the Global Influenza Hospital Surveillance Network (GIHSN) has used active surveillance to prospectively collect epidemiological and virological data on patients hospitalized with influenza virus infection. Here, we describe influenza virus strain circulation in the GIHSN participant countries during 2017-2018 season and examine factors associated with complicated hospitalization among patients admitted with laboratory-confirmed influenza illness. METHODS: The study enrolled patients who were hospitalized in a GIHSN hospital in the previous 48 h with acute respiratory symptoms and who had symptoms consistent with influenza within the 7 days before admission. Enrolled patients were tested by reverse transcription-polymerase chain reaction to confirm influenza virus infection. "Complicated hospitalization" was defined as a need for mechanical ventilation, admission to an intensive care unit, or in-hospital death. In each of four age strata (< 15, 15-< 50, 50-< 65, and ≥ 65 years), factors associated with complicated hospitalization in influenza-positive patients were identified by mixed effects logistic regression and those associated with length of hospital stay using a linear mixed-effects regression model. RESULTS: The study included 12,803 hospitalized patients at 14 coordinating sites in 13 countries, of which 4306 (34%) tested positive for influenza. Influenza viruses B/Yamagata, A/H3N2, and A/H1N1pdm09 strains dominated and cocirculated, although the dominant strains varied between sites. Complicated hospitalization occurred in 10.6% of influenza-positive patients. Factors associated with complicated hospitalization in influenza-positive patients included chronic obstructive pulmonary disease (15-< 50 years and ≥ 65 years), diabetes (15-< 50 years), male sex (50-< 65 years), hospitalization during the last 12 months (50-< 65 years), and current smoking (≥65 years). Chronic obstructive pulmonary disease (50-< 65 years), other chronic conditions (15-< 50 years), influenza A (50-< 65 years), and hospitalization during the last 12 months (< 15 years) were associated with a longer hospital stay. The proportion of patients with complicated influenza did not differ between influenza A and B. CONCLUSIONS: Complicated hospitalizations occurred in over 10% of patients hospitalized with influenza virus infection. Factors commonly associated with complicated or longer hospitalization differed by age group but commonly included chronic obstructive pulmonary disease, diabetes, and hospitalization during the last 12 months.

Thirty-day hospital readmission predictors in older patients receiving hospital-at-home: a 3-year retrospective study in France.

OBJECTIVE: This study described older patients receiving hospitalisation-at-home (HaH) services and identified factors associated with 30-day hospital readmission. DESIGN: 3-year retrospective study in 2017-2019 in France. PARTICIPANTS: 75 108 patients aged 75 years and older who were discharged from hospital medical wards (internal medicine and geriatric units) and admitted to HaH. PRIMARY OUTCOME MEASURE: 30-day hospital readmission. RESULTS: The mean age of patients was 83.4 years (SD 5.7), 52.3% were male and 88.4% lived in a private household. Patients were primarily discharged from the internal medicine unit (85.3%). The top four areas of care in the HaH were palliative care, complex dressing, intravenous therapy and complex nursing care. Overall, 23.5% of patients died during their HaH stay and 27.8% were readmitted to the hospital at 30 days. In the multivariate model, male (OR 1.19, 95% CI 1.16 to 1.23), supportive cancer HaH care (OR 1.78, 95% CI 1.51 to 2.11) and very high intensity care during the previous in-person hospitalisation (OR 1.45, 95% CI 1.34 to 1.57) increased the risk of hospital readmission at 30 days. Older age (OR 0.97, 95% CI 0.97 to 0.98), living in a nursing home (OR 0.51, 95% CI 0.48 to 0.54), postsurgery HaH care (OR 0.49, 95% CI 0.41 to 0.58) and having been previously hospitalised in a geriatric unit (OR 0.81, 95% CI 0.77 to 0.85) decreased the risk of hospital readmission at 30 days. CONCLUSIONS: HaH provides complex care to very old patients, which is associated with high mortality. Several factors are associated with rehospitalisation within 30 days that could be avoided with better integration of different services with higher geriatric skills. TRIAL REGISTRATION NUMBER: CNIL:2228861.

Home emergency response team for the seriously ill palliative care patient: feasibility and effectiveness.

OBJECTIVES: To characterise trajectories associated with a new team organisation combining critical care and palliative care approaches at home. METHODS: We describe the pattern of an emergency response team 24/7 directed to patients with advanced illness presenting a distressing symptom at home, who wanted to stay at home and for whom hospitalisation was considered inappropriate by a shared medical decision-making process in an emergency situation. To assess preliminary impact of this Programme, we conducted a descriptive study on all consecutive patients receiving this intervention during the first year (between 6 September 2021 and 5 September 2022). RESULTS: Among the 352 patients included, main advanced illnesses were cancer (41%), dementia (28%) or chronic organ failure (10%). They were critically ill with acute failures: respiratory (52%), neurological (48%) or circulatory (20%). Main distressing symptoms were breathlessness (43%) and pain (17%). Median response time from call to home-visit (IQR) was 140 (90-265) min. Median length of follow-up (IQR) was 4 (2-7) days. Main outcomes were death at home (72%), improvement (19%) or hospitalisation (9%) including three visits to emergency department (1%). CONCLUSIONS: Our study supports that shared decision-making process and urgent care at home are feasible and might prevent undesired hospitalisations.

[Clinical profile and care pathways of nursing home residents having the intervention of hospital at home and comparison according to the referrers]. / Profil clinique et parcours de soins des résidents bénéficiant de l'intervention de l'hospitalisation à domicile en Établissement d'hébergement pour personnes âgées dépendantes et comparaison des interventions selon leur provenance.

Background : Nursing homes' (NH) residents present a mix of medical, psychological and social needs associated with a high risk of hospitalization. The intervention of the hospitalization at home (HAH) in NH has been implemented in France to better fit the residents' needs and decrease the risk of hospitalization. No study has described the population of residents receiving this intervention. This study aimed to define the profile and the care pathway of residents and compare their characteristics according to the referrals (NH or hospitals). METHODS: A retrospective study on 1,436 residents' stays in the intervention of the Assistance Publique-Hôpitaux de Paris'HAH in Ile de France between 2014 and 2019 was implemented. The Programme de Médicalisation des Systèmes d'Information (PMSI) data was used for the analysis. RESULTS: Residents were 88 years old with 69% of women with functional disability and the care was mainly represented by the complex dressing (68%). For the care pathway, 65% of the referrers were from the NH and 35% from the hospital settings, 33% of the residents died at the end of the stay in the NH and 25% were transferred to hospitals. When the referrer was the hospital, the residents were mainly men (p < 0.001), younger (p < 0.001), receiving more often intravenous treatment and palliative care (p < 0.01) with a higher level of indice of Karnofsky (p < 0.01). When the NH was the referrer, deaths were more frequent, whereas the transfers to hospitals were less common (p < 0.001). DISCUSSION: Residents had complex clinical situation and their care pathway were different according to the referrer. From the NH, the HAH was used to provide more often end of life care, and from hospital setting, the residents received more acute care with a higher risk of readmission. Readmission causes should be analyzed.

Clinical profile and care pathways of nursing home residents having the intervention of hospital at home and comparison according to the referrers / Profil clinique et parcours de soins des résidents bénéficiant de l'intervention de l'hospitalisation à domicile en Établissement d'hébergement pour personnes âgées dépendantes et comparaison des interventions selon leur provenance

Background: Nursing homes' (NH) residents present a mix of medical, psychological and social needs associated with a high risk of hospitalization. The intervention of the hospitalization at home (HAH) in NH has been implemented in France to better fit the residents' needs and decrease the risk of hospitalization. No study has described the population of residents receiving this intervention. This study aimed to define the profile and the care pathway of residents and compare their characteristics according to the referrals (NH or hospitals). Methods: A retrospective study on 1,436 residents' stays in the intervention of the Assistance Publique-Hôpitaux de Paris'HAH in Ile de France between 2014 and 2019 was implemented. The Programme de Médicalisation des Systèmes d'Information (PMSI) data was used for the analysis. Results: Residents were 88 years old with 69 % of women with functional disability and the care was mainly represented by the complex dressing (68 %). For the care pathway, 65 % of the referrers were from the NH and 35 % from the hospital settings, 33 % of the residents died at the end of the stay in the NH and 25 % were transferred to hospitals. When the referrer was the hospital, the residents were mainly men (p < 0.001), younger (p < 0.001), receiving more often intravenous treatment and palliative care (p < 0.01) with a higher level of indice of Karnofsky (p < 0.01). When the NH was the referrer, deaths were more frequent, whereas the transfers to hospitals were less common (p < 0.001). Discussion : Residents had complex clinical situation and their care pathway were different according to the referrer. From the NH, the HAH was used to provide more often end of life care, and from hospital setting, the residents received more acute care with a higher risk of readmission. Readmission causes should be analyzed.

Introduction: Les résidents d'Établissement d'hébergement pour personnes âgées dépendantes (Ehpad) présentent un haut risque d'hospitalisation. Afin d'éviter le recours à l'hôpital, l'hospitalisation à domicile (HAD) en Ehpad s'est développée. Cette étude a pour objectifs de caractériser le profil clinique et le parcours de soins des résidents d'Ehpad ayant bénéficié de l'HAD, et de comparer leur profil selon la provenance de l'intervention (Ehpad ou hôpital). Méthodes: Une étude rétrospective des séjours de résidents d'Ehpad ayant bénéficié de l'HAD de l'Assistance publique-Hôpitaux de Paris entre 2014 et 2019 a été mise en place à partir des données du PMSI. Résultats: Les résidents étaient âgés de 88 ans en moyenne avec 69 % de femmes. Ils étaient principalement pris en charge pour des plaies complexes (68 %). Concernant les séjours, 65 % étaient en provenance de l'Ehpad. Les modes de sortie montraient 33 % de décès en Ehpad et 25 % de réhospitalisations. Selon la provenance du séjour, les résidents présentaient un profil clinique et des parcours de soins différents. Discussion/conclusion: L'intervention de l'HAD en Ehpad permet de répondre aux caractéristiques et aux besoins spécifiques des résidents tout en évitant un recours systématique à l'hospitalisation.

Enhancing Nationwide Medico-Administrative Databases Analysis with SAF4SUHAD: A Statistical Analysis Framework for Secondary Use of Healthcare Administrative Databases.

Many epidemiological studies now rely on the reuse of large healthcare administrative databases. In those studies, most of the time is consumed in managing data and performing basic statistical analyses and is not available anymore for complex statistical and medical analysis, therefore the potential of such databases is sometimes underexploited. The objective of this work is to build SAF4SUHAD, a statistical analysis framework for secondary use of healthcare administrative databases, using literature-based specifications. A literature review was performed on PubMed in four different medical domains: caesarian deliveries, cholecystectomies, hip replacement surgeries and bariatric surgeries. We identified 22 papers relating analyses of large databases. They reported epidemiological indicators (e.g. mean age), that were abstracted to features (e.g. univariate description of a quantitative variable), and then were implemented through 32 functions available for the user in R programming language. For instance, a function will draw a histogram, compute the mean with confidence interval, quantiles, etc. Those functions comprehend 4 functions for data management, 9 for univariate analysis, 8 for bivariate analysis, 11 for multivariate analysis, and many other intermediate functions. Those functions were successfully used to analyze a French database of 250 million discharge summaries. The set of R ready-to-use functions defined in this work could enable to secure repetitive tasks, and to refocus efforts on expert analysis.

Underuse of Oral Anticoagulants and Inappropriate Prescription of Antiplatelet Therapy in Older Inpatients with Atrial Fibrillation.

BACKGROUND: Several studies have shown that the prescription of antiplatelet therapy (APT) is associated with an increased risk of oral anticoagulant (OAC) underuse in patients aged 75 years and over with atrial fibrillation (AF). An associated atheromatous disease may be the underlying reason for APT prescription. The objective of the study was to determine whether the association between underuse of OAC and APT prescription was explained by the presence of an atheromatous disease. METHODS AND RESULTS: We performed a retrospective, observational, single-centre study between 2009 and 2013 based on administrative data. Patients aged 75 years and over with non-valvular AF were identified in a database of 72,090 hospital stays. Prescriptions of anti-thrombotic medications and their association with the presence of atheromatous disease were evaluated by the mean of a logistic regression. A total of 2034 hospital stays were included (mean age 84.3 ± 5.2 years). The overall prevalence of known atheromatous disease was 25.9%. OAC underuse was observed in 58.5% of the stays. In multivariable analysis, the prescription of an APT was associated with an increased risk of OAC underuse [odds ratio (OR) 6.85; 95% confidence interval (CI) 5.50-8.58], independently of the presence of a concomitant known atheromatous disease (OR 0.78; 95% CI 0.60-1.01). Among the 692 stays with APT monotherapy (34.0%), 232 (33.5%) displayed an atheromatous disease. CONCLUSIONS: The underuse of OAC is associated with the prescription of APT in older patients with AF, regardless of the presence or absence of known atheromatous disease. Our results suggest that APT is often inappropriately prescribed instead of OAC.

Rational and efficient geometric definition of pharmacophores is essential for the patent process.

The geometric description of pharmacophores suffers from approximations. No consensus has been clearly established, despite the increasing interest in using pharmacophores in drug design and in patent applications. We therefore propose an original definition of a pharmacophore using spherical coordinates. These coordinates give a precise description of each point using three parameters: distance to a geometric origin and two angles. If necessary, these parameters can be easily and rapidly converted to cartesian coordinates. Our method can guarantee, to the patent applicant, the safe protection of his intellectual property by both improving markedly the readability of a pharmacophore definition and bringing, to the person who is skilled in the art, enough information to understand easily the essence of the invention.

Cation-π Interactions in Serotonin: Conformational, Electronic Distribution, and Energy Decomposition Analysis.

An adiabatic conformational analysis of serotonin (5-hydroxytryptamine, 5-HT) using quantum chemistry led to six stable conformers that can be either +gauche (Gp), -gauche (Gm), and anti (At) depending upon the value taken by ethylamine side chain and 5-hydroxyl group dihedral angles φ1, φ2, and φ4, respectively. Further vibrational frequency analysis of the GmGp, GmGm, and GmAt conformers with the 5-hydroxyl group in the anti position revealed an additional red-shifted N-H stretch mode band in GmGp and GmGm that is absent in GmAt. This band corresponds to the 5-HT side-chain N-H bond involved in an intramolecular nonbonded interaction with the 5-hydroxy indole ring. The influence of this nonbonded interaction on the electronic distribution was assessed by analysis of the spin-spin coupling constants of GmGp and GmGm that show a marked increase for C2-C3 and C8-C9 bonds in GmGm and GmGp, respectively, with a decrease of their double bond character and an increase of their length. The Atoms in Molecules (AIM), Natural Bond Orbital (NBO), and fluorescence and CD spectra (TDDFT method) analyses confirmed the existence in GmGp and GmGm of a through-space charge-transfer between the HOMO and the HOMO-1 π-orbital of the indole ring and the LUMO σ* N-H antibonding orbital of the ammonium group. The strength of the cation-π interaction was determined by calculating binding energies of the NH4(+)/5-hydroxyindole complexes extracted from stable conformers. The energy decomposition analysis indicated that cationic-π interactions in the GmGp and GmGm conformers are governed by the electrostatic term with significant contributions from polarization and charge transfer. The lower stability of the GmGm over the GmGp comes from a higher exchange repulsion and a weaker polarization contributions. Our results provide insight into the nature of intramolecular forces that influence the conformational properties of 5-HT.