Risk factors for readmission to the emergency department in patients aged 75 or older: a systematic review.

A systematic literature review was carried out to assess the risk factors for readmission to the emergency department in people aged 75 and over. This review shows that certain socio-demographic factors (older age, male gender, not being single), certain underlying conditions (cardio-respiratory diseases, diabetes, cognitive impairment, cancer, depression), a recent history of falling, and impaired autonomy prior to admission are risk factors for readmission to the emergency department more than the cause of admission itself or its severity in people aged 75 and over. The best predictive score for readmission to the emergency department for elderly patients remains to be determined, as does the systematic identification of risk factors associated with specific management in the oldest at-risk group to reduce their readmission after a first visit to the emergency department.

[Risk factors of readmission into emergency department in patients aged 75 or older: a systematic review]. / Facteurs de risque de réadmission aux urgences chez les personnes âgées de 75 ans ou plus : une revue systématique de la littérature.

A systematic review of the literature was carried out to assess the risk factors for readmission to the emergency room in people aged 75 and over. This review shows that some socio-demographic factors (high age, male gender, not being single), some underlying conditions (cardio-respiratory diseases, diabetes, cognitive impairment, cancer, depression), a recent history of falling and an impaired autonomy before admission are risk factors for readmission to the emergency room more than the cause of admission itself or its severity in people aged 75 and over. It remains to determine the best predictive readmission score in the elderly and whether a systematic identification of risk factors associated with specific management in the at-risk oldest reduce their readmission after a first visit to the emergency room.

Impact of a pharmacist and geriatrician medication review on drug-related problems in older outpatients with cancer.

OBJECTIVES: Older patients with cancer have increased risk for comorbidity, polypharmacy (PP) and drug related problems (DRP). The aim of this study was to assess the effect of a clinical pharmacist and geriatrician medication review (MR) among older outpatients with cancer to optimize management of comorbidities during comprehensive geriatric assessment (CGA). MATERIAL AND METHODS: We conducted a single-center prospective study among older outpatients with cancer (≥75 years). A pharmacist consultation was added into CGA process. The clinical pharmacist detected and assessed PP and DRP such as potentially inappropriate medications (PIM) according to the Laroche French list and STOPP criteria, START criteria and adverse drug events (ADE) risk. After a multidisciplinary MR, the proposals for prescription modification were sent to general practitioners (GPs). RESULTS: Fifty-one consenting patients were recruited between May 2016 and March 2017, with a median age of 83 years. Prevalence of PP was 80.4%. 165 DRP were detected among 86% patients (median number of DRP = 3.0): 19.4% were misuse, 43.6% underuse, and 37.0% overuse. A significant decrease was observed in prevalence of PIM use (Laroche: 31.4% versus 5.9%, p = 0.002), START criteria (66.7% to 5.9%; P < 0.001) and ADE score (4.0 before MR versus 2.0 after, p = 0.023). A trend was observed for a lower number of medications (10.0 versus 8.0, p = 0.092) and on STOPP criteria prevalence (56.9% versus 31.4%, p = 0.12). CONCLUSION: A clinical pharmacist and a geriatrician MR is effective to detect and reduce DRP in older outpatients with cancer.

Quality of life determinants in older patients with cancer: Results from a French prospective monocenter cohort.

OBJECTIVES: The aim of this study is to describe determinants of quality of life (QOL) quoted by vulnerable older patients with cancer and compare them with domains included in cancer-specific QOL questionnaires. MATERIAL AND METHODS: This prospective, monocenter, observational study was performed in a French university hospital. Cancer patients Patients with cancer aged over 74 years were recruited when referred for an out-patient geriatric evaluation (n = 102). After geriatric assessment, they were invited to respond to open-ended questions, Q1: "For you, what is most important to have a good QOL?" Q2: "What could improve your QOL?" Q3: "What could worsen your QOL?" A Delphi process was conducted to categorize patient responses according to content analysis. RESULTS: The most frequently patient-reported determinants for high quality of life were maintaining close ties with family/friends or social relations, autonomy for decision and mobility without depending on others, being in good health, not suffering from pain and the absence of problems concerning relatives. Global health status, physical functioning/mobility, social functioning and worries about others were the more frequently mentioned QOL domains related to the EORTC QLQ-C30 and ELD14 questionnaires. Some determinants of QOL were not linked to pre-defined domains, some others without a 100% consensus after the Delphi process, illustrating the subjectivity of QOL analysis by a single practitioner. CONCLUSION: Patient interview with open-ended questions provides valuable supplementary information to QOL questionnaires, in order to personalize health related (cancer treatment, pain management…) and global (maintenance of autonomy and family/social relations…) assessment and intervention.

Tillage intensity and pasture in rotation effectively shape soil microbial communities at a landscape scale.

Soil microorganisms are essential to agroecosystem functioning and services. Yet, we still lack information on which farming practices can effectively shape the soil microbial communities. The aim of this study was to identify the farming practices, which are most effective at positively or negatively modifying bacterial and fungal diversity while considering the soil environmental variation at a landscape scale. A long-term research study catchment (12 km2 ) representative of intensive mixed farming (livestock and crop) in Western Europe was investigated using a regular grid for soil sampling (n = 186). Farming systems on this landscape scale were described in terms of crop rotation, use of fertilizer, soil tillage, pesticides treatments, and liming. Molecular microbial biomass was estimated by soil DNA recovery. Bacterial and fungal communities were analyzed by 16S and 18S rRNA gene pyrosequencing. Microbial biomass was significantly stimulated by the presence of pasture during the crop rotation since temporary and permanent pastures, as compared to annual crops, increased the soil microbial biomass by +23% and +93% respectively. While soil properties (mainly pH) explained much of the variation in bacterial diversity, soil tillage seemed to be the most influential among the farming practices. A 2.4% increase in bacterial richness was observed along our gradient of soil tillage intensity. In contrast, farming practices were the predominant drivers of fungal diversity, which was mainly determined by the presence of pastures during the crop rotation. Compared to annual crops, temporary and permanent pastures increased soil fungal richness by +10% and +14.5%, respectively. Altogether, our landscape-scale investigation allows the identification of farming practices that can effectively shape the soil microbial abundance and diversity, with the goal to improve agricultural soil management and soil ecological integrity.

Discrimination of farm waste contamination by fluorescence spectroscopy coupled with multivariate analysis during a biodegradation study.

The persistence of potential tracers of dissolved organic matter (DOM) generated from farm waste-amended soil was investigated by fluorescence spectroscopy coupled with classification and regression tree (CART) and principal component analysis (PCA) during a short-term (8 days) to midterm (60 days) biodegradation study. Pig manure (PM), cow manure (CM), wheat straw (WS), and soil alone (SA) treatment inputs were used. Waste amendments were potential sources of higher DOM concentrations. PCA revealed the DOM quality differences between farm wastes and soil alone as well as a significant shift observed from the biochemical to the geochemical fluorescent fraction in SA and PM treatments. The tryptophan:Humic-Like ratio and tryptophan zone were the potential discriminators of recent and midterm pollution by farm wastes. Integral intensities of the Fulvic-Like zone and region III discriminated the PM from CM and WS during the 60 days. CART analysis showed 90 and 100% potential for farm wastes discrimination from soil during P1 and P2, respectively. The prediction successes were 72 and 57% for PM from other wastes and 60 and 100% for WS during both periods. Fluorescence spectroscopy in combination with CART analysis can be a nondestructive innovative method for monitoring susceptible farm waste contamination.