Perspectives on Communication Technology Use for Alleviating the Impact of COVID-19 on Hospitalized Patients' Well-Being and Transitions in Care.

BACKGROUND: The COVID-19 pandemic created many challenges for in-patient care including patient isolation and limitations on hospital visitation. Although communication technology, such as video calling or texting, can reduce social isolation, there are challenges for implementation, particularly for older adults. OBJECTIVE/METHODS: This study used a mixed methodology to understand the challenges faced by in-patients and to explore the perspectives of patients, family members, and health care providers (HCPs) regarding the use of communication technology. Surveys and focus groups were used. FINDINGS: Patients who had access to communication technology perceived the COVID-19 pandemic to have more adverse impact on their well-beings but less on hospitalization outcomes, compared to those without. Most HCPs perceived that technology could improve programs offered, connectedness of patients to others, and access to transitions of care supports. Focus groups highlighted challenges with technology infrastructure in hospitals. DISCUSSION: Our study findings may assist efforts in appropriately adopting communication technology to improve the quality of in-patient and transition care.

[Hereditary epidermolysis bullosa in children]. / L'épidermolyse bulleuse héréditaire chez les enfants.

Hereditary epidermolysis bullosa (HES) is a heterogeneous group of rare genetic disorders characterized by localized or generalized fragility of the skin and/or mucous membranes, varying greatly in severity from one form to another and even within a subgroup. Skin wounds can be a source of pain, pruritus and discomfort from birth. Progression varies from patient to patient and from form to form. Specific care must be provided from the neonatal period onwards, and throughout life, to aid healing and limit complications. Nurses are at the heart of skin care for HES patients, and must be familiar with the main principles, while adapting to the individual.

[Implementation of an EMG IPA in the emergency department]. / Implantation d'une IPA de l'EMG au service d'accueil des urgences.

An advanced practice nurse from the Bretonneau-Bichat (AP-HP) hospitals' mobile geriatric outpatient team works in the emergency department (SAU). Its mission is to facilitate the identification, evaluation and referral of frail elderly patients discharged home after a visit to the emergency department. Description of the implementation of this project, its progress, and one-year assessment.

[Reversibility of frailty in elderly patients thanks to a multicomponent training programme]. / Réversibilité de la fragilité chez des patients âgés grâce à un programme d'entraînement multicomposante.

A retrospective study was conducted to evaluate the effects of a multi-component training program with strength machines on physical performance and reversibility of frailty in elderly people. At the end of the program, a significant increase in physical performance was observed and there was a significant decrease in frailty.

Validity and Accuracy of the Tilburg Frailty Indicator Part B for Identification of Frailty in Older Adults Consulting a Rural Geriatric Medicine Clinic.

The Tilburg Frailty Indicator (TFI) is a validated tool for determining frailty in older adults. This study examined the validity and accuracy of the TFI Part B (TFI-B) in a North American context. Seventy-two individuals ≥ 65 years of age recruited from a rural geriatric medicine clinic completed a set of self-reported and performance-based measures, including TFI-B. Frailty level was determined using modified Fried's Frailty Phenotype (FFP). Pearson correlation coefficients (r) assessed the concurrent relationships between the TFI-B and other measures. Accuracy of the TFI-B in classifying frailty level was assessed using assessing area under the curve (AUC). The TFI-B scores showed low correlations (r < 0.4) with gait speed and grip, suggesting that the TFI-B did not consider frailty as merely a physical problem. The AUC of 0.82 indicated that the TFI-B scores accurately classified frail versus non-frail individuals. The score of ≥ 5 on the TFI-B scores showed satisfactory sensitivity/specificity (73%/77%) and excellent negative predictive value (91.95%). This indicates that a TFI-B score of < 5 can be used to rule out frailty.

[Screening for frailty in the elderly subject]. / Dépister la fragilité chez le sujet âgé.

The identification of frailty can be done by any health professional. This assessment allows corrective measures to be taken in order to act early on reversible elements.

[Undernutrition in the elderly, a syndrome with multiple deleterious consequences]. / La dénutrition du sujet âgé, un syndrome aux multiples conséquences délétères.

The prevalence of undernutrition is 4-10% in elderly people living at home, 15-38% in those living in institutions. Fifty percent of hospitalized elderly are undernourished and 40% are hospitalized for the consequences of undernutrition. This is a major problem in geriatrics.

[Responding to the concern of the link]. / Répondre au souci du lien.

Modern psychiatry, which considers the patient as a human subject, places the intersubjective relationship at the center of therapeutic work. The concern for singularity and proximity is therefore at the heart of its practices. The caregiver exposes himself in person to the patient, supported in this adventure by the institution, which helps him by its principles and its devices to regulate emotions and affects. However, the concern for objectification that drives management logic should not lead contemporary psychiatry to abandon the human relationship for dashboards.

MoveStrong at home: a feasibility study of a model for remote delivery of functional strength and balance training combined with nutrition education for older pre-frail and frail adults.

Exercise and nutrition interventions are often recommended for frailty; however, effective strategies are required for real-world implementation. Our primary aim was to assess the feasibility and acceptability of telephone and virtual delivery of MoveStrong, an 8-week exercise and nutrition program with a 4-week follow-up for older pre-frail and frail adults. A priori criteria for success included: recruitment (≥25/12 weeks), retention at follow-up (≥80%), and adherence to exercise and nutrition sessions (≥70%). We recruited community-dwelling Ontario residents; ≥60 years, ≥1 chronic condition, ≥1 FRAIL scale score. Participants received mailed materials, a personalized exercise program, 11 remote one-on-one training sessions with an exercise physiologist and 3 online dietitian-led nutrition education sessions. We completed exploratory analyses of secondary outcomes including physical function and dietary protein intake. Semi-structured interviews supported program evaluation. In total, 30 participants were enrolled. 28 (93%) participants completed program and follow-up assessments. Adherence to exercise and nutrition sessions (CI) was 84% (77%-91%) and 82% (70%-93%) respectively. At program end and follow-up [mean change (CI)], significant improvements were measured in 30-second chair stand test [3.50 (1.12-5.86), 4.54 (1.94-7.13) chair stands] and dietary protein intake [12.9 (5.7-20.0), 9.2 (0.4-18.1) g]. Overall, participants were satisfied with program delivery. Trial registration number: NCT04663685.

Directive clinique no 422g : Ménopause et ostéoporose.

OBJECTIF: Proposer des stratégies pour améliorer les soins aux femmes en périménopause ou ménopausées d'après les plus récentes données probantes publiées. POPULATION CIBLE: Femmes en périménopause ou ménopausées. BéNéFICES, RISQUES ET COûTS: La population cible bénéficiera des plus récentes données scientifiques publiées que leur communiqueront les fournisseurs de soins de santé. Aucun coût ni préjudice ne sont associés à cette information, car les femmes seront libres de choisir parmi les différentes options thérapeutiques offertes pour la prise en charge des symptômes et morbidités associés à la ménopause, y compris l'abstention thérapeutique. DONNéES PROBANTES: Les auteurs ont interrogé les bases de données PubMed, Medline et Cochrane Library pour extraire des articles publiés entre 2002 et 2020 en utilisant des termes MeSH spécifiques à chacun des sujets abordés dans les 7 chapitres. MéTHODES DE VALIDATION: Les auteurs ont évalué la qualité des données probantes et la force des recommandations en utilisant le cadre méthodologique GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). Voir l'annexe A en ligne (tableau A1 pour les définitions et tableau A2 pour l'interprétation des recommandations fortes et faibles). PROFESSIONNELS CONCERNéS: Médecins, y compris gynécologues, obstétriciens, médecins de famille, internistes, urgentologues; infirmières, y compris infirmières autorisées et infirmières praticiennes; pharmaciens; stagiaires, y compris étudiants en médecine, résidents, moniteurs cliniques; et autres fournisseurs de soins auprès de la population cible. DÉCLARATIONS SOMMAIRES: RECOMMANDATIONS.

[Colorectal cancer and preoperative geriatric assessment]. / Cancer colorectal et évaluation gériatrique préopératoire.

With the ageing of the population and the increase in the incidence of cancer in the population over 75 years of age, a partnership between geriatricians and oncologists is becoming necessary to optimise the management of these patients. There is great variability in the profiles of elderly patients and age cannot be the only criterion of the decision making. Thus, it is necessary to identify patients who will benefit from an in-depth geriatric assessment (IGA) and the G8 screening tool used in oncology consultations allows to do so. The EGA offers a multidisciplinary approach to functional, psychological, nutritional, cognitive and social status of the person, and has been shown to have prognostic value for survival and relevance in guiding treatment choices.

[The coordination support device to facilitate patient referral]. / Le dispositif d'appui à la coordination pour faciliter l'orientation du patient.

In the continuity of institutional care, it is important to visualize the return home as a possible entry into a new institution, an interdepartmental transfer. This allows to position oneself in a logic of decompartmentalization of two worlds - the city and the hospital - that seem to be quite distinct until now whereas they are entirely part of a single pathway for the supported person. This change of place is the logical consequence of the acute episode of hospitalization.

[Specificities of supportive care in geriatric oncology]. / Spécificités onco-gériatriques des soins de support.

Supportive care in geriatric oncology is crucial care that should be proposed from the beginning of cancer treatment. More than the quantity of life, the quality of life is a primary goal when treating cancer in the older patients. An initial assessment of the frailty of the older patients should be carried out. The eight domains requiring in-depth assessment are social environment, functional status, walking and balance, cognition, psychological status, co-morbidity and polypharmacy, nutrition and sensory deficiencies. The alteration of these domains has an impact on the patient's outcome, his quality of life and the tolerance of the treatment. One of the major challenges is to maintain the autonomy of the older patient, which involves preserving his functional status, his neuropsychological state and his nutritional state. Corrective actions for each of the domains must be implemented and must be adjusted throughout the course. It is also important to anticipate risks that may compromise or delay the continuation of anti-tumor treatment such as falls, delirium, organ decompensation, iatrogenic risk and social isolation.

[Oncogeriatric assessment: The first step in personalizing cancer treatment in the elderly]. / L'évaluation oncogériatrique : la première étape de la personnalisation du traitement du cancer du sujet âgé.

With aging worldwide population and the high incidence of cancer in the population of people over 75 years old, there is a need for oncologists and geriatricians to strengthen their collaboration to improve elderly patients care. Complexity of cancer and aging issues must be considered simultaneously to establish a personalized care plan. Thus, the G8 is a screening tool that allows to identify patients who should benefit from a geriatric assessment, which is a key step in the management process. This specific evaluation offers a multidisciplinary approach to functional, psychological, nutritional, cognitive and social status and has demonstrated its prognostic value in terms of choice of treatment but also in terms of patient survival. In nearly 20% of cases, the geriatric assessment leads to a change in the choice of treatment, and at one year the initial care plan is not carried out in a quarter of cases. The presence of malnutrition and functional impairment leading to dependence on basic activities of daily living had a significant impact on this change in therapeutic choice. Survival is not only impacted by malnutrition and functional impairment but also by the presence of severe comorbidities and thymic and neurocognitive impairment. The patient's choice must remain at the center of the elaboration of the care plan with the oncologists and geriatricians in order to propose the most appropriate treatment for his or her situation.

Older Adults' Perceptions of Frailty Language: A Scoping Review.

There is growing interest in conceptualizing and diagnosing frailty. Less is understood, however, about older adults' perceptions of the term "frail", and the implications of being classified as "frail". The purpose of this scoping review was to map the breadth of primary studies; and describe the meaning, perceptions, and perceived implications of frailty language amongst community-dwelling older adults. Eight studies were included in the review and three core themes were identified: (1) understanding frailty as inevitable age-related decline in multiple domains, (2) perceiving frailty as a generalizing label, and (3) perceiving impacts of language on health and health care utilization. Clinical practice recommendations for health care professionals working with individuals with frailty include: (1) maintaining a holistic view of frailty that extends beyond physical function to include psychosocial and environmental constructs, (2) using person-first language, and (3) using a strengths-based approach to discuss aspects of frailty.

[Step 1 screening: experimentation in Occitania with nurses and pharmacists]. / Le dépistage step 1 : expérimentation en Occitanie avec les infirmiers et les pharmaciens.

Screening with the step 1 tool is the principal modality of entry into the ICOPE program. This preliminary step is particularly an initiative of primary care health professionals, who are daily caring older people. In Occitania, as part of the deployment of ICOPE program, nurses and pharmacists, were invited to integrate the step 1 in their practices. They benefited, if they wished, from a free webinar training.

[Geriatric and social assessment by the heart failure patients' nurse in the FIL-EAS ic]. / Évaluation gériatrique et sociale des patients insuffisants cardiaques par l'infirmière dans la FIL-EAS ic.

The use of geriatric and social assessment grids by dedicated nurses for patients hospitalised for acute heart failure allows for an early and safe return home in home hospitalisation. These grids isolate a sub-group of older patients with a high risk of re-hospitalisation for whom specific actions can be envisaged.

Occupational Therapy in the Emergency Department: Patient Frailty and Unscheduled Return Visits.

Background. Occupational therapy facilitates care for complex frail emergency department (ED) patients who may have unscheduled return visits (URVs). Purpose. To determine the prevalence of frailty amongst ED patients referred to occupational therapy and if frailty affected the rates and reasons for URVs. Methods. A mixed-methods health records review was conducted of older adults referred to an ED-based occupational therapy program. Findings. Most patients were frail (60.6%). 31.0% of patients discharged home had a URV within 30 days, with no difference in URV rates between frail and non-frail populations. Providing occupational therapy education reduced the frequency of URVs. Frail patients had complex reasons for their URVs, including functional, social/environmental, safety concerns, and/or "failure to thrive". Occupational therapy ED patients were typically vulnerable to moderately frail, dependent in some activities of daily living, and complex. Implications. ED-based occupational therapists must be aware of their patient's frailty and risk of URVs.

A fundamental change in vision: where black lives matter.

Using the lens of clinical work, the author, a white supervisor, plots her concerns about unconscious racism in the training of a black supervisee. Years later this supervisee brings a distressed black trainee nurse to supervision who is struggling with relational difficulties while suffering from unconscious racism in her hospital. Supervisor and supervisee grapple to offer the patient treatment on both fronts. The author explores the underlying presence of 'white privilege' and 'unconscious racism' which finds a global audience as a result of the killing of George Floyd - an event which also had implications for the long-term supervisory partnership. Links to Jessica Benjamin's concept of 'doer and done to' are made, as well as discussion of a gradual change of vision in the supervisor herself. The author also makes use of insights gained from consultancy work in a multi-racial company and two Channel 4 UK television programmes that feature workshops on unconscious racism in a mixed secondary school in the London Borough of Sutton.

A travers la perspective du travail clinique, l'auteur, une analyste didacticienne blanche, retrace ses préoccupations concernant le racisme inconscient dans la formation d'une personne noire qu'elle a supervisée. Des années plus tard cette personne amène en supervision le cas d'une infirmière en formation. Cette infirmière est noire, elle est perturbée du fait qu'elle se débat avec des difficultés relationnelles tout en souffrant de racisme inconscient dans son hôpital. L'analyste didacticienne et la personne qu'elle supervise bataillent pour offrir à la patiente une aide sur ces deux fronts. L'auteur explore la présence sous-jacente du « privilège blanc ¼ et du « racisme inconscient ¼, dans un climat plus attentif suite au meurtre de George Floyd - événement qui eut également des conséquences sur le long terme dans la relation entre superviseur et supervisée. L'auteur fait des liens avec les concepts de 'dominant et dominé' de Jessica Benjamin, et elle étudie le changement progressif de sa perspective en tant que superviseur. Elle utilise également les prises de conscience gagnées par le travail en tant que consultante dans une entreprise employant des personnes d'horizons raciaux différents et de deux émissions de télévisions de Channel 4 UK qui traitent d'ateliers sur le racisme inconscient dans un collège mixte dans le quartier londonien de Sutton.

Utilizando la lente del trabajo clínico, la autora, una supervisora blanca, argumenta sus preocupaciones acerca del racismo inconsciente en la formación de un supervisando negro. Años después, dicho supervisando trae a supervisión el caso de una enfermera practicante negra quien está luchando con dificultades relacionales a la vez que sufriendo de un racismo inconsciente en su hospital. Supervisora y supervisando lidian para ofrecerle a la paciente, tratamiento en ambos frentes. La autora explora la presencia subyacente del 'privilegio del blanco' y del 'racismo inconsciente' los cuales encuentran una audiencia global como resultado del asesinato de George Floyd - evento que también tuvo sus implicancias en la prolongada relación de supervisión, Se establecen relaciones con los conceptos de Jessica Benjamin de 'doer and done to' (el que hace y al que le hacen), así como también un análisis del gradual cambio de visión en la supervisora. La autora a su vez utiliza ciertas comprensiones obtenidas de su trabajo como consultora en una compañía multi racial y en dos programas del Canal 4 la televisión inglesa que muestran talleres sobre racismo inconsciente en una escuela secundaria mixta en el distrito de Sutton, en Londres.

[Kidney transplantation in the elderly: A benefit for all patients?] / Transplantation rénale du sujet âgé : un bénéfice pour tous ?

Age per se should not be a contraindication to kidney transplantation. The first studies have shown a benefit for the survival of elderly eligible patients getting a kidney transplant compared to be maintained on the waiting list. However, more recent data suggest that this benefit is not as constant, notably with a significant early mortality period. The eligibility of elderly patients for transplantation must be based on the usual consideration of co-morbidities, but should also include, for some patients, a geriatric evaluation to detect clinical symptoms of frailty. The decision to transplant an elderly recipient must also integrate the characteristics of the donors, since the use of donors with increasingly expanding criteria can have a negative impact on the survival of these patients.