The French memory clinics network system Rachez, Chloé; Desprez, Anne; Hertzog, Maurice ...
Gériatrie et psychologie neuropsychiatrie du vieillissement,
12/2019, Letnik:
17, Številka:
4
Journal Article
In France, the management of patients with neurocognitive disorders is based on a network of memory clinics. The current operating mode is presented with projects aiming to its improvement, and ...potential evolution. Interviews were conducted at Memory resources and research centers (CMRR) as well as at the Regional health authorities (ARS) on organization, difficulties, innovation and projects for care management of patients suffering from Alzheimer's disease or related disorder. Twenty-seven semi-structured interviews were performed at the CMRR, and ten with the ARS. The collaboration with the medico-social and associative sectors was unequal. All CMRR were involved in clinical research. The links between ARS and CMRR were sometimes difficult with a lack of dialogue on the projects. However, many innovative plans have been led by the memory clinics and have sometimes been supported by the Health authorities: a therapeutic education program for patients with mild cognitive disorders, deployment of tele-medicine consultations to diagnose neurocognitive disorders in nursing home residents, setting of a network for management of behavioral disorders, creation of a mobile team specialized in clinical research, and creation of a multidisciplinary consultation following diagnosis to work on a personalized care plan. Experienced professionals mentioned a mature and efficient structure of the care management system thanks to the CMRRs' labeling and the different Alzheimer's national plans. However, this highly specialized system does not meet the demands of integrated care and should adapt to the increasing prevalence of patients. Therefore, structuration of primary care should be an emerging subject of reflection at national and international level.
Cardiovascular disease is a leading cause of morbidity and mortality in the elderly population. We evaluated the adequacy of prescribing (miss and under used) with respect to STOPP-START criteria.
A ...sample of 100 patients hospitalized in cardiovascular specialty divisions (medicine or surgery) or in the different sectors making up the geriatric network (day-care hospital, short or rehabilitation ward, nursing home) has been considered. Drug prescriptions at the admission time were analysed.
Eight hundred and seventy-four prescriptions were analysed. In 65% of patients, from 5 to 10 medications were prescribed and in 28% over 10. Fifty-four percent of patients had, at least, one potentially inappropriate prescription (PIP) by STOPP. Among them, 48% of PIP prescriptions contained 1, 41% 2 and 11% 3 or more. The omission of one medication according to START criteria concerned 57% of the sample. Among them, 46% had one omission, 44% 2 to 3 and 10% 4 omissions or over. The cardiovascular system is the one most concerned by the PIP. Whether 28.1% of the PIP by STOPP criteria concerned cardiovascular drugs, the omission of prescription, according to START criteria, was 41.8%. There was no significant difference between the different settings studied. There was no effect of age or sex on the impact of PIP (P>0.20) or being polymédiqué (P=0.44). According to the criteria STOPP-A, the prescription of antiplatelet (indication and dose) was highlighted. Prescribing omission also concerned antiplatelet agents but also statins in patients with atherosclerosis as well as antiplatelet and anticoagulant in patients with permanent atrial fibrillation and inhibitor of angiotensin converting enzyme (ACE) after myocardial infarction or with chronic heart failure.
Potentially inappropriate prescribing medications were very common in elderly patients with cardiovascular conditions. They concerned as much as underusing of important drugs with potential benefits and prescribing commission of treatment that did not fit with patients' comorbidities and/or characteristics.
Les maladies cardiovasculaires sont une des premières causes de morbi-mortalité dans la population âgée. Nous avons évalué l’adéquation des prescriptions (« sur » et « sous » prescription) au regard ...de l’outil STOPP-START.
Un échantillon de 100 patients âgés, hospitalisés soit en service de spécialité cardiovasculaire (médecine ou chirurgie) ou dans les différents secteurs composant la filière gériatrique (hôpital de jour, court ou moyen séjour, EHPAD), a été considéré. Leurs prescriptions médicamenteuses à l’admission ont été analysées.
Huit cent soixante-quatorze prescriptions médicales ont été étudiées. Pour 65 % des patients, de 5 à 10 médicaments étaient prescrits et pour 28 % plus de 10. Plus de la moitié des patients (54 %) avaient au moins une prescription potentiellement inappropriée (PPI) selon STOPP. Parmi eux, 48 % des prescriptions comportaient 1 PPI, 41 % 2 et 11 % 3 ou plus. L’omission d’au moins une prescription selon START concernait 57 % de l’échantillon. Parmi eux, 46 % avaient une omission, 44 % 2 à 3 omissions et 10 % 4 omissions ou plus. Le système cardiovasculaire était le plus concerné par les PPI. Si 28,1 % des PPI, selon les critères STOPP, concernaient des médicaments cardiovasculaires, l’omission de prescription, selon les critères START, s’élevait à 41,8 %. Il n’a été observé aucune différence significative entre les différents services. Il y avait effet ni de l’âge ni du sexe sur l’incidence des PPI (p>0,20) ou le fait d’être polymédiqué (p=0,44). Selon les critères STOPP-A, la prescription des antiagrégants plaquettaires (indication et dose) était identifiée. L’omission de prescription concernait principalement les antiagrégants plaquettaires et les statines en présence d’une athéromatose, les anticoagulants et antiagrégants en présence d’une fibrillation auriculaire permanente et les inhibiteurs de l’enzyme de conversion après un infarctus du myocarde ou en cas d’insuffisance cardiaque.
Les prescriptions médicamenteuses potentiellement inappropriées étaient très fréquentes chez les patients âgés atteints de maladies cardiovasculaires. Elles concernaient autant le défaut de prescription de médicaments ayant un bénéfice potentiel important que la prescription de médicaments inadaptés aux pathologies et/ou caractéristiques du patient.
Cardiovascular disease is a leading cause of morbidity and mortality in the elderly population. We evaluated the adequacy of prescribing (miss and under used) with respect to STOPP-START criteria.
A sample of 100 patients hospitalized in cardiovascular specialty divisions (medicine or surgery) or in the different sectors making up the geriatric network (day-care hospital, short or rehabilitation ward, nursing home) has been considered. Drug prescriptions at the admission time were analysed.
Eight hundred and seventy-four prescriptions were analysed. In 65% of patients, from 5 to 10 medications were prescribed and in 28% over 10. Fifty-four percent of patients had, at least, one potentially inappropriate prescription (PIP) by STOPP. Among them, 48% of PIP prescriptions contained 1, 41% 2 and 11% 3 or more. The omission of one medication according to START criteria concerned 57% of the sample. Among them, 46% had one omission, 44% 2 to 3 and 10% 4 omissions or over. The cardiovascular system is the one most concerned by the PIP. Whether 28.1% of the PIP by STOPP criteria concerned cardiovascular drugs, the omission of prescription, according to START criteria, was 41.8%. There was no significant difference between the different settings studied. There was no effect of age or sex on the impact of PIP (P>0.20) or being polymédiqué (P=0.44). According to the criteria STOPP-A, the prescription of antiplatelet (indication and dose) was highlighted. Prescribing omission also concerned antiplatelet agents but also statins in patients with atherosclerosis as well as antiplatelet and anticoagulant in patients with permanent atrial fibrillation and inhibitor of angiotensin converting enzyme (ACE) after myocardial infarction or with chronic heart failure.
Potentially inappropriate prescribing medications were very common in elderly patients with cardiovascular conditions. They concerned as much as underusing of important drugs with potential benefits and prescribing commission of treatment that did not fit with patients’ comorbidities and/or characteristics.
•Evapotranspiration (ET) was 13% greater for pasture compared to ryegrass seed crop.•Grazing had little impact on actual ET in a pasture.•Final harvest reduced ET to 35% of reference ET in a seed ...crop.•Management affected temporal variability of source components of ET.
Irrigation is an important component of the hydrologic cycle in agricultural ecosystems, affecting both quantity and quality of surface and ground water. Well-managed irrigation involves balancing irrigation with water consumption by evaporation and transpiration (collectively evapotranspiration), maximizing ecosystem water-use efficiency and minimizing drainage. Here we compare rates of actual crop evapotranspiration (ETC) measured by eddy covariance with reference evapotranspiration (ET0) calculated from meteorological variables for two irrigated ryegrass systems in central South Island, New Zealand between June 2011 and March 2013. The sites were similar in climate, but contrasted in management: one grazed by dairy cattle and the other harvested annually for seed. Over the first year of measurements, cumulative ETC was very similar at the two sites, totalling 791 and 819mm for the dairy pasture and seed crop respectively, although temporal patterns of partitioning of ETC amongst evaporation and transpiration differed as a result of management activities. Responses of ETC to global radiation, temperature and vapour pressure deficit were all similar during active growing season periods. Differences between the two sites were observed at the end of the second measurement season, when irrigation was ceased in the seed crop prior to final harvest and ETC was reduced compared to ET0. As a result, cumulative ETC was 13% greater for the dairy pasture at the end of the study period.
Les villes se transforment en permanence sous les effets conjugués des dynamiques économiques, des projets d'aménagement et des choix des ménages. Les opérations de rénovation urbaine occupent une ...place particulière car elles modifient de façon radicale la physionomie des espaces urbains. Voulues par les acteurs politiques, elles sont généralement appréhendées selon le point de vue des aménageurs : quels sont leurs objectifs, quel grand dessein poursuivent-ils, quels sont les moyens mobilisés ? Le projet de cet ouvrage consiste à inverser le regard en partant de ceux qui vivent dans les périmètres en cours de rénovation. Si la décision initiale de rénover ne leur appartient pas, les habitants devraient être associés aux projets qui vont modifier leurs territoires de vie, tel que l'annoncent les politiques urbaines françaises depuis la circulaire HVS (Habitat et vie sociale) de 1977. Le concept de « participation » figure également dans les préoccupations de nombreux pays, en particulier européens. De quoi s'agit-il ? Le rôle que les habitants sont censés devoir jouer se positionne-t-il en amont des projets, dans une logique de coconstruction, ou en aval pour valider les décisions, voire les infléchir à la marge ? À cet égard, les opérations de rénovation urbaine engagées depuis la loi d'orientation pour la ville d'août 2003, dite « loi Borloo », constituent un archétype. Elles visent à améliorer le cadre de vie dans des secteurs urbains considérés comme dégradés en promouvant par ailleurs la mixité sociale. La « participation » des habitants est annoncée comme indispensable mais se heurte à de multiples difficultés : réticences des aménageurs à leur octroyer une place, hésitation de ceux-ci à s'engager dans des processus dont ils ne cernent ni les objectifs, ni les effets potentiels. La « participation » attendue peut prendre d'autres voies et conduire à des mobilisations qui interrogent la légitimité des opérations en regard de la valeur patrimoniale de ce qui va être détruit. Renforcer la place des habitants dans les opérations de rénovation urbaine représente un objectif indispensable, susceptible de constituer ces populations en acteurs à part entière de la démocratie locale. Il est en effet paradoxal d'ignorer les attentes et les avis de ceux qui sont les premiers concernés par l'avenir de leurs lieux de résidence. Néanmoins, les mots ne peuvent servir d'alibi. Cet ouvrage résolument pluridisciplinaire consiste à interroger le rôle joué par les habitants dans l'élaboration des projets urbains et à plaider pour une amélioration en profondeur des pratiques de participation. La ville ne peut se transformer sans s'appuyer d'abord sur ceux qui y vivent.
