- Email: [email protected]
Persistent vegetative state and minimally conscious state units in France, current situation 10 years after their creation
Annals of Physical and Rehabilitation Medicine 58S (2015) e61–e65
Available online at
ScienceDirect www.sciencedirect.com
Care pathway and support of the patient Oral communications CO05-001-e
Prevention and motor disability: A survey of 145 wheelchair users M. Genelle Dra,*, D. Bensmail Profb, A. Eddi Profc, P. Thoumie Profd, A. Yelnik Profe a Versailles, France b Service de MPR, hoˆpital R.-Poincare´ (AP–HP), 92380 Garches, France c De´partement de me´decine ge´ne´rale, Faculte´ Paris 7, France d Service de MPR, hoˆpital Rothschild, 75012 Paris, France e Service de MPR, GH St.-Louis-Lariboisie`re-F.-Widal, 200, rue du Faubourg-St-Denis, 75010 Paris, France *Corresponding author. E-mail address: [email protected] (M. Genelle) Objectives To estimate the quality of health prevention among persons with severe motor disabilities. Methods Descriptive study conducted by questionnaire among adults from 18 to 74 years old, users of wheelchair. Survey led from June 2013 until June 2014, on various sites of ˆIle-de-France (specialized hospitals, ‘‘SAMSAHs’’, ‘‘MAS’’, ‘‘Salon Autonomic’’). Results The study population included 145 persons. If cardiovascular prevention (screening for hypertension, current smoking and dyslipidemia) appears to be satisfactory, the same cannot be said for other prevention topics such as vaccinations, gynecological follow-up or cancer screening. Only 53% of respondents thought their vaccinations were up to date, 28% thought their vaccinations were not and 18% did not know. Among the 57 women in our study, only 26% had had a gynecological examination within a year. Among the women aged 50 to 74 in our sample, 22 of 34 (64,7%) had done a mammography in the previous 2 years. Of the 26 women in our sample involved by cervical cancer screening, only 15 (57,7%) had made a smear in the past 3 years. Regarding the colorectal cancer screening, among people aged 50 to 74 with no history of colonoscopy, only 9 of 47 (19%) had made an Hemoccult test within 2 years. Discussion Our results concerning the vaccinations are less good than those observed in the investigation ‘‘Health Barometer 2010 [1]’’ led in general population: in our study, vaccinations appear less often up to date and more frequently unknown. Our participation rates reported for cancer screening are lower than those observed in the ‘‘Cancer Barometer 2010 [2]’’ where they reached 87.5% for mammography, 81.4% for smears and 44.5% for colorectal cancer screening test. Health prevention should be improved with people with severe motor disabilities by organizing regular checkups on prevention and improving the accessibility of health care settings. Keywords Motor disability; Preventive healthcare
1877-0657/
Disclosure of interest The authors have not supplied their declaration of conflict of interest. References [1] Gautier A, Jestin C, Beck F. Vaccination: baisse de l’adhe´sion de la population et roˆle cle´ des professionnels de sante´. La Sante´ en action 2013;423:50–3. [2] Beck F, Gautier A. Barome`tre cancer 2010. Saint-Denis: INPES, coll. Barome`tres sante´; 2012. http://dx.doi.org/10.1016/j.rehab.2015.07.143 CO05-004-e
Persistent vegetative state and minimally conscious state units in France, current situation 10 years after their creation J. Drigny a,*, C. Kiefer Drb, B. Albinet-Fournot Drc, A. Ruet Dra, J. Charanton Drd, P. Pradat-Diehl Profd a Service de me´decine physique et de re´adaptation, CHU de Caen, Caen, France b Service de me´decine physique et de re´adaptation, hoˆpital Nord 92, Villeneuve-la-Garenne, France c Service SSR EVC/EPR, Korian Canal de L’Ourcq, Villeneuve-laGarenne, France d Centre Ressources Francilien du Traumatisme Craˆnien, Paris *Corresponding author. E-mail address: [email protected] (J. Drigny) Introduction Since May 2002, hospital care for Persistent Vegetative State (PVS) or Minimally Conscious State (MCS) patients in France are structured in dedicated units: PVS/MCS units. The aim of this survey is to analyze the current situation after 10 years. Method In 2012, the 135 health institutions with PVS/MCS units were contacted to fill out a questionnaire with information about health facilities, human resources, patients care pathways and characteristics. Results Fifty-one institutions (38%) answered the questionnaire. The PVS/MCS units had an average of 8.3 authorized beds (max– min: 4–19), for 8.1 available beds and a 97% bed occupation rate. They admitted on average 21 patients since their creation. Important disparities regarding staff resources existed between these Units. With regard to the 348 patients documented (mean age: 48.2; min: 13; max: 82), 36% were in PVS ans, 51% were in MCS, 10% had left MCS. Arousal state improved since admission for 25% and decreased for 1%. Initial pathology was traumatic brain injury for 35%, anoxic brain injury for 27%, stroke for 22%. Initially, 70% of the patients had quadriplegia, and 30% had hemiplegia, 88% of them had orthopedic complications. Among the patients, 45% had a tracheotomy and 92% had a digestive stomy. Mean length of stay was 4.5 years. The annual mortality rate was below 5%. Finally,
e62
Care pathway and support of the patient / Annals of Physical and Rehabilitation Medicine 58S (2015) e61–e65
12% awaited another living unit because their state of consciousness had improved. Discussion/Conclusion Structured hospital care for Persistent Vegetative State (PVS) patients or Minimally Conscious State (MCS) in France appears adequate to meet the quality objectives fixed by the May 3rd, 2012 commission regarding health facilities, admission criteria and health care. Patients require important care and staff resources. Patient discharge from these units is frequently a problem in case of improvement because of a lack of adequate living places. Keywords Disorders of consciousness; Health-care facilities; human ressources Disclosure of interest The authors have not supplied their declaration of conflict of interest. http://dx.doi.org/10.1016/j.rehab.2015.07.144
analysis of individual situations, which combines a functional approach to a social support, gives a comprehensive insight into the neurological handicap and its challenges at home and in the community. The acquired knowledge enables the teams to improve the management of recent stroke in preparing home transitions and to take into account the complexity of strokerelated disabilities at all ages. The limits of the interventions of these teams are related to the large geographical territories which need to be addressed, to the incomplete knowledge of care and residential possibilities, and sometimes to an under-evaluation of the medical work time required. Keywords Mobile clinical teams; Stroke; Return and maintaining at home Disclosure of interest The authors have not supplied their declaration of conflict of interest. http://dx.doi.org/10.1016/j.rehab.2015.07.145
CO05-005-e
Mobile clinical teams for stroke and neurological handicaps in the community: A pilot project in the ˆIlede-France area
CO05-006-e
L. Josse a,*, P. Azouvi Profb, P. Pradat-Diehl Profc, G. Robain Profd, A. Yelnik Profe, T. Albert Drf, M. Bourzam Drg, J.B. Peyre Drh, F. Vautrin Dri a Hoˆpital Lariboisie`re, centre de ressources et de responsabilite´ de re´e´ducation, Paris cedex 10, France b Hoˆpital Raymond-Poincare´, service de me´decine physique et de re´adaptation c Hoˆpital de la Salpeˆtrie`re, service de me´decine physique et de re´adaptation d Hoˆpital Rothschild, service de me´decine physique et de re´adaptation e GH St.-Louis, Lariboisie`re-F.-Widal, service de me´decine physique et de re´adaptation f Centre de me´decine physique et de re´adaptation, Bobigny g Hoˆpitaux universitaires Paris Ouest, Site Vaugirard, service de ge´rontologie h Centre Le´on-Binet, service de re´e´ducation, Provins i GH Intercommunal du Vexin, site d’Aincourt, service re´e´ducation neurologique *Corresponding author. E-mail address: [email protected] (L. Josse)
M. Hubault *,a, N. Petit Dra, S. JacquinCourtois Profa, B. Charpiat Drb, J. Luaute´ Profc, G. Rode Profc, A. Janoly-Dumenil Drc a CHU, hoˆpital H.-Gabrielle, hospices Civils de Lyon, Saint-Genis-Laval, France b CHU, hoˆpital de la Croix-Rousse, hospices Civils de Lyon c CHU, hoˆpital Henry-Gabrielle, hospices Civils de Lyon *Corresponding author. E-mail address: [email protected] (M. Hubault)
Introduction In December 2013 the Regional Health Agency in ˆIle-de-France (Paris city and surrounding districts) started an experimental project of mobile clinical teams for post-acute care and rehabilitation of serious neurological conditions such as stroke. This pilot project was organized in 8 departments. The goal was to coordinate health and social services in order to facilitate home transitions and home living maintenance for persons with disabilities, while enhancing persons’ independence. Material/patients and methods In this communication, we compare the organizations of these teams: their part-time team members as specialists in geriatrics or Physical Medicine and Rehabilitation, social workers, occupational therapists and secretaries; their intervention types and places (in acute or post-acute care, or in the community); the methods of referral to the teams; the tools used for evaluation, functioning and communication. Since one year, monthly global meetings of the teams have led to an harmonization of these tools and to a useful sharing of experiences. Results As most teams have been fully functional since September 2014, a synthesis of 6 months of activity can be drawn. The number of patients managed by each team was between 9 and 40. Main reasons for referral to the teams were assistance in the transition from hospital to home, help in home living maintenance, functional evaluations, and administrative assistance. The teams performed between 3 and 32 home visits. Discussion Through this first experiment, the added value of these mobile teams was highlighted. The multidisciplinary
Patient’s drug therapy: Clinical impact of pharmacist’s intervention in neurological rehabilitation units
Introduction Inpatients in neurological rehabilitation units are often polymedicated. This polypharmacy is at risk of adverse events. It justifies the analysis of prescriptions by a pharmacist. The objective is to describe drug-related problems detected by pharmacist, pharmaceutical interventions (PI) performed and PI clinical impact over a period of 1 year. Methods The computerized prescriptions of 165 beds were analyzed by one pharmacist and one resident pharmacist once a week based on the methodology of the French Society of Clinical Pharmacy. Detected drug related problems and proposed PI were collected. Their clinical impact was evaluated by two physicians and two hospital pharmacists independently, according Hatoum 1988 [1]: zero impact ( ), significant (+), highly significant (++), lifesaving (+++). Results Four thousand two hundred and twenty-eight prescriptions resulted in 999 PI (24%) and 788 accepted by physicians (79%). The most involved drugs were: analgesics/anti-inflammatory drugs (25%), anti-acids (20%), psychotropic drugs (17%) and anti-infectives (14%). The main problems found were: no clinical indication (26%), non-conformity with guidelines (16%) and supra or infratherapeutic dose (15%). Most common suggestions (PI) were drug discontinuation (33%) and dose adjustment (22%). After excluding IP only having an economic impact, 842 IP were evaluated in a clinical point of view. They concerned mainly: antiacids (n = 198), analgesic/anti-inflammatory drugs (n = 170), psychotropic drugs (n = 136), anti-infectives (n = 110) and anticoagulants (n = 76). The evaluations were: no impact (n = 96); significant (n = 574) very significant (n = 169); lifesaving (n = 3). These 3 PI were related anticoagulants. Drugs with a great number of IP (++) were: anticoagulants (60%), intravenous electrolytes (43%), anti-infectives (37%) and analgesics/anti-inflammatory drugs (24%). Physicians have found a large number of PI (++) concerning antiinfectives compared pharmacists (43% versus 30%). Conversely, pharmacists felt more PI (++) involving intravenous electrolytes (71% versus 15%) and psychotropic drugs (21% versus 8%). Conclusion Pharmacists detected many drug-related problems during analysis of prescriptions. Their potential adverse clinical
Available online at
ScienceDirect www.sciencedirect.com
Care pathway and support of the patient Oral communications CO05-001-e
Prevention and motor disability: A survey of 145 wheelchair users M. Genelle Dra,*, D. Bensmail Profb, A. Eddi Profc, P. Thoumie Profd, A. Yelnik Profe a Versailles, France b Service de MPR, hoˆpital R.-Poincare´ (AP–HP), 92380 Garches, France c De´partement de me´decine ge´ne´rale, Faculte´ Paris 7, France d Service de MPR, hoˆpital Rothschild, 75012 Paris, France e Service de MPR, GH St.-Louis-Lariboisie`re-F.-Widal, 200, rue du Faubourg-St-Denis, 75010 Paris, France *Corresponding author. E-mail address: [email protected] (M. Genelle) Objectives To estimate the quality of health prevention among persons with severe motor disabilities. Methods Descriptive study conducted by questionnaire among adults from 18 to 74 years old, users of wheelchair. Survey led from June 2013 until June 2014, on various sites of ˆIle-de-France (specialized hospitals, ‘‘SAMSAHs’’, ‘‘MAS’’, ‘‘Salon Autonomic’’). Results The study population included 145 persons. If cardiovascular prevention (screening for hypertension, current smoking and dyslipidemia) appears to be satisfactory, the same cannot be said for other prevention topics such as vaccinations, gynecological follow-up or cancer screening. Only 53% of respondents thought their vaccinations were up to date, 28% thought their vaccinations were not and 18% did not know. Among the 57 women in our study, only 26% had had a gynecological examination within a year. Among the women aged 50 to 74 in our sample, 22 of 34 (64,7%) had done a mammography in the previous 2 years. Of the 26 women in our sample involved by cervical cancer screening, only 15 (57,7%) had made a smear in the past 3 years. Regarding the colorectal cancer screening, among people aged 50 to 74 with no history of colonoscopy, only 9 of 47 (19%) had made an Hemoccult test within 2 years. Discussion Our results concerning the vaccinations are less good than those observed in the investigation ‘‘Health Barometer 2010 [1]’’ led in general population: in our study, vaccinations appear less often up to date and more frequently unknown. Our participation rates reported for cancer screening are lower than those observed in the ‘‘Cancer Barometer 2010 [2]’’ where they reached 87.5% for mammography, 81.4% for smears and 44.5% for colorectal cancer screening test. Health prevention should be improved with people with severe motor disabilities by organizing regular checkups on prevention and improving the accessibility of health care settings. Keywords Motor disability; Preventive healthcare
1877-0657/
Disclosure of interest The authors have not supplied their declaration of conflict of interest. References [1] Gautier A, Jestin C, Beck F. Vaccination: baisse de l’adhe´sion de la population et roˆle cle´ des professionnels de sante´. La Sante´ en action 2013;423:50–3. [2] Beck F, Gautier A. Barome`tre cancer 2010. Saint-Denis: INPES, coll. Barome`tres sante´; 2012. http://dx.doi.org/10.1016/j.rehab.2015.07.143 CO05-004-e
Persistent vegetative state and minimally conscious state units in France, current situation 10 years after their creation J. Drigny a,*, C. Kiefer Drb, B. Albinet-Fournot Drc, A. Ruet Dra, J. Charanton Drd, P. Pradat-Diehl Profd a Service de me´decine physique et de re´adaptation, CHU de Caen, Caen, France b Service de me´decine physique et de re´adaptation, hoˆpital Nord 92, Villeneuve-la-Garenne, France c Service SSR EVC/EPR, Korian Canal de L’Ourcq, Villeneuve-laGarenne, France d Centre Ressources Francilien du Traumatisme Craˆnien, Paris *Corresponding author. E-mail address: [email protected] (J. Drigny) Introduction Since May 2002, hospital care for Persistent Vegetative State (PVS) or Minimally Conscious State (MCS) patients in France are structured in dedicated units: PVS/MCS units. The aim of this survey is to analyze the current situation after 10 years. Method In 2012, the 135 health institutions with PVS/MCS units were contacted to fill out a questionnaire with information about health facilities, human resources, patients care pathways and characteristics. Results Fifty-one institutions (38%) answered the questionnaire. The PVS/MCS units had an average of 8.3 authorized beds (max– min: 4–19), for 8.1 available beds and a 97% bed occupation rate. They admitted on average 21 patients since their creation. Important disparities regarding staff resources existed between these Units. With regard to the 348 patients documented (mean age: 48.2; min: 13; max: 82), 36% were in PVS ans, 51% were in MCS, 10% had left MCS. Arousal state improved since admission for 25% and decreased for 1%. Initial pathology was traumatic brain injury for 35%, anoxic brain injury for 27%, stroke for 22%. Initially, 70% of the patients had quadriplegia, and 30% had hemiplegia, 88% of them had orthopedic complications. Among the patients, 45% had a tracheotomy and 92% had a digestive stomy. Mean length of stay was 4.5 years. The annual mortality rate was below 5%. Finally,
e62
Care pathway and support of the patient / Annals of Physical and Rehabilitation Medicine 58S (2015) e61–e65
12% awaited another living unit because their state of consciousness had improved. Discussion/Conclusion Structured hospital care for Persistent Vegetative State (PVS) patients or Minimally Conscious State (MCS) in France appears adequate to meet the quality objectives fixed by the May 3rd, 2012 commission regarding health facilities, admission criteria and health care. Patients require important care and staff resources. Patient discharge from these units is frequently a problem in case of improvement because of a lack of adequate living places. Keywords Disorders of consciousness; Health-care facilities; human ressources Disclosure of interest The authors have not supplied their declaration of conflict of interest. http://dx.doi.org/10.1016/j.rehab.2015.07.144
analysis of individual situations, which combines a functional approach to a social support, gives a comprehensive insight into the neurological handicap and its challenges at home and in the community. The acquired knowledge enables the teams to improve the management of recent stroke in preparing home transitions and to take into account the complexity of strokerelated disabilities at all ages. The limits of the interventions of these teams are related to the large geographical territories which need to be addressed, to the incomplete knowledge of care and residential possibilities, and sometimes to an under-evaluation of the medical work time required. Keywords Mobile clinical teams; Stroke; Return and maintaining at home Disclosure of interest The authors have not supplied their declaration of conflict of interest. http://dx.doi.org/10.1016/j.rehab.2015.07.145
CO05-005-e
Mobile clinical teams for stroke and neurological handicaps in the community: A pilot project in the ˆIlede-France area
CO05-006-e
L. Josse a,*, P. Azouvi Profb, P. Pradat-Diehl Profc, G. Robain Profd, A. Yelnik Profe, T. Albert Drf, M. Bourzam Drg, J.B. Peyre Drh, F. Vautrin Dri a Hoˆpital Lariboisie`re, centre de ressources et de responsabilite´ de re´e´ducation, Paris cedex 10, France b Hoˆpital Raymond-Poincare´, service de me´decine physique et de re´adaptation c Hoˆpital de la Salpeˆtrie`re, service de me´decine physique et de re´adaptation d Hoˆpital Rothschild, service de me´decine physique et de re´adaptation e GH St.-Louis, Lariboisie`re-F.-Widal, service de me´decine physique et de re´adaptation f Centre de me´decine physique et de re´adaptation, Bobigny g Hoˆpitaux universitaires Paris Ouest, Site Vaugirard, service de ge´rontologie h Centre Le´on-Binet, service de re´e´ducation, Provins i GH Intercommunal du Vexin, site d’Aincourt, service re´e´ducation neurologique *Corresponding author. E-mail address: [email protected] (L. Josse)
M. Hubault *,a, N. Petit Dra, S. JacquinCourtois Profa, B. Charpiat Drb, J. Luaute´ Profc, G. Rode Profc, A. Janoly-Dumenil Drc a CHU, hoˆpital H.-Gabrielle, hospices Civils de Lyon, Saint-Genis-Laval, France b CHU, hoˆpital de la Croix-Rousse, hospices Civils de Lyon c CHU, hoˆpital Henry-Gabrielle, hospices Civils de Lyon *Corresponding author. E-mail address: [email protected] (M. Hubault)
Introduction In December 2013 the Regional Health Agency in ˆIle-de-France (Paris city and surrounding districts) started an experimental project of mobile clinical teams for post-acute care and rehabilitation of serious neurological conditions such as stroke. This pilot project was organized in 8 departments. The goal was to coordinate health and social services in order to facilitate home transitions and home living maintenance for persons with disabilities, while enhancing persons’ independence. Material/patients and methods In this communication, we compare the organizations of these teams: their part-time team members as specialists in geriatrics or Physical Medicine and Rehabilitation, social workers, occupational therapists and secretaries; their intervention types and places (in acute or post-acute care, or in the community); the methods of referral to the teams; the tools used for evaluation, functioning and communication. Since one year, monthly global meetings of the teams have led to an harmonization of these tools and to a useful sharing of experiences. Results As most teams have been fully functional since September 2014, a synthesis of 6 months of activity can be drawn. The number of patients managed by each team was between 9 and 40. Main reasons for referral to the teams were assistance in the transition from hospital to home, help in home living maintenance, functional evaluations, and administrative assistance. The teams performed between 3 and 32 home visits. Discussion Through this first experiment, the added value of these mobile teams was highlighted. The multidisciplinary
Patient’s drug therapy: Clinical impact of pharmacist’s intervention in neurological rehabilitation units
Introduction Inpatients in neurological rehabilitation units are often polymedicated. This polypharmacy is at risk of adverse events. It justifies the analysis of prescriptions by a pharmacist. The objective is to describe drug-related problems detected by pharmacist, pharmaceutical interventions (PI) performed and PI clinical impact over a period of 1 year. Methods The computerized prescriptions of 165 beds were analyzed by one pharmacist and one resident pharmacist once a week based on the methodology of the French Society of Clinical Pharmacy. Detected drug related problems and proposed PI were collected. Their clinical impact was evaluated by two physicians and two hospital pharmacists independently, according Hatoum 1988 [1]: zero impact ( ), significant (+), highly significant (++), lifesaving (+++). Results Four thousand two hundred and twenty-eight prescriptions resulted in 999 PI (24%) and 788 accepted by physicians (79%). The most involved drugs were: analgesics/anti-inflammatory drugs (25%), anti-acids (20%), psychotropic drugs (17%) and anti-infectives (14%). The main problems found were: no clinical indication (26%), non-conformity with guidelines (16%) and supra or infratherapeutic dose (15%). Most common suggestions (PI) were drug discontinuation (33%) and dose adjustment (22%). After excluding IP only having an economic impact, 842 IP were evaluated in a clinical point of view. They concerned mainly: antiacids (n = 198), analgesic/anti-inflammatory drugs (n = 170), psychotropic drugs (n = 136), anti-infectives (n = 110) and anticoagulants (n = 76). The evaluations were: no impact (n = 96); significant (n = 574) very significant (n = 169); lifesaving (n = 3). These 3 PI were related anticoagulants. Drugs with a great number of IP (++) were: anticoagulants (60%), intravenous electrolytes (43%), anti-infectives (37%) and analgesics/anti-inflammatory drugs (24%). Physicians have found a large number of PI (++) concerning antiinfectives compared pharmacists (43% versus 30%). Conversely, pharmacists felt more PI (++) involving intravenous electrolytes (71% versus 15%) and psychotropic drugs (21% versus 8%). Conclusion Pharmacists detected many drug-related problems during analysis of prescriptions. Their potential adverse clinical