Falls in older adults represent a major cause of disability and a pivotal indicator of the transition from robustness to frailty. Implementing large-scale prevention programs remains challenging because it requires the mobilization of extensive skills and human resources. In France, Advanced Practice Nurses (APN) are emerging as key actors in primary care, with the potential to provide multimodal, preventive, and patient-centered follow-up for older adults. The APN-FIT trial (Advanced Practice Nurses for Fall Incidence prevenTion in robust very old adults) is a hybrid type 1, multicenter, randomized, open-label, superiority trial conducted in seven medical centers in the Pays de la Loire region, France. The study will assess whether a 12-month, personalized, multimodal follow-up by APN reduces fall incidence among robust participants aged ≥ 80 years (Clinical Frailty Scale ≤ 3). A mixed-methods implementation study and a cost-utility analysis will be performed. A total of 386 participants will be randomized 1:1 after an initial comprehensive geriatric assessment (CGA). The intervention group will be followed by APN at 1, 3, 6, 9, and 12 months. Primary and secondary outcomes, including intrinsic capacity domains, will be reassessed at 12 months. We expect that APN follow-up will reduce fall incidence and delay transitions to pre-frailty or impaired mobility. This pragmatic hybrid trial will provide evidence on the clinical, economic, and implementation impact of APN-led fall prevention in community-dwelling very old adults. This study has been registered on clinicaltrials.gov, NCT06617806, registration date 2024-09-26.

BACKGROUND:Within French intensive care units (ICUs), patients are treated with two levels of care (intensive or intermediate) with different nurse-to-patient ratios legally defined. OBJECTIVES:We aimed to compare the nursing workload associated with these two levels of care. RESEARCH METHODOLOGY:A nationwide prospective observational study was conducted in France between April and July 2023. Each ICU was allowed to choose its own two-week period of data collection during which the Nursing Activities Score was collected by nurses at patients' bedside, during each shift. The Nursing Activities Score ranges from 20 to 177% and a 100% score represents a nurse per shift. The number of patients per nurse was collected and the Nursing Activities Score per nurse was assessed. RESULTS:One hundred and five ICUs participated. Overall, 21,665 measurements of Nursing Activities Score per patient and 9,885 Nursing Activities Score per nurse were collected. ICUs were composed by 2083 beds distributed into 1520 (73 %) intensive care beds and 563 (27 %) intermediate care beds. Among the participating units, 93 (89 %) of the teams worked in 2 shifts. Median [p25-p75] Nursing Activities Score per adult patient was 61 % [49-80] for intensive care patients and 47 % [38-61] for intermediate care patients (p < 0.001). Median Nursing Activities Score per nurse for adult population was 127 % [92-167], 143 % [92-198], and 164 % [126-213] for nurses only providing intensive care, only intermediate care or both levels of care, respectively (p < 0.001). A Nursing Activities Score per nurse value >100 % was observed in 71.4 %. CONCLUSIONS:Nurses' workload was high in the ICU, especially when providing intermediate or mixed levels of care. IMPLICATIONS FOR PRACTICE:In order to reduce nurses' workload, a review of the nurse-to-patient ratios is expected. Physically separating the two levels of care may be a valuable option.

Aim. We investigated the impact of empowering leadership on both perceived stress and salivary cortisol, a commonly utilized biological indicator for stress assessment. Background. Empowering leadership is gaining increasing interest in companies. However, the impact of empowering leadership on stress is still insufficiently explored, with conflicting findings within the literature on this topic. While certain studies indicate that empowering leadership reduces perceived stress, other studies have suggested that empowering leadership could be stressful. Methods. We conducted a cross-sectional study using a questionnaire among a sample of 397 participants working in a French hospital. Participants' salivary cortisol was assessed. All analyses exploring the relationships between empowering leadership, perceived stress, and salivary cortisol were performed using multiple imputation methods. Results. Empowering leadership could simultaneously increase and decrease perceived stress. Specifically, although the empowering leadership global factor showed a negative correlation with perceived stress, some specific empowering leadership behaviors were positively associated with perceived stress. However, salivary cortisol was positively related to perceived stress and strictly negatively related to empowering leadership. Furthermore, salivary cortisol could be explained by a significant interaction effect between perceived stress and empowering leadership, indicating that empowering leadership enables employees to cope with perceived stress. Conclusions. Although empowering leadership was an ambiguous antecedent of perceived stress, our findings suggested that empowering leadership was a protective factor against increased salivary cortisol. These results suggest that empowering leadership behaviors could prevent biological stress. Implications for Nursing Management. While empowering leadership showed a protective effect on salivary cortisol, it is essential for managers to adopt the full set of empowering leadership practices to guarantee protective effects on perceived stress. This trial is registered with NCT04010773.

PurposeThe development of vitrification and blastocyst culture have recently led to a rapidly growing number of single frozen thawed blastocyst transfer (FBT) cycles worldwide. Although the impact of female smoking on spontaneous fertility is well established, its effect on assisted reproductive technologies (ART) outcome is still controversial, and no study has specifically evaluated its effect on FBT cycles’ outcome.MethodsThis retrospective study was conducted in all consecutive FBT cycles conducted between 2012 and 2021 in a single University-based ART centre. Endometrial preparation was standard and based on hormonal replacement therapy. One or two blastocysts were transferred according to couple's history and embryo quality. Female smoking status was recorded for each cycle, and the association between female smoking status and Live Birth Rate (LBR) after FBT cycle was evaluated with univariate and multivariate analysis.ResultsA total of 1537 FBT cycles performed in non-smoking women and 397 FBT cycles performed in smoking women were included in the analysis. No independent association between female smoking status and LBR in FBT cycles was found after logistic regression (OR=1.07 [0.79-1.45], p=0.649).ConclusionOur study suggests that female smoking might not impair endometrial receptiveness in non-stimulated FBT cycles. Further studies should nevertheless consider assessing more precisely the current smoking exposure.

Training novice ophthalmology residents on the EyeSi® simulator increases cataract surgery safety. However, there is no consensus regarding how much training residents should perform before their first time on patients. We evaluated the French national training program through the analysis of the learning curves of novice residents. This prospective multicentric pedagogic study was conducted with French novice residents. Each resident completed the recommended four two-hour training sessions and performed a standardized assessment simulating standard cataract surgery before the first session (A0), at the end of the first (A1), second (A2), third (A3) and fourth (A4) sessions. For each surgical step of each attempt, the following data were collected: score, odometer, completion time, posterior capsular rupture and cumulative energy delivered (ultrasounds) during phacoemulsification. A performance threshold was set at a score of 80/100 for each surgical step, 400/500 for the overall procedure. Only descriptive statistics were employed. Sixteen newly nominated ophthalmology residents were included. Median score progressively increased from 95 [IQR 53; 147]) at A0 to 425 [IQR 411; 451] at A4. Despite a significant progression, the “emulsification” step had the lowest A4 scores 86 [IQR 60; 94] without reduction in completion time, odometer or ultrasounds delivered. The rate of posterior capsular rupture decreased linearly from 75

Cataract surgery is the most common surgical procedure performed in France. While the incidence of intraoperative complications affecting visual prognosis is extremely low, given the large number of patients operated on, the absolute number of patients affected by complications is quite high. Complication rates are significantly higher when ophthalmology residents (ORs) perform the surgery. Although lack of experience remains the main risk factor, sleep deprivation may adversely affect ORs’ successful surgery rate. The value of the EyeSi® surgical simulator in initial training has been demonstrated to increase cataract surgery safety through the transfer of surgical skills from the simulator to the operating room. However, there is no consensus regarding how much training is needed before the first-time ORs are allowed to operate. There is also no scientific evidence that sleep deprivation is associated with a decrease in surgical performance. Establishing a validated protocol for cataract surgery training using the EyeSi surgical simulator (referred to further as the EyeSi) and identifying risk factors for intraoperative complications related to sleep deprivation will improve cataract surgery safety and lead to the reorganization of our healthcare systems. This multi-centre educational cohort study will include two distinct axes which will both aim to reduce the risks of cataract surgery. Enrollment will include 16 first-year ORs for Axis 1 and 25 experienced residents for Axis 2, all from the University Hospitals of Nantes, Tours, Angers and Rennes. Axis 1 will focus on investigating the learning curve of first-year ORs using the EyeSi, following the training program recommended by the “College des Ophtalmologistes Universitaires de France” in order to set up a future “licence to operate.” Axis 2 will evaluate the impact of sleep deprivation on the surgical performance of experienced ORs using the EyeSi. ClinicalTrial.gov identifier: NCT05722080.

The number of homeless people has been constantly increasing in Europe over recent years, as well as the proportion of women among the homeless population. Pregnancy can increase the risk of becoming homeless and, on the other hand, homelessness has been widely connected to adverse perinatal outcomes. The objective of this study was to describe the overall perceived impact of homelessness on health during pregnancy and the postpartum period, using a qualitative research approach to prioritize women's perspective. One-time semi structured interviews were conducted with 10 pregnant women and 10 women in the postpartum period experiencing homelessness in the metropolitan area of Nantes, as well as with six people from their social surroundings. A thematic analysis was performed to identify major themes and sub-themes. Homelessness was perceived as having an overall negative impact on all aspects of health (physical health, mental health, and social well-being) during pregnancy and the postpartum period. Stress and anxiety, food insecurity, social isolation, physical suffering, deterioration of chronic diseases, and pregnancy complications, were the main perceived consequences of homelessness on health. On the other hand, social support, and the "welcomeness" of healthcare professionals during pregnancy and the postpartum period were identified as capable of palliating those consequences. Finally, basic needs, such as having access to suitable housing, being independent, and being in good health, were identified by participants in the study as their main priorities. The results of this study, as well as those found by previous research, allowed us to identify possible axes in tackling homelessness and its complex consequences on health during pregnancy and the postpartum period. Housing and income assistance interventions, promoting social support and employment, outreach services enhancing collaborative networks among healthcare service providers, and integrating coordinated multidisciplinary approaches in primary care have shown to provide promising solutions to this issue.

The COVID-19 pandemic imposed two lockdowns of eight and six weeks in France. While access to care was reduced during lockdown periods, these stressful situations with the pandemic and lockdown periods may have a negative impact on mental health, especially in vulnerable subgroups. Monitoring of psychotropic drugs consumption in France is a comprehensive and reliable tool for indirectly analyzing the mental health of French people. This historical cohort study (n = 767 147) investigated the short-term and long-term evolution of the weekly trend of psychotropic drugs users in 2020 by performing a Seasonal Trend decomposition time series analysis. Rate of progression of consumers per week increased from 186 in the last week of 2019 to 261 per week in the last week of 2020 (+40.3%). Our results did not show a significant break in psychotropic drugs consumption trends during the year 2020 and its two lockdowns. The increase in trend regarding psychotropic drugs consumptions was greatest in young people (<15 years) and patients not being socially deprived. Despite the increase in consumers with restrictive health measures, the French drugs delivery system has been able to adapt with the support of government and pharmacy network. This point should be kept in mind as the necessary reforms to the health care system are undertaken. The COVID-19 pandemic has a negative impact on mental health and two lockdowns occurred in France with reduced access to care. In this context, monitoring of psychotropic drugs consumption is a comprehensive and reliable tool for analyzing the mental health of French people. We hypothesized that the psychotropic drugs consumption has increased during the 2020 COVID-19 pandemic, testifying to French people mental health deterioration, with psychotropic drugs consumption breaks during lockdowns, especially during the first "grand national lockdown", due to the closure or difficulties for accessing to health care structures. By carrying out a historical cohort study among Pays de la Loire residents (n = 767 147), we investigated evolution of the weekly trend of psychotropic drugs users in 2020 compared to 2019 by performing a Seasonal Trend decomposition time series analysis. Between 2019 to 2020, we found a + 40.3% rate of progression of consumers per week. During the year 2020, changes in trend regarding psychotropic drugs consumptions was observed in various sub-groups, e.g. greater in the youngest (< 15 years), which may indicate a vulnerable group strongly impacted by COVID-19 negative consequences, and patients not being socially deprived, which may indicate a group with probably an easier access to care. Lockdown periods were not associated with a significant change in psychotropic drug use, suggesting a form of resilience in the French health care system to maintain its capacity to deliver psychotropic treatments. We mainly discussed that despite the increase in consumers and the policies of restricting access to care during lockdown periods, the French drugs delivery system has been able to adapt thanks to supportive policy actions (extension of the prescriptions validity without the need for a renewal by a physician during periods of lockdowns), an efficient pharmacy network with a collaborative practice of health actors that need to be developed and/or conserved to face potential future health crises.

Actuellement, en France, le traitement des morsures de vipères repose sur l'utilisation d'un antivenin adapté, Viperfav® [1]. Une classification clinicobiologique permet d'évaluer précisément la sévérité de l'envenimation, son évolution dans le temps et poser l'indication de l'antivenin [2]. VipGrade® est un système d'aide informatique à la décision clinique, développé en partenariat avec la Société de toxicologie clinique, dont l'objectif est d'évaluer la gravité de ces envenimations par vipère et guider leur traitement (https://www.toxicologie-clinique.org/morsure-de-vipere-grade/). L'objectif de cette étude préliminaire est de comparer, au regard des recommandations actuelles nationales des centres antipoison (CAP), les évaluations de la gravité des envenimations proposées par l'outil VipGrade® avec celles initialement réalisées par des toxicologues des CAP français. Il s'agit d'une revue rétrospective monocentrique qui concerne les cas de morsures de serpent Vipera spp. enregistrés par le CAP de Bordeaux, entre le 1er janvier 2018 et le 31 décembre 2020. Nous avons mesuré la concordance entre les évaluations VipGrade®, les évaluations des toxicologues du CAP et les recommandations actuelles. Au total, 133 patients présentant des morsures de serpent Vipera spp. ont été inclus. Il y avait une concordance de 100 % dans la classification de la gravité entre les recommandations actuelles et VipGrade®. Cependant, la classification par les toxicologues et VipGrade® divergeait dans 19 cas (85 % de concordance ; κ = 0,80 ; 95 % CI : 0,71 à 0,87) liée à une sous-évaluation ou surévaluation de la gradation réelle. La gradation de l'outil VipGrade® reflète parfaitement les recommandations actuelles des CAP français et peut permettre une détermination rapide et fiable de la prise en charge et du suivi des patients mordus par une vipère. Il pourrait faciliter également la comparaison spatio-temporelle, par une gradation standardisée, des conséquences cliniques des morsures par vipère en France et plus largement en Europe. Il faut, cependant, noter que les aspects plus complexes et dynamiques de la prise en charge nécessitent l'avis d'un expert toxicologue. VipGrade® permet de conseiller à bon escient l'administration de l'antivenin et favorise ainsi l'harmonisation de la prise en charge des vipères en France, quel que soit le niveau d'expertise du médecin prenant en charge le patient. L'objectif de VipGrade® est bien d'assister et non de remplacer les conseils des toxicologues qui devraient être sollicités chaque fois qu'une morsure de vipère est rencontrée dans la pratique clinique.

BackgroundDeprescribing benzodiazepines and related drugs (BZDR) is a challenge due to a lack of time on physicians’ part, a lack of involvement of other health professionals, and the need for adapted tools. This study is based on primary care collaboration, by evaluating the effectiveness of a joint intervention between general practitioners and community pharmacists on the implementation of BZDR deprescribing in older adults.MethodsThis is a cluster randomized controlled trial in which each cluster will be formed by a physician-pharmacist pair. Within a cluster allocated to the intervention, the pharmacist will be trained in motivational interviewing (MI), and will offer the patient 3 interviews after inclusion by the physician. They will base their intervention on validated deprescribing guidelines. The pharmacist will receive methodological support during the first interviews. Interprofessional collaboration will be encouraged by writing reports for the physician after each interview. The following implementation outcomes will be evaluated: acceptability/adoption, appropriateness, cost, and fidelity. They will be measured by means of sociological interviews, observations, logbooks, and cost-utility analysis. Focus groups with physicians and pharmacists will be carried out to identify levers and barriers experienced in this collaboration. Observations will be conducted with pharmacists to assess their approach of the MIs. Effectiveness outcomes will be based on medication (discontinuation or reduction of BZDR) and clinical outcomes (such as quality of life, insomnia or anxiety), assessed by health insurance databases and validated questionnaires.DiscussionThis study will determine whether collaboration in primary care between physicians and pharmacists, as well as training and coaching of pharmacists in motivational interviewing, allows the implementation of BZDR deprescribing in the older adults.This study will provide an understanding of the processes used to implement deprescribing guidelines, and the contribution of collaborative practice in implementing BZDR discontinuation. The cluster methodology will allow to assess the experience of the relationship between the different primary care actors, and the related obstacles and levers.The results obtained will make it possible to produce guidelines on the involvement of community pharmacists in the management of substance abuse in older adults, or even to legislate new missions or care pathways.Clinical trial registrationClinicalTrials.gov, identifier, NCT05765656.

AIM:The aim of this study is to assess the effect of a systemic intervention on the evolution of empowering leadership and emotional exhaustion in a university hospital sub-centre compared to a control sub-centre, both being part of a large French university hospital complex.BACKGROUND:Empowering leadership is a promising strategy for developing hospital team engagement and performance. However, the bureaucratic functioning of large hospitals, characterized by a managerial culture of control and a stratified organization, can be a barrier to empowering leadership.METHODS:The intervention included empowering leadership training, direct field experimentation of empowering leadership and coaching, involving all the sub-centre hierarchical levels for 12 months. Data were collected before and after the intervention. A total of 441 and 310 participants were, respectively, included in the intervention and control sub-centres.RESULTS:Empowering leadership was decreased, and emotional exhaustion was increased in the control sub-centre, while the scores remained stable in the intervention sub-centre. The increased emotional exhaustion in the control sub-centre could partially be explained by the change in empowering leadership.CONCLUSION:In a context of decreased empowering leadership and increased emotional exhaustion, the intervention had a protective effect. Implications for the design of future interventions were discussed.IMPLICATIONS FOR NURSING MANAGEMENT:This study unequivocally showed the benefit of transforming hospital management towards empowering leadership, to prevent increased emotional exhaustion.REGISTRATION NUMBER:This study is registered on ClinicalTrials.gov on 4 July 2019 (NCT04010773).

Introduction:The growing needs related to the loss of autonomy of elderly people should be the opportunity to imagine alternatives to nursing homes. In this context, our study aimed to assess the effect of a reinforced home care model on the evolution of frailty in elderly people whose health conditions could have justified entering a nursing home.Methods:A retrospective observational study focusing on the evolution of the SEGA score and other variables reflecting the frailty of people over 75 years old according to classic home care, institutionalization, or reinforced home care.Results:The average SEGA scores of the Ehpad-@-Dom (reinforced home care) and SAD (classic home care) groups are significantly better than that of the Ehpad group after 6 months (T6: Ehpad-@-Dom vs Ehpad, p =0.01 and SAD vs Ehpad, p=0.039) and 12 months (T12: Ehpad-@-Dom vs Ehpad, p=0.021).Conclusion:“Reinforced home care” seems to be an alternative to the classic nursing home model.

Background Geophagy is an ancestral practice particularly found among African women who describe beneficial effects on the sympathetic signs of pregnancy. Studies have reported a significant prevalence of consumption of kaolin, known as geophagy, within migrant population. However, this behavior, like other environmental factors, could lead to obstetrical and neonatal risks. Objective The objective of our study was to evaluate the obstetrical and neonatal impact of kaolin consumption, especially on Z-SCORE for weight-for-gestational age in the newborn. Methods This mono-centric historical cohort study was carried out on the basis of questionnaires and patients' obstetrical records. It was conducted between January 1 and July 1, 2017. Patients were divided into two groups: 1) women who consumed kaolin (at least once during their pregnancy), and 2) women who did not consume kaolin. Morphometric characteristics of the newborn were retrieved in obstetrical records. Results Results: 105 pregnant women were included: 26 exposed and 79 non exposed. Women who consumed kaolin were more frequently without social protection at their first consultation (p < .01). Multivariate analysis did not show a significant association between Z-SCORE for weight-for gestational age in the newborn and kaolin consumption (beta = 0.13, p = .54) after adjusting on age, precariousness, BMI, intake of toxic substances, anemia and beginning eclampsia. Among these covariates, precariousness was significantly associated with both a decrease in Z-SCORE for weight (beta = -0.87, p < .002) and size (beta = -0.68, p < .01). Conclusion Geophagy is not to be neglected in socially advantaged countries due to increased immigration. This study found no association between kaolin consumption and birth weight. However, there was a correlation between precariousness and low birth weight which reinforces the importance of tightening the follow-up during pregnancies in the most precarious women.

Aims The risk for drug-drug interactions (DDIs) associated with antiseizure drugs (ASDs) used to manage status epilepticus (SE) patients in the intensive care unit (ICU) has been poorly investigated. We aimed to quantify and describe those potential DDIs and determine SE patient risk profiles. Methods We conducted an observational bi-centric cohort study including all SE patients admitted to the ICU in the period 2016-2020. Results Overall, 431 SE patients were included and 5504 potential DDIs were identified including 1772 DDIs (33%) between ASDs, 2610 DDIs (47%) between ASDs and previous usual treatments (PUTs), and 1067 DDIs (20%) between ASDs and ICU treatments (ICUTs). DDIs were moderate (n = 4871), major (n = 562) or severe (n = 16). All patients exhibited potential DDIs, which were major-to-severe DDIs in 47% of the cases. DDIs were pharmacokinetic (n = 1972, 36%), mostly involving cytochrome P450 modulators, and pharmacodynamic (n = 3477, 64%), mainly leading to increased sedation. ASD/PUT DDIs were the most frequent and severe. Age, PUT and ASD drug numbers and length of ICU stay were significantly associated with increased DDI number. We identified four SE patient profiles with different DDI risks and outcomes including (1) epileptic or brain trauma patients, (2) withdrawal syndrome patients, (3) older patients with comorbidities and (4) self-poisoned patients with psychiatric disorders and/or past epilepsy. Conclusion SE patients are subject to potential DDIs between ASDs, ASD/PUT and ASD/ICUT. Major-to-severe DDIs mostly occur between ASDs and PUTs. Physicians should pay attention to SE patient characteristics and history to limit DDI numbers and prevent their consequences.

Anti-Mullerian Hormone (AMH) is considered to be one of the most relevant markers of ovarian reserve. However, its association with oocyte quality, pregnancy occurrence and evolution remain to be further investigated. The objective of this study was to compare miscarriage rate after fresh blastocyst(s) transfer in young women (<37 years old) with or without diminished ovarian reserve (DOR), as reflected by low serum AMH levels. This monocentric retrospective study was conducted in 669 women undergoing 1,891 blastocyst transfers. Patients were divided into 2 groups: (1) 190 transfers performed in 106 women with a 'low' serum AMH (< 10th percentile) (i.e. AMH < 0.85 ng/mL); and (2) 961 transfers performed in 563 patients with a 'normal' serum AMH (25th-75th percentile) (i.e. AMH 1.4-4 ng/mL). Miscarriage rate was comparable in both groups (9.5 and 6.8% respectively; p = 0.2) as well as implantation rate, pregnancy rate, live birth rate per transfer (p = 0.4, p = 0.07 and p = 0.6, respectively). After multivariate analysis, no significant association was found between serum AMH level and miscarriage rate (p = 0.22). In women <37 years, low serum AMH level is not associated with an increase in miscarriage rate after fresh blastocyst transfer.

Methods We conducted a retrospective review of Vipera spp. snakebite cases registered by the PCC of Bordeaux, France, between January 1, 2018, and December 31, 2020, evaluating the agreement between VipGrade(R) assessments, toxicologists' assessments, and current guidelines. Results 133 patients with Vipera aspis snakebites were included. There was 100% agreement in severity grading by PCC guidelines and VipGrade(R). However, grading by toxicologists and VipGrade(R) diverged in 19 cases (85% agreement; kappa = 0.80; 95% CI: 0.71 to 0.87). Conclusions The VipGrade(R) tool's grading reflects current PCC guidelines, which are authoritative in France, and may allow for a more rapid and standardized determination of management and follow-up of viper-bitten patients. It should be noted, however, that the more complex and dynamic aspects of management are not included in VipGrade(R). Its purpose is to supplement, not replace, the advice of the PCC's clinical toxicologists, and this advice should be sought whenever a viper bite is encountered in clinical practice.

Background Proton pump inhibitors (PPIs) are one of the most widely prescribed drug classes in the community and at hospital. The significant misuse of PPIs requires the implementation for a deprescribing strategy. Numerous studies aiming at evaluating the impact of deprescribing interventions have been set up, implying a precisely known evolution of consumption of PPIs in the population studied without intervention. The main objective of the study was to study overall changes in PPI prescribing and deprescribing in a regional population of chronic consumers without intervention, according to health insurance databases. Methods This historical cohort study was based on the French National Health Data System databases. All adult patients living in the Pays de la Loire area and covered by the French National Health Insurance and who had at least one reimbursement for a PPI dispensing between 01 October 2016 and 31 December 2020 were included. Only chronic consumer patients were included, defined as patients who has had PPI dispensed for 3 consecutive months with a temporal coverage of at least 80%. Patients under 18 years of age and patients who received parenteral PPIs only were excluded. Results The percentage of chronic treatment discontinuation in 2017 was 12.5% and remained stable to reach 12.4% in 2020. The number of new chronic patients increased from year to year to reach 77,222 patients in 2020, with an increasing rate of 1.2 to 2% between 2017 and 2020. The prevalent patient population increased from year to year to reach 167 751 patients in 2020, with an increasing rate of 4.2 to 4.4% between 2017 and 2020. Regarding the initiation of PPI therapy, in 2020, 87.1% of treatment initiations were done by general practitioners. They renewed 2,402,263 prescriptions (89.3%) between 2017 and 2020. Conclusions This study shows a stagnation over the last 4 years in the deprescribing of chronic PPI treatments in a French region despite the information on their inappropriate use reported by national agencies and in the literature with increasing frequency. This reinforces the interest of setting up a deprescribing project.

The growing needs related to the loss of autonomy of elderly people should be the opportunity to imagine alternatives to nursing homes. In this context, our study aimed to assess the effect of a reinforced home care model on the evolution of frailty in elderly people whose health conditions could have justified entering a nursing home.A retrospective observational study focusing on the evolution of the SEGA score and other variables reflecting the frailty of people over 75 years old according to classic home care, institutionalization, or reinforced home care.The average SEGA scores of the Ehpad-@-Dom (reinforced home care) and SAD (classic home care) groups are significantly better than that of the Ehpad group after 6 months (T6: Ehpad-@-Dom vs Ehpad, p =0.01 and SAD vs Ehpad, p=0.039) and 12 months (T12: Ehpad-@-Dom vs Ehpad, p=0.021).“Reinforced home care” seems to be an alternative to the classic nursing home model.Face aux besoins liés à la perte d’autonomie des personnes âgées vieillissantes, des alternatives à l’institutionnalisation doivent être imaginées. Dans ce contexte, notre étude visait à évaluer l’effet d’un modèle de maintien à domicile renforcé sur l’évolution de la fragilité de personnes âgées dont l’état de santé aurait pu justifier une institutionnalisation.Étude observationnelle rétrospective s’intéressant à l’évolution du score SEGA et d’autres variables reflétant la fragilité de personnes âgées de plus de 75 ans en fonction d’un maintien à domicile classique, une institutionnalisation, ou un maintien à domicile renforcé.Les score SEGA moyens des groupes Ehpad-@-Dom (maintien à domicile renforcé) et SAD (maintien à domicile classique) sont significativement meilleurs que celui du groupe Ehpad après 6 mois (T6 : Ehpad-@-Dom vs Ehpad, p = 0,01 et SAD vs Ehpad, p = 0,039) et 12 mois (T12 : Ehpad-@-Dom vs Ehpad, p = 0,021).Le « maintien à domicile renforcé » semble être une alternative à l’entrée classique en Ehpad.

Aims In recent years, zolpidem has been the subject of numerous reports of misuse, abuse and dependence. In view of these risks, the French drug agency (ANSM) decreed in April 2017 the implementation of secure prescription pads. The objective of this study was to evaluate the impact of this regulatory measure on the prescription of zolpidem and other sedative medications (zopiclone, benzodiazepines and antihistamines) in long-term users of zolpidem and associated factors. Methods We performed a historical cohort study using data from the Generalist Sample of Beneficiaries (EGB). All patients aged over 18 years old who were long-term users (at least 3 months) before the measure were enacted. We analysed the reimbursement trajectories of zolpidem, zopiclone, benzodiazepines and antihistamines (hydroxyzine and alimemazine) up to 2 years after the measure using a state sequence analysis. Results Overall, 2502 patients were analysed. A four-cluster typology was identified: continuation of zolpidem (n = 1044, 42%), discontinuation of sedative medications (n = 766, 31%), change to zopiclone (n = 537, 21%) and change to hypnotic benzodiazepines (n = 155, 6%). The most frequently prescribed hypnotic benzodiazepine was lormetazepam. We identified age, sex, treatment for psychiatric or addictive disorder and volume of zolpidem use before the measure as factors associated with different reimbursement trajectories after the regulatory change. Conclusion The regulatory change for zolpidem prescriptions reduced exposure to zolpidem among long-term users and also had a broad impact on prescriptions of other sedative medications. Switching to other medications that also present a potential risk of abuse or dependence should be carefully monitored.