No abstract

Programme Hospitalier Recherche Clinique, Institut Pasteur, Inserm, French Public Health Agency.

Frailty is a clinical syndrome relative to ageing, and characterizes an intermediate state between robust health and the loss of autonomy. The preservation of one's capacities or abilities falls within a dependency prevention approach, based on a thorough understanding of one's medical and social situation, and his/her environment of life. This understanding is usually gained through an extensive collection of data, using standardized assessment surveys. The obtained data is next analyzed in order to provide personalized recommendations relative to the ways of living. In this paper, we describe the concept, architecture and use of an ICT platform which aims to support professionals and patients in the assessment of frailty at home. Our prototype consists of a knowledge-based system relative to assessment surveys which is connected to a smartphone application and IoT devices.

ImportanceAmyloid positron emission tomography (PET) allows the direct assessment of amyloid deposition, one of the main hallmarks of Alzheimer disease. However, this technique is currently not widely reimbursed because of the lack of appropriately designed studies demonstrating its clinical effect.ObjectiveTo assess the clinical effect of amyloid PET in memory clinic patients.Design, Setting, and ParticipantsThe AMYPAD-DPMS is a prospective randomized clinical trial in 8 European memory clinics. Participants were allocated (using a minimization method) to 3 study groups based on the performance of amyloid PET: arm 1, early in the diagnostic workup (within 1 month); arm 2, late in the diagnostic workup (after a mean [SD] 8 [2] months); or arm 3, if and when the managing physician chose. Participants were patients with subjective cognitive decline plus (SCD+; SCD plus clinical features increasing the likelihood of preclinical Alzheimer disease), mild cognitive impairment (MCI), or dementia; they were assessed at baseline and after 3 months. Recruitment took place between April 16, 2018, and October 30, 2020. Data analysis was performed from July 2022 to January 2023.InterventionAmyloid PET.Main Outcome and MeasureThe main outcome was the difference between arm 1 and arm 2 in the proportion of participants receiving an etiological diagnosis with a very high confidence (ie, ≥90% on a 50%-100% visual numeric scale) after 3 months.ResultsA total of 844 participants were screened, and 840 were enrolled (291 in arm 1, 271 in arm 2, 278 in arm 3). Baseline and 3-month visit data were available for 272 participants in arm 1 and 260 in arm 2 (median [IQR] age: 71 [65-77] and 71 [65-77] years; 150/272 male [55%] and 135/260 male [52%]; 122/272 female [45%] and 125/260 female [48%]; median [IQR] education: 12 [10-15] and 13 [10-16] years, respectively). After 3 months, 109 of 272 participants (40%) in arm 1 had a diagnosis with very high confidence vs 30 of 260 (11%) in arm 2 (P < .001). This was consistent across cognitive stages (SCD+: 25/84 [30%] vs 5/78 [6%]; P < .001; MCI: 45/108 [42%] vs 9/102 [9%]; P < .001; dementia: 39/80 [49%] vs 16/80 [20%]; P < .001).Conclusion and RelevanceIn this study, early amyloid PET allowed memory clinic patients to receive an etiological diagnosis with very high confidence after only 3 months compared with patients who had not undergone amyloid PET. These findings support the implementation of amyloid PET early in the diagnostic workup of memory clinic patients.Trial RegistrationEudraCT Number: 2017-002527-21

Improving patient safety and quality of care has become a priority for healthcare organizations, given the frequency and potential severe clinical consequences of medication errors and adverse drug events during the Medication-use Process. Medication error reporting can be one most effective strategies to achieve these goals. Indeed, high error reporting rates indicate a positive safety culture rather than an unsafe healthcare environment. It is through the identification of these errors safety barriers can be put in place to prevent a similar event from occurring in the future. However, current healthcare organizations still suffer from a lack of attention in this context, especially in establishing a digital tool dedicated to medication error reporting, which is the motivation for the work described in this paper. The latter proposes a novel tool to make the local reporting of medication errors easier and encourage reporting these errors with the healthcare professionals' confidentially. The overall response to the tool provided was positive from the staff participating.