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Biomedical subjects

Christophe Büla

Publications and source records attributed to Christophe Büla.

8 recordsLinked to original sources
PubMed2006

[Geriatrics].

This overview covers several topics related to the management of frequent problems in elderly persons. Several studies have shown that treatment of neuropsychiatric symptoms of dementia with psychotropic medication is modestly effective and could increase the risk of adverse events, including death. Influenza vaccination in long term care residents was shown to be effective in a systematic review, while post-exposure prophylaxis with oseltamivir, a neuraminidase inhibitor, seems cost-effective in vaccinated residents during an epidemics in a nursing home. Conflicting results were observed in studies of fracture prevention with vitamine D. Finally, one study showed the potential pifalls of guidelines developed for specific chronic medical conditions when applied simultaneously to older patients with complex comorbidities.

Aged↗
PubMed2003

Composition and cost of drugs stored at home by elderly patients.

BACKGROUND: Elderly people often have multiple chronic diseases, are frequently treated by several physicians, and also use over-the-counter medications. Excessive prescribing, imperfect therapeutic adherence, treatment modifications after hospitalization, and oversized drug packages result in home storage of leftover drugs, resulting in a waste of healthcare resources. PATIENTS AND METHODS: All patients aged >/=75 years hospitalized for >24 hours during a 6-month period in an urban teaching hospital in Switzerland were eligible for inclusion in a study collecting sociodemographics, medical, functional, and psychosocial characteristics. Six months later, a research nurse visited the patients at home and recorded the names, number of tablets, and expiration dates of all open or intact drug packages, and the doses actually taken. Acquisition costs of these drugs were computed. RESULTS: One hundred ninety-five patients were included (127 women; mean age 82.2 +/- 4.8 y, range 75-96). They had a total of 2059 drugs (mean per patient 10.3 +/- 6.7, range per patient 1-42), corresponding to a total cost of (US) $62 826 (mean per patient 322 +/- 275, range per patient 10-1571). Self-reported drug intake was regular for 36% of the drugs (46.5% of total costs) and occasional for 11% (6.1%), whereas 35.7% (30.1%) had been stopped during the last month. Cardiovascular drugs amounted to 36.6% of the drugs and 55.5% of the costs. None of the patients' characteristics was significantly associated with a greater number of drugs and higher costs. CONCLUSIONS: Drugs stored at home by elderly patients were worth about $320 per patient. Only about one-third of these drugs were regularly taken. In the context of resources shortage, innovative solutions should be found to reduce the waste linked with drugs stopped in previous months.

Aged↗
PubMed2003

[Screening and prevention in the elderly: which interventions should be proposed, to whom, and up to what age?].

Recommendations on preventive services rarely mention how to apply them to older people. Even though general criteria (prevalence of disease, quality of screening tests) that influence screening's efficacy remain important, appropriateness of screening in older persons depends much more on individual criteria, such as comorbidity, functional status, and life expectancy. More than with any other age group, patients preferences regarding future investigation and treatment guide the clinical decision. This article focuses on primary and secondary prevention, and discusses specific criteria to consider in each patient. A table summarizes the appropriate recommendations.

Age Factors↗
PubMed2003

[Acute confusional state in the elderly].

Delirium is common and associated with important adverse consequences in elderly persons. It is an acute syndrome characterized by the rapid onset of cognitive and attention impairment, with a fluctuating course. In most cases, the etiology is multifactorial, combining predisposing and precipitating factors. Delirium management combines specific treatments of precipitating factors with the symptomatic treatment of delirium manifestations, based on nonpharmacologic as well as pharmacologic approaches.

Acute Disease↗
PubMedDate not supplied

Major depressive disorder in the general hospital: adaptation of clinical practice guidelines.

Major Depressive Disorder is particularly frequent among physically ill inpatients. Despite the considerable human burden and financial costs, Major Depressive Disorder remains under-detected and under-treated. To improve this situation, clinical practice guidelines for the management of Major Depressive Disorder were developed for patients in the general hospital. They were adapted from existing good quality guidelines. A literature search has been conducted to identify guidelines and systematic reviews about the management of Major Depressive Disorder. The quality of the existing guidelines was evaluated by means of the AGREE instrument (Appraisal of Guidelines for Research and Evaluation). Complementary literature searches were necessary to answer questions such as "depression and physical illness" or "antidepressants and somatic medication". The guidelines were discussed by a multidisciplinary internal panel. The final version was reviewed by an external panel. This paper presents the development process and a summary of these guidelines for the management of Major Depressive Disorder. The adaptation of good quality guidelines to local needs requires much time, effort and skills. Easier ways for the adaptation and use of high quality guidelines at the local level may result from better coordination, organization and updating of guidelines at a national or supranational level.

Major Depressive Disorder↗