RECOMMENDATIONS FOR MONITORING AND INTERNAL DOSIMETRY FOR NUCLEAR MEDICINE STAFF EXPOSED TO RADIOPHARMACEUTICALS 223Ra DICHLORIDE.

223Ra is a radiopharmaceutical used as unsealed source in nuclear medicine. In the case of staff inhalation contamination of 223Ra, methods to estimate the committed effective dose should be chosen with care. Three methods are available: whole-body measurement and gamma spectrometry for urine or faeces samples. Considering the analytical performances and uncertainties of these three methods, we propose recommendations for special dose assessment. As a first choice, due to its rapidity and its non-invasiveness, an in vivo analysis (with HPGe detector) is the most appropriate method. However, after 24 h, whole-body counting is not sensitive enough to detect a minimum effective dose of 1 mSv. Sufficient sensitivity can only be reached up to 8 days after contamination by true 24 h faeces samples analyses. Thus, despite its main drawbacks, this method appears to be more appropriate than urine to estimate the committed effective dose in addition to whole-body counting.

[Principles, modalities and indications of the administration of Radium in cancers, focus on metastatic prostate cancer: State of arts]. / Principes, modalités et indication de l'administration du Radium dans les cancers, focus sur le cancer de la prostate métastatique : état des lieux.

Prostate cancer is the first cancer in men and has a specific tropism to bones. This tropism provided the rationale to develop bone targeting radiopharmaceutical agents, such as strontium, samarium and more recently the Radium-223, an alpha-emitter. In a phase III trial, ALSYMPCA, Radium-223 not only improved pain relief, but also impacted on overall survival. Despite an approval by both FDA and EMA, prescription of this agent remains limited by the lack of refund, especially in France. Radium-223 is currently evaluated in several clinical trials (combination with chemotherapy, radiotherapy or hormone therapy) in order to optimize the therapeutic sequences in metastatic bone prostate cancer and argues for being incorporated into the current therapeutic arsenal.

Medication dispensing errors in a French military hospital pharmacy.

OBJECTIVE: To determine the rate and the primary types of medication dispensing errors detected by pharmacists during implementation of a unit dose drug dispensing system. SETTING: The central pharmacy at the Percy French military hospital (France). METHOD: The check of the unit dose medication cassettes was performed by pharmacists to identify dispensing errors before delivering to the care units. From April 2006 to December 2006, detected errors were corrected and recorded into seven categories: unauthorized drug, wrong dosage-form, improper dose, omission, wrong time, deteriorated drug, and wrong patient errors. MAIN OUTCOME MEASURE: Dispensing error rate, calculated by dividing the total of detected errors by the total of filled and omitted doses; classification of recorded dispensing errors. RESULTS: During the study, 9,719 unit dose medication cassettes were filled by pharmacy technicians. Pharmacists detected 706 errors for a total of 88,609 filled and omitted unit doses. An overall error rate of 0.80% was found. There were approximately 0.07 detected dispensing errors per medication cassette. The most common error types were improper dose errors (n = 265, 37.5%) and omission errors (n = 186, 26.3%). Many causes may probably explain the occurrence of dispensing errors, including communication failures, problems related to drug labeling or packaging, distractions, interruptions, heavy workload, and difficulties in reading handwriting prescriptions. CONCLUSION: The results showed that a wide range of errors occurred during the dispensing process. A check performed after the initial medication selection is also necessary to detect and correct dispensing errors. In order to decrease the occurrence of dispensing errors, some practical measures have been implemented in the central pharmacy. But because some dispensing errors may remain undetected, there is a requirement to develop other strategies that reduce or eliminate these errors. The pharmacy staff is widely involved in this duty.

[Drug use process and nurses practices: evaluation in a French military hospital in 2006]. / Circuit du médicament et pratiques infirmières: evaluation dans un hôpital des armées en 2006.

The study carried out at Percy hospital (Clamart, France) gives a description of nurses' practices for each stage of the drug use process. Their knowledge about drugs risk was also evaluated. Results of this background give an assessment of practices before hospital accreditation and will be used to define the priority actions of improvement. Recent implementation of unit dose drug dispensing system and simplification of adverse drug event report illustrate these actions to enhance safety and to decrease iatrogenic risk. In addition, pharmacists proposed a training for nurses about drug iatrogenic disease.