[Roles and impacts of pharmaceutical activity from 1990 to today: Literature review and research perspectives]. / Rôles et impacts des interventions pharmaceutiques de 1990 à nos jours : revue de littérature et perspective de recherche.

CONTEXT: There is more and more evidence about the roles and impacts of the pharmacist. Health decision makers, managers, clinicians and patients need evidence to support an appropriate allocation of funds to different models of practice. OBJECTIVES: The main objective is to present an inventory of the roles and impacts of pharmaceutical activity in the international literature. METHODS: Review of literature. The articles related to the pharmacist's roles and impacts were selected according to a reproducible research strategy from 1990 to the present day (French/English with description of the intervention and impacts, where applicable) and a standard operating procedure. The following variables were extracted: author, country, specifications, pharmaceutical activities, care programs, targeted pathologies, impacts according to eight markers (mortality, morbidity, costs, adverse events, medication errors, compliance, satisfaction, others) and quality score. Only descriptive statistics were performed. RESULTS: As of February 1st, 2019, we recorded 2424 articles divided into 100 subjects (41 pharmaceutical activities, 30 pathologies, 29 care programs). Studies come from the United States (46.66%), multiple countries (8.00%), Canada (7.67%), France (6.06%), the United Kingdom (5.19%), Australia (3.50%) and other countries (22.92%). Studies are cross-sectional (47.55%), retrospective (33.68%) and prospective (17.87%) or non-categorized (<1%). The markers associated with the pharmacist's activity concern morbidity (23.12%), medication errors (11.82%), satisfaction (7.13%), compliance (6.06%), costs (5.47%), adverse events (3.74%), mortality (1.36%), and other indicators (41.31%). The studies have 6763 descriptive parameters and 5224 impact parameters (60.42% are positive, 38.55% are neutral and 1.03% are negative). CONCLUSION: This literature review confirms the roles and impacts of the pharmaceutical activity both in the pharmacy and in the hospital. A majority of the pharmaceutical interventions studied have positive impacts. It is essential to consider evidence about the roles and impacts of the pharmaceutical activities to take full advantage of the pharmacist's expertise in healthcare.

[Indicators of research impact: Tools for measuring journals, researchers and published articles in health - Pharmaceutical perspective]. / Indicateurs de notoriété des revues scientifiques, des chercheurs et des articles publiés en santé : perspective pharmaceutique.

There are several indicators to evaluate the impact of the scientific publication in pharmacy. Given their number, complexity, heterogeneity, strengths and weaknesses, we believe that pharmacists are not sufficiently familiar with these indicators. The main objective is to present an inventory of available indicator to measure the research impact. PubMed, GoogleScholar and Google were interviewed in October 2017 from the following terms: bibliométrique/bibliometrics, facteur d'impact/impact factor, impact de citations/citation impact, revue/journal, chercheur/researcher, article, indicateur/indicator, score. For each identified indicator, the following variables were extracted: name, calculation method, calculation time window, data sources considered, access conditions, inclusion of self-citation, strengths and weaknesses. A total of 15 indicators were included: seven for journals, four for researchers and four for articles. Among them two are non-bibliometric indicators: the Altmetric attention score, the RGscore and one other indicator deriving from the impact factor: the SIGAPS indicator developed to finance the research activity of French hospitals. Of the 12 bibliometric indicators, nine include self-citation. All involve forces (e.g. exclusion of editorials, letters, free access) and weaknesses (e.g. self-citations included, time window too short, disciplinary indistinction). There is no indicator with no weaknesses and pharmacists should be able to understand their strengths and weaknesses.

[Evaluation of knowledge and perceptions of pharmacists and residents pharmacists about bibliometric indicators applied to the scientific literature in pharmacy]. / Évaluation des connaissances et perceptions des pharmaciens et internes en pharmacie sur les indicateurs de notoriété appliqués à la publication scientifique en pharmacie.

OBJECTIVES: Evaluate the level of knowledge and perceptions of French and Quebec hospital's pharmacists/residents about bibliometrics indicators applied in pharmacy. Identify the determinants associated with this knowledge. METHODS: This is a descriptive cross-sectional study. An anonymous questionnaire of 17 questions answers was developed. The questionnaire was published on the SurveyMonkey site (www.SurveyMonkey.com, SurveyMonkey, Portland, OR, USA) and released from March 19 to April 9, 2018. We calculated and compared the proportion of respondents in Quebec and France by using a Chi2 test. A value less than 0.05 is considered statistically significant. RESULTS: A total of 899 pharmacists (646 in Quebec and 253 in France) and 147 residents (70 in Quebec and 77 in France) were contacted by email. The survey was completed by 401 respondents, e.g., 301 in Quebec (participation rate: 42%) and 100 in France (30%). Overall 26% (106/401) of respondents (67/301 in Quebec vs. 39/100 in France) reported having knowledge or good knowledge of those indicators. These data are corroborated by many other results. CONCLUSIONS: Small proportions are aware of those indicators. A good knowledge is associated with being a French pharmacist, working in a teaching hospital or university, having a professional experience of 10 years or more, be involved in a research project, having a scientific watch or having an online profile on database. It appears necessary to inform pharmacists and residents on notoriety indicators.

[The roles and the impacts of pharmacists in the management of medical devices at the hospital: A literature review]. / Rôles et retombées des pharmaciens dans la gestion des dispositifs médicaux en établissement de santé : une revue de littérature.

OBJECTIVES: Identify the training profile and the published evidences about the roles and the impacts of hospital pharmacists in medical devices. METHODS: A literature review was conducted using Google, Google Scholar and Pubmed for 1990-2016 associated with a manual search conducted in three non-indexed pharmaceutical journals for 2000-2016. RESULTS: The analysis of training programs available did not allow us to identify a specific training profile. A total of 72 articles related to the roles and the impacts of the pharmacist were identified, 52 of which came from non-indexed journals. Those articles did not deal specifically about the roles and the impacts of pharmacist; however, articles were analyses for three spheres including the referencing of medical devices (n=36), the evaluation (n=19) and the distribution system (n=13). CONCLUSIONS: French pharmacists have many theoretical and practical training opportunities. There are a few articles describing precisely the roles and the impacts of hospital pharmacists in medical device. It appears urgent to better document this activity in professional and indexed literature.

[The law number 2005-370 of April 22, 2005 concerning the patients' rights at the end of life: a case of prehospital medicine]. / Loi no 2005-370 du 22avril 2005 relative aux droits des malades et à la fin de vie : application à un cas de médecine préhospitalière.

The law number 2005-370 of April 22, 2005 concerning the patients' rights at the end of life imposes from now the refusal of futility of care, a shared decision-making in unconscious patients and the duty of a palliative strategy. Our observation underlines the feasibility to withhold or withdraw life-sustaining treatments in prehospital area, in following the different steps of the legal decision-making process. However, this case also shows the major difficulty to decide, because of a lack of traceability. Finally, this case illustrates the current difficulty to identify or to join the consultant, provided by the law.

[The law number 2005-370 of April 22, 2005 concerning the patients' rights at the end of life: a case of polytrauma]. / Loi n(o) 2005-370 du 22 avril 2005 relative aux droits des malades et à la fin de vie: application à un cas de polytraumatisme.

The law number 2005-370 of April 22, 2005 concerning the patients' rights at the end of life imposes from now the refusal of futility of care, a shared decision-making in unconscious patients and the duty of a palliative strategy. We describe a case of polytrauma, for which the shared decision-making process led to a palliative strategy after initial aggressive life-support treatments. This case underlines the need for a two-step model of decision-making process, which distinguishes between goals of care and withdrawal or withholding of life support. It suggests that implementation of written procedures could improve the quality of management at the end of life and traceability of decisions.

Participation of French general practitioners in end-of-life decisions for their hospitalised patients.

BACKGROUND AND OBJECTIVE: Assuming the hypothesis that the general practitioner (GP) can and should be a key player in making end-of-life decisions for hospitalised patients, perceptions of GPs' role assigned to them by hospital doctors in making withdrawal decisions for such patients were surveyed. DESIGN: Questionnaire survey. SETTING: Urban (districts located near Paris) and rural (southern France) areas. PARTICIPANTS: GPs. RESULTS: The response rate was 32.2% (161/500), and it was observed that 70.8% of respondents believed that their participation in withdrawal decisions for their hospitalised patients was essential, whereas 42.1% believed that the hospital doctors were sufficiently skilled to make withdrawal decisions without input from the GPs. Most respondents were found to believe that they had the necessary skills (91.9%) and enough time (87.6%) to participate in withdrawal decisions. The last case of treatment withdrawal in hospital for one of their patients was described by 40% (65/161) of respondents, of whom only 40.0% (26/65) believed that they had participated actively in the decision process. The major factors in the multivariate analysis were the GP's strong belief that his or her participation was essential (p = 0.01), information on admission of the patient given to the GP by the hospital department (p = 0.007), rural practice (p = 0.03), visit to the patient dying in hospital (p = 0.02) and a request by the family to be kept informed about the patient (p = 0.003). CONCLUSION: Strong interest was evinced among GPs regarding end-of-life issues, as well as considerable experience of patients dying at home. As GPs are more closely corrected to patients' families, they may be a good choice for third-party intervention in making end-of-life decisions for hospitalised patients.

[A case of atypical cryptogenic organising pneumonitis during pregnancy]. / Un cas atypique de pneumopathie organisée cryptogénique au cours d'une grossesse.

Cryptogenic organising pneumonitis (COP) is now a well defined clinico-pathological entity. It may be idiopathic or secondary to infection, a drug reaction or a connective tissue disorder. Corticosteroid treatment is remarkably effective. We describe a case of COP occurring during the course of an acute respiratory distress syndrome in a pregnant woman. The unusual association of blood and pulmonary eosinophilia leads us to envisage a borderline form of COP and eosinophilic pneumonitis. Other unusual features were the poor response to steroids and the rapid improvement following death of the foetus.

Decision-making capacity and surrogate designation in French ICU patients.

OBJECTIVE: To evaluate the capacity and willingness of French-speaking patients to designate a surrogate within 24 h of their ICU admission. French laws fail to indicate what should be done when an otherwise legally competent patient transiently loses his decision-making capacity. DESIGN: Surrogate designation was prospectively evaluated during two study periods. Only conscious patients were assessed using the Glasgow Come Score in the first study period, and all admitted patients were assessed in the second period. Decision-making capacity was evaluated using the Mini Mental Status Examination (MMSE) in the second study period. SETTING: Twenty six-bed intensive care unit (ICU) in a French teaching hospital. PATIENTS AND PARTICIPANTS: Over a 8-month period 495 patients were included in the study, 415 in the first study period and 80 in the second. MEASUREMENTS AND RESULTS: Of the 495 patients 185 (37.3%) were interviewed, and 62.7% designated a surrogate. The surrogate was the spouse in 50% of cases and a child in 28.4%. Only 25.8% were considered to have decision-making capacity; 78.1% of competent patients and 28% of the patients without decision-making capacity agreed to designate a surrogate. CONCLUSIONS: Surrogate designation by a patient should be evaluated in the light of the decision-making capacity of the patient. The traditional French paternalism still practiced by many French physicians appears out of tune with the wishes of their patients. We suggest that there is a need for developing a simple and effective tool for assessing decision-making capacity in ICU patients.

Withholding and withdrawal of life support in intensive-care units in France: a prospective survey. French LATAREA Group.

BACKGROUND: In France, there are no guidelines available on withholding and withdrawal of life-sustaining treatments, and information on the frequency of such decisions is scarce. METHODS: We undertook a prospective 2-month survey in 113, of a total of 220, intensive-care units (ICUs) in France to study the frequency of, and processes leading to, decisions to withhold and withdraw life-sustaining treatments. FINDINGS: Life-supporting therapies were withheld or withdrawn in 807 (11.0%) of 7309 patients (withholding in 336 [4.6%] and withdrawal in 471 [6.4%], preceded in 358 by withholding). Of 1175 deaths in ICU, 628 (53%) were preceded by a decision to limit life-supporting therapies. Futility and poor expected quality of life were the most frequently cited reasons. Decisions were strongly correlated with the simplified acute physiological score, but an independent centre effect persisted after adjustment for this score. Decisions were mostly taken by all the ICU medical staff, with (54%) or without (34%) the nursing staff; however, a single physician made decisions in 12% of cases. The patient's family was involved in the decision-making process in 44% of cases. The patient's willingness to limit his or her own care was known in only 8% of the cases; only 0.5% of the patients were involved in decisions. INTERPRETATION: Withholding and withdrawal of life-support therapies are widely practised in French ICUs, despite their prohibition by the French legislation. The lack of an official statement from French scientific bodies may explain several limitations on the various steps of the decision-making process.

Nosocomial pneumonia with isolation of anaerobic bacteria in ICU patients: therapeutic considerations and outcome.

PURPOSE: Evaluate the influence of the anti-anaerobic antimicrobial therapy in the outcome of patients with nosocomial pneumonia. MATERIALS AND METHODS: The population study included 53 intensive care unit patients with nosocomial pneumonia in whom, using a protected specimen brush, anaerobic bacteria were isolated, which were associated or not with aerobes. Current and empirical antibiotherapies were retrospectively analyzed, regarding their efficacy against anaerobic bacteria. Since it was debated, sensitivity to cefotaxime, ceftazidime, and ciprofloxacin was determined in 38 strains of Prevotella species. Outcome was evaluated 10 days after the day of protected specimen brushes. Improvement was defined as a decrease of Murray score or ventilator weaning. RESULTS: The most frequently isolated bacteria were Prevotella species, which were more frequently resistant to cefotaxime (37%), ceftazidime (50%), and ciprofloxacine (32%) than usually reported in the literature. Sixty-six percent of these strains produced beta-lactamase. The effect of empirical anti-anaerobic antibiotherapy on the outcome at day 10 was evaluable in 39 patients. Twenty-nine patients were improved and 10 patients worsened. Interestingly, patients who had received well-adapted antibiotics against anaerobes had a better outcome after 10 days (P < .02). CONCLUSIONS: This study suggests that specific antianaerobic therapy may be considered in the choice of empirical antibiotherapy in patients with nosocomial pneumonia.