Appropriateness of proton pump inhibitors prescription in patient admitted to hospital: An observational study.

OBJECTIVES: The objective of this study was to assess the relevance of proton pump inhibitors prescribing in patients entering a ward with a clinical pharmacist and therefore identifying inappropriate prescribing. METHODS: A prospective study was conducted for 4 months. Patients admitted to the hospital for elective or emergency surgery, who had medication reconciliation performed by the clinical pharmacy team and who were prescribed proton pump inhibitors before admission were included. The indication for the proton pump inhibitors was collected from the patient or inferred from the medical history. The compliance of the prescriptions with the marketing authorization indications and the duration of treatment and dose was analyzed. The indications were classified into 3 groups: compliant with marketing authorization, off label but relevant use, and strictly off label use. RESULTS: During the study period, 100 patients were included among whom only 29% had a PPI prescription that did fully comply with the recommendations. Among the twenty-three prescriptions that did not comply with the recommendations in terms of indication, 15 were not relevant at all. Among the 65 prescriptions relevant for indication, 36 were not compliant with dose or duration recommendations. 59% of the total number of patients reported that they had never tried to stop treatment. CONCLUSIONS: Our study highlights the need for regular reassessment of proton pump inhibitors prescriptions. Multi-disciplinary collaboration on the appropriate use of this class of medication as well as increased awareness among general practitioners and hospital doctors is essential.

Compliance with antibiotic prophylaxis guidelines in surgery: Results of a targeted audit in a large-scale region-based French hospital network.

INTRODUCTION: While regional monitoring of antibiotic use has decreased since 2011 by 3.2%, in some healthcare facilities a significant increase (+43%) has occurred. The purpose of this study was to assess regional antibiotic prophylaxis (ABP) compliance with national guidelines. MATERIAL AND METHODS: In 2015, 26 healthcare facilities, both public and private, were requested to audit five items: utilization of antibiotic prophylaxis, the antimicrobial agent (the molecule) administered, time between injection and incision, initial dose, number of intraoperative and postoperative additional doses. Seven surgical procedures were selected for assessment: appendicectomy (APP), cataract (CAT), cesarean section (CES), colorectal cancer surgery (CCR), hysterectomy (HYS), total hip arthroplasty (THA) and transurethral resection of the prostate (TURP). A statistical analysis of the 2303 records included was carried out. RESULTS: The general rate of antibiotic prophylaxis compliance was 64%. The antimicrobial agent used and initial dose were in compliance with the guidelines for 93% and 97.4% of cases respectively, and administration of antibiotic prophylaxis was achieved 60minutes before incision in 77.6% of the records included. Regarding gastrointestinal surgery, amoxicillin/clavulanic acid was used in 32% of patients. In 26% of appendectomy files, administration occurred after incision, and one out of two files showed non-complaint perioperative and postoperative consumption. CONCLUSION: Compliance with nationwide ABP guidelines is in need of pronounced improvement, especially with regard to time interval between injection and incision and the molecule prescribed. An action plan based on specific recommendations addressed to each establishment and an updated regionwide ABP protocol are aimed at achieving better and reduced consumption of antimicrobial agents.

Time measurement in the photoperiodic induction of sexual rest in the terrestrial isopod Armadillidium vulgare (Latreille).

The photoperiodic control of sexual rest in Armadillidium vulgare was investigated using various experimental protocols. When reared in conditions of a Nanda-Hamner (i.e. resonance) protocol from their first parturial moult to their post experimental moult, females showed a weak resonance effect in sexual rest incidence. The transfer from a long day cycle to a symmetrical skeleton photoperiod--consisting of two equal light pulses per 24 h of continuous darkness--revealed the involvement of a circadian oscillatory system in the photoperiodic clock of this species. The data, obtained in the whole experiments, suggested that both oscillator and hourglass features are involved in the photoperiodic response controlling the sexual rest in Armadillidium vulgare. Moreover, when non-24-h light-dark cycles (with a long photophase) were applied, a mechanism responsible of arrest of reproduction also implied a photoperiodic counter which accumulated and added up the photoperiodic information within a sensitive period during post parturial intermoult.

The myocardial plasma membrane during development: influence of glutaraldehyde fixation on the density and size of intramembranous particles.

The ultrastructure of the plasma membrane of mouse myocardial cells has been studied during development (from 10 days post-coïtum to the adult stage) using the freeze-cleave method, and the effect of glutaraldehyde-fixation on this structure has also been evaluated. Blebs, free of intramembranous particles (IMP), were found to be dependent upon the developmental stage and upon fixation with glutaraldehyde. On P and E fracture faces, the presence of IMP-free areas was age-dependent and fixation-independent. No difference was demonstrated in the IMP density during heart development. Fixation with glutaraldehyde retains in the plasma membrane approximately 40% of IMP, probably by preventing an alteration induced by glycerol. Whatever the developmental stage, E face-associated particles are significantly larger than P face-associated particles. The diameter of both types of particle increases slightly but irregularly as myocardial cells mature. Fixation reduces the particle size on both fracture faces in such a way that no significant difference between them can be demonstrated.

Formation and growth of gap junctions in mouse myocardium during ontogenesis: a freeze-cleave study.

The freeze-cleave technique demonstrates the presence of gap junctions at early stages of mouse cardiac muscle ontogenesis. The formation and growth of these junctions were studied at 4 stages of development: 10, 14, 18 days post-coitum (dpc) and at the adult stage. The diverse aspects of the gap junctions are interpreted as different steps in their formation. The first indication of this formation seems to be the presence of linear arrays of 9-nm particles on PF faces. At one end of these arrays a small aggregate of particles appears which acts as nucleation site and grows by incorporating individual gap particles and/or linear arrays. Nexuses with arms and/or central particle-free zones would represent intermediate steps in the formation of junctions. The largest nexuses could be formed by fusion of smaller ones and/or by accretion of gap particles. Analysis of the size distribution of gap junctions shows their growth during their development. At 10 dpc the surface area (S) of nexuses ranges from 0.1 to 3 x 10(-2) micrometer2, at 14 dpc from 0.1 to 15 x 10(-2) micrometer2, at 18 dpc from 0.1 to 26 x 10(-2) micrometer2, and at the adult stage from 0.1 to 54 x 10(-2) micrometer2. The percentage of large nexuses (Sgreater than 0.5 x 10(-2) micrometer2) steadily increases from 10 dpc to the adult stage. Fixation by glutaraldehyde before glycerol infiltration does not induce any modification in the size distribution of adult heart gap junctions.