Ketamine and magnesium association reduces morphine consumption after scoliosis surgery: prospective randomised double-blind study.

BACKGROUND: Scoliosis repair is a major orthopaedic surgery associated with severe post-operative pain. Ketamine and magnesium have an established efficacy as morphine-sparing agents. Our purpose was to evaluate the morphine-sparing effect of both magnesium and ketamine given simultaneously compared with ketamine alone during scoliosis surgery. METHODS: Fifty patients scheduled for posterior instrumentation were randomised in a prospective double-blind study. The Gr (K + Mg) received, after induction, an intravenous (IV) bolus of ketamine 0.2 mg/kg and magnesium 50 mg/kg, followed by continuous infusion of ketamine (0.15 mg/kg/h) and magnesium (8 mg/kg/h) until extubation. The Gr (K) received the same dose of ketamine associated with bolus and continuous infusion of normal saline. All patients received multimodal analgesia associated with IV morphine administered via patient-controlled analgesia pump. Morphine consumption, visual analogue scale (VAS) pain scores and occurrence of side effects were followed until 48 h post-operatively. Sleep quality and patient satisfaction were also followed. P < 0.05 was considered statistically significant. RESULTS: The average cumulative morphine consumption was significantly lower in the Gr (K + Mg) compared with the Gr (K) at post-operative hours 4, 8, 12, 18, 30, 36 and 48. The relative difference in the post-operative morphine consumption was 29.5%: Gr (K + Mg) 51.53 mg vs. Gr (K) 73.16 mg. VAS scores were not statistically different between the two groups. However, qualities of sleep and satisfaction scores on the first night were significantly better in the Gr (K + Mg) (P = 0.027 and P = 0.016, respectively). CONCLUSION: Ketamine and magnesium association reduces the post-operative morphine consumption after scoliosis surgery. It seems to provide a better sleep quality and improves patient satisfaction.

Assessing the impact of the presence of pharmacists in a clinical department of a Lebanese hospital.

BACKGROUND: Clinical pharmacy services are still in their very early implementation stages in Lebanon. The objective of this pilot study was to evaluate the impact of clinical pharmacist's presence at the infectious diseases department of Hôtel-Dieu de France University Hospital of Beirut (HDF) and to evaluate the acceptance of pharmacist's interventions by healthcare providers. MATERIAL AND METHODS: A 21-month prospective analysis was conducted, including 240 hospitalized patients in the infectious diseases department of HDF and 475 interventions performed by the pharmacist. A clinical pharmacist and pharmacy residents were present for 1 to 2hours/day in the ward. A pharmaceutical care plan was established and used to document patients' problems and pharmacist's interventions. Main criteria analyzed were: types and frequencies of pharmaceutical problems detected, types of pharmaceutical interventions performed, their acceptance by the prescribers and/or nurses, and factors affecting the interventions and their acceptance. RESULTS: The most frequent pharmaceutical problem detected was incorrect dosage and the three most frequent interventions performed by the pharmacist were stop/start/substitute a drug, change drug dosage/or daily distribution, and change administration time. The acceptance was the highest for I.TIM (change drug administration time) and the lowest for I.FOL (request a lab test/exam/clinical follow-up). DISCUSSION AND CONCLUSION: Even a short daily pharmacist's presence is an added value in inpatient care at the infectious diseases department of Hôtel-Dieu de France University Hospital. Areas of improvement are a better communication between the pharmacist and the prescribers, a direct contact between pharmacist and patient and a longer presence of the clinical pharmacist in the clinical department.

Association between adherence, treatment satisfaction and illness perception in hypertensive patients.

The relationship between adherence to antihypertension medications, treatment satisfaction and illness perception has not been studied so far. The primary objective of this study was to examine the association between adherence to medication, treatment satisfaction and illness perception in Lebanese hypertensive patients. The relation between medication adherence and blood pressure (BP) control was also assessed. In this cross-sectional study, patients were recruited from the physician's practice offices and community pharmacies in Beirut. Patients who had been treated for hypertension for at least 3 months were invited to participate in the study; they completed three questionnaires: the 8-item Morisky Medication Adherence Scale (MMAS-8), the Treatment Satisfaction Questionnaire for Medication (TSQM-4) and the Brief Illness Perception Questionnaire (BIPQ). BP was also measured and recorded. A total of 117 subjects were included, of whom 29.1% had poor adherence to their antihypertension treatment (MMAS-8 scores<6). The odds of having well-controlled hypertension was 3.5 times higher in patients with high adherence compared with patients with poor adherence (P=0.010). Treatment satisfaction was significantly greater in patients with good adherence (P<0.001). Neither socio-demographic, disease- nor drug-related characteristics of the participants were significantly associated with medication adherence. As for illness perception, even though the mean BIPQ score of adherent participants was lower than the mean score of non-adherent participants, this difference did not reach statistical significance. In conclusion, treatment satisfaction was found to be a predictor of adherence. Studies are needed to determine whether interventions to increase satisfaction can improve adherence and BP control.