Prescriptions analysis by clinical pharmacists in the post-operative period: a 4-year prospective study.

BACKGROUND: Clinical pharmacists can help prevent medication errors. However, data are scarce on their role in preventing medication prescription errors in the post-operative period, a high-risk period, as at least two prescribers can intervene, the surgeon and the anesthetist. We aimed to describe and quantify clinical pharmacist' intervention (PIs) during validation of drug prescriptions on a computerized physician order entry system in a post-surgical and post-transplantation ward. We illustrate these interventions, focusing on one clearly identified recurrent problem. METHODS: In a prospective study lasting 4 years, we recorded drug-related problems (DRPs) detected by pharmacists and whether the physician accepted the PI when prescription modification was suggested. RESULTS: Among 7005 orders, 1975 DRPs were detected. The frequency of PIs remained constant throughout the study period, with 921 PIs (47%) accepted, 383 (19%) refused and 671 (34%) not assessable. The most frequent DRP concerned improper administration mode (26%), drug interactions (21%) and overdosage (20%). These resulted in a change in the method of administration (25%), dose adjustment (24%) and drug discontinuation (23%) with 307 drugs being concerned by at least one PI. Paracetamol was involved in 26% of overdosage PIs. Erythromycin as prokinetic agent, presented a recurrent risk of potentially severe drug-drug interactions especially with other QT interval-prolonging drugs. Following an educational seminar targeting this problem, the rate of acceptation of PI concerning this DRP increased. CONCLUSION: Pharmacists detected many prescription errors that may have clinical implications and could be the basis for educational measures.

Effectiveness of pulmonary rehabilitation in COVID-19 respiratory failure patients post-ICU.

INTRODUCTION: Some COVID-19 patients develop respiratory failure requiring admission to intensive care unit (ICU). We aim to evaluate the effects of pulmonary rehabilitation (PR) post-ICU in COVID-19 patients. METHODS: Twenty-one COVID-19 patients were evaluated pre- and post-PR and compared retrospectively to a non-COVID-19 group of 21 patients rehabilitated after ICU admission due to respiratory failure. RESULTS: PR induced greater 6-min walking distance improvement in COVID-19 patients (+205 ± 121 m) than in other respiratory failure patients post-ICU (+93 ± 66 m). The sooner PR was performed post-ICU, the better patients recovered. CONCLUSIONS: PR induced large functional improvements in COVID-19 patients post-ICU although significant physical and psychosocial impairments remained post-PR.

Management of psychiatric disorders and addictive behaviors in patients with viral hepatitis C in France.

INTRODUCTION: Guidelines concerning the management of psychiatric disorders and addictive behaviors in patients with chronic hepatitis C and the conditions of collaboration between hepatogastroenterologists, infectiologists, psychiatrists and psychologists have not been published. This has a negative influence on optimal therapeutic management of chronic hepatitis C virus (HCV) infection. The aim of this study was to describe the current clinical practices for ambulatory management of psychiatric disorders and addictions, and the influence of a possible psychiatric and/or psychological collaboration. PATIENTS AND METHODS: A retrospective survey was conducted among 101 clinicians treating patients with chronic hepatitis C. Data were collected from personal interviews with the managing clinicians and from the files of patients with chronic hepatitis C patients who presented psychiatric disorders. RESULTS: Analysis of the 101 interviews and 598 patient files showed that 19% of patients had not received an optimal treatment for their HCV infection because of a psychiatric problem, and that less than 50% of the managing clinicians were working in collaboration with a psychiatrist or a psychologist. In conclusion, lack of collaboration between hepatogastroenterologists and psychiatrists could be deleterious for the optimal treatment of HCV infected patients. Improvement is required.

[Management of patients with hepatitis C by French psychologists and psychiatrists: a practical investigation]. / Prise en charge des patients atteints d'hépatites C par les psychiatres et les psychologues: une enquête de pratique.

INTRODUCTION: A first part of this survey showed that up to 19% of patients with hepatitis C virus did not receive optimal treatment because of a psychiatric problem (psychiatric disorders or addictive behaviours) and that less than 50% of the managing clinicians worked with a psychiatrist or a psychologist in these cases. The aim of the second part of the survey was to describe the current practices provided by the psychiatrists and the psychologists to HCV infected patients as well as the knowledge and expectations of professionals in this area. PATIENTS AND METHODS: Forty-seven psychiatrists and 43 psychologists who were or were not working with French reference poles for hepatitis C virus responded to a questionnaire of their practices. RESULTS: Analysis of the 90 questionnaires showed that psychiatric and/or psychological care was not systematic. Psychiatrists and psychologists should be given more information and specific training about this topic. CONCLUSION: Psychiatric and psychological care of chronic hepatitis C virus infected patients should be improved. French reference poles should also become "references" for psychiatric care.

Acute fatal pulmonary embolism during cyanoacrylate injection in gastric varices.

We report a case of massive pulmonary embolism during cyanoacrylate glue endoscopic injection in a patient with gastric varices from portal hypertension. A review of the literature and results in an animal model show the physiopathology and risk factors associated with this endoscopic procedure.

[Anaesthesia for a non cardiac surgery in a patient with an Eisenmenger syndrome. Interest of a non invasive haemodynamic monitoring]. / Anesthésie pour une chirurgie non cardiaque chez une patiente avec un syndrome d'Eisenmenger. Intérêt de la surveillance hémodynamique non invasive.

Patients with an Eisenmenger syndrome have an instuble hemodynamic status. During a general anaesthesia, the intracardiac shunt has to maintain the correct orientation and volume, adapted to each patient, in such a condition, to avoid the risk of hypoxemia and cardiac failure. The haemodynamic monitoring with a Swan Ganz catheter could be useful. But it is necessary to evaluate the advantage and the risks when the technique is used in these pathological circumstances. Moreover, when the cardiac output is measured with the thermodilution technique, the right-left intra cardiac shunt volume, is not taking into account. The continuous haemodynamic monitoring, with a simplified transoesophageal echo-Doppler system, as it was done in this case, allows appreciate the real quantitative variations of the shunt. In this way the more adequate calculation of some others haemodynamic parameters, over all the total systemic vascular resistances, allows a more precise therapeutic approach.

[Case report: a bacteremic pasteurellosis]. / Pasteurellose bactériémique: à propos d'un cas.

Bacteremic pasteurellosis is an uncommon form of Pasteurella multocida infection, usually involved in local infections. This systemic infection often occurs in immuno-compromised patient such as cirrhotic or alcoholic patients, with a high mortality rate (up to 60%). Septic shock may occur and neurological disorders or coma are frequent. We report such a case. Treatment associated local care, antibiotics (beta-lactam antibiotics plus fluoroquinolone) during 14 days and resuscitation of septic shock. Owing these therapies, septic shock was successfully treated without complications.

Evaluation of perioperative risk in elderly patients.

From a medical point of view, aging is characterized by a potential failure to maintain homeostasis under conditions of physiological stress. This failure is associated with an increase in vulnerability. Physiological changes associated with aging are progressive but concomitant injury or diseases may rapidly worsen the health status of the patient. Increasing age independently predicts morbidity and mortality. Hypertension and dyspnea are probably two of the most frequent risk factors in elderly patients. The history of the elderly patient should assess functional status, including cardiovascular reserve sufficient to withstand very stressful operations. The type of surgery has important implications for perioperative risk and emergency surgery, particularly in the elderly, is associated with a high risk of morbidity. Elderly patients who are otherwise acceptable surgical candidates should not be denied surgery based solely on their age and concerns for postoperative renal, cardiovascular, cognitive or pulmonary complications. Renal impairment becomes more prevalent with advancing age as the glomerular filtration rate decreases. The surgical site is the single most important predictor of pulmonary complications. Concerning postoperative comfort and neurological complications, age is the highest risk factor for developing dementia. Pain is underassessed and undermanaged. The elderly are at higher risk of adverse consequences from unrelieved or undertreated pain.

[Profile and motivations of students performing a universitary degree in 2011]. / Profil et motivations des étudiants inscrits à un diplôme universitaire en 2011.

OBJECTIVE: Observational study relating to the inscriptions with universitary diplomas (DU) in relation with anesthesiology and intensive care during the year 2010-2011. We had in mind to know the profile and the motivations of the students concerned. METHOD: A questionnaire was put on line and the registered students with the various diplomas were contacted by e-mail. Different items investigated concerned: demography, type of exercise of the students, heading of diplomas, scientific level of the students, their motivations at the time of the inscription and finally practical organization. RESULTS: We collected 265 questionnaires, that is to say 42 % of answers. The demographic distribution of the registered voters was the followed: 71% of MD, 28% of residents. These doctors exerted for the majority with the public hospital (87%). The inscriptions concerned intensive care diplomas in 90% of the cases. The total scientific level of the students was high, since 46% of them had a diploma other than their medicine thesis. The students were registered for the majority of them "to widen their field of competence" (65%) or "in complement of their initial training" (46%). The other reasons were: "to make up a deficit of their initial training (26%)", "as continuous medical training" (16%) and finally "for the university validation of an asset" (10%). The rate of total satisfaction of the diplomas was very high (96%). Financial aid was assumed by the institution for 46% of students. Residents were less financially helped than senior practitioners. The overall costs of the DU/DIU, including the registration fee, transport and lodging, were important (>500 euros in 61% of the cases). CONCLUSION: DUs related to our specialty are much appreciated. They interest a majority of senior doctors, but also a considerable number of residents, which poses the problem of the place of these additional trainings within the framework of initial training. The principal motivations of the registered voters are to supplement their initial training or to widen their field of competence, much more than to make up a deficit of this initial training. Lastly, the total financial expenses associated with these diplomas remain important and appear inversely proportional to the incomes of the registered students.

[Increased troponin I level in a Duchenne muscular dystrophy patient with normal coronarography]. / Elévation de troponine I à coronarographie normale chez un patient porteur d'une myopathie de Duchenne.

Duchenne muscular dystrophy (DMD) is a neuromuscular disease characterized by a progressive skeletal muscular weakness. As the respiratory care of such patients has been dramatically improved during the past few years, the DMD associated cardiomyopathy is becoming a new concern. We report a clinical case of a Troponin I level increase with normal coronarography occurring after an acute episode of respiratory failure. This report suggests the sensitivity of cardiomyocytes to hypoxemia in DMD patients.