Attitude of community pharmacists toward patients with a substance-related disorder (heroin, alcohol and tobacco), estimation of harmfulness and knowledge of these substances, and continuing education: A pilot cross-sectional study.

OBJECTIVES: To investigate attitude of community pharmacists toward patients with a substance-related disorder (heroin, alcohol and tobacco). MATERIAL AND METHODS: The attitudes were assessed thanks to the Attitude to Mental Illness Questionnaire (AMIQ) for heroin, alcohol and tobacco-related disorders in three independent groups of pharmacists. Estimation of substance-related harmfulness, knowledge of substance-related disorders and activities/needs for continuing education on substance-related disorders were also recorded. RESULTS: Thirty-five pharmacists were included (heroin: 11, alcohol: 10 and tobacco: 14). AMIQ scores for heroin-related disorder were negative and lower than for alcohol (P<0.01) and tobacco (P<0.001). AMIQ scores for alcohol-related disorder were lower than for tobacco (P<0.05). The estimation of heroin-related harmfulness was higher than for alcohol and tobacco (P<0.001). The estimations of knowledge of substance-related disorders were lower for opioid and alcohol than for tobacco (P<0.001). AMIQ scores and the needs for continuing education on each associated addiction showed a positive relation (P<0.01). CONCLUSION: Pharmacists had a negative attitude toward heroin and alcohol-related disorders. A positive attitude toward patients with a substance-related disorder was associated with a need for continuing education. Efforts should be made to change attitudes and to promote continuing education on heroin and alcohol-related disorders.

Assessing the validity of the clinician-rated distress thermometer in palliative care.

BACKGROUND: The distress of patients suffering from a terminal illness can lead to a state of despair and requests for euthanasia and assisted suicide. It is a major challenge for palliative care workers. The Distress Thermometer (DT) is recommended by the National Comprehensive Cancer Network as a means of more easily assessing distress. It is available as a Self-assessment reported Distress Thermometer, but for a wider use in palliative care it should also be implemented in the form of a clinician-reported outcome (clinRO). Clinicians need to rate patient's distress when the patient is not able to do so (subject that cannot be addressed, defensive patient…). The primary aim of the quantitative study was to assess the validity of the Clinician-Rated Distress Thermometer in palliative care. METHOD: The assessments were performed by teams working in three palliative care centres. The primary endpoint was concordance between the patient and clinicians' responses via Lin's concordance coefficient. Eligible patients were aged 18 years or older, suffering from a severe disease in the palliative phase, and with a sufficient level of awareness to consent to participate in the study. A total of 51 patients were recruited, 55% were male, with a mean age of 65.8 years [39-90 years]. RESULTS: Three hundred sixty-four clinician-Rated Distress Thermometer and 467 Self-Reported Distress Thermometer were performed. Only 364 of the 467 Self-Reported Distress Thermometer were used for the study, as investigators did not systematically ask the patient to give an account of his distress. Concordance between patient and clinician responses: The Lin's concordance coefficient with a threshold (alpha) of 5% was 0.46 [0.38; 0.54]. At the first assessment, it was 0.61 [0.44; 0.79]. The Cohen's kappa coefficient was 0.52, with a concordance rate of 79.6%. The sensitivity was 82.9% [66.4-93.4] and the specificity 71.4% [41.9-91.6]. CONCLUSION: The first assessment gave the best results in terms of concordance between Clinician-Rated DT and Self-Reported DT. In the next assessments, the Clinician-Rated DT were less consistent with the patients' Self-Reported DT.

IPADAM "Pharmaceutical interventions on the issue of pharmaceutical records and self-medication" quanti survey in 482 French pharmacies.

OBJECTIVES: This study aims to: (i) quantify the number of pharmaceutical interventions (PIs) linked to spontaneous requests for the two oral target molecules, ibuprofen and pseudoephedrine (ii) analyse the causes and proposed solutions (iii) quantify the number of registrations in the patient's pharmaceutical record and identify the various causes of non-registration. METHODS: The study was conducted over a 2 weeks' period in the months of February and April 2014 in 482 pharmacies affiliated to the training supervisor associations of 8 French Faculties of Pharmacy. Data regarding spontaneous requests for the target molecules was collected, with due respect to a patient care flow chart at the pharmacy, by incorporating the systematic proposal for registration of the medication in the patient's pharmaceutical record. Each PI was the subject of a notification made with reference to a standardized grid. RESULTS: A total of 12,160 dispensations were made over the two weeks of the study. Overall 815 of them gave rise to an PI (6.7%), justified in almost half of the cases by a contraindication. The alternative proposed by the dispensing pharmacist was accepted in more than 9 out of 10 cases. In half of the cases, the dispensing pharmacist had access to the patient's French healthcare card; more than 2/3 of the dispensations thus led to the registration of the medication in the patient's pharmaceutical record. CONCLUSION: The pairing of the two tools, these being the notification grid and the pharmaceutical record, aims to maximize dispensation security while patients are being guided in their approach to self-medication.

[IPADAM quali study. Intervention of the Pharmacist in the Issue of Self-medication: Experience of pharmacy team focus groups and patients' perceptions]. / IPADAM quali « Interventions Pharmaceutiques À propos du Dossier pharmaceutique et de l'AutoMédication ¼ : expérience des équipes officinales et ressenti des patients.

OBJECTIVES: This study had two main aims: (i) document the experience of community pharmacists receiving a spontaneous request for ibuprofen and oral pseudoephedrine, and their use of pharmaceutical records, and (ii) explore patients' perceptions of pharmaceutical records and pharmaceutical interventions. METHODS: The study was conducted over two weeks between February and April 2014 in 482 community pharmacies and 8 French faculties of pharmacy. It was based on data collected by pharmacy team focus groups during patient telephone interviews using standardized question grids. Textual and thematic analyses were made of the patient responses. RESULTS: Four pharmacy team focus groups carried out 49 telephone interviews. Examination of the practice of the groups showed that pharmaceutical interventions, although incompletely registered, are performed on a daily basis and enhance the value of the pharmacist's function. Analysis of the telephone interviews also showed the importance of the advisory role of the pharmacist in dispensing an optional medical prescription. The thematic analysis of the results identified a positive response of patients to pharmaceutical interventions if made by their regular pharmacist and accompanied by explanatory information. The focus groups and patients agreed that pharmaceutical records were not consulted often enough. CONCLUSION: This study underlines the need for greater safety in the use of optional medical prescription drugs. Promoting responsible self-medication in compliance with proper use should include systematic reference to a PR and informed dialogue with the patient.

[Pharmacist's interview with type 2 diabetes: Development of a follow-up form]. / L'entretien pharmaceutique pour le patient diabétique de type 2 : élaboration d'une fiche de suivi.

OBJECTIVES: Type 2 diabetes is a major public health concern because of its prevalence, the severity of complications and the financial implications. Compliance and patient's autonomy in medications intake play key roles in the success of treatment. Pharmacists' interviews ensure an optimized and individual follow-up. Type 2 diabetes is not one of the targeted diseases to perform pharmacists' interviews on under Health Insurance. We thus judged useful to contribute to their development. METHODS: We applied a cross-disciplinary methodological process in order to define the specifications of the follow-up form useful to conduct the pharmacist's interview 1 by focusing on the identification of a non-compliance and its origins. A feasibility study was carried out in order to check its workability to the pharmacy practice. RESULTS: The follow-up form, associated with a pharmacist practical guide, includes 3 parts: (1) General informations, (2) Survey establishing patient's knowledge, (3) Summary including a level of knowledge assessment grid. Outcomes provide a long but appropriate-felt duration, few difficulties to conduct the interview and a proven usefulness in 90% of all cases that make the follow-up form suitable to the pharmacy practice. CONCLUSIONS: This tool could serve as a model for the pharmacist to conduct his future interviews for the type 2 diabetes patients, thus improving patient care, together with other health professionals.

Benzodiazepine dependence: focus on withdrawal syndrome.

Benzodiazepines are potentially addictive drugs: psychological and physical dependence can develop within a few weeks or years of regular or repeated use. The socioeconomic costs of the present high level of long-term benzodiazepine use are considerable. These consequences could be minimised if prescriptions for long-term benzodiazepines were decreased. However, many physicians continue to prescribe benzodiazepines and patients wishing to withdraw receive little advice or support. Particular care should be taken in prescribing benzodiazepines for vulnerable patients such as elderly persons, pregnant women, children, alcohol- or drug-dependent patients and patients with comorbid psychiatric disorders. The following update gives recent research results on the withdrawal pathophysiology and practical information in order to treat or prevent benzodiazepine withdrawal syndrome.

[Oral freeze-dried forms of procyanidins]. / Mise au point de lyophilisats oraux de procyanidines.

Oral freeze-dried forms based on procyanidins were prepared. Effort was focused on the choice of the binder and the determination of the optimal conditions of freeze-drying.

[Standardization of propolis extract and identification of principal constituents]. / Standardisation d'un extrait de propolis et identification des principaux constituants.

Preparation of a propolis extract was codified, conditions of pulverization, extraction and treatment of the extractive solution are specified. The wounds healing properties of this extract are related to flavonoids and phenolic acids, which were identified by TLC.

Skin healing preparations: compared in vitro diffusion of the active ingredients.

We have developed skin healing preparations based on propolis extract:ointments, emulsions, and transparent oil-water (TOW) gels. The formulations were optimized in terms of macroscopic characteristics including spreadability and penetrability, and limpidity and isotropy for the TOW gels. We describe here the results of a study of in vitro diffusion of the active ingredients, flavonoids, and phenolic acids, from some of the preparations we developed. These results show the influence of the dosage form and the choice of excipients on the release of the active product. The least satisfactory results were obtained for hydrophobic ointments and o/w emulsions. The strongest diffusion was obtained with a TOW gel associating isopropyl palmitate, Eumulgin B3, and Cetiol HE.

Procyanidins from tormentil: fractionation and study of the anti-radical activity towards superoxide anion.

A standardised water-soluble extract was prepared from rhizomes of Potentilla tormentilla. The procyanidins in the extract were fractionated according to their degree of polymerisation by chromatography on Sephadex LH20. The anti-radical activities of the different fractions towards superoxide anion were compared when pentamers and hexamers were found to be the most active.

Functionalization of hydrocolloids: principal component analysis applied to the study of correlations between parameters describing the consistency of hydrogels.

This work was part of a pure research project on the functionalization of three families of hydrocolloids: cellulose derivatives, carrageenates, and alginates. Principal component analysis (PCA), a powerful statistical method, was used to demonstrate the relations existing among these different parameters that describe the consistency of hydrogels and their spreadability. This approach therefore provides a basis for modeling hydrogel consistency. PCA also afforded a classification of hydrogels that demonstrated the remarkable adhesiveness of very stiff gels based on cellulose derivatives and sodium or potassium alginates. The corresponding semi-fluid gels and all the gels based on carrageenates and mixed sodium-calcium alginates, whatever their spreadability, were found to be very poorly adhesive. Generalized to all the many colloids currently marketed, this approach can be used to set up a databank for the formulation of mucoadhesive excipients.

Comparative texturometric analysis of hydrogels based on cellulose derivatives, carraghenates, and alginates: evaluation of adhesiveness.

This paper reports a texturometric study of hydrogels based on cellulose derivatives, carraghenates (with or without Na+ or K+), and alginates (associated or not with Ca++). The stiffness, elasticity, and cohesiveness are evaluated and the influence of the nature and the concentration of gelling agent on the adhesiveness, an indicator of bioadhesion, is discussed. The highest adhesiveness values are found among the semi-stiff gels, particularly with those based on either sodium or potassium alginate, or cellulose derivatives. The least satisfactory results are obtained with the formulations associating carraghenates and Na+ or K+.

Tannins from Hamamelis virginiana: identification of proanthocyanidins and hamamelitannin quantification in leaf, bark, and stem extracts.

The tannins in leaf, bark, and stem extracts of HAMAMELIS VIRGINIANA were analyzed. Four proanthocyanidins were isolated by HPLC. One was a procyanidin polymer containing only one type of flavanol unit; the other three were polymers of procyanidin and prodelphinidin containing two types of flavanol units. A method of assay of hamamelitannin showed the bark extract to be 31 times richer in hamamelitannin than the leaf extract and 87 times richer than the stem extract.

Anti-ulcer activity of procyanidins preparation of water-soluble procyanidin-cimetidine complexes.

The anti-ulcer properties of water-soluble procyanidins prepared by fermentation of tannins from Fragaria vesca were studied. Complexes of procyanidins and cimetidine were prepared. The procyanidins increased the water-solubility of the cimetidine and may prevent undesirable nitrosamine formation in the stomach as they block its cyanamide function.

Procyanidins from tormentil: antioxidant properties towards lipoperoxidation and anti-elastase activity.

Procyanidins extracted from the rhizomes of Potentilla tormentilla were fractionated according to their degree of polymerization by chromatography on Sephadex LH20. Dimers and trimers displayed the highest anti-radical activity towards lipoperoxidation. Pentamers and hexamers possessed the most marked anti-elastase properties.