[Anti-pneumococcal vaccine coverage for hospitalized risk patients: Assessment and suggestions for improvements]. / Couverture vaccinale anti-pneumococcique chez des patients à risque hospitalisés : évaluation et propositions d'amélioration.

Streptococcus pneumoniae can cause invasive infections. Incidence and severity are linked to patients' risk factors. Due to the resistance to leading antibiotics, the anti-pneumococcal vaccination has become a major public health issue. The purpose of this survey was to evaluate the anti-pneumococcal vaccine coverage in a population of adults with risk factors. This was a prospective study that included patients with at least one recommendation for pneumococcal vaccination as indicated by the Weekly Epidemiological Bulletin (BEH), to which three further US recommendations were added (diabetes, obesity and age>65years). One hundred and thirty-four patients with an average age of 70 years were included. The physician could only confirm 68 % of the patients' vaccination status. Vaccination coverage as recommended by the BEH board was 30 % (n=54). All HIV patients were vaccinated (n=2) and the vaccination coverage was 75 % (n=8) for patients treated for autoimmune diseases and only 10 % (n=20) for patients treated with chemotherapy. Patients with no vaccination didn't know the existence of the vaccine or didn't know that vaccination was recommended to them. This study has highlighted a deficit in pneumococcal vaccination coverage and a high level of ignorance of the existence of recommended vaccination. In addition to awareness campaign for patients and caregiver training, the expansion of the vaccine e-book utilization could improve the vaccination status.

[Treatment of imported Plasmodium falciparum malaria: role of the combination of dihydroartemisinin and piperaquine]. / Traitement du paludisme d'importation à Plasmodium falciparum: place de l'association dihydroartémisinine-pipéraquine.

The dihydroartemisinin-piperaquine combination is an antimalarial agent newly available in Europe. It is an artemisinin-combined therapy (ACT) that has been used for more than 10 years in malaria-endemic areas and is recommended since 2010 by the WHO as a first-line treatment of uncomplicated Plasmodium falciparum malaria. In Europe, it has recently been authorized for the treatment of uncomplicated P. falciparum malaria in adults, children, and infants aged 6 months or older and weighing at least 5 kg. Its efficacy is similar to the combination of artemether and lumefantrine, and the regimen is easier. The tolerability profile is nearly the same as the other ACTs. Prolongation of the QT interval appears to be greater than with the artemether-lumefantrine combination in the first 48 hours of treatment, although no clinical consequences have been described. This side effect requires the use of electrocardiographic monitoring in some patients. A risk management plan has been set up by the manufacturer.

[Evaluation of the performance of transfer devices in a closed system using a radioactive solution of [(99m)Tc]]. / Évaluation de la performance de dispositifs de transfert en système clos au moyen d'une solution radioactive de [(99m)Tc].

INTRODUCTION: The exposure of workers to antineoplastic agents is potentially dangerous in the long term because of the teratogenic, carcinogenic and mutagenic hazardous of these products. These risks could be reduced by individual and collective shield measures. It's recommended to use transfer devices in a closed system for preparation of chemotherapy. METHOD: The aim of the survey is to analyse for five devices (four devices in a closed system transfer and a needle equipped with an air intake), the following criteria: transfer performance of a solution of a vial to another one, no leakage of the device and practicality in the use. A method implementing a radioactive solution of sodium pertechnetate [(99m)Tc] is used. RESULTS: Teva(®) and Cardinal(®) devices seem to be more efficient according to the ability to transfer one solution from a vial to another one with a low dead volume and low-level contamination in the around of the manipulation area. The Hospira(®) device appears an intermediate solution, while the Phaseal(®) device may be irrelevant for the transfer of a solution. DISCUSSION-CONCLUSION: Our study could attest that the methodology is simple to implement and cheap to compare devices on multiple selection criteria. This evaluation method is interesting because it allows a classification according to several criteria weighted according to the type of intended use. In addition to economic issues and protection of the worker, the use of such devices should be extended to other areas as the preparation of chemotherapy such as preparation of radiopharmaceuticals drugs.

Drug administration error related to computerized prescribing.

INTRODUCTION: One of the main reasons for the implementation of computer-based prescribing was to reduce medication errors. However, the risk has not fallen to zero and new kinds of errors have been detected. SETTING: the following case relates one of these medication errors involving a preparation of vincristine. This antineoplastic drug was injected to a patient via a subcutaneous route of administration instead of an intravenous bolus injection. RESULTS: consequently, a cutaneous erythema appeared. This incident resulted from an error in the programming of the administration route of the protocol operated by a pharmacist and a physician. The pharmacist, who was responsible for the validation of the computerized medical order and then for the compounding and the dispensing of the drug, did not detect the error. CONCLUSION: this case highlights the need of improved and irreproachable therapeutic protocols. Recorded in a database, they must be validated pharmaceutically and medicinally to secure computer-based prescribing, drug handling, dispensing, and administering of the antineoplastic drugs. Even if the pharmaceutical analysis of prescriptions is made easier with computerization, we encourage the training of nurses and the evaluation of their knowledge as well as the necessity for pharmacists to learn to detect new kinds of errors and to verify periodically protocols.

[Evaluation of therapies in oncology by positron emission tomography: towards therapeutical personalization]. / Evaluation par tomographie par émission de positons des traitements en cancérologie: vers la personnalisation thérapeutique.

Recently introduced into clinical practice, positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) has proven its utility for diagnosis and staging of malignant diseases on account of its ability for tissue identification. Its utilization is now moving toward the evaluation of anti-tumoral effects of anticancer therapy, because of the correlation between the uptake of a metabolic tracer and malignant cells viability. Metabolic effects of chemotherapy are first observed in cells and this is the explanation for the precocity of scintigraphic visualisation of therapeutic activity. However, monitoring response with FDG-PET requires rigorous method and needs to take into account the limitations of SUV. Moreover, in order to go beyond the limitations of FDG, new tracers are developed and their main indication could be precisely the monitoring of therapy response. The properties of positron emitters allow us to foresee the labelling of the therapeutic molecules themselves in order to try them in vivo before their utilization for a given patient. These prospects are the ground for real treatment personalization in oncology. They open up a wide field of clinical research but the means for image acquisition and radioactive tracers production will be mandatory for anyone who wants to contribute to this work. Due to the current performances of the imaging systems, the critical point will be availability of equipment allowing the designing and synthesis of the radiopharmaceuticals of the future.

[Doxycycline]. / La doxycycline.

Doxycycline is a semi-synthetic derivative of tetracycline family exhibiting an interesting pharmacokinetic profile since no dosage adjustment is required for renal failure. Doxycycline displays good bacteriostatic activity against most bacteria as well as anti-inflammatory activity. Bacterial resistance is mainly acquired. Many infectious diseases can be treated with doxycycline including brucellosis, pasteurellosis, borreliosis, rickettsioses, trepanomatosis, cholera, leptospirosis, Q fever, pulmonary and urinary infections due to Chlamydia and Mycoplasma, gonococcia, and anthrax. Doxycycline also prevents development of Plasmodium in the blood and is thus useful for malaria prophylaxis. In dermatology, doxycycline is indicated for acnea and rosacea. Doxycycline is well tolerated. The most frequent adverse effects are stomach upset, nausea, and diarrhea, but new formulations that reduce these manifestations are now available. Phototoxicity is dose-dependant and other side effects are rare. Like other tetracylines, doxycycline is contraindicated in children, pregnant women after the second trimester, and breast-feeding mothers.

[Medication dispensing errors detected in medication cassettes intended for in-hospital patients]. / Erreurs de dispensation des médicaments détectées dans les piluliers destinés aux patients hospitalisés.

BACKGROUND AND OBJECTIVE: Many dispensing errors occur in hospital pharmacies and can harm patients if they are not intercepted. The aim of this study was to determine the incidence and the primary types of medication dispensing errors at a French military hospital. METHOD: The check of unit dose medication cassettes was performed by nurses. From February 2007 to April 2007, detected dispensing errors were systematically recorded and classified into 6 categories: unauthorized drug, wrong dosage-form, improper dose, omission, wrong time, and deteriorated drug errors. The overall error rate was calculated. RESULTS: During the study, 5112 medication cassettes were checked. 106 dispensing errors have been detected by nurses for a total of 45,573 filled (n=45,518) and omitted (n=55) unit doses. An overall error rate of 0.23% was found. There were approximately 0.02 detected dispensing errors per medication cassette. The most common error types were omission errors (n=55, 51.88%) and improper dose errors (n=30, 28.30%). DISCUSSION-CONCLUSION: The results of this study showed that a check performed by nurses after the dispensing process is necessary to detect the dispensing errors. Many causes may explain the occurrence of dispensing errors and must be corrected. Because some dispensing errors may remain undetected, there is a requirement to develop strategies in order to reduce or eliminate these errors, such as the implementation of a computerized prescribing system. The pharmacy staff is widely involved in this duty.