Assessment of insulin adherence in diabetic outpatients: An observational study.

OBJECTIVES: In the management of diabetic patients on insulin therapy, adherence to medication is a key element for avoiding chronic complications. The purpose of this study was to evaluate diabetic patients' ability to translate glycemic results into an appropriate insulin dose and thus, adherence to insulins. METHODS: This was an observational, retrospective, monocentric pilot study. Diabetic patients on insulin therapy being followed at the metabolic and endocrine diseases department were divided into two groups depending on their mode of glycemic control at home: capillary glycemia (Notebook group) or interstitial glycemia using the FreeStyle Libre® flash system (FSL group). Adherence was assessed based on the rate of compliance in adapting insulin doses to the prescribed protocols (depending on type of insulin, glycemic targets, and patients' characteristics) by a pharmacy resident and a senior diabetologist. Good adherence was defined as a minimum rate of 80% of conforming insulin injections for each patient. RESULTS: A total of 50 patients were included, 35 in the Notebook group and 15 in the FSL group. Two-thirds of patients were non-adherent to insulin. Dose adjustment errors mainly concerned rapid-acting insulin with 51.1% of non- conformities, 10.0% of which were due to underdosing in the Notebook group and 21.7% to overdosing in the FSL group. Hyperglycemia was predominant in both populations with a median time in range of 19.0% in the FSL group and well below recommendations (>70%). CONCLUSIONS: Despite the use of increasingly efficient, easy-to-use devices in diabetes monitoring, insulin non-adherence and glycemic imbalance are unresolved major issues. Diabetic patients require reinforced medical follow-up for optimal insulin management.

[Optimization of post-surgical wound by a multidisciplinary team: pilot feasibility study]. / Optimisation de la prise en charge de la plaie post-chirurgicale par une équipe pluridisciplinaire : étude pilote de faisabilité.

OBJECTIVES: The management of post-surgical wounds is complex and suffers from a lack of coordination between the hospital and the community. The pharmacist could improve the efficiency of the care pathway by optimizing the compliance of discharge orders (DO) with current standards and reducing the associated expenditures. The objective of this study was to evaluate the impact of a multidisciplinary intervention on the quality and cost of acute post-surgical wound management. METHODS: This is a pilot study, monocentric, prospective, before/after. Non-conformities (NC) of DO for post-surgical wounds were analyzed before and after a multidisciplinary intervention (development of protocols, provision of prescription aid supports, training) in 3 surgical departments. The cost of each OS filled in the community was collected and the satisfaction of community pharmacists was evaluated. RESULTS: Out of 120 OS collected, 576 NC were detected. The intervention halved the number of DO with at least 1 NC and divided the median number of NC per order by 7. Community pharmacists were 4 times more satisfied with the quality of DO after the intervention. The cost of the multidisciplinary intervention was estimated at 787 euro. This intervention did not change the average cost per prescription. CONCLUSION: The multidisciplinary intervention improved the quality of post-surgical wound management by making the hospital-city pathway more fluid. The intervention requires a low investment in human resources and could be economically interesting if the costs avoided by the prevention of complications were valued.

[Pharmaceutical analysis of medication orders in health care facilities: A France-Quebec comparison]. / Analyse pharmaceutique des prescriptions médicamenteuses en établissement de santé : comparaison France-Québec.

OBJECTIVES: The pharmaceutical analysis of drug prescriptions is one of the key steps in the drug circuit. This mandatory regulatory practice in France and Quebec is based on national standards. The main objective of this work was to compare the practical methods of pharmaceutical analysis performed in French and Quebec university hospitals. METHODS: This is a prospective comparative survey conducted in 2 French and Quebec university hospital centres among pharmacists and pharmacy residents. RESULTS: The response rate to the survey was 60% (45/75). Between 16 and 22 elements were deemed necessary to structure the centralized, decentralized or mixed pharmaceutical analysis. The chronological ranking of these elements was comparable between the French and Quebec participants. All participants were in favour of the development of initial and continuing training in pharmaceutical analysis. Finally, the majority of participants were against using individual pharmaceutical analysis performance indicators to optimize the process (82%; 37/45). CONCLUSIONS: The French-Quebec practice of prescription analysis by a ward-pharmacist complies with national standards. The main differences in the practice of pharmaceutical analysis are related to the types of organization, the tools available and the length of time pharmacists have been deployed in care units in France and Quebec.

Impact of a clinical pharmacist's intervention on pneumococcal vaccination in a population of at- risk hospitalized patients: The IP-VAC study.

OBJECTIVES: The aim of this study was to evaluate the impact of clinical pharmacist intervention on compliance with pneumococcal vaccination (PV) recommendations in hospitalized patients. METHODS: This was a prospective, single-center, before-and-after study conducted in 2019-2020. Patients had to be over 18 years of age, at risk of pneumococcal infection, and with no PV. No changes were made in the observational phase. During the interventional phase, the clinical pharmacist discussed a prescription for preventive PV and a mention in the discharge letter. A pharmaceutical consultation sensitized the patient to the interest of PV. The clinical pharmacist ensured that a complete vaccination protocol would be carried out by the retail pharmacist within 3 months of hospitalization. RESULTS: One hundred and sixty-seven (167) patients were included. In the observational phase, 2.3% of patients received a complete vaccination protocol after discharge from primary care. The rate increased to 63.8% after the clinical pharmacist's intervention (p < 0.001). Vaccines were prescribed by hospital physicians in 97.5% of cases, while 40% of discharge letters included the indication for PV. CONCLUSION: The clinical pharmacist's intervention led to delivery of a complete PV protocol after discharge for over half the patients. This study demonstrated the feasibility of a pharmaceutical intervention to promote PV in hospital activities.

Reusable laryngoscope blades: a more eco-responsible and cost-effective alternative.

INTRODUCTION: Consumption of single-use medical devices has increased considerably, contributing to the excessive wastage produced during surgical procedures. The present study aimed to describe a methodology to assess the transition from single-use blades (SUB) to reusable laryngoscope blades (RUB) and to assess the ecological and economic impact of the switch. METHODS: The ecological analysis was based on the life cycle assessment method. Based on 30 operating rooms in a single tertiary university hospital, the economic analysis compared the usual SUB supplier with four RUB suppliers considering different costs: blade purchasing and depreciation, reprocessing, logistics and waste management. RESULTS: In 2021, 17,200 intubations were performed requiring about 147 RUBs. Switching from SUB to RUB led to an annual saving of 26.5 tons of CO2eq (global warming impact), equivalent to 120 000 km by car. It avoids the extraction of 6.6 tons Oileq (petroleum) and 579 kg of copper (mineral resources) per year. This action also leads to a land occupation reduction of 626 m2 per year and water savings of 221.6 m3 per year. The average cost per intubation varies from 3.16 [3.15-3.16] for SUB to 2.81 [2.77-2.85] for RUB, representing an average saving of 0.35 per intubation leading to 5783.50 annual gain [5074.00-6192.00]. RUB are preferable from 3 and 86 uses from an ecological and economic viewpoint, respectively. CONCLUSION: In a model of 17,200 intubations /year, switching SUD to RUB would save 26.5 tons of CO2eq and 6.6 tons of Oileq with 5783.50 annual gain. RUBs are ecologically and cost-effective after 3 and 86 uses, respectively.

Ecoresponsible actions in operating rooms: A health ecological and economic evaluation.

BACKGROUND: In the current context of climate change, actions must be taken to improve the hospital's ecological footprint, particularly in the operating room, which is a major consumer of medical devices. METHODS: This prospective pilot study assessed the ecological and economic impacts of sustainable actions targeting medical devices designed by a multidisciplinary working group and implemented in the 24 operating rooms of a University Hospital over one year. The ecological analysis was based on the life cycle assessment method and categorized in seven impacts. The economic impact was assessed by a micro-costing analysis and divided in four main expense items: human and material resources, logistics, and waste management. RESULTS: In total, 13 actions were implemented with the aim of reducing waste volume, improving waste sorting, and increasing eco-responsible purchases. In one year, these 13 actions allowed avoiding the emission of 203 tons eq CO2. The environmental and human toxicity benefits were 707.8 and 156.2 tons of 1.4 dichlorobenzene, respectively. Concerning non-renewable resources, these actions avoided the extraction of 9 tons of oil (petroleum) and 610 kg of copper per year. These actions led to a land occupation reduction of 1071.3 m2year and to water saving of 552 m3. From the economic side, the implementation of these actions brought a gain of €3747.9 for the first year and of €5188.2 for the following years. CONCLUSION: The integration of sustainable measures in operating rooms leads to important ecological benefits and also generating savings. This more eco-responsible approach should be considered in all healthcare establishments that generate a significant annual volume of waste.

Interactions between antiretroviral therapy and complementary and alternative medicine: a narrative review.

BACKGROUND: The use of complementary and alternative medicine including herbal medicine (phytotherapy), vitamins, minerals and food supplements is frequent among people living with HIV/AIDS (PLWHAs) who take antiretroviral (ARV) drugs, but is often not known by their prescribing physicians. Some drug-supplement combinations may result in clinically meaningful interactions. AIMS: In this literature review, we aimed to investigate the evidence for complementary and alternative medicine interactions with ARVs. SOURCES: A bibliographic search of all in vitro, human studies and case reports of the PubMed database was performed to assess the risk of interactions between complementary and alternative self-medication products and ARVs. The 'HIV drug interaction' (https://www.hiv-druginteractions.org) and 'Natural medicines comprehensive database' (https://naturalmedicines.therapeuticresearch.com) interaction checkers were also analysed. CONTENT: St John's wort, some forms of garlic, grapefruit and red rice yeast are known to have significant interaction and thus should not be co-administered, or should be used with caution with certain ARV classes. Data on other plant-based supplements come from in vitro studies or very small size in vivo studies and are thus insufficient to conclude the real in vivo impact in case of concomitant administration with ARVs. Some polyvalent minerals such as calcium, magnesium, and iron salts can reduce the absorption of integrase inhibitors by chelation. Potential interactions with vitamin C and quercetin with some ARVs should be noted and efficacy and tolerance of the treatment should be monitored. IMPLICATIONS: This review shows the importance of screening all PLWHAs for complementary and alternative medicine use to prevent treatment failure or adverse effects related to an interaction with ARVs. Further human studies are warranted to describe the clinical significance of in vitro interactions between numerous complementary and alternative medicine and ARVs.

Can we use robotic surgery for the treatment of pelvic recurrence and locally advanced tumors in gynecological surgery?

Over the past 20 years, feasibility of laparoscopic approaches has been validated in gynecologic surgery. This procedure has specific challenges due its longer learning curve and the limits imposed by the technique. For the surgical treatment of recurrent pelvic cancers or locally advanced tumors, open surgery remains the gold standard for most surgical teams. Robotic assistance could be an interesting alternative. The aim of this study is to present our department's robotic surgical procedures in this specific field and show its feasibility and reproducibility on several patients.

Assessing the costs of disposable and reusable supplies wasted during surgeries.

BACKGROUND: The management of disposable and reusable supplies might have an impact on the cost efficiency of the Operating Room (OR). This study aimed to evaluate the cost and reasons for wasted supplies in the OR during surgical procedures. METHODS: We conducted an observational and prospective study in a French university hospital. We assessed the cost of wasted supplies in the OR (defined by opened unused devices), the reasons for the wastage, and the circulator retrievals. At the end, we assessed the perception of surgeons and nurses relative to the supply wastage. RESULTS: Fifty routine procedures and five non-scheduled procedures were observed in digestive (n = 20), urologic (n = 20) and gynecologic surgery (n = 15). The median cost [IQR] of open unused devices was €4.1 [0.5; 10.5] per procedure. Wasted supplies represented up to 20.1% of the total cost allocated to surgical supplies. Considering the 8000 surgical procedures performed in these three surgery departments, the potential annual cost savings were 100 000€. The most common reason of wastage was an anticipation of the surgeon's needs. The circulating nurse spent up to 26.3% of operative time outside of the OR, mainly attending to an additional demand from the surgeon (30%). Most of the survey respondents (68%) agreed that knowing supply prices would change their behavior. CONCLUSIONS: This study showed the OR is a major source of wasted hospital expenditure and an area wherein an intervention would have a significant impact. Reducing wasted supplies could improve the cost efficiency of the OR and also decrease its ecological impact.

A randomized prospective study comparing pregnancy rates after clomiphene citrate and human menopausal gonadotropin before intrauterine insemination.

OBJECTIVE: To determine whether hMG offers an advantage over clomiphene citrate (CC) in achieving pregnancy after IUI with husband's sperm. DESIGN: Randomized prospective trial. SETTING: Infertility patients in a university teaching hospital. PATIENT(S): Fifty-eight women under 39 years old undergoing ovulation induction before IUI. INTERVENTION(S): The women were assigned randomly to one of two treatment groups. Patients in group I (CCHH) received CC for the first two cycles and hMG for the last two cycles. Patients in group II (HHCC) received hMG for the first two cycles and CC for the last two cycles. MAIN OUTCOME MEASURE(S): Cycle fecundity rates for the two treatment modalities were compared statistically with use of life-table analysis. RESULT(S): Of the 174 cycles studied, overall cycle fecundity rate was 11.11 (9 of 81 cycles) in the CCHH group and 10.75 (10 of 93 cycles) in the HHCC group. The difference was not statistically significant. The cycle fecundity rate was 14.44% (13 of 90 cycles) for cycles with CC and 7.14% (6 of 84) with hMG. The difference was not statistically significant. CONCLUSION(S): These data suggest that CC is an effective alternative to hMG in the population examined.

Value of ultrasound-guided fine-needle aspiration in the management of ovarian and paraovarian cysts.

This study was designed to assess if cytology was accurate for an appropriate diagnosis of ovarian and paraovarian cysts, and if the ultrasound-cytology-estradiol (UCE) triad was sufficient to discriminate functional vs. nonfunctional cysts, the latter requiring surgical resection. One hundred twenty-two ultrasound-diagnosed adnexal cysts were punctured and surgically removed, and then subjected to cytologic and histologic examinations; 90 of these fluids were assayed for estradiol. Histologically, 30 cysts were functional and 92 were nonfunctional. A correct discrimination between functional and nonfunctional origin was obtained in 54.9% of cases with cytology, in 94.4% with estradiol assay, in 50.8% with ultrasonography, and in 97.8% with these three examinations combined (UCE triad). Among the 34 patients with no criteria of neoplastic origin (age >40, ultrasonographic findings), the UCE triad diagnosed six functional cysts. Therefore, 17.6% (6/34) of these young women could have avoided unnecessary surgery. Diagn. Cytopathol. 2000;22:70-80.

[Comparison of classic and digital pelvimetry for measuring the medial transverse diameter in 50 female patients]. / Comparaison du diamètre transverse médian mesuré par pelvimétrie classique et numérisée chez 50 patientes.

The medial transverse diameter (MTD) has been measured in 50 female patients using both CT and classical pelvimetry. Comparison between these two matched series allows to confirm (p less than 0.001) that the measurement obtained by CT is on the average smaller than that obtained by classical pelvimetry. The relative mean deviation is 3%, the means differ by 4 mm. Management of obstetrical patients taking into account measurements obtained by pelvimetry (Magnin indices) should then be modified depending on the results obtained by this new technique of scanopelvimetry, that will soon become the technique of reference.

[Prognostic value of a single umbilical artery. 87 cases]. / Valeur pronostique de l'artère ombilicale unique. A propos de 87 cas.

OBJECTIVE: To study the effect of a single umbilical artery on infant prognosis. METHOD: Unicentric retrospective case-control study based on 18,425 births and semi-late pregnancy interruptions. RESULTS: There were 87 cases of single umbilical artery, frequently associated with a familial history of malformation in the sibhood (6.8%), gravid pathology (hypertension 11.5%, diabetes 6.8%), funicular anomaly (32%). One or several malformations were seen in 21% of the infants, the main cause of infant mortality (9%) and morbidity. The case-control study demonstrated that single umbilical artery corresponded to a moderate reduction in weight (-310 g), term (-1.4 weeks gestation), AGPAR scor at 1 and 5 minutes (-0.7) which was not significant when single umbilical artery was the sole pathology. CONCLUSION: When occurring alone, single umbilical artery has little effect on infant prognosis which is more dependant on associated malformations and gravid pathologies determining antenatal and postnatal management.

[Choriocentesis: comparison of the effectiveness of a new choriocentesis needle and a transcervical biopsy forceps]. / Choriocentèse: comparaison des performances d'une nouvelle aiguille à choriocentèse et de la pince à biopsie transcervicale.

71 samples taken by the transabdominal route were compared with 71 samples taken by forceps through the cervix. A fine (1 mm) transabdominal choriocentesis needle with a thin wall (0.1 mm), a short bevel, and a lateral hole was made to bring together simplicity, effectiveness and safety; success was obtained in 95% of the cases (39/41) of our last 41 samples on the first attempt. For comparison with the forceps, the success rate on the first attempt was only 66% (26/41), but it rose to 97.5% if the patient could take 3 attempts at most. The forceps made it possible to collect a mean quantity large enough (19.9 mg) but it was quite variable (16.7 mg being the range) of complete villi, whereas the choriocentesis needle only gathered a smaller volume (12.7 mg) but more reliable (the range being 3.7 mg). The villi were fragmented, however. To work out the study of the DNA and the karyotype, there is a choice between the forceps and the needle. This choice depends principally on the damage the two techniques can do. This has not been worked out yet in our study except indirectly.

Assessment of patient adherence to anti-infective treatment after returning home.

OBJECTIVE: The lack of patient adherence to medical treatment has become a major concern for healthcare professionals. The World Health Organization estimated patient adherence to treatment at 50% only. The inadequate use of antibiotics can cause bacterial resistance the progression of which reduces therapeutic alternatives. The objective of this pilot study was to assess the patient's adherence to anti-infective agents prescribed for acute infection, after returning home. METHOD: Thirty-seven patients hospitalized in the Infectious and Tropical Diseases unit were included. Their adherence to anti-infective drugs was assessed indirectly through data collected by calling the pharmacy and the patient in the week following discontinuation of anti-infective treatment. RESULTS: Sixteen patients were identified as non-adherent (43.2%). A single patient could have several behaviors: extension of treatment (50%), dose modification (6.3%), voluntary omission (12.5%), and involuntary (6.3%). One patient (6.3%) did not take his anti-infective treatment. There was no major cause of non-adherence; every patient had his own reasons. The comparison of several criteria between adherent and non-adherent patients did not reveal any predictive risk factors. CONCLUSION: Our study results revealed for the first time that 50% of patients were adherent to anti-infective agents, after returning home. They confirm the need to implement preventive actions such as a discharge pharmaceutical consultation.

[Hydatidiform mole in Vietnam. The contribution of ultrasonography]. / Môle hydatiforme au Vietnam. Apport de l'échographie.

One-hundred-and-four cases of histopathologically confirmed hydatiform moles were subjected to ultrasound examination at the Hung Vuong Hospital, Ho-Chi-Minh-ville (Vietnam) over a period of 16 months (1988-1989). The diagnosis was confirmed only in some cases on clinical grounds (18%) or by laboratory tests (52%). In contrast, typical ultrasound signs were found in 82% of cases; in the other 18% of cases, other aspects had suggested disorders calling for aspiration (partial mole, clear ovum, pregnancy terminated). Some ultrasound images, highly suggestive of mole, were found in occasional cases of mucoid ovarian cyst, endometrial cancer or cystic necrobiosis of fibroma (HCG tests negative). Despite its limitations in Vietnam ultrasound constitutes the primary method of detecting hydatiform mole, the acquisition of practical experience is facilitated by the high number of cases and the concentration of cases reported.

[t(Y; 15) translocation in a fertile male, detected at the time of amniocentesis]. / Translocation t(Y; 15) chez un homme fertile, dépistée à l'occasion d'une amniocentèse.

Cytogenetic studies on a phenotypically normal fertile male revealed an unbalanced Y; 15 translocation. His wife referred for a prenatal diagnosis because of maternal age. The foetus was male and carried the same translocation.