[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.