The PhaSeal® system: impact of its use on workplace contamination and duration of chemotherapy preparation.

PURPOSE: The primary objective of this study was to compare the levels of environmental contamination before and after the introduction of PhaSeal® (closed-system drug transfer device) in two hospital pharmacies. Our secondary objective was to assess the impact of the device on the duration of drug preparation compared to procedures involving the use of needles and syringes. METHODS: The study involved two French hospitals, which prepared antineoplastic chemotherapy using a biological safety cabinet and an isolator. Five skilled pharmacy technicians at each hospital prepared a total of 100 chemotherapy preparations using the standard procedure and 100 using the PhaSeal® system. To control for possible contamination occurring in the course of the procedure, we used fluorescein which becomes fluorescent when exposed to UV light. To reply the second objective, we timed the duration of the different steps of the manipulation. RESULTS: Our findings showed a major reduction in the contamination of the work environment when using the PhaSeal® system for drug preparation. Reduction rates higher than 93% were obtained, whatever the type of protection used. On the duration of preparation, our results indicate that this duration would be approximately 1 h longer for the preparation of 100 samples. CONCLUSION: In conclusion, this study clearly establishes the benefit of using PhaSeal® for protecting the staff members who work with hazardous agents. It also indicates that the duration of drug preparation is not impacted by the use of the system.

[Experience with an automated dispensing system in department of pharmacy]. / Automatisation de la dispensation nominative au sein d'une pharmacie à usage intérieur. Expérience du centre hospitalier Le Vinatier.

Nominative drug dispensation significantly reduces the incidence of medication errors. Computerized automated unit dose drug distribution system could be a safest hospital drug distribution system and allows an improvement of drug distribution in clinical ward. In 2005, at the Vinatier Hospital, an automated ward dispensing device was acquired. This report describes the implementation of this system and the experience of the pharmacy department. The implementation of an automated unit dose system includes expanding computerized order entry system, physicians' training and nurses to use the software, pharmaceutic staff's training to use the new dispensing system and setting under quality assurance the dispensation process.

[Pharmaceutical counselling and evaluation of the knowledge of hospitalized patients treated with anti-vitamin K drugs]. / Consultation de pharmacie et niveau de connaissance des patients hospitalisés traités par des médicaments anti-vitamine K.

The report published by the French Agency for the Medical Safety of Health Products in 2001 estimated the number of hospital admissions in France for hemorrhagic accidents caused by oral anticoagulants (OA) to be 17,000. For this reason, we have set up pharmaceutical counselling for hospitalized patients treated with OA. The object of this article is to describe this therapeutic education program and to present the level of knowledge that patients have of their OA treatment. Among 68 patients treated prior to their admission, 87% knew the name of the OA, 86% the role of this treatment, 80% the dosing schedule, 57% what to do if a dose had been forgotten, 34% the signs of overdose, 48% the signs of and risks associated with not following the treatment schedule, 94% the advantage of biological follow-up and 68% the principal combinations of drugs that should be avoided. Among 118 patients whose treatment was begun during hospitalization, the level of knowledge for each item were respectively: 41%, 61%, 38%, 37%, 19%, 23%, 34% and 24% at the time of counselling. Newly treated patients acquired their knowledge from contact with nurses. The least known items were the symptoms and risks associated with overdosing or underdosing. This knowledge is therefore fragmentary and does not guarantee the patients' safety, which justifies the proposition of this type of counselling to such hospitalized patients.

Medium- and long-chain triacylglycerols in postoperative patients: structured lipids versus a physical mixture.

Forty patients, scheduled for abdominal surgery, were randomized to receive postoperatively either a structured or a physical mixture of long-chain triacylglycerols/medium-chain triacylglycerols (LCT/MCT) emulsions to assess the tolerance and the effectiveness of the structured triacylglycerol emulsion. Total parenteral nutrition started the day after surgery and covered 100% of measured energy expenditure with nitrogen (0.2 g N.kg-1.d-1) and non-protein calories: glucose (50%) and lipids (50%). Blood samples for liver function tests, albumin, transthyretin, and triacylglycerols were checked at 0800 h on the day before surgery and on day 1, day 3, and day 6 after surgery. Urine samples were taken each day from day 1 to day 7 for 3-methylhistidine (3 Me His) and total nitrogen measurements. Aspartate transaminase (ASAT), alanine transaminase (ALAT), and triacylglycerol plasma levels in routine clinical biochemistry increased significantly in the physical mixture group. Nitrogen balance and 3 Me His excretion were not significantly different between groups. Structured triacylglycerol (STG) lipid emulsions are as efficacious as the physical mixture on nitrogen balance in postoperative patients. They could have some advantages: no disturbances were found to occur in liver function tests or plasma triacylglycerol levels.

Segmental necrosis of ascending colon in haemodialysis patients.

A segmental necrosis of the ascending colon sometimes affecting the terminal ileum was observed 13 times in 12 end-stage renal disease patients over a 5400 patient-years observation period. In all but three cases the patient was operated within 24 h of onset of the abdominal pain. Three patients had a bowel perforation; nine had a limited intestinal necrosis. All underwent a partial resection or colectomy. Two died within 1 month. In all cases the mucosa was necrotic, the submucosa small vessels were congested and the mesenteric vessels were normal. Ischaemic bowel disease has been previously reported in uraemic patients, but our cases do not fit with the usual reported features of this complication. The absence of typical mesenteric infarction, vascular thrombosis, stenosis or major atherosclerotic lesions is surprising. The ascending colon topography of the lesions is very unusual. Ischaemia, constipation and other factors may play a role.

[Anterior resection for cancer of the middle third of the rectum, though always possible, is it desirable?]. / La résection antérieure pour cancer du tiers moyen du rectum, toujours possible, est-elle souhaitable?

Description with details of an operative procedure for anterior resection (A.R.) of rectal carcinoma, with low colorectal anastomosis using circular stapling device. It is quite always possible. Is it desirable? The number of local and regional recurrencies after A.R. for Dukes B and C carcinomas of the mid third of the rectum, higher than in case of Miles operation, incite to ask the question. The five year survival being the same in the two groups make the answer uneasy, regarding handicaps induced by Miles operation. Would, the association to A.R. of pre-operative radiotherapy and/or immunotherapy, be one step to the solution?

[Low colorectal suture with the EEA stapling device for carcinoma of the rectum. A report of 50 cases (author's transl)]. / L'anastomose colo-rectale basse à la pince EEA dans la chirurgie du cancer du rectum. A propos de 50 cas.

50 cases of low colorectal anastomosis (between 3 to 10 cm from the anal verge) are reported. They have been done with the EEA stapling device after resection for rectal or rectosigmoïdal carcinomas. The peroperative incidents (5 cases) and details to prevent them are described. A protective colostomy was done in 10 cases. No leak had been observed. Recurrency and suture line stenosis are discussed. No anal incontinency, even for very low anastomosis had been observed.