Variability in the prevalence of inappropriate medication use among older adults: A review highlighting the importance of screening methods and database types.

AIMS: The global older population is growing rapidly, and the rise in polypharmacy has increased potentially inappropriate medication (PIM) encounters. PIMs pose health risks, but detecting them automatically in large medical databases is complex. This review aimed to uncover PIM prevalence in individuals aged 65 years or older using health databases and emphasized the risk of underestimating PIM prevalence due to underutilization of detection tools. METHODS: This study conducted a broad search on the Medline database to identify articles about the prevalence of PIMs in older adults using various databases. Articles published between January 2010 and June 2023 were included, and specific criteria were applied for study selection. Two literature reviews conducted before our study period were integrated to obtain a perspective from the 1990s to the present day. The selected papers were analysed for variables including database type, screening method, adaptations and PIM prevalence. The study categorized databases and original screening tools for clarity, examined adaptations and assessed concordance among different screening methods. RESULTS: This study encompassed 48 manuscripts, covering 58 sample evaluations. The mean prevalence of PIMs within the general population aged over 65 years was 27.8%. Relevant heterogeneity emerged in both the utilized databases and the detection methods. Adaptation of original screening tools was observed in 86.2% (50/58) of cases. Half of the original screening tools used for assessing PIMs belonged to the simple category. About a third of the studies employed less than half of the original criteria after adaptation. Only three studies used over 75% of the original criteria and more than 50 criteria. CONCLUSIONS: This extensive review highlights PIM prevalence among the older adults, emphasizing method intricacies and the potential for underestimation due to data limitations and algorithm adjustments. The findings call for enhanced methodologies, transparent algorithms and a deeper understanding of intricate rules' impact on public health implications.

Economic impact of a clinical pharmacist in the orthopaedic sector: a review of the literature.

OBJECTIVES: This review of the literature aimed to evaluate the economic impact of a clinical pharmacist in the orthopaedic sector. METHODS: The review followed the PRISMA recommendations. A bibliographic search was conducted on 23 June 2023 using PubMed, Cochrane Library and Web of Science. All articles in French or English with economic data on clinical pharmacy activities in orthopaedics were included. Articles not mentioning the term 'orthopaedics' and those published prior to 1990 were excluded. Data from the studies were compiled in an Excel table. A bias analysis using the ROBINS-I Cochrane tool was performed. The methodology of the studies was compared and weighted using the CHEERS and STROBE checklists. RESULTS: Among 529 articles initially identified, 10 were included in the review. The cost-benefit ratio of a clinical pharmacist in orthopaedics ranged from 0.47:1 to 28:1. The maximum savings reached US$73 410 /year in the American study and €1 42 356 /year in the French study. For three studies, the cost of a clinical pharmacist was not evaluated. Eight studies showed a positive economic impact. The Dutch study showed a balance and the Danish study showed a negative economic impact of €3442/month. CONCLUSIONS: This literature review has shown an economic benefit of a clinical pharmacist in the orthopaedic sector despite several biases and methodological limitations. The two studies that did not confirm this benefit only evaluated a limited number of expected benefits. Nevertheless, the economic impact of the clinical pharmacist in the orthopaedic sector seems positive and undervalued.

Statistical approach for radioactivity detection: A brief review.

Radioactivity detection is a major research and development priority for many practical applications. Amongst the various technical challenges in this field is the need to carry out accurate low-level radioactivity measurements in the presence of a large fluctuations in the natural radiation background, while reducing the false alarm rates. The task becomes even more harder with high detection limits under low signal-to-background ratios. A detection method based on the statistical inference, following either a frequentist or a Bayesian paradigm, adopted to overcome these challenges as well as to ensure a reliable and accurate diagnosis with a competitive tradeoff between sensitivity, specificity and response time. With this respect, several research studies, addressing a range of applications from decommissioning and dismantling to homeland security, have been proposed. Our main goal in this paper is to present a succinct survey of these studies based on a frequentist and Bayesian approaches used to decision-making, uncertainty and risk evaluation, in the context of radioactive detection. In this prospect, a theoretical background of statistical frequentist and Bayesian inferences was presented. Then, a comparative study of both approaches was performed to determine the optimal approach in regards to accuracy and pros/cons. A case of study for low-level radioactivity detection in nuclear decommissioning operations was provided to validate the optimal approach. Results proved the efficiency and usefulness of Bayesian approach against frequentist one with respect to the most challenging scenarios in radiation detection applications.

[Overview of the implementation of pharmaceutical interviews in pharmacies in France: Analysis of responses to a questionnaire]. / État des lieux de la mise en place en France des entretiens pharmaceutiques en officine : analyse des réponses issues d'un questionnaire.

OBJECTIVE: To evaluate the development of pharmaceutical interviews in pharmacies in France, in order to understand the organization implemented, any limitations and the expansion of eligible pathologies. METHOD: A dematerialized questionnaire was designed and distributed between November 2022 and February 2023 to pharmacists and pharmacy students in France (mainland and overseas) via a link to a Google Form. RESULTS: Ninety-four pharmacists from 8 different regions of France responded to the survey. The 94 responses showed that 56% of pharmacists practiced pharmaceutical interviews. Among pharmacists who practiced interviews, pharmacy owners practiced significantly more interviews than other statuses within the pharmacy (67% vs. 38% P=0.014). No other factor, such as dispensary size or geographical area of practice, had a significant impact on whether or not pharmaceutical interviews were carried out. These talks are often carried out at the patient's request, and 89% of them are accompanied by documents for the patient's attention. For pharmacists who do not carry out interviews, time, staffing and remuneration are the 3 main blocking factors found in both quantitative and verbatim variables. Whether or not pharmacists carry out pharmaceutical interviews, this activity received 87% approval from the 94 respondents, and 84% of them would like to include more chronic disease themes. CONCLUSION: The survey shows that pharmacists approve of the pharmaceutical interviewing activity, but it also highlights obvious logistical obstacles linked to a lack of resources. Thus, even among pharmacists who carry out pharmaceutical interviews, this activity is still carried out relatively infrequently on a routine basis, and often by the incumbent pharmacist, who takes on the responsibility of carrying out this activity.

Cost effectiveness of using trastuzumab biosimilars compared to trastuzumab original drugs to treat breast cancer in a hospital setting.

INTRODUCTION: Subcutaneous (SC) drug administration, such as the Herceptin® in an oncology day hospital reduces the administration time of trastuzumab. In the context of combination therapy administration, this time-saving may be called into question. The challenge posed by the deployment of much less expensive IV biosimilar forms raises questions about the cost-effectiveness of SC administration. METHODS: Using data from a french Diagnostic Related Groups regarding prescriptions of intravenous Herceptin® (HIV), Herceptin® biosimilar IV (BSIV), and Herceptin® subcutaneous (HSC), we conducted two simulations. This simulation involved replacing all HSC with BSIV in combination therapy administration (Simulation 1) and subsequently substituting IV forms with SC forms only when prescribed as monotherapy (Simulation 2). A cost-benefit analysis was conducted based on these two simulations, from the hospital's perspective, for Normandy's population over a 1-year timeframe. RESULTS: In Simulation 1, there was an average cost-saving of €12 per patient per year, but it resulted in a loss of 10140 min, equivalent to 10 min per patient per year when compared to the current situation. Simulation 2 yielded average cost-savings for the hospital amounting to €51 per patient per year, along with a time-saving of 67 min per patient per year compared to the current situation. CONCLUSIONS: The development of a program aimed at optimizing the prescription of Trastuzumab holds the potential to deliver significant cost-savings to hospitals while enhancing the quality of service provided to the patients. This optimization involves using H SC in monotherapy and BS IV in combination therapy administration.

[Tobacco and surgery: A survey of health professionals' practices and knowledge. A role for the community pharmacist]. / Tabac et chirurgie : enquête sur les pratiques et les connaissances des professionnels de santé. Un rôle pour le pharmacien d'officine.

OBJECTIVE: To evaluate the knowledge and management of preoperative smoking patients by different health professionals. METHOD: We conducted a survey among surgeons, anesthesiologists, and pharmacists using questionnaires. The study included 115 pharmacists and 7 physicians. RESULTS: Only 28% of pharmacists felt they had the necessary knowledge about smoking cessation before surgery and its consequences. Moreover, pharmacists were informed of the surgery less than one month before in 61% of cases, whereas physicians claimed to inform patients at least 3 months before in 57% of cases. The main reasons mentioned by the pharmacist for not informing the patient about presurgical smoking cessation were a lack of knowledge of the information to be relayed and a late knowledge of the scheduling of a surgery. Additionally, 57% of physicians stated that they never prescribed nicotine replacement products, while 42% of pharmacists felt that they never dispensed them. CONCLUSION: The study provides a clear picture of the smoking pathway before surgery and highlights areas for improvement in the management of preoperative smoking patients by different health professionals.

Pharmacist tracking and correction of medication errors: An improvement project in the observation ward of the emergency department.

OBJECTIVE: The risk of medication errors is high in emergency departments. Implementation of medication reconciliation activity complemented by pharmaceutical analysis of prescription is an effective way to reduce drug related problems. This study aimed to assess the potential clinical impact of these activities to prevent medication errors for the observation ward patients. The secondary objective was to assess these activities' cost-avoidance and benefit-to-cost ratio. MATERIAL AND METHODS: This study was conducted in a 16-bed unit, over a 5-month period. The patients' demographic and treatment details, and data from pharmaceutical activities were collected and analyzed by a pharmacist. Two pharmacists and an emergency physician assessed the potential clinical impact of medication errors. RESULTS: Medication reconciliation for 250 patients (15.7% of 1589 admitted patients) and pharmaceutical analysis of prescription for 302 patients (19%) were performed by the pharmacist. Medication reconciliation detected 752 errors in 197 patients; 19% were related to high-risk medications and 14% had a potential clinical impact assessed as major, critical or fatal. Pharmaceutical analysis of prescription revealed 159 drug related problems in 118 patients; of which 26% involved high-risk medications and 24% had a potential clinical impact assessed "at least major". In total, 16% of pharmacist interventions had a potential clinical impact assessed "at least major" in 33% of patients: this represents 1.8 pharmacist interventions formulated per day. CONCLUSION: The presence of a pharmacist in the observation ward of the emergency department is useful in detecting iatrogenic drug related problems and reducing their medical impact. The benefit-to-cost ratio is favorable for the hospital.

Impact of Clinical Pharmacist Consultations on Postoperative Pain in Ambulatory Surgery.

Post-operative pain is a common symptom of ambulatory surgery. The objective of this study was to evaluate a pain management protocol integrating a pharmacist consultation. We conducted a quasi-experimental, single center, before-after study. The control group was recruited between 1 March and 31 May 2018 and the intervention group between 1 March and 31 May 2019. Outpatients in the intervention group received a pharmacist consultation, in addition to the usual anesthesiologist and nurse consultations. Pharmacist consultations were conducted in two steps: the first step consisted of general open-ended questions and the second step of a specific and individualized pharmaceutical interview. A total of 125 outpatients were included in each group. There were 17% (95% CI 5 to 27%, p = 0.022) fewer patients with moderate to severe pain in the pharmaceutical intervention group compared with the control group, which corresponded to a decrease in the mean pain level of 0.9/10 (95% CI -1.5/10; -0.3/10; p = 0.002). The multivariate analysis did not reveal any confounding factors, showing that only the pharmaceutical intervention could explain this result. This study demonstrates a positive impact of pharmacist consultations on postoperative pain in ambulatory surgery.

Reconstruction, analysis and interpretation of posterior probability distributions of PET images, using the posterior bootstrap.

The uncertainty of reconstructed PET images remains difficult to assess and to interpret for the use in diagnostic and quantification tasks. Here we provide (1) an easy-to-use methodology for uncertainty assessment for almost any Bayesian model in PET reconstruction from single datasets and (2) a detailed analysis and interpretation of produced posterior image distributions. We apply a recent posterior bootstrap framework to the PET image reconstruction inverse problem and obtain simple parallelizable algorithms based on random weights and on existing maximuma posteriori(MAP) (posterior maximum) optimization-based algorithms. Posterior distributions are produced, analyzed and interpreted for several common Bayesian models. Their relationship with the distribution of the MAP image estimate over multiple dataset realizations is exposed. The coverage properties of posterior distributions are validated. More insight is obtained for the interpretation of posterior distributions in order to open the way for including uncertainty information into diagnostic and quantification tasks.

PET Reconstruction of the Posterior Image Probability, Including Multimodal Images.

In PET image reconstruction, it would be useful to obtain the entire posterior probability distribution of the image, because it allows for both estimating image intensity and assessing the uncertainty of the estimation, thus leading to more reliable interpretation. We propose a new entirely probabilistic model: the prior is a distribution over possible smooth regions (distance-driven Chinese restaurant process), and the posterior distribution is estimated using a Gibbs Markov chain Monte Carlo sampler. Data from other modalities (here one or several MR images) are introduced into the model as additional observed data, providing side information about likely smooth regions in the image. The reconstructed image is the posterior mean, and the uncertainty is presented as an image of the size of 95% posterior intervals. The reconstruction was compared with the maximum-likelihood expectation-maximization and OSEM algorithms, with and without post-smoothing, and with a penalized ML or MAP method that also uses additional images from other modalities. Qualitative and quantitative tests were performed on realistic simulated data with statistical replicates and on several clinical examinations presenting pathologies. The proposed method presents appealing properties in terms of obtained bias, variance, spatial regularization, and use of multimodal data, and produces, in addition, potentially valuable uncertainty information.