[Implementation of a territorial hospital pharmacy (PUI) ensuring a robotized nominative dispensation of treatments for two external sites: A dependent old people's home (EHPAD) and a follow-up care institution (SSR)]. / Carnet de bord pour la mise en place d'une PUI territoriale assurant une dispensation nominative robotisée des traitements pour deux sites extérieurs : Un EHPAD et un SSR.

The territorial hospital pharmacy (PUI) of the West of Paris, dispenses treatments for a follow-up care instituion (SSR) and a dependent old people's home (EHPAD) via a hospital pharmacy equipped with an automatic machine producing dry oral forms packaged in labeled pillboxes. This project was completed with the support of the Regional Health Agency (ARS) and aims to secure the medication circuit. The methodology for qualifying the computer system and production, the implementation of the medication circuit and the inter-site logistical organization are presented. The prescription software was interfaced with the management software, which is itself interfaced with the robot's, and with the automatic machine's software. Tests and developments allowed to convert dispensing units into prescription units over a period of time. Also, the drugs consumed by these two institutions allowed to establish the therapeutic booklet and drug provision as well as anticipating the automaton filling. Medical devices, solutions and narcotics are exclusively managed as supplies with a specific circuit. Treatments are dispensed weekly (pillboxes and off-robot). For the SSR, an additional daily production concerns the entries of new patients and the modifications of treatment. Automation saves time and security, but human intervention is involved on a daily basis. The institutions have adopted the new organization over about 6 months and the production activity is now smoothed out. In the next few weeks, two other EHPADs with 100 patients will be integrated into the PUI territorial. One of the main challenges is to integrate them into our pre-existing organization, while maintaining their habits.

Oxford-AstraZeneca COVID-19 vaccine: need of a reasoned and effective vaccine campaign.

OBJECTIVES: A strong COVID-19 vaccine campaign is needed to reach the herd immunity and reduce this pandemic infection. STUDY DESIGN: In the Foch Hospital, France, in February 2021, 451 healthcare workers were vaccinated by a first dose of AstraZeneca vaccine. METHODS: Adverse effects were reported to our pharmaco-vigilance circuit, by an online and anonymous questionnaire following the first weeks of the vaccinal campaign to healthcare workers. RESULTS: Two hundred seventy-four (60.8%) of them reported multiple adverse effects. Main adverse effects reported were feverish state/chills (65.7%), fatigue/physical discomfort (62.4%), arthralgia/muscle pain (61.0%) and fever (44.5%). CONCLUSIONS: On March 2021 many European countries suspended AstraZeneca vaccine for one week due to safety uncertainty. Thus, confidence in its efficacy is undermined. However, the benefit/risk balance is clearly in favor of vaccination.

Improving safety of preparation and administration of medicines and enteral nutrition in a neonatal care unit: Global risk analysis.

OBJECTIVE: To date, few adapted pharmaceutical forms are available for infants leading to multiple steps of preparation and medicines dilution before administration. The main purpose of this study was to assess the risks on the steps of preparation and administration of medicines in a neonatal care unit and to propose corrective actions to ensure the medicines safety. METHODS: A global risk analysis was performed, conducted by a multidisciplinary working group of 9 experts, that is 9 meetings. RESULTS: We identified 57 scenarios: 59,6% of scenarios had an initial criticality C1, 31,6% C2 and 8,8% C3. The most risky phases were phases of needs identification including the step of doses calculation and phases of preparation. The strategic management together with the human factor were the most risky dangers. Nineteen corrective actions were proposed. After implementing those actions, 82,5% of scenarios had residual criticality C1, 17,5% C2 and no scenario had residual criticality C3. Follow-up actions have been implemented to control the residual risk as in service training. CONCLUSION: Neonatal unit care is a risky service and should be a priority in the risk management policy. This analysis joins the quality policy implemented in the hospital and similar risk analysis is on process.

Urinary tract infection after acute stroke: Impact of indwelling urinary catheterization and assessment of catheter-use practices in French stroke centers.

INTRODUCTION: Urinary catheterization and acute urinary retention increase the risk of urinary tract infection (UTI). Our study aimed to investigate the incidence of UTI following acute stroke at our stroke center (SC) and to assess urinary catheter-care practices among French SCs. METHODS: Stroke patients hospitalized within 24h of stroke onset were prospectively enrolled between May and September 2013. Neurological deficit level was assessed on admission using the US National Institutes of Health Stroke Scale (NIHSS). Patients were followed-up until discharge. Indwelling urinary catheterization (IUC) was the only technique authorized during the study. An electronic survey was also conducted among French SCs to assess their practices regarding urinary catheterization in acute stroke patients. RESULTS: A total of 212 patients were included, with 45 (21.2%) receiving indwelling urinary catheters. The overall estimated incidence of UTI was 14.2%, and 18% among patients receiving IUC. On univariate analysis, IUC was significantly associated with older age, longer hospital stays and higher NIHSS scores. Of the 30 SCs that responded to our survey, 19 (63.3%) declared using IUC when urinary catheterization was needed. The main argument given to justify its use was that it was departmental policy to adopt this technique. Also, 27 participants (90%) stated that conducting a study to assess the impact of urinary catheterization techniques on UTI rates in acute stroke patients would be relevant. DISCUSSION: Our results are in accord with previously reported data and confirm the high burden of UTI among acute stroke subjects. However, no association was found between IUC and UTI on univariate analysis due to a lack of statistical power. Also, our survey showed high heterogeneity in catheter-use practices among French SCs, but offered no data to help determine the best urinary catheterization technique. CONCLUSION: Urinary catheterization is common after acute stroke and a well-known risk factor of UTI. However, as high heterogeneity in catheter-use practices is found among French SCs, randomized studies comparing the efficacy of urinary catheterization techniques in terms of UTI prevention in acute stroke patients are now warranted.

[Quality insurance system establishment in the management of home-based chemotherapy: example of hospital at home "Assistance publique-Hôpitaux de Paris"]. / Mise en place d'un système d'assurance-qualité dans la prise en charge des chimiothérapies à domicile : exemple de l'hospitalisation à domicile « Assistance publique-Hôpitaux de Paris ¼

While home-based chemotherapy improves comfort and quality of life of patients, quality and safety conditions must be equivalent to hospital settings. In addition, organization is much more complex. At the hospital at home "Assistance publique-Hôpitaux de Paris", prescribers are potentially spread across 21 health facilities. The administration of chemotherapy is performed by about 300 nurses at the patient's home in Paris and its suburbs. Centralized preparations of chemotherapy began in September 2009 by the pharmacy department of Georges-Pompidou European hospital, with a progressive increase of the activity. This article describes the quality insurance system established with this new organization to meet the specific challenges of home therapy: choice of eligible anticancer drugs, computerized information systems and networking with other heath facilities, secure transport conditions, traceability from the prescription to the administration, security of administration. This experience can offer an important support for other centres in their approach of quality insurance for home chemotherapy.

Relevance of urinalysis monitoring of methadone maintenance patients: a clinical-biological agreement on 41 patients.

Abstract This study evaluated the concordance of concomitant urinalysis and clinical assessments of drug abusers included in a methadone maintenance programme. The agreement between a clinical subjective score and an objective biological score, both measuring the evolution of illicit substance consumption over 12 months, was analysed. The clinical score, established by physicians and applied during patient interviews, was determined at entry into the programme and re-evaluated after 6 and 12 months. Forty-one patients were evaluated. The urinalysis score was based on regular screening of urine samples with the EMIT method. Agreement between the two scores was determined by using the kappa coefficient for each substance (opiates, benzodiazepines and cocaine) for each time-point. The calculated kappa coefficients showed poor agreement between the two scores, but could indicate the complementarity of these clinical and biological appraisals. Indeed, the urinalysis objectively detected change in drug use before the clinician. Thus, urinalysis monitoring should be considered as an additional and complementary biological procedure for patient follow-up by physicians.

[Severe Frey syndrome after parotidectomy: treatment with botulinum neurotoxin type A]. / Syndrome de Frey sévère post-parotidectomie: traitement par la neuro-toxine botulique de type A.

Based upon an inception cohort of 30 patients with severe Frey's syndrome, after conservative parotidectomy, the technique and the results of intracutaneous injection of botulinum toxin type A are presented. The skin surface involved with Frey's syndrome was managed with intracutaneous injection of 2.5 international units of botulinum toxin type A per square centimeter. A minimum follow-up of 16 months was achieved. The only adverse side effect encountered was a temporary paresis of the upper lid noted in 2 patients. Frey's syndrome vanished within 2-5 days from the intracutaneous injection of botulinum toxin type A. Frey's syndrome was controlled in 53.2% of cases (17/30) after the initial injection of botulinum toxin type A. Five of the 13 patients with recurrence of Frey's syndrome elicited to undergo a watch and wait policy due to the lack of discomfort induced by the recurrence. The remaining eight patients with recurrence of Frey's syndrome were successfully managed with a secondary intracutaneous injection of botulinum toxin type A. Such preliminary data, together with the review of the literature suggests, that the intracutaneous injection of botulinum toxin type A should now be the first line treatment option in patients with severe Frey syndrome.

Recurrent gustatory sweating (Frey syndrome) after intracutaneous injection of botulinum toxin type A: incidence, management, and outcome.

OBJECTIVE: To evaluate the duration of effectiveness of intracutaneous injection of botulinum toxin type A for gustatory sweating as well as the incidence, severity, management, and outcome of recurrent gustatory sweating. DESIGN: An inception cohort with a minimum of 18 months of follow-up. SETTING: A tertiary care center and university teaching hospital. PATIENTS: Thirty-three patients with severe gustatory sweating. INTERVENTION: Intracutaneous injection of 25 to 175 IU (mean, 86 IU) of botulinum toxin type A. MAIN OUTCOME MEASURES: Analysis of the effectiveness of the intracutaneous injection of botulinum toxin type A using the Kaplan-Meier actuarial life-table method; completion of the Minor starch-iodine test in patients without symptomatic recurrent gustatory sweating; and the patients' self-assessment of the severity of the recurrent gustatory sweating. RESULTS: The 1-, 2-, and 3-year actuarial estimate for symptomatic recurrent gustatory sweating was 27%, 63%, and 92%, respectively. In the 7 patients without symptomatic recurrent gustatory sweating, the Minor starch-iodine test revealed persistent gustatory sweating in 6, resulting in an overall 97% rate (32 of 33 patients) for recurrent gustatory sweating. No statistical relationship could be demonstrated between the duration of effectiveness, the incidence of recurrent gustatory sweating, the severity of recurrent gustatory sweating, and the following variables: age, sex, cause of gustatory sweating, skin surface involved, and dose of botulinum toxin type A injection. Within the group of 26 patients with symptomatic recurrent gustatory sweating, (1) the severity of the recurrent gustatory sweating was always reduced when compared with the severity of the initial gustatory sweating, and (2) the recurrent gustatory sweating always remained amenable to reinjection of botulinum toxin type A. CONCLUSIONS: The present series demonstrated a linear regression in the effectiveness of the intracutaneous injection of botulinum toxin type A in patients with gustatory sweating, while no factors appeared to be statistically related to the duration of effectiveness and/or the incidence of recurrent gustatory sweating. However, because the severity of recurrent gustatory sweating is reduced when compared with the severity of the initial gustatory sweating and because recurrent gustatory sweating remains amenable to reinjection of botulinum toxin type A, we believe that the intracutaneous injection of botulinum toxin type A should become the first-line treatment option in patients with gustatory sweating.

Botulinum toxin type A for Frey's syndrome: a preliminary prospective study.

Fourteen patients with severe Frey's syndrome (occurring after conservative parotidectomy) managed with intracutaneous injection of botulinum toxin type A were prospectively evaluated. Results were analyzed for effectiveness, complications, and adverse effects. Complications were not encountered. The only adverse effect noted was a temporary and slight partial paresis of the upper lip of 3 months' duration in 2 patients. Permanent paresis was not encountered. Frey's syndrome was always controlled within 2 days following the intracutaneous injection of botulinum toxin A. Frey's syndrome recurrence was not encountered with a follow-up duration that varied from 3 to 9 months (mean follow-up 7 months). This preliminary report confirmed that in patients who have Frey's syndrome after conservative parotidectomy, the intracutaneous injection of botulinum toxin is a valuable treatment option that should be further investigated.

Treatment of Frey's syndrome with topical 2% diphemanil methylsulfate (Prantal): a double-blind evaluation of 15 patients.

Fifteen patients with severe gustatory sweating after total parotidectomy and facial nerve preservation were asked to take part in a double-blind study. All patients were alternatively treated with topically applied placebo and topically applied 2% diphemanil methylsulfate (an anticholinergic agent). A 10-day period was allowed between applications for return of symptoms. Two-percent diphemanil methylsulfate provided partial relief in 33.3% of patients and total relief in 40% of patients. Involvement of the hairy temporal line region with gustatory sweating was the main reason for failure. Duration of relief varied from 2 to 4 days. The only side effect was dryness of the mouth noted in two patients.

Inhibition of mitochondrial beta-oxidation of fatty acids by pirprofen. Role in microvesicular steatosis due to this nonsteroidal anti-inflammatory drug.

Administration of pirprofen may produce microvesicular steatosis of the liver in humans. The effects of pirprofen on the mitochondrial beta-oxidation of fatty acids have been investigated in mice. In vitro, addition of 2 mM pirprofen decreased by 50% the formation of [14C]acid-soluble beta-oxidation products, and decreased by 70% the formation of [14C]CO2 upon incubation of hepatic mitochondria with [14C]palmitic acid, ATP, carnitine and coenzyme A. In vivo, administration of pirprofen (2 mmol . kg-1 i.p.), 1 hr before that of [U-14C]palmitic acid, decreased by 70% the exhalation of [14C]CO2 during the next 6 hr. Administration of pirprofen (2 mmol . kg-1 i.p.), 1 hr before the measurement, decreased plasma beta-hydroxybutyrate by 60%, plasma acetoacetate by 30% and blood glucose by 40%. Administration of pirprofen (2 mmol . kg-1 i.p.) 6 hr before sacrifice, doubled hepatic triglycerides content and produced microvesicular steatosis of the liver. We conclude that pirprofen inhibits the mitochondrial beta-oxidation of fatty acids in mice, thus explaining the microvesicular steatosis observed in mice and in some human subjects.