Pro re nata medications in mental health: Results of a transversal study.

BACKGROUND: Pro re nata are frequent in psychiatry. The risks engendered by this treatment requires that their prescription and administration be made safer. The frequency of administration of pro re nata depends mainly on the nurse's clinical judgment. AIMS: Our first objective was to assess nurses' satisfaction about the quality of doctors' pro re nata prescriptions. Our second objective was to assess the nurses' self-reported practices for administering pro re nata treatments as written in the prescription. METHOD: Self-administered questionnaires were sent by the hospital's internal mail between November 13, 2014, and December 10, 2014 to all nurses in our psychiatric establishment in France. The questionnaire included multiple-choice questions and questions based on clinical vignettes. RESULTS: The response rate was 51.9% (124/239). Overall, 75.6% considered that the quality of the prescriptions in terms of dosage was satisfactory. However, regardless of the quality of the doctor's pro re nata prescription, nurses did not contact the doctor even when the prescription quality was poor. Unexpectedly, we found that 88.7% have administered medication "as needed" without a doctor's prescription and sometimes acted without consulting doctors. CONCLUSIONS: The nurses appeared globally satisfied with doctors' prescriptions of pro re nata medications. On the other hand, most administered some medications without any prescription, that is, illegally. Physicians must be rigorous in the quality of their PRN prescriptions. At the same time, nurses must comply with the medical prescription or contact the physician if the quality of the PRN prescription appears poor.

Circadian variation in O6-methylguanine-DNA methyltransferase activity in mouse liver.

Bifunctional chloroethylating cytostatic agents produce lethal DNA lesions, as a result of the formation of O6-alkylguanines. These lesions can be repaired by O6-methylguanine-DNA methyltransferase (MGMT). This ubiquitous nuclear and cytosolic enzyme removes the alkyl group by accepting it to the cysteine residue of its active site, thus preventing the formation of DNA interstrand cross-links. The role of the circadian organization in cellular protection against such DNA insults was examined in male B6D2F1 mice, synchronized with an alternation of 12 h of light and 12 h of darkness (LD12:12). MGMT activity was determined in liver of mice obtained at eight different circadian times, located 3 h apart. MGMT activity varied 5-fold along the 24 h time-scale, from 7 +/- 1 pmol/g of tissue at 7 h after light onset (HALO), during the rest span, up to 32 +/- 9 pmol/g at 19 HALO (second mid to late activity span). This large amplitude circadian rhythm in MGMT activity may be an important determinant of the susceptibility rhythms to alkylating agents. The greatest DNA repair activity occurred at night when mice were active, eat and drink, and thus are at a higher risk of being exposed to chemical insults.