[Medical information of patients with implants: Findings and prospects]. / Information médicale du patient porteur d'implants : constats et perspectives.

OBJECTIVES: The main objective of this study was to assess the level of knowledge and information received by patients regarding their implants and to discuss the role of community pharmacists. METHODS: A prospective survey was conducted in 3 pharmacies among patients presenting for various reasons. Firstly, on the same day, all patients visiting the pharmacy were asked if they had an implant. Secondly, patients with implants were offered a short survey consisting of 16 questions concerning the implant and the information received. RESULTS AND DISCUSSION: The survey was conducted with 178 patients, among whom 11.4% had implants. The majority of them reported having osteoarticular, dental, or ophthalmic implants. Women were 67.1% of the cohort. None of the 178 patients with implants in the survey had complete information about their implant and its follow-up, which would enable optimal care and effective reporting in case of potential complications. CONCLUSION: The majority of patients visiting the pharmacy had received limited or inadequate information about their implants. Community pharmacists, as local healthcare providers, in collaboration with hospitals, could play a crucial role in patient education. During the initial dispensing of postoperative treatments, pharmacists could inform and advise patients to enhance their patient journey.

Patient information pathway in orthopedic surgery: Roles of ERAS and pharmacists.

INTRODUCTION: Enhanced Rehabilitation After Surgery (ERAS) pathways significantly improve the care of patients in orthopedic surgery. However, patient knowledge and memorization of the information provided are currently poorly documented. HYPOTHESIS: The information provided by a postoperative pharmacist could have a positive impact on patient care, in particular by improving knowledge about their prosthesis. MATERIAL AND METHOD: This prospective feasibility study included a cohort of 80 patients operated on for a hip or knee prosthesis and who received postoperative pharmacist interviews (POPI). These POPIs informed the patient about the prosthesis, the complications, positions to avoid, as well as the postoperative follow-up. The objective was to measure the patient's knowledge before and after the POPI. Qualitative and quantitative analyses, by indication and patient pathway, were performed. RESULTS: The patient's knowledge before POPI was 70% correct. After POPI this rate rose to 91%. DISCUSSION: Patients' knowledge was weak and heterogeneous, especially regarding the implanted prosthesis. The POPI led to significant improvement and standardization of knowledge which should contribute to the prevention of iatrogenic harm (positions to avoid, infection prevention, compliance with analgesics and anticoagulants). CONCLUSION: A POPI with a pharmacist improves overall patient management during hip or knee arthroplasty. LEVEL OF EVIDENCE: III; non-randomized prospective feasibility study.

Implementation of automated dispensing cabinets for management of medical devices in an intensive care unit: organisational and financial impact.

BACKGROUND: Automated dispensing cabinets (ADCs) have been tested and approved for medication management in hospitals. OBJECTIVES: First, to evaluate the logistics and organisational effect of a similar system for management of sterile medical devices in a medical intensive care unit (ICU). Second, to assess the cost savings of this new organisation for the sterile medical devices budget of this department. METHODS: The organisational effect was evaluated by comparing (1) the workload of head nurse, nursing auxiliary and pharmacy technician and (2) sterile medical devices emergency orders, 1 year before and after implementation of three ADCs and 100 wireless open-access devices. The hospital's costs (ADC, wireless devices and software) and benefits (stock value and resupplying value before and after implementation) were evaluated. RESULTS: Employment of ADCs led to organisational improvement: the total time saved by the pharmacy and ICU together was 34% of the time spent before introduction. The number of emergency orders decreased from 6% to 1% of total orders after 1 year. €55 000 were saved (stock value + resupplying value) 1 year after introduction of ADCs. These benefits were almost equal to the cost of introducing the system. CONCLUSIONS: ADCs could provide an innovative and efficient solution for the management of sterile medical devices in hospitals. Further investigations are needed to complete the financial evaluation, and to develop this system to provide a secure a medical devices circuit.

Safety of a novel high tibial osteotomy locked plate fixation for immediate full weight-bearing: a case-control study.

PURPOSE: The safety and efficacy of the novel Limmed® system (locked plate fixation) for immediate full weight-bearing after medial opening wedge high tibial osteotomy (HTO) were evaluated in patients with symptomatic varus gonarthrosis. METHODS: A case series of 85 consecutive osteotomies performed with Limmed® locked plate fixation for medial opening wedge HTO was compared to a historical matched case-control series of 85 HTOs (85 patients) performed using the same implant without locked screws. Subjects were observed at seven and 15 days and three, six and 12 months after surgery. Endpoints for evaluation included the reporting of adverse events, weight-bearing status without pain, radiographic evidence of bony union and changes in correction angle during healing. RESULTS: Statistically significant differences were seen between groups in terms of safety (thrombophlebitis), time to weight-bearing, radiographic union and radiographic stability between the two groups. Patients of the Limmed® group reported less thrombophlebitis (one versus nine), outcome with shorter time for full weight-bearing (average 45 days difference, p = 0.01) and a shorter time for union (average four weeks difference). At the one-year follow-up the post-operative hip-knee-ankle angle was 4.2° of valgus in the Limmed® group and 2° of valgus in the control group. The adjusted mean difference of 2.2° was significant (p = 0.02) and related to loss of correction during healing in the control group with difference in implant stability. The severity of pain, knee score and walking ability improved in both groups with a significant difference before the third month (quicker for Limmed® group), while at the most recent follow-up only the difference for mobility in flexion was significant. CONCLUSIONS: The Limmed® medial opening wedge HTO system represents a novel method of achieving a reliable correction while producing a stable fixation allowing satisfactory stability and bone healing with immediate full weight-bearing.