Clinical pharmacist and pharmaceutical interventions in HBH unit: a French observational study.

Objectives: Home-Based Hospital (HBH) services concern patients of all ages suffering from conditions requiring technical care, close clinical monitoring, or hospital treatments that would normally be provided during hospitalisation. Drug-related problems are common in chronically-ill patients and many such events are preventable. Nevertheless, little data is available for outpatients, especially for HBH unit patients. The aim of the study was to assess the rates and types of drug-related problems prevented and resolved by the clinical pharmacist in a Home-Based Hospital unit.Methods: The drug-related problems were registered prospectively by the clinical pharmacist from May 2011 to April 2015. These pharmaceutical interventions were analysed according to the intervention tool recommended by the French Society of Clinical Pharmacy (Act IP).Results: 20,195 medication prescriptions relating to 2,878 patients were analysed. We registered 388 drug-related problems involving 267 patients (71.2% female; mean age 32.1 ± 29.7 years), mainly concerning untreated conditions (24.2%), drugs used without indications (14.7%), non-conformity to guidelines or contra-indication (12.6%) and drug monitoring (12.4%). Pharmaceutical interventions involved 186 drugs, mainly for hematopoiesis, infections and the digestive system (34%, 16.5%, and 14.6%, respectively). 87.6% of the pharmacist's recommendations were accepted.Conclusions: A formatted clinical pharmacist evaluation was able to detect a high level of drug-related problems, and prevent complications in patients cared for by a Home-Based Hospital unit.

A low effective dose of interleukin-7 is sufficient to maintain cord blood T cells alive without potentiating allo-immune responses.

Slow reconstitution of T cell immunity remains a critical issue after umbilical cord blood (CB) transplantation. Although this may be a consequence of the low cell dose, it may also reflect the propensity of naïve T cells, which predominate in CB, to undergo apoptotic cell death. Exogenous interleukin 7 (IL-7) can prevent apoptosis of naïve T cells, but at high concentrations, IL-7 may also expand alloreactive T cells, thereby aggravating the risk of graft-versus-host disease. We evaluated the survival of CB T cells from 34 healthy full-term pregnancies, and we found wide interdonor variation, from 17.4% to 79.7%, of CB T cells that were still alive after being rested for 4 days in culture medium without cytokine supplementation. The viability of CB T cells was negatively correlated to infant birth weight (Spearman's ρ = .376; P = .031) and positively correlated to venous CB pH (ρ = .397; P = .027); both associations were confirmed by multivariate analysis (P = .023 and P = .005, respectively). A low supplemental concentration (100 pg/mL) of recombinant human IL-7 was sufficient to maintain the viability of cryopreserved/thawed CB T cells, with most (>80%) cells remaining in a quiescent state and without significant changes in their CD4/CD8 ratio and the proportion of CD4(+) CD31(+) PTK7(+) recent thymic emigrants. IL-7 at 100 pg/mL did not lead to any significant enhancement of the alloreactive response of CB T cells, as evaluated by proliferation rates (thymidine incorporation and carboxyfluorescein diacetate succinimidyl ester dilution) and interferon-gamma production (ELISPOT). This effective concentration of IL-7 is far lower than that obtained in vivo after pharmacological administration of the cytokine. This study suggests that administration of lower doses of recombinant human IL-7 than used in previous clinical trials may be sufficient to sustain the viability of infused CB T cells and, thus, help to accelerate naïve T cell reconstitution without potentiating their alloreactivity.