[Crushing drugs in geriatric units: an "handicraft" practice with frequent errors which imposed recommendations]. / L'écrasement des médicaments en gériatrie: une pratique « artisanale ¼ avec de fréquentes erreurs qui nécessitait des recommandations.

PURPOSE: Swallowing disorders or psycho-behavioural distress frequently interfere on drug administration in elderly inpatients. Crushing drugs is a common although non validated practice. The objective of this first prospective study, performed in all geriatric units of the Rouen university hospital by a multidisciplinary group, was to assess the crushing practice, from the prescription to the administration of the drugs in order to elaborate corrective measures. METHODS: A survey was performed in June 2009 and included 683 inpatients, 65 years and above, in 23 geriatric units. If a patient received drugs after crushing, we recorded the reason for crushing, what drugs were crushed, the galenic presentations and the technique used for preparation and administration. RESULTS: Two hundred and twenty-one patients (32.3%) (85.5 ± 6.5 years, females 74.2%) received 1528 drugs (6.9 ± 4 per patient) including 966 drugs (63.2%) after crushing (crushed pills or crushed content of opened capsules), mainly in the morning (50.4%). The main reasons for crushing drugs were swallowing disorders and psycho-behavioural distress. Forty-two percent of crushed drugs had a galenic presentation which did not allow crushing. The patient's drugs were crushed together three out of four times and mixed with different vehicules for administration. The material used for crushing (a mortar, 92.6%) was often the same for several patients (59.4%); 83.5% of crushed drugs were immediately administered to the patients, though there were important variations about schedules of administration. CONCLUSION: Crushing drugs expose both to iatrogenic hazards and professional risks. Regional and national recommendations were developed in order to correct the errors linked to this practice.

[Evaluation of in-hospital prescription of fluoroquinolones]. / Evaluation des pratiques de prescription des fluoroquinolones à l'hôpital.

PURPOSE: Quinolones are widely prescribed in various hospital departments (about 20% of antibiotics prescriptions in some of them) and antibiotic resistances is increasingly documented. The aim of this prospective study was to assess the prescriptions of quinolones in several departments of medicine of Rouen University Hospital and compare them to the guidelines of good medical practice for antibiotic prescriptions. METHODS: This study was performed in four medicine departments during two months. When a physician prescribed a quinolone treatment, he had to record informations regarding the infection (type and site, bacteriological proof or not), the patient (age, sex and glomerular filtration rate) and the prescription of quinolone (indication, dosage, administration, combination with another antibiotic, duration of treatment). RESULTS: A hundred and three prescriptions of quinolones were analysed (mean age 75+/-0.5 years). Quinolones treatments were more often used alone, in first intention and without bacteriological proof. The dosage of quinolones was generally adapted but the duration of treatment was often excessive. Quinolones prescriptions were in majority in accordance with the guidelines for pulmonary infections, but were more often inappropriate for urinary infections. CONCLUSION: According to the infections, this study shows discrepancies with the published guidelines with respect to prescription of quinolones, but there are also differences between available guidelines that may at least in part explain our results. An harmonization and a large diffusion of uniform guidelines could improve patients antibiotherapy.

Application of the SCADA system in wastewater treatment plants.

The implementation of the SCADA system has a positive impact on the operations, maintenance, process improvement and savings for the City of Houston's Wastewater Operations branch. This paper will discuss the system's evolvement, the external/internal architecture, and the human-machine-interface graphical design. Finally, it will demonstrate the system's successes in monitoring the City's sewage and sludge collection/distribution systems, wet-weather facilities and wastewater treatment plants, complying with the USEPA requirements on the discharge, and effectively reducing the operations and maintenance costs.

[Efficacity of antiseptic products]. / Efficacité des produits antiseptiques.

Chemical antiseptics are used in specified conditions. This work studied the actual standards to evaluate the activity of antiseptics. Afterward, the main indications of antiseptics are summarized.

Contribution to the study of surface microflora on Cantal cheese.

Bacteria and mould were isolated from microflora of Cantal cheese rind. They were identified and the influence of pH, temperature and water activity on growth rate were studied. An equation for growth rate mu(h-1) relative to temperature is described according to a mathematical model.

Remarks on the appearance of "violine" on Cantal cheese (a note).

A mould, Scopulariopsis brevicaulis was isolated from a Cantal cheese. This mould was responsible for the "violine" phenomenon. It's optimum pH growth was about 7 and the mould was able to grow suitably at 10 degrees C, the temperature of cellar for cheese ripening. It was inhibited by high sodium chloride contents or low water activities.

[Prolonged home enteral feeding]. / La nutrition entérale prolongée à domicile.

Home enteral nutrition (HEN) is a method that will develop as an alternative to hospitalization. It is indicated mainly in patients who would normally be kept in neurology, ENT, gastroenterology, oncology, paediatrics or geriatrics hospital departments. The technicalities of HEN, such as route, periodicity and modalities of administration and choice of the diet, must be adjusted to the patient's condition and to the foreseeable duration of the procedure. HEN is best organized by a team of hospital specialists who will educate the patient prior to his discharge and follow him up at home in cooperation with the family doctor and district nurse. The extent of financial assistance provided by health insurance organizations is currently under evaluation.

[Lipoma of the posterior mediastinum. 2 cases in children]. / Lipome du médiastin postérieur. Deux cas chez l'enfant.

The authors report the cases of 2 children, 12 and 4 years old respectively, presenting with a lipoma of the postero-superior mediastinum, that were investigated within a 6 year-period. Costal erosions were present in both cases with intraspinal extension in one child. Standard X-ray films should have led to the diagnosis, because of the relative low density of the mass considering its volume. In one case, CT scan confirmed the homogeneous fatty nature of the mass.