[A prevalence study to monitor the consumption of antibiotics]. / Une enquête de prévalence pour suivre la consommation en antibiotiques.

Following the second Antibiotics Plan, in association with the hospital hygiene operational team, the hospital pharmacy department of the Desgenettes military teaching hospital led a study into the prevalence of the prescribing of antibiotics in December 2011. The study highlighted the trends in prescriptions and assessed the effectiveness of corrective or preventive actions implemented following the first prevalence study of 2006, in particular the multidisciplinary antibiotherapy coordination meetings.

[Improving collaboration between the pharmacy and the nurses]. / Améliorer la collaboration entre la pharmacie et les infirmierès.

In hospitals, improving collaboration between the diferent players in the health care chain is an ongoing issue. Numerous tools are available to facilitate interprofessional communication. Satisfaction surveys can be of particular interest.

Assessing user satisfaction and hospital pharmacy practice: application to an individualized dispensing system in a French military teaching hospital.

RATIONALE AND AIMS: Hospital pharmacy aims at optimizing pharmaceutical care practice. Classically, assessing patient's satisfaction is required. Same manner, for a service provider such as a hospital pharmacy, it is necessary to evaluate the satisfaction of its customers: physicians, nurses and pharmacy staff. The aim of this paper was to assess user satisfaction with an individualized dispensing system. METHOD: A survey including 14 close-ended and 1 open-ended questions was repeated at several years' distance in a French military teaching hospital. Questionnaires were administered anonymously to the different actors involved: physicians, nurses, pharmacy staff. RESULTS: Fifty-seven users of an individualized dispensing system (29 nurses, 18 physicians and 10 pharmacy staff) were included in the survey. At the level of the establishment, users' opinion about the system was positive. None of the dimensions studied concerning the pharmaceutical service was rated negatively. Overall user opinion about the computer system was the only parameter rated negatively. In total, most dimensions were judged satisfactory: confidence in the individualized dispensing system, time of delivery at the care unit, impact on cost control, quality of the presentation of unit doses and performance of respondents. The benefit for the patients was judged very satisfactory. The workload involved, the frequency and severity of errors, the serviceability of the information processing system and its impact on patient safety were judged fairly satisfactory. Finally, the quality of pharmaceutical information was rated average. CONCLUSIONS: An evaluation of a service or a practice should include an assessment of how well the service meets the needs of the user and how well the service is provided. A comprehensive, reliable and valid instrument for assessing user's satisfaction with individualized dispensing system is then available in our hospital. This paper demonstrated the interest of using simple and robust tools in professional practice.

Optimizing clinical practice with case-based reasoning approach.

RATIONALE AND AIMS: Learning through experience is an important approach that humans employ to comprehend new problems. The knowledge of physicians does not only consist of rules, but of a mixture of textbook knowledge and experience. Medical treatment is facing a challenge of knowledge discovery from the growing volume of information. METHOD: Case-based reasoning (CBR) matches the natural reasoning model of human. This approach is similar to that used by physicians when they are thinking: 'I have seen a patient like this', and provides instant recollection of past cases that may be relevant to the present case. In fact, CBR is an approach for solving problems based on solutions of similar past cases. Unlike other forms of reasoning such as rule-based reasoning, CBR does not draw conclusions by chaining together generalized rules. CONCLUSION: The application of CBR to medical databases can be powerful techniques to aid physicians in making decisions about the management of their patients, in various types of medical units. CBR is an effective reasoning strategy for optimizing clinical practice.

[Continuous training program for technicians handling antineoplastic drugs and occupational exposure risk]. / Formation continue des manipulateurs de cytotoxiques et prévention du risque de contamination.

Training and regular evaluation of technicians involved in the preparation of antineoplastic agents seems essential to reduce occupational exposure. In this way, a continuous training program was established. Technicians were asked to prepare a safe simulated liquid cytotoxic drug with a fluorescein solution (10 mg/L). After, occupational exposure with this solution was simulated. Ultra-violet light (365 nm) was employed to determine surface contamination. This continuous training program is tested and validated with pharmacy technicians. All people handling these drugs (physicians, nurses, pharmacy staff) can use this program. Short mandatory training courses are stimulating and well appreciated.

Bioequivalence evaluation of a fixed combination of chloroquine and proguanil in a capsule formulation versus a standard medication.

To assess the bioequivalence between a test capsule with a fixed combination of chloroquine (CAS 54-05-7) and proguanil (CAS 500-92-5), and chloroquine and proguanil administered as separate tablets, an open two-sequence, two-period cross-over randomized study was performed in twelve healthy volunteers who received a single oral dose of 100 mg chloroquine and 200 mg proguanil either in the form of one capsule or the reference tablets. Biological samples (plasma, whole blood and erythrocytes) were collected up to 43 days after drug administration. The parent drugs and their main metabolites were analyzed using high performance liquid chromatography assay. Bioequivalence was assessed for whole blood and plasma AUC and Cmax of chloroquine, proguanil, cycloguanil and 4-chlorophenylbiguanide. Bioequivalence in erythrocytes was also established except for Cmax of chloroquine. While the differences for Cmax of chloroquine in erythrocytes may be related to technical problems during the erythrocyte sampling procedure (contamination with leukocytes), bioequivalence can be concluded from the plasma concentration data. Therefore, the use of a single capsule instead of one chloroquine tablet and two proguanil tablets daily can be proposed in order to increase the prophylactic compliance without decreasing the prophylactic efficacy.