[Drug prescription and utilization in Morocco]. / Prescription et utilisation des médicaments au Maroc.

The aim of this study was to assess drug prescription and utilization in Morocco 8 years after the statement of the Action Program for Essential Drugs. To evaluate the role of essential drugs in these prescriptions, a study of about 600 prescriptions and questionnaires sent to a random sample of 111 prescribers and a series of visits with the investigator as a neutral observer was undertaken. The average number of drugs prescribed was 3.27, which reflected the feelings of most of the clinicians, for whom 3 drugs per patient is the required number. The number of drugs prescribed is lower in the public health structure (2.0 +/- 0.14 depending on the type of institution: hospital or primary health care centre). Specialties from the national list of essential drugs accounted for 15.48 per cent of all drugs which is to be compared with 16.2 per cent of the clinicians stating knowledge of the action programme for essential drugs. In public structures, these prescriptions ranged between 29.8 per cent and 82.4 per cent of the essential drugs (WHO general list). The length of the visit ranged between 3.27 +/- 0.96 min and 4.87 +/- 1.04 min according to the health centres and prescriptions included at least one antibiotic in 47.5 per cent of cases (25 per cent to 64 per cent). At least one antibiotic was prescribed in 43.3 per cent of cases in the study of prescriptions and 17.3 per cent of prescriptions included at least one injectable drug. The average cost of one prescription was 146.25 dirhams (ranging between 4 and 1200 dirhams = US $17). According to 68.6 per cent of the prescribers, the patients felt there to be a strong relation between efficacy and cost. Among the prescription motivations, cost ranked above availability of the drug and after efficacy.

[Digestive surgery in patients over 80 years of age. Apropos of 690 operations]. / La chirurgie digestive chez les sujets de plus de 80 ans. A propos de 690 interventions.

Between January 1981 and December 1990, 690 patients over the age of 80 years underwent gastrointestinal surgery. These operations were performed for diseases of the biliary tract in 248 cases (28%), colon or rectum in 238 cases (27%), stomach or duodenum in 130 cases (15%), small bowel in 32 cases (1.6%), oesophagus in 16 cases (1.8%), and for peritoneal carcinologic dissemination in 26 cases (3%). Emergency operation was performed in 43% of patients. Surgery was considered to be curative in 61% of patients. Overall postoperative mortality was 23%. The six following factors were associated with increased mortality: age over 85 years, ASA categories 3, 4, 5; surgery for malignant disease, peritonitis, palliative surgery, emergency surgery.