[Enthalpies: Evidence and theory applied to sterilization practice]. / Base de données Enthalpies : évidence et théorie appliquée à la pratique en stérilisation.

OBJECTIVES: In order to share their knowledge, sterilization unit managers publish the results of their work in journals or at scientific conferences. The aim of Enthalpies is to list all such work in a single database. The work presented describes the construction of this database and the assessment of its feasibility for the washing step. METHODS: The first step was to carry out a literature review. Only articles published over 10years (2013-2023) in connection with the ten-year washing stage were included. Then, each publication was categorized, coded, graded and summarized by a pharmacist-internal pair. All this data was collated in an Excel® spreadsheet, and from the data categorization a tree structure was created, enabling the interface between the user and the platform hosting Enthalpies to be understood. RESULTS: Eighty-one publications were identified. These were categorized into 6 themes and 27 sub-themes. A reading grid was drawn up for each publication. Genially®, an online platform, was chosen to host our database. CONCLUSION: Enthalpies was not designed to issue recommendations for best practice. However, by collating published scientific data, this tool can be used to assist decision-making. It represents an innovative solution for providing a literature review in the field of hospital sterilization.

In vitro comparative study of deformation of 3D-printed models using different polylactic acids treated by steam sterilization.

INTRODUCTION: 3D printing, which is becoming ever more widespread in orthopedic surgery, requires specific materials. Polylactic acid (PLA) is the most widely used in general-purpose 3D printing, but its thermosensitivity can be incompatible with sterilization. Even so, it is easy to use, inexpensive, non-toxic and biodegradable. Controversy surrounds its use. 3D printing of directly sterilizable PLA parts according to surgeons' needs would be highly advantageous, but doubts remain. We therefore performed an in vitro study to determine which PLAs resist steam sterilization regarding deformation. HYPOTHESIS: The study hypothesis was that, depending on make and shape, 3D-printed PLA parts can retain their properties after steam sterilization. MATERIAL AND METHODS: We selected 4 makes of PLA and used each to print 4 simple cubes and 4 complex shapes corresponding to cuboid bones. They were subjected to steam sterilization under normal French hospital conditions. The size of the cubes was measured before and after sterilization, using a digital caliper. RESULTS: Cuboid parts in HT-PLA and PLA-WANAO showed mean deformation of -0.02mm and -0.4mm, respectively after sterilization, the differences being non-significant (p=0.679 and p=0.241, respectively). Cuboid parts in PLA-SUNLU and PLA-G3D showed significant mean deformation: respectively, -1.37mm (p=0.026) and -35.03mm (p>0.001). Cubes in all types of PLA showed significant mean deformation: HT-PLA, -0.61mm (p=0.004); PLA-SUNLU, -2.70mm (p=0.002); PLA-G3D, -28.64mm (p>0.001); and PLA-WANAO, -1.33mm (p=0.010). DISCUSSION: The study confirmed recent findings that steam sterilization is feasible with certain PLA-printed parts, with deformations less than 1mm, and that choice of PLA is crucial for success. Computer-designed objects (here, cubes) did not resist sterilization without significant deformation. Analysis of resistance to various stresses was not performed, and therefore it cannot be claimed that the process could be used other than for printing anatomic parts. Use of 3D printing in French hospitals is probably a real source of innovation and improvement in care quality; however, a legal framework needs establishing for the use of 3D-printed parts, to ensure patient safety and promote research in this field. LEVEL OF EVIDENCE: III; prospective in vitro study.

[Not Available]. / Démarche pour la mise à niveau d'un secteur de soins pharmaceutiques : le cas de l'hémato-oncologie pédiatrique.

BACKGROUND: Although the concept of clinical pharmacy was originally developed some time ago, in the 1960s, there is a wide variety of programs in existence, as well as great disparity between programs where the presence of a pharmacist is provided in outpatient and inpatient settings. OBJECTIVE: To test a method for upgrading pharmaceutical care areas in a hospital setting. METHOD: This descriptive study was conducted at the Sainte-Justine university health centre, a 500-bed mother-and-child hospital. The pharmaceutical care area that was used to exemplify the upgrading method was pediatric hematology-oncology. A 3-step method was used: review of the scientific literature, creation of a profile of the targeted area, and upgrading of the practice level according to the pre- and post-upgrading profile of the pharmaceutical activities in the area. RESULTS: A total of 108 articles were identified in a search of the PubMed database, of which 22 were retained. After a complementary manual search, a total of 36 articles were evaluated. The articles retained included 3 guidelines, 11 development studies, 1 review of scientific literature, 6 pre- and post-intervention studies, and 15 quasi-experimental studies. Although patients in the pediatric hematology-oncology area account for only 5% of admissions to this hospital, the cases are highly complex, in terms of both the codification of the care phase and the potential for pharmaceutical intervention per admission. CONCLUSION: There are few data to illustrate a method for upgrading practice in a pharmaceutical care area. This study tested a method for upgrading pharmaceutical care in a pediatric hematology-oncology service, with a review of the scientific literature, a profile of the area, and the pharmacists' pre- and post-upgrading job description in this area. [Publisher's translation].

[Antibiotics given subcutaneously to elderly]. / Antibiotiques par voie sous-cutanée chez la personne âgée.

AIM: To find out data of antibiotics efficiency and tolerance given subcutaneously (SC) to elderly. METHOD: A literature review based on subcutaneous route of antibiotic has been done in PubMed and Cochrane Library. RESULTS: Seventeen studies about ten antibiotics have been selected. According to HAS recommendations, methodology of these articles is poor: 3 are level B and 14 level C. Only amikacin, ceftriaxon and thiamphenicol have an official mention about SC route. Our literature review indicates that other antibiotics have been injected by SC route sometimes with local complication: gentamicin, netilmicin, tobramycin, sisomicin, cefepim, ampicillin, teicoplanin and ertapenem. Aminoside SC administration seems to be contra-indicated in clinical practice because of skin necrosis. However for other antibiotics, studies reveal poor evidence-based medicine and non specific geriatric patient inclusion. For these reasons, SC route for elderly isn't recommended. CONCLUSION: Antibiotics given SC are little documented despite the great interest for elderly. Reasons of administration are often non official mention engaging prescriber responsibility.