Improvement of radiology requisition.

PURPOSE: Inadequate or incomplete information on radiology requisitions may have a substantial impact on the radiological process. This study aimed to evaluate the impact of standardization and computerization of radiology requisitions on the quality of provided data, satisfaction of hospital staff and access time. METHODS: The impact of requisition support was assessed at each step of the improvement process for inpatients: before (Step 1), after standardization (Step 2) and after computerization of radiology requisition (Step 3). The quality of information provided was assessed by proportion of missing data on MRI and CT requisitions. Satisfaction was assessed by an anonymous auto-questionnaire filled by ordering physicians, radiologists and radiology technicians. Access time was prospectively assessed. RESULTS: Standardization of radiology requisition resulted in a significant drop in proportion of missing data. Computerization of radiology requisition, based on the single standardized radiology requisition, further improved the quality of information reported on radiology requisitions. The median access time was significantly improved (from 5 to 3days) for the largest provider of CT requisitions. CONCLUSIONS: Standardization and computerization have a synergistic effect on the overall quality improvement. Moreover, the computerized provider order entry enables traceability of information, makes communication between radiologists and ordering physicians easier and improves examination planning.

[Raman spectroscopy applied to analytical quality control of injectable drugs: analytical evaluation and comparative economic versus HPLC and UV / visible-FTIR]. / La spectroscopie Raman appliquée au contrôle de qualité analytique des médicaments injectables: évaluation analytique et économique comparative versus CLHP et uv/visible-iRTF.

In France, central IV admixture of chemotherapy (CT) treatments at the hospital is now required by law. We have previously shown that the shaping of Therapeutic Objects (TOs) could profit from an Analytical Quality Assurance (AQA), closely linked to the batch release, for the three key parameters: identity, purity, and initial concentration of the compound of interest. In the course of recent and diversified works, we showed the technical superiority of non-intrusive Raman Spectroscopy (RS) vs. any other analytical option and, especially for both HPLC and vibrational method using a UV/visible-FTIR coupling. An interconnected qualitative and economic assessment strongly helps to enrich these relevant works. The study compares in operational situation, the performance of three analytical methods used for the AQC of TOs. We used: a) a set of evaluation criteria, b) the depreciation tables of the machinery, c) the cost of disposables, d) the weight of equipment and technical installations, e) the basic accounting unit (unit of work) and its composite costs (Euros), which vary according to the technical options, the weight of both human resources and disposables; finally, different combinations are described. So, the unit of work can take 12 different values between 1 and 5.5 Euros, and we provide various recommendations. A qualitative evaluation grid constantly places the SR technology as superior or equal to the 2 other techniques currently available. Our results demonstrated: a) the major interest of the non-intrusive AQC performed by RS, especially when it is not possible to analyze a TO with existing methods e.g. elastomeric portable pumps, and b) the high potential for this technique to be a strong contributor to the security of the medication circuit, and to fight the iatrogenic effects of drugs especially in the hospital. It also contributes to the protection of all actors in healthcare and of their working environment.

A prospective open-labeled trial with levetiracetam in pediatric epilepsy syndromes: continuous spikes and waves during sleep is definitely a target.

Although LVT is currently extensively prescribed in childhood epilepsy, its effect on the panel of refractory epilepsy syndromes has not been entirely evaluated prospectively. In order to study the efficacy and safety of LVT as adjunctive therapy according to syndromes, we included 102 patients with refractory seizures (6 months to 15 years) in a prospective open-labeled trial. The responder rate was respectively 36% and 32% at 3 and 6 months with 6% and 7% patients becoming seizure free. Among the responders at 6 months (n=33), seizure frequency decreased by 66% and 79% at 3 and 6 months LVT compared to baseline. The highest benefit was for CSWS patients with 2/3 responders, 50% seizure free and no aggravation. LVT provided respectively 39% and 42% responders in focal and absence epilepsies. Infantile spasms and Dravet syndrome experienced the lowest efficacy. No patient with myoclonic-astatic epilepsy or Lennox-Gastaut syndrome was aggravated. LVT dose over 40 mg/kg/d was associated with a lower response rate. Tolerability was excellent. In spite of a small sample, we assume that CSWS is a good candidate for a randomized-controlled trial with LVT.