[Consumption of narcotics, substances assimilated to narcotics and psychotropic drugs in health establishments: Profile of a hospital from France and a hospital from Quebec]. / Consommation des stupéfiants, substances assimilées aux stupéfiants et psychotropes en établissement de santé : profil d'un hôpital français et d'un hôpital québécois.

OBJECTIVES: The objective was to describe the trends in the consumption of narcotic drugs, substances related to narcotic drugs (SAS) and psychotropic drugs between a French hospital and a Quebec hospital between 2013 and 2017. METHODS: This is a retrospective descriptive study. The consumption data was obtained from the pharmacy management software and was extracted by financial year (January 1st, 2013 to December 31st, 2017 for the French hospital and April 1st, 2013 to March 31st, 2018 for the Quebec hospital). For each drug considered to be narcotics, SAS and psychotropic drugs in France or subject to the legislation on designated substances in Quebec, we identified the quantities consumed from 2013 to 2017. The data werepresented according to the following therapeutic classes: opioids (N02A), other analgesics (N02B), anxiolytics (N05B), hypnotics and sedatives (N05C), general anesthetics (N01A), psychostimulants (N06B), androgens (G03B) and antagonists peripheral opioid receptors (A06A). The data were expressed as a defined daily dose (DDJ) for 1000 patient-days (PDs). RESULTS: In the French hospital, the consumption of narcotics, SAS and psychotropic drugs varied from 676 to 560 DDJ per 1000 PDs between 2013 and 2017. While it varied from 1019 to 756 DDJ per 1000 PDs between 2013 and 2017 in the Quebec hospital. In 2017, the most widely used therapeutic classes in French hospitals were, in decreasing order, anxiolytics (211 DDJ per 1000 PDs) (i.e. alprazolam), opioids (205 DDJ per 1000 PDs) (i.e. tramadol, morphine injectable) and hypnotics and sedatives (64 DDJ per 1000 PDs) (i.e. midazolam injectable). In Quebec hospitals, the three therapeutic classes the most used in 2017 were, in decreasing order, opioids (314 DDJ per 1000 PDs) (i.e. hydromorphone injectable, morphine injectable), anxiolytics (221 DDJ per 1000 PDs) (i.e. clobazam) and hypnotics and sedatives (108 DDJ per 1000 PDs) (i.e. midazolam injectable). CONCLUSION: This study notes a decrease in the consumption of opioids and other substances in both the French and Quebec establishments between 2013-2017. More work is needed to better describe the differences observed between the profile of each establishment. This is why monitoring consumption trends, therapeutic indications and preventive measures are essential.

[Retrospective cohort study of rituximab biosimilar (Rixathon®) adverse events in adult hematology and pediatric nephrology]. / Etude de cohorte rétrospective sur les effets indésirables du biosimilaire du rituximab (Rixathon®) en hématologie adulte et néphrologie pédiatrique.

The purpose of this study was to describe rituximab biosimilar safety in adult hematology and pediatric nephrology units. Adverse events were classified using the Common Terminology Criteria for Adverse Events (CTCAE) classification. Fifty adult patients were enrolled for a total of 126 cures and 11 pediatric patients for a total of 24 biosimilar cures. Among adults, three infusion-related reactions of biosimilar occurred : a bronchospasm, a reaction at the injection site and emesis. Among children, infusion-related reactions were: a bronchospasm, an injection site reaction, an emesis, and diarrhea. For adults, the most common adverse events included neutropenia (13.5 %) with 9 severe grade 3/4 cases, anemia (8.7 %), grade 1 thrombocytopenia (6.3 %), asthenia (2.4 %), infection (2.4 %), and chills (1.6 %). For children, a case of severe grade 4 neutropenia, a fever and conjunctivitis were observed. Results of this study show a confident safety profile of rituximab biosimilar in adults and children in «real life¼.

L'objectif de ce travail est de décrire les effets indésirables du biosimilaire du rituximab en «vie réelle¼ dans les services d'Hématologie adulte et de Néphrologie pédiatrique. Les effets indésirables ont été codés selon la classification des «Common Terminology Criteria for Adverse Events¼ (CTCAE). Cinquante patients adultes ont été inclus pour un total de 126 cures et 11 enfants pour un total de 24 cures de biosimilaire. Chez l'adulte, des réactions liées à la perfusion du biosimilaire ont été caractérisées par un bronchospasme avec frissons, une réaction au point d'injection et un cas de vomissements. Chez les enfants, les réactions liées à la perfusion étaient similaires avec un bronchospasme, une réaction au point d'injection, un cas de vomissements, et un cas de selles liquides. Chez les adultes, les effets indésirables les plus fréquents étaient la neutropénie (13,5 %), une anémie (8,7 %), une thrombopénie de grade 1 (6,3 %), une asthénie (2,4 %), une infection (2,4 %). Chez les enfants, un cas de neutropénie de grade 4, une fièvre et une conjonctivite ont été enregistrés. Le profil d'effets indésirables du biosimilaire du rituximab chez les adultes et les enfants est rassurant.

[Compliance of nursing professional practices related to drug preparation and administration: A cross-sectional and longitudinal descriptive study]. / Observations des pratiques des professionnelles en soins infirmiers liées à la préparation et à l'administration des médicaments : une étude descriptive transversale et longitudinale.

OBJECTIVES: Evaluate the compliance of practices of nursing professionals related to the preparation and administration of drugs in 2018. Discuss the evolution of compliance practices from 2014 to 2018. METHODS: Prospective transversal observational study. Based on an observation grid with 55 compliance criteria, we conducted direct observation of medication doses prepared and administered by nursing professionals. For each compliance criterion, the auditor could indicate whether the practice was compliant, non-compliant or not applicable. A convenience target of 250 observations has been set. RESULTS: A total of 252 doses of drugs were observed between March 1, 2018 and April 29, 2018. Drug doses were observed by day (52 %), evening (30 %) or night (18 %) mainly nurses (80 %) working on regular shifts (94 %). Just over half of the doses required preparation by a nurse (58 %) and almost half of the doses were administered parenterally (48 %). In 2018, the observed compliance rate of the drug circuit ranged from 25.0 % to 86.3 %. CONCLUSION: This descriptive study shows a compliance rate of practices of nursing professionals related to the preparation and administration of drugs, which varies from 25.0 % to 86.3 % by observed stage of the drug circuit. 2018. The study identified 15 action actions for continuous improvement.

Drug shortages in Canada: Data for 2016-2017 and perspectives on the problem.

OBJECTIVES: Many signs point to the growing importance of drug shortages in Canada and around the world. Although drug shortages affect clinicians and patients every day, there is a paucity of literature describing the specific problems experienced and their clinical consequences. To describe the drug shortage situation in Canada in 2016-2017 and to discuss this issue in the Canadian context. METHODS: This retrospective study was based on data from one Canadian wholesaler (McKesson Canada) and the official Drug Shortages Canada website. RESULTS: From August 31, 2016, to September 4, 2017, the McKesson database showed 583 drug shortages, averaging 160 (standard deviation [SD] 180) days, and the drug shortage website showed 2,129 shortages, averaging 118 (SD 113) days. Of these shortages, 26% in the McKesson database and 14% at the official drug shortage website were for parenteral products. In both the McKesson database and the Canadian drug shortage database, the leading drug classes with shortages were central nervous system drugs (26.4% and 31.8%, respectively), cardiovascular drugs (12.0% and 21.9%), anti-infective agents (11.2% and 8.5%), gastrointestinal drugs (7.9% and 6.2%) and antineoplastic agents (7.4% and 5.1%). CONCLUSIONS: This descriptive study highlights the high number of shortages in Canada in 2016-2017. The new federal regulation requiring declaration of drug shortages should lead to better monitoring of this problem at the national level. Although the causes of shortages are often identified, manufacturers and regulators are frequently unable to address or effectively prevent drug shortages.

[Benefit of the geriatric mobile unit's intercession on the quality of medical prescriptions for the elderly: Past year assessment]. / Intérêt de l'intervention de l'unité d'évaluation gériatrique dans la cité sur la qualité des prescriptions médicamenteuses de la personne âgée : bilan à 1 an.

Our multidisciplinary geriatric mobile unit works in behalf of the frail elderly people, aged at least 75, who are in loss of self-reliance. One of its main aims is so optimize medical prescriptions. The purpose of this study was to show the benefit of geriatrician and pharmacist interventions over the quality of medical prescriptions for the elderly. Medication reconciliation of treatment and reassessment of the appropriateness of the prescriptions was systematically carried out. The problems related to drug therapy have been listed and classified according to the criteria of pharmaceutical interventions defined by the French Society of Clinical Pharmacy (SFPC). Out of 181 patients, 86,2% had potentially an inappropriate or sub-optimal prescription. Finally, 462 optimizations were proposed (2.9±1.9 by patients): 204 withdrawals, 166 additions, 58 dosage adaptations, 21 therapeutic follow-ups and 13 modalities of administration. This reassessment of the prescriptions allowed to develop between our geriatric mobile unit and the liberal professionals a communication focused on the therapeutic optimization and to spread recommendations on the proper use of drugs in the elderly population.

[A comparative cost analysis of single-use versus reusable fiberoptic bronchoscopes: Is single-use fiberscope worth it?] / Analyse comparative de coût entre les fibroscopes bronchiques à usage unique et réutilisables : le fibroscope à usage unique, est-ce que ça vaut le coût ?

OBJECTIVE: To present a minimization-cost analysis to compare reusable and single-use fiberscopes in a French health institution. MATERIALS AND METHODS: The amortization cost assessment has been achieved over a period of five years, and took into account the acquisition and maintenance costs, as well as the costs related to disinfection of reusable fiberscopes. The cost of single-use fiberscopes was calculated according to its acquisition and elimination costs. Finally, we compared the costs of single-use vs. reusable use during nights, weekends and days off to estimate the additional cost of the referencing of single-use fiberscopes for theses specific periods. RESULTS: The total cost of reusable fiberscopes was 62,511 € including VAT over 5 years whereas the cost of single-use fiberscope was 79,200 € including VAT over 5 years. The total cost of single-use fiberscopes if utilized during nights, weekends and days off was estimated to 19,800 € including VAT over 5 years, with an estimated activity at 15 intubations per year. Conversely, the cost of the utilization of reusable fiberscopes during nights, weekends and days off was estimate to 13,075 € including VAT over 5 years. CONCLUSION: This study shows that the utilization costs of single use and reusable fiberscopes are very close. But because of the benefits of single-use fiberscopes and according to current recommendations, we consider to acquire single-use fiberscope especially for emergencies such as difficult tracheal intubation and for restrictive periods (nights, weekends and day off).

[Benign fibrolipomyomatous tumor of the perinephric capsule. A report on one case]. / Les tumerus fibro-lipo-myomateuses bénignes de la capsule rénale. Une observation.

The authors describe a case of perinephric capsule tumor and emphasize the difficult in establishing diagnosis by radiological and especially angiographic investigations. The exact nature of the tumor can be determined only by histological examination. They review the published literature which demonstrates the rare nature of capsular fibrolipomyomata having clinical manifestations, the difficulty in making a differential diagnosis from hamartoma, and the possibility of malignant changes occurring in the tumor.