ANTIFON-CLIC®, a new clinical decision support system for the treatment of invasive aspergillosis: is it clinically relevant?

BACKGROUND

Invasive aspergillosis (IA) is increasing especially in new groups of patients. Despite advances in management, morbidity and mortality related to IA remain high. Thus, Clinical Decision Support System (CDSS) dedicated to IA are needed to promote the optimal antifungal for each group of patients.

PATIENTS AND METHODS

This was a retrospective multicenter cohort study involving intensive care units and medical units. Adult patients who received caspofungin, isavuconazole, itraconazole, liposomal amphotericin B, posaconazole, or voriconazole, for the treatment of IA were eligible for enrollment. The primary objective was the concordance between the clinician's prescription and the prescription recommended by the CDSS. The secondary objective was the concordance according to different hospitals, departments, and indications.

RESULTS

Eighty-eight patients (n=88) from three medical hospitals were included. The overall concordance was 97% (85/88) including 100% (41/41) for center A, 92% (23/25) for center B, and 95% (21/22) for center C. There was no significant difference in concordance among the hospitals (P=0.973), the departments (P=1.000), and the indications (P=0.799). The concordance was 70% (7/10) for isavuconazole due to its use as an empirical treatment and 100% (78/78) for the other antifungals.

DISCUSSION

The concordance rate was high whatever the hospital, the department, and the indication. The only discrepancy was attributed to the use of isavuconazole as an empirical treatment which is a therapeutic option not included in the CDSS.

CONCLUSIONS

This new CDSS dedicated to IA is meeting the clinical practice. Its implementation in routine will help to support antifungal stewardship.

Personalized bacteriophage therapy to treat pandrug-resistant spinal Pseudomonas aeruginosa infection

Bone and joint infections (BJI) are one of the most difficult-to-treat bacterial infection, especially in the era of antimicrobial resistance. Lytic bacteriophages (phages for short) are natural viruses that can selectively target and kill bacteria. They are considered to have a high therapeutic potential for the treatment of severe bacterial infections and especially BJI, as they also target biofilms. Here we report on the management of a patient with a pandrug-resistant Pseudomonas aeruginosa spinal abscess who was treated with surgery and a personalized combination of phage therapy that was added to antibiotics. As the infecting P. aeruginosa strain was resistant to the phages developed by private companies that were contacted, we set up a unique European academic collaboration to find, produce and administer a personalized phage cocktail to the patient in due time. After two surgeries, despite bacterial persistence with expression of small colony variants, the patient healed with local and intravenous injections of purified phages as adjuvant therapy.

Here, the authors describe a patient with a pandrug-resistant Pseudomonas aeruginosa spinal abscess successfully treated with a personalized combination of phage therapy and antibiotics.

[Consumption of narcotics, substances assimilated to narcotics and psychotropic drugs in health establishments: Profile of a hospital from France and a hospital from Quebec]

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.

[Contribution of a hospital pharmacy team to critical care of patients infected with SARS-CoV-2]

Le circuit du médicament hospitalier le plus sûr est la dispensation journalière individuelle nominative automatisée assurée par la pharmacie. Depuis plusieurs années nous essayons de convaincre les décideurs hospitaliers de l’implanter dans notre établissement. En attendant, pour pallier les risques d’erreurs médicamenteuses encourus par les patients et les soignants, nous avons constitué plusieurs équipes de travail au sein des unités de soins. Ces équipes sont constituées d’un pharmacien et d’un ou deux préparateurs en pharmacie hospitalière qui assurent notamment la gestion des armoires à pharmacie des unités de soins. La collaboration étroite avec médecins et personnel infirmier développée au fil des années a été un élément favorable déterminant lorsqu’il a fallu doter en médicaments et en dispositifs médicaux stériles (DMS) les nouvelles unités de soins critiques face à l’afflux de patients contaminés par le SARS-CoV2. Le suivi quotidien des médicaments consommés par patient, particulièrement les curares, et des DMS en rupture d’approvisionnement a été un élément clé de la gestion des stocks et des changements de principes actifs, de conditionnements et/ou de références de matériel. Les faits relatés donnent du poids au rapport Claris qui souligne les effets positifs en termes de qualité et de sécurité de prise en charge des patients du travail des PPH et pharmaciens dans les unités de soins. Ils soulignent par ailleurs les dangers auxquels sont exposés patients et soignants samedi, dimanche et jours fériés quand la pharmacie est fermée. Ils légitiment la question de l’extension de l’ouverture de la pharmacie en équipe complète 365 jours par an.

A systematic review of interventions and performance measures for antifungal stewardship programmes

Objectives

Antifungal resistance is a significant and emerging threat. Stewardship programmes (SPs) have been proposed as an opportunity to optimize antifungal use. While examples of antifungal SP implementation have been recently described, there is yet to be an overview of interventions and their impacts on performance measures.

Methods

We systematically reviewed published articles using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses check-list 2009. MEDLINE was searched using the term 'antifungal stewardship' on 15 February 2017. Eligible studies were those that described an antifungal SP and included an intervention and an evaluation of performance measures.

Results

A total of 97 studies were identified and 14 were included. Only five studies reported an antifungal stewardship team composed of all the recommended members. The main intervention was the formulation of recommendations to change treatment (12 of 14). The main performance measure collected was antifungal consumption (10 of 14), followed by antifungal expenditure (7 of 14), adherence to therapeutic advice (4 of 14) and impact on mortality (4 of 14). Antifungal consumption was reduced by 11.8% to 71% and antifungal expenditure by as much as 50%. Adherence to therapeutic advice ranged from 40% to 88%, whereas antifungal SPs had no impact on mortality.

Conclusions

All antifungal SPs had an impact, in particular on antifungal consumption and antifungal expenditure. Active intervention including a review of prescriptions seems to have more impact than implementation of treatment guidelines only. According to available published studies, antifungal consumption appears to be the most achievable performance measure to evaluate the impact of an antifungal SP.

Promoting oral potassium administration in a tertiary care hospital: An eleven-year study

INTRODUCTION

Potassium is used to treat or prevent hypokalemia and exhibits all the characteristics of an intravenous to oral therapy conversion program. Despite this, the intravenous route for potassium replacement seems frequently unjustified.

OBJECTIVES

To determine the impact of a conversion program on the use of intravenous and oral galenic forms in a university tertiary care hospital.

METHODS

Two promotion campaigns were conducted in 2006 and 2009. The following years this was completed by pharmacist interventions during prescription analysis and face-to-face discussions with physicians during ward rounds. The consumption of products containing potassium was obtained by analyzing the hospital's financial database.

RESULTS

The proportion of the oral route increased from 18% in 2006 to 22% in 2011, and from 25% in 2012 to 44% in 2016; the increase was significantly greater in the second period (P<0.0001). In 2016, in emergency, pulmonology, infectious diseases, and cardiology departments, the proportion of oral use ranged from 57% and 82%. The greatest progression from 2006 to 2016 was found for intensive care (4% vs. 12%) and visceral surgery departments (9% vs. 34%) that increased approximately four-fold, followed by the emergency department (28% vs. 57%) that increased approximately two-fold.

CONCLUSION

Promoting the oral route for potassium replacement modifies prescriber habits and is followed by a notable increase in the proportion of potassium administered orally irrespective of department type.

[Off-label use of intravenous immunoglobulin therapy in the treatment of lupus myocarditis: Two case reports and literature review]

INTRODUCTION

Several case reports have reported the benefit of intravenous immunoglobulin therapy in many autoimmune diseases, including systemic lupus erythematosus.

CASE REPORTS

Here, we report on two cases of lupus myocarditis treated with high dose of intravenous immunoglobulin. The first patient was a 42-year-old woman who presented with lupus myocarditis that was resistant to corticosteroids and cyclophosphamide, and who was finally successfully treated with a single dose of 2 g/kg of intravenous immunoglobulin. The patient displayed clinical improvement a few days later. The second case - a 43-year-old woman was diagnosed with lupus myocarditis and immunosuppressive drugs were contraindicated because of the context of a recent infective endocarditis. She was treated with repeated dose of 2 g/kg of intravenous immunoglobulin. Clinical improvement was observed and the left ventricular ejection fraction increased from 20 % to 60 % within a few days. We also report 9 similar observations identified from a literature review.

CONCLUSION

The use of intravenous immunoglobulin in lupus myocarditis is not officially recognized but could be considered as an alternative when conventional therapies have failed or are contraindicated.

[Medication errors with concentrated potassium intravenous solutions: Data of the literature, context and prevention]

Accidental direct intravenous injection of a concentrated solution of potassium often leads to patient death. In France, recommendations of healthcare agencies to prevent such accidents cover only preparation and intravenous infusion conditions. Accidents continue to occur in French hospitals. These facts demonstrate that these recommendations are insufficient and ineffective to prevent such deaths, especially those occurring during a catheter flushing. This article reviews the measures able to reduce the number of accidents. Countries which removed concentrated ampoules from ward stocks observed a decrease of the number of accidental deaths. This withdrawal, recommended by the World Health Organization, is now part of standards in studies aimed at determining the safety of care in hospitals. However, removal alone is insufficient to eliminate the risk. The combination with other measures should be considered. These measures are the provision of a combination of diluted intravenous ready to use solutions, the promotion of the oral route with tablets and oral solutions for potassium replenishment and to make available products with safeguards to prevent single shot intravenous injection. Studies aimed at determining the consequences on preventing concentrated potassium accidents of a widespread distribution of isotonic sodium chloride pre-filled ready-to-use syringes for catheter flushing should be performed.

Overdosed prescription of paracetamol (acetaminophen) in a teaching hospital

INTRODUCTION

Paracetamol is the most commonly used analgesic and antipyretic. Reviews of hospital use of paracetamol are scarce. Little is known about the appropriateness of the dose of paracetamol prescribed for hospitalized adults. The aim of this study was to report on the nature and the frequency of the overdosed prescription of paracetamol observed in adult patients over a 4.5-year period in a teaching hospital.

METHODS

Prescription analysis by pharmacists was performed once a week in six medical and three surgical departments and daily in a post-emergency unit. In cases of prescription error, the pharmacist notified the physician through an electronic alert when a computerized prescription order entry system was available or otherwise by face-to-face discussion. For each drug-related problem detected, the pharmacists recorded relevant details in a database.

RESULTS

From October 2006 to April 2011, 44,404 prescriptions were reviewed and 480 alerts related to the overdosed prescription of paracetamol were made (1% of analyzed prescriptions). The extent of errors of dosage was within the intervals [90-120 mg/kg/d] and greater than 120 mg/kg/d for 87 and 11 patients respectively, who were prescribed a single non-combination paracetamol containing product. Sixty alerts concerned co-prescription of at least two paracetamol containing products with similar frequency for computerized (1.4/1000) or handwritten (1.2/1000) prescriptions.

DISCUSSION

Prescriptions of paracetamol for hospitalized adults frequently exceed the recommended dosage.

CONCLUSION

These results highlight the need for increased awareness of unintentional paracetamol overdose and support the initiation of an educational program aimed at physicians and nurses.

[Accidental intravenous injection of potassium chloride: analysis of contributing factors and barriers to risk reduction]

Errors linked to injectable potassium chloride (KCl) have been the cause of deaths which have occurred for many years. Following an accidental direct intravenous injection of KCl of no clinical consequence for the patient, we have analyzed the contributive factors, established an action plan to prevent this risk and finally assessed its impact. Among the causes leading to medication errors, we have identified those linked to the handling of the drugs by nurses, the team, the work conditions, the organization, the institutional context and finally to the drug itself. The risk reduction procedure involved a withdrawal of injectable KCI ampoules from wards, possible in 52% of the care units, a reorganization of storage for the others. The subsequent monitoring of floorstocks revealed that these measures were insufficient and that the risks prevailed due to the presence of KCI ampoules in drawers assigned to other ionic solutions. A study carried out among the medical and nursing personnel revealed that 61.2% of the doctors thought that the risk existed in their ward and 68% of the nurses considered themselves to be exposed to the risk of a medication error. The drug supply chain of our institution, as in numerous others, is not safe. Hospitals are not yet organized adequately to prevent the occurrence of such an error. The comparison with foreign organizations of drug dispensation allows us to think that the improvement and professionalization of the drug supply chain will both be assets in the prevention of such medication errors.

Consultation de pharmacie et niveau de connaissance des patients hospitalisés traits par des médicaments anti-vitamine K

The report published by the French Agency for the Medical Safety of Health Products in 2001 estimated the number of hospital admissions in France for hemorrhagic accidents caused by oral anticoagulants (OA) to be 17,000. For this reason, we have set up pharmaceutical counselling for hospitalized patients treated with OA. The object of this article is to describe this therapeutic education program and to present the level of knowledge that patients have of their OA treatment. Among 68 patients treated prior to their admission, 87% knew the name of the OA, 86% the role of this treatment, 80% the dosing schedule, 57% what to do if a dose had been forgotten, 34% the signs of overdose, 48% the signs of and risks associated with not following the treatment schedule, 94% the advantage of biological follow-up and 68% the principal combinations of drugs that should be avoided. Among 118 patients whose treatment was begun during hospitalization, the level of knowledge for each item were respectively: 41%, 61%, 38%, 37%, 19%, 23%, 34% and 24% at the time of counselling. Newly treated patients acquired their knowledge from contact with nurses. The least known items were the symptoms and risks associated with overdosing or underdosing. This knowledge is therefore fragmentary and does not guarantee the patients' safety, which justifies the proposition of this type of counselling to such hospitalized patients.

Epidural analgesia with 0.15% ropivacaine plus sufentanil 0.5 microgram ml-1 versus 0.10% bupivacaine plus sufentanil 0.5 microgram ml-1: a double-blind comparison during labour

BACKGROUND

Ropivacaine has been claimed to produce less motor block than bupivacaine during epidural analgesia. However, this advantage has not been clearly confirmed in obstetric studies using low analgesic concentrations in a ratio close to that suggested to be equianalgesic.

METHODS

This double-blind, randomized, prospective study was performed in 140 parturients who requested epidural analgesia. After a lumbar epidural catheter had been placed, patients received either 0.10% bupivacaine plus sufentanil 0.5 microgram ml-1 or 0.15% ropivacaine plus sufentanil 0.5 microgram ml-1 followed by a continuous infusion. Additional boluses were used for inadequate levels of analgesia. Visual analogue pain scores, motor block, level of sensory block, supplementary boluses and main characteristics of labour were recorded.

RESULTS

No differences were observed between the two groups for pain scores, total volume of anaesthetic solution used [59 (23) and 57 (24) ml in the bupivacaine and ropivacaine groups respectively], duration of labour, mode of delivery, side-effects or satisfaction score. The incidence of motor block was not statistically different between the groups (54 and 69% in the bupivacaine and ropivacaine groups respectively, P = 0.07). However, when motor block occurred, survival analysis showed that it occurred sooner in the course of labour with ropivacaine compared with bupivacaine (log rank test, P = 0.012).

CONCLUSION

Combined with sufentanil 0.5 microgram ml-1, 0.10% bupivacaine and 0.15% ropivacaine produce effective and equivalent analgesia during labour, with similar incidences of motor block.

Progesterone inhibits female courtship behavior in domestic canaries (Serinus canaria)

We studied copulation solicitation display (CSD) responses to playback in photostimulated female canaries given systemic injections of progesterone. Eight females received injections of 0.1 mg of progesterone dissolved in olive oil during their first breeding cycle and were untreated during their second breeding cycle; eight females received only the oil vehicle during their first breeding cycle and received no treatment during their second breeding cycle. The injections were performed every second day during 15 days, after the onset of nest building. Progesterone treatment resulted in a significant increase of plasma progesterone which in turn provoked an inhibition of females' CSDs and decreased the size of the clutch. During the first breeding cycle, progesterone-treated females had lower CSDs and egg-laying scores than did control females. During the second breeding cycle, when females received no treatment, no differences emerged between the two groups. The suppressive effect of progesterone on female sexual responses was observed as soon as 48 h after the beginning of the treatment. We propose that progesterone plays a key role in mediating the transition from active female courtship behavior to sexual refractoriness in this species. Suppressive effects of progesterone on female sexual behavior have been previously described in lizards as well as in rodents. Our data are consistent with the hypothesis of Godwin et al. (J. Godwin, V. Hartman, M. Grammer, and D. Crews, Horm. Behav. 30, 138-144, 1996) which proposed that the decrease in sexual behavior following plasma progesterone increase represents an evolutionarily conserved mechanism in the regulation of female sexual behavior.

Effects of fadrozole on sexual displays and reproductive activity in the female canary

We used fadrozole, a potent inhibitor of the aromatization of androgens to estrogens, to investigate the influence of estradiol on copulation solicitation displays (CSD) and reproductive activity in female canaries (Serinus canaria). Systemic injections of fadrozole during 10 consecutive days were effective in reducing plasma estradiol concentrations in adult female canaries submitted to photostimulation. Fadrozole provides a powerful tool for limiting an individual's exposure to estradiol, and the results of this study emphasize the influence of estradiol secretion in the regulation of behavioral transitions along the reproductive cycle of the female canary. When females were injected at the beginning of photostimulation, the emergence of copulation solicitation displays in response to conspecific songs was delayed. When females were injected later, after they were sexually active, the fadrozole treatment did not affect sexual displays. These results are consistent with the hypothesis that a threshold level of estradiol is critical to activate the neural circuitry mediating the copulation solicitation displays response in the female canary. They also suggest that the magnitude of sexual response is not related in a dose-dependent manner to estrogen concentrations observed during the period of sexual responsiveness. When females were injected at the beginning of photostimulation, egg-laying was delayed; when females were injected later, after they were sexually active, the fadrozole treatment dramatically reduced egg-laying and prevented incubation.

The selectivity of sexual responses to song displays: effects of partial chemical lesion of the HVC in female canaries

By stimulating female canaries with computer edited songs, we investigated the involvement of the caudal nucleus of the ventral hyperstriatum or high vocal center (HVC) in the selectivity of sexual responsiveness to different kinds of conspecific songs. Due to the fact that the types of conspecific song phrases act as relevant cues to give song its sexual potency, we compared courtship responses to two conspecific songs, highly sexually-stimulating and weakly sexually-stimulating song, before and after the partial ibotenate lesion of the HVC. Sexual responses to heterospecific song were also tested. Copulation solicitation displays were used as an index of female responses. The partial chemical lesions of the HVC whatever the HVC portion damaged affected female bird behavior; they responded more strongly to weakly sexually-stimulating song and to heterospecific song than before the lesions. However, the conspecific sexually attractive song continued to elicit the highest level of sexual displays. None of the control birds ever altered their pattern of responses to the three song types. The results suggest that the HVC is part of the neural network engaged in the control of sexual preferences to conspecific song displays.

Influence of the presence of chicks on the ability to resume incubation behavior in domestic hens (Gallus domesticus)

In this study, hormonal and behavioral changes associated with nest deprivation in the absence or in the presence of chicks (replaced every day or not) were investigated in incubating hens. Prolactin levels decreased, whereas LH and E2 levels increased following nest deprivation. Surprisingly, the presence of chicks had no effect on prolactin changes. However, the presence of chicks significantly limited increases in plasma LH and estradiol. Furthermore, this inhibitory effect was greater when day-old chicks were replaced every day. On the other hand, the presence of chicks induced the emergence of specific maternal behavior, while, surprisingly, one-third of the nest-deprived hens without chicks continued to incubate. After a 3-day deprivation period, readiness to renest was maintained for a percentage of hens. Thus more than 2/3 of hens deprived of the nest for 3 days in the presence of chicks returned to their nests during the first day of being allowed to do so, versus less than 1/3 of hens without chicks among those that previously disrupted incubation behavior. Plasma prolactin concentrations of these renesting hens increased rapidly and reached again levels characteristic of incubating hens. We conclude that, under our experimental conditions, presence of chicks maintains readiness to incubate without maintaining high levels of plasma prolactin.

Respective effects of chicks and nest on behavior and hormonal concentrations of incubating domestic hens

Removal of incubating hens from their nestboxes or substitution of chicks for eggs disrupt incubation; prolactin levels decrease whereas luteinizing hormone and gonadal steroid concentrations tend to rise. The present experiment was undertaken to determine the relative influence of removing the nest (nest-deprived hens), adding chicks (maternal hens), or both (maternal nest-deprived hens), on the behavior and hormone concentrations of incubating hens. The results confirm that nest removal, as well as adding chicks, stops incubation. No differences were found between maternal and maternal nest-deprived hens' behavioral responses or hormonal concentrations. These results do not support the hypothesis that the drop of plasma prolactin observed in maternal hens is the consequence of the nest abandonment. In contrast, nest-deprived hens presented lower concentrations of prolactin and higher concentrations of estradiol than maternal and maternal nest-deprived hens. Moreover, the nest-deprived hens presented lower concentrations of prolactin and higher concentrations of LH and estradiol than the hens given chicks. We assume that physical contact with chicks, during brooding bouts, slows down the decrease of prolactin secretion and inhibits LH and estradiol release at the end of incubation.

Incubation and maternal behaviour in domestic hens: influence of the presence of chicks on circulating luteinising hormone, prolactin and oestradiol and on behaviour

1. The consequences of the adoption of chicks and their subsequent removal on behaviour and plasma hormone concentrations of incubating hens were investigated. Birds were divided into two group: in group A, incubating hens were given chicks for 11 d; in group B chicks were left with the hens for 3 d only. 2. Incubating hens given chicks immediately showed maternal responses. The introduction of chicks induced a gradual nest desertion. Their removal stopped nest desertion temporarily on day 4 in group B hens. 3. Plasma prolactin concentrations fell one day after introduction of chicks and continued to decline for about one week in group A hens, although there was no further significant decrease in group B hens. Circulating prolactin tended to decrease with time in both groups. 4. Plasma luteinising hormone (LH) concentrations increased concurrently with the decrease of prolactin. The increase was more abrupt in group B hens. 5. Plasma oestradiol concentrations decreased slightly on the day chicks were introduced. The decline was arrested by removal of chicks in group B; in group A the tendency was reversed about 10 days after chick introduction. 6. Irrespective of group, before chick removal hens which deserted their nest rapidly had less contact with chicks and lower prolactin concentrations.

Maternal behavior in normal and androgenized female rats: effect of age and experience

The aim of the experiments presented here was to evaluate the influence of age and of previous maternal experience on care of pups in normal virgin and androgenized Wistar female rats. When sensitization occurred before they were 60 days old, androgenized females failed to develop consistent retrieving, probably because of excessive timidity (Experiments 1 and 2) whereas they were able to keep pups warm in their nests. During pup-toy choice tests (Experiment 2) young androgenized females displayed only erratic carrying of toys. On the other hand, 60-, 80- or 100-day-old androgenized females developed full maternal behavior like cyclic controls. In the third experiment, control and androgenized females exposed to pups when 60 days old, were reexposed when 95 days old. Androgenized females proved to be more sensitive to earlier exposure to pups than control females and showed significant reductions in latencies of emergence of maternal responses.

Tendency to display spontaneous incubation does not affect maternal responsiveness in the domestic hen

Induction of maternal behavior was performed in 63-week-old hens of the JV15 (or "Vedette") strain which had previously exhibited brief incubating phases during the preceding egg-laying period to discover if their maternal behavior differed from that induced in hens who had no previous record of incubating. The degree of maternal behavior exhibited showed large variation among individuals. However, hens with a history of one or more spontaneous, brief incubation bouts and hens without such histories showed similar responsiveness toward chicks and similar levels of general activity. In most of the subjects, the establishment of maternal behavior was accompanied by a significant long-term fall in the plasma levels of luteinizing hormone whereas the plasma levels of prolactin appeared to be unaffected.

Influence of food restriction and of the presence of chicks on the reproductive system of the domestic hen

An experiment was conducted with 4 groups of hens: a control group of laying hens, a group subjected to food deprivation for 7 d, a group subjected to food deprivation for 7 d, then re-fed for 10 d and a group subjected to food deprivation for 7 d then re-fed for 10 d with two chicks per hen introduced during the last 7 d of refeeding. Food deprivation provoked the involution of the oviduct and ovarian regression, as well as a decrease in the plasma concentrations of luteinising hormone (LH) and sex steroids (progesterone, testosterone and oestradiol). After 3 d of re-feeding, there was a significant increase in the plasma concentrations of LH and steroid hormones. This phenomenon was even more marked after 10 d of re-feeding; most of the hens of the third group which were not given chicks, were at the point of lay. The presence of chicks resulted in the expression of maternal behaviour and suppressed a rapid return to laying. This was especially marked in hens showing typical maternal behaviour traits, for which the morphological and endocrine measurements indicated a decrease in the activity of the hypothalamo-hypophyseal-gonadal axis.

Induction of maternal behavior in incubating and non-incubating hens: influence of hormones

Maternal responses and variations in plasma levels of prolactin and testosterone have been studied in incubating and in non-incubating, non-laying hens during forced adoption experiments. The results demonstrate the ability of incubating hens to display complete maternal behavior as early as the 10th day of incubation after being exposed to stimulation by chicks during one night. Maternal responses also emerged in non-laying hens but more gradually. In both groups, a decline in plasma testosterone occurred after the introduction of the chicks and, in the incubating hens, prolactin levels fell as they abandoned their nests.

Induction of maternal behavior and some hormonal and physiological correlates in the domestic hen

The manifestation of maternal behavior and the variations of plasmatic levels of gonadic hormones (testosterone, delta 4-androstenedione, and 17 beta-estradiol) have been studied in two groups of domestic hens (layers and nonlayers) during a forced adoption experiment. Maternal behavior appears later in actively laying hens than in nonlayers. The former hens show a higher level of androgens (T and delta 4). The appearance of typical maternal behavior coincides with a pause in laying and a decrease in all the plasmatic steroid levels measured.