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Yailian AL, Huet E, Charpiat B, Conort O, Juste M, Roubille R, Bourdelin M, Gravoulet J, Mongaret C, Vermorel C, Bedouch P, Janoly-Duménil A. Characteristics of Pharmacists' Interventions Related to Proton-Pump Inhibitors in French Hospitals: An Observational Study. Int J Clin Pract 2022; 2022:9619699. [PMID: 35846437 PMCID: PMC9256420 DOI: 10.1155/2022/9619699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 06/03/2022] [Indexed: 12/31/2022] Open
Abstract
METHODS The study was based on a retrospective analysis of pharmacist interventions for DRPs detected during the medication order review and documented into the French Act-IP© database over a 12-year period. DRPs and PIs were analyzed, and independent factors of physician acceptance were assessed via multiple logistic regression. RESULTS Out of the 620,620 PIs registered, 29,694 targeted a PPI (4.8%). PPI's DRPs were mostly related to the prescription of a "drug not available at the hospital" (26.1%) and a "drug use without indication" (18.3%); PIs were mostly "drug switch" (35.9%) and "drug discontinuation" (26.1%). In all, 18,919 PIs were accepted by physicians (63.7%). Acceptance was significantly associated with patient age: less accepted for the 18-75 years group (OR = 0.59, 95 CI [0.46-0.76]), and the >75 years group (OR = 0.57, 95 CI [0.44-0.73]) vs. <18 years group; for the type of DRP, "drug use without indication" was the less accepted (OR = 0.73, 95 CI [0.63-0.85]); for the type of PI, "dose adjustment" was the less accepted (OR = 0.32, 95 CI [0.23-0.45]). CONCLUSION Pharmacists contribute to preventing DRPs associated with PPI prescriptions during the medication order review process. Moreover, they often detect PPIs used without indication and they propose drug discontinuation, which contributes to the PPI deprescribing process. PIs should be further developed in the future to reduce PPI overprescription.
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Affiliation(s)
- AL Yailian
- Pharmacy Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
- Université Claude Bernard Lyon 1, Université de Lyon, UR 4129 Parcours Santé Systémique, Lyon, France
| | - E. Huet
- Pharmacy Department, Dieppe Hospital, Dieppe, France
| | - B. Charpiat
- Pharmacy Department, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon 69004, France
- Université Grenoble Alpes, CNRS/TIMC UMR5525, F-38041, Grenoble, France
- Working Group ‘Valorization of Pharmaceutical Interventions/Valorisation des Interventions Pharmaceutiques – Act-IP©' of the French Society for Clinical Pharmacy, Marseille, France
| | - O. Conort
- Working Group ‘Valorization of Pharmaceutical Interventions/Valorisation des Interventions Pharmaceutiques – Act-IP©' of the French Society for Clinical Pharmacy, Marseille, France
- Clinical Pharmacy Department, Cochin Hospital, APHP Centre, Cochin, Université de Paris, Paris, France
| | - M. Juste
- Working Group ‘Valorization of Pharmaceutical Interventions/Valorisation des Interventions Pharmaceutiques – Act-IP©' of the French Society for Clinical Pharmacy, Marseille, France
- Pharmacy Department, Auban Mouet Hospital, Epernay, France
| | - R. Roubille
- Pharmacy Department, Lucien Hussel Hospital, Vienne, France
| | - M. Bourdelin
- Working Group ‘Valorization of Pharmaceutical Interventions/Valorisation des Interventions Pharmaceutiques – Act-IP©' of the French Society for Clinical Pharmacy, Marseille, France
- Pharmacy Department, Nord-Ouest Villefrance Hospital, Villefranche sur Saône, France
| | - J. Gravoulet
- Working Group ‘Valorization of Pharmaceutical Interventions/Valorisation des Interventions Pharmaceutiques – Act-IP©' of the French Society for Clinical Pharmacy, Marseille, France
- Regional Union of Healthcare Professionals Pharmacists of the Grand Est (URPS), Nancy 54000, France
- Lorraine University, Faculty of Pharmacy, Nancy 54000, France
| | - C. Mongaret
- Working Group ‘Valorization of Pharmaceutical Interventions/Valorisation des Interventions Pharmaceutiques – Act-IP©' of the French Society for Clinical Pharmacy, Marseille, France
- Pharmacy Department, Reims University Hospital, Reims, France
- Reims Champagne Ardennes, Faculty of Pharmacy, Reims, France
| | - C. Vermorel
- Université Grenoble Alpes, CNRS/TIMC UMR5525, F-38041, Grenoble, France
| | - P. Bedouch
- Université Grenoble Alpes, CNRS/TIMC UMR5525, F-38041, Grenoble, France
- Working Group ‘Valorization of Pharmaceutical Interventions/Valorisation des Interventions Pharmaceutiques – Act-IP©' of the French Society for Clinical Pharmacy, Marseille, France
- Pharmacy Department, Grenoble Alpes University Hospital, Grenoble 38043, France
| | - A. Janoly-Duménil
- Pharmacy Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
- Université Claude Bernard Lyon 1, Université de Lyon, UR 4129 Parcours Santé Systémique, Lyon, France
- Working Group ‘Valorization of Pharmaceutical Interventions/Valorisation des Interventions Pharmaceutiques – Act-IP©' of the French Society for Clinical Pharmacy, Marseille, France
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Juste M. Surmédicalisation. Le Pharmacien Hospitalier et Clinicien 2020. [PMCID: PMC7548116 DOI: 10.1016/j.phclin.2020.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Juste M. Humilité épistémique. Le Pharmacien Hospitalier et Clinicien 2020. [PMCID: PMC7423507 DOI: 10.1016/j.phclin.2020.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Juste M. On ne meurt qu’une fois. Le Pharmacien Hospitalier et Clinicien 2020. [PMCID: PMC7185920 DOI: 10.1016/j.phclin.2020.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Allenet B, Juste M, Mouchoux C, Collomp R, Pourrat X, Varin R, Honoré S. De la dispensation au plan pharmaceutique personnalisé : vers un modèle intégratif de pharmacie clinique. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.phclin.2018.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Parent G, Rose FX, Bedouch P, Conort O, Charpiat B, Juste M, Roubille R, Allenet B. [Pharmacists' interventions conducted by hospital pharmacists on psychotropic drugs pharmacotherapy]. Encephale 2014; 41:339-45. [PMID: 25523124 DOI: 10.1016/j.encep.2014.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 06/12/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The French Society of Clinical Pharmacy (SFPC) through the special interest group "standardization and optimization of clinical pharmacy activities" stated that the study of pharmacists' interventions (PIs) conducted during prescription analysis was a priority. The SFPC developed an internet website named Act-IP(®) (http://www.sfpc.eu/fr/) where French speaking pharmacists were able to document PIs using a normalized codification. The objective of this study was to analyze medication-related problems linked to psychotropic drugs in hospital and to investigate PIs performed during prescription analysis. MATERIALS AND METHODS This is a multicenter, retrospective, observational study using PIs involving psychotropic medications recorded between September 2006 and February 2009 on the Act-IP(®) website. RESULTS Four thousand six hundred and twenty PIs recorded by 165 pharmacists in 57 hospitals were related to psychotropic drugs. Patients concerned by these drug-related problems were 64 years old on average. Seven categories of medication-related problems represented more than 69% of PIs (1.1-Non Conformity of the drug choice compared to the formulary; 4.1 Supratherapeutic dose; 5.3 Therapeutic redundancy; 6.2 Drug interaction (all levels of severity); 7.0 Adverse drug reaction; 8.3 Inappropriate drug form; 8.5 Inappropriate timing of administration). The PIs related to 9.2 Patient's non compliance, 2.0 Untreated indication and 3.2 Length of the treatment too short were infrequent (less than 1%). The most common type of intervention was the dose adjustment. Almost 45% of these PIs involved Zopiclone or Zolpidem prescription in elderly patients. Seven hundred and nine drug interactions were identified by pharmacists. The most common type of drug interaction considered the risk of cardiac arrhythmias due to antipsychotic medications. One hundred and thirty-three PIs concerned adverse drug reaction. The most frequent adverse drug reactions were a fall (36 PIs), hemorrhage/bleeding (32 PIs), drowsiness (12 PIs) and extrapyramidal syndrome (12 PIs). Antidepressant drugs were the greatest pharmacological class concerning adverse drug reaction. The overall acceptance rate was 57%. Eight hundred and seventy-four PIs (19%) were refused and 1111 (24%) were non-assessable. DISCUSSION PIs avoids drug-related problems, such as the polyprescription of benzodiazepine or supratherapeutic dose. However, few PIs concern compliance to therapy or polyprescription of antipsychotic drugs. These two categories of medication-related problems are known to be an issue in mental health therapy. The lack of guidelines describing mental health pathology (such as the HAS guideline) is an obstacle for performing evidence-based PIs. The lack of information describing the context of the prescription is a limitation of this study. In order to improve their practice, pharmacists have to focus more on the context in which patients are evolving, and to take into account its entire situation based on Anglo-Saxon approaches. A second way is to identify clinical settings where PIs are useful and to describe PIs needed. Doctors and pharmacists should get together and talk about these clinical situations and PIs, because some may be misunderstood or disapproved by prescribers. This collaboration could take the form of a thesaurus combining clinical situation and PIs. CONCLUSION It appears important for pharmacists to show their daily involvement in the quality of medical care. This feedback on medication problems encountered and PIs proposed should help prescribers to identify clinical situations at risk. Nevertheless, this study also suggests that progress is possible. Dialogue must allow pharmacists and physicians to delete misunderstandings about their practices.
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Affiliation(s)
- G Parent
- Service de pharmacie, EPSM Novillars-Besançon, rue du Dr-Charcot, 25220 Novillars, France
| | - F-X Rose
- Service de pharmacie, EPSM-Morbihan, rue de l'Hôpital, BP 10, 56826 Saint-Avé, France.
| | - P Bedouch
- CNRS/TIMC, IMAG UMR 5525, université Joseph-Fourier Grenoble 1, Themas, 38041 Grenoble, France; Pôle pharmacie, CHU de Grenoble, BP 217, 38043 Grenoble 09, France
| | - O Conort
- Service pharmacie, hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - B Charpiat
- Service pharmacie, hôpital de la Croix-Rousse, 103, Grande-Rue-de-la-Croix-Rousse, 69317 Lyon cedex 04, France
| | - M Juste
- Centre hospitalier Auban-Moët, 137, rue de l'Hôpital-Auban-Moët, 51200 Epernay, France
| | - R Roubille
- Service pharmacie, centre hospitalier Lucien-Hussel, Mont-Salomon, BP 127, 38209 Vienne cedex 9, France
| | - B Allenet
- CNRS/TIMC, IMAG UMR 5525, université Joseph-Fourier Grenoble 1, Themas, 38041 Grenoble, France; Pôle pharmacie, CHU de Grenoble, BP 217, 38043 Grenoble 09, France
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Bedouch P, Sylvoz N, Charpiat B, Juste M, Roubille R, Rose FX, Bosson JL, Conort O, Allenet B. Trends in pharmacists' medication order review in French hospitals from 2006 to 2009: analysis of pharmacists' interventions from the Act-IP© website observatory. J Clin Pharm Ther 2014; 40:32-40. [PMID: 25303720 DOI: 10.1111/jcpt.12214] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 09/10/2014] [Indexed: 11/27/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVES The French Society of Clinical Pharmacy has developed a website, named Act-IP©, enabling hospital pharmacists to document and analyse pharmacists' interventions (PIs) proposed during medication order review when a drug-related problem is detected. This study analyses PIs documented in Act-IP© and assesses factors associated with physicians' acceptance of PIs. METHODS PIs documented into Act-IP© over a 30-month period were analysed. Independent predictors of physicians' acceptance were assessed using multiple logistic regression. RESULTS AND DISCUSSION A total of 34,522 PIs were registered by 201 pharmacists working in 59 hospitals. PIs were mostly related to 'dose adjustment' (25%), 'drug discontinuation' (20%) and 'drug switch' (19%). Of the 43,343 medications involved, 28% targeted drugs acting on the central nervous system, 17% anti-infective drugs and 16% cardiovascular drugs. Sixty-eight per cent of PIs were accepted by physicians (15% refusals and 17% non-assessable). Physicians' acceptance was significantly associated with 1/ drug group: antineoplastics and immunomodulators (OR = 2.29, CI 95[1.94-2.69]), anti-infectives (OR = 1.19, CI 95 [1.11-1.28]); 2/ type of intervention: drug switch (OR = 1.54, CI 95 [1.43-1.65]), drug discontinuation (OR = 1.38, CI 95 [1.29-1.48]), administration modality optimization (OR = 1.19, CI 95 [1.11-1.29]), addition of a new drug (OR = 1.12, CI 95 [1.00-1.24]); 3/ ward specialty: paediatrics (OR = 1.83, CI 95 [1.24-2.70]) and intensive care (OR = 1.34, CI 95 [1.10-1.64]); 4/ level of pharmacist integration in the ward: higher when the pharmacist is regularly in the ward compared with occasionally (OR = 0.74, CI 95 [0.70-0.79]) or never (OR = 0.68, CI 95 [0.60-0.75]) present. WHAT IS NEW AND CONCLUSION This study highlights the role of routine pharmacist review of medication orders to prevent drug-related problems and gives new insights for a successful collaboration between physicians and pharmacists.
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Affiliation(s)
- P Bedouch
- Grenoble-Alpes University/CNRS, ThEMAS TIMC UMR 5525, Grenoble, France; Pharmacy Department, Grenoble University Hospital, Grenoble, France
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Charpiat B, Bedouch P, Conort O, Juste M, Rose FX, Roubille R, Allenet B. Pharmacists' interventions on intravenous to oral conversion for potassium. Int J Clin Pharm 2014; 36:513-8. [PMID: 24633449 DOI: 10.1007/s11096-014-9916-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 01/14/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Guidelines recommend use of the oral route whenever possible to treat or prevent hypokalemia. Although a myriad of papers have been published regarding intravenous to oral (IV to PO) therapy conversion programs and about clinical pharmacy services provided in hospitals, little is known on the role of hospital pharmacists in promoting the oral route for potassium administration. OBJECTIVE The aim of this work was to describe the frequency of interventions related to IV to PO potassium therapy conversions performed by hospital pharmacists. Setting French hospitals recording pharmacist's interventions on the website tool of the French Society of Clinical Pharmacy. METHODS From the pharmacist's interventions (PI) dataset recorded we extracted all interventions related to potassium IV to PO conversion. We assessed the acceptance rate of these PI by prescribers. Additional free text information in the dataset was analysed. MAIN OUTCOME MEASURES IV to PO potassium therapy conversions related to potassium chloride. RESULTS From January 2007 to December 2010, 87 hospitals recorded 1,868 PIs concerning IV to PO therapy conversion. Among these, 16 (<1 %) concerned potassium chloride. They were recorded by four hospitals (4.6 %) with respectively 12, 2, 1 and 1 PIs. Six PIs were accepted by physicians and the prescriptions were modified. CONCLUSION PIs to promote the administration of potassium by the oral route are extremely rare. Our results and scarce previously published data reveal that this field of practice remains almost unexplored. These findings highlight an important gap in the field of intravenous to oral therapy programs. This situation must be regarded as unsatisfactory and should lead to setting up more education and research programs.
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Affiliation(s)
- B Charpiat
- CNRS, TIMC-IMAG UMR 5525, Joseph-Fourier University-Grenoble 1, Themas, Domaine de la Merci, 38706, La Tronche Cedex, France,
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Charpiat B, Bedouch P, Rose F, Juste M, Roubille R, Conort O, Allenet B. Overdosed paracetamol (acetaminophen) prescriptions and subsequent pharmacist interventions in French hospitals. Annales Pharmaceutiques Françaises 2013; 71:410-7. [DOI: 10.1016/j.pharma.2013.08.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Revised: 08/03/2013] [Accepted: 08/06/2013] [Indexed: 11/16/2022]
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Charpiat B, Bedouch P, Conort O, Rose F, Juste M, Roubille R, Allenet B. Opportunités d’erreurs médicamenteuses et interventions pharmaceutiques dans le cadre de la prescription informatisée : revue des données publiées par les pharmaciens hospitaliers français. Annales Pharmaceutiques Françaises 2012; 70:62-74. [DOI: 10.1016/j.pharma.2012.02.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2011] [Revised: 02/05/2012] [Accepted: 02/13/2012] [Indexed: 11/28/2022]
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Auzéric M, Bellemère J, Conort O, Roubille R, Allenet B, Bedouch P, Rose FX, Juste M, Charpiat B. [Designing a tool to describe drug interactions and adverse events for learning and clinical routine]. Ann Pharm Fr 2009; 67:433-41. [PMID: 19900608 DOI: 10.1016/j.pharma.2009.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2009] [Revised: 09/06/2009] [Accepted: 09/07/2009] [Indexed: 11/16/2022]
Abstract
Pharmacists play an important role in prescription analysis. They are involved in therapeutic drug monitoring, particularly for drugs with a narrow therapeutic index, prevention and management of drug interactions, and may be called in to identify side effects and adverse events related to drug therapy. For the polymedicated patient, the medical file, the list of prescribed drugs and the history of their administration may be insufficient to adequately assign the responsibility of a given adverse effect to one or more drugs. Graphical representations can sometimes be useful to describe and clarify a sequence of events. In addition, as part of their academic course, students have many occasions to hear about "side effects" and "drug interactions". However, in the academic setting, there are few opportunities to observe the evolution and the consequences of these events. In the course of their hospital training, these students are required to perform patient follow-up for pharmacotherapeutic or educational purposes and to comment case reports to physicians. The aim of this paper is to present a tool facilitating the graphic display of drug interaction consequences and side effects. This tool can be a useful aid for causality assessment. It structures the students' training course and helps them better understand the commentaries pharmacists provide for physicians. Further development of this tool should contribute to the prevention of adverse drug events.
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Affiliation(s)
- M Auzéric
- Service de pharmacie, hôpital de la Croix-Rousse, hospices civils de Lyon, 3, Quai-Célestins, 69002 Lyon, France
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Juste M, Martin-Eauclaire MF, Devaux C, Billiald P, Aubrey N. Using a recombinant bispecific antibody to block Na+ -channel toxins protects against experimental scorpion envenoming. Cell Mol Life Sci 2007; 64:206-18. [PMID: 17187174 DOI: 10.1007/s00018-006-6401-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In recent years, several molecular engineering methods of designing bispecific antibodies in various formats have been developed. Tandem-scFvs comprising two scFvs fused together via a peptide are 55-kDa molecules, and are one of the most promising and most straightforward approaches to bispecific antibody production. We report an attempt to design more effective antivenoms to the Androctonus australis scorpion using murine scFvs as building blocks to create a unique bispecific molecule that neutralizes the potent neurotoxins AahI and AahII. The tandem-scFv was produced in recombinant bacteria, purified by immobilized metal ion affinity chromatography, and analyzed by polyacrylamide gel electrophoresis, Western blot, gel filtration, mass spectrometry, and direct and competitive radioimmunoassay. In vivo, it neutralized the binding of the AahI and AahII toxins to their receptor, and protected mice against experimental envenomation. The findings reported here highlight the potential of recombinant antibody fragments for protecting against scorpion venom toxicity.
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Affiliation(s)
- M Juste
- Faculté de Pharmacie, UMR Université-INRA 483, 31 Avenue Monge, 37200, Tours, France
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Arranz I, Martín-Suárez A, Lanao JM, Mora F, Vázquez C, Escribano A, Juste M, Mercader J, Ripoll E. Population pharmacokinetics of high dose ibuprofen in cystic fibrosis. Arch Dis Child 2003; 88:1128-30. [PMID: 14670788 PMCID: PMC1719401 DOI: 10.1136/adc.88.12.1128] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To evaluate ibuprofen population pharmacokinetics in a large series of data collected in children with cystic fibrosis (CF) treated with high doses of ibuprofen (59 patients; 2-18 years), and to identify the main causes responsible for the considerable interindividual variability in ibuprofen serum levels. METHODS Blood samples were collected during routine clinical care; serum ibuprofen concentrations were determined by HPLC. Fitting of the concentration/time data to a one compartment kinetic population model was performed by a non-linear mixed effect regression method. RESULTS Body weight, dose, and ibuprofen dosage form (lysinate salt or the free acid form), for elimination clearance (CL/F); and body weight, dose, and fasting status for the apparent distribution volume (Vd/F) proved to be the covariates with influence in the model. The four factors identified helped to explain part of the interindividual variability observed, but the remaining unexplained variability made therapeutic drug monitoring absolutely essential.
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Affiliation(s)
- I Arranz
- Biochemical Service, Ramón y Cajal Hospital, Madrid, Spain.
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Moya M, Juste M, Cortés E, Carratalá F. Fatty acid composition of mature breast milk according to the mothers diet during pregnancy. Adv Exp Med Biol 2001; 478:405-6. [PMID: 11065104 DOI: 10.1007/0-306-46830-1_49] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Mothers taking 200 g of fish per week, showed a greater content in mature breast milk of n-3 fatty acids, particularly DHA. AA was not decreased. Vitamin D content was low despite mothers were living in a sunny and temperate area. The content of 25 hydroxyvitamin D is increased in the group on fish intake, probably pointing out its marine source.
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Affiliation(s)
- M Moya
- Pediatric Department Hospital Universitario San Juan, Universidad Miguel Hernández, Alicante, Spain
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Moya M, Cortés E, Juste M, De Dios JG, Vera A. Fatty acid absorption in preterms on formulas with and without long-chain polyunsaturated fatty acids and in terms on formulas without these added. Eur J Clin Nutr 2001; 55:755-62. [PMID: 11528489 DOI: 10.1038/sj.ejcn.1601219] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2000] [Revised: 02/14/2001] [Accepted: 02/28/2001] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVE Long chain polyunsaturated fatty acids have beneficial effects in preterm neurophysiological development and are semi-essential. Their levels and variation in plasma and red cells in term and preterms are better known than their intestinal absorption. In this paper the absorption of supplemented arachidonic acid (AA) and docosahexaenoic acid (DHA) is evaluated in a preterm group. DESIGN Four newborn randomized groups were studied. Group T comprised 11 terms on regular formula. Preterms: group P (n=9) was on a classic preterm formula. INTERVENTION groups PA (n=9) and PB (n=13) were on the same formula but PB contained AA and DHA in similar proportion to breast milk. At 20 days a 3 day metabolic balance was taken for Ca, P(i), Mg, total fat and individual fatty acids (C8-C24, saturated unsaturated). RESULTS Calcium absorption was (mean+/-s.d.) 51+/-13% in terms. In preterms it was respectively 45+/-18, 38+/-11 and 37+/-21%. Total fat absorption was 92.0+/-8.0% in terms, and from 95.0+/-2.0 to 91.0+/-8.0% in preterms. Absorption of 8:0, 10:0 and 12:0 showed a very high and constant rate despite significant intake differences (715-33 mg/kg/day). Linoleic acid and alpha-linolenic acid were absorbed in the three groups at around 94% regardless of a greater LA intake in group P. Details of absorption (mg/kg/day) were: for AA, intake 17+/-7, fecal excretion 5+/-4, net retention 12+/-5 (75.0+/-18%); for DHA, intake 10+/-3, fecal excretion 3+/-2, net retention 6+/-4 (62.3+/-30%). CONCLUSION Intestinal absorption of fatty acids is high and is comparable in terms and preterms as regards the studied acids. Longer acids were less well absorbed. The supplemented amounts of AA and DHA were less well absorbed and probably not impairing calcium absorption. SPONSORSHIP University of Alicante, University of Miguel Hernández.
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Affiliation(s)
- M Moya
- Department of Pediatrics, Hospital Universitario San Juan, Universidad Miguel Hernández, Alicante, Spain
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Moya M, Cortés E, Juste M, Vera A, González de Dios J. [Absorptive pattern of individual fatty acids and total fat in full term babies. Its stability in the absence of lactose]. An Esp Pediatr 1998; 48:515-21. [PMID: 9656540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Lactose absence implies a decrease in calcium absorption. If not absorbed, calcium soaps can be produced with the intestinal fatty acids. Absorption and retention of total fat, individual fatty acids, calcium, magnesium and phosphate have been compared between two groups of children, one fed with lactose free formula and higher levels of calcium (FSL) and the other with standard starting formula (FI). None of them had additional arachidonic or docosahexaenoic acids. PATIENTS AND METHODS A randomized prospective study was made on 19 term newborn babies by means of metabolic balance measurement during an 8 day period (four days of a stabilization period on the formula, 3 days of the balance period and the final day for feces collection). Both groups were selected following the same criteria for gestational age, balance age, and weight and length at both time periods. Aliquos from the formula were collected daily, as well as all feces and urine during the balance period. Calcium and magnesium quantification of the corresponding ashed products was performed by means of atomic absorption, while Pi was with a colorimetric assay. Total fat was extracted by organic solvents and quantified by gravimetry. Lipid phase fatty acids were methylated, extracted and quantified by means of gas chromatography with a detector of flame ionization. RESULTS Total fat content and the percentages of each fatty acid did not differ, only calcium concentration in FSL was slightly higher (64.9 +/- 6.9 vs 58.9 +/- 7.0 mg/100 g). No differences were found between groups in relation to ingestion, excretion and retention. The percentages of calcium and total fat retention, however, were slightly superior in the FI in relation to the FSL group. Ca: 68 +/- 22 mg/kg/d, 49 +/- 14% vs 56 +/- 23 mg/kg/d, 48 +/- 17% and total fat: 6.6 +/- 1.2 g/kg/d, 92 +/- 8% vs 6.8 +/- 1.5 g/kg/d, 90 +/- 9%. Absorption of MC fatty acids was 99% for C8. Linoleic and alfalinolenic acid showed an absorption of around 90% despite the big differences in their intake (10/1). Net retention of linoleic acid was 933 +/- 168 mg/kg/d (FI) and 963 +/- 190 mg/kg/d (FSL) and the amount of alpha-linolenic acid was 95 +/- 16 (FI) and 100 +/- 22 mg/kg/d (FSL). No correlation could be found between the amount of excreted calcium and the total amount of fat in feces or with any of the fatty acids studied. This was true for each group studied separately or when considered as a single group. CONCLUSIONS The absorptive pattern of fatty acids in full term babies, when quantified did not show any conspicous alterations in relation to the accepted values of other ages. The absence of lactose (FSL) in a formula does not make any change in the absorption of total fat and the individual fatty acids when compared to lactose containing formula (FI), when these are present in the same proportions. Supplemented calcium in the formula without lactose could compensate for its lower absorbtion. The absorptive pattern of fatty acid in full term babies did not show any conspicuos alterations in relationship to the accepted values of other ages.
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Affiliation(s)
- M Moya
- Departamento de Pediatría, Universidad Miguel Hernández
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Abstract
A vitamin D-independent paracellular and not saturable mechanism important for intestinal calcium absorption turned out to be less effective in lactose-free diets. Twelve normal term babies with identical repletion levels of 25-hydroxyvitamin D (25D) were fed sequentially with starting formulas that differed only in their carbohydrate sources: lactose (control) and polycose. A 3-day test was performed after a 1-week adjustment to the new diet. Fecal excretion of calcium was significantly higher in the lactose-free formula period compared to the control one: 56.6 (13.9) versus 39.6 (12.8) mg/kg/day (p less than 0.02); subsequently, the net retention was considerably higher and statistically significant (p less than 0.01) for the control period versus the lactose-free formula period: 99.4 (15.3) versus 78.1 (14.3). Plasma 25D values were 21.8 (9.1) and 23.7 (7.1) ng/ml at the beginning of the lactose and polycose periods, respectively, and 1,25-dihydroxyvitamin-D values were 64 (62) and 75 (45) pg/ml, not significant. Results suggest that formulas containing polycose as the sole carbohydrate source may reduce the intestinal absorption of calcium in term newborns, but determining long-term biological significance requires further observation.
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Affiliation(s)
- M Moya
- Pediatric Department, Faculty of Medicine/Hospital Provincial, Universidad de Alicante, Spain
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Moya M, Cortés E, Aguilar MS, Galán F, Juste M. [Diagnostic advances in biochemical and molecular analysis]. An Esp Pediatr 1991; 35 Suppl 47:110-4. [PMID: 1821557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Juste M, González Perabá J, Mayol MJ, Moya M. Hyperimmunoglobulinemia E syndrome of neonatal onset. Allergol Immunopathol (Madr) 1990; 18:229-31. [PMID: 2264554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A case of hyperimmunoglobulinemia IgE with recurrent infections of neonatal onset and unfavourable evolution is described. The first clinical finding was the appearance of maculopapular rash in the skin when the child was fifteen days old. From this period onwards, respiratory and cutaneous infections were continuous, leading to a progressive deterioration of the general condition, and malnutrition, which ended fatally at the age of three years. IgE levels were measured on several occasions, this being 17 IU/ml at the onset of the symptoms; afterwards, the mean value was 17.680 IU/ml (Range: 14.9-32.710 IU/ml).
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Affiliation(s)
- M Juste
- Departamento de Pediatría y Anatomía Patológica, Facultad de Medicina, Universidad de Alicante, Spain
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Moya M, Vento M, Cortés E, Juste M, Buades A. [Infections in the newborn infant]. An Esp Pediatr 1989; 31 Suppl 38:33-7. [PMID: 2562316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- M Moya
- Departamento de Pediatría, Hospital Provincial, Facultad de Medicina, Alicante
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Moya M, Ballester I, Cortés E, Juste M, Campello MJ, Clemente F, Durá T. [Importance of vitamin D doses in bone mineralization in preterm infants]. An Esp Pediatr 1989; 31:216-20. [PMID: 2631604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
MESH Headings
- Bone Diseases, Metabolic/blood
- Bone Diseases, Metabolic/drug therapy
- Bone Diseases, Metabolic/metabolism
- Humans
- Infant, Newborn
- Infant, Premature, Diseases/blood
- Infant, Premature, Diseases/drug therapy
- Infant, Premature, Diseases/metabolism
- Random Allocation
- Vitamin D/administration & dosage
- Vitamin D/metabolism
- Vitamin D/therapeutic use
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Affiliation(s)
- M Moya
- Departamento de Pediatría, Facultad de Medicina, Hospital Provincial de Alicante
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Martínez Valverde A, Argemi Renom J, Bosque M, Marco MT, Pérez Frías J, Martínez Antón J, Pérez Navero JL, Romanos Lezcano A, Moya M, Juste M. [Chronic bronchopneumopathies. Round table]. An Esp Pediatr 1987; 27 Suppl 29:15-26. [PMID: 3442354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Durá T, Moya M, Muñoz M, Juste M, Castaño C. [Combination of hydantoins and valproate. Evidence of its teratogenic effect in 4 consecutive gestations]. An Esp Pediatr 1986; 25:457-61. [PMID: 3103508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Four siblings are presented with a malformative syndrome. All were born to an epileptic woman treated with phenytoin and valproic acid. A considerable high fetal pathology is found. Perhaps increased teratogenic effects are related with this pharmacological association not previously described.
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Castaño C, Juste M, Durá T, Muñoz M, Moya M. [Hepato-biliary dysfunction caused by total parenteral nutrition in a low weight newborn infant]. An Esp Pediatr 1986; 25:129-31. [PMID: 3092710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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