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Perrier Q, Tuloup V, Chevallier-Brilloit C, Bedouch P, Chanoine S. Polyvalent immunoglobulin use: Issues between good use, economic constraints and shortages over 25 years. Eur J Intern Med 2024:S0953-6205(24)00124-9. [PMID: 38531763 DOI: 10.1016/j.ejim.2024.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 03/13/2024] [Indexed: 03/28/2024]
Affiliation(s)
- Q Perrier
- Univ. Grenoble Alpes, INSERM, LBFA, U1055, Pharmacy department, Grenoble Alpes University Hospital, Grenoble, France.
| | - V Tuloup
- Univ. Grenoble Alpes, Pharmacy department, Grenoble Alpes University Hospital, Grenoble, France
| | - C Chevallier-Brilloit
- Univ. Grenoble Alpes, Pharmacy department, Grenoble Alpes University Hospital, Grenoble, France.
| | - P Bedouch
- Univ. Grenoble Alpes, CNRS, TIMC, IMR5525, Pharmacy department, Grenoble Alpes University Hospital, Grenoble, France
| | - S Chanoine
- Univ. Grenoble Alpes, CNRS, TIMC, IMR5525, Pharmacy department, Grenoble Alpes University Hospital, Grenoble, France
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2
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Bosson A, Durand M, Mazet R, Jouannet-Romaszko M, Chennell P, Mounsef F, Quessada T, Choisnard L, Bedouch P. [Comparative study of production and control processes of parenteral nutritional admixtures in neonatology]. Ann Pharm Fr 2024; 82:306-317. [PMID: 38159720 DOI: 10.1016/j.pharma.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/04/2023] [Accepted: 12/26/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES To assess the impact of disparities in production and analytical control processes on the quality of parenteral nutrition (PN) preparations produced in the Auvergne-Rhône-Alpes region. METHODS This study was carried out in four hospital pharmacies of the Auvergne-Rhône-Alpes region. To assess the impact of production processes, each centre produced ten PN preparations from the same prescription. Analytical controls (sodium, potassium and calcium dosage) were carried out on all the preparations. To assess the impact of the control processes, a batch of ten preparations was produced from the same prescription. Samples were sent to the four hospital pharmacies for analytical control (sodium, potassium and calcium dosage). RESULTS Measurements of relative production bias show that there is a significant difference between the preparations from the four centres in terms of sodium and potassium content. Each centre had at least one production bias for one of the three electrolytes measured. Concerning analytical controls, there was a significant difference between the four centres in the sodium and potassium levels measured. With the exception of calcium, all the centres reported measurements within the usual specifications of±10% of the target value. The results obtained have no clinically significant impact. CONCLUSION The diversity of NP practices has a real impact on the quality of the preparations made. A regional collaboration should be envisaged to standardise patient care.
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Affiliation(s)
- Alizée Bosson
- Pôle pharmacie, centre hospitalier universitaire Grenoble-Alpes, Grenoble, France
| | - Marjorie Durand
- Pôle pharmacie, centre hospitalier universitaire Grenoble-Alpes, Grenoble, France
| | - Roseline Mazet
- Pôle pharmacie, centre hospitalier universitaire Grenoble-Alpes, Grenoble, France
| | | | - Philip Chennell
- Université Clermont Auvergne, CHU Clermont Ferrand, Clermont Auvergne INP, CNRS, ICCF, F-63000, Clermont-Ferrand, France
| | - Freddy Mounsef
- Service pharmacie, hôpital Nord, CHU de Saint-Étienne, Saint-Étienne, France
| | - Thierry Quessada
- Service pharmacie, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France
| | - Luc Choisnard
- CNRS 5063, DPM, université Grenoble-Alpes, Saint-Martin-d'Hères, France.
| | - Pierrick Bedouch
- Pôle pharmacie, centre hospitalier universitaire Grenoble-Alpes, Grenoble, France; CNRS, TIMC-IMAG UMR 5525, THEMAS, université Grenoble-Alpes, Grenoble, France
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3
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Pluchart H, Chanoine S, Moro-Sibilot D, Chouaid C, Frey G, Villa J, Degano B, Giaj Levra M, Bedouch P, Toffart AC. Lung cancer, comorbidities, and medication: the infernal trio. Front Pharmacol 2024; 14:1016976. [PMID: 38450055 PMCID: PMC10916800 DOI: 10.3389/fphar.2023.1016976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 09/25/2023] [Indexed: 03/08/2024] Open
Abstract
Most patients with lung cancer are smokers and are of advanced age. They are therefore at high risk of having age- and lifestyle-related comorbidities. These comorbidities are subject to treatment or even polypharmacy. There is growing evidence of a link between lung cancer, comorbidities and medications. The relationships between these entities are complex. The presence of comorbidities and their treatments influence the time of cancer diagnosis, as well as the diagnostic and treatment strategy. On the other hand, cancer treatment may have an impact on the patient's comorbidities such as renal failure, pneumonitis or endocrinopathies. This review highlights how some comorbidities may have an impact on lung cancer presentation and may require treatment adjustments. Reciprocal influences between the treatment of comorbidities and anticancer therapy will also be discussed.
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Affiliation(s)
- Hélène Pluchart
- Pôle Pharmacie, Centre Hospitalier Universitaire Grenoble Alpes, La Tronche, France
- Université Grenoble Alpes, Grenoble, France
- Université Grenoble Alpes, CNRS, Grenoble INP, TIMC UMR5525, Grenoble, France
| | - Sébastien Chanoine
- Pôle Pharmacie, Centre Hospitalier Universitaire Grenoble Alpes, La Tronche, France
- Université Grenoble Alpes, Grenoble, France
- Institut pour l’Avancée des Biosciences, UGA/INSERM U1209/CNRS 5309, Université Grenoble Alpes, La Tronche, France
| | - Denis Moro-Sibilot
- Université Grenoble Alpes, Grenoble, France
- Institut pour l’Avancée des Biosciences, UGA/INSERM U1209/CNRS 5309, Université Grenoble Alpes, La Tronche, France
- Service Hospitalier Universitaire de Pneumologie Physiologie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Christos Chouaid
- Service de Pneumologie, Centre Hospitalier Intercommunal de Créteil, Créteil, France
- Inserm U955, UPEC, IMRB, équipe CEpiA, CréteilFrance
| | - Gil Frey
- Service de Chirurgie Thoracique, Vasculaire et Endocrinienne, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Julie Villa
- Service de Radiothérapie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Bruno Degano
- Université Grenoble Alpes, Grenoble, France
- Service Hospitalier Universitaire de Pneumologie Physiologie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
- Laboratoire HP2, INSERM U1042, Université Grenoble Alpes, Grenoble, France
| | - Matteo Giaj Levra
- Institut pour l’Avancée des Biosciences, UGA/INSERM U1209/CNRS 5309, Université Grenoble Alpes, La Tronche, France
- Service Hospitalier Universitaire de Pneumologie Physiologie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Pierrick Bedouch
- Pôle Pharmacie, Centre Hospitalier Universitaire Grenoble Alpes, La Tronche, France
- Université Grenoble Alpes, Grenoble, France
- Université Grenoble Alpes, CNRS, Grenoble INP, TIMC UMR5525, Grenoble, France
| | - Anne-Claire Toffart
- Université Grenoble Alpes, Grenoble, France
- Institut pour l’Avancée des Biosciences, UGA/INSERM U1209/CNRS 5309, Université Grenoble Alpes, La Tronche, France
- Service Hospitalier Universitaire de Pneumologie Physiologie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
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Salomez-Ihl C, Tanguy S, Alcaraz JP, Davin C, Pascal-Moussellard V, Jabeur M, Bedouch P, Le Hegarat L, Fessard V, Blier AL, Huet S, Cinquin P, Boucher F. Hydrogen inhalation: in vivo rat genotoxicity tests. Mutat Res Genet Toxicol Environ Mutagen 2024; 894:503736. [PMID: 38432775 DOI: 10.1016/j.mrgentox.2024.503736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/28/2024] [Accepted: 01/29/2024] [Indexed: 03/05/2024]
Abstract
Preclinical and clinical studies have shown that molecular hydrogen (H2) has anti-oxidant, anti-inflammatory, and anti-apoptotic properties. Safety data are available in the literature and acute toxicity has been tested in isolated cells and laboratory animals. We have evaluates the genotoxicity of H2 in vivo in rats after 72 h exposure, following the International Council for Harmonization guidelines ICH S2 (R1). The study was conducted on three groups of male Wistar rats: a negative control group, a positive control group receiving methyl methanesulfonate, and a H2-treated group receiving a 3.1% H2 gas mixture for 72 h. Alkaline comet, formamidopyrimidine DNA glycosylase (Fpg)-modified comet and bone marrow micronucleus assays were performed. H2 exposure increased neither comet-tail DNA intensity (DNA damage) nor frequency of "hedgehogs" in blood, liver, lungs, or bronchoalveolar lavage fluid. No increase in Fpg-sensitive sites in lungs, no induction of micronucleus formation, and no imbalance of immature erythrocyte to total erythrocyte ratio (IME%) was observed in rats exposed to H2. The ICH S2 (R1) test-battery revealed no in vivo genotoxicity in Wistar rats after 72 h inhalation of a mixture containing 3.1% H2.
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Affiliation(s)
- Cordélia Salomez-Ihl
- Univ. Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, 38000 Grenoble, France; CHU Grenoble Alpes, 38000 Grenoble, France
| | - Stéphane Tanguy
- Univ. Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, 38000 Grenoble, France
| | - Jean-Pierre Alcaraz
- Univ. Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, 38000 Grenoble, France
| | - Chloé Davin
- Univ. Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, 38000 Grenoble, France
| | | | - Mariem Jabeur
- Univ. Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, 38000 Grenoble, France
| | - Pierrick Bedouch
- Univ. Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, 38000 Grenoble, France; CHU Grenoble Alpes, 38000 Grenoble, France
| | - Ludovic Le Hegarat
- ANSES, French Agency for Food, Environmental and Occupational Health and Safety, Fougères Laboratory, Toxicology of Contaminants Unit, Fougères, France
| | - Valérie Fessard
- ANSES, French Agency for Food, Environmental and Occupational Health and Safety, Fougères Laboratory, Toxicology of Contaminants Unit, Fougères, France
| | - Anne-Louise Blier
- ANSES, French Agency for Food, Environmental and Occupational Health and Safety, Fougères Laboratory, Toxicology of Contaminants Unit, Fougères, France
| | - Sylvie Huet
- ANSES, French Agency for Food, Environmental and Occupational Health and Safety, Fougères Laboratory, Toxicology of Contaminants Unit, Fougères, France
| | - Philippe Cinquin
- Univ. Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, 38000 Grenoble, France; CHU Grenoble Alpes, 38000 Grenoble, France
| | - François Boucher
- Univ. Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, 38000 Grenoble, France.
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5
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Tanty A, Vitale E, Lombardo-Duron D, Grevy A, Gibert P, Chapuis C, Chevallier-Brilloit C, Allenet B, Bedouch P, Chanoine S. Clinical pharmacy as a guarantee of safety in times of crisis: evolution and relevance of the continued presence of clinical pharmacists in frontline medical units during the first wave of COVID-19. Eur J Hosp Pharm 2024:ejhpharm-2023-003815. [PMID: 37875284 DOI: 10.1136/ejhpharm-2023-003815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/20/2023] [Accepted: 09/26/2023] [Indexed: 10/26/2023] Open
Abstract
BackgroundThe COVID-19 pandemic has had a major impact on the organisation of health services worldwide. In the first wave, many therapeutic options were explored, exposing patients to significant iatrogenic risk. In a context in which patient management was not well defined by clear recommendations and in which healthcare professionals were under great stress, was it still relevant to maintain pharmaceutical care or did it bring an additional factor of disorganisation? OBJECTIVE The aim of our study was to compare the relevance of pharmaceutical care practices before and during the COVID-19 crisis. METHODS A retrospective, comparative, observational analysis was conducted in two medical units in a French university hospital that were receiving patients with COVID-19 and benefiting from pharmaceutical care prior to the crisis. This study compared clinical pharmacy performance between two 1.5-month periods before and during the COVID-19 crisis. Performance was assessed according to the CLEO scale, rating the clinical, economic and organisational impacts of the accepted pharmaceutical interventions (PIs) performed in these units. RESULTS Of the 675 accepted PIs carried out in the two medical units over the entire study period, PIs performed during the COVID-19 period had a greater significant clinical impact (72% vs 56%, p˂0.0001), a more positive economic impact (38% vs 23%, p˂0.0001) and a more favourable organisational impact (52% vs 20%, p˂0.0001) than those performed prior to the COVID-19 period. CONCLUSIONS The health crisis generated important changes in care practices. Our study demonstrates the sustained relevance of pharmaceutical care during a health crisis. This local experience confirms the major interest in improving the integration of pharmaceutical expertise within French healthcare teams.
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Affiliation(s)
| | | | | | | | | | | | | | - Benoît Allenet
- Pharmacy, CHU Grenoble Alpes, Grenoble, France
- ThEMAS (Techniques for Evaluation and Modeling of Health Actions) TIMC-IMAG (Techniques for biomedical engineering and complexity management - informatics, mathematics and applications) UMR CNRS (National Institute of Sciences of the Universe - Research Unit 5525), Université Grenoble Alpes, Saint-Martin-d'Heres, France
| | - Pierrick Bedouch
- Pharmacy, CHU Grenoble Alpes, Grenoble, France
- Pharmacy, Université Grenoble 1, Saint-Martin-d'Heres, France
| | - Sebastien Chanoine
- Pharmacy, CHU Grenoble Alpes, Grenoble, France
- Pharmacy, Université Grenoble 1, Saint-Martin-d'Heres, France
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6
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Le Cras R, Mazet R, Dubois-Teklali F, Sabourdy C, Chanoine S, Lehmann A, Morin A, Leenhardt J, Durand M, Desruet MD, Bedouch P. Place of magistral preparations to continue the treatment if the drug is commercially stopped worldwide? A case report of a 10-year-old child with subacute sclerosing panencephalitis (SSPE) requiring inosiplex. Emerg Microbes Infect 2023; 12:2148563. [PMID: 36458570 PMCID: PMC9788679 DOI: 10.1080/22221751.2022.2148563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Subacute sclerosing panencephalitis (SSPE) is a late-onset and fatal viral disease caused by persistent infection of the central nervous system by measles virus (MeV). We present the case of a 10-year-old child from South Asia affected by SSPE, stabilized with a combination of intrathecal interferon-α2b (INF-α2b) injections and oral inosiplex and how we continued the treatment when inosiplex was commercially stopped worldwide.
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Affiliation(s)
- Renan Le Cras
- Pharmacy Department, Grenoble University Hospital, Grenoble, France
| | - Roseline Mazet
- Pharmacy Department, Grenoble University Hospital, Grenoble, France, Roseline Mazet Pharmacy Department, Grenoble University Hospital, F-38000Grenoble, France
| | | | - Cécile Sabourdy
- Neurology Unit, Grenoble University Hospital, Grenoble, France
| | - Sébastien Chanoine
- Pharmacy Department, Grenoble University Hospital, Grenoble, France,Université Grenoble Alpes TIMC, CNRS UMR 5525, Grenoble, France
| | - Audrey Lehmann
- Pharmacy Department, Grenoble University Hospital, Grenoble, France
| | - Agathe Morin
- Pharmacy Department, Grenoble University Hospital, Grenoble, France
| | - Julien Leenhardt
- Pharmacy Department, Grenoble University Hospital, Grenoble, France,Université Grenoble Alpes, INSERM, LRB, Grenoble, France
| | - Marjorie Durand
- Pharmacy Department, Grenoble University Hospital, Grenoble, France
| | | | - Pierrick Bedouch
- Pharmacy Department, Grenoble University Hospital, Grenoble, France,Université Grenoble Alpes TIMC, CNRS UMR 5525, Grenoble, France
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7
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Vieux N, Perrier Q, Bedouch P, Epaulard O. Much ado about nothing? Discrepancy between the available data on the antiviral effect of hydroxychloroquine in March 2020 and its inclusion in COVID-19 clinical trials and outpatient prescriptions. Public Health 2023; 225:35-44. [PMID: 37918175 DOI: 10.1016/j.puhe.2023.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/10/2023] [Accepted: 09/24/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVES Many of the 2020 COVID-19 clinical trials included an (hydroxy)chloroquine ((H)CQ) arm. We aimed to juxtapose the state of science before April 2020 regarding the benefits of (H)CQ for viral infections with the number and size of the clinical trials studying (H)CQ and the volume of (H)CQ dispensed in France. STUDY DESIGN We identified and analysed published scientific material regarding the antiviral activity of (H)CQ and publicly available data regarding clinical trials and drug dispensation in France. METHODS We conducted a review of scientific publications available before April 2020 and a systematic analysis of COVID-19 clinical trials featuring (H)CQ registered on clinicaltrials.gov. RESULTS Before April 2020, 894 scientific publications mentioning (H)CQ for viruses other than coronaviruses were available, including 35 in vitro studies (reporting an inconstant inhibition of viral replication), 11 preclinical studies (reporting no or disputable positive effects), and 32 clinical trials (reporting no or disputable positive effects). Moreover, 67 publications on (H)CQ and coronavirus infections were available, including 12 in vitro studies (reporting an inconstant inhibition of viral replication), two preclinical studies (reporting contradictory results), and no clinical trials. Meanwhile, 253 therapeutic clinical trials featuring an HCQ arm were registered in 2020, intending to enrol 246,623 patients. CONCLUSIONS The number and size of (H)CQ clinical trials for COVID-19 launched in 2020 were not supported by the literature published before April 2020.
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Affiliation(s)
- N Vieux
- Pôle Pharmacie, Université Grenoble Alpes, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Q Perrier
- Pôle Pharmacie, Université Grenoble Alpes, Centre Hospitalier Universitaire Grenoble Alpes, Laboratory of Fundamental and Applied Bioenergetic (LBFA), INSERM U1055, Grenoble, France
| | - P Bedouch
- Pôle Pharmacie, Université Grenoble Alpes, Centre Hospitalier Universitaire Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, CHU Grenoble Alpes, TIMC, 38000 Grenoble, France
| | - O Epaulard
- Infectious Disease Department, Université Grenoble Alpes, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France; Groupe de Recherche en Infectiologie Clinique, CIC-1406, INSERM-UGA-CHUGA, France.
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8
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Daikh A, Reymond F, Lombardo D, Thuillier C, Bedouch P, Faucheron JL. Retrospective study of sacral neuromodulator implantations in a French hospital center: Lifespan and hospital costs assessment. Int J Colorectal Dis 2023; 38:273. [PMID: 38015254 DOI: 10.1007/s00384-023-04569-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/23/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE Sacral nerve neuromodulation (SNM) is a safe and effective therapy for the management of fecal and/or urinary incontinence. The generators InterStim™ and InterStim™ II (Medtronic™) are non-rechargeable active implantable medical devices with a limited lifespan. The aims of this study were to assess the generators' median lifespan for all indications and the long-term hospital costs of the therapy. METHODS This was a retrospective monocentric study that included 215 patients aged over 18 years who were treated by SNM for fecal incontinence and/or urinary incontinence. Lifespan was considered as the amount of time between definitive implantation and observed battery depletion by the surgeon and was assessed by the Kaplan-Meier method. Costs were assessed according to the activity-based pricing of the French public health care system. RESULTS The median observed lifetime of stimulators implanted in our center was 7.29 years and 5.9 years for InterStim™ and InterStim™ II, respectively. The difference observed between the two generations was statistically significant. The modelling of primary implantation and renewal costs allowed us to observe that the decrease in the lifetime of Interstim™ II is associated with an increase in hospital costs over time. The retrospective study design is one limitation and we did not take into consideration stimulation's settings. CONCLUSIONS The InterStim™ II lifespan is shorter than the first-generation device. This is associated with an increase of the long-term hospital costs. Additional information about the new neuromodulator will be required to choose the most appropriate IPG for the patient while optimizing the costs.
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Affiliation(s)
- Assia Daikh
- Department of Pharmacy, Grenoble Alpes University Hospital, F-38000, Grenoble, France.
| | - Fabienne Reymond
- Department of Pharmacy, Grenoble Alpes University Hospital, F-38000, Grenoble, France
| | - Dorothée Lombardo
- Department of Pharmacy, Grenoble Alpes University Hospital, F-38000, Grenoble, France
| | - Caroline Thuillier
- Department of Urology, Grenoble Alpes University Hospital, F-38000, Grenoble, France
| | - Pierrick Bedouch
- Department of Pharmacy, Grenoble Alpes University Hospital, F-38000, Grenoble, France
- Faculty of Pharmacy, University Grenoble Alpes, F-38000, Grenoble, France
- TIMC-IMAG UMR5525, CNRS, University Grenoble Alpes, F-38041, Grenoble, France
| | - Jean-Luc Faucheron
- TIMC-IMAG UMR5525, CNRS, University Grenoble Alpes, F-38041, Grenoble, France
- Colorectal Surgery Unit, Department of Visceral Surgery and Acute Care Surgery, Grenoble Alpes University Hospital, F-38000, Grenoble, France
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9
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Pluchart H, Bailly S, Chanoine S, Moro-Sibilot D, Bedouch P, Toffart AC. Comparison of seven comorbidity scores on four-month survival of lung cancer patients. BMC Med Res Methodol 2023; 23:256. [PMID: 37923993 PMCID: PMC10623755 DOI: 10.1186/s12874-023-01994-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 07/20/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND The comorbidity burden has a negative impact on lung-cancer survival. Several comorbidity scores have been described and are currently used. The current challenge is to select the comorbidity score that best reflects their impact on survival. Here, we compared seven usable comorbidity scores (Charlson Comorbidity Index, Age adjusted Charlson Comorbidity Index, Charlson Comorbidity Index adapted to lung cancer, National Cancer Institute combined index, National Cancer Institute combined index adapted to lung cancer, Elixhauser score, and Elixhauser adapted to lung cancer) with coded administrative data according to the tenth revision of the International Statistical Classification of Diseases and Related Health Problems to select the best prognostic index for predicting four-month survival. MATERIALS AND METHODS This cohort included every patient with a diagnosis of lung cancer hospitalized for the first time in the thoracic oncology unit of our institution between 2011 and 2015. The seven scores were calculated and used in a Cox regression method to model their association with four-month survival. Then, parameters to compare the relative goodness-of-fit among different models (Akaike Information Criteria, Bayesian Information Criteria), and discrimination parameters (the C-statistic and Harrell's c-statistic) were calculated. A sensitivity analysis of these parameters was finally performed using a bootstrap method based on 1,000 samples. RESULTS In total, 633 patients were included. Male sex, histological type, metastatic status, CCI, CCI-lung, Elixhauser score, and Elixhauser-lung were associated with poorer four-month survival. The Elixhauser score had the lowest AIC and BIC and the highest c-statistic and Harrell's c-statistic. These results were confirmed in the sensitivity analysis, in which these discrimination parameters for the Elixhauser score were significantly different from the other scores. CONCLUSIONS Based on this cohort, the Elixhauser score is the best prognostic comorbidity score for predicting four-month survival for hospitalized lung cancer patients.
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Affiliation(s)
- Hélène Pluchart
- Pôle Pharmacie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France.
- Université Grenoble Alpes, Grenoble, France.
- Univ. Grenoble Alpes, CNRS, Grenoble INP, Centre Hospitalier Universitaire Grenoble Alpes, TIMC UMR5525, Grenoble, 38000, France.
| | - Sébastien Bailly
- Univ. Grenoble Alpes, Inserm, Centre Hospitalier Universitaire Grenoble Alpes, HP2, Grenoble, 38000, France
| | - Sébastien Chanoine
- Pôle Pharmacie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
- Université Grenoble Alpes, Grenoble, France
- Institute for Advanced Biosciences, UGA/INSERM U1209/CNRS 5309, Université Grenoble Alpes, Grenoble, France
| | - Denis Moro-Sibilot
- Université Grenoble Alpes, Grenoble, France
- Institute for Advanced Biosciences, UGA/INSERM U1209/CNRS 5309, Université Grenoble Alpes, Grenoble, France
- Clinique de Pneumologie, Unité d'Oncologie Thoracique, Pôle Thorax et Vaisseaux, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Pierrick Bedouch
- Pôle Pharmacie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
- Université Grenoble Alpes, Grenoble, France
- Univ. Grenoble Alpes, CNRS, Grenoble INP, Centre Hospitalier Universitaire Grenoble Alpes, TIMC UMR5525, Grenoble, 38000, France
| | - Anne-Claire Toffart
- Université Grenoble Alpes, Grenoble, France
- Institute for Advanced Biosciences, UGA/INSERM U1209/CNRS 5309, Université Grenoble Alpes, Grenoble, France
- Clinique de Pneumologie, Unité d'Oncologie Thoracique, Pôle Thorax et Vaisseaux, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
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10
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Chapuis C, Daru É, Trochet C, Gibert P, Bedouch P. Les incompatibilités physico-chimiques. Rev Infirm 2023; 72:49-50. [PMID: 37952999 DOI: 10.1016/j.revinf.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Affiliation(s)
- Claire Chapuis
- Université Grenoble Alpes, pôle pharmacie, CHU Grenoble Alpes, 38000 Grenoble, France
| | - Émeline Daru
- Université Grenoble Alpes, pôle pharmacie, CHU Grenoble Alpes, 38000 Grenoble, France
| | - Claire Trochet
- Université Grenoble Alpes, pôle pharmacie, CHU Grenoble Alpes, 38000 Grenoble, France
| | - Prudence Gibert
- Université Grenoble Alpes, pôle pharmacie, CHU Grenoble Alpes, 38000 Grenoble, France; Université Grenoble Alpes, pôle pharmacie, CHU Grenoble Alpes, 38000 Grenoble, France.
| | - Pierrick Bedouch
- Université Grenoble-Alpes, CNRS, pôle pharmacie, CHU Grenoble-Alpes, Grenoble INP, TIMC, 38000 Grenoble, France
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11
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Leenhardt J, Durand M, Choisnard L, Desruet MD, Mazet R, Bedouch P. Comparison of three automated compounding devices for parenteral nutrition according to four key technical tests. Eur J Hosp Pharm 2023; 30:347-352. [PMID: 34972687 PMCID: PMC10647869 DOI: 10.1136/ejhpharm-2021-002993] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 12/07/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Automation of parenteral nutrition (PN) preparation is nowadays a recommended practice in order to reduce human errors and thus improve the safety and accuracy of the finished product. Other benefits of automation may include full documentation of preparation and a reduction in personnel requirements or staff injuries. The market of automation compounding presents different automated compounding devices (ACDs). The aim of this study is to compare the technical characteristics of ACDs by carrying out four specific challenges. METHODS Three ACDs: Two piston pumps with ACD 1: MediMix Multi 4120R (Impromediform) and ACD 2: Mibmix Compounder C12 (Hemedis), and one peristaltic pump ACD 3: ExactaMix Compounder EM2400 (Baxter) were assessed in a pharmaceutical manufacturing unit within a controlled atmosphere area, under horizontal laminar flow hood (LFH) according to four tests: volumetric accuracy, flush volume, smoke test, and a production test with three configurations of PN bags. For this test, a PN bag was considered accepted when all quality controls (weight, molar concentration of sodium, potassium and calcium) were fulfilled. RESULTS The maximum relative biases found for the different ACDs were heterogeneous. ACD 1 had the best volumetric accuracy with respect to supplier specifications and for extreme volumes (0.2 mL). Evaluation of the flushing volume allowed the validation of 50 mL volumes for ACD 1 and ACD 3. The smoke test was only conclusive for ACD 1 under a horizontal LFH. The percentage of PN bags accepted were 98.8% for ACD 1, 70% for ACD 2%, and 95.5% for ACD 3. CONCLUSION This study compared three ACDs according to four relevant and specific tests. Based on the data acquired, we conclude that ACD 1 is the most accurate, has the lowest flushing volume, is suitable for use in a LFH, and achieves the best results in the production test.
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Affiliation(s)
- Julien Leenhardt
- Pharmacy, University Hospital Centre Grenoble Alpes, Grenoble, Auvergne-Rhone-Alpes, France
- Faculty of pharmacy, Univ. Grenoble Alpes, Saint-Martin-d'Heres, Rhône-Alpes, France
- Univ. Grenoble Alpes, INSERM, CHU Grenoble Alpes, LRB, 38000 Grenoble, France
| | - Marjorie Durand
- Pharmacy, University Hospital Centre Grenoble Alpes, Grenoble, Auvergne-Rhone-Alpes, France
| | - Luc Choisnard
- Univ. Grenoble Alpes, DPM, UMR CNRS 5063, ICMG FR 2607, Saint-Martin-d'Heres, Rhône-Alpes, France
| | - Marie-Dominique Desruet
- Pharmacy, University Hospital Centre Grenoble Alpes, Grenoble, Auvergne-Rhone-Alpes, France
- Univ. Grenoble Alpes, INSERM, CHU Grenoble Alpes, LRB, 38000 Grenoble, France
| | - Roseline Mazet
- Pharmacy, University Hospital Centre Grenoble Alpes, Grenoble, Auvergne-Rhone-Alpes, France
| | - Pierrick Bedouch
- Pharmacy, University Hospital Centre Grenoble Alpes, Grenoble, Auvergne-Rhone-Alpes, France
- Faculty of pharmacy, Univ. Grenoble Alpes, Saint-Martin-d'Heres, Rhône-Alpes, France
- Univ. Grenoble Alpes, CNRS TIMC-IMAG, UMR 5525, 38000, Grenoble, France
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12
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Videau M, Charpiat B, Conort O, Janoly-Dumenil A, Bedouch P. [Translation and adaptation of a tool prescribing errors related to computerized physician order entry coding to the French hospital background]. Ann Pharm Fr 2023; 81:1054-1071. [PMID: 37356663 DOI: 10.1016/j.pharma.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 12/12/2021] [Revised: 05/15/2023] [Accepted: 06/21/2023] [Indexed: 06/27/2023]
Abstract
Prescribing errors related to computerized physician order entry are current and may have serious consequences for patients. They can be detected by pharmacists during prescriptions analysis and lead to pharmacist's interventions. In France, few monocentric studies have studied Pharmacist Interventions triggered by prescribing errors identified as System-Related Errors (PISREs) in French hospitals. However, their respective analysis method prevent any comparison between computerized physician order entry systems in order to identify the safest and rule out the most dangerous. A computerized physician prescribing error related to the software is characterized by its causes, consequences and mechanism of occurrence. US researchers have developed and validated a tool to classify and illustrate these three characteristics. The objectives of this article are to present this tool, to propose a French adaptation and to describe the perspectives analyze and understand prescription errors related to computerized physician order entry based on data of Act-IP©. The adaptation was performed using PISREs extracted from the Act-IP© observatory of the French Society of Clinical Pharmacy. Each item of the codification is illustrated with an example of PI. We are considering a training plan in order to allow wide use of this tool. Once adopted this tool, the next step will be to organize a prospective multicenter study including as many computerized prescription order entry systems as possible. The aim of this study will be identifying the safest systems. Consequently, it will then be possible to have arguments to qualify the most dangerous and thus propose their withdrawal from the market.
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Affiliation(s)
- Manon Videau
- Université Grenoble Alpes, CNRS/TIMC-IMAG UMR5525, 38041, Grenoble, France; Pôle pharmacie, Centre Hospitalier Universitaire Grenoble Alpes, 38043, Grenoble, France; Groupe de travail "Valorisation des Interventions Pharmaceutiques-Act-IP©" de la Société Française de Pharmacie Clinique.
| | - Bruno Charpiat
- Université Grenoble Alpes, CNRS/TIMC-IMAG UMR5525, 38041, Grenoble, France; Département de pharmacie, hôpital Croix Rousse, Hospices civils de Lyon, 69004, Lyon, France; Groupe de travail "Valorisation des Interventions Pharmaceutiques-Act-IP©" de la Société Française de Pharmacie Clinique
| | - Ornella Conort
- Département de pharmacie, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 75879, Paris, France; Groupe de travail "Valorisation des Interventions Pharmaceutiques-Act-IP©" de la Société Française de Pharmacie Clinique
| | - Audrey Janoly-Dumenil
- Département de pharmacie, hôpital Édouard-Herriot, Hospices civils de Lyon, 69003, Lyon, France; EA 4129 P2S Parcours santé systémique, université Claud-Bernard Lyon 1, Université de Lyon, Lyon, France; Groupe de travail "Valorisation des Interventions Pharmaceutiques-Act-IP©" de la Société Française de Pharmacie Clinique
| | - Pierrick Bedouch
- Université Grenoble Alpes, CNRS/TIMC-IMAG UMR5525, 38041, Grenoble, France; Pôle pharmacie, Centre Hospitalier Universitaire Grenoble Alpes, 38043, Grenoble, France; Groupe de travail "Valorisation des Interventions Pharmaceutiques-Act-IP©" de la Société Française de Pharmacie Clinique
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13
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Leenhardt J, Choisnard L, Plasse M, Ardisson V, de Leiris N, Djaileb L, Bedouch P, Brunet MD. Bacterial survival in radiopharmaceutical solutions: a critical impact on current practices. EJNMMI Radiopharm Chem 2023; 8:34. [PMID: 37882937 PMCID: PMC10602993 DOI: 10.1186/s41181-023-00221-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 10/19/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND The aim of this brief communication is to highlight the potential bacteriological risk linked to the processes control of radiopharmaceutical preparations made in a radiopharmacy laboratory. Survival rate of Pseudomonas aeruginosa (ATCC: 27853) or Staphylococcus aureus (ATCC: 25923) or Staphylococcus epidermidis (ATCC: 1228) in multidose technetium-99 m solution was studied. RESULTS Depending on the nature and level of contamination by pathogenic bacteria, the lethal effect of radioactivity is not systematically observed. We found that P. aeruginosa was indeed affected by radioactivity. However, this was not the case for S. epidermidis, as the quantity of bacteria found in both solutions (radioactive and non-radioactive) was rapidly reduced, probably due to a lack of nutrients. Finally, the example of S. aureus is an intermediate case where we observed that high radioactivity affected the bacteria, as did the absence of nutrients in the reaction medium. The results were discussed in the light of current practices on the sterility test method, which recommends waiting for radioactivity to decay before carrying out the sterility test. CONCLUSION In terms of patient safety, the results run counter to current practice and the latest EANM recommendation of 2021 that radiopharmaceutical preparations should be decayed before sterility testing.
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Affiliation(s)
- Julien Leenhardt
- Univ. Grenoble Alpes, INSERM, CHU Grenoble Alpes, LRB, 38000, Grenoble, France.
| | - Luc Choisnard
- Univ. Grenoble Alpes, Domaine Universitaire de Grenoble, DPM, UMR CNRS 5063, 470, rue de la Chimie, 38400, Saint Martin d'Hères, France.
| | - Maelle Plasse
- Univ. Grenoble Alpes, CHU Grenoble Alpes, Pharmacy , 38000, Grenoble, France
| | - Valérie Ardisson
- Cancer Institute Eugène Marquis, Department of Nuclear Medicine, 35000, Rennes, France
| | - Nicolas de Leiris
- Univ. Grenoble Alpes, INSERM, CHU Grenoble Alpes, LRB, 38000, Grenoble, France
| | - Loic Djaileb
- Univ. Grenoble Alpes, INSERM, CHU Grenoble Alpes, LRB, 38000, Grenoble, France
| | - Pierrick Bedouch
- Univ. Grenoble Alpes, CHU Grenoble Alpes, Pharmacy , 38000, Grenoble, France
- Univ. Grenoble Alpes, CNRS 5525, TIMC-IMAG, Grenoble, France
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14
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Pluchart H, Bailly S, Chanoine S, Moro-Sibilot D, Bedouch P, Toffart AC. Impact of polypharmacy and comorbidity on survival and systemic parenteral treatment administration in a cohort of hospitalized lung-cancer patients. BMC Cancer 2023; 23:585. [PMID: 37353729 DOI: 10.1186/s12885-023-10939-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 05/09/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND Although polypharmacy has been described among cancer patients, very few studies have focused on those with lung cancer. We aimed to assess whether polypharmacy and comorbidity have an impact on systemic parenteral treatment administration and survival among lung-cancer patients. METHODS In this retrospective monocenter cohort study, we included patients hospitalized in thoracic oncology for the first time between 2011 and 2015. The Elixhauser score was used to assess comorbidity and polypharmacy was estimated with a threshold of at least five prescribed medications. The Fine and Gray competitive risk model was used to estimate the impact of polypharmacy and comorbidity on systemic parenteral treatment administration within the first two months of hospitalization. The effect of comorbidity and polypharmacy on overall survival was evaluated by Cox proportional hazards analysis. RESULTS In total, 633 patients were included (71% men), with a median age of 66 years. The median Elixhauser score was 6 and median overall survival was four months. Among the patients, 24.3% were considered to be receiving polypharmacy, with a median number of medications of 3, and 49.9% received systemic parenteral treatment within two months after hospitalization. Severe comorbidity (Elixhauser score > 11), but not polypharmacy, was independently associated with a lower rate of systemic parenteral treatment prescription (SdHR = 0.4 [0.3;0.6], p < 0.01) and polypharmacy, but not a high comorbidity score, was independently associated with poorer four-month survival (HR = 1.4 [1.1;1.9], p < 0.01) CONCLUSIONS: This first study to evaluate the consequences of comorbidity and polypharmacy on the care of lung-cancer patients shows that a high comorbidity burden can delay systemic parenteral treatment administration, whereas polypharmacy has a negative impact on four-month survival.
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Affiliation(s)
- Hélène Pluchart
- Pôle pharmacie, CHU Grenoble Alpes, Grenoble, France.
- Université Grenoble Alpes, Grenoble, France.
- Univ. Grenoble Alpes, CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC, Grenoble, 38000, France.
| | - Sébastien Bailly
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, Grenoble, 38000, France
| | - Sébastien Chanoine
- Pôle pharmacie, CHU Grenoble Alpes, Grenoble, France
- Université Grenoble Alpes, Grenoble, France
- Institute for Advanced Biosciences, UGA/INSERM U1209/CNRS 5309, Université Grenoble Alpes, Grenoble, France
| | - Denis Moro-Sibilot
- Université Grenoble Alpes, Grenoble, France
- Institute for Advanced Biosciences, UGA/INSERM U1209/CNRS 5309, Université Grenoble Alpes, Grenoble, France
- Clinique de Pneumologie, Unité d'Oncologie Thoracique, Pôle Thorax et Vaisseaux, CHU Grenoble Alpes, Grenoble, France
| | - Pierrick Bedouch
- Pôle pharmacie, CHU Grenoble Alpes, Grenoble, France
- Université Grenoble Alpes, Grenoble, France
- Univ. Grenoble Alpes, CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC, Grenoble, 38000, France
| | - Anne-Claire Toffart
- Université Grenoble Alpes, Grenoble, France
- Institute for Advanced Biosciences, UGA/INSERM U1209/CNRS 5309, Université Grenoble Alpes, Grenoble, France
- Clinique de Pneumologie, Unité d'Oncologie Thoracique, Pôle Thorax et Vaisseaux, CHU Grenoble Alpes, Grenoble, France
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15
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Perrier Q, Minoves M, Cerana S, Reymond F, Ducki C, Decaens T, Lehmann A, Bedouch P. Evaluation of drug cost savings related to clinical trials from the perspective of a university hospital. Eur J Hosp Pharm 2023:ejhpharm-2022-003671. [PMID: 37248032 DOI: 10.1136/ejhpharm-2022-003671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 12/26/2022] [Accepted: 05/10/2023] [Indexed: 05/31/2023] Open
Abstract
OBJECTIVES Clinical trials are an opportunity for patients to access innovative therapy, but patient inclusion in clinical trials can also result in cost savings for hospitals. Our objective was to evaluate the economic impact of clinical trials drug cost savings in a French academic institution from the perspectives of both the French Health Insurance (FHI) and hospitals. METHODS A retrospective, observational, cost saving analysis was performed on all the clinical trials initiated in our university hospital between 2015 and 2020. Only trials involving an investigational medicinal product were considered. Drug cost savings were defined as the best standard of care, defined in the protocol, whose cost was covered by a sponsor. RESULTS Of the 646 trials undertaken during the 6 years analysed, 21% (212/646) led to cost savings, mostly driven by the industrial sponsor (92%, €6 984 283/€7 591 612) for a total of €7 591 612 (91% from the FHI's perspective (€6 959 115/€7 591 612)). Oncology trials generated 79.1% (€6 004 966/€7 591 612) of global cost savings, mostly driven by onco-haematology (33.1%, €1 983 146/€6 004 966), onco-pneumology (29.2%, €1 754 333/€6 004 966) and onco-dermatology (23.5%, €1 409 553/€6 004 966) followed by hepatogastroenterology trials (6.9%, €413 113/€6 004 966). Of the 162 drugs, the top 15 generated 75.3% (€5 715 479/€7 591 612) of savings and were grouped together: 12 antineoplastic agents (six per os and six intravenous) and three per os antiviral for hepatitis C. CONCLUSIONS With ever-changing prices and new innovative treatments, such cost avoidance must be regularly evaluated. We provided objective evidence that clinical trials could achieve potential cost savings for the FHI and hospitals, in addition to the potential benefit to patients of having access to innovative investigational medicinal products.
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Affiliation(s)
- Quentin Perrier
- Univ. Grenoble Alpes, LBFA, INSERM, U1055, Pôle Pharmacie, Grenoble Alpes University Hospital, Grenoble, France
| | - Mélanie Minoves
- Univ. Grenoble Alpes, Hp2, INSERM, U1300, Pôle Pharmacie, Grenoble Alpes University Hospital, Grenoble, France
| | - Sophie Cerana
- Grenoble Alpes University, Grenoble Alpes University Hospital, Pôle Pharmacie, Grenoble, France
| | - Fabienne Reymond
- Grenoble Alpes University, Grenoble Alpes University Hospital, Pôle Pharmacie, Grenoble, France
| | - Camille Ducki
- Univ. Grenoble Alpes, IAB-INSERM U1209/ CNRS UMR 5309, Clinique Universitaire d'Hépato-gastroentérologie, Grenoble Alpes University Hospital, Grenoble, France
| | - Thomas Decaens
- Univ. Grenoble Alpes, IAB-INSERM U1209/ CNRS UMR 5309, Clinique Universitaire d'Hépato-gastroentérologie, Grenoble Alpes University Hospital, Grenoble, France
| | - Audrey Lehmann
- Univ. Grenoble Alpes, TIMC, CNRS, UMR5525, Pôle Pharmacie, Grenoble Alpes University Hospital, Grenoble, France
| | - Pierrick Bedouch
- Univ. Grenoble Alpes, TIMC, CNRS, UMR5525, Pôle Pharmacie, Grenoble Alpes University Hospital, Grenoble, France
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16
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Ranchon F, Chanoine S, Lambert-Lacroix S, Bosson JL, Moreau-Gaudry A, Bedouch P. Development of Indirect Health Data Linkage on Health Product Use and Care Trajectories in France: Systematic Review. J Med Internet Res 2023; 25:e41048. [PMID: 37200084 DOI: 10.2196/41048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 03/22/2023] [Accepted: 03/22/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND European national disparities in the integration of data linkage (ie, being able to match patient data between databases) into routine public health activities were recently highlighted. In France, the claims database covers almost the whole population from birth to death, offering a great research potential for data linkage. As the use of a common unique identifier to directly link personal data is often limited, linkage with a set of indirect key identifiers has been developed, which is associated with the linkage quality challenge to minimize errors in linked data. OBJECTIVE The aim of this systematic review is to analyze the type and quality of research publications on indirect data linkage on health product use and care trajectories in France. METHODS A comprehensive search for all papers published in PubMed/Medline and Embase databases up to December 31, 2022, involving linked French database focusing on health products use or care trajectories was realized. Only studies based on the use of indirect identifiers were included (ie, without a unique personal identifier available to easily link the databases). A descriptive analysis of data linkage with quality indicators and adherence to the Bohensky framework for evaluating data linkage studies was also realized. RESULTS In total, 16 papers were selected. Data linkage was performed at the national level in 7 (43.8%) cases or at the local level in 9 (56.2%) studies. The number of patients included in the different databases and resulting from data linkage varied greatly, respectively, from 713 to 75,000 patients and from 210 to 31,000 linked patients. The diseases studied were mainly chronic diseases and infections. The objectives of the data linkage were multiple: to estimate the risk of adverse drug reactions (ADRs; n=6, 37.5%), to reconstruct the patient's care trajectory (n=5, 31.3%), to describe therapeutic uses (n=2, 12.5%), to evaluate the benefits of treatments (n=2, 12.5%), and to evaluate treatment adherence (n=1, 6.3%). Registries are the most frequently linked databases with French claims data. No studies have looked at linking with a hospital data warehouse, a clinical trial database, or patient self-reported databases. The linkage approach was deterministic in 7 (43.8%) studies, probabilistic in 4 (25.0%) studies, and not specified in 5 (31.3%) studies. The linkage rate was mainly from 80% to 90% (reported in 11/15, 73.3%, studies). Adherence to the Bohensky framework for evaluating data linkage studies showed that the description of the source databases for the linkage was always performed but that the completion rate and accuracy of the variables to be linked were not systematically described. CONCLUSIONS This review highlights the growing interest in health data linkage in France. Nevertheless, regulatory, technical, and human constraints remain major obstacles to their deployment. The volume, variety, and validity of the data represent a real challenge, and advanced expertise and skills in statistical analysis and artificial intelligence are required to treat these big data.
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Affiliation(s)
- Florence Ranchon
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de pharmacie clinique oncologique, Pierre-Bénite, France
- Translational Innovation in Medicine and Complexity - Unité Mixte de Recherche 5525, Université Grenoble Alpes, Grenoble, France
| | - Sébastien Chanoine
- Translational Innovation in Medicine and Complexity - Unité Mixte de Recherche 5525, Université Grenoble Alpes, Grenoble, France
- Pôle Pharmacie, Centre hospitalo-Universitaire Grenoble Alpes, Grenoble, France
- Faculté de Pharmacie, Université Grenoble Alpes, Grenoble, France
| | - Sophie Lambert-Lacroix
- Translational Innovation in Medicine and Complexity - Unité Mixte de Recherche 5525, Université Grenoble Alpes, Grenoble, France
| | - Jean-Luc Bosson
- Translational Innovation in Medicine and Complexity - Unité Mixte de Recherche 5525, Université Grenoble Alpes, Grenoble, France
| | - Alexandre Moreau-Gaudry
- Translational Innovation in Medicine and Complexity - Unité Mixte de Recherche 5525, Université Grenoble Alpes, Grenoble, France
| | - Pierrick Bedouch
- Translational Innovation in Medicine and Complexity - Unité Mixte de Recherche 5525, Université Grenoble Alpes, Grenoble, France
- Pôle Pharmacie, Centre hospitalo-Universitaire Grenoble Alpes, Grenoble, France
- Faculté de Pharmacie, Université Grenoble Alpes, Grenoble, France
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17
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Perrier Q, Hosni A, Leenhardt J, Desruet MD, Durand M, Bedouch P. Automation of parenteral nutrition: impact on process and cost analysis. Eur J Hosp Pharm 2023:ejhpharm-2022-003602. [PMID: 37068926 DOI: 10.1136/ejhpharm-2022-003602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/06/2022] [Accepted: 03/27/2023] [Indexed: 04/19/2023] Open
Abstract
OBJECTIVES On the basis of its safety and accuracy, automation is recommended for parenteral nutrition (PN). The aim of this study was to highlight the changes in practices related to the automation of PN and to perform a cost study comparing manual vs automated production costs. METHODS We conducted a micro-costing study using 1 year of manual production data for adult, neonatal and paediatric PN bagsat a hospital. We used the data to estimate the costs of automating the production process for adult, neonatal and paediatric bags. RESULTS Major modification to the PN production process resulted in: rationalisation of raw materials, computerisation and optimisation of human needs. Switching from a manual to an automated process reduced the cost of neonatal/paediatric custom bags (€130.73 vs €124.58) and semi-custom bags (€172.08 vs €166.86); but increased the cost of adult bags (€93.06 vs €127.92). CONCLUSIONS The changes resulting from the automation and revision of the production process globally increased annual expenditures by approximately 9.7%. However, automation minimised the risk of misproduction, bag contamination, and led to a more secure production process that reduced risks incurred by the teams. In view of the gain in patient and staff safety (linked to the use of an automated compounding device) the moderate economic impact (<10%) should not deter the automation of PN production circuits.
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Affiliation(s)
- Quentin Perrier
- Univ. Grenoble Alpes, LBFA, INSERM, U1055, Pôle Pharmacie, Grenoble Alpes University Hospital, Grenoble, France
| | - Amor Hosni
- Univ. Grenoble Alpes, Pôle Pharmacie, Grenoble Alpes University Hospital, Grenoble, France
| | - Julien Leenhardt
- Univ. Grenoble Alpes, LRB, INSERM, U1039, Pôle Pharmacie, Grenoble Alpes University Hospital, Grenoble, France
| | | | - Marjorie Durand
- Univ. Grenoble Alpes, Pôle Pharmacie, Grenoble Alpes University Hospital, Grenoble, France
| | - Pierrick Bedouch
- Univ. Grenoble Alpes, TIMC, CNRS, UMR5525, Pôle Pharmacie, Grenoble Alpes University Hospital, Grenoble, France
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18
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Ranchon F, Chanoine S, Lambert-Lacroix S, Bosson JL, Moreau-Gaudry A, Bedouch P. Development of artificial intelligence powered apps and tools for clinical pharmacy services: A systematic review. Int J Med Inform 2023; 172:104983. [PMID: 36724730 DOI: 10.1016/j.ijmedinf.2022.104983] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 09/01/2022] [Revised: 12/15/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Artificial Intelligence (AI) offers potential opportunities to optimize clinical pharmacy services in community or hospital settings. The objective of this systematic literature review was to identify and analyse quantitative studies using or integrating AI for clinical pharmacy services. MATERIALS AND METHODS A systematic review was conducted using PubMed/Medline and Web of Science databases, including all articles published from 2000 to December 2021. Included studies had to involve pharmacists in the development or use of AI-powered apps and tools.. RESULTS 19 studies using AI for clinical pharmacy services were included in this review. 12 out of 19 articles (63.1%) were published in 2020 or 2021. Various methodologies of AI were used, mainly machine learning techniques and subsets (natural language processing and deep learning). The datasets used to train the models were mainly extracted from electronic medical records (6 studies, 32%). Among clinical pharmacy services, medication order review was the service most targeted by AI-powered apps and tools (9 studies), followed by health product dispensing (4 studies), pharmaceutical interviews and therapeutic education (2 studies). The development of these tools mainly involved hospital pharmacists (12/19 studies). DISCUSSION AND CONCLUSION The development of AI-powered apps and tools for clinical pharmacy services is just beginning. Pharmacists need to keep abreast of these developments in order to position themselves optimally while maintaining their human relationships with healthcare teams and patients. Significant efforts have to be made, in collaboration with data scientists, to better assess whether AI-powered apps and tools bring value to clinical pharmacy services in real practice.
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Affiliation(s)
- Florence Ranchon
- CNRS, TIMC UMR5525, MESP, Université Grenoble Alpes, F-38041 Grenoble, France; Hospices Civils de Lyon, Hôpital Lyon Sud, unité de pharmacie clinique oncologique, Pierre-Bénite, France; Université Lyon-1, EA 3738 CICLY, Oullins cedex F-69921, France.
| | - Sébastien Chanoine
- CNRS, TIMC UMR5525, MESP, Université Grenoble Alpes, F-38041 Grenoble, France; Pôle Pharmacie, CHU Grenoble Alpes, F-38043 Grenoble, France; Université Grenoble Alpes, Faculté de Pharmacie, F-38041 Grenoble, France
| | | | - Jean-Luc Bosson
- CNRS, TIMC UMR5525, MESP, Université Grenoble Alpes, F-38041 Grenoble, France
| | | | - Pierrick Bedouch
- CNRS, TIMC UMR5525, MESP, Université Grenoble Alpes, F-38041 Grenoble, France; Pôle Pharmacie, CHU Grenoble Alpes, F-38043 Grenoble, France; Université Grenoble Alpes, Faculté de Pharmacie, F-38041 Grenoble, France
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Bouzeid M, Clarenne J, Mongaret C, Pluchart H, Chanoine S, Vermorel C, Bosson JL, Bedouch P, Conort O, Gravoulet J, Janoly-Dumenil A, Juste M, Mongaret C, Bosson JL, Bedouch P. Using national data to describe characteristics and determine acceptance factors of pharmacists' interventions: a six-year longitudinal study. Int J Clin Pharm 2022; 45:430-441. [PMID: 36566276 DOI: 10.1007/s11096-022-01526-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 08/16/2022] [Accepted: 11/30/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND In France, hospital pharmacists perform medication order reviews during patients' hospital stays. This activity can be centralized in the pharmacy or carried out directly in the ward, in collaboration with the healthcare team. During this review, pharmacists can make recommendations to optimize therapeutics. Since 2006, they can document their interventions, via the national Act-IP© observatory. AIM To determine the characteristics of pharmacists' interventions and their acceptance by physicians in French hospitals. METHOD A 6-year observational study of pharmacists' interventions documented on the Act-IP© French observatory between 2009 and 2014 was performed. Multiple logistic regression was undertaken to determine the predictors of physicians' acceptance of interventions. RESULTS A total of 194,684 pharmacists' interventions were documented and concerned mainly "dosage adjustment" (25.6%). These interventions were mostly related to drugs from the central nervous system (23.7%). Seventy percent of pharmacists' interventions were accepted by physicians. Acceptance rate was higher when conducted by a pharmacist regularly practicing in the ward (ORa = 1.60, CI 95 [1.57-1.64]). Physicians' acceptance was significantly associated with (1) ward specialty: emergency (ORa = 1.24, CI 95 [1.14-1.35]); (2) type of intervention: "drug discontinuation", "drug switch" (ORa = 1.15, CI 95 [1.12-1.19]) and "addition of a new drug" (ORa = 1.15, CI 95 [1.12-1.19]); (3) drug group: antineoplastic and immunomodulators (ORa = 3.67, CI 95 [3.44-3.92]). CONCLUSION This 6-year longitudinal study highlights the role of clinical pharmacists, and particularly the impact of those integrated into wards. This was found to improve intervention acceptance, potentially through collaboration with physicians in pursuit of patient care and drug safety.
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Affiliation(s)
- Mayssam Bouzeid
- CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, Univ. Grenoble Alpes, 38000, Grenoble, France
| | - Justine Clarenne
- BIOS EA 4691, Université de Reims Champagne-Ardenne, 51100, Reims, France.,Pharmacy Department, CHU Reims, 51100, Reims, France
| | - Céline Mongaret
- BIOS EA 4691, Université de Reims Champagne-Ardenne, 51100, Reims, France.,Pharmacy Department, CHU Reims, 51100, Reims, France
| | - Hélène Pluchart
- CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, Univ. Grenoble Alpes, 38000, Grenoble, France.,Pharmacy Department, Grenoble-Alpes University Hospital, 38000, Grenoble, France
| | - Sébastien Chanoine
- CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, Univ. Grenoble Alpes, 38000, Grenoble, France.,Pharmacy Department, Grenoble-Alpes University Hospital, 38000, Grenoble, France
| | - Céline Vermorel
- CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, Univ. Grenoble Alpes, 38000, Grenoble, France
| | | | - Jean-Luc Bosson
- CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, Univ. Grenoble Alpes, 38000, Grenoble, France
| | - Pierrick Bedouch
- CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, Univ. Grenoble Alpes, 38000, Grenoble, France. .,Pharmacy Department, Grenoble-Alpes University Hospital, 38000, Grenoble, France.
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20
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Tanty A, Vitale E, Chanoine S, Jost J, Mille F, Gourieux B, Collomp R, Allenet B, Thiveaud D, Dode X, Honoré S, Bedouch P. FAQ Vaccins COVID-19 : la mobilisation des sociétés savantes pharmaceutiques pour répondre aux enjeux de la vaccination. Le Pharmacien Clinicien 2022. [PMCID: PMC9748206 DOI: 10.1016/j.phacli.2022.10.472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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21
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Vitale E, Tanty A, Allenet B, Chanoine S, Bedouch P. Pandémie COVID-19 : YouTubeFR, un outil de communication efficace pour répondre aux besoins d’informations des professionnels de santé concernant la campagne vaccinale. Le Pharmacien Clinicien 2022. [PMCID: PMC9748196 DOI: 10.1016/j.phacli.2022.10.426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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22
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Tanty A, Vitale E, Lombardo D, Grévy A, Gibert P, Chapuis C, Chevallier Brilloit C, Allenet B, Bedouch P, Chanoine S. Pandémie COVID-19 : impact des soins pharmaceutiques dans la prise en charge des patients atteints de COVID-19 en période de crise sanitaire. Le Pharmacien Clinicien 2022. [PMCID: PMC9748210 DOI: 10.1016/j.phacli.2022.10.377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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23
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Orhon P, Perrier Q, Gibert P, Trochet C, Bedouch P. Entre bon usage et adhésion thérapeutique des sprays. Rev Infirm 2022; 71:53-55. [PMID: 36599536 DOI: 10.1016/j.revinf.2022.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Pauline Orhon
- Centre hospitalier universitaire Grenoble-Alpes, avenue Maquis-du-Grésivaudan, 38700 La Tronche, France
| | - Quentin Perrier
- Centre hospitalier universitaire Grenoble-Alpes, avenue Maquis-du-Grésivaudan, 38700 La Tronche, France
| | - Prudence Gibert
- Centre hospitalier universitaire Grenoble-Alpes, avenue Maquis-du-Grésivaudan, 38700 La Tronche, France.
| | - Claire Trochet
- Centre hospitalier universitaire Grenoble-Alpes, avenue Maquis-du-Grésivaudan, 38700 La Tronche, France
| | - Pierrick Bedouch
- Centre hospitalier universitaire Grenoble-Alpes, avenue Maquis-du-Grésivaudan, 38700 La Tronche, France
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24
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Pollani C, Brudieu E, Metais J, Grévy A, Gibert P, Bedouch P. Campagne de vaccination contre la Covid-19: Retour d’expérience de l’équipe pharmaceutique d’un établissement pivot. Le Pharmacien Clinicien 2022. [PMCID: PMC9684104 DOI: 10.1016/j.phacli.2022.11.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Perrier Q, Lupo J, Gerster T, Augier C, Falque L, Rostaing L, Pelletier L, Bedouch P, Blanc M, Saint-Raymond C, Boignard A, Bonadona A, Noble J, Epaulard O. SARS-CoV-2 anti-spike antibodies after a fourth dose of COVID-19 vaccine in adult solid-organ transplant recipients. Vaccine 2022; 40:6404-6411. [PMID: 36184404 PMCID: PMC9444490 DOI: 10.1016/j.vaccine.2022.08.065] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/16/2022] [Accepted: 08/28/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND A fourth dose of SARS-CoV-2 vaccine is recommended in solid-organ transplant (SOT) recipients, but the immunogenicity is poorly known. METHODS We conducted a retrospective, observational, monocentric study between the 1st January 2021 and 31st March 2022 of the anti-Spike antibody titers after one to four doses of vaccine in SOT. RESULTS 825 SOT were included. Median age at first vaccine injection was 61.2 (IQR 50.9-69.3) years; 66.7 % were male; 63.4 % had received four vaccine doses. The proportion of participants with a strong humoral response (>260 BAU/mL) increased with the number of vaccine doses: 10.6 % after the 1st dose (D1), 35.1 % after the 2nd (D2), 48.5 % after the 3rd (D3), and 65.1 % after the 4th (D4) (p < 0.001). Among the tested patients, the proportion with a detectable humoral response was significantly higher after D4 than after D3 (47 % vs 22 %, p = 0.01). Liver transplant recipients had more frequently a strong humoral response after D2, D3 and D4 (OR = 5.3, 3.7 and 6.6 respectively when compared with other organ transplant recipients, p < 0.001). In kidney transplant recipients, belatacept-containing regimen was associated with a lower rate of detectable humoral (9 % vs 40 %, p = 0.025) after D3, but there was no statistical difference after D4. CONCLUSION A fourth dose should be proposed to SOT recipients who did not developed an immune response after 3 doses. Kidney transplant recipients receiving belatacept have a poorer, although frequently detectable response.
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Affiliation(s)
- Quentin Perrier
- Pharmacy Department, Grenoble Alpes University Hospital and Univ. Grenoble Alpes, Laboratory of Fundamental and Applied Bioenergetic (LBFA), INSERM U1055, Grenoble, France
| | - Julien Lupo
- Virology Laboratory, Grenoble Alpes University Hospital and Univ. Grenoble Alpes, Institut de Biologie Structurale (IBS), CEA, CNRS, Grenoble, France
| | - Théophile Gerster
- Hepatogastroenterology Department, Grenoble Alpes University Hospital, Grenoble, France
| | - Caroline Augier
- Cardiology Department, Grenoble Alpes University Hospital, Grenoble, France
| | - Loïc Falque
- Pneumology and Physiology Department, Grenoble Alpes University Hospital, Grenoble, France
| | - Lionel Rostaing
- Nephrology, Hemodialysis, Apheresis and Kidney Transplantation Department, Grenoble Alpes University Hospital and Univ. Grenoble Alpes, Grenoble, France
| | - Laurent Pelletier
- Virology Laboratory, Grenoble Alpes University Hospital, Grenoble, France
| | - Pierrick Bedouch
- Pharmacy Department, Grenoble Alpes University Hospital and Univ. Grenoble Alpes, CNRS, TIMC-IMAG, Grenoble, France
| | - Myriam Blanc
- Infectious Diseases Department, Grenoble Alpes University Hospital and Univ. Grenoble Alpes, Groupe de Recherche en Infectiologie Clinique, CIC-1406, INSERM, Grenoble, France
| | - Christel Saint-Raymond
- Pneumology and Physiology Department, Grenoble Alpes University Hospital, Grenoble, France
| | - Aude Boignard
- Cardiology Department, Grenoble Alpes University Hospital, Grenoble, France
| | - Agnès Bonadona
- Hepatogastroenterology Department, Grenoble Alpes University Hospital, Grenoble, France
| | - Johan Noble
- Nephrology, Hemodialysis, Apheresis and Kidney Transplantation Department, Grenoble Alpes University Hospital and Univ. Grenoble Alpes, Grenoble, France
| | - Olivier Epaulard
- Infectious Diseases Department, Grenoble Alpes University Hospital and Univ. Grenoble Alpes, Groupe de Recherche en Infectiologie Clinique, CIC-1406, INSERM, Grenoble, France,Corresponding author at: Service des maladie infectieuses, CHU Grenoble Alpes, France
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26
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Salomez-Ihl C, Zdonowski AC, Grévy A, George K, Chapuis C, Brudieu E, Gibert P, Bedouch P. Quel impact des évolutions du circuit du médicament sur l’activité de dispensation durant la permanence pharmaceutique ? Annales Pharmaceutiques Françaises 2022; 81:519-528. [PMID: 36209901 DOI: 10.1016/j.pharma.2022.09.008] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 08/22/2022] [Accepted: 09/29/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Pharmaceutical permanence (PP), outside the working hours of an in-house pharmacy (PUI), allows to guarantee the continuity of care in health-care institutions. A retrospective review of urgent drug dispensing was carried out in the light of changes in the drug circuit. MATERIALS AND METHOD The analysis of drug dispensations was performed over a period from 2011 to 2019. The average number of drugs dispensed per shift, annual dispensations, and their variation by day of the week were studied. The increase is statistically significant and is found on both weekdays and weekends. Each drug was identified according to its Anatomical Therapeutic Chemical (ATC) classification. Data on the activities of our institution (number of hospitalizations, average length of stay) were also collected. RESULTS In 2011, an average of 36 medications were dispensed per on-call period, compared with 77 in 2019 (a doubling of activity). The increase is statistically significant and is found on both weekdays and weekends. Neurological drugs and anti-infectives represent on average 43 % of the drugs dispensed. At the same time, there was a decrease in average length of stay and an increase in hospitalizations (-10 % and +16 % respectively). DISCUSSION The increase in the average number of medications dispensed per shift is notable. It reflects a strong and gradual increase in activity, which was increased when the full vacuum cabinets (FVCs) were introduced, which improved the quality and safety of the pharmaceutical circuit. The revision of the allocations and the information of prescribers on the drug circuit will optimize the activity and refocus it on the pharmaceutical analysis of urgent needs.
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Affiliation(s)
- C Salomez-Ihl
- Pôle pharmacie, CHU Grenoble Alpes, CS 10217, avenue des Maquis-du-Grésivaudan, 38043 Grenoble cedex 9, France; Université de Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, CHU Grenoble Alpes, TIMC, 38000 Grenoble, France
| | - A-C Zdonowski
- Pôle pharmacie, CHU Grenoble Alpes, CS 10217, avenue des Maquis-du-Grésivaudan, 38043 Grenoble cedex 9, France
| | - A Grévy
- Pôle pharmacie, CHU Grenoble Alpes, CS 10217, avenue des Maquis-du-Grésivaudan, 38043 Grenoble cedex 9, France
| | - K George
- Pôle pharmacie, CHU Grenoble Alpes, CS 10217, avenue des Maquis-du-Grésivaudan, 38043 Grenoble cedex 9, France
| | - C Chapuis
- Pôle pharmacie, CHU Grenoble Alpes, CS 10217, avenue des Maquis-du-Grésivaudan, 38043 Grenoble cedex 9, France
| | - E Brudieu
- Pôle pharmacie, CHU Grenoble Alpes, CS 10217, avenue des Maquis-du-Grésivaudan, 38043 Grenoble cedex 9, France
| | - P Gibert
- Pôle pharmacie, CHU Grenoble Alpes, CS 10217, avenue des Maquis-du-Grésivaudan, 38043 Grenoble cedex 9, France.
| | - P Bedouch
- Pôle pharmacie, CHU Grenoble Alpes, CS 10217, avenue des Maquis-du-Grésivaudan, 38043 Grenoble cedex 9, France; Université de Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, CHU Grenoble Alpes, TIMC, 38000 Grenoble, France
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27
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Perrier Q, Piquemal M, Leenhardt J, Choisnard L, Mazet R, Desruet MD, Durand M, Bedouch P. A quality by design approach for the qualification of automating compounding device for parenteral nutrition. Eur J Pharm Sci 2022; 179:106275. [PMID: 35987326 DOI: 10.1016/j.ejps.2022.106275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 09/13/2021] [Revised: 03/16/2022] [Accepted: 08/11/2022] [Indexed: 11/16/2022]
Abstract
Automated compounding device (ACD) are increasingly used for parenteral nutrition (PN) bag production, and their acquisition must be sufficiently thought. The law requires the qualification of these ACD, but did not specify the tests to be performed. The quality by design (QbD) risk based approach allowed to define the quality target product profile in order to acquire the best ACD for each unit, and thanks a risk analysis permitted to define the critical quality attributes (CQA). These CQA will allowed to define tests performed during qualification. The ACD qualified was a 12 pump volumetric system. The CQA for PN bags consisted in sterile, precisely and accurately production with enough stability. During operational qualification volumetric accuracy test was performed, and during the performance qualification: flush volume, media fill, microbiological integrity of environment, sterility of control bag and production test were performed. At the end, all tests were conclusive (excepted for some results mostly due to analytical bias) and the ACD was considered to produce sterile bags in a control environment, precisely (relative standard deviation < 4%) and accurately (mean bias < 1% for weight and < 7% for other controls) with a sufficient stability. The QbD risk based approach allowed to acquire the best ACD for our need, and qualify relevant elements regarding the production process.
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Affiliation(s)
- Quentin Perrier
- Department of Pharmacy, Grenoble Alpes University Hospital, Grenoble, France; Univ. Grenoble Alpes, INSERM U1055, Laboratory of Fundamental and Applied Bioenergetics, Grenoble, France
| | - Marie Piquemal
- Department of Pharmacy, Grenoble Alpes University Hospital, Grenoble, France
| | - Julien Leenhardt
- Department of Pharmacy, Grenoble Alpes University Hospital, Grenoble, France; Univ. Grenoble Alpes, INSERM U1039, Laboratory of Bioclinical Radiopharmaceutics, Grenoble, France
| | - Luc Choisnard
- Univ. Grenoble Alpes, CNRS 5063, DPM, Saint Martin d'Hères, France.
| | - Roseline Mazet
- Department of Pharmacy, Grenoble Alpes University Hospital, Grenoble, France; Univ. Grenoble Alpes, CNRS 5063, DPM, Saint Martin d'Hères, France
| | | | - Marjorie Durand
- Department of Pharmacy, Grenoble Alpes University Hospital, Grenoble, France.
| | - Pierrick Bedouch
- Department of Pharmacy, Grenoble Alpes University Hospital, Grenoble, France; Univ. Grenoble Alpes, CNRS 5525, TIMC-IMAG, Grenoble, France
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Liaigre L, Perrier Q, Orhon P, Briault A, Romand P, Falque L, Raymond CS, Degano B, Bedouch P. Sotorasib associated with tacrolimus and everolimus: A significant drug interaction in lung transplant patients. Transpl Immunol 2022; 74:101678. [PMID: 35901952 DOI: 10.1016/j.trim.2022.101678] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/20/2022] [Accepted: 07/20/2022] [Indexed: 11/28/2022]
Abstract
The management of immunosuppressors in solid organ transplantation requires pharmacological therapeutic monitoring with regular adaptation of the dosage to the residual level. An obvious cause of these fluctuations is drug interactions, particularly for mTOR inhibitors and anti-calcineurin drugs, which are highly metabolized by cytochromes P450. A 72-year-old lung transplanted man, treated by tacrolimus and everolimus in the long term, had his residual immunosuppressor levels unbalanced by the introduction of sotorasib, which is used for metastatic pulmonary adenocarcinoma. This imbalance is explained by the fact that sotorasib is an inducer of CYP3A4 and an inhibitor of PGP, but the strength of the interaction has never been studied. This will have required a threefold increase in dosages and weekly monitoring before satisfactory residual levels were achieved.
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Affiliation(s)
- Léa Liaigre
- Pharmacy Department, Grenoble Alpes University Hospital, Grenoble, France.
| | - Quentin Perrier
- Pharmacy Department, Grenoble Alpes University Hospital, Univ. Grenoble Alpes, LBFA, INSERM U1055, St Martin d'Heres, France
| | - Pauline Orhon
- Pharmacy Department, Grenoble Alpes University Hospital, Grenoble, France
| | - Amandine Briault
- Respiratory Medicine University Hospital Service, Grenoble Alpes University Hospital, Grenoble, France
| | - Philippe Romand
- Respiratory Medicine Service, Hôpitaux du Leman, Thonon Les Bains, France
| | - Loic Falque
- Respiratory Medicine University Hospital Service, Grenoble Alpes University Hospital, Grenoble, France
| | - Christel Saint Raymond
- Respiratory Medicine University Hospital Service, Grenoble Alpes University Hospital, Grenoble, France
| | - Bruno Degano
- Respiratory Medicine University Hospital Service, Grenoble Alpes University Hospital, Grenoble, France
| | - Pierrick Bedouch
- Pharmacy Department, Grenoble Alpes University Hospital, CNRS, TIMC UMR 5525, Grenoble, France
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Maljean L, Gavazzi G, Gibert P, Grevy A, Payen M, Zerhouni N, Tiffet T, Cracowski JL, Mitha N, Maindet C, Baudrant M, Bedouch P, Drevet S. Tolerance of Fentanyl Pectin Nasal Spray for Procedural Pain in Geriatric Patients. J Am Med Dir Assoc 2022; 23:1005-1010. [DOI: 10.1016/j.jamda.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 03/04/2022] [Accepted: 03/08/2022] [Indexed: 10/18/2022]
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Chapuis C, Collomp R, Albaladejo L, Terrisse H, Honoré S, Bosson JL, Bedouch P, Albaladejo P. Redistribution of critical drugs in shortage during the first wave of COVID-19 in France: from operating theaters to intensive care units. J Pharm Policy Pract 2022; 15:28. [PMID: 35365212 PMCID: PMC8972643 DOI: 10.1186/s40545-022-00425-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/25/2022] [Indexed: 11/17/2022] Open
Abstract
Background Tension in the supply of highly consumed drugs for patients with COVID-19 (propofol, midazolam, curares) led the French government to set up a centralized supply of hospitals with distribution based on the number of resuscitation beds in March 2020. The French Societies of Clinical Pharmacy and of Anesthesia and Critical Care aimed to evaluate the changes in total needs and the distribution between anesthesia and critical care activities (CCU), to prepare resumed surgical activity. Methods National declarative survey among pharmacists, via an online form (SurveyMonkey®), was conducted in April and May 2020. The analysis focused on quantities dispensed during the whole year 2019, and March and April of year 2019 and 2020 for the drugs subject to quota, and on their distribution in CCU and operating theaters. Results For the 358 establishments (47% public, 53% private), dispensations in CCU in March 2020 compared to March 2019 increased, respectively: propofol (+81%), midazolam (+125%), cisatracurium (+311%), atracurium (+138%), rocuronium (+119%); and decreased for anaesthesia: propofol (−27%), midazolam (-10%), cisatracurium (−19%), atracurium (−27%), rocuronium (+16%). Conclusions Variation of dispensations between CCU and others was directly related to the increase of COVID patients in CCU and the decrease in surgical activity. Each establishment could receive up to five or six different presentations and concentrations, leading to a major risk of medication error. This collaborative national survey provided accurate data on the drugs’ usual consumption. This work emphasized the need for a strong collaboration between pharmacists and anesthesiologists and intensive care physicians. It was further used by the Health Ministry to adjust the drug distribution.
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Affiliation(s)
- Claire Chapuis
- Pôle Pharmacie, Pôle Anesthésie-Réanimation, CHU Grenoble Alpes, CS10217, 380143, Grenoble cedex 9, France.
| | - Rémy Collomp
- Pôle Pharmacie Stérilisation, CHU De Nice, Société Française de Pharmacie Clinique (SFPC), Nice, France
| | - Laura Albaladejo
- Equipe Themas, Timc-Imag Umr5525, Université Grenoble Alpes, Grenoble, France
| | - Hugo Terrisse
- Equipe Themas, Timc-Imag Umr5525, Université Grenoble Alpes, Grenoble, France
| | - Stéphane Honoré
- Pôle Pharmacie, Hôpital De La Timone, Société Française de Pharmacie Clinique (SFPC), Marseille, France
| | - Jean-Luc Bosson
- Equipe Themas, Timc-Imag Umr5525, Université Grenoble Alpes, Grenoble, France.,Pôle Santé Publique, CHU Grenoble Alpes, Grenoble, France
| | - Pierrick Bedouch
- Equipe Themas, Timc-Imag Umr5525, Université Grenoble Alpes, Grenoble, France.,Pôle Pharmacie, CHU Grenoble Alpes, Société Française de Pharmacie Clinique (SFPC), Grenoble, France
| | - Pierre Albaladejo
- Equipe Themas, Timc-Imag Umr5525, Université Grenoble Alpes, Grenoble, France.,Pôle Anesthésie-Réanimation, CHU Grenoble Alpes, Société Française d'Anesthésie Réanimation (SFAR), Grenoble, France
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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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Le Maréchal M, Batel A, Bouvier S, Mahdhaoui H, Margotton M, Vittoz JP, Brudieu E, Chevallier C, Bedouch P, Touati S, Epaulard O. "When did you decide to receive the Covid-19 vaccine?" Survey in a high-volume vaccination center. Hum Vaccin Immunother 2021; 17:5099-5104. [PMID: 35041799 PMCID: PMC8903941 DOI: 10.1080/21645515.2021.2013081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Highly efficient and safe Covid-19 vaccines are available in Europe in amounts that theoretically allow for a high immune coverage. However, a notable proportion of the population is reluctant toward immunization. We aimed to determine, among people who chose to be vaccinated, when they made the decision and whether they would have preferred an earlier vaccination. A survey was conducted in a high-volume Covid-19 vaccination center in France from 28 May to 9 July 2021 through an anonymous questionnaire. The 2519 participants (54.1% males; median age 39 years) attributed lower efficacy and safety to Covid-19 vaccines than to vaccines in general. When asked when they decided to receive the vaccine, 15.5% and 16.0% answered "less than one month ago" and "less than one week ago," respectively; age <40 and female sex were independently associated with these responses. When asked whether they would have preferred to have been vaccinated earlier, 57.6% answered "definitely no," "rather no," or "neither yes nor no"; female sex (independently from age) was associated with these answers. When asked whether they would have preferred to receive the vaccine as early as January 2021, 65.2% answered "definitely no," "rather no," or "neither yes nor no"; age <40 and female sex were independently associated with these responses. In conclusion, one-third people had made the decision to be vaccinated only recently, while more than half would not have preferred an earlier vaccination, in particular women and those aged <40 years. Vaccine campaigns should take such short-term decision-making processes into account.
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Affiliation(s)
- Marion Le Maréchal
- Service des maladies infectieuses, Centre hospitalier universitaire Grenoble-Alpes, Grenoble, France,Groupe de recherche en infectiologie clinique, CIC-1406, Inserm – CHUGA – Université Grenoble-Alpes, Grenoble, France
| | - Amina Batel
- Groupe de recherche en infectiologie clinique, CIC-1406, Inserm – CHUGA – Université Grenoble-Alpes, Grenoble, France
| | - Stéphanie Bouvier
- Groupe de recherche en infectiologie clinique, CIC-1406, Inserm – CHUGA – Université Grenoble-Alpes, Grenoble, France
| | - Hajer Mahdhaoui
- Groupe de recherche en infectiologie clinique, CIC-1406, Inserm – CHUGA – Université Grenoble-Alpes, Grenoble, France
| | - Morgane Margotton
- Groupe de recherche en infectiologie clinique, CIC-1406, Inserm – CHUGA – Université Grenoble-Alpes, Grenoble, France
| | - Jean-Philippe Vittoz
- Groupe de recherche en infectiologie clinique, CIC-1406, Inserm – CHUGA – Université Grenoble-Alpes, Grenoble, France
| | - Etienne Brudieu
- Département de Pharmacie, Centre hospitalier universitaire Grenoble-Alpes, Grenoble, France
| | - Christine Chevallier
- Département de Pharmacie, Centre hospitalier universitaire Grenoble-Alpes, Grenoble, France
| | - Pierrick Bedouch
- Département de Pharmacie, Centre hospitalier universitaire Grenoble-Alpes, Grenoble, France,TIMC UMR 5525, Université Grenoble-Alpes/CNRS, Grenoble, France
| | - Saber Touati
- Groupe de recherche en infectiologie clinique, CIC-1406, Inserm – CHUGA – Université Grenoble-Alpes, Grenoble, France
| | - Olivier Epaulard
- Service des maladies infectieuses, Centre hospitalier universitaire Grenoble-Alpes, Grenoble, France,Groupe de recherche en infectiologie clinique, CIC-1406, Inserm – CHUGA – Université Grenoble-Alpes, Grenoble, France,Institut de biologie structurale, UMR 5075 – CEA-CNRS-UGA, Grenoble, France,CONTACT Olivier Epaulard Infectiologie, CHU Grenoble Alpes, CS 10217, Grenoble38043, France
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Affiliation(s)
- Sébastien Chanoine
- Centre hospitalier universitaire Grenoble Alpes, avenue Maquis-du-Grésivaudan, 38700 La Tronche, France
| | - Armance Grévy
- Centre hospitalier universitaire Grenoble Alpes, avenue Maquis-du-Grésivaudan, 38700 La Tronche, France
| | - Prudence Gibert
- Centre hospitalier universitaire Grenoble Alpes, avenue Maquis-du-Grésivaudan, 38700 La Tronche, France.
| | - Louise Billon
- Centre hospitalier universitaire Grenoble Alpes, avenue Maquis-du-Grésivaudan, 38700 La Tronche, France
| | - Claire Trochet
- Centre hospitalier universitaire Grenoble Alpes, avenue Maquis-du-Grésivaudan, 38700 La Tronche, France
| | - Pierrick Bedouch
- Centre hospitalier universitaire Grenoble Alpes, avenue Maquis-du-Grésivaudan, 38700 La Tronche, France
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Pluchart H, Bailly S, Fauconnier J, Delafosse P, Chanoine S, Dumas I, Bedouch P, Toffart AC. Study protocol to assess polypharmacy and comorbidities in lung cancer. Respir Med Res 2021; 80:100861. [PMID: 34662777 DOI: 10.1016/j.resmer.2021.100861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/21/2021] [Revised: 09/14/2021] [Accepted: 09/21/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND At least half of patients with lung cancer have comorbidities, which can affect treatment decisions and survival. Associated with comorbidity, polypharmacy can also have consequences on patient care. This study will evaluate both polypharmacy and comorbidities in a cohort of hospitalized patients on the administration of chemotherapy and survival. METHODS In this monocentric retrospective study, patients diagnosed with lung cancer during their first hospitalization in thoracic oncology were included between 2011 and 2015. Four datasets were obtained containing the variables of interest. Deterministic data linkage will be performed. The main objective will be to assess the impact of polypharmacy and comorbidities on chemotherapy administration within two months after the first hospitalization in thoracic oncology. The probability of chemotherapy administration will be estimated using the Kaplan Meier method. Prognostic factors will be identified using a Cox model. The Fine and Gray method will be used to analyze the competitive risk of death. EXPECTED RESULTS We first aim to demonstrate the feasibility of working with real-life data and aggregate different databases. Then our goal is to assess impact of polypharmacy and comorbidities on chemotherapy administration and on the survival of lung cancer patients. This would help to understand the possibilities to aggregate several database for a protocol in view to help clinicians to rationalize treatment and define inappropriate medications for this population.
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Affiliation(s)
- Hélène Pluchart
- Pôle pharmacie, Centre Hospitalier Universitaire Grenoble Alpes, France; Université Grenoble Alpes, Grenoble, France; Univ. Grenoble Alpes, CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC, 38000 Grenoble, France.
| | - Sébastien Bailly
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, 38000 Grenoble, France
| | - Jérôme Fauconnier
- Univ. Grenoble Alpes, CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC, 38000 Grenoble, France
| | | | - Sébastien Chanoine
- Pôle pharmacie, Centre Hospitalier Universitaire Grenoble Alpes, France; Université Grenoble Alpes, Grenoble, France; Institute for Advanced Biosciences, UGA/INSERM U1209/CNRS 5309, Université Grenoble Alpes, France
| | - Isabelle Dumas
- Centre de Coordination en Cancérologie, Pavillon E.Chatin, CHU Grenoble Alpes
| | - Pierrick Bedouch
- Pôle pharmacie, Centre Hospitalier Universitaire Grenoble Alpes, France; Université Grenoble Alpes, Grenoble, France; Univ. Grenoble Alpes, CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC, 38000 Grenoble, France
| | - Anne-Claire Toffart
- Université Grenoble Alpes, Grenoble, France; Institute for Advanced Biosciences, UGA/INSERM U1209/CNRS 5309, Université Grenoble Alpes, France; Clinique de Pneumologie, Unité d'Oncologie Thoracique, Pôle Thorax et Vaisseaux, CHU Grenoble Alpes, France
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Videau M, Charpiat B, Vermorel C, Bosson JL, Conort O, Bedouch P. Characteristics of pharmacist's interventions triggered by prescribing errors related to computerised physician order entry in French hospitals: a cross-sectional observational study. BMJ Open 2021; 11:e045778. [PMID: 34635512 PMCID: PMC8506887 DOI: 10.1136/bmjopen-2020-045778] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES Computerised physician order entry (CPOE) systems facilitate the review of medication orders by pharmacists. Reports have emerged that show conception flaws or the misuse of CPOE systems generate prescribing errors. We aimed to characterise pharmacist interventions (PIs) triggered by prescribing errors identified as system-related errors (PISREs) in French hospitals. DESIGN This was a cross-sectional observational study based on PIs prospectively documented in the Act-IP observatory database from January 2014 to December 2018. SETTING PISREs from 319 French computerised healthcare facilities were analysed. PARTICIPANTS Among the 319 French hospitals, 232 (72.7%) performed SRE interventions, involving 652 (51%) pharmacists. RESULTS Among the 331 678 PIs recorded, 27 058 were qualified as due to SREs (8.2%). The main drug-related problems associated with PISREs were supratherapeutic (27.5%) and subtherapeutic dosage (17.2%), non-conformity with guidelines/contraindications (22.4%) and improper administration (17.9%). The PI prescriber acceptation rate was 78.9% for SREs vs 67.6% for other types of errors. The PISRE ratio was estimated relative to the total number of PIs. Concerning the certification status of CPOE systems, the PISRE ratio was 9.4% for non-certified systems vs 5.5% for certified systems (p<0.001). The PISRE ratio for senior pharmacists was 9.2% and that for pharmacy residents 5.4% (p<0.001). Concerning prescriptions made by graduate prescribers and those made by residents, the PISRE ratio was 8.4% and 7.8%, respectively (p<0.001). CONCLUSION Computer-related prescribing errors are common. The PI acceptance rate by prescribers was higher than that observed for PIs that were not CPOE related. This suggests that physicians consider the potential clinical consequences of SREs for patients to be more frequently serious than interventions unrelated to CPOE. CPOE medication review requires continual pharmacist diligence to catch these errors. The significantly lower PISRE ratio for certified software should prompt patient safety agencies to undertake studies to identify the safest software and discard software that is potentially dangerous.
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Affiliation(s)
- Manon Videau
- Pharmacy, Grenoble Alpes University Hospital, Grenoble, France
- CNRS/TIMC-IMAG UMR5525/ThEMAS, F-38041, Université Grenoble Alpes, Grenoble, France
| | - Bruno Charpiat
- CNRS/TIMC-IMAG UMR5525/ThEMAS, F-38041, Université Grenoble Alpes, Grenoble, France
- Pharmacy, Hopital de la Croix-Rousse, Hospices civils de Lyon, Lyon, France
| | - Céline Vermorel
- CNRS/TIMC-IMAG UMR5525/ThEMAS, F-38041, Université Grenoble Alpes, Grenoble, France
| | - Jean-Luc Bosson
- CNRS/TIMC-IMAG UMR5525/ThEMAS, F-38041, Université Grenoble Alpes, Grenoble, France
| | - Ornella Conort
- Pharmacy, Hopital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Pierrick Bedouch
- Pharmacy, Grenoble Alpes University Hospital, Grenoble, France
- CNRS/TIMC-IMAG UMR5525/ThEMAS, F-38041, Université Grenoble Alpes, Grenoble, France
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Affiliation(s)
- Armance Grévy
- Centre hospitalier universitaire Grenoble Alpes, avenue Maquis-du-Grésivaudan, 38700 La Tronche, France
| | - Sébastien Chanoine
- Centre hospitalier universitaire Grenoble Alpes, avenue Maquis-du-Grésivaudan, 38700 La Tronche, France
| | - Prudence Gibert
- Centre hospitalier universitaire Grenoble Alpes, avenue Maquis-du-Grésivaudan, 38700 La Tronche, France.
| | - Louise Billon
- Centre hospitalier universitaire Grenoble Alpes, avenue Maquis-du-Grésivaudan, 38700 La Tronche, France
| | - Claire Trochet
- Centre hospitalier universitaire Grenoble Alpes, avenue Maquis-du-Grésivaudan, 38700 La Tronche, France
| | - Pierrick Bedouch
- Centre hospitalier universitaire Grenoble Alpes, avenue Maquis-du-Grésivaudan, 38700 La Tronche, France
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Lalanne F, Bedouch P, Simonnet C, Depras V, Bordea G, Bourqui R, Hamon T, Thiessard F, Mougin F. Visualizing Food-Drug Interactions in the Thériaque Database. Stud Health Technol Inform 2021; 281:253-257. [PMID: 34042744 DOI: 10.3233/shti210159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This paper presents a prototype for the visualization of food-drug interactions implemented in the MIAM project, whose objective is to develop methods for the extraction and representation of these interactions and to make them available in the Thériaque database. The prototype provides users with a graphical visualization showing the hierarchies of drugs and foods in front of each other and the links between them representing the existing interactions as well as additional details about them, including the number of articles reporting the interaction. The prototype is interactive in the following ways: hierarchies can be easily folded and unfolded, a filter can be applied to view only certain types of interactions, and details about a given interaction are displayed when the mouse is moved over the corresponding link. Future work includes proposing a version more suitable for non-health professional users and the representation of the food hierarchy based on a reference classification.
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Affiliation(s)
| | - Pierrick Bedouch
- CNHIM, F-75014, Paris, France
- Univ. Grenoble Alpes, CNRS, TIMC UMR 5525, F-38000 Grenoble, France
| | - Cyril Simonnet
- Univ. Bordeaux, INSERM, BPH, U1219, F-33000 Bordeaux, France
| | | | - Georgeta Bordea
- Univ. Bordeaux, INSERM, BPH, U1219, F-33000 Bordeaux, France
| | - Romain Bourqui
- Univ. Bordeaux, CNRS, LaBRI UMR 5800, F-33000 Bordeaux, France
| | - Thierry Hamon
- Univ. Paris-Saclay, CNRS, LISN, F-91400 Orsay, France
- Univ. Sorbonne Paris Nord, F-93430 Villetaneuse, France
| | | | - Fleur Mougin
- Univ. Bordeaux, INSERM, BPH, U1219, F-33000 Bordeaux, France
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Vo HT, Charpiat B, Chanoine S, Juste M, Roubille R, Rose FX, Conort O, Allenet B, Bedouch P. CLEO: a multidimensional tool to assess clinical, economic and organisational impacts of pharmacists' interventions. Eur J Hosp Pharm 2021; 28:193-200. [PMID: 33883205 DOI: 10.1136/ejhpharm-2020-002642] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [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: 12/06/2020] [Revised: 03/05/2021] [Accepted: 03/22/2021] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES Clinical pharmacists' interventions (PIs) are an important element in ensuring good pharmaceutical care. We aimed to develop and validate a comprehensive multidimensional tool for assessing the potential impact of PIs for daily practice of medication review. METHODS Experts of the French Society of Clinical Pharmacy (SFPC) developed the CLinical, Economic and Organisational (CLEO) tool, consisting of three independent dimensions concerning clinical, economic and organisational impact. They were asked to analyse 30 scenarios of PIs, and re-rated 10 PIs with a washout of 1 month (internal validation). Then, seven external experts not involved in the development of the tool rated 60 scenarios collected when using the CLEO in daily practice. Inter- and intra-rater reliabilities were determined by calculation of the intra-class correlation (ICCA,1). Users' satisfaction and acceptability of the tool were assessed on a 7-level Likert scale with a 17-item questionnaire. RESULTS For internal reliability, the inter-rater reliability for the CLEO tool was good for clinical dimensions (ICCA,1=0.693), excellent for economic dimensions (ICCA,1=0.815) and fair for organisational dimensions (ICCA,1=0.421); and the intra-rater reliability was good for clinical dimensions (ICCA,1=0.822), excellent for economic dimensions (ICCA,1=0.918) and good for organisational dimensions (ICCA,1=0.738). For external reliability, the inter-rater reliability was good for clinical dimensions (ICCA,1=0.649), excellent for economic dimensions (ICCA,1=0.814) and fair for organisational dimensions (ICCA,1=0.500). CLEO was viewed as relevant (mean±SD 4.93±1.27), acceptable (4.81±1.78), practicable (5.56±1.45) and precise (5.38±1.47). CONCLUSIONS CLEO is a comprehensive tool assessing clinical, economic and organisational impacts of PIs which has been developed, validated and was reliable and feasible for use in routine clinical practice.
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Affiliation(s)
- Ha Thi Vo
- Faculty of Pharmacy, Pham Ngoc Thach University of Medicine, Ho Chi Minh, Vietnam .,ThEMAS (Techniques for Evaluation and Modeling of Health Actions) TIMC-IMAG (Techniques for Biomedical Engineering and Complexity Management - Informatics, Mathematics and Applications) UMR CNRS (National Institute of Sciences of the Universe - Research Unit 5525), Grenoble Alpes University, Grenoble, France
| | - Bruno Charpiat
- ThEMAS (Techniques for Evaluation and Modeling of Health Actions) TIMC-IMAG (Techniques for Biomedical Engineering and Complexity Management - Informatics, Mathematics and Applications) UMR CNRS (National Institute of Sciences of the Universe - Research Unit 5525), Grenoble Alpes University, Grenoble, France.,Pharmacy Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Sebastien Chanoine
- Grenoble School of Pharmacy, Univ Grenoble Alpes, Grenoble, France.,Pharmacy Department, Grenoble University Hospital, Grenoble, France
| | - Michel Juste
- Centre Hospitalier Auban-Moët, Pharmacie, Epernay, France
| | | | | | - Ornella Conort
- Pharmacy hôpital Cochin, Assistance Publique - Hopitaux de Paris, Paris, France
| | - Benoît Allenet
- ThEMAS (Techniques for Evaluation and Modeling of Health Actions) TIMC-IMAG (Techniques for Biomedical Engineering and Complexity Management - Informatics, Mathematics and Applications) UMR CNRS (National Institute of Sciences of the Universe - Research Unit 5525), Grenoble Alpes University, Grenoble, France.,Grenoble School of Pharmacy, Univ Grenoble Alpes, Grenoble, France.,Pharmacy Department, Grenoble University Hospital, Grenoble, France
| | - Pierrick Bedouch
- ThEMAS (Techniques for Evaluation and Modeling of Health Actions) TIMC-IMAG (Techniques for Biomedical Engineering and Complexity Management - Informatics, Mathematics and Applications) UMR CNRS (National Institute of Sciences of the Universe - Research Unit 5525), Grenoble Alpes University, Grenoble, France.,Grenoble School of Pharmacy, Univ Grenoble Alpes, Grenoble, France.,Pharmacy Department, Grenoble University Hospital, Grenoble, France
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Perrier Q, Noble J, Grangé S, Bedouch P, Tetaz R, Rostaing L. Atypical Evolution of Secondary Hemolytic Uremic Syndrome Defined as Paraneoplastic Syndrome under Eculizumab and Palbociclib Therapies. Case Rep Oncol 2021; 14:676-680. [PMID: 33976652 PMCID: PMC8077600 DOI: 10.1159/000514982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 01/01/2023] Open
Abstract
Thrombotic microangiopathy (TMA) is most of the time caused by thrombotic thrombocytopenic purpura or hemolytic uremic syndrome. A 60-year-old female was diagnosed in 2014 with mammary breast adenocarcinoma treated by several-line therapy: mastectomy, docetaxel, cyclophosphamide, radiotherapy, doxorubicine, and capecitabine. By mid-November, the patient was admitted to the hospital with regenerative, mechanical, and hemolytic anemia, schistocytes at 3%, and thrombopenia (99 G/L), associated with high blood transfusion requirement. After 9 sessions of plasmapheresis, there was no significant improvement in the biological parameters, nor after 2 cycles of paclitaxel. The patient was then treated with eculizumab during 4 weeks, with a slight reduction in blood requirement, and simultaneously with palbociclib. Since being treated with palpociclib, she had a great reduction in blood requirement and a good clinical condition. To conclude, we reported an initial moderate improvement of paraneoplasm-related TMA syndrome under eculizumab therapy with a slight reduction in red blood cell requirement; however, palbociclib therapy achieved a very good response with a dramatic reduction in red blood cell requirement.
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Affiliation(s)
- Quentin Perrier
- Department of Clinical Pharmacy, Grenoble Alpes University Hospital, Grenoble, France
| | - Johan Noble
- Nephrology, Hemodialysis, Apheresis and Kidney Transplantation Department, Grenoble Alpes University Hospital, Grenoble, France
| | - Steven Grangé
- Medical Intensive Care Unit, Rouen University Hospital, Rouen, France.,Centre de référence des microangiopathies thrombotiques (CNR-MAT), AP-HP, Paris, France
| | - Pierrick Bedouch
- Department of Clinical Pharmacy, Grenoble Alpes University Hospital, Grenoble, France.,Grenoble Alpes University, Grenoble, France.,Grenoble Alpes University, CNRS TIMC-IMAG, UMR 5525, Grenoble, France
| | - Rachel Tetaz
- Nephrology, Hemodialysis, Apheresis and Kidney Transplantation Department, Grenoble Alpes University Hospital, Grenoble, France
| | - Lionel Rostaing
- Nephrology, Hemodialysis, Apheresis and Kidney Transplantation Department, Grenoble Alpes University Hospital, Grenoble, France.,Grenoble Alpes University, Grenoble, France
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Perrier Q, Portais A, Terrec F, Cerba Y, Romanet T, Malvezzi P, Bedouch P, Tetaz R, Rostaing L. A Case of Pneumocystis jirovecii Pneumonia under Belatacept and Everolimus: Benefit-Risk Balance between Renal Allograft Function and Infection. Case Rep Nephrol Dial 2021; 11:10-15. [PMID: 33708795 PMCID: PMC7923707 DOI: 10.1159/000510842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/12/2020] [Indexed: 11/20/2022] Open
Abstract
Pneumocystis jirovecii pneumonia is an opportunistic disease usually prevented by trimethoprim-sulfamethoxazole. A 49-year-old HLA-sensitized male with successful late conversion from tacrolimus-based to belatacept-based immunosuppression developed P. jirovecii pneumonia for which he presented several risks factors: low lymphocyte count with no CD4+ T cells detected since 2 years, hypogammaglobulinemia, history of acute cellular rejection 3 years before, and immunosuppressive treatment (belatacept, everolimus). Because of respiratory gravity in the acute phase, the patient was given oxygen, corticosteroids, and trimethoprim-sulfamethoxazole. Thanks to the improvement of respiratory status, and because of the renal impairment, trimethoprim-sulfamethoxazole was converted to atovaquone for 21 days. Indeed, after 1 week on intensive treatment, the benefit-risk balance favored preserving renal function according to respiratory improvement status. P. jirovecii pneumonia prophylaxis for the next 6 months was monthly aerosol of pentamidine. Long-term safety studies or early/late conversion to belatacept did not report on P. jirovecii pneumonia. Four other cases of P. jirovecii pneumonia under belatacept therapy were previously described in patients having no P. jirovecii pneumonia prophylaxis. Studies on the reintroduction of P. jiroveciipneumonia prophylaxis after conversion to belatacept would be of interest. It could be useful to continue regular evaluation within the second-year post-transplantation regarding immunosuppression: T-cell subsets and immunoglobulin G levels.
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Affiliation(s)
- Quentin Perrier
- Department of Clinical Pharmacy, Grenoble Alpes University Hospital, Grenoble, France
| | - Antoine Portais
- Infectious Diseases Department, Grenoble Alpes University Hospital, Grenoble, France
| | - Florian Terrec
- Nephrology, Hemodialysis, Apheresis, and Kidney Transplantation Department, Grenoble Alpes University Hospital, Grenoble, France
| | - Yann Cerba
- Nephrology, Hemodialysis, Apheresis, and Kidney Transplantation Department, Grenoble Alpes University Hospital, Grenoble, France
| | - Thierry Romanet
- Department of Clinical Pharmacy, Grenoble Alpes University Hospital, Grenoble, France
| | - Paolo Malvezzi
- Nephrology, Hemodialysis, Apheresis, and Kidney Transplantation Department, Grenoble Alpes University Hospital, Grenoble, France
- Université Grenoble-Alpes, Grenoble, France
| | - Pierrick Bedouch
- Department of Clinical Pharmacy, Grenoble Alpes University Hospital, Grenoble, France
- Université Grenoble Alpes, CNRS TIMC-IMAG, UMR 5525, Grenoble, France
| | - Rachel Tetaz
- Department of Clinical Pharmacy, Grenoble Alpes University Hospital, Grenoble, France
| | - Lionel Rostaing
- Nephrology, Hemodialysis, Apheresis, and Kidney Transplantation Department, Grenoble Alpes University Hospital, Grenoble, France
- Université Grenoble-Alpes, Grenoble, France
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Duwez M, Chanoine S, Lepelley M, Vo TH, Pluchart H, Mazet R, Allenet B, Pison C, Briault A, Saint-Raymond C, Camara B, Claustre J, Bedouch P. Clinical evaluation of pharmacists' interventions on multidisciplinary lung transplant outpatients' management: results of a 7-year observational study. BMJ Open 2020; 10:e041563. [PMID: 33247028 PMCID: PMC7703423 DOI: 10.1136/bmjopen-2020-041563] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Lung transplant (LT) recipients require multidisciplinary care because of the complexity of therapeutic management. Pharmacists are able to detect drug-related problems and provide recommendations to physicians through pharmacists' interventions (PIs). We aimed at assessing the clinical impact of PIs on therapeutic management in LT outpatients. DESIGN Data were collected prospectively from an LT recipients cohort during 7 years. A multidisciplinary committee assessed retrospectively the clinical impact of accepted PIs. SETTING French University Hospital. PARTICIPANTS LT outpatients followed from 2009 to 2015. PRIMARY OUTCOME MEASURES Clinical impact of PIs performed by pharmacists using the CLEO tool and the Pareto chart. RESULTS 1449 PIs led to a change in patient therapeutic management and were mainly related to wrong dosage (39.6%) and untreated indication (19.6%). The clinical impact of PIs was 'avoids fatality', 'major' and 'moderate', in 0.1%, 7.0% and 57.9%, respectively. Immunosuppressants, antimycotics for systemic use and antithrombotic agents had the greatest clinical impact according to the Pareto chart. PIs related to drug-drug interactions (10%) mainly had a moderate and major clinical impact (82.3%, p<0.0001). CONCLUSION Clinical pharmacists play a key role for detecting drug-related problems mostly leading to a change in therapeutic management among LT outpatients. Our study provides a new insight to analyse the clinical impact of PIs in order to target PIs which have most value and contribute to patient care through interdisciplinary approach.
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Affiliation(s)
| | - Sébastien Chanoine
- Pharmacy, CHUGA, Grenoble, France
- TIMC-IMAG UMR5525, CNRS, Grenoble, France
| | | | - Thi Ha Vo
- Pharmacy Faculty, Pham Ngoc Thach Medical University, Hochiminh, Viet Nam
| | | | | | - Benoit Allenet
- Pharmacy, CHUGA, Grenoble, France
- TIMC-IMAG UMR5525, CNRS, Grenoble, France
| | - Christophe Pison
- Service Hospitalier Universitaire Pneumologie Physiologie, CHUGA, Grenoble, France
| | - Amandine Briault
- Service Hospitalier Universitaire Pneumologie Physiologie, CHUGA, Grenoble, France
| | | | - Boubou Camara
- Service Hospitalier Universitaire Pneumologie Physiologie, CHUGA, Grenoble, France
| | - Johanna Claustre
- Service Hospitalier Universitaire Pneumologie Physiologie, CHUGA, Grenoble, France
| | - Pierrick Bedouch
- Pharmacy, CHUGA, Grenoble, France
- TIMC-IMAG UMR5525, CNRS, Grenoble, France
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Chanoine S, Gautier-Veyret E, Pluchart H, Tonini J, Fonrose X, Claustre J, Bedouch P, Stanke-Labesque F. Tablets or oral suspension for posaconazole in lung transplant recipients? Consequences for trough concentrations of tacrolimus and everolimus. Br J Clin Pharmacol 2020; 87:427-435. [PMID: 32472569 DOI: 10.1111/bcp.14398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 02/22/2020] [Revised: 05/14/2020] [Accepted: 05/18/2020] [Indexed: 11/28/2022] Open
Abstract
AIMS A new formulation of posaconazole (PCZ), delayed-release tablets (PCZ-tab), increases PCZ bioavailability and plasma trough concentrations (Cmin ) over those achieved with an oral suspension (PCZ-susp). PCZ is an inhibitor of cytochrome P450 3A4 and P-glycoprotein. We therefore investigated the impact of PCZ-tab treatment on blood Cmin and doses of tacrolimus (TAC) and everolimus (EVR). METHODS Eighteen lung transplant patients receiving TAC (n = 13) or TAC + EVR (n = 5) between June 2015 and March 2016 were retrospectively included. Ten of these patients received both PCZ-tab and PCZ-susp (i.e. switched patients); the other 8 received only PCZ-tab. Plasma Cmin of PCZ (n = 64), blood Cmin of TAC (n = 299) and EVR (n = 80) were determined during routine therapeutic drug monitoring by liquid chromatography-tandem mass spectrometry. RESULTS PCZ Cmin on PCZ-tab treatment (n = 48) was 2.5 times higher than that on PCZ-susp therapy (n = 16), for both PCZ patients (P < .0001) and for switched patients (P = .003). PCZ initiation, regardless of galenic form, increased TAC and EVR Cmin adjusted for dose (D), 3-fold and 3.5-fold, respectively (P < .0001 for both). PCZ-tab treatment was associated with a higher TAC Cmin /D (PCZ-tab vs PCZ-susp: 0.004 ± 0.004 L-1 vs 0.009 ± 0.006 L-1 , P < .0001) and lower TAC daily dose than PCZ-susp (PCZ-tab vs PCZ-susp: 1.08 ± 0.92 vs 2.32 ± 1.62 mg d-1 , P < .0001). EVR Cmin /D was higher and EVR dose tended to be lower on PCZ-tab than on PCZ-susp. CONCLUSION The greater PCZ exposure achieved during PCZ-tab treatment increased drug-drug interactions with TAC and EVR, resulting in greater exposure, potentially exposing patients to higher risks of adverse effects.
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Affiliation(s)
- Sébastien Chanoine
- Université Grenoble Alpes, Faculté de Pharmacie, Grenoble, France.,Institute for Advanced Biosciences UGA - Inserm U 1209 - CNRS UMR 5309, Grenoble, France.,Pôle Pharmacie, CHU Grenoble Alpes, Grenoble, France
| | - Elodie Gautier-Veyret
- Université Grenoble Alpes, HP2, Grenoble, France.,INSERM U1042, Grenoble, France.,Laboratoire de Pharmacologie, Pharmacogénétique et Toxicologie, CHU Grenoble Alpes, Grenoble, France
| | - Hélène Pluchart
- Université Grenoble Alpes, Faculté de Pharmacie, Grenoble, France.,Pôle Pharmacie, CHU Grenoble Alpes, Grenoble, France
| | - Julia Tonini
- Laboratoire de Pharmacologie, Pharmacogénétique et Toxicologie, CHU Grenoble Alpes, Grenoble, France
| | - Xavier Fonrose
- Laboratoire de Pharmacologie, Pharmacogénétique et Toxicologie, CHU Grenoble Alpes, Grenoble, France
| | - Johanna Claustre
- Université Grenoble Alpes, Faculté de Médecine, Grenoble, France.,Service hospitalo-universitaire de Pneumologie-Physiologie, CHU Grenoble Alpes, Grenoble, France
| | - Pierrick Bedouch
- Université Grenoble Alpes, Faculté de Pharmacie, Grenoble, France.,Pôle Pharmacie, CHU Grenoble Alpes, Grenoble, France.,CNRS, TIMC-IMAG UMR5525/ThEMAS, Univ Grenoble Alpes, Grenoble, France
| | - Françoise Stanke-Labesque
- Université Grenoble Alpes, HP2, Grenoble, France.,INSERM U1042, Grenoble, France.,Laboratoire de Pharmacologie, Pharmacogénétique et Toxicologie, CHU Grenoble Alpes, Grenoble, France
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43
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Cancé C, Madiot PE, Lenne C, Artemova S, Cohard B, Bodin M, Caporossi A, Blatier JF, Fauconnier J, Olive F, Pagonis D, Le Magny D, Bosson JL, Charriere K, Paturel I, Lavaire B, Schummer G, Eterno J, Ravey JN, Bricault I, Ferretti G, Chanoine S, Bedouch P, Barbier E, Thevenon J, Mossuz P, Moreau-Gaudry A. Cohort Creation and Visualization Using Graph Model in the PREDIMED Health Data Warehouse. Stud Health Technol Inform 2020; 270:108-112. [PMID: 32570356 DOI: 10.3233/shti200132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Grenoble Alpes University Hospital (CHUGA) is currently deploying a health data warehouse called PREDIMED [1], a platform designed to integrate and analyze for research, education and institutional management the data of patients treated at CHUGA. PREDIMED contains healthcare data, administrative data and, potentially, data from external databases. PREDIMED is hosted by the CHUGA Information Systems Department and benefits from its strict security rules. CHUGA's institutional project PREDIMED aims to collaborate with similar projects in France and worldwide. In this paper, we present how the data model defined to implement PREDIMED at CHUGA is useful for medical experts to interactively build a cohort of patients and to visualize this cohort.
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Affiliation(s)
| | | | | | - Svetlana Artemova
- CHU Grenoble Alpes (CHUGA), Grenoble, France
- Clinical Investigation Centre - Technological Innovation, Inserm, CHUGA, UGA, Grenoble, France
| | | | - Marjolaine Bodin
- CHU Grenoble Alpes (CHUGA), Grenoble, France
- Grenoble Institut des Neurosciences, Grenoble, France
| | - Alban Caporossi
- Univ. Grenoble Alpes (UGA), Grenoble, France
- CHU Grenoble Alpes (CHUGA), Grenoble, France
- Clinical Investigation Centre - Technological Innovation, Inserm, CHUGA, UGA, Grenoble, France
- TIMC-IMAG Laboratory, UGA, CNRS, Vet Agro, Grenoble, France
| | | | | | | | | | | | - Jean-Luc Bosson
- Univ. Grenoble Alpes (UGA), Grenoble, France
- CHU Grenoble Alpes (CHUGA), Grenoble, France
- Clinical Investigation Centre - Technological Innovation, Inserm, CHUGA, UGA, Grenoble, France
- TIMC-IMAG Laboratory, UGA, CNRS, Vet Agro, Grenoble, France
| | - Katia Charriere
- CHU Grenoble Alpes (CHUGA), Grenoble, France
- Clinical Investigation Centre - Technological Innovation, Inserm, CHUGA, UGA, Grenoble, France
| | | | | | | | | | | | - Ivan Bricault
- Univ. Grenoble Alpes (UGA), Grenoble, France
- CHU Grenoble Alpes (CHUGA), Grenoble, France
- Clinical Investigation Centre - Technological Innovation, Inserm, CHUGA, UGA, Grenoble, France
- TIMC-IMAG Laboratory, UGA, CNRS, Vet Agro, Grenoble, France
| | - Gilbert Ferretti
- Univ. Grenoble Alpes (UGA), Grenoble, France
- CHU Grenoble Alpes (CHUGA), Grenoble, France
- IAB, UGA, Inserm, CNRS, France
| | - Sébastien Chanoine
- Univ. Grenoble Alpes (UGA), Grenoble, France
- CHU Grenoble Alpes (CHUGA), Grenoble, France
- TIMC-IMAG Laboratory, UGA, CNRS, Vet Agro, Grenoble, France
- IAB, UGA, Inserm, CNRS, France
| | - Pierrick Bedouch
- Univ. Grenoble Alpes (UGA), Grenoble, France
- CHU Grenoble Alpes (CHUGA), Grenoble, France
- TIMC-IMAG Laboratory, UGA, CNRS, Vet Agro, Grenoble, France
| | | | - Julien Thevenon
- Univ. Grenoble Alpes (UGA), Grenoble, France
- CHU Grenoble Alpes (CHUGA), Grenoble, France
- IAB, UGA, Inserm, CNRS, France
| | - Pascal Mossuz
- Univ. Grenoble Alpes (UGA), Grenoble, France
- CHU Grenoble Alpes (CHUGA), Grenoble, France
- IAB, UGA, Inserm, CNRS, France
| | - Alexandre Moreau-Gaudry
- Univ. Grenoble Alpes (UGA), Grenoble, France
- CHU Grenoble Alpes (CHUGA), Grenoble, France
- Clinical Investigation Centre - Technological Innovation, Inserm, CHUGA, UGA, Grenoble, France
- TIMC-IMAG Laboratory, UGA, CNRS, Vet Agro, Grenoble, France
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44
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Larrouquere L, Gabin M, Poingt E, Mouffak A, Hlavaty A, Lepelley M, Khouri C, Bellier A, Alexandre J, Bedouch P, Bertoletti L, Bordet R, Bouhanick B, Jonville-Bera AP, Laporte S, Le Jeunne C, Letinier L, Micallef J, Naudet F, Roustit M, Molimard M, Richard V, Cracowski JL. Genesis of an emergency public drug information website by the French Society of Pharmacology and Therapeutics during the COVID-19 pandemic. Fundam Clin Pharmacol 2020; 34:389-396. [PMID: 32394481 PMCID: PMC7273039 DOI: 10.1111/fcp.12564] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 12/27/2022]
Abstract
On March 16, 2020, the French Society of Pharmacology and Therapeutics put online a national Question and Answer (Q&A) website, https://sfpt-fr.org/covid19 on the proper use of drugs during the COVID‐19 pandemic. The working group ‘Drugs and COVID‐19’ was composed of a scientific council, an editorial team, and experts in the field. The first questions were posted online during the first evening of home‐confinement in France, March 17, 2020. Six weeks later, 140 Q&As have been posted. Questions on the controversial use of hydroxychloroquine and to a lesser extent concerning azithromycin have been the most consulted Q&As. Q&As have been consulted 226 014 times in 41 days. This large visibility was obtained through an early communication on Twitter, Facebook, traditional print, and web media. In addition, an early communication through the French Ministry of Health and the French National Agency for Medicines and Health Products Safety ANSM had a large impact in terms of daily number of views. There is a pressing need to sustain a public drug information service combining the expertise of scholarly pharmacology societies, pharmacovigilance network, and the Ministry of Health to quickly provide understandable, clear, expert answers to the general population’s concerns regarding COVID‐19 and drug use and to counter fake news.
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Affiliation(s)
| | - Manon Gabin
- Univ. Grenoble Alpes, CHU Grenoble Alpes, Grenoble, France
| | | | - Amelle Mouffak
- Univ. Grenoble Alpes, CHU Grenoble Alpes, Grenoble, France
| | - Alex Hlavaty
- Univ. Grenoble Alpes, CHU Grenoble Alpes, Grenoble, France
| | | | - Charles Khouri
- Univ. Grenoble Alpes, CHU Grenoble Alpes, Grenoble, France
| | | | | | | | | | | | | | | | - Silvy Laporte
- Univ. Saint Etienne, CHU Saint Etienne, Saint Etienne, France
| | | | | | - Joëlle Micallef
- Aix-Marseille Université, Hôpitaux Universitaires de Marseille - APHM, Marseille, France
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Roustit M, Chaumais MC, Chapuis C, Gairard-Dory A, Hadjadj C, Chanoine S, Allenet B, Sitbon O, Pison C, Bedouch P. Evaluation of a collaborative care program for pulmonary hypertension patients: a multicenter randomized trial. Int J Clin Pharm 2020; 42:1128-1138. [PMID: 32440738 DOI: 10.1007/s11096-020-01047-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 04/23/2019] [Accepted: 04/27/2020] [Indexed: 10/24/2022]
Abstract
Background Pulmonary hypertension is a rare, chronic and life-threatening group of diseases. Recent advances in pulmonary hypertension management prolong survival and improve quality-of-life. However, highly complex drug therapy enhances the risk of drug-related problems. Objective To assess the impact of involving clinical pharmacists in the collaborative care of pulmonary hypertension patients. Setting Ten French University Hospital Pneumology departments, all members of the French Network for Pulmonary Hypertension. Methods This prospective multicenter randomized controlled trial included incident pulmonary hypertension patients who were followed-up for 18 months. Randomization using an adapted Zelen method allocated patients to collaborative care (n = 41) or usual care groups (n = 51). A collaborative care program involving clinical pharmacists was developed through a close partnership between with physicians, nurses and pharmacists. Besides usual care, the program includes regular one-to-one interviews between the pharmacist and the patient. These interviews had following objectives: to perform an exhaustive medication history review; to identify the patient' needs, knowledge and skills; to define educational objectives and to provide patients with relevant information when needed. Following each interview, a standardized report form containing the pharmacist's recommendations was provided to physicians and nurses and discussed collaboratively. An ancillary economic analysis was performed. Main outcome measure Number of drug-related problems and their outcomes. Results The number of drug-related problems was not significantly different between groups (1.6 ± 1.5 vs. 1.9 ± 2.4; p = 0.41). More problems were resolved in the collaborative care group than in the usual care group (86.5% vs. 66.7%, p = 0.01). Time to clinical worsening, therapeutic adherence, satisfaction or quality-of-life were not statistically different between groups. Collaborative care decreased costs of drug-related hospitalizations. Conclusion Including clinical pharmacists in the multidisciplinary care of hospitalized patients with pulmonary hypertension improved the outcome of drug-related problems and reduced the costs of related hospitalization. However, we observed no efficacy on medication errors, clinical outcomes or medication adherence. Clinical Trial Registration ClinicalTrials.gov Identifier NCT01038284.
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Affiliation(s)
- Matthieu Roustit
- Faculty of Medicine and Pharmacy, Grenoble Alpes University, 38000, Grenoble, France. .,INSERM U1042- HP2 Laboratory, 38000, Grenoble, France. .,Clinical Pharmacology- INSERM CIC1406, Research Division, Grenoble Alpes University Hospital, 38000, Grenoble, France.
| | - Marie-Camille Chaumais
- Faculty of Pharmacy, Paris-Sud University, 92290, Châtenay Malabry, France.,Pharmacy Department, DHU Thorax Innovation, Antoine Béclère Hospital, Paris Hospitals, 92140, Clamart, France.,INSERM UMR_S 999, Marie Lannelongue Surgery Center, 92350, Le Plessis Robinson, France
| | - Claire Chapuis
- Faculty of Medicine and Pharmacy, Grenoble Alpes University, 38000, Grenoble, France
| | - Anne Gairard-Dory
- Pharmacy Department, Strasbourg University Hospital, 67000, Strasbourg, France
| | - Caroline Hadjadj
- Health Products Division, Bordeaux University Hospital, 33600, Pessac, France
| | - Sébastien Chanoine
- Faculty of Medicine and Pharmacy, Grenoble Alpes University, 38000, Grenoble, France.,INSERM U823 - Albert Bonniot Institute, 38000, Grenoble, France.,CNRS, TIMC-IMAG, 38000, Grenoble, France
| | - Benoît Allenet
- Faculty of Medicine and Pharmacy, Grenoble Alpes University, 38000, Grenoble, France.,CNRS, TIMC-IMAG, 38000, Grenoble, France
| | - Olivier Sitbon
- INSERM UMR_S 999, Marie Lannelongue Surgery Center, 92350, Le Plessis Robinson, France.,Faculty of Medicine, Paris-Sud University, 94270, Le Kremlin-Bicêtre, France.,Pneumology Department, Bicêtre Hospital, Paris Hospitals, 94270, Le Kremlin-Bicêtre, France
| | - Christophe Pison
- Faculty of Medicine and Pharmacy, Grenoble Alpes University, 38000, Grenoble, France.,Fundamental and Applied Bioenergetics Laboratory, INSERM U1055, 38000, Grenoble, France.,University Pneumology Clinic, Thorax and Vessels Division, Grenoble Alpes University Hospital, 38000, Grenoble, France
| | - Pierrick Bedouch
- Faculty of Medicine and Pharmacy, Grenoble Alpes University, 38000, Grenoble, France.,CNRS, TIMC-IMAG, 38000, Grenoble, France
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Zecchini C, Vo TH, Chanoine S, Lepelley M, Laramas M, Lemoigne A, Allenet B, Federspiel I, Bedouch P. Clinical, economic and organizational impact of pharmacist interventions on injectable antineoplastic prescriptions: a prospective observational study. BMC Health Serv Res 2020; 20:113. [PMID: 32050957 PMCID: PMC7017539 DOI: 10.1186/s12913-020-4963-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 02/05/2020] [Indexed: 11/10/2022] Open
Abstract
Background Pharmacists play a key role in ensuring the safe use of injectable antineoplastics, which are considered as high-alert medications. Pharmaceutical analysis of injectable antineoplastic prescriptions aims to detect and prevent drug related problems by proposing pharmacist interventions (PI). The impact of this activity for patients, healthcare facilities and other health professionals is not completely known. This study aimed at describing the clinical, economic, and organizational impacts of PIs performed by pharmacists in a chemotherapy preparation unit. Methods A prospective 10-week study was conducted on PIs involving injectable antineoplastic prescriptions. Each PI was assessed by one of the four multidisciplinary expert committees using a multidimensional tool with three independent dimensions: clinical, economic and organizational. An ancillary quantitative evaluation of drug cost savings was conducted. Results Overall, 185 patients were included (mean age: 63.5 ± 13.7 years; 54.1% were male) and 237 PIs concerning 10.1% prescriptions were recorded. Twenty one PIs (8.9%) had major clinical impact (ie: prevented hospitalization or permanent disability), 49 PIs (20.7%) had moderate clinical impact (ie: prevented harm that would have required further monitoring/treatment), 62 PIs (26.2%) had minor clinical impact, 95 PIs (40.0%) had no clinical impact, and 9 PIs (3.8%) had a negative clinical impact. For one PI (0.4%) the clinical impact was not determined due to insufficient information. Regarding organizational impact, 67.5% PIs had a positive impact on patient management from the healthcare providers’ perspective. A positive economic impact was observed for 105 PIs (44.3%), leading to a saving in direct drug costs of 15,096 €; 38 PIs (16.0%) had a negative economic impact, increasing the direct drug cost by 11,878 €. Overall cost saving was 3218€. Conclusions PIs are associated with positive clinical, economic and organizational impacts. This study confirms the benefit of pharmacist analysis of injectable antineoplastic prescriptions for patient safety with an overall benefit to the healthcare system.
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Affiliation(s)
- Céline Zecchini
- Centre Hospitalo-Universitaire Grenoble Alpes, Pôle Pharmacie, F-38000, Grenoble, France.
| | - Thi-Ha Vo
- Centre Hospitalo-Universitaire Grenoble Alpes, Pôle Pharmacie, F-38000, Grenoble, France.,CNRS, TIMC-IMAG, UMR5525, F-38000, Grenoble, France.,Pham Ngoc Thạch University of Medicine, Hochiminh, V-70000, Vietnam
| | - Sébastien Chanoine
- Centre Hospitalo-Universitaire Grenoble Alpes, Pôle Pharmacie, F-38000, Grenoble, France.,CNRS, TIMC-IMAG, UMR5525, F-38000, Grenoble, France.,University Grenoble Alpes, F-38000, Grenoble, France
| | - Marion Lepelley
- Centre Régional de Pharmacovigilance, F-38000, Grenoble, France
| | - Mathieu Laramas
- Centre Hospitalo-Universitaire Grenoble Alpes, Pôle Cancer et maladies du sang, F-38000, Grenoble, France
| | - Aude Lemoigne
- Centre Hospitalo-Universitaire Grenoble Alpes, Pôle Pharmacie, F-38000, Grenoble, France
| | - Benoît Allenet
- Centre Hospitalo-Universitaire Grenoble Alpes, Pôle Pharmacie, F-38000, Grenoble, France.,CNRS, TIMC-IMAG, UMR5525, F-38000, Grenoble, France.,University Grenoble Alpes, F-38000, Grenoble, France
| | - Isabelle Federspiel
- Centre Hospitalo-Universitaire Grenoble Alpes, Pôle Pharmacie, F-38000, Grenoble, France
| | - Pierrick Bedouch
- Centre Hospitalo-Universitaire Grenoble Alpes, Pôle Pharmacie, F-38000, Grenoble, France.,CNRS, TIMC-IMAG, UMR5525, F-38000, Grenoble, France.,University Grenoble Alpes, F-38000, Grenoble, France
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Pluchart H, Chanoine S, Briault A, Claustre J, Bedouch P. Restrictive allograft dysfunction after lung transplantation: is there a place for nintedanib?—a case report. Fundam Clin Pharmacol 2020; 34:408-411. [DOI: 10.1111/fcp.12522] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 11/14/2019] [Accepted: 11/19/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Hélène Pluchart
- Pôle pharmacie Centre Hospitalier Universitaire Grenoble Alpes F-38000 Grenoble France
- Université Grenoble Alpes F-38000 Grenoble France
- CNRS, TIMC‐IMAG UMR 5525, ThEMAS F-38000 Grenoble France
| | - Sébastien Chanoine
- Pôle pharmacie Centre Hospitalier Universitaire Grenoble Alpes F-38000 Grenoble France
- Université Grenoble Alpes F-38000 Grenoble France
- CNRS, TIMC‐IMAG UMR 5525, ThEMAS F-38000 Grenoble France
| | - Amandine Briault
- Service Hospitalier Universitaire de Pneumologie Pôle Thorax et Vaisseaux, Centre Hospitalier Universitaire Grenoble Alpes F-38000 Grenoble France
| | - Johanna Claustre
- Université Grenoble Alpes F-38000 Grenoble France
- Service Hospitalier Universitaire de Pneumologie Pôle Thorax et Vaisseaux, Centre Hospitalier Universitaire Grenoble Alpes F-38000 Grenoble France
| | - Pierrick Bedouch
- Pôle pharmacie Centre Hospitalier Universitaire Grenoble Alpes F-38000 Grenoble France
- Université Grenoble Alpes F-38000 Grenoble France
- CNRS, TIMC‐IMAG UMR 5525, ThEMAS F-38000 Grenoble France
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Brosseau C, Danger R, Durand M, Durand E, Foureau A, Lacoste P, Tissot A, Roux A, Reynaud-Gaubert M, Kessler R, Mussot S, Dromer C, Brugière O, Mornex JF, Guillemain R, Claustre J, Magnan A, Brouard S, Velly J, Rozé H, Blanchard E, Antoine M, Cappello M, Ruiz M, Sokolow Y, Vanden Eynden F, Van Nooten G, Barvais L, Berré J, Brimioulle S, De Backer D, Créteur J, Engelman E, Huybrechts I, Ickx B, Preiser T, Tuna T, Van Obberghe L, Vancutsem N, Vincent J, De Vuyst P, Etienne I, Féry F, Jacobs F, Knoop C, Vachiéry J, Van den Borne P, Wellemans I, Amand G, Collignon L, Giroux M, Angelescu D, Chavanon O, Hacini R, Martin C, Pirvu A, Porcu P, Albaladejo P, Allègre C, Bataillard A, Bedague D, Briot E, Casez‐Brasseur M, Colas D, Dessertaine G, Francony G, Hebrard A, Marino M, Protar D, Rehm D, Robin S, Rossi‐Blancher M, Augier C, Bedouch P, Boignard A, Bouvaist H, Briault A, Camara B, Chanoine S, Dubuc M, Quétant S, Maurizi J, Pavèse P, Pison C, Saint‐Raymond C, Wion N, Chérion C, Grima R, Jegaden O, Maury J, Tronc F, Flamens C, Paulus S, Philit F, Senechal A, Glérant J, Turquier S, Gamondes D, Chalabresse L, Thivolet‐Bejui F, Barnel C, Dubois C, Tiberghien A, Pimpec‐Barthes F, Bel A, Mordant P, Achouh P, Boussaud V, Méléard D, Bricourt M, Cholley B, Pezella V, Brioude G, D'Journo X, Doddoli C, Thomas P, Trousse D, Dizier S, Leone M, Papazian L, Bregeon F, Coltey B, Dufeu N, Dutau H, Garcia S, Gaubert J, Gomez C, Laroumagne S, Mouton G, Nieves A, Picard C, Rolain J, Sampol E, Secq V, Perigaud C, Roussel J, Senage T, Mugniot A, Danner I, Haloun A, Abbes S, Bry C, Blanc F, Lepoivre T, Botturi‐Cavaillès K, Loy J, Bernard M, Godard E, Royer P, Henrio K, Dartevelle P, Fabre D, Fadel E, Mercier O, Stephan F, Viard P, Cerrina J, Dorfmuller P, Feuillet S, Ghigna M, Hervén P, Le Roy Ladurie F, Le Pavec J, Thomas de Montpreville V, Lamrani L, Castier Y, Mordant P, Cerceau P, Augustin P, Jean‐Baptiste S, Boudinet S, Montravers P, Dauriat G, Jébrak G, Mal H, Marceau A, Métivier A, Thabut G, Lhuillier E, Dupin C, Bunel V, Falcoz P, Massard G, Santelmo N, Ajob G, Collange O, Helms O, Hentz J, Roche A, Bakouboula B, Degot T, Dory A, Hirschi S, Ohlmann‐Caillard S, Kessler L, Schuller A, Bennedif K, Vargas S, Bonnette P, Chapelier A, Puyo P, Sage E, Bresson J, Caille V, Cerf C, Devaquet J, Dumans‐Nizard V, Felten M, Fischler M, Si Larbi A, Leguen M, Ley L, Liu N, Trebbia G, De Miranda S, Douvry B, Gonin F, Grenet D, Hamid A, Neveu H, Parquin F, Picard C, Stern M, Bouillioud F, Cahen P, Colombat M, Dautricourt C, Delahousse M, D'Urso B, Gravisse J, Guth A, Hillaire S, Honderlick P, Lequintrec M, Longchampt E, Mellot F, Scherrer A, Temagoult L, Tricot L, Vasse M, Veyrie C, Zemoura L, Dahan M, Murris M, Benahoua H, Berjaud J, Le Borgne Krams A, Crognier L, Brouchet L, Mathe O, Didier A, Krueger T, Ris H, Gonzalez M, Aubert J, Nicod L, Marsland B, Berutto T, Rochat T, Soccal P, Jolliet P, Koutsokera A, Marcucci C, Manuel O, Bernasconi E, Chollet M, Gronchi F, Courbon C, Hillinger S, Inci I, Kestenholz P, Weder W, Schuepbach R, Zalunardo M, Benden C, Buergi U, Huber L, Isenring B, Schuurmans M, Gaspert A, Holzmann D, Müller N, Schmid C, Vrugt B, Rechsteiner T, Fritz A, Maier D, Deplanche K, Koubi D, Ernst F, Paprotka T, Schmitt M, Wahl B, Boissel J, Olivera‐Botello G, Trocmé C, Toussaint B, Bourgoin‐Voillard S, Séve M, Benmerad M, Siroux V, Slama R, Auffray C, Charron D, Lefaudeux D, Pellet J. Blood CD9 + B cell, a biomarker of bronchiolitis obliterans syndrome after lung transplantation. Am J Transplant 2019; 19:3162-3175. [PMID: 31305014 DOI: 10.1111/ajt.15532] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 12/03/2018] [Revised: 06/12/2019] [Accepted: 07/07/2019] [Indexed: 01/25/2023]
Abstract
Bronchiolitis obliterans syndrome is the main limitation for long-term survival after lung transplantation. Some specific B cell populations are associated with long-term graft acceptance. We aimed to monitor the B cell profile during early development of bronchiolitis obliterans syndrome after lung transplantation. The B cell longitudinal profile was analyzed in peripheral blood mononuclear cells from patients with bronchiolitis obliterans syndrome and patients who remained stable over 3 years of follow-up. CD24hi CD38hi transitional B cells were increased in stable patients only, and reached a peak 24 months after transplantation, whereas they remained unchanged in patients who developed a bronchiolitis obliterans syndrome. These CD24hi CD38hi transitional B cells specifically secrete IL-10 and express CD9. Thus, patients with a total CD9+ B cell frequency below 6.6% displayed significantly higher incidence of bronchiolitis obliterans syndrome (AUC = 0.836, PPV = 0.75, NPV = 1). These data are the first to associate IL-10-secreting CD24hi CD38hi transitional B cells expressing CD9 with better allograft outcome in lung transplant recipients. CD9-expressing B cells appear as a contributor to a favorable environment essential for the maintenance of long-term stable graft function and as a new predictive biomarker of bronchiolitis obliterans syndrome-free survival.
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Affiliation(s)
- Carole Brosseau
- Centre de Recherche en Transplantation et Immunologie, UMR 1064, INSERM, Université de Nantes, Nantes, France.,Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France.,Institut du thorax, Inserm UMR 1087, CNRS, UMR 6291, Université de Nantes, Nantes, France.,Institut du thorax, CHU de Nantes, Nantes, France
| | - Richard Danger
- Centre de Recherche en Transplantation et Immunologie, UMR 1064, INSERM, Université de Nantes, Nantes, France.,Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France
| | - Maxim Durand
- Centre de Recherche en Transplantation et Immunologie, UMR 1064, INSERM, Université de Nantes, Nantes, France.,Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France.,Faculté de Médecine, Université de Nantes, Nantes, France
| | - Eugénie Durand
- Centre de Recherche en Transplantation et Immunologie, UMR 1064, INSERM, Université de Nantes, Nantes, France.,Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France
| | - Aurore Foureau
- Institut du thorax, Inserm UMR 1087, CNRS, UMR 6291, Université de Nantes, Nantes, France.,Institut du thorax, CHU de Nantes, Nantes, France
| | - Philippe Lacoste
- Institut du thorax, Inserm UMR 1087, CNRS, UMR 6291, Université de Nantes, Nantes, France.,Institut du thorax, CHU de Nantes, Nantes, France
| | - Adrien Tissot
- Centre de Recherche en Transplantation et Immunologie, UMR 1064, INSERM, Université de Nantes, Nantes, France.,Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France.,Institut du thorax, Inserm UMR 1087, CNRS, UMR 6291, Université de Nantes, Nantes, France.,Institut du thorax, CHU de Nantes, Nantes, France.,Faculté de Médecine, Université de Nantes, Nantes, France
| | - Antoine Roux
- Hôpital Foch, Suresnes, France.,Université Versailles Saint-Quentin-en-Yvelines, UPRES EA220, Versailles, France
| | | | | | - Sacha Mussot
- Centre Chirurgical Marie Lannelongue, Service de Chirurgie Thoracique, Vasculaire et Transplantation Cardiopulmonaire, Le Plessis Robinson, France
| | | | - Olivier Brugière
- Hôpital Bichat, Service de Pneumologie et Transplantation Pulmonaire, Paris, France
| | | | | | - Johanna Claustre
- Clinique Universitaire Pneumologie, Pôle Thorax et Vaisseaux, CHU Grenoble Alpes, Université Grenoble Alpes, Inserm U1055, Grenoble, France
| | - Antoine Magnan
- Institut du thorax, Inserm UMR 1087, CNRS, UMR 6291, Université de Nantes, Nantes, France.,Institut du thorax, CHU de Nantes, Nantes, France
| | - Sophie Brouard
- Centre de Recherche en Transplantation et Immunologie, UMR 1064, INSERM, Université de Nantes, Nantes, France.,Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France.,Centre d'Investigation Clinique (CIC) Biothérapie, CHU Nantes, Nantes, France
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Duron D, Chanoine S, Peron M, Lepelley M, Allenet B, Epaulard O, Camara B, Bedouch P. A successful antibiotic treatment by a new administration route: a case report of a subcutaneous administration of ceftazidime and tobramycin. Fundam Clin Pharmacol 2019; 33:703-706. [PMID: 31038766 DOI: 10.1111/fcp.12477] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 02/21/2019] [Revised: 04/13/2019] [Accepted: 04/25/2019] [Indexed: 11/30/2022]
Abstract
When intramuscular or intravenous administrations of parenteral drugs are not possible, the use of other routes (e.g., subcutaneous route) should be considered. We report a patient with Duchenne muscular dystrophy, who was hospitalized for acute pneumonia due to antibiotic-resistant strains of bacteria. Our patient was successfully recovered with antimicrobial therapy by subcutaneous administration of ceftazidime and tobramycin, for which no safety and efficacy data are available in humans. To the best of our knowledge, this case is the first supporting the subcutaneous administration safety and potential efficacy of both ceftazidime and tobramycin in humans.
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Affiliation(s)
- Dorothée Duron
- Pôle Pharmacie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble 38000, France
| | - Sébastien Chanoine
- Pôle Pharmacie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble 38000, France.,Université Grenoble Alpes, Grenoble 38000, France.,CR UGA/Inserm 1209/CNRS UMR 5309, Institute for Advanced Biosciences, Grenoble 38000, France
| | - Maud Peron
- Pôle Pharmacie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble 38000, France
| | - Marion Lepelley
- Centre Régional de Pharmacovigilance, Grenoble 38000, France
| | - Benoît Allenet
- Pôle Pharmacie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble 38000, France.,Université Grenoble Alpes, Grenoble 38000, France.,TIMC-IMAG UMR 5525/ThEMAS, CNRS, Grenoble 38000, France
| | - Olivier Epaulard
- Université Grenoble Alpes, Grenoble 38000, France.,Clinique Universitaire des Maladies infectieuses et tropicales, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble 38000, France
| | - Boubou Camara
- Service Hospitalier Universitaire de Pneumologie-Physiologie, Pôle Thorax et Vaisseaux, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble 38000, France
| | - Pierrick Bedouch
- Pôle Pharmacie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble 38000, France.,Université Grenoble Alpes, Grenoble 38000, France.,TIMC-IMAG UMR 5525/ThEMAS, CNRS, Grenoble 38000, France
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50
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Chapuis C, Chanoine S, Colombet L, Calvino-Gunther S, Tournegros C, Terzi N, Bedouch P, Schwebel C. Interprofessional safety reporting and review of adverse events and medication errors in critical care. Ther Clin Risk Manag 2019; 15:549-556. [PMID: 31037029 PMCID: PMC6450184 DOI: 10.2147/tcrm.s188185] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The intensive care unit (ICU) environment is prone to the risk of adverse events (AEs) and medication errors (MEs). The objective of this work was to describe a multidisciplinary safety program focused on AE and ME reporting and review in an ICU over a 7-year period. Methods The program was implemented in an 18-bed medical ICU of a 2,200-bed university hospital. A multidisciplinary steering committee (intensivist, clinical pharmacist, nurses, and research assistants) met monthly. The first part of the meeting was dedicated to the review of events targeted through an internal voluntary reporting system, and the second part concerned the analysis of the previous month's events, according to a standardized method called Orion, inspired by the aeronautic industry. Results A total of 808 AEs were reported, mostly related to medication processes (30.3% and 33.4% for prescription and administration, respectively). Among these, 526 AEs were related to medications (65.1%), of which 464 were MEs (88.2%). These MEs concerned mostly anti-infective drugs (23.5%) and related to wrong doses (35.8%). Among all AEs reported, 58 (43 MEs [74.1%]) were analyzed further and found to be associated with anti-infective (16.1%) and vasoactive drugs (16.1%). According to National Coordinating Council for Medication Error Reporting and Prevention classification, most AEs caused no harm to patients (category A-D: 38 events, 65.5%). Nurses were most often involved in the analysis (50.7%), along with pharmacists (37.5%). Training was identified as the most frequent corrective action (45.1%). Conclusion This program dedicated to AE and ME reporting, review, and analysis in ICU showed long-term engagement of the health care team in AE surveillance and helped in targeting measures for education, organization, and promoting teamwork and safety.
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Affiliation(s)
- Claire Chapuis
- Pôle Pharmacie, CHU Grenoble Alpes, Grenoble 38000, France,
| | - Sébastien Chanoine
- Pôle Pharmacie, CHU Grenoble Alpes, Grenoble 38000, France, .,Université Grenoble Alpes, Grenoble 38000, France
| | - Laurence Colombet
- CHU Grenoble Alpes, Réanimation Médicale Pôle Urgences Médecine Aiguë, Grenoble 38000, France
| | - Silvia Calvino-Gunther
- CHU Grenoble Alpes, Réanimation Médicale Pôle Urgences Médecine Aiguë, Grenoble 38000, France
| | - Caroline Tournegros
- CHU Grenoble Alpes, Réanimation Médicale Pôle Urgences Médecine Aiguë, Grenoble 38000, France
| | - Nicolas Terzi
- Université Grenoble Alpes, Grenoble 38000, France.,CHU Grenoble Alpes, Réanimation Médicale Pôle Urgences Médecine Aiguë, Grenoble 38000, France.,INSERM, U1042, Université Grenoble-Alpes, HP2, Grenoble 38000, France
| | - Pierrick Bedouch
- Pôle Pharmacie, CHU Grenoble Alpes, Grenoble 38000, France, .,Université Grenoble Alpes, Grenoble 38000, France.,CNRS (UMR5525), TIMC-IMAG, Grenoble 38000, France
| | - Carole Schwebel
- Université Grenoble Alpes, Grenoble 38000, France.,CHU Grenoble Alpes, Réanimation Médicale Pôle Urgences Médecine Aiguë, Grenoble 38000, France.,Inserm U1039 Radiopharmaceutiques Biocliniques, Domaine de la Merci, La Tronche 38700, France
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