Current trends in vasopressor use to the operating room : a pharmacoepidemiologic study in French teaching and military hospitals

Objectives: Phenylephrine, ephedrine and norepinephrine are the vasopressors most commonly used in the operating room to treat anaesthesia-induced hypotension. Two new diluted forms of phenylephrine were released in 2011 (500 μg/10 mL and 500 μg/5 mL). We initiated a study to evaluate trends in the use of vasopressors in the operating room in French hospitals over the period 2011–2014. Methods: We conducted a longitudinal, retrospective, observational study between 2011 and 2014 in French teaching and military hospitals. A questionnaire was sent in February 2015 to hospital pharmacists of each centre to retrospectively collect the consumption of each type of vasopressor. Yearly numbers of vasopressor ampoules were divided by the yearly numbers of anaesthetics recorded. For each vasopressor, we calculated the number of ampoules per 100 anaesthetics recorded (/100A). Results: Thirty-two hospitals (82%) completed the questionnaire. One hundred per cent of hospitals had registered the diluted form of phenylephrine (61% had chosen the dilution 500 μg/10 mL), whereas concentrated ampoules were available in 68% of hospitals. Over the period, an exponential increase in the use of diluted phenylephrine was observed (from 1.0 ampoule/100A in 2012 to 31.7 in 2014), the use of ephedrine remained stable (26 ampoules and 17 prefilled syringe/100A), and use of norepinephrine trended upwards (from 6.7 to 8.2 ampoules/100A). Conclusions: The use of diluted phenylephrine has exponentially increased without reducing consumption of other vasopressors. This trend might be secondary to practice changes in hypotension treatment following the release of French guidelines in 2013 related to fluid management, the restriction of indications of hydroxylethyl-starch solutions in 2013, and a better knowledge of the benefit of blood pressure optimisation to reduce postoperative morbidity

Clavier DUCK : Utilisation d'un système de déduction de mots pour faciliter la saisie de texte sur écran tactile pour les non-voyants

International audienceTouch screens rapidly and significantly replace physical keyboards on mobile devices. Hence, text entry is now dependent on software (or virtual) keyboards that are widely used by sighted people, but raise accessibility issues for visually impaired users. These users rely on tactile exploration with vocal feedback of the whole screen for entering text, which is time consuming. We designed a software keyboard that aims reducing tactile exploration and speeding up text entry for VI users. It relies on the selection of the first letter of a word and rapid and inaccurate typing of the remaining letters. It then proposes a list of words having the same first letter and a similar total distance between letters. The evaluation with twelve VI users showed that this keyboard is very efficient for words larger than five characters. It also helps preventing certain typing errors.L'utilisation des écrans tactiles et en particulier les claviers logiciels est extrêmement compliquée pour les non-voyants qui manquent de repères physiques sur ce type d'appareil. Nous proposons dans cet article une solution clavier logicielle qui propose une liste de mots pouvant correspondre au mot recherché à partir de frappes approximatives des utilisateurs non-voyants. Cette technique évite ainsi à l'utilisateur d'explorer le clavier en permanence pour trouver précisément les caractères à saisir. Une première évaluation nous permet de montrer que notre système est efficace pour les mots de plus de quatre caractères. Il permet aussi d'éviter certains types d'erreur de frappe. Mots Clés Saisie de texte ; déficience visuelle ; écran tactile ; dispositifs mobiles ; clavier logiciel ; système déductif

Pharmacie clinique et dispositifs médicaux

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Pharmacie clinique dans le domaine des dispositifs médicaux : définition et enjeux.

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Impact économique des seringues d’éphédrine préremplies en anesthésiologie

Nous avons lu avec beaucoup d’intérêt le travail publié par l’équipe du CHU de Dijon [1] à propos de l’évaluation médico-économique du recours à l’éphédrine en seringues préremplies. En effet, cette présentation, qui n’est pas disponible à ce jour dans le livret thérapeutique des hospices civils de Lyon (HCL), a fait l’objet de discussions récurrentes au niveau de la commission du médicament (COMEDIMS) de notre établissement depuis son lancement commercial en 2004

Assessment of the impact of adherence and other predictors during HAART on various CD4 cell responses in resource-limited settings

Danho Pascal Abrogoua1,2, Brou Jerome Kablan1, Boua Alexis Thierry Kamenan1,3, Gilles Aulagner4, Konan N'Guessan1, Christian Zohoré11Laboratoire de Pharmacie Clinique, Pharmacologie et Therapeutique – UFR Sciences Pharmaceutiques et Biologiques, 2Laboratoire de Pharmacologie Clinique, CHU de Cocody, 3Service de Pharmacie, CHU de Cocody, Abidjan, Cote d'Ivoire, 4Service Pharmaceutique Hopital Louis Pradel, Lyon, FranceObjective: The aim of this study was to quantify, by modeling, the impact of significant predictors on CD4 cell response during antiretroviral therapy in a resource-limited setting.Methods: Modeling was used to determine which antiretroviral therapy response predictors (baseline CD4 cell count, clinical state, age, and adherence) significantly influence immunological response in terms of CD4 cell gain compared to a reference value at different periods of monitoring.Results: At 6 months, CD4 cell response was significantly influenced by baseline CD4 count alone. The probability of no increase in CD4 cells was 2.6 higher in patients with a baseline CD4 cell count of ≥200/mm3. At 12 months, CD4 cell response was significantly influenced by both baseline CD4 cell count and adherence. The probability of no increase in CD4 cells was three times higher in patients with a baseline CD4 cell count of ≥200/mm3 and 0.15 times lower with adherent patients. At 18 months, CD4 cell response was also significantly influenced by both baseline CD4 cell count and adherence. The probability of no increase in CD4 cells was 5.1 times higher in patients with a baseline CD4 cell count of ≥200/mm3 and 0.28 times lower with adherent patients. At 24 months, optimal CD4 cell response was significantly influenced by adherence alone. Adherence increased the probability (by 5.8) of an optimal increase in CD4 cells. Age and baseline clinical state had no significant influence on immunological response.Conclusion: The relationship between adherence and CD4 cell response was the most significant compared to that of baseline CD4 cell count. Counseling before initiation of treatment and educational therapy during follow-up must always help to strengthen adherence and optimize the efficiency of antiretroviral therapy in a resource-limited setting.Keywords: antiretroviral therapy, CD4 cells response, adherence, predictors, modeling, Abidja

Impact économique à l’hôpital de dispositifs médicaux non remboursés en sus des GHS : exemple des prothèses de renfort biologiques

Objectives: To present a method aimed to evaluate the economic impact associated with the use of medical devices (DM) not reimbursed in addition to diagnosis related groups (DRGs) tariffs using the example of biological meshes for parietal reinforcement. Methods: In this multicenter retrospective cohort study, we included all patients who received a biological mesh between January 2010–April 2014 (University hospitals of Saint-Étienne, France) or between January 2010–March 2015 (Lyon University hospitals, France). Measured costs associated with biologic meshes were compared to those of the “Étude nationale des coûts à méthodologie commune” (2012) to weigh the economic impact of biologic meshes with the French DRGs costs. We also compared these costs to the fares perceived by the hospital from the French sickness fund (GHS). Results: Thirty-six patients received a biological mesh and were treated by a total of 38 biological meshes. Of these, the implant was Protexa®, Permacol® and Strattice® in 66%, 29% and 5% of cases respectively. The hospitals incomes were 10,496 ± 5562€ per stay. Meshes-related expenditures represented in average 28% of DRGs costs and 38% of GHS tariffs. The mean additional cost for biological meshes was 3793 ± 2292 euros compared to the mean cost on implantable medical devices in the French DRGs. Conclusion: Given their currently restricted use, the hospital budget impact of biological meshes remains limited although the incremental cost per patient is substantial. Analytic costs data can be useful within the scope of decision-making related to DM not refunded by the French health system

Expérience de l’utilisation du sugammadex au sein d’un centre hospitalo-universitaire français

Le sugammadex (Bridion®) est une gamma-cyclodextrine encapsulant spécifiquement et uniquement les curares non dépolarisants à structure stéroïdienne (rocuronium ou vécuronium) entraînant leur inactivation. Dans un contexte national de moindre utilisation des curares stéroïdiens au profit des curares dérivés des benzylisoquinolines (cisatracurium et atracurium) [1] et compte tenu de son coût unitaire élevé, le positionnement du sugammadex en utilisation courante était difficile à appréhender. Compte tenu de son intérêt pharmacologique, la Commission du médicament et des dispositifs médicaux stériles (COMEDIMS) des hospices civils de Lyon (HCL) a décidé d’inscrire le sugammadex au livret thérapeutique en octobre 2009 en limitant a priori son utilisation dans le cadre d’une prescription encadrée aux deux indications pour lesquelles il n’existe pas d’alternative pharmacologique : la décurarisation immédiate en cas d’intubation impossible d’un bloc neuromusculaire très profond induit par le rocuronium ; la décurarisation d’un bloc neuromusculaire profond induit par le rocuronium ou le vécuronium. Cette décision s’accompagnait de la mise en place d’un observatoire, pour évaluer les circonstances, les modalités d’emploi, l’impact économique et les pratiques de curarisation liés à l’utilisation du sugammadex

Commercial syringes of atropine : a cost-effective option in the operating room?

Atropine is commonly administered when sinus bradycardia occurs in the operating room. It can also be administered to block muscarinic effects when neostigmine is used to counteract muscle relaxants. Timely administration of atropine plays a critical role in the management of sinus bradycardia. Syringes of atropine are usually prepared ahead of time to minimize the time to injection. If not administered, those standard syringes are discarded. Prefilled syringes of atropine have been commercialized in order to decrease the rate of wastage of standard syringes. However, commercial syringes are very expensive compared to ampoules

Ranibizumab versus bevacizumab for neovascular age-related macular degeneration: Results from the GEFAL noninferiority randomized trial

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