Chemotherapeutic errors in hospitalised cancer patients: attributable damage and extra costs

<p>Abstract</p> <p>Background</p> <p>In spite of increasing efforts to enhance patient safety, medication errors in hospitalised patients are still relatively common, but with potentially severe consequences. This study aimed to assess antineoplastic medication errors in both affected patients and intercepted cases in terms of frequency, severity for patients, and costs.</p> <p>Methods</p> <p>A 1-year prospective study was conducted in order to identify the medication errors that occurred during chemotherapy treatment of cancer patients at a French university hospital. The severity and potential consequences of intercepted errors were independently assessed by two physicians. A cost analysis was performed using a simulation of potential hospital stays, with estimations based on the costs of diagnosis-related groups.</p> <p>Results</p> <p>Among the 6, 607 antineoplastic prescriptions, 341 (5.2%) contained at least one error, corresponding to a total of 449 medication errors. However, most errors (n = 436) were intercepted before medication was administered to the patients. Prescription errors represented 91% of errors, followed by pharmaceutical (8%) and administration errors (1%). According to an independent estimation, 13.4% of avoided errors would have resulted in temporary injury and 2.6% in permanent damage, while 2.6% would have compromised the vital prognosis of the patient, with four to eight deaths thus being avoided. Overall, 13 medication errors reached the patient without causing damage, although two patients required enhanced monitoring. If the intercepted errors had not been discovered, they would have resulted in 216 additional days of hospitalisation and cost an estimated annual total of 92, 907€, comprising 69, 248€ (74%) in hospital stays and 23, 658€ (26%) in additional drugs.</p> <p>Conclusion</p> <p>Our findings point to the very small number of chemotherapy errors that actually reach patients, although problems in the chemotherapy ordering process are frequent, with the potential for being dangerous and costly.</p

"La première cigarette, tu m'expliques !"

Delcambre Isabelle, Brassart Dominique-Guy, Darras Francine, Graczyk B., Gruwez Claudine, Cauterman M. M., Constant Marylène. "La première cigarette, tu m'expliques !". In: Repères pour la rénovation de l'enseignement du français, n°72, 1987. Discours explicatifs en classe : quand? comment? pourquoi? sous la direction de Jean-François Halté. pp. 81-92

Effects of chronic paroxetine treatment on dialysate serotonin in 5-HT1B receptor knockout mice

Abstract The role of serotonin (5-HT) 1B receptors in the mechanism of action of selective serotonin re-uptake inhibitors (SSRI) was studied by using intracerebral in vivo microdialysis in conscious, freely moving wild-type and 5-HT 1B receptor knockout (KO 5-HT 1B ) mice in order to compare the effects of chronic administration of paroxetine via osmotic minipumps (1 mg per kg per day for 14 days) on extracellular 5-HT levels ([5-HT]ext) in the medial prefrontal cortex and ventral hippocampus. Basal ext values in the medial prefrontal cortex and ventral hippocampus, 20 h after removing the minipump, were not altered by chronic paroxetine treatment in both genotypes. On day 15, in the ventral hippocampus, an acute paroxetine challenge (1 mg/kg i.p.) induced a larger increase in [5-HT]ext in saline-pretreated mutant than in wild-type mice. This difference between the two genotypes in the effect of the paroxetine challenge persisted following chronic paroxetine treatment. Conversely, in the medial prefrontal cortex, the paroxetine challenge increased [5-HT]ext similarly in saline-pretreated mice of both genotypes. Such a challenge produced a further increase in cortical [5-HT]ext compared with that in salinepretreated groups of both genotypes, but no differences were found between genotypes following chronic treatment. To avoid the interaction with raphe 5-HT 1A autoreceptors, 1 lM paroxetine was perfused locally through the dialysis probe implanted in the ventral hippocampus; similar increases in hippocampal [5-HT]ext were found in acutely or chronically treated wild-type mice. Systemic administration of the mixed 5-HT 1B/1D receptor antagonist GR 127935 (4 mg/kg) in chronically treated wildtype mice potentiated the effect of a paroxetine challenge dose on [5-HT]ext in the ventral hippocampus, whereas systemic administration of the selective 5-HT 1A receptor antagonist WAY 100635 did not. By using the zero net flux method of quantitative microdialysis in the medial prefrontal cortex and ventral hippocampus of wild-type and KO 5-HT 1B mice, we found that basal [5-HT]ext and the extraction fraction of 5-HT were similar in the medial prefrontal cortex and ventral hippocampus of both genotypes, suggesting that no compensatory response to the constitutive deletion of the 5-HT 1B receptor involving changes in 5-HT uptake capacity occurred in vivo. As steady-state brain concentrations of paroxetine at day 14 were similar in both genotypes, it is unlikely that differences in the effects of a paroxetine challenge on hippocampal [5-HT]ext are due to alterations of the drug&apos;s pharmacokinetic properties in mutants. These data suggest that there are differences between the ventral hippocampus and medial prefrontal cortex in activation of terminal 5-HT 1B autoreceptors and their role in regulating dialysate 5-HT levels. These presynaptic receptors retain their capacity to limit 5-HT release mainly in the ventral hippocampus following chronic paroxetine treatment in mice. Keywords: antidepressant drug, 5-hydroxytryptamine 1B autoreceptor, intracerebral microdialysis, knockout mice, paroxetine, selective serotonin re-uptake inhibitor

Results from a nationwide atrial fibrillation screening effort in Belgium

Monitoring and investigating temporal trends in antimicrobial data is a high priority for human and animal health authorities. Timely detection of temporal changes in antimicrobial resistance (AMR) can rely not only on monitoring and analyzing the proportion of resistant isolates based on the use of a clinical or epidemiological cutoff value, but also on more subtle changes and trends in the full distribution of minimum inhibitory concentration (MIC) values. The nature of the MIC distribution is categorical and ordinal (discrete). In this contribution , we developed a particular family of multicategory logit models for estimating and modelling MIC distributions over time. It allows the detection of a multitude of temporal trends in the full discrete distribution, without any assumption on the underlying continuous distribution for the MIC values. The experimental ranges of the serial dilution experiments may vary across laboratories and over time. The proposed categorical model allows to estimate the MIC distribution over the maximal range of the observed experiments, and allows the observed ranges to vary across labs and over time. The use and performance of the model is illustrated with two datasets on AMR in Salmonella

WALOWA (wave loads on walls) - Large-scale experiments in the delta flume

Overtopping wave loads on vertical structures on top of a dike have been investigated in several small scale experiments in the past. A large-scale validation for a mild foreshore situation is still missing. Hence the WALOWA experimental campaign was carried out to address this topic. In the present paper the objectives of the WALOWA project are outlined in detail, the model and measurement set-up described and the test program presented. Furthermore, preliminary results featuring a single 1000 irregular waves test of the test program are highlighted. This includes the study of the mild and sandy foreshore evolution by comparing profiles before and after the test execution. The profile measurements are obtained with a mechanical profiler. The wave parameters offshore and at the dike toe are numerically simulated using a SWASH model. The numerical results are validated against the measurements. Finally, the force and pressure time series of the waves impacting against the wall are processed and filtered. The load cell measurements and the time series of integrated pressures are compared to each other and for each impact event the maximum force is derived