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

Climate warming and atmospheric deposition affect seed viability of common juniper (Juniperus communis) via their impact on the nutrient status of the plant

Global environmental change is increasingly affecting species worldwide. One of the emblematic casualties among plants in several European countries is common juniper (Juniperus communis). Many populations of common juniper throughout its distribution range are declining. The relative lack of viable seed production, resulting in low probabilities for successful natural regeneration, is one of the main reasons for this decline. Climate warming and elevated atmospheric depositions have been shown to negatively affect seed viability of common juniper, but our understanding of the underlying mechanisms remains scarce. One possible pathway is via changes in the plant nutrient status that, in turn, may affect seed viability. Here we took advantage of large-scale gradients in climate and atmospheric depositions between central Sweden and northern Spain, and analysed foliar nutrient concentrations and stoichiometry and seed viability in 20 juniper populations spread across Europe. Our results show that increasing temperatures can negatively affect needle N and P concentrations while enhanced potentially acidifying depositions resulted in lower foliar N and Ca concentrations. Needle C:N ratios increased with higher temperature, acidifying depositions and precipitation. By linking these patterns to seed viability, we found that low needle P, Ca and Mg concentrations were related to low seed viability. Thus, a shortage of these key elements during seed development and seed nutrient storage, can lead to anomalies and seed abortion. These findings help to explain the low seed viability of juniper in Europe and may help to assist land managers to take urgently needed conservation actions