In Vivo Nitric Oxide Synthase Inhibitors Can Be Deprived of This Activity: Unexpected Influence of the Tetrachloroplatinate(II) Counteranion. Crystal Structures of Bis(S-Methyl-Isothiouronium)-N,N′-Bis(3-Guanidinopropyl)Piperazinium and Hexamidinium Tetrachloroplatinates(II) Salts

The synthesis and crystal structures of bis(S-methylisothiouronium) (MSTUH)+, N,N′-bis((3- guanidinopropyl)piperazinium (PipeC3GuaH4)4+ and hexamidinium (HexaH2)2+ tetrachloro platinate(ll) salts ( called hereafter PtMSTU, PtPipeC3Gua and PtHexa respectively ) were investigated. These compounds contain the “amidine” function ( - C(=NH)NH2 ) in which the H atoms supplied by the acid have become attached to the imino group of each terminal amidino function. Moreover, in PtPipeC3Gua, the nitrogen atoms of the chair-piperazine moiety are also protonated. The influence of tetrachloroplatinate(ll) counteranion ( versus sulfate, nitrate and diisethionate ) in the in vivo nitrite inhibition by the (MSTUH)+, (PipeC3GuaH4)4+ and (HexaH2)2+ cations was investigated. The three tetrachloroplatinate(ll) salts, unexpectedly, do not inhibit significantly the in vivo nitrite production in comparison with the other salts (sulfate, nitrate and diisethionate and their corresponding previous countercations) which exhibit NO synthase inhibition, especially bis(S-methylisothiouronium) sulfate, a selective and potent inducible NO synthase (iNOS) inhibitor commonly used as standard

Chronology of prescribing error during the hospital stay and prediction of pharmacist's alerts overriding: a prospective analysis

<p>Abstract</p> <p>Background</p> <p>Drug prescribing errors are frequent in the hospital setting and pharmacists play an important role in detection of these errors. The objectives of this study are (1) to describe the drug prescribing errors rate during the patient's stay, (2) to find which characteristics for a prescribing error are the most predictive of their reproduction the next day despite pharmacist's alert (<it>i.e</it>. override the alert).</p> <p>Methods</p> <p>We prospectively collected all medication order lines and prescribing errors during 18 days in 7 medical wards' using computerized physician order entry. We described and modelled the errors rate according to the chronology of hospital stay. We performed a classification and regression tree analysis to find which characteristics of alerts were predictive of their overriding (<it>i.e</it>. prescribing error repeated).</p> <p>Results</p> <p>12 533 order lines were reviewed, 117 errors (errors rate 0.9%) were observed and 51% of these errors occurred on the first day of the hospital stay. The risk of a prescribing error decreased over time. 52% of the alerts were overridden (<it>i.e </it>error uncorrected by prescribers on the following day. Drug omissions were the most frequently taken into account by prescribers. The classification and regression tree analysis showed that overriding pharmacist's alerts is first related to the ward of the prescriber and then to either Anatomical Therapeutic Chemical class of the drug or the type of error.</p> <p>Conclusions</p> <p>Since 51% of prescribing errors occurred on the first day of stay, pharmacist should concentrate his analysis of drug prescriptions on this day. The difference of overriding behavior between wards and according drug Anatomical Therapeutic Chemical class or type of error could also guide the validation tasks and programming of electronic alerts.</p

Evaluation of drug administration errors in a teaching hospital

<p>Abstract</p> <p>Background</p> <p>Medication errors can occur at any of the three steps of the medication use process: prescribing, dispensing and administration. We aimed to determine the incidence, type and clinical importance of drug administration errors and to identify risk factors.</p> <p>Methods</p> <p>Prospective study based on disguised observation technique in four wards in a teaching hospital in Paris, France (800 beds). A pharmacist accompanied nurses and witnessed the preparation and administration of drugs to all patients during the three drug rounds on each of six days per ward. Main outcomes were number, type and clinical importance of errors and associated risk factors. Drug administration error rate was calculated with and without wrong time errors. Relationship between the occurrence of errors and potential risk factors were investigated using logistic regression models with random effects.</p> <p>Results</p> <p>Twenty-eight nurses caring for 108 patients were observed. Among 1501 opportunities for error, 415 administrations (430 errors) with one or more errors were detected (27.6%). There were 312 wrong time errors, ten simultaneously with another type of error, resulting in an error rate without wrong time error of 7.5% (113/1501). The most frequently administered drugs were the cardiovascular drugs (425/1501, 28.3%). The highest risks of error in a drug administration were for dermatological drugs. No potentially life-threatening errors were witnessed and 6% of errors were classified as having a serious or significant impact on patients (mainly omission). In multivariate analysis, the occurrence of errors was associated with drug administration route, drug classification (ATC) and the number of patient under the nurse's care.</p> <p>Conclusion</p> <p>Medication administration errors are frequent. The identification of its determinants helps to undertake designed interventions.</p

Contribution à la démarche de sécurisation et d'optimisation du circuit des dispositifs médicaux à l'hôpital Vaugirard, AP-HP

CHATENAY M.-PARIS 11-BU Pharma. (920192101) / SudocSudocFranceF

Contribution à l'analyse des substrats d'accumulation et des enzymes déficientes impliqués dans les sphingolipidoses (exemple de la maladie de Fabry)

PARIS-BIUP (751062107) / SudocSudocFranceF

Mise en place de procédures de bionettoyage et de contrôles d'environnement au niveau de l'unité de radiopharmacie à l'Hôpital européen Georges Pompidou

Les médicaments radiopharmaceutiques injectables sont encadrés par une double réglementation : celle des médicaments et celle des radioéléments artificiels. Les médicaments radiopharmaceutiques utilisés à l Hôpital Européen Georges Pompidou sont tous des médicaments injectables soit à préparer extemporanément, soit prêts à l emploi. Au même titre que pour toutes les autres préparations stériles, les contraintes de qualité en terme d hygiène et de maîtrise de l environnement sont donc à prendre en considération. Malheureusement, les contraintes de radioprotection (arrêté du 30 octobre 1981) conduisent bien souvent le personnel de Médecine Nucléaire à occulter les règles d hygiène.A l occasion de la mise en enquête publique en mai 2007 des Bonnes Pratiques de Préparations (BPP), nous avons souhaité renforcer notre démarche qualité et nous mettre en conformité avec les BPP sur le plan de l hygiène avec la mise en place de procédures de bionettoyage et de contrôles microbiologiques d environnement (air et surface) des enceintes et des locaux. Partant d un local de préparation non classé, et bien que son aménagement n y soit pas favorable (absence de sas, pas de filtre en entrée d air, local en dépression), nous sommes parvenus à atteindre un environnement de classe D. De même, bien que les BPP ne donnent pas de recommandation sur la classe à atteindre dans les enceintes où sont réalisés les préparations radiopharmaceutiques, nous sommes parvenus à atteindre au minimum une classe C.Afin d améliorer encore davantage ce niveau, l ensemble de l organisation de la radiopharmacie (en particulier flux du personnel) et l aménagement des locaux devront être repensés et cette première étape de mise en conformité avec les BPP devra être poursuivie.CHATENAY M.-PARIS 11-BU Pharma. (920192101) / SudocSudocFranceF

L'exaltation de la photoluminescence des xénobiotiques de faible masse moléculaire par marquage covalent et non covalent

CHATENAY M.-PARIS 11-BU Pharma. (920192101) / SudocPARIS-BIUP (751062107) / SudocSudocFranceF

Contrôle physicochimique d'une préparation stérile en milieu hospitalier (application au 5 fluoro-uracile)

PARIS-BIUP (751062107) / SudocSudocFranceF

CONTAMINATION ALUMINIQUE DES SOLUTIONS DE NUTRITION PARENTERALE (RECHERCHE D'ALUMINIUM PAR SPECTROMETRIE D'ABSORPTION ATOMIQUE (PRODUITS FINIS ET MATIERES PREMIERES))

CHATENAY M.-PARIS 11-BU Pharma. (920192101) / SudocSudocFranceF