Conciliation médicamenteuse de sortie en gériatrie (impact de la transmission hôpital-ville d'un bilan médicamenteux sur le maintien des optimisations thérapeutiques)

Les pharmaciens et gériatres du CHU de Grenoble collaborent pour améliorer la prise en charge médicamenteuse du sujet âgé. L optimisation thérapeutique peut être menacée par l'absence d'information précise des médecins traitants (MT) sur les changements réalisés. Dans notre service de gériatrie, l'interne en pharmacie réalise une conciliation de sortie et un bilan médicamenteux de sortie (BMS) envoyé au MT, synthétisant les changements et leur justification. Notre étude vise à évaluer l'impact du BMS sur le maintien des optimisations thérapeutiques après la sortie. L'étude a inclus 34 patients sortis entre mai 2012 et octobre 2013. Les MT ont reçu le bilan médicamenteux par courrier et ont été contactés pour recueillir les changements apportés à ceux réalisés à l'hôpital. Les changements ont été comparés aux critères START/STOPP et Beers. A l'hôpital, 209 changements ont été effectués : 88 ajouts, 27 modifications de dose ou substitutions et 94 arrêts. Les causes d'arrêt étaient l'absence d'indication, une contre-indication ou un médicament inapproprié, un effet indésirable ou une interaction médicamenteuse. Les médicaments ajoutés étaient des vitamines, antalgiques, laxatifs, inhibiteurs du système rénine angiotensine, anticoagulants. Au moins un changement était recommandé par START, STOPP ou Beers pour 29 patients. Après la sortie, 88.5% des changements ont été maintenus. Parmi les 11.5% remodifiés par les MT, 70.8% étaient justifiés. Les changements réalisés à l'hôpital constituent une optimisation thérapeutique selon les critères START/STOPP. Le BMS semble permettre leur maintien après la sortie. Nous avons donc formalisé sa réalisation pour diffuser cette pratique.In the Grenoble University hospital, geriatricians and pharmacists collaborate to improve drug therapies for elderly patients. Medication improvements may be threatened after discharge if no precise information about adjustments is sent to general practitioners (GP). In our geriatric unit, Pharmacy resident performs a conciliation at discharge and summarizes drug changes with justification into a medication report sent to GP. Our study aims to assess if such intervention can help keeping therapeutic improvements after hospitalization. The study included 34 patients discharged between May 2012 and October 2013. GP received the medication report by post and they were contacted to evaluate the additional changes over those set by the Hospital. Drug changes were compared with START/STOPP criteria and Beers list. In the hospital setting, 209 treatment changes were made, including 88 new prescriptions, 27 dosage modifications or substitutions, and 94 cessations. Stops were motivated by the following causes: no indication, contra-indication or inappropriate prescription, adverse effect and drug interaction. New treatments included vitamins, analgesics, laxatives, conversion enzyme inhibitors and anticoagulants. Changes were as recommended by START, STOPP or Beers for 29 patients. After discharge, 88.5% of drug adjustments were kept. Among the 11.5% changed by GP, 70.8% were clinically relevant. Most treatments were improved in hospital according to START/STOPP criteria. Systematic information of the introduced changes sent to GP could motivate them to maintain the updated treatment. We have so developed a process for performing medication report in order to extend the practice.GRENOBLE1-BU Médecine pharm. (385162101) / SudocSudocFranceF

Optimisation de la prise en charge médicamenteuse chez la personne âgée hospitalisée (diffusion d'un guide local et évaluation de la qualité de la prescription par mesure de la conformité des posologies à la fonction rénale)

La réduction des effets indésirables graves dans la population âgée est une priorité réglementairement établie. Une étude de type un jour donné a été réalisée dans l ensemble des unités de soins susceptibles d accueillir des patients de plus de 75 ans au sein de notre CHU, dans le but de mesurer la qualité des prescriptions. L objectif était d évaluer la conformité de l adaptation des posologies des médicaments à la fonction rénale de ces patients. 412 patients ont été inclus dans l étude. Les médicaments dont la posologie doit être adaptée à la fonction rénale étaient présents dans 97 % des prescriptions. Le jour de l étude, 30 % des patients n avaient pas d évaluation de la fonction rénale. Lorsqu une clairance de la créatinine était calculée et rapportée dans le dossier médical, 31 % des médicaments nécessitant une adaptation avaient une posologie incorrecte. La présence d une pesée, d un antécédent de maladie rénale chronique, le nombre de médicaments, la compétence gériatrique et la présence pharmaceutique dans les unités de soins étaient associés à une évaluation plus fréquente de la fonction rénale. Les facteurs indépendamment associés à un sur-risque de non-adaptation des posologies à la fonction rénale étaient le poids, le nombre d antécédents, et la sévérité de l insuffisance rénale. Bien que la prescription chez le sujet âgé soit complexe, il paraît urgent d améliorer l évaluation de la fonction rénale et l adaptation des posologies à la fonction rénale des patients âgés. La sensibilisation des prescripteurs aux problématiques iatrogènes chez le sujet âgé représente un enjeu de santé publique pour lequel le pharmacien clinicien peut et doit avoir un rôle.GRENOBLE1-BU Médecine pharm. (385162101) / SudocSudocFranceF

A Spoken Drug Prescription Dataset in French for Spoken Language Understanding

International audienceSpoken medical dialogue systems are increasingly attracting interest to enhance access to healthcare services and improve quality and traceability of patient care. In this paper, we focus on medical drug prescriptions acquired on smartphones through spoken dialogue. Such systems would facilitate the traceability of care and would free clinicians' time. However, there is a lack of speech corpora to develop such systems since most of the related corpora are in text form and in English. To facilitate the research and development of spoken medical dialogue systems, we present, to the best of our knowledge, the first spoken medical drug prescriptions corpus, named PxSLU. It contains 4 hours of transcribed and annotated dialogues of drug prescriptions in French acquired through an experiment with 55 participants experts and non-experts in prescriptions. We also present some experiments that demonstrate the interest of this corpus for the evaluation and development of medical dialogue systems

A Spoken Drug Prescription Dataset in French for Spoken Language Understanding

International audienceSpoken medical dialogue systems are increasingly attracting interest to enhance access to healthcare services and improve quality and traceability of patient care. In this paper, we focus on medical drug prescriptions acquired on smartphones through spoken dialogue. Such systems would facilitate the traceability of care and would free clinicians' time. However, there is a lack of speech corpora to develop such systems since most of the related corpora are in text form and in English. To facilitate the research and development of spoken medical dialogue systems, we present, to the best of our knowledge, the first spoken medical drug prescriptions corpus, named PxSLU. It contains 4 hours of transcribed and annotated dialogues of drug prescriptions in French acquired through an experiment with 55 participants experts and non-experts in prescriptions. We also present some experiments that demonstrate the interest of this corpus for the evaluation and development of medical dialogue systems

Reshaping the gut microbiome with bacterial transplantation and antibiotic intake

The intestinal microbiota consists of over 1000 species, which play key roles in gut physiology and homeostasis. Imbalances in the composition of this bacterial community can lead to transient intestinal dysfunctions and chronic disease states. Understanding how to manipulate this ecosystem is thus essential for treating many disorders. In this study, we took advantage of recently developed tools for deep sequencing and phylogenetic clustering to examine the long-term effects of exogenous microbiota transplantation combined with and without an antibiotic pretreatment. In our rat model, deep sequencing revealed an intestinal bacterial diversity exceeding that of the human gut by a factor of two to three. The transplantation produced a marked increase in the microbial diversity of the recipients, which stemmed from both capture of new phylotypes and increase in abundance of others. However, when transplantation was performed after antibiotic intake, the resulting state simply combined the reshaping effects of the individual treatments (including the reduced diversity from antibiotic treatment alone). Therefore, lowering the recipient bacterial load by antibiotic intake prior to transplantation did not increase establishment of the donor phylotypes, although some dominant lineages still transferred successfully. Remarkably, all of these effects were observed after 1 mo of treatment and persisted after 3 mo. Overall, our results indicate that the indigenous gut microbial composition is more plastic that previously anticipated. However, since antibiotic pretreatment counterintuitively interferes with the establishment of an exogenous community, such plasticity is likely conditioned more by the altered microbiome gut homeostasis caused by antibiotics than by the primary bacterial loss

Optimizing medication use in elderly people in primary care: Impact of STOPP criteria on inappropriate prescriptions

International audienc

Optimizing medication use in elderly people in primary care: Impact of STOPP criteria on inappropriate prescriptions

International audienc