Assistive products in pharmacy practice to optimize medications use for visually impaired patients: Focus groups to explore community pharmacists' opinions and expectations.

Background: Visual impairment can significantly affect a person's ability to take medications safely. Therefore, pharmacists need to ensure safe and effective access to medication information, particularly through the use of assistive products, which are devices that compensate for partial or total vision loss. Although assistive products are used by visually impaired patients for activities of daily living, their use in medication management needs to be more widespread. Objective: The study aimed to investigate community pharmacists' opinions and excpectations on the use of assistive products in pharmacy practice to optimize and secure medications use for visually impaired patients. The goal is to transfer these assistive products to pharmacy practice. Methods: Focus groups were conducted with 6 French-speaking community pharmacists via videoconference in Belgium, following the principle of participatory action-research. The participants were recruited voluntarily, and moderator's guides were developed to lead the discussion. The focus groups were recorded, transcribed verbatim, and analyzed in a double-blind fashion using thematic analysis. The data were organized by NVivo software. Results: Four themes were identified: easy-to-use assistive products according to pharmacists, usefulness of assistive products in pharmacy practice, barriers to the use of assistive products, and potential solutions. According to community pharmacists, certain assistive products were deemed easy-to-use and transferable to pharmacy practice. Conclusions: This qualitative study demonstrates the transferability of assistive products to pharmacy practice for visually impaired patients in medications use. The study taken into account the patient's profile and the multidisciplinary approach, which community pharmacists consider essential.

Pharmaceutical care for visually impaired patients: a qualitative study of community pharmacists' needs and professional experience.

BACKGROUND: Visual impairment is a disability that can have a significant impact on the ability to take medication safely. As a result, pharmacists must adjust their practice to provide targeted and adapted support for this type of patient. AIM: The aims of the present study were (1) to illustrate the usual clinical practice of community pharmacists to support the optimisation of medication use in visually impaired patients, and (2) to identify solutions to improve pharmaceutical care for visually impaired patients. METHOD: Semi-structured interviews with 18 French-speaking community pharmacists were conducted via videoconference in Belgium. Participants were recruited on a voluntary basis and through a snowball method. An interview guide was developed based on literature review. Interviews were carried out until theoretical saturation of the data, recorded, transcribed verbatim and analysed using thematic analysis. Data were organised by NVivo Software. RESULTS: Four themes were identified: community pharmacists' training, identification of visually impaired patients by the pharmacist, communication with visually impaired patients and their proxies, and provision of appropriate pharmaceutical care. Participants stated that they had not received any training regarding visual impairment. They described that they did not always know how to recognise visually impaired patients and that communication was often difficult. CONCLUSION: This qualitative study has highlighted a lack of knowledge and skills among community pharmacists regarding visual impairment. One possible solution could be to develop recommendations and tools to improve the care of these patients.

Exploring female students' perceptions of the use of digital technologies in managing academic stress.

Objective: The purpose of this research is to explore the perceptions of female students regarding the implementation of digital technologies for academic stress management. We aim to determine if the contribution of these technologies could offer to female students a better management of the stress related to their studies and thus, a better deployment of strategies to cope with academic difficulties. Method: A qualitative study using the focus group methodology was conducted. Our inductive and exploratory approach allowed us to focus on the experience and perception of eleven female students from the University of Mons. The cohort was divided into two groups according to their score on the Perceived Stress Scale-10. Results: The data collected was analyzed using the thematic analysis of which allowed us to identify fourteen sub-themes divided into three axes: coping strategies used to manage academic stress, students' needs to improve their management of academic stress, and the implementation of technology for managing academic stress. Conclusion: Our results show that the issues present in the academic context lead students to use various coping strategies, some of which are harmful to their physical and mental health. The implementation of digital technologies and biofeedback seems to be an approach that could help students adopt more functional coping strategies and alleviate their daily difficulties in managing academic stress.

When contextual realities hinder the process of welcoming new patients in psychiatric emergency units / Quand les réalités contextuelles entravent le processus d'accueil aux urgences psychiatriques

Introduction: Questioning the implementation of care in psychiatry requires a reflection on and around the moment when patients first arrive at an emergency unit. In other words, it is necessary to take a look at the contextual conditions of this first moment of care. Our objective is to study the ingredients that contribute to the development or maintenance of a welcoming attitude. Methods: Grounded theory allowed us to better understand the complexity of the phenomenon by meeting people working in crisis and psychiatric emergency units. Results: The results present three pathways associated with the welcoming process: (1) pathway to activate the process; (2) pathway to weaken the process; (3) pathway to counteract the weakening pathway and feed the activation pathway. Reintroducing time to think and "spaces to speak" remains a challenge in the welcoming of patients in psychiatric emergency units. Discussion: A welcoming reception depends on a favorable context-societal, political, institutional and environmental-being fostered and maintained in the professional and personal world of professionals.

Introduction: S'interroger sur la mise en place des soins en psychiatrie nécessite de prime à bord de nourrir une réflexion sur et autour du moment de l'accueil des patients au sein des services d'urgences. Dit autrement, de porter un regard sur les conditions contextuelles de ce primo moment du soin. Notre objectif est d'étudier les ingrédients qui participent au développement ou au maintien d'une attitude dite accueillante. Méthode: La théorisation enracinée nous a permis d'approcher au mieux la complexité du phénomène, en allant à la rencontre d'intervenants exerçant en unité de crise et d'urgences psychiatriques. Résultats: Les résultats exposent trois voies impliquées dans le processus d'accueil : (1) voie d'activation du processus ; (2) voie d'affaiblissement du processus ; (3) voie pour contrer la voie d'affaiblissement et alimenter la voie d'activation. Réintroduire le temps de penser et des « espaces du dire ¼ reste l'enjeu à l'accueil des urgences psychiatriques. Discussion: Accueillir dépend avant tout qu'un contexte propice ­ sociétal, politique, institutionnel et environnemental ­ soit encouragé et maintenu dans l'univers professionnel et personnel des intervenants de la crise.

"We Become a Madman to Be Calmed"-Patients' Voices: Crossing the Threshold of Psychiatric Emergency Departments.

Crossing the threshold of a psychiatric emergency room is a real ordeal. It is a passage that upsets, worries and sometimes paralyzes. However, it can also become an opportunity if psychological suffering is welcomed, accepted and understood. The welcome is the starting point for care. Our objective is to understand the meaning given to the phenomenon of "being welcomed" by patients experiencing psychiatric emergencies. The research is based on Grounded Theory Methodology (Glaser and Strauss, 1967) to explore and understand the complexity of the phenomenon. The results reveal that being welcomed can be considered as a rite of passage taking place in four successive phases, which are themselves organized into four interactive dimensions. The welcome as a rite of passage constitutes a powerful psychic support which arranges the transitional space in which the individual finds themself, and accompanies the identity transformations, the anguish, and the various sufferings which are not lacking in these moments of crisis.

Predictive factors of intracranial bleeding in head trauma patients receiving antiplatelet therapy admitted to an emergency department.

BACKGROUND: In head trauma cases involving antiplatelet agent treatment, the French Society of Emergency Medicine recommends performing computed tomography (CT) scans to detect brain lesions, 90% of which are normal. The value of CT is still debatable given the scarce number of studies and controversial results. METHODS: We used the RATED registry (Registry of patient with Antithrombotic agents admitted to an Emergency Department, NCT02706080) to assess factors of cerebral bleeding related to antiplatelet agents following head trauma. RESULTS: From January 2014 to December 2015, 993 patients receiving antiplatelet agents were recruited, 293 (29.5%) of whom underwent CT scans for brain trauma. Intracranial bleeding was found in 26 (8.9%). Multivariate analysis revealed these patients more likely to have a history of severe hemorrhage (odds ratio [OR]: 8.47, 95% confidence interval [CI]: 1.56-45.82), dual antiplatelet therapy (OR: 6.46, 95%CI:1.46-28.44), headache or vomiting (OR: 4.27, 95%CI: 1.44-2.60), and abnormal Glasgow coma scale (OR: 8.60; 95%CI: 2.85-25.99) compared to those without intracranial bleeding. The predictive model derived from these variables achieved 98.9% specificity and a negative predictive value of 92%. The area under the ROC curve (AUROC) was 0.85 (95%CI: 0.77-0.93). CONCLUSIONS: Our study demonstrated that the absence of history of severe hemorrhage, dual antiplatelet therapy, headache or vomiting, and abnormal Glasgow coma scale score appears to predict normal CT scan following traumatic brain injury in patients taking antiplatelets. This finding requires confirmation by prospective studies. TRIAL REGISTRATION: ClinicalTrials.gov number: NCT02706080 .

Assessment of the Impact of L-Thyroxine Therapy on Bleeding Risk in Patients Receiving Vitamin K Antagonists.

BACKGROUND: Several studies have suggested a link exists between L-thyroxine and the coagulation system, and, according to some drug interaction studies, L-thyroxine can potentiate the effect of warfarin. This study sought to assess whether thyroid hormone therapy could impact the risk of bleeding in patients receiving vitamin K antagonists (VKAs). METHODS: We conducted a monocentric, retrospective study on prospectively collected data from consecutive patients enrolled in the Registry of patient with AntiThrombotic agents admitted to an Emergency Department (RATED) database, and compared the hemorrhage rates (both major and nonmajor) of patients receiving treatment with and without L-thyroxine. Propensity score matching analysis was performed to reduce the differences between patients receiving L-thyroxine and those not receiving L-thyroxine in order to reassess bleeding outcomes in patients receiving VKAs. RESULTS: From January 2014 to June 2015, 1454 patients receiving VKAs were recruited into the RATED database. Overall, 187 patients (12.8%) received L-thyroxine. Patients receiving L-thyroxine were more likely to be female than those not receiving L-thyroxine (78.1 vs. 55%) and more likely to exhibit hypertension (65.5 vs. 55.7%; p = 0.015), but less likely to have history of myocardial infarction (9.6 vs. 16.6%; p = 0.022) or higher creatinine levels (96.1 vs. 112.1 µmol/L; p = 0.04). After propensity score matching, bleeding outcomes were not significantly different between patients receiving L-thyroxine and those not receiving L-thyroxine. CONCLUSIONS: Our study revealed no evidence that L-thyroxine could increase bleeding risk in patients receiving VKAs. However, physicians must be aware that patients with thyroid disease receiving VKA therapy could have other drug interactions, particularly with amiodarone therapy. CLINICALTRIALS. GOV NUMBER: NCT02706080.

Dose intensity and toxicity associated with Taxotere formulation: a retrospective study in a population of breast cancer patients treated with docetaxel as an adjuvant or neoadjuvant chemotherapy.

Docetaxel is an antineoplastic drug from the taxane family that inhibits tubulin polymerization. Its brand name is Taxotere. In mid-2010, the formulation of Taxotere changed from a two-vial preparation needing a predilution (T2V) to a one-vial ready-to-use preparation (T1V). The aim of this study was to compare the toxicity profile of these two formulations. This retrospective observational and monocentric study included all patients who received Taxotere-based chemotherapy (100 mg/m) as an adjuvant or a neoadjuvant treatment for localized breast cancer, following initial treatment with anthracycline-based chemotherapy. Patients received either T2V or T1V Taxotere depending on the period of treatment. The main endpoint was the ratio of the dose of Taxotere received to that scheduled (R=docetaxel dose received/docetaxel dose scheduled). The secondary endpoint was tolerance. A total of 97 patients were included: 39 in the T2V group and 58 in the T1V group. The ratio of docetaxel received/docetaxel scheduled was significantly lower in the T1V than in the T2V group (0.83 vs. 0.95, respectively; P=0.028). A higher proportion of patients did not receive the totality of the scheduled dose in the T1V than in the T2V group (28 vs. 8%, respectively; P=0.03). Furthermore, the proportion of patients experiencing cutaneous toxicity was significantly higher in the T1V than in the T2V group (50 vs. 15%, respectively; P<0.001) as well as for neurological toxicity (31 vs. 15%, respectively; P=0.03). The frequency of grade 3 toxicities was higher in the T1V than in the T2V group (50 vs. 8%, P=0.016). The frequency of idiosyncratic toxicities was not affected by the change of formulation (4.7 vs. 5.4%, P=0.98). This study shows that patients treated with the T1V formulation received a significantly smaller dose of Taxotere than patients treated with T2V. In this small retrospective study, no conclusions can be drawn as to why a change in formulation would be associated with differences in dose tolerance. However, it does encourage caution and need for clinical data analysis when adopting even minor changes in the formulation of well-known anticancer drugs.