Drug-related problems among older patients: Analysis of 8 years of pharmacist's interventions.

OBJECTIVES: To analyse the most frequent DRP over time and pharmacists' interventions made among older patients aged over 75 years old. DRP between older patients and younger patients aged 18 to 74 years and between older patients treated in geriatric wards or not were also compared. METHODS: A cross-sectional observational study conducted on DRP detected by pharmacists at the university hospital centre of Lyon and prospectively recorded in the Act-IP© database from January 2008 to December 2015. RESULTS: A total of 56,223 DRP were investigated - 19,056 in older patients and 37,167 in younger patients. A supratherapeutic dosage was mainly reported (22.4% in older patients vs. 19.0% in younger patient) and pharmacists made interventions mostly to adjust dosage (27.3% vs. 24.2%). Physicians' acceptance was significantly lower in older patients (57.1% vs. 64.3%). DRP associated to a drug included a supratherapeutic use of acetaminophen (5.2% vs. 3.8%) and hypnotics (4.0% vs. 1.4%), medication in cardiology used without indication (1.4% vs. 0.2%) and underuse of vitamin D (1.2% vs. 0.1%). Supratherapeutic dosages were more significantly detected with a lower overall physicians' acceptance in older patients treated in general wards. CONCLUSIONS: This study highlights the specificity of DRP among older patients and encourages health care professionals to remain especially alert regarding older patients treated in general wards. These findings can contribute to define or adjust training needs and quality indicators to improve the daily practices of health care professionals.

[Medication management of hypertension and heart failure in older patients: What happens to therapeutic changes after hospitalization?] / Prise en charge médicamenteuse de l'hypertension artérielle et de l'insuffisance cardiaque chez la personne âgée : les modifications effectuées à l'hôpital sont-elles poursuivies en ville ?

PURPOSE: The objective of this study was to objectivize if the cardiovascular therapeutic changes performed during hospitalization of older patients with hypertension and/or heart failure (HF), were maintained in ambulatory 3 month after hospitalization. METHODS: This is a longitudinal study conducted in a geriatric unit. Patients over 65 years with hypertension and/or HF, who had at least one change in cardiovascular medicaton during hospitalization, and who accepted the 3-month follow-up were included in the longitudinal study. At admission, during hospitalization and 3 months after hospitalization data concerning cardiovascular medication were collected. RESULTS: During hospitalization, 142 (73.6%) patients had at least one change in hypertension and/or HF medication. Overall, 249 changes were performed. Forty-one patients received follow-up at 3 months. At 3 months, therapeutic changes were maintained by 48.8% of the general practitioners (n=20 patients). For the rest, 41.5% of the patients had benefited from new therapeutic changes (28 changes for 10 patients) and 9.7% of the general practitioners (n=4 patients) had restored the initial prescription before hospitalization. CONCLUSIONS: Medication review performed by geriatricians and pharmacists during hospitalization resulted in 249 changes. These changes aimed at limiting iatrogenic disease, by reducing overtreatment and potentially inappropriate prescriptions. Difficulties in the patient care continuity between the hospital and ambulatory setting have been identified.

[Community pharmacists' and pharmacy technicians' attitudes and beliefs about depression in elderly]. / Représentations des pharmaciens et préparateurs en pharmacie vis-à-vis de la prise en soin de la dépression chez la personne âgée.

OBJECTIVES: To analyze attitudes and beliefs of community pharmacists and pharmacy technicians about depression and treatment in older patients. METHODS: A qualitative study was conducted with community pharmacists and pharmacy technicians. The first step of the study was to develop an interview guide to conduct semi-directive interviews. A thematic analysis was conducted based on the transcripts of the recording of audio interviews. RESULTS: Eight pharmacists and 5 pharmacy technicians were included. The mean duration of semi-directive interviews was 14.8±4.6minutes. The main identified themes were as follows: 1/the depression: beliefs about depression and its risk factors in older patients; how to talk about depression with older patients at the counter; 2/the management of depression: how to talk about antidepressant with older patients at the counter, including treatment duration, dosage, efficacy and adverse effects of treatment, but also alternative therapies and advices; 3/barriers and facilitators of antidepressant adherence in older patients. CONCLUSIONS: Barriers to conduct pharmaceutical care focusing on depression among older patients in community pharmacy have been identified: disease stigmatization, lack of privacy at the counter and lack of communication with the prescribing physician; but also a lack of knowledge concerning the specific therapeutic strategy for depression in the elderly. Thus, strengthening the pharmacy student teaching and the community pharmacist and pharmacy technician training regarding the posture to adopt and the therapeutic management of older patients with mental illness would be beneficial.

Caregiver in Alzheimer's disease, pharmacist, and pharmacy technician attitudes and knowledge about caregiver burden screening in community pharmacies.

OBJECTIVES: To explore caregiver, pharmacist and pharmacy technician attitudes toward burden screening in community pharmacies and assess caregiver burden in community pharmacies. METHODS: Descriptive cross-sectional study conducted in 10 community pharmacies in France. Pharmacists, pharmacy technicians and caregivers of patients with Alzheimer's disease were included in this study. Two self-reported questionnaires were used to explore attitudes of participants toward the burden screening in community pharmacy and to assess the caregiver burden in community pharmacy. The short version of the Zarit Burden Interview (range 0-7) was used for the burden screening. RESULTS: Fifty-two pharmacists and pharmacy technicians, and 20 caregivers (61.8±13.7years) participated in this study. Seventy percent of caregivers and 96% of pharmacists/pharmacy technicians stated that caregiver burden screening should be conducted in community pharmacies. 65% of caregivers reported their caregiver status to their community pharmacist. Eighty-two percent of pharmacist/pharmacy technicians thought they had to inform the caregiver's general practitioners (GP) about the detected burden level. Of the 20 included caregivers, 18 had a perception of burden. The mean caregiver burden score detected in this exploratory study was 4.0±1.7, corresponding to a moderate to severe burden. CONCLUSIONS: According to caregivers' opinion, community pharmacists and pharmacy technicians represent accessible health care professionals in primary care to quantify caregiver burden. The burden screening can be easily incorporated into clinical service offerings in community pharmacy practice. It provides a valuable opportunity to identify high-risk caregivers with the aim of referring them to their GP to prevent the caregiver's frailty.

How to explore the needs of informal caregivers of individuals with cognitive impairment in Alzheimer's disease or related diseases? A systematic review of quantitative and qualitative studies.

BACKGROUND: This study aims to review the methodologies used to identify the needs, the existing needs assessment instruments and the main topics of needs explored among caregivers of patients with mild cognitive impairment to dementia. METHODS: MEDLINE, PsycINFO, The Cochrane Library and Web of science were searched from January 1980 to January 2017. Research studies in English or French were eligible for inclusion if they fulfilled the following criteria: quantitative, qualitative and mixed method studies that used instrument, focus group or semi-structured interviews to assess the informal caregiver's needs in terms of information, coping skills, support and service. RESULTS: Seventy studies (n = 39 quantitative studies, n = 25 qualitative studies and n = 6 mixed method studies) met the inclusion criteria and were included. Thirty-six quantitative instruments were identified but only one has been validated for the needs assessment of dementia caregivers: the Carer's Needs Assessment for Dementia (CNA-D). The main areas of needs explored in these instruments were: information, psychosocial, social, psychoeducational and other needs. CONCLUSIONS: No instrument has been developed and validated to assess the needs of informal caregivers of patients with cognitive impairment, whatever the stage and the etiology of the disease. As the perceived needs of caregivers may evolve with the progression of the disease and the dementia transition, their needs should be regularly assessed.

PHARMAID study protocol: Randomized controlled trial to assess the impact of integrated pharmaceutical care at a psychosocial intervention on caregiver's burden in Alzheimer's disease or related diseases.

INTRODUCTION: Alzheimer's Disease and Related Diseases (ADRD) are associated with a caregiver burden that increases with the progression of the disease. Psychosocial interventions reported a moderate improvement on caregivers' burden. Patients with ADRD and their older caregivers are also exposed to a higher risk of developing drug-related problems. The main objective of the PHARMAID study is to measure the impact of personalized pharmaceutical collaborative care integrated to a multidisciplinary psychosocial program on the burden of caregivers. METHODS: The PHARMAID study is a 18-month randomized controlled trial that started in September 2016. This paper describes the study protocol. PHARMAID plans to enroll 240 dyads, i.e. ADRD patients and caregivers, whose inclusion criteria are: outpatient with mild or major neurocognitive disorders due to ADRD, living at home, receiving support from a family caregiver. Three parallel groups will compare a control group with two experimental groups: psychosocial intervention and integrated pharmaceutical care at a psychosocial intervention. The main outcome is the caregiver's burden assessed by the Zarit Burden Index at 6, 12 and 18months. DISCUSSION: This is the first trial designed to assess the specific impact of the integration of pharmaceutical care in a multidisciplinary psychosocial program on the caregiver's burden. The results will inform policymakers on strategies to implement in the near future. TRIAL REGISTRATION NUMBER: [ClinicalTrials.gov: NCT02802371] Registered in June 2016.

[Chemistry approach for therapeutic education of children with hemophilia and their parents: Representation of complex phenomena related to treatment]. / La chimie au service de l'éducation thérapeutique des enfants atteints d'hémophilie et de leurs parents : représentation de phénomènes complexes liés au traitement.

INTRODUCTION: The therapeutic management of hemophilia is based on replacement therapy by clotting factor concentrates and may require several injections per week. In teenagers, non-compliance with treatment may be responsible for major orthopedic complications. The aim of this study was to develop and assess an educational intervention for children with hemophilia and their parents, thus illustrating the complex phenomena related to treatment and its adhesion. METHODS: The construction of the educational workshop and tools was based on the concrete, visual, and playful representation of the following concepts: pathophysiology, the replacement therapy's mechanism of action, drug elimination requiring repeated administrations, and inhibitor development. The procedure was then assessed by a sample of children and parents using a questionnaire. RESULTS: A 60- to 90-min workshop was developed. The different tools used to illustrate the severity of the disease, the effect of the injected drug, drug elimination, and the inhibitor effect were: a blue-to-transparent colorimetric scale in bottles, a weekly timeline, Muppets, and a slow redox reaction. Five children and eight parents assessed this educational intervention with a rating of 3.75/4 (±0.10) and 3.60/4 (±0.45), respectively. CONCLUSION: The intervention developed could be transposed to other chronic diseases with similar therapeutic characteristics (including replacement mechanism of action and pharmacokinetics). Understanding the transmitted pharmacological concepts in a playful way is a major challenge to encourage treatment adhesion during adolescence.

[Management of outpatient medications in care units: An audit of clinical practices]. / Traitement personnel du patient hospitalisé : audit de pratiques.

OBJECTIVES: To assess the outpatient medication management in care units two years after the release of an institutional procedure. To assess the patients' satisfaction with their treatment and with the information transmitted by healthcare professionals. METHODS: An audit of clinical practices was conducted in 23 units of our universitary hospital - general, surgery, emergency departments. Questionnaires were developed and validated by an institutional working group and were composed of three themes: management of the outpatient medication at the admission, awareness of tools and information transmission. Two physicians (a senior and a resident), a registered nurse, a head nurse and a patient were interviewed. RESULTS: Eighty-one medical and paramedical team members and 21 patients were interviewed for the study. According to statements collected, the procedure was unknown by 100% of the interviewed surgeons and 69% of the interviewed physicians. The practices being used by the medical units were more in line with recommendations than the surgery units. Among the patients interviewed, 19 (86%) were satisfied with the information they received during their hospitalization and 4 (19%) managed their own medication treatment with the help of a nurse in only 36% of the cases according to their statements. CONCLUSIONS: The management of outpatient medications during hospitalization is representative of the difficulties to master the continuity of pharmaceutical care at the various transition points. Coordination and cooperation between the different healthcare professionals and patients are the major key success to ensure an optimized healthcare procedure.

[Malignant hypertension and cardiac decompensation after overuse of nasal decongestant: A case report and literature review]. / Hypertension artérielle maligne et décompensation cardiaque globale après consommation abusive de vasoconstricteur par voie nasale : à propos d'un cas et revue de la littérature.

INTRODUCTION: Vasoconstrictors, widely prescribed in the congestive states during acute rhinitis, are responsible for many cases of drug-related iatrogenic disease. CASE REPORT: We report the case of a 40-year-old man, who presented with an episode of malignant hypertensive crisis associated with life-threatening congestive heart decompensation. The patient interview revealed consumption to supra-therapeutic dosage of an association of naphazoline and prednisolone nasal sprays. The diagnostic work-up allowed to rule out disease-related causes of secondary hypertension. The drug-related disease was thus retained. CONCLUSION: The results of the literature review showed many cases of vasoconstrictor poisoning responsible for central nervous system and cardiovascular involvement, especially in young children. This first case of heart failure related to nasal decongestant administration increases the scope of potentially serious risks of these drugs and demonstrates the outreach needs for health professionals and patients about their proper use.

[Technical criteria of central venous catheters: Anaesthesiologist/intensivist and pharmacist opinions]. / Critères de choix d'un cathéter veineux central : points de vue de l'anesthésiste-réanimateur et du pharmacien.

INTRODUCTION: The lack of technical information from suppliers and from the literature, a wide variety of features and the absence of medical device reference document explain the difficulty for medical and pharmaceutical staffs to choose a central venous catheter (CVC). The aim of this study was to establish the specifications to choose a CVC according to the clinician needs. METHODS: An analysis of suppliers' technical documentation and a literature review was performed to identify criteria and to collect them in a questionnaire to conduct semi-structured interviews between 1 pharmacist and 5 anaesthesiologists/intensivists. With these interviews, the technical criteria were classified according to their importance in 3 levels. RESULTS: Thirteen technical criteria were identified after reading the technical documents and the literature. Among them, 8 were classified as "essential criteria" (level I) by the physicians: J-shaped guide, one clamp on each way, identified lumen, radiopacity, graduation every centimeter by 5 to 20 cm from the distal extremity, a length of 15 to 25 cm, a single-lumen catheter with a 14 to 16G way and a three-lumen catheter with 14 to 18G way. Finally, three criteria were classified as "intermediate criteria" (level II) and two as "optional criteria" (level III). CONCLUSIONS: This collaborative approach allowed to reference new medical devices according to the clinicians needs. These CVC are a mean to respect guidelines for physicians and nurses and to secure the patient's care.

Atividade antibacteriana em alguns extratos de vegetais do semi-árido brasileiro

Espécies nativas ou endêmicas do semi-árido brasileiro foram investigadas com o intuito de se descobrir novas drogas antimicrobianas. Os ensaios foram realizados contra cepas padrões de Staphylococcus aureus e Escherichia coli através do método de difusão em disco. Dos 137 extratos de vegetais avaliados, sete apresentaram atividade significativa contra o Staphylococcus aureus. Os extratos ativos foram preparados a partir de espécies pertencentes às famílias Leguminosae e Rutaceae e serão futuramente fracionados com o intuito de se chegar às moléculas ativas.

Species native or endemic of the Brazilian semi-arid were investigated with the intention of discovering new antibacterial drugs. The rehearsals were accomplished against standard strains of Staphylococcus aureus and Escherichia coli through the diffusion method in disk. Of the 137 extracts of appraised vegetables, seven presented significant activity against the Staphylococcus aureus. The active extracts were prepared starting from species belonging to the Leguminosae and Rutaceae families and they will be fractional hereafter with the intention of arriving to the active molecules.