[Drug dosage adjustment in patients with renal impairment and evaluation of renal function: focus on the cardiologic patients]. / Adaptation posologique chez les patients insuffisants rénaux chroniques et évaluation de la fonction rénale : focus sur les patients de cardiologie.

Chronic kidney disease is a progressive disease which has become a real public health issue. In patients with renal disease, drugs pharmacokinetics may be altered. The handling of drugs requires a special attention in these patients. Indeed, there is a risk of accumulation and drug overdose if dosage is not adjusted to the stage of renal insufficiency. Thus, to achieve a dosage adjustment knowing how to evaluate renal function is absolutely necessary. Different formulae are available including the Cockcroft and Gault formula aMDRD and CKD-EPI. In patients with cardiac issues, it appears that the CKD-EPI formula is that of choice in terms of clinical risk stratification. However, some summaries of product characteristics (SmPC) of drugs used in cardiology, such as Dabigatran(®), mention the need to use the Cockcroft-Gault, less accurate than aMDRD and CKD-EPI, in order to adjust the dose in patients with impaired renal function. Standardization of recommendations is necessary to limit disparities in dosage and drug exposure according to the formula. SmPCs however, are not the only source of information to obtain data on the use of drugs in the renal insufficient population. Some other information sources exist, reliable, updated and easily accessible.

A psychosocial summary flow sheet: facilitating the coordination of care, enhancing the quality of care.

To improve the continuity of care and to better coordinate psychosocial care, the Psychosocial Oncology Program at the Ontario Cancer Institute/Princess Margaret Hospital developed a psychosocial summary flow sheet. The objectives of the pilot project evaluation were: (a) to examine preparation to use the flow sheet prior to its implementation, (b) to gather information on how staff used the flow sheet, and (c) to determine how its design and implementation could be improved. The charts of all the patients on the units participating in the pilot project were examined and a questionnaire was sent to all staff involved with patient care on these units. The results of the evaluation indicated that the psychosocial summary flow sheet was perceived to be an asset to psychosocial care and could be implemented hospital-wide. Based on the evaluation, a number of changes were made in its design and a strategy for hospital-wide implementation was planned.