[Information transmission to the community pharmacist after a patient's discharge from the hospital: setting up of a written medication discharge form, prospective evaluation of its impact, and survey of the information needs of the pharmacists]. / Transmission d'information au pharmacien d'officine après hospitalisation du patient: élaboration d'une feuille de transfert, évaluation prospective de son effet et enquête sur les besoins d'information des pharmaciens.

INTRODUCTION: Discharge from the hospital is a period at risk for the continuity of patient's medication (seamless pharmaceutical care). The community pharmacist is often the first health care professional seen by the patient after hospital discharge. The clinical pharmacist has potentially a key role in establishing an efficient information transfer from the hospital to the community pharmacy. OBJECTIVE: (1) To develop and, (2) to evaluate the impact of a structured discharge medication form prepared at hospital discharge by the clinical pharmacist and containing information items related to the medication regimen for the community pharmacist, and (3) to survey the information needs of the Belgian community pharmacists to ensure continuity of care after hospitalization. METHODS: (1) A structured discharge medication form has been developed based on a Literature review and on opinions expressed by community and clinical pharmacists, members of the Belgian Pharmaceutical Union (Association Pharmaceutique Belge) and an ethical committee. (2) A prospective study has been conducted with patients from geriatrics and orthopaedics wards of the University Hospital Dinant-Godinne returning home after hospital discharge with the discharge medication form to be given to their commuiity pharmacist; its use, the reasons for non-use, the perceived impact and the satisfaction of the community pharmacist have been assessed. (3) An on-line survey addressed to all Belgian community pharmacists evaluated their information needs. RESULTS: (1) The final version of the discharge medication form included key information items concerning the hospital, the patient, the discharge treatment (including the type of modifications made as compared to medications taken before admission), and on medication management at home. Some items were excluded because of Lack of perceived utility by pharmacists, confidentiality issues, and respect of patient's freedom of choice. (2) From the 71 medication forms given to patients, 48 were received by the community pharmacist. One quarter of respondents stated that they did not use the form, the main reason being that it was received after dispensing of the discharge treatment (n=6/11). The majority of the community pharmacists considered most of the information items as useful and the discharge medication form as being valuable for continuity of care. Requests for additional information were made (e.g., reason of admission and of treatment modifications, etc.). (3) The utility, benefits, and need for additional information items beyond what was included in the discharge medication form were highlighted by the respondents (n=309) of the national survey. Most of these respondents confirmed the value of the different information items included in the discharge medication form. CONCLUSION: The transmission of a structured medication form containing information about the medication regimen upon hospital discharge is of real interest and value for the community pharmacist because it goes beyond what is usually provided on a medical prescription. However, this discharge medication form should include more information items for effective pharmaceutical care.

Estimation of dominance variance for live body weight in a crossbred population of pigs.

The objective of this study was to estimate the dominance variance for repeated live BW records in a crossbred population of pigs. Data were provided by the Walloon Pig Breeding Association and included 22,197 BW records of 2,999 crossbred Piétrain × Landrace K+ pigs from 50 to 210 d of age. The BW records were standardized and adjusted to 210 d of age for analysis. Three single-trait random regression animal models were used: Model 1 without parental subclass effect, Model 2 with parental subclasses considered unrelated, and Model 3 with the complete parental dominance relationship matrix. Each model included sex, contemporary group, and heterosis as fixed effects as well as additive genetic, permanent environment, and residual as random effects. Variance components and their SE were estimated using a Gibbs sampling algorithm. Heritability tended to increase with age: from 0.50 to 0.64 for Model 1, from 0.19 to 0.42 for Model 2, and from 0.31 to 0.53 for Model 3. Permanent environmental variance tended to decrease with age and accounted for 29 to 44% of total variance for Model 1, 29 to 37% of total variance for Model 2, and 34 to 51% of total variance for Model 3. Residual variance explained <10% of total variance for the 3 models. Dominance variance was computed as 4 times the estimated parental subclass variance. Dominance variance accounted for 22 to 40% of total variance for Model 2 and 5 to 11% of total variance for Model 3, with a decrease with age for both models. Results showed that dominance effects exist for growth traits in pigs and may be reasonably large. The use of the complete dominance relationship matrix may improve the estimation of additive genetic variances and breeding values. Moreover, a dominance effect could be especially useful in selection programs for individual matings through the use of specific combining ability to maximize growth potential of crossbred progeny.

Estimation of genetic parameters for birth weight, preweaning mortality, and hot carcass weight of crossbred pigs.

Genetic parameters for birth weight (BWT), preweaning mortality (PWM), and HCW were estimated for a crossbred pig population to determine if BWT could be used as an early predictor for later performances. Sire genetic effects for those traits were estimated to determine if early selection of purebred sires used in crossbreeding could be improved. Data were recorded from 1 commercial farm between 2008 and 2010. Data were from 24,376 crossbred pigs from Duroc sires and crossbred Large White × Landrace dams and included 24,376 BWT and PWM records and 13,029 HCW records. For the analysis, PWM was considered as a binary trait (0 for live or 1 for dead piglet at weaning). A multitrait threshold-linear animal model was used, with animal effect divided into sire genetic and dam effects; the dam effects included both genetic and environmental variation due to the absence of pedigree information for crossbred dams. Fixed effects were sex and parity for all traits, contemporary groups for BWT and HCW, and age at slaughter as a linear covariable for HCW. Random effects were sire additive genetic, dam, litter, and residual effects for all traits and contemporary group for PWM. Heritability estimates were 0.04 for BWT, 0.02 for PWM, and 0.12 for HCW. The ratio between sire genetic and total estimated variances was 0.01 for BWT and PWM and 0.03 for HCW. Dam and litter variances explained, respectively, 14% and 15% of total variance for BWT, 2% and 10% for PWM, and 3% and 8% for HCW. Genetic correlations were -0.52 between BWT and PWM, 0.55 between BWT and HCW, and -0.13 between PWM and HCW. Selection of purebred sires for higher BWT of crossbreds may slightly improve survival until weaning and final market weight at the commercial level.

Using test station and on-farm data for the genetic evaluation of Pietrain boars used on Landrace sows for growth performance.

The aim of this study was to develop a new genetic evaluation model to estimate the genetic merit of boars for growth based on 1) performance of their crossbred progeny fattened in the test station and 2) their own performance or those of relatives from the on-farm testing system. The model was a bivariate random regression animal model with linear splines and was applied to Piétrain boars from the Walloon Region of Belgium mated with Landrace sows. Data contained 1) 12,610 BW records from the test station collected on 1,435 crossbred pigs from Piétrain boars and Landrace sows, and 2) 52,993 BW records from the on-farm testing system collected on 50,670 pigs with a breed composition of at least 40% Piétrain or Landrace. Since 2007, 56 Piétrain boars have been tested in the station. Data used to estimate variance components and breeding values were standardized for the age to take into account heterogeneity of variances and then pre-adjusted at 210 d of age to put all records on the same scale. Body weight records from the test station and from the on-farm testing system were considered as 2 different traits. The heterosis effect was modeled as fixed regression on the heterozygosity coefficient. As all test station animals were similarly crossbred, smaller variation in heterozygosity caused the sampling error of the regression estimate at 210 d to be larger in the test station than in on-farm data with estimates of 28.35 ± 14.55 kg and 9.02 ± 0.67 kg, respectively. Therefore, the most likely reason for the large differences in estimates was sampling. Heritability estimates ranged from 0.37 to 0.60 at 210 and 75 d, respectively, for test station BW and from 0.42 to 0.60 at 210 d and 175 d, respectively, for on-farm BW. Genetic correlation decreased when the age interval between records increased, and were greater between ages for test station than for on-farm data. Genetic correlations between test station and on-farm BW at the same age were high: 0.90 at 175 d and 0.85 at 210 d. For the 56 boars tested in the station, the average reliability of their EBV for ADG between 100 and 210 d was improved from 0.60 using only test station data to 0.69 using jointly test station and on-farm data. Based on these results, the new model developed was considered as a good method of detection of differences in growth potential of Piétrain boars based on test station and on-farm data.

[Novel comparative profile of the clinical activity of antidepressive agents]. / Une physionomie comparée originale de l'activité clinique des antidépresseurs.

In order to develop practical criteria to guide in the selection of antidepressant medication according to depressive symptomatology, we propose a graphical representation of the clinical activity of 24 antidepressants according to a "star" model. Six parameters have been evaluated from 0 to 5 in comparison to reference drugs (rated 5) by 11 independent "blind" psychiatrists expert in pharmacotherapy. Three parameters were used as measures of therapeutic activity: antidepressant, psychostimulant, and anxiolytic, with iproniazide 75 mg/d, metamphetamine 15 mg/d, and diazepam 20 mg/d as reference drugs respectively. Three additional parameters assessed the level of side-effects: anticholinergic, sedative, and hypotensive, with atropine 0.75 mg/d, phenobarbital 200 mg/d, and iproniazide 75 mg/d as reference drugs respectively. The defined dose represented the standard maintenance daily dose for depressive outpatients. Mean values for each parameter, rounded off to the closest number, were used for the graphical representation. Results showed an excellent agreement among evaluators for the clinical profile of classical tricyclic and MAOI antidepressants, but serious divergences for the more recent drugs (e.g., viloxazine and mianserine), possibly reflecting more atypical or more variable clinical profile of these compounds.

[The practitioner faced with anxiety and somatic symptoms (author's transl)]. / Le praticien face à l'anxiété et ses somatisations.

In order to determine the psychopharmacological profile of tiapride, the authors carried out 3 studies. The first study of ten resistant psychiatric cases permitted us to detect the direction of later studies. The object of the second was to analyse the neurovisceral properties and the action of tiapride on somatic symptoms due to anxiety in 25 ambulatory patients. The last study was a therapeutic approach. Tiapride appears to be one of the best drugs for anxiety in one of the 3 following circumstances: a paroxysmal or chronic somatic expression, depression, or behaviour suggesting latent and masked psychosis or early psychosis. Tiapride is tolerated in the same way as a neuroleptic for even in low dosage (150-300 mg/day) may appear undesirable side effects of extrapyramidal type. On the other hand, and contrary to sulpiride, neuro-endocrine effects are exceptional.