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1.
Childs Nerv Syst ; 37(1): 211-215, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32661646

RESUMO

BACKGROUND: Acute flaccid myelitis (AFM) syndrome consists of loss of lower motor neurons following a viral infection, with preserved sensory function. It usually affects the upper limbs asymmetrically, with proximal more than distal muscle involvement. METHODS: Five cases were surgically treated with nerve transfers: spinal accessory to suprascapular nerve transfer (4 patients), branch of radial nerve to axillary nerve transfer (Somsak's procedure) (2 patients), and transfer of a fascicle of the ulnar nerve to the motor branch to the biceps (Oberlin's procedure) (1 patient). RESULTS: Motor improvement was seen in three cases. Widespread motor involvement was associated with poor outcome. CONCLUSION: This small series of cases reinforces that nerve transfers are a reliable option for treatment of selected children with AFM.


Assuntos
Viroses do Sistema Nervoso Central , Mielite , Transferência de Nervo , Doenças Neuromusculares , Criança , Humanos , Mielite/cirurgia , Nervo Ulnar
2.
Leukemia ; 34(7): 1775-1786, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-31925317

RESUMO

In chronic-phase chronic myeloid leukaemia (CP-CML), residual BCR-ABL1+ leukaemia stem cells are responsible for disease persistence despite TKI. Based on in vitro data, CHOICES (CHlorOquine and Imatinib Combination to Eliminate Stem cells) was an international, randomised phase II trial designed to study the safety and efficacy of imatinib (IM) and hydroxychloroquine (HCQ) compared with IM alone in CP-CML patients in major cytogenetic remission with residual disease detectable by qPCR. Sixty-two patients were randomly assigned to either arm. Treatment 'successes' was the primary end point, defined as ≥0.5 log reduction in 12-month qPCR level from trial entry. Selected secondary study end points were 24-month treatment 'successes', molecular response and progression at 12 and 24 months, comparison of IM levels, and achievement of blood HCQ levels >2000 ng/ml. At 12 months, there was no difference in 'success' rate (p = 0.58); MMR was achieved in 80% (IM) vs 92% (IM/HCQ) (p = 0.21). At 24 months, the 'success' rate was 20.8% higher with IM/HCQ (p = 0.059). No patients progressed. Seventeen serious adverse events, including four serious adverse reactions, were reported; diarrhoea occurred more frequently with combination. IM/HCQ is tolerable in CP-CML, with modest improvement in qPCR levels at 12 and 24 months, suggesting autophagy inhibition maybe of clinical value in CP-CML.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Análise Citogenética/métodos , Proteínas de Fusão bcr-abl/genética , Leucemia Mielogênica Crônica BCR-ABL Positiva/tratamento farmacológico , Idoso , Feminino , Seguimentos , Humanos , Hidroxicloroquina/administração & dosagem , Mesilato de Imatinib/administração & dosagem , Leucemia Mielogênica Crônica BCR-ABL Positiva/genética , Leucemia Mielogênica Crônica BCR-ABL Positiva/patologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida
3.
Ann Pharm Fr ; 77(2): 168-177, 2019 Mar.
Artigo em Francês | MEDLINE | ID: mdl-30678804

RESUMO

OBJECTIVES: Medication reconciliation is widely promoted by international health authorities. Its expansion requires human resources, which are limited and unequally distributed among health care facilities. Recent international studies support the involvement of pharmacy technician in the medication reconciliation process but his role remains unstructured in France. We aimed to assess pharmacy technicians' opinions and willingness to be involved in the medication reconciliation process expansion and to identify the levers and barriers of the project. METHODS: A field study was conducted among health facilities of our territory hospital group. Semi-structured interviews were carried out with different pharmacy technicians. Data were analyzed using a qualitative thematic analysis approach. RESULTS: Overall, 12 pharmacy technicians from 5 hospitals were interviewed and almost all assumed their rightful place in the medication reconciliation process (n=11), with a view to revaluating tasks. For all pharmacy technicians, the main barriers to participate in medication reconciliation were the lack of time and training. The spread of a "patient culture", the supervision by pharmacists, the desire to be part of the care team in the ward and additional training requests were major levers of change. CONCLUSIONS: Pharmacy technicians' role in expanding medication reconciliation process is legitimate and must be standardized in France. The deployment of the project requires to be formalized within a territory and should consider and develop local organisations.


Assuntos
Reconciliação de Medicamentos/métodos , Serviço de Farmácia Hospitalar/organização & administração , Técnicos em Farmácia , Atitude do Pessoal de Saúde , França , Humanos , Organização e Administração , Farmacêuticos , Técnicos em Farmácia/educação
5.
Eur J Clin Microbiol Infect Dis ; 35(6): 1023-32, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27039341

RESUMO

The diagnosis and follow-up of candidemia still rely on blood cultures (BCs). In vitro studies show that antifungals can significantly modify the result of blood culture not containing adsorbing agents. We aimed to evaluate, under clinical conditions, the impact on BC yeast detection of systemic antifungal therapy (SAT). Patients (n = 125) experiencing candidemia at Grenoble University Hospital (France) were included in a 4-year retrospective study. The Plus Aerobic/F (Aerobic) and Plus Anaerobic/F (Anaerobic) bottles, which both contain adsorbing resins and the non-resin selective Mycosis IC/F (Mycosis) bottles, were compared using multivariate hierarchical models adjusted for clinical characteristics. The positivity rate (PR) is decreased in patients with SAT (p < 0.01), abdominal surgery (p = 0.01), and hemodialysis (p = 0.02). In all bottles, SAT reduces PR by a factor of 0.16 (95 % CI: [0.08; 0.32]) and increases the time to positivity (TTP) by a factor of 1.76 ([1.30; 2.40]; p < 0.01). In the presence of SAT, TTP is higher in non-resin bottles (Mycosis) than in resin bottles (RR = 1.76, [1.30; 2.40]); however, the TTP in nonresin and resin bottles remains comparable. Although discordant results are observed with and without SAT (37 and 58 % respectively), we showed that the presence of SAT decreases significantly the agreement rate by a factor of 0.29 (CI: [0.12; 0.68]). The combination of Anaerobic and Mycosis bottles allowed a 100 % positivity rate for C. glabrata. SAT significantly affects BC results. Because they provide additional and complementary results, this study supports the concomitant use of resin and selective bottles, especially in patients receiving SAT.


Assuntos
Antifúngicos/uso terapêutico , Candida , Candidemia , Candidíase/tratamento farmacológico , Candidíase/microbiologia , Idoso , Candida/isolamento & purificação , Candidíase/diagnóstico , Feminino , Humanos , Masculino , Técnicas Microbiológicas , Pessoa de Meia-Idade , Razão de Chances , Estudos Retrospectivos
6.
Med Mal Infect ; 46(2): 72-8, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26874673

RESUMO

OBJECTIVE: We aimed to evaluate carbapenem prescription compliance with guidelines for nosocomial and community-acquired infections. PATIENTS AND METHODS: We conducted a prospective study over a four-month period at our university hospital. We included all adult and pediatric hospitalized patients who had received at least one dose of carbapenem. Data was collected from patients' medical records (hard copy and computerized data; CristalLink software). Compliance with guidelines was assessed by two infectious disease specialists. Assessment criteria included indication, antibiotic choice, dosage, and treatment duration. RESULTS: We included 152 patients in the study (65.4% of men). Carbapenem prescription was appropriate for 76.3% of prescriptions. The use of carbapenems was considered appropriate for 73.9% of empirical prescriptions and for 77.8% of documented prescriptions. Non-compliance with guidelines was mainly due to prescriptions for community-acquired infections. Antibiotic de-escalation could not be initiated in 40.3% of patients and was only initiated in 51.7% of patients for whom it could be considered. Although the average treatment duration was 7.5 days, 23.7% of patients received carbapenems for more than 10 days. CONCLUSION: These results highlight the need for a strong carbapenem stewardship program in our hospital.


Assuntos
Infecções Bacterianas/tratamento farmacológico , Carbapenêmicos/uso terapêutico , Infecção Hospitalar/tratamento farmacológico , Fidelidade a Diretrizes/estatística & dados numéricos , Infecções Comunitárias Adquiridas/tratamento farmacológico , Feminino , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
7.
Ann Pharm Fr ; 73(5): 378-90, 2015 Sep.
Artigo em Francês | MEDLINE | ID: mdl-25721763

RESUMO

INTRODUCTION: Within the cystic fibrosis patients' home care, EMERAA network ("Together against Cystic fibrosis in Rhone-Alpes and Auvergne") organizes parenteral antibiotics cures at home prepared in elastomeric infusion devices by hospital pharmacies. However, patients and nurses found that the durations of infusion with these devices were often longer than the nominal duration of infusion indicated by their manufacturer. This study aimed to identify the potential different causes in relation to these discordances. MATERIAL AND METHODS: Three hundred and ninety devices of two different manufacturers are tested in different experimental conditions: three antibiotics each at two different doses, duration of cold storage (three days or seven days) or immediate tests without cold storage, preparation and storage of the solution in the device (protocol Device) or transfer in the device just before measurement (protocol Pocket). RESULTS: All tests highlighted a longer flow duration for devices prepared according to the protocol Device versus the protocol Pocket (P=0.004). Flow duration is increased in the case of high doses of antibiotics with high viscosity such as piperacilline/tazobactam. DISCUSSION: The results of this in vitro study showed the impact of: (1) the time between the filling of the device and the flow of the solution; (2) cold storage of elastomeric infusion devices; (3) concentration of antibiotics and therefore the viscosity of the solution to infuse. CONCLUSION: It is therefore essential that health care teams are aware of factors, which may lead to longer infusion durations with these infusion devices. When the additional time for infusion remain acceptable, it should be necessary to inform the patient and to relativize these lengthening compared to many benefits that these devices provide for home care.


Assuntos
Antibacterianos/análise , Temperatura Baixa , Armazenamento de Medicamentos , Elastômeros/administração & dosagem , Análise de Injeção de Fluxo , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Fibrose Cística/tratamento farmacológico , Estabilidade de Medicamentos , Armazenamento de Medicamentos/métodos , Bombas de Infusão , Soluções Farmacêuticas
8.
Leukemia ; 29(5): 999-1003, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25652737

RESUMO

Treatment of chronic myeloid leukemia (CML) with tyrosine kinase inhibitors has advanced to a stage where many patients achieve very low or undetectable levels of disease. Remarkably, some of these patients remain in sustained remission when treatment is withdrawn, suggesting that they may be at least operationally cured of their disease. Accurate definition of deep molecular responses (MRs) is therefore increasingly important for optimal patient management and comparison of independent data sets. We previously published proposals for broad standardized definitions of MR at different levels of sensitivity. Here we present detailed laboratory recommendations, developed as part of the European Treatment and Outcome Study for CML (EUTOS), to enable testing laboratories to score MR in a reproducible manner for CML patients expressing the most common BCR-ABL1 variants.


Assuntos
Regulação Leucêmica da Expressão Gênica , Leucemia Mielogênica Crônica BCR-ABL Positiva/metabolismo , Proteínas Tirosina Quinases/antagonistas & inibidores , Calibragem , Europa (Continente) , Proteínas de Fusão bcr-abl/genética , Perfilação da Expressão Gênica , Variação Genética , Humanos , Leucemia Mielogênica Crônica BCR-ABL Positiva/tratamento farmacológico , Limite de Detecção , Reação em Cadeia da Polimerase , Reprodutibilidade dos Testes , Resultado do Tratamento
9.
Leukemia ; 29(2): 369-76, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25036192

RESUMO

Serial quantification of BCR-ABL1 mRNA is an important therapeutic indicator in chronic myeloid leukaemia, but there is a substantial variation in results reported by different laboratories. To improve comparability, an internationally accepted plasmid certified reference material (CRM) was developed according to ISO Guide 34:2009. Fragments of BCR-ABL1 (e14a2 mRNA fusion), BCR and GUSB transcripts were amplified and cloned into pUC18 to yield plasmid pIRMM0099. Six different linearised plasmid solutions were produced with the following copy number concentrations, assigned by digital PCR, and expanded uncertainties: 1.08±0.13 × 10(6), 1.08±0.11 × 10(5), 1.03±0.10 × 10(4), 1.02±0.09 × 10(3), 1.04±0.10 × 10(2) and 10.0±1.5 copies/µl. The certification of the material for the number of specific DNA fragments per plasmid, copy number concentration of the plasmid solutions and the assessment of inter-unit heterogeneity and stability were performed according to ISO Guide 35:2006. Two suitability studies performed by 63 BCR-ABL1 testing laboratories demonstrated that this set of 6 plasmid CRMs can help to standardise a number of measured transcripts of e14a2 BCR-ABL1 and three control genes (ABL1, BCR and GUSB). The set of six plasmid CRMs is distributed worldwide by the Institute for Reference Materials and Measurements (Belgium) and its authorised distributors (https://ec.europa.eu/jrc/en/reference-materials/catalogue/; CRM code ERM-AD623a-f).


Assuntos
Proteínas de Fusão bcr-abl/genética , Proteínas de Fusão bcr-abl/metabolismo , Plasmídeos/genética , Reação em Cadeia da Polimerase em Tempo Real/normas , Calibragem , Clonagem Molecular , DNA , Proteínas de Escherichia coli/genética , Dosagem de Genes , Humanos , Proteínas de Membrana Transportadoras/genética , Proteínas Proto-Oncogênicas c-bcr/genética , RNA Mensageiro/metabolismo , Padrões de Referência
10.
Clin Pharmacol Ther ; 96(6): 694-703, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25188725

RESUMO

Approximately 40% of patients with chronic myeloid leukemia (CML) receiving imatinib fail treatment. There is an increased risk of CML in subjects with (i) deletions of genes encoding glutathione-S-transferase (GST)-θ1 (GSTT1) and -µ1, (GSTM1) and (ii) the GST-π1 (GSTP1) single-nucleotide polymorphism (SNP) Ile105Val (GSTP1*B; rs1695); however, their effects on imatinib treatment outcome are not known. Here, we assess the role of these GSTs in relation to imatinib treatment outcome in 193 CML patients. Deletion of GSTT1 alone, or in combination with deletion of the GSTM1 gene, significantly increased the likelihood of imatinib failure (P = 0.021 and P < 0.001, respectively). The GSTP1*B SNP was not associated with time to imatinib failure. Losses of the GSTT1 and GSTM1 genes are therefore important determinants of imatinib failure in CML. Screening for GSTT1 and GSTM1 gene deletions during diagnosis may identify patients who may be better treated using an alternative therapy.


Assuntos
Benzamidas/uso terapêutico , Deleção de Genes , Glutationa Transferase/genética , Leucemia Mielogênica Crônica BCR-ABL Positiva/tratamento farmacológico , Piperazinas/uso terapêutico , Inibidores de Proteínas Quinases/uso terapêutico , Pirimidinas/uso terapêutico , Linhagem Celular Tumoral , Dosagem de Genes , Glutationa S-Transferase pi/genética , Glutationa S-Transferase pi/fisiologia , Glutationa Transferase/fisiologia , Humanos , Mesilato de Imatinib , Leucemia Mielogênica Crônica BCR-ABL Positiva/genética , Polimorfismo de Nucleotídeo Único , Falha de Tratamento
11.
Bone Marrow Transplant ; 48(10): 1324-8, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23686098

RESUMO

Although the feasibility of using HLA-mismatched unrelated donors as an alternate graft source for haematopoietic SCT (HSCT) has been shown, little is known about the safety of HLA-mismatched DLI for the treatment of relapse. We examined the outcome of 58 consecutive leukaemia patients who received escalating-dose DLI for treatment of relapse after alemtuzumab-conditioned myeloablative unrelated donor HSCT at our institution. High-resolution HLA typing on stored DNA samples revealed mismatches in 28/58 patients who were considered HLA-matched at the time of transplantation. Following DLI from HLA-matched (10/10) (n=30) or -mismatched (7-9/10) (n=28) unrelated donors, we found no significant difference in the incidence of acute GVHD (17.2% versus 23.1%, P=0.59), probability of remission at 3 years (62.1% versus 63.9%, P=0.89) or 5-year OS (89.8% versus 77.7%, P=0.22). We conclude that escalating-dose DLI can be safely given to HLA-mismatched recipients following T-depleted myeloablative HSCT.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Antígenos HLA/imunologia , Leucemia/terapia , Transplante de Células-Tronco/métodos , Linfócitos T/transplante , Adolescente , Adulto , Alemtuzumab , Feminino , Histocompatibilidade/imunologia , Humanos , Leucemia/tratamento farmacológico , Leucemia/imunologia , Leucemia/cirurgia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/tratamento farmacológico , Recidiva Local de Neoplasia/imunologia , Recidiva Local de Neoplasia/terapia , Estudos Retrospectivos , Linfócitos T/imunologia , Transplante Homólogo , Resultado do Tratamento , Adulto Jovem
12.
J Hosp Infect ; 82(4): 293-6, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23102819

RESUMO

High-risk units with air-control measures at Grenoble University Hospital are equipped with automated dispensing systems that are filled daily using drug trolleys routed from the pharmacy to the ward. The aim of this study was to evaluate the level of filamentous fungi (FF) contamination present in trolleys under usual conditions and after cleaning with Aniosurf(®) (fungicidal disinfectant). FF were detected in all samples, and 83.3% of samples were contaminated with Aspergillus fumigatus. Cleaning trolleys with Aniosurf(®) decreased the level of FF significantly, but contamination re-appeared within 24 h due to storage in a non-controlled environment.


Assuntos
Aspergillus fumigatus/isolamento & purificação , Infecção Hospitalar/prevenção & controle , Desinfetantes/administração & dosagem , Microbiologia Ambiental , Controle de Infecções/métodos , Aspergilose Pulmonar Invasiva/prevenção & controle , França , Hospitais Universitários , Humanos , Estudos Prospectivos
13.
Leukemia ; 26(2): 296-302, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-21844874

RESUMO

Natural killer (NK) cells are expanded in chronic myeloid leukemia (CML) patients on tyrosine kinase inhibitors (TKI) and exert cytotoxicity. The inherited repertoire of killer immunoglobulin-like receptors (KIR) may influence response to TKI. We investigated the impact of KIR-genotype on outcome in 166 chronic phase CML patients on first-line imatinib treatment. We validated our findings in an independent patient group. On multivariate analysis, KIR2DS1 genotype (RR=1.51, P=0.03) and Sokal risk score (low-risk RR=1, intermediate-risk RR=1.53, P=0.04, high-risk RR=1.69, P=0.034) were the only independent predictors for failure to achieve complete cytogenetic response (CCyR). Furthermore, KIR2DS1 was the only factor predicting shorter progression-free (PFS) (RR=3.1, P=0.03) and overall survival (OS) (RR=2.6, P=0.04). The association between KIR2DS1 and CCyR, PFS and OS was validated by KIR genotyping in 174 CML patients on first-line imatinib in the UK multi-center SPIRIT-1 trial; in this cohort, KIR2DS1(+) patients had significantly lower 2-year probabilities of achieving CCyR (76.9 vs 87.9%, P=0.003), PFS (85.3 vs 98.1%, P=0.007) and OS (94.4 vs 100%, P=0.015) than KIR2DS1(-) patients. The impact of KIR2DS1 on CCyR was greatest when the ligand for the corresponding inhibitory receptor, KIR2DL1, was absent (P=0.00006). Our data suggest a novel role for KIR-HLA immunogenetics in CML patients on TKI.


Assuntos
Antineoplásicos/uso terapêutico , Leucemia Mielogênica Crônica BCR-ABL Positiva/tratamento farmacológico , Piperazinas/uso terapêutico , Pirimidinas/uso terapêutico , Receptores KIR/genética , Adolescente , Adulto , Idoso , Benzamidas , Feminino , Genótipo , Humanos , Mesilato de Imatinib , Leucemia Mielogênica Crônica BCR-ABL Positiva/genética , Masculino , Pessoa de Meia-Idade , Indução de Remissão , Análise de Sobrevida
17.
Eur J Vasc Endovasc Surg ; 40(3): 365-74, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20570185

RESUMO

OBJECTIVES AND DESIGN: To establish whether in diabetic patients with peripheral artery obstructive disease (PAOD) vasa vasorum (vv) neoangiogenesis is altered with increased arterial damage. MATERIALS: Thirty-three patients with PAOD and critical lower limb ischaemia, 22 with type II diabetes. METHODS: Immunohistochemistry for endothelial cell markers (CD34 and von Willebrand Factor); real-time reverse transcription polymerase chain reaction (RT-PCR) to quantify arterial wall expression of vascular endothelial growth factor (VEGF); enzyme-linked immunosorbent assay (ELISA) to assess blood VEGF; flow cytometry to detect circulating endothelial cells (CECs). RESULTS: Patients with PAOD and diabetes have a higher frequency (60% vs. 45%) of advanced atherosclerotic lesions and a significant reduction (p = 0.0003) in CD34(+) capillaries in the arterial media. Adventitial neoangiogenesis was increased equally (CD34(+) and vWF(+)) in all patients. Likewise, all patients have increased CEC and VEGF concentration in the blood as well as in-situ VEGF transcript expression. CONCLUSIONS: Patients with PAOD have remarkable arterial damage despite increased in-situ and circulating expression of the pro-angiogenic VEGF; a dysfunctional vv angiogenesis was seen in diabetics which also showed a higher frequency of parietal damage; it is suggested that in diabetic arterial wall, injury is worsened by vv inability to finalise an effective VEGF-driven arterial wall neoangiogenesis.


Assuntos
Arteriopatias Oclusivas/fisiopatologia , Angiopatias Diabéticas/fisiopatologia , Isquemia/fisiopatologia , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/fisiopatologia , Neovascularização Fisiológica , Vasa Vasorum/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antígenos CD34/análise , Arteriopatias Oclusivas/metabolismo , Arteriopatias Oclusivas/patologia , Estudos de Casos e Controles , Estado Terminal , Diabetes Mellitus Tipo 2/metabolismo , Diabetes Mellitus Tipo 2/patologia , Diabetes Mellitus Tipo 2/fisiopatologia , Angiopatias Diabéticas/metabolismo , Angiopatias Diabéticas/patologia , Células Endoteliais/patologia , Ensaio de Imunoadsorção Enzimática , Feminino , Citometria de Fluxo , Humanos , Imuno-Histoquímica , Isquemia/metabolismo , Isquemia/patologia , Itália , Masculino , Pessoa de Meia-Idade , RNA Mensageiro/análise , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Vasa Vasorum/química , Vasa Vasorum/patologia , Fator A de Crescimento do Endotélio Vascular/sangue , Fator A de Crescimento do Endotélio Vascular/genética , Fator de von Willebrand/análise
19.
Leukemia ; 23(6): 1054-61, 2009 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19282833

RESUMO

Imatinib mesylate is considered standard of care for first-line treatment of chronic phase chronic myeloid leukemia (CML-CP). In the phase III, randomized, open-label International Randomized Study of Interferon vs STI571 (IRIS) trial, previously untreated CML-CP patients were randomized to imatinib (n=553) or interferon-alpha (IFN) plus cytarabine (n=553). This 6-year update focuses on patients randomized to receive imatinib as first-line therapy for newly diagnosed CML-CP. During the sixth year of study treatment, there were no reports of disease progression to accelerated phase (AP) or blast crisis (BC). The toxicity profile was unchanged. The cumulative best complete cytogenetic response (CCyR) rate was 82%; 63% of all patients randomized to receive imatinib and still on study treatment showed CCyR at last assessment. The estimated event-free survival at 6 years was 83%, and the estimated rate of freedom from progression to AP and BC was 93%. The estimated overall survival was 88% -- or 95% when only CML-related deaths were considered. This 6-year update of IRIS underscores the efficacy and safety of imatinib as first-line therapy for patients with CML.


Assuntos
Leucemia Mielogênica Crônica BCR-ABL Positiva/tratamento farmacológico , Piperazinas/administração & dosagem , Pirimidinas/administração & dosagem , Benzamidas , Progressão da Doença , Seguimentos , Insuficiência Cardíaca/induzido quimicamente , Humanos , Mesilato de Imatinib , Leucemia Mielogênica Crônica BCR-ABL Positiva/complicações , Leucemia Mielogênica Crônica BCR-ABL Positiva/mortalidade , Segunda Neoplasia Primária/induzido quimicamente , Piperazinas/toxicidade , Pirimidinas/toxicidade , Indução de Remissão , Análise de Sobrevida , Resultado do Tratamento
20.
Ann Pharm Fr ; 67(1): 3-15, 2009 Jan.
Artigo em Francês | MEDLINE | ID: mdl-19152845

RESUMO

Drug supply chain safety has become a priority for public health which implies a collective process. This process associates all health professionals including the pharmacist who plays a major role. The objective of this present paper is to describe the several approaches proven effective in the reduction of drug-related problem in hospital, illustrated by the Grenoble University Hospital experience. The pharmacist gets involved first in the general strategy of hospital drug supply chain, second by his direct implication in clinical activities. The general strategy of drug supply chain combines risk management, coordination of the Pharmacy and Therapeutics Committee, selection and purchase of drugs and organisation of drug supply chain. Computer management of drug supply chain is a major evolution. Nominative drug delivering has to be a prior objective and its implementation modalities have to be defined: centralized or decentralized in wards, manual or automated. Also, new technologies allow the automation of overall drug distribution from central pharmacy and the implementation of automated drug dispensing systems into wards. The development of centralised drug preparation allows a safe compounding of high risk drugs, like cytotoxic drugs. The pharmacist should develop his clinical activities with patients and other health care professionals in order to optimise clinical decisions (medication review, drug order analysis) and patients follow-up (therapeutic monitoring, patient education, discharge consultation).


Assuntos
Erros de Medicação/prevenção & controle , Sistemas de Medicação no Hospital/organização & administração , Serviço de Farmácia Hospitalar/organização & administração , Automação , Serviços Centralizados no Hospital/organização & administração , Controle de Custos , Composição de Medicamentos/métodos , Composição de Medicamentos/normas , Monitoramento de Medicamentos , Armazenamento de Medicamentos/métodos , Prescrição Eletrônica , França , Hospitais Universitários/estatística & dados numéricos , Humanos , Erros de Medicação/legislação & jurisprudência , Sistemas de Medicação no Hospital/economia , Sistemas de Medicação no Hospital/estatística & dados numéricos , Política Organizacional , Educação de Pacientes como Assunto , Farmacêuticos , Serviço de Farmácia Hospitalar/estatística & dados numéricos , Gestão de Riscos/organização & administração , Papel (figurativo)
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