Oral anticoagulants: Interventional pharmaceutical study with reminder of good practices, and iatrogenic impact.

OBJECTIVES: Study of the impact of geriatricians' training on the improvement of their prescribing practices, and comparison of iatrogenesis between the two classes of oral anticoagulants. MATERIAL AND METHODS: Before/after and here/there comparison between a trained prescribers group and a control group, before and after the pharmacist intervention, with comparison of the iatrogenesis of two oral anticoagulant classes. Patients in the acute and post-acute geriatric departments treated with a vitamin K antagonist or a direct oral anticoagulant were included. Criteria for Good practice were rated according to a scale of severity: calculation of a score and a percentage of compliance per patient, and then an average of the percentage of compliance (main criterion) within the populations to be compared. The proportion of iatrogenic elements between the two classes was compared. We used statistical tests (significance threshold of 5%). RESULTS: Vitamin K antagonist: a decreasing trend in the control group (P=0.086) and an increasing trend in the trained group (P=0.183) was observed in prescription compliance before/after training. Direct oral anticoagulants: the compliance before/after decreased in the control group (P=0.005) and increased in the trained group (P=0.024). After training, compliance is higher among the group of trained prescribers for both vitamin K antagonist (P=0.018) and direct oral anticoagulant (P=0.003). The proportion of iatrogenic events in the two oral anticoagulants classes was not significantly different. CONCLUSIONS: Interest of good practice reminders in the quality of oral anticoagulants prescriptions with no difference in safety of use between the two classes.

[Securing the therapy management during the leave permissions for the elderly patients]. / Sécurisation de la prise en charge médicamenteuse des patients âgés pendant les permissions de sortie.

Leave permission can be granted over a limited period of hospitalisation during which the patient can return home under the responsibility of the hospital. Despite its frequency, this practice is not evaluated in terms of maintaining the security of medication. This complex process involves several actors, processes and locations. In that case, the drug iatrogenic risk is not at all negligible, especially for the elderly. Patient comprehension of medication is not always easy and must be evaluated before leaving the hospital. Therefore, a risk analysis has been initiated to ensure the medical practice's security of our geriatric hospital. Multidisciplinary working group meetings were dedicated to analyse and overcome 21 unacceptable failure modes. The establishment of traceability nurse/patient for the medication intake, information and evaluation of drug monitoring allowed the patient's medication compliance. In the meanwhile, the role of the working group on the security of the internal drug circuit in the hospital has integrated the harmonization of practices, a unique source of information and a variety of comprehensible, readable and informative materials to propose to the patients. These preventive actions have been formulated to secure, optimize and to individualize drug management during the leave permission. In the context of optimization during transit period home/hospital, this process reorganized by the working group can be integrated in a public health approach to reduce the number of preventable readmissions.

[Euthanasia and/or medically assisted suicide: Reflection on the new responsibility of the hospital pharmacist]. / Euthanasie et/ou suicide médicalement assisté : réflexion sur la nouvelle responsabilité du pharmacien hospitalier.

CONTEXT: Concern about euthanasia and medically assisted suicide is currently growing around the world and particularly in France. Though not authorized at present in France, the role of hospital pharmacist in this issue needs to be discussed. OBJECTIVES: This article aims to gather medical and legal literature of European Union member states on these issues and particularly in France. To propose a practical thinking on the possible role of hospital pharmacist. RESULTS: Among European Union, euthanasia and/or assisted suicide have already been introduced in some member states' laws. In France, Leonetti law currently sets the legal framework for the management of end of life. To address the society's demand on these issues, French President F. Hollande made two ethics committees responsible for working on it. Both were mainly against euthanasia and assisted suicide. Though a bit forgotten in this debate, hospital pharmacist needs to be associated in the thinking, as the main "drug-keeper". Indeed, guidelines are necessary to outline and ensure a safe drug use, complying with professional ethics, if lethal doses are voluntarily prescribed. CONCLUSION: Pharmaceutical work is in constant evolution and is addressing new issues still unanswered, including assisted suicide and euthanasia. French pharmaceutical authorities should seize upon them, in order to guarantee pharmaceutical ethics. These practices, if authorized by law, should remain exceptional, and law strictly enforced. The pharmacist could be one of these "lawkeepers".

Orocecal transit time in humans assessed by sulfapyridine appearance in saliva after sulfasalazine intake.

PURPOSE: We propose a noninvasive method for the measurement of orocecal transit time assessed by the sulfapyridine appearance time in saliva after ingestion of sulfasalazine. METHOD: In 12 healthy volunteers, we studied the correlation between plasma and saliva sulfapyridine appearance times and then the sulfapyridine appearance times in saliva under various experimental conditions to assess the reproducibility, the effects of meals, and the role of the formulation, and the effects of gastrointestinal kinetic drugs. RESULTS: The correlation between saliva and plasma sulfapyridine appearance times was strong (r = 0.84; p = 0.0004). The sulfapyridine saliva appearance time was significantly delayed by the meal. Compared with placebo, the saliva sulfapyridine appearance time was reduced by cisapride (312 +/- 128 versus 551 +/- 97 minutes; p = 0.0001) and increased by loperamide (674 +/- 267 versus 501 +/- 131 minutes; p = 0.044). CONCLUSION: We propose the salivary sample method as a validated simplification of the plasma sulfasalazine-sulfapyridine test for the measurement of orocecal transit time.

Relationships between fat and plasma androstenone and plasma testosterone in fatty and lean young boars during growth and after hCG stimulation.

The effect of weight of fatty tissue on fat and plasma androstenone and on plasma testosterone relationships in the young boar was studied. For this purpose, hCG stimulation of steroid testicular production was performed in 12 boars and fat androstenone concentration subsequently measured. In addition plasma androstenone and testosterone were determined in 8 of them, previously cannulated. The results show that: 1) although plasma testosterone response to hCG stimulation was similar in all boars, fat and plasma androstenone responses were very variable between boars, 2) weight of fatty tissue appeared to have little influence, if any, on androstenone exchanges between plasma and fatty tissue and 3) plasma androstenone/testosterone ratio appeared to be less variable within boars than between boars. The data show that there is probably some between-boars-variability in the respective rates of elimination of testosterone and androstenone.

Relationships between fat and plasma androstenone and plasma testosterone in fatty and lean young boars following castration.

The effect of weight of fatty tissue on fat and plasma androstenone and on plasma testosterone relationships was studied in the young boar following castration. For this purpose, 9 boars were castrated at 175 days of age, plasma steroid levels were determined daily up to 10 days after orchidectomy and fat androstenone concentration was measured 1, 3, 6, 10 and 15 days after castration. The results show that the apparent half-life of stored androstenone is very variable between boars (range: 4 to 14 days) and do not depend on the weight of fatty tissue. The rate of elimination of plasma androstenone is also very variable between boars. The rate of disappearance of fat androstenone following castration does not depend on the rate of androstenone release from fatty tissue to peripheral plasma but is more likely dependent on the intensity of plasma androstenone catabolism and elimination. Therefore, fat androstenone concentration in the intact boar is almost only depending on the equilibrium between the respective rates of testicular production and elimination.

Bacterial formation of omega-muricholic acid in rats.

In the feces of conventional rats, the amount of omega-muricholic and hyodeoxycholic acids vary according to the diet. To understand this phenomenon, we investigated the bacterial formation of these bile acids. The present paper reports the first isolation, from conventional rat feces, of a strain of Clostridium group III which transforms beta-muricholic acid, the main bile acid in germfree rats, into omega-muricholic acid.

[Formation of omega-muricholic acid and fecal excretion of biliary acids in rats]. / Formation d'acide omega-muricholique et excrétion fécale des acides biliaires chez le rat

Two groups of Rats which were fed the same diet, excreted fecal bile acids of different patterns: in one group, the feces contained a large amount of omega-muricholic acid and very little hydrodeoxycholic acid; in the other group the reversed composition was observed. The first group excreted more total bile acids than the second. This observation suggests that the formation of a large amount of omega-muricholic acid results in an increase in total bile acid fecal excretion.