[The pharmaceutical record in an emergency department: Assessment of its accessibility and its impact on the level of knowledge of the patient's treatment]. / Le dossier pharmaceutique dans un service d'accueil des urgences : évaluation de son accessibilité et de son impact sur le niveau de connaissance du traitement du patient.

Knowledge of the home medication list may impact therapeutic decisions made in the emergency department (ED). In France, the pharmaceutical record (PR) is a shared professional tool arising from the pharmacists lists of all drugs dispensed during the last 4 months. This PR is included in a microchip equipping a "Vitale" card detained by each beneficiary of health insurance benefits. Since 2011, the law authorises experimentally the consultation of the PR by some hospital doctors such as those working in emergency medicine. The purpose of this work is to assess the accessibility to this PR and to verify the hypothesis that its consultation increases the level of information concerning the treatment of patients admitted in an ED. A prospective, single-center, observational study was conducted during a 15-day period on all patients arriving at the Agen hospital emergency department. Of the 1046 patients enrolled in the study, 828 (79 %) presented a "Vitale" card in which a PR furnished with data was found in 45 % of the cases. The only paper source of information available was provided by the PR (25 %), a medical letter (6 %) or a prescription (3 %). A dual reconciliation between 2 of these sources was possible at a rate of about 4 % each whereas only 3 % of patients showed up with the 3 sources of available information. The consultation of PR by the ED staff is significantly possible. It improves quantitatively the level of information and thus optimizes medication assessment, the initial and critical step of the medical management of patients.

Internal morphology of poly(D,L-lactide-co-glycolide) BCNU-loaded microspheres. Influence on drug stability.

The solvent extraction/evaporation process has been used to form poly(D,L-lactide-co-glycolide) (PLAGA) BCNU-loaded microspheres designed for use as intracranial controlled-release implants. Their actual payload could reach 25% with a 20-50 microns size distribution. Scanning electron microscopy showed that such carriers had a smooth surface and a spherical geometry. Differential scanning calorimetry analyses carried out on drug-loaded microspheres established that the PLAGA Tg was markedly shifted towards the low temperatures along with the disappearance of the BCNU melting endotherm. Annealing experiments performed at room temperature did not induce any change of the loaded microsphere DSC profiles. These features indicated that the BCNU acted as a plasticizer for the coating material and formed with it a solid solution. Similarly, stability of encapsulated BCNU was assessed in different conditions of storage. It appeared that drug degradation increased with temperature increase: 5.4, 8.8, 32.4 and 51.2% of decomposition after 3 month storage at -18, 4, room temperature (RT) and 37 degrees C respectively. Since the free drug was stable at 4 degrees C and experienced only 10.6% decomposition at RT during the same storage time, the state of solid solution involving the intimate mixing of the drug and the polyester in the matrix favors a progressive decomposition of BCNU. However, keeping the microspheres 6 months at -18 degrees C or 3 months at 4 degrees C prevents a loss of drug superior to 10%.

Plasma sialic acid as a marker of the effect of the treatment on metastatic colorectal cancer.

The concentration of total sialic acid (TSA) is increased in the plasma of patients with many types of cancer. The purpose of this study was to assess the usefulness of the TSA marker in predicting the efficacy of the treatment, and to compare TSA with two common markers, carcinoembryonic antigen (CEA) and the carbohydrate antigen 19-9 (CA 19-9). The study was performed on 44 patients treated for advanced colorectal carcinoma by a weekly 8 h continuous infusion of 5-fluorouracil (1300 mg/m2) plus bolus injection of L-folinic acid (100 mg/m2). TSA, CEA and CA 19-9 levels were measured before and after 3 months of treatment and their variations analysed as a function of the response to the treatment. TSA levels of patients with metastatic colorectal carcinoma before treatment (959 +/- 265 mg/l) were significantly higher than those of 32 healthy people (584 +/- 99 mg/l). The percentage of patients with TSA concentration above the cut-off level (782 mg/l) was 73% before treatment and 23% after. All patients who experienced an objective response to the treatment (complete, partial or minor response) (n = 29) had a significant decrease of TSA levels (t = 5.96; P < 0.001). When the disease was considered as stabilised (n = 10), TSA changed slightly, but it increased with progressive disease (4 out of 5 patients). Changes in CEA and CA 19-9 did not correlate as well as TSA to the treatment efficacy. Initial levels of TSA did not permit prediction of the efficacy of the treatment since they were not significantly different between the five response groups. TSA seems to be more likely involved in tumour changes than in tumour volume. Its determination could provide useful information about the spreading and metastatic properties of the tumour. TSA normalisation is an indicator of probable tumour growth arrest and its elevation could be a marker of relapse.