[The clinical impact of treatment discrepancies recorded for 200 patients in an acute geriatric unit]. / Impact clinique des divergences de traitement constatées chez 200 patients conciliés dans un service de gériatrie aiguë.

INTRODUCTION: Medication reconciliation is a process used to identify and prevent medication errors at care transition points in hospitals. The present study's main objectives were to quantify the frequency of inadvertent discrepancies (IDs) per patient and estimate the seriousness of the IDs' clinical impact. PATIENTS AND METHODS: This was a prospective, single-center study performed in a 38-bed acute geriatric unit. All patients hospitalized over a 70-day period were included in the study. RESULTS: Over a 70-day period, 200 patients were included (mean±SD age: 85.5±5.9). A total of 316 IDs were recorded in 117 patients (58.5%, i.e. 1.58 per patient). One third of the IDs were considered to be serious or even life-threatening. Omission was the most common type of ID (58%). Cardiovascular drugs were most frequently involved in IDs (33%). CONCLUSION: We observed an average of more than one ID per patient, when comparing drug treatment at home and drug treatment upon admission to hospital. A third of these IDs may be clinically significant. Geriatric populations with polypharmacy and multiple comorbidities are particularly sensitive to this type of error. Medication reconciliation can detect and correct IDs. Collaboration between physicians and pharmacists will improve the quality of patient care and reduce the iatrogenic risk.

[Haematopoietic stem cell transplantation in the treatment of autoimmune diseases]. / Intensification thérapeutique dans les maladies auto-immunes.

PURPOSE: During the past ten years, more than 1000 patients suffering from severe autoimmune disease have received an autologous haematopoietic stem cell transplant. These new therapeutic have been used in systemic sclerosis (scleroderma), multiple sclerosis, rheumatoid arthritis, juvenile idiopathic arthritis and systemic lupus erythematosus. CURRENT KNOWLEDGE AND KEY POINTS: Autologous haematopoietic stem cell transplantation has become a curative option for condition with very poor prognosis as severe systemic sclerosis, lupus erythematosus or other systemic diseases. This review summarizes the current experience in the phase I and II clinical trials in Europe and North America. We describe the main results and the limits of stem cell transplantation in systemic diseases. FUTURE PROSPECTS AND PROJECTS: Autologous haematopoietic stem cell transplant in the treatment of autoimmune disease has evolved from a experimental concept to a clinically feasible and powerful therapy for selected patients with severe disease.

Myelofibrosis and cytopenia are not always malignant.

Myelofibrosis (MF) is characterized by reticulin fibrosis of the bone marrow. It may occur in neoplastic disorders such as myelofibrosis with myeloid metaplasia (MMM) or other neoplasms involving the bone marrow. However, autoimmune phenomena have been described in patients with MF defining a distinct clinicopathological entity called autoimmune myelofibrosis (AIMF). We report two cases of AIMF and review the literature.