Journal de pharmacie de Belgique最新文献

Background: "Dose-banding" is a concept of cytotoxic drugs standardization allowing the preparation in advance of standardized rounded doses (SRD covering the most frequently prescribed doses rounded to +/-5%. Standard doses will be prepared in advance by batch in order to increase production capacity and at the same time to regulate pharmacy workflow as well as to reduce patient waiting time.

Purpose: To identify anticancer drugs suitable for dose banding and to fix standardized doses.

Methods: The interesting molecules are first selected in accordance with several criteria: preparations frequency, long-term physicochemical stability after reconstitution, repetition of the prescribed doses and savings opportunity. The selected molecules were: Carboplatin, Cetuximab, Cisplatin, Cyclophosphamide, Doxorubicin, 5-Fluorouracil, Gemcitabine, Oxaliplatine, Paclitaxel, Rituximab, Trastuzumab and Vinorelbine. We established an inventory of the prescriptions retrospectively for a period of six months in order to highlight the most often prescribed doses. For the analysis, we fixed bands with a standard deviation of +/- 5%, 7% and +/- 10%.

Results: Standardization of doses of chemotherapy was deemed interesting if > or =60% of the doses were standardisable with a maximum of five SRD and a minimum of one delivery per week, in order to guarantee a good turnover of the batch. A maximum of 5% standard deviation is added to those three criteria, the deviation currently accepted among our medical staff. After analyzing 3506 prescriptions, 7 molecules are eligible: Doxorubicine, 5-Fluorouracil infusion, 5-Fluorouracil pump, Gemcitabine, Paclitaxel, Rituximab, Trastuzumab and Vinorelbine, with a percentage of standardisation of 77% [SRD: 30 mg), 61% [SRD: 700 mg, 750 mg, 800 mgl, 75% (SRD: 4000 mg, 4500 mg, 5000 mg), 72% [SRD: 1600 mg, 1800 mg, 2000 mg), 61% [SRD: 140 mg, 150 mg, 160 mgl, 64% (SRD: 600 mg, 700 mg, 750 mg], 71% (SRD: 350 mg, 400 mg. 450 mgl et 62% [SRD: 40 mg, 50 mg] respectively.

Conclusion: This preliminary study allows us to consider implementing the dose banding concept in order to optimize the chemotherapy circuit at our institution.

This article gives an update on how the composition of the influenza virus vaccine is determined, how the infection spreads, and what the consequences are of the disease. Next flu season for the first time a quadrivalent and intranasal vaccine will be available on the Belgian market. What is the difference with what we know until now? Is there an added value? How about the contraindications? Furthermore we elaborate on the composition of the influenza vaccine on the Belgian market for the season 2015-2016 and we give a reminder of the patient groups with a high risk for complications. As pharmacists we should motivate these patients to get themselves vaccinated. Finally, we discuss the reimbursement conditions of the National Institute for Health and Disability Insurance INIHDII.

Adherence of patients with chronic conditions to their treatment is generally low. However, poor medication adherence or persistence reduces therapeutic effectiveness and increases morbidity and health care costs. This is also the case for anti-osteoporotic treatments that, in order to be effective, must be taken correctly, regularly and long-term. The community pharmacist can play an important role in encouraging long-term adherence to antiosteoporotic treatments. To promote adherence, it is essential, from the beginning, to give to the patient the information needed for a good understanding and a proper course of treatment. The repeated contact between pharmacist and patient creates an opportunity to regularly assess adherence. In order to improve adherence, one needs to identify the causes of non-adherence and adapt the interventions accordingly. Persistence also requires follow-up of the patient. Regular reassessment of patient's adherence, taking into account changes that may affect his expectations, preferences and priorities, is essential to adjust interventions to his new needs. This article suggests ways and tools to improve therapeutic adherence, particularly in osteoporotic patients.

Background: Other injectable preparations than parenteral nutrition admixture and injectable cytotoxic drugs could be prepared by Centralised IntraVenous Admixture Service (CIVAS) if the Long-term stability of the drugs is known. However, this information is not always available.

Purpose: To develop a program of chemical drug stability analysis in collaboration between Hospital Pharmacy, Medical Laboratory and Scientific Support Unit to determine the long-term stability of largely used injectable anti-infectious and non-anti-infectious drugs.

Material and methods: After a setup of the High Performance Liquid Chromatography (HPLCI method, 28 drugs were reconstituted in laminar air flow hood, 17 of them stored directly at 5 +/- 3 degrees C and 19 stored in the freezer at -20 degrees C, thawed by microwave following a standardised procedure and stored at 5 +/- 3 degrees C before use. Concentration stability was evaluated by regression analysis.

Results: For each drug, long-term stability has varied from 11 days to 180 days. The freeze-thaw treatment by microwave may enhance the stability (from 30 to 120 days) and allow batch-scale production of intravenous drugs, less expensive in term of manpower and sterile device than a drug reconstitution at the ward. The results were published by 55 posters in international congress and by 36 publications in national and international pharmaceutical journals.

Conclusions: Our findings contribute to enhance the scale of drugs that may be take on by a CIVAS.

Background: Medication errors (ME) could lead to severe adverse events. Hospital staff have to gain practical knowledge and ME preventing methods. Simulation is a teaching method more and more used in health system. The aim of this study was to create an error patient room which represents a factitious patient room with ME for health professionals of the hospital.

Method: Chosen according 3 criteria (errors already observed, "never events" related errors, errors associated with frequent issues), 21 ME were designed concerning the different steps of the medication process (prescribing, dispensing and administration) and took place in a patient room reserved for training. Seven sessions were proposed from april to june 2014. All health professionals were invited to participate on a voluntary basis. Training session was not time limit. An individual debriefing was done after each session.

Results: Forty-six health professional participated of 13 different hospitals' departments: 7 medicine residents, 26 nurses and 13 persons of the pharmacy staff (8 pharmacy technicians, 3 pharmacy students and 2 pharmacists). EM rate ranged of 33% (medicine residents), 50% (nurses) to 47% (pharmacy staff).

Discussion - conclusion: The training ME room represents an easy, useful and reusable simulating tool, to train health professional and to improve their knowledge's and practical methods. This learning tool is developed in order to provide patient safety. This successful study will be evaluated by satisfaction questionnaire. Future sessions will be programmed.

In order to prevent and control the chemotherapy-induced nausea and vomiting (CINV), the military hospital Percy (Clamart, France) developed a systematic "CINV consultation". With 1.500 consultations conducted in 2013, the aim of this study was to confront professional practices and the patient's point of view to assess the efficiency of this procedure and consider a restructuring to optimize it. A preliminary study was conducted: 30 medical records of patients who had chemotherapy cure during 2013 have been analysed and 30 patients have completed an evaluation questionnaire anonymously. Patients were very satisfied (63%) or satisfied (37%) of these consultations. Most of them (71%) said the consultations were useful before every cure, while 27% thought that the consultation at first cure or when the chemotherapy protocol changed was enough. CINV consultations were estimated as complementary of the medical consultation for 93% of the patients. Most of the patients (70%) never had CINV or just at the first cure. Furthermore, the anti-emetic treatment was adapted to the new chemotherapy emetic level in only 53% of protocol changes. Patients have expressed a real interest in these CINV consultations and the benefits they could get from them. Moreover, patients' side effects are stabilized faster thanks to those pharmaceutical interviews. In fact, it seems that these consultations are mostly needed for the first cure (until patient stabilization) and when there is a chemotherapy protocol change.