Background and ImportanceTherapeutic angioplasty (TA) allows the dilatation of coronary stenosis. This minimally invasive procedure, often combined with diagnostic angiography, requires various ...costly medical devices (MD).Aim and ObjectivesThis study was conducted to highlight if there is a difference in interventional cardiology (IC) practices between physicians and estimate the associated costs.Material and MethodsFirst, data (characteristics of cardiac procedures (CP), number and type of MD (nMD)) were extracted from the cardiovascular information software (Cardioreport®) on a period of three months. Then, Excel® was used to calculate the average MD cost (AC) per procedure for each operator. Finally, data were explored in RStudio® using the Multiple-Regression, Clustering with K-means and Ward’s method, in order to classify the similitudes and visualise the differences in practices.ResultsOur sample of 74 CP includes 11 TA and 63 combined procedures. These, concerned 63 patients (average age 68 years), 26% of females and 76% of males among whom 10 had at least 2 CP. The AC estimated per procedure is €1125 of which €602 is not covered by additional payments (NCA) while €523 is covered (CA). Five physicians A/B/C/D/E operate in IC with a respective percentage of activity of 5%/9%/12%/22%/51%.Abstract 2SPD-013 Table 1 Operator A B C D E CA 539€ 821€ 899€ 474€ 552€ NCA 327€ 989€ 675€ 578€ 407€ Multiple-Regression shows that cost of CP is explained at 89% by nMD and NCA cost as significant variables (adjusted R²=0.891 with P-value <5% (1.465e-12) so null-hypothesis can be rejected). Clustering and Ward’s dendrogram grouped procedures with common characteristics and showed that there were differences in practices among physicians. After excluding operators, A and E, clustering shows that operator C is singular in his practices (with a higher rate of complex procedures defined as longer than 90 minutes for combined procedures), while B and D have similarities in terms of choice of MD.Conclusion and RelevanceThe hospital pharmacist, as MD expert plays a central role in managing consumption analysis. Expanding the sample to confirm the results would be more relevant. Thus, it would be interesting to explore the impact of communicating this work to physicians in order to homogenise their practices.References and/or AcknowledgementsConflict of InterestNo conflict of interest
Dextrous artificial hand design and manipulation is an active research topic. A very interesting practical application is the field of upper limb prosthetics. This paper presents the mechanical ...design and manipulation aspects of the MANUS-HAND project to develop a multifunctional upper limb prosthesis. The kinematics of our design makes use of the so-called underactuated principle and leads to an innovative design that triples the performance of currently existing commercial hand prosthesis. In addition, the thumb design allows its positioning both in flexion and opposition. As a consequence, up to four grasping modes (cylindrical, precision, hook and lateral) are available with just two actuators.The proposed impedance control approach allows the fingers to behave as virtual springs. Given the difficulty of including the user in the control loop, this approach is based on an autonomous coordination and control of the grasp. As a consequence, the requirements on the Human Machine interface are reduced. At the end of the paper, we briefly describe the clinical trials that were set up for evaluation purposes.
BackgroundThe Falsified Medicines Directive (FMD) and the Delegated Regulation (DR) 2016/161 will require, from 9 February 2019, hospital pharmacies to check the authenticity of each medicinal ...product they receive. Our hospital participates in a test with the National Medicines Verification Organisation to evaluate possible strategies, compatible with legislation, for the implementation of serialisation.PurposeThe aim of the first test is to evaluate the feasibility of decommissioning of each unique identifier at the reception of medicinal products in the pharmacy.Material and methodsDuring 14 days (summer 2018), the pharmacy technician scanned the data-matrix of each box received with an Optel certa tabletop (possibility of switching between vertical and handheld scanner). Quantitative indicators (number of boxes received, number of serialised drugs in circulation, products with a non-compliant data matrix) were recorded. The scanning time of each carton was measured and the equipment’s ergonomics evaluated.ResultsDuring the study, the pharmacy received an average of 822 boxes/day (min: 273; max: 1737), of which 90% were in the scope of the FMD and the RD. The average scanning time per pack was 5 s, totalling an average of 56 minutes/day to scan all boxes. Only 3/530 medications displayed a serial number, while three of them (nicardipine, pemetrexed, midazolam) had a non-readable data-matrix (colour inversion) on their packaging and thus could not be scanned. The Optel certa tabletop and its software are considered easy to use. But the manoeuverability and malfunctions of the handheld scanner contributed to inflate the scanning time.ConclusionThis first test demonstrated the technical feasibility of decommissioning boxes on their reception in real working conditions. The connection to the National Medicines Verification System was not effective during the test, so the upload time between interfaces could not be evaluated. The imposing equipment leads to opting for mobile and compact scanning devices. Decommissioning at reception confronts us with repeated interruptions of tasks (deliveries, phone calls …) but avoids the storage of non-authentic and non-conforming boxes. A second decommissioning test just before dispensing to patients is planned to assess the feasibility of this scenario.References and/or acknowledgementsFalsified Medicines Directive.Delegated Regulation 2016/161.No conflict of interest.
4CPS-174 A new breath for clozapine Chane-Kene, A; Plassart, F; Chauvel, O ...
European journal of hospital pharmacy. Science and practice,
03/2019, Letnik:
26, Številka:
Suppl 1
Journal Article
Recenzirano
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BackgroundClozapine, the first atypical neuroleptic (NL) marketed has had to compete with other NL medications, better tolerated and without any prescription constraints.PurposeIn order to understand ...the situation of clozapine today, a study reviewed clozapine prescriptions (Q1 and Q2 of 2018) and a perception survey with the hospital’s psychiatrists.Material and methodsA computerised extraction of hospitalised patients receiving clozapine from January to June 2018 was performed. The criteria collected were: age, gender, indication, previous treatment and coprescription. The survey investigated the prescription modalities: practice, average dosage (AD), adverse events (AE), efficacy and opinion about the risk management plan (RMP).ResultsThe study retrieved 13 patients (four females; nine males), average age 59.7 years. Schizophrenia was diagnosed for seven of them (AD 350 mg), and a Lewy Body Dementia (LBD) (AD 31 mg) for the six others. Clozapine dosage for LBD never exceeded 50 mg per day. For schizophrenia, clozapine was prescribed in the third or fourth line due to the previous treatment inefficacy (linked to noncompliance in 60%). Clozapine was maintained from 10 months to 4 years. Eight psychiatrists answered our survey: risperidone was favoured (6/8) for its sustained-release formulation and clozapine was prescribed in the third line (5/8). Sedation, hypersialorrhea and priapism were reported by three psychiatrists and one reported agranulocytosis. Clozapine was judged effective (5/8) to very effective (3/8) and the RMP did not limit the prescription (8/8). The prescription of clozapine fulfilled the official recommendations and the AE were already described in the literature. Our study concerned hospitalised patients, unrepresentative of those who were followed up by the Medico-Psychologic Centre (38 patients). Its use is positively perceived by psychiatrists. Nonetheless, the quality of the doctor-patient relationship influences compliance because hospitalisation for starting therapy and medical monitoring are needed. On the other hand, patients responding to treatment can be stabilised for many years. In a word, the psychiatrists prefer a sustained-released formulation (one tablet per day) and lighter medical monitoring.ConclusionPatient’s acceptance of clozapine is a sine qua non condition for a successful therapy. Its efficacy can predict an earlier and frequent use.References and/or acknowledgementsNone.No conflict of interest.
BackgroundOur production unit realises more than 35 000 cytotoxic drug preparations per year in an isolator chamber (IC). The control method is done by in-process gravimetric analysis coupled with ...scan identification, led by software with interactive instructions. The balances are certified once a year, yet outside the IC. Indeed, turbulent airflow could impact the scales’ measurements. The accepted errors percentages are a function of the volumes weighted.PurposeAfter software development and setup, we need to validate this control method with the two components: the weighing scales and the software.Material and methodsFor the weighting scales, a qualification was made inside and outside the IC with standard weights. For the validation the tests performed were fidelity, accuracy and eccentricity. Then, a comparison to visual control was performed to evaluate the bias of the balance. Six syringes with different volumes were made and then verified by a third person. Next, they were weighed 15 times to obtain the total error. For the software, a method is being developed to analyse the specificity and the sensitivity. For the specificity, an extraction of the software was done to study the forced steps (the steps refused by the software but accepted by the pharmacist because of the correct volume read) over a period of 6 months.ResultsThe metrological tests enable to qualify the balances. The bias of the weighing scales fluctuates between 0.94% and 4.40%. Over 6 months, 15 227 preparations were realised with a total of 1 89 334 steps including 49 180 weighing steps. Among those, there were 2023 forced steps (4.1%). The most forced cytotoxic molecules were identified. The two most forced stages were the weighing of the syringe with cytotoxic (41%) and of the final pouch (23%). The 50 ml syringe is responsible for 41% of this forced stage and, in 85% of the cases, it is because the volume to collect has a decimal value.ConclusionConcerning the sensitivity, a method is elaborated to determine the rate of the false negatives with a fake cytotoxic preparations plan and calculated weighing errors. Our method validation plan is complete with the validation of the two components: precision scale and software.References and/or acknowledgementsNo conflict of interest.
BackgroundLidocaine 5% plaster is licensed for the symptomatic relief of pain associated with post-herpetic neuralgia. Over the past 4 years, an increase of more than 50% of its consumption has been ...observed within our hospital.PurposeThe objective of this work was to evaluate the use of this drug in our institution as well as the impact of hospital practices on primary care.Material and methodsA retrospective study of 5% lidocaine plaster prescriptions was conducted from 1 January 2017 to 1 May 2018. Using computerised and physical patient records, the following data were collected: age, service, indication, dosage, duration of prescription and mention on the discharge prescription.In parallel, the evolution of hospital spending on this drug was compared to the evolution of the expenses generated by hospital outpatients’ prescriptions.ResultsIn this evaluation, 111 prescriptions of lidocaine 5% plaster were analysed for the period studied. The average age of patients was 72 years (18–99 years). Less than half of the prescriptions mentioned the therapeutic window (53/111). The largest prescribing services were the palliative care unit (36/111) and the geriatric long-term care unit (28/111). Regarding the indications, only 3% (3/111) of the prescriptions matched the official labelling, 79% (88/111) were off-label and 18% (20/111) did not specify an indication. The lidocaine 5% plaster was mentioned on approximately 50% of the discharge prescriptions.ConclusionMost of the prescriptions analysed concern off-label indications initiated by doctors specialised in pain management. The bibliographic review shows efficacy results that vary from one publication to another. In consequence it is necessary to set up a multidisciplinary working group to supervise the prescription procedures in our hospital (characterisation and evaluation of neuropathic pain, validation of the main indications).This initiation of this work already shows an impact on primary care: since the introduction of a systematic pharmaceutical control on the dispensing of this drug within the hospital, expenses in community pharmacies were reduced by 16% (€2 32 000 in 2016 versus €1 95 000 in 2017).This first evaluation allows us to assess the use in real life of an increasingly prescribed anaesthetic medication.References and/or acknowledgementshttps://www.has-sante.fr/portail/upload/docs/application/pdf/2012–06/versatis_ct_8107.pdfNo conflict of interest.
BackgroundSacubitril-valsartan (SV) is a new drug association for chronic symptomatic heart failure (HF) with altered left ventricular ejection fraction (LVEF). Since January 2016, three different ...strengths (24/26 mg, 49/51 mg, 97/103 mg) are available in hospital pharmacies only.PurposeThe main objective is to assess the conformity of SV prescriptions in clinical practice, in agreement with its summary of product characteristics (SPC), after 1 year on the market. The second aim is to evaluate the patients’ compliance and quality of life (QoL).Material and methodsPatients who received SV at our hospital’s dispensing desk from 1 January 2016 to 30 June 2017 are included. SPC conformity is evaluated only for the prescriptions initiated in our hospital. Compliance is measured by the medication possession ratio (MPR) for the patients receiving SV for more than 3 months. QoL is evaluated with the Minnesota Living with Heart Failure Questionnaire, for the patients who came at the hospital’s dispensing desk from June 2017 to September 2017.ResultsFifty-two patients are included, sex ratio M/F 5, average age 64±15 years. Thirty-five treatments were initiated by our hospital’s physicians: 94% by cardiologists and 6% following cardiologic advice. In accordance with the SPC, no patient presented any contraindication. Sixty-nine per cent and 20% of the patients were previously treated by angiotensin-converting-enzyme inhibitor and angiotensin II receptor blockers respectively. All patients had a glomerular filtration rate >30 mL/min. But SV is non-indicated for five patients (LVEF >35%). Moreover, the initial dose was given according to the SPC for only 28 patients, 17 patients had no titration to the target dose and 13 patients had a follow-up with a brain natriuretic peptide rate measurement.Compliance has been evaluated for 43 patients. It is optimal (MPR ≥100%) for 19 patients and poor for 16 patients (MPR <80%).QoL measured for 14 patients, averaged 27±16, which seems to be better than in the general HF population: 63.7±2.30.1 ConclusionSV is prescribed in the right indication, but the initiation dose’s choice, its subsequent titration and the biological follow-up can be improved. Despite a low compliance, SV might help to strongly improve the QoL of HF patients.Reference and/or Acknowledgements1. Alla F. Self-rating of quality-of-life provides additional prognostic information in heart failure. Eur J Heart Fail2002;4:337–343.No conflict of interest
1ISG-014 Iso 9001 certification: customer focus Cayre, F; Baillet, L; Fercocq, C ...
European journal of hospital pharmacy. Science and practice,
03/2018, Letnik:
25, Številka:
Suppl 1
Journal Article
Recenzirano
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BackgroundAs part of the ISO 9001 certification process of our hospital’s centralised cytotoxic preparation unit, customer focus is essential for monitoring and continuously improving quality. An ...annual satisfaction survey was carried out among the physicians and nurses of our hospital (14 000 annual preparations) and the pharmacists of the five health institutions which subcontracted the preparation of their cytotoxic drugs to our unit (22 500 annual preparations).PurposeTo evaluate the adequacy of the satisfaction survey methodology for the annual monitoring of quality and customer satisfaction.Material and methodsThree separate questionnaires (physicians, nurses, pharmacists) were sent to the concerned staff to assess the past year. The items addressed were overall satisfaction, communication, overall circuit quality, clinical pharmacy activities, preparations’ quality, transport and delivery, billing and management of customer claims. For each item, a score or a rate of satisfaction was calculated and each centre’s specific problems were identified. A personalised report detailing the causes and remedial actions was then sent to each health institution.ResultsThirty-seven people participated to the survey (including 75% of the pharmacists surveyed and 47% of the physicians surveyed). The overall satisfaction grade was 17.4/20 and the satisfaction rates were: 99.5% (communication); 94.6% (circuit); 94.3% (clinical pharmacy); 98.3% (preparations); 89.5% (transport/delivery); 100% (billing) and 99.1% (customer claims). The remedial actions implemented in our hospital were the preparation in advance of standardised doses of rituximab to limit patients’ wait and the creation of several quality indicators, including the time between the demand and the delivery of a preparation. For the health institutions in subcontracts for their preparations, a quality indicator has been set up to monitor the conformity of the departure times of deliveries and the carrier company has been replaced for one of them.ConclusionThe methodology used (format of the questionnaires, items addressed, staff surveyed, rating modalities) allows the standardisation of answers and their exploitation. Repeated annually, this satisfaction survey will permit an objective comparison of the results and a follow-up of the evolution of quality and customer satisfaction.No conflict of interest
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