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Background Clinical pharmacy is an effective pharmaceutical discipline in drug therapy management and in preventing iatrogenic events. Clinical pharmacy studies in the medical device context are, however, rare in the current literature. Purpose The purpose of this study is to prove that clinical pharmacy is effective in the medical device context by reducing PICC line complications post-implantation. Methods CLIPICC is a prospective before-and-after single-centre study conducted in a University Hospital. The study comprised two successive phases: an initial observational phase (OP), where no clinical pharmacy activities were carried out, followed by an interventional phase (IP), where clinical pharmacy activities were implemented along the patient’s hospital and primary care pathway. The key outcome of the study was the number of complications per month and per patient in each phase. Comparisons were made using negative binomial regression. Univariate and multivariate analyses were performed with R software. Results A total of 138 patients were enrolled in the study. In the OP, 40 patients (59.7%) presented at least one complication with 80 complications being recorded overall in 67 patients. In the IP, 30 patients (45.5%) had at least one complication with a total of 39 complications documented in 66 patients. The number of complications per patient and per month was halved in the interventional phase. Conclusion Clinical pharmacy interventions along the entire care pathway are effective in preventing complications following implantation of PICC lines. Trial registration: NCT04359056.

BACKGROUND Smartwatches enable physicians to monitor symptoms in patients with knee osteoarthritis, their behavior, and their environment. Older adults experience fluctuations in their pain and related symptoms (mood, fatigue, and sleep quality) that smartwatches are ideally suited to capture remotely in a convenient manner. OBJECTIVE The aim of this study was to evaluate satisfaction, usability, and compliance using the real-time, online assessment and mobility monitoring (ROAMM) mobile app designed for smartwatches for individuals with knee osteoarthritis. METHODS Participants (N=28; mean age 73.2, SD 5.5 years; 70% female) with reported knee osteoarthritis were asked to wear a smartwatch with the ROAMM app installed. They were prompted to report their prior night’s sleep quality in the morning, followed by ecological momentary assessments (EMAs) of their pain, fatigue, mood, and activity in the morning, afternoon, and evening. Satisfaction, comfort, and usability were evaluated using a standardized questionnaire. Compliance with regard to answering EMAs was calculated after excluding time when the watch was not being worn for technical reasons (eg, while charging). RESULTS A majority of participants reported that the text displayed was large enough to read (22/26, 85%), and all participants found it easy to enter ratings using the smartwatch. Approximately half of the participants found the smartwatch to be comfortable (14/26, 54%) and would consider wearing it as their personal watch (11/24, 46%). Most participants were satisfied with its battery charging system (20/26, 77%). A majority of participants (19/26, 73%) expressed their willingness to use the ROAMM app for a 1-year research study. The overall EMA compliance rate was 83% (2505/3036 responses). The compliance rate was lower among those not regularly wearing a wristwatch (10/26, 88% vs 16/26, 71%) and among those who found the text too small to read (4/26, 86% vs 22/26, 60%). CONCLUSIONS Older adults with knee osteoarthritis positively rated the ROAMM smartwatch app and were generally satisfied with the device. The high compliance rates coupled with the willingness to participate in a long-term study suggest that the ROAMM app is a viable approach to remotely collecting health symptoms and behaviors for both research and clinical endeavors.

Resume Les reactions cutanees associees a une prise medicamenteuse sont frequentes. Elles representent 20 % des notifications spontanees et peuvent compliquer 2 a 3 % des hospitalisations. Les effets indesirables lies a la prise de medicaments psychotropes sont nombreux mais la frequence des toxidermies est rare dans la litterature, probablement sous-notifiee. L’objectif de cet article est de faire un etat des lieux des divers cas de reactions cutanees declares dans la population suite a la prise d’un traitement psychotrope. Une recherche bibliographique a donc ete effectuee sur differentes bases de donnees (EBM Reviews, PubMed, Web of Science, PsycINFO et PsycArticles) en utilisant les termes anglais de « rash », « cutaneous » et le nom des medicaments incrimines. Un certain nombre de reactions cutanees d’origine medicamenteuses sont rapportees, dans la litterature, sous psychotropes. De nombreux cas de reactions urticariennes, des erythemes ou des exanthemes maculopapuleux ont ete decrits. Ces reactions ne sont pas anodines puisqu’elles peuvent provoquer une prolongation d’hospitalisation et, dans une faible proportion, le deces. Une reaction cutanee severe doit faire arreter le medicament incrimine. Une connaissance de ces toxidermies sous psychotropes doit etre acquise par tous les praticiens utilisant cette classe medicamenteuse. Il convient de garder en memoire que chaque medicament prescrit doit etre considere comme potentiellement capable de provoquer, parmi les effets indesirables, des reactions cutanees. Ainsi, les psychotropes n’echappent pas a cette regle et le prescripteur ainsi que le patient doivent etre sensibilises a ce type d’effet indesirable.

The objective of this study was to evaluate satisfaction, usability and compliance using the Real-Time, Online Assessment and Mobility Monitor (ROAMM) application designed for smartwatches. Twenty-eight older adults with knee osteoarthritis (66-88 years old) wore a Samsung Gear S3 smartwatch with ROAMM. While wearing the watch for 13.16 (±2.94) days, participants gave ecological momentary assessments (EMA) of pain intensity, mood and fatigue at random times in the morning, afternoon and evening. EMA compliance rate was 82.5%. Satisfaction ratings were high with 73% reporting being satisfied with the function, 78% reported being satisfied with the comfort and 73% reported as likely to use ROAMM on a daily basis for a one-year research study. Participants reported to reduce watch size and weight, style and increase battery life. Older adults were compliant to ecological assessment of their symptoms and reported positive usability and satisfaction of wearing a smartwatch and ROAMM app.

Arterial hypertension is among the leading risks for mortality. This burden requires in hypertensive patients the use of single, double or more antihypertensive drugs. The relationship between intracranial pressure (ICP) and arterial blood pressure is complex and still under debate. The impact of antihypertensive drugs on ICP is unknown. We wanted to understand whether the use of antihypertensive drugs has a significant influence on ICP and cerebrospinal fluid (CSF)/brain related parameters.In a cohort of 95 patients with suspected normal pressure hydrocephalus, we prospectively collected drug details according to the Anatomical Therapeutic Chemical (ATC) classification. Lumbar infusion studies were performed. Using ICM+ software, we calculated at baseline and plateau ICP and pulse amplitude, resistance to CSF outflow, elastance, and pressure in the sagittal sinus and CSF production rate. We studied the influence of the administration of 1, 2, 3 or more antihypertensive drugs on ICP-derived parameters. We compared the data using Student's and Mann-Whitney tests or Chi-squared and Fisher's exact test.Elastance is significantly higher in patients with at least one antihypertensive drug compared with patients without medication. On the contrary, pressure volume index (PVI) is significantly decreased in patients with antihypertensive drugs compared with patients not on these medications. However, the number of antihypertensive drugs does not seem to influence other ICP parameters.Patients on antihypertensive drugs seem to have a stiffer brain than those not on them.

Rationale, aims and objectives Hospital clinical pharmacists are involved in teaching students during professional internship. Organization between the unit care and the pharmacy place is complicated. This study evaluated the effectiveness of two pharmaceutical teams: an experienced pharmacist in the pharmacy place, reachable by phone (team 1) or an experienced pharmacist in the ward, near patients and students (team 2). Methods Pharmaceutical interventions were collected during two successive time periods, each of 6 months in a 15-bed unit (neurology). During the first time period, prescriptions were analyzed by the student (resident) in the ward and experienced pharmacist in the pharmacy place. During the second time period, prescriptions were analyzed by both experienced pharmacist and the resident in the ward. We compared the number, the type, the approval of pharmaceutical interventions and the medication reconciliation activities. Proportions were compared by a chisquared test (or Fisher exact test) as well as the quantitative value was calculated by a Student test. Results ‘Mentoring and supervising’ students in the ward increased significantly the number of pharmaceutical interventions (PI; 104 interventions for 1408 analyzed prescriptions (7.4%) by the students in the ward and 317 interventions for 1391 (22.8%) by both the experienced pharmacist and the students in the ward (P = 0.002). Furthermore, specific interventions from medication reconciliation were significantly increased by the presence of experienced pharmacist in the ward (0.96% vs. 8.83% P = 0.018). Conclusion Effectiveness of clinical pharmacists can be improved by the presence of experienced pharmacist at patients’ bedside, near students.

Resume Introduction L’accident vasculaire cerebral (AVC) est une pathologie de survenue brutale, responsable d’un grand nombre de handicaps, de demences et de deces dans les pays occidentaux. Le traitement de reference de la prevention secondaire, essentiel pour diminuer le risque de recidive, est l’acetylsalycilate de lysine ou aspirine. En cas de fibrillation atriale (FA), les anticoagulants sont indiques. En 2012, l’extension de l’autorisation de mise sur le marche (AMM) des nouveaux anticoagulants oraux (communement appeles NOAC), plus precisement les anticoagulants oraux directs (AOD) dans la prevention des AVC chez les patients adultes atteints de FA non valvulaire, a entraine une progression des prescriptions d’AOD et notamment de dabigatran et rivaroxaban. Devant le risque iatrogene hemorragique, une information du patient, un accompagnement a la prescription et a l’analyse pharmaceutique ainsi qu’un suivi dans le temps, paraissent indispensables conformement au plan national pour la securite des patients (PNSP 2013–2017). Methodes Des outils ont ete elabores par les medecins de l’unite neurovasculaire (UNV) du CHU Toulouse Purpan, en collaboration avec les pharmaciens cliniciens, grâce a un partenariat avec les equipes d’education therapeutique de cardiologie et de medecine vasculaire. Les sources bibliographiques validees sont les recommandations des caracteristiques des produits, les avis de transparence de la Haute Autorite de sante (HAS) et les communications de l’Agence nationale de la securite du medicament (ANSM). Les documents ont ete valides par la Commission des medicaments et des dispositifs medicaux steriles (COMEDIMS) et une diffusion est prevue sur le site de l’Agence regionale de sante (ARS). Resultats Les outils crees sont des brochures informatives personnalisees pour le patient servant de support a l’entretien pharmaceutique, un tableau d’aide a la prescription et a l’analyse pharmaceutique dans le but de lutter contre l’iatrogenie medicamenteuse et un feuillet d’enregistrement permettant de realiser un suivi a plus long terme des patients. Conclusion Ce travail pluridisciplinaire a pour but de prevenir l’iatrogenie medicamenteuse et de promouvoir le bon usage du medicament. Il resulte et concretise une bonne integration des pharmaciens cliniciens dans une UNV.

Objectives: Arterial hypertension is among the leading risks for mortality. This burden requires in hypertensive patients the use of single, double or more antihypertensive drugs. The relationship between intracranial pressure (ICP) and arterial blood pressure is complex and still under debate. The impact of antihypertensive drugs on ICP is unknown. We wanted to understand whether the use of antihypertensive drugs has a significant influence on ICP and cerebrospinal fluid (CSF)/brain related parameters.

Peripheral serotonin (5-HT) has been involved in adverse cardiac remodeling and valve fibrosis. The peripheral levels of 5-HT mainly depend on its release from activated platelets and degradation by monoamine oxidase A (MAO-A). The SERAOPI study investigated the relationship between arterial serotoninergic system, degree of platelet activation and cardiac remodeling, in patients with aortic valve stenosis (AS). Thirty patients with severe AS and 15 control subjects underwent transthoracic echocardiography, radial, and aortic arterial blood sampling. Measurements of 5-HT and its MAO-A-dependent degradation product, 5-HIAA, were performed by HPLC. Arterial platelet activation was assessed by flow cytometry analysis of platelet surface expression of P-selectin and activated integrin GPIIb/IIIa. Activated platelets and arterial plasma 5-HT increased in AS patients as compared to control subjects (P-selectin 1.08 ± 0.2MFI vs. 0.49 ± 0.1MFI, P = 0.04; GPIIb/IIIa 0.71 ± 0.1MFI vs. 0.35 ± 0.1MFI; P = 0.0015 and arterial plasma 5-HT 11.55 ± 1.6 nM vs. 6.18 ± 0.7 nM, P = 0.028, respectively). Moreover, 5-HT was strongly correlated to left ventricular hypertrophy assessed by echocardiography. The correlation was independent of cardiovascular risk comorbidities and others echocardiographic AS parameters. Finally, plasma 5-HIAA increased in AS patients (74.64 ± 9.7 nM vs. 37.16 ± 4.1 nM; P = 0.0002) indicating a higher 5-HT degradation rate by MAO-A. Platelet activation, arterial circulating serotonin, and serotonin degradation increased in patients with AS. These observations suggest that the serotoninergic system may contribute to the pathogenesis of AS including valve fibrosis and adverse ventricular remodeling. Am. J. Hematol. 90:15–19, 2015. © 2014 Wiley Periodicals, Inc.

International audience; Serotonin (5-HT) regulates different cardiac functions by acting directly on cardiomyocytes, fibroblasts and endothelial cells. Today, it is widely accepted that activated platelets represent a major source of 5-HT. In contrast, a supposed production of 5-HT in the heart is still controversial. To address this issue, we investigated the expression and localization of 5-HT synthesizing enzyme tryptophan hydroxylase (TPH) and L-aromatic amino acid decarboxylase (AADC) in the heart. We also evaluated their involvement in cardiac production of 5-HT. TPH1 was weakly expressed in mouse and rat heart and appeared restricted to mast cells. Degranulation of mast cells by compound 48/80 did not modify 5-HT cardiac content in mice. Western blots and immunolabelling experiments showed an abundant expression of AADC in the mouse and rat heart and its co-localization with endothelial cells. Incubation of cardiac homogenate with the AADC substrate (5-hydroxy-L-tryptophan) 5-HTP or intraperitoneal injection of 5-HTP in mice significantly increased cardiac 5-HT. These effects were prevented by the AADC inhibitor benserazide. Finally, 5-HTP administration in mice increased phosphorylation of aortic nitric oxide synthase 3 at Ser (1177) as well as accumulation of nitrates in cardiac tissue. This suggests that the increase in 5-HT production by AADC leads to activation of endothelial and cardiac nitric oxide pathway. These data show that endothelial AADC plays an important role in cardiac synthesis of 5-HT and possibly in 5-HT-dependent regulation of nitric oxide generation.