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Death rattle, which could often be associated with a pulmonary fluid overload, occurs in 25% to 90% of dying patients. The co-administration of scopolamine (anticholinergic drug) and bumetanide (loop diuretic) could be considered in order to avoid unnecessary fluid overload at end-stage of life. The objective of this study was to investigate the physical and chemical stabilities of the admixture bumetanide and scopolamine in order to prepare them in advance by a centralized intravenous additive service in-hospital pharmacy. The stability of the lowest (LOW) concentration was evaluated on five polypropylene syringes containing the admixture bumetanide (Burinex, 2 mg/4 mL) and scopolamine (0.25 mg/mL) at 41.67 µg/mL and 5.21 µg/mL. The highest (HIGH) concentration with 125 µg/mL of bumetanide and 31.25 µg/mL of scopolamine was evaluated on five polypropylene syringes. All syringes were stored for 18 days at 5°C ± 3°C. Periodic samples were visually and microscopically examined to observe any particle appearance or color change. The pH and absorbance at 3 wavelengths (350 nm, 410 nm, and 550 nm) were monitored. The concentrations were measured by ultra-high performance liquid chromatography-photodiode array detection, using a newly developed method. During the 18 days of test, there was no change in color or appearance of opacity, turbidity, or precipitation, and the pH remained stable. Mean concentrations of bumetanide and scopolamine at LOW and HIGH concentrations after 18 days remained statistically unchanged. The lower limits of the 95% confidence intervals of both molecules at LOW and HIGH concentrations remained higher than a 90% threshold of concentration, indicating the mixture was chemically stable. Degradation rates of bumetanide and scopolamine content at LOW and HIGH concentrations should not exceed a maximum of 0.70% every 10 days. This study was the first to show that the admixture of bumetanide and scopolamine is physically and chemically stable at two concentrations used in a palliative-care unit. This combination available in ready-to-use polypropylene syringes presents numerous advantages for patient's comfort and safety.

Table S1. Fried’s Frailty Criteria used for the study. The 5 criteria of the Fried’s Phenotype included unintentional weight loss (more than 4.5Kg in the past year), exhaustion, low physical activity (adapted from the InChianty study), slow walking speed (first quintile of walking speed in FRéLE study) and weakness (first quintile of grip strength in FRéLE study). (DOCX 15 kb)

Table S2. Mean (SD) of biomarkers in robust, pre-frail and frail caregivers. At baseline, trends were observed between inflammatory and nutritional markers and frailty status. The mean levels of CRP and IL-6 were higher in frail caregivers than in robust caregivers. In contrast, mean levels of nutritional markers were lower in frail caregivers than in robust ones. (DOCX 13â kb)

Souvent portés par le seul « amour des animaux », les étudiants entamant des études de médecine vétérinaire n’ont pas toujours pleinement conscience des finalités de leur future profession qui se situe au carrefour de nombreuses spécialités, dont la Médecine humaine, la Biologie, l’Ecologie, l’Agronomie, la Psychologie et la Pharmacie. Bien souvent, la diversité et l’étendue de leur formation et plus encore de leur profession leur échappent. Dès lors, si le cours d’Éthologie – dispensé en première année – suscite un grand intérêt chez les étudiants, les cours théoriques et exercices pratiques de Génétique (année 2) et de Statistiques (année 3) génèrent nettement moins d’enthousiasme.Pour pallier ce déficit de motivation, les enseignants en charge de ces trois matières ont décidé d’intégrer leurs exercices pratiques au sein d’un protocole original faisant travailler les étudiants des trois années sur une question scientifique impliquant la mobilisation de connaissances issues des trois cours. Ce 85e numéro de RESEAU présente ce protocole de travaux pratiques trans-générationnels et multidisciplinaires ainsi que les résultats d’une enquête menée auprès des étudiants sur leurs perceptions du dispositif. Il a été rédigé par Claire Diederich, Benoît Bihin, Françoise Tilquin, Jérôme Coppine, Eric Depiereux, Jean-Yves Matroule et Marc Romainville, sur la base d’une communication plus longue.