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En France, les prescriptions hospitalières de médicaments exécutées en ville (PHMEV) représentent près de 30 % du montant total (18 milliards d’euros) de médicaments remboursés sur l’enveloppe de soins de ville. L’objectif de ce travail était d’étudier les trois classes thérapeutiques ayant le plus d’impact sur les dépenses liées aux PHMEV de notre établissement et de proposer une stratégie d’optimisation. A partir de la base Open-PHMEV (Assurance maladie), les données concernant notre établissement pour 2017 ont été analysées. Les dépenses liées aux PHMEV de notre établissement représentent 12,5 millions d’euros, dont principalement les antirétroviraux (ARV), les médicaments de la procréation médicalement assistée (PMA) et les antidiabétiques. Quatre axes d’amélioration sont proposés : promotion de la prescription d’ARV inscrits au répertoire des génériques via un logiciel d’aide à la prescription, tout en maintenant le nombre de prises afin de préserver l’observance, diffusion de fiches sur les coût des stratégies thérapeutiques (VIH, diabète), mise en place d’ordonnances types incluant les génériques et biosimilaires (PMA), et bilans annuels par service prescripteur. La maîtrise de l’évolution des dépenses engendrées par les PHMEV est un enjeu majeur qui s’inscrit dans une démarche d’amélioration de la pertinence des soins.

Connaître les attentes des pharmaciens hospitaliers sur le livret thérapeutique dématérialisé.

The efficacy and safety of an oral pentobarbital suspension for sedation during pediatric MR imaging were assessed.

Le service des urgences accueille quotidiennement des patients victimes d’accidents d’exposition au Virus de l’Immunodéficience Humaine’(VIH) : exposition au sang ou sexuelle (AES). Les trois-quarts de ces AES ont lieu la nuit et le week-end, où les patients sont pris en charge par l’interne de garde de la pharmacie (IDG) qui dispense les médicaments et les conseils associés. Les IDG sont formés à ces dispensations par un cours théorique, mais ils sont seuls en garde et sont parfois confrontés à des situations complexes auxquelles les cours théoriques ne les ont pas toujours préparés. Cette formation trop théorique et peu pratique nous semble donc insuffisante et il nous a paru nécessaire de la renforcer grâce à la simulation.

Comme dans la vie quotidienne, les smartphoneset les Apps ont investi le monde médical. Cette pénétration du monde médical a commencé dès l’apparition des premiers PDAs (Personal Digital Assistants), ancêtre des smartphones, à la fin des années 1980 et s’est accrue à partir de 2007 et l’apparition de l’iPhone. Suite à cette émergence de la m-health, le pharmacien se trouve en face de 3 questions que nous avons étudié dans cette revue : (1) Quelles sont les Apps disponibles pour la pratique et comment les trouver ? (2) Qu’est-ce qui est utile pour la pratique ? (3) Quelles sont les précautions à prendre ?

On précise tout d’abord la notion « d’ions libres » et on rappelle les techniques utilisées pour la détermination de la concentration et de la dimension des particules en suspension dans l’atmosphère des mines d’uranium françaises. La mesure au compteur de noyaux de condensation montre que la concentration moyenne des particules présentes dans l’air de la mine est de l’ordre de 5.104particules/cm3, leur diamètre moyen étant de l’ordre de 0,1 à 0,2 pm. Le spectre de mobilité des particules chargées montre que 60 % du RaA, B et C est fixé sur des particules inférieures à 0,1 µm environ et que moins de 1 % est fixé sur les « ions libres». Les résultats sont ensuite discutés, comparés à la théorie et à ceux obtenus par différents chercheurs étrangers.

Electrical conductivity measurements for aqueous solutions of imipramine and clomipramine hydrochlorides have been carried out from (283 to 313) K. From these data, critical micelle concentrations (CMCs) have been obtained by application of the local polynomial regression method, which is based on a nonparametric estimation of the regression function. The method is extremely flexible because it does not impose any parametric model on the subjacent structure of the data but rather allows the data to speak for themselves. The variation of the CMC with temperature was a second-order polynomial, with different trends for imipramine (convex) and clomipramine (concave). This distinct behavior was analyzed by the effects of dehydration of the headgroups and thermal solubility of molecules.

ABSTRACTWe describe a 7-month outbreak of nosocomial Burkholderia cepaciabacteremia involving eight children in a pediatric hospital and the results of epidemiological investigations. A B. cepaciastrain genotypically identical to the blood isolates was recovered from the upper surface of capped rubber stoppers of bottles of a commercial lipid emulsion used for parenteral nutrition.

Aim:The aim of this study was to evaluate the rates and types of drug prescription and administration errors in one pediatric nephrology ward, comparing two dispensing schemes : the first one defined as handwritten prescription plus ward stock distribution system (WSDS), and the second one as computerized prescription plus unit dose drug dispensing system (UDDDS). Method:Data were collected over an 8‐week period, from 1 February to 31 March 1999. Two fifth‐year pharmacy students photocopied prescription and administration documents on the ward each day, under the supervision of a senior pharmacist. The medical record analysis was used to compare the prescription with the administration report. Prescribing and administration medication errors were classified according to the American Society of Health‐System Pharmacists.Results:Prescribing errors: overall, for both dispensing schemes, a total of 511 prescriptions, resulting in 4532 prescribed drugs (an average of 9 drugs per prescription) were prescribed. The total prescription error rate was 20.7% (937 of 4532), resulting in 1.9 errors per patient per day. The computerized prescription error rate was 10.6% (419 of 3943), the handwritten prescription error rate was 87.9% (518 of 589). This difference was very significant (P< 0.0001).Administration errors:the total opportunity of administration errors was 4589 (sum of administered and omitted drugs). The total administration error rate was 23.5% (1077 of 4589) including wrong administration time, and 11.7% (538 of 4589) excluding administration time. The administration error rate, including administration associated with time errors, was only 22.5% (888 of 3943) for computerized prescription + UDDDS, compared with 29.3% (189 of 646) for handwritten prescriptions plus WSDS (P< 0.001). Excluding administration associated with time errors, the administration error rates were 9.7% and 24.3%, respectively (P< 0.0001). Conclusion:The drug prescription and administration error rates were significantly decreased using computerized prescription plus UDDDS as compared with handwritten prescription plus WSDS in a pediatric unit (even with potential biases taken into account).

The self-association of sodium n-hexyl sulfate (SHS) in aqueous solution has been examined at 25.0 and 35.0 °C. The critical micellar concentration (cmc) and the degree of counterion binding, β, were determined by conductivity measurements at 25.0 °C. Both quantities were used to calculate the standard Gibbs energy change on micellization. The standard enthalpy change on aggregation was measured by microcalorimetry at the same temperature. Good agreement has been found when comparing with the properties of other sodium alkyl sulfates. Densities were measured at the same temperatures. The apparent molal volumes and partial molal volumes have been evaluated at concentrations above and below the cmc. The change in partial molal volumes in the formation of micelles has been evaluated from these measurements. Ultrasound velocity measurements were used to obtain the cmc in water. Apparent adiabatic compressibilities were calculated from a combination of density and ultrasound velocity measurements. Surface tension was measured at a temperature of 25.0 °C. Surface properties were calculated from these data.

This review recounts recent advances in the understanding and treatment of the processes that cause pulmonary hypertension in infancy and childhood. New discoveries have begun to unveil connections between the basic physiological mechanisms responsible for the regulation of pulmonary vascular tone and the abnormal responses of the pulmonary vasculature in a variety of disease conditions. These discoveries raise hope for new therapeutic interventions that may improve the high mortality and morbidity of both children and adults with pulmonary vascular disease. In the meantime, treatment efforts continue to be focused on the relief of pulmonary vaspcon-stnction with inhaled nitric oxide and intravenous prostacyclin in the short term and oral calcium channel blockers as the mainstay of long-term therapy. Lung transplantation often remains as the only viable option for continued survival when the pulmonary vascular disease is progressive. Curr Opin Pediatr 1999, 11:218–222 © Lippincott Williams 4 Wilkins, Inc.

On a etudie l'evolution journaliere des concentrations d'ozone dans une zone urbaine du Sud-Ouest de la France de 500 000 habitants, caracterisee par une pollution essentiellement liee aux automobiles. Les teneurs maximales observees sont inferieures a 60 ppb. La pollution urbaine, c'est-a-dire essentiellement les oxydes d'azote et les hydrocarbures se traduit, dans l'agglomeration, par une diminution des concentrations d'ozone. On observe aussi une anti-correlation tres marquee entre noyaux d'Aitken, indicateur de la pollution, et ozone. Les augmentations observees pendant la journee sont dues principalement au developpement de la convection et aux echanges verticaux de matiere dans la couche limite planetaire.

Infants with respiratory failure are often ventilated at rates exceeding 60 breath–min–1. To obtain insight into the factors controlling the delivery and distribution of tidal volume at these ventilatory rates, we analyzed the inspiratory and expiratory pressure-flow relationships of the respiratory system and its components (lungs, endotracheal tube, and chest wall) in anesthetized, paralyzed rabbits ventilated at 60, 90, and 120 breath–min–1. Inspiratory times were 0.3,0.2, and 0.1 s. Driving pressure was maintained constant. We expressed the effect of ventilatory rate and flow direction on the pressure-flow relationships as changes in compliance, mean resistance, and inertance. We found a nonlinear pressure-flow relationship in both endotracheal tube and respiratory system. This nonlinearity could be accurately described as a function of gas flow and volume acceleration with similar coefficients for tube and respiratory system. Although the inspiratory and expiratory compliance and the mean inspiratory resistance of the lungs were lower at the higher ventilatory rates, the constant resistive behavior of the endotracheal tube and the constant elastic behavior of the chest wall caused a relatively rate-independent pressure-flow behavior of the respiratory system. The lower inspiratory resistance of the lungs was offset by the higher inspiratory resistance of the endotracheal tube, resulting in the resistance of the respiratory system being independent of the direction of gas flow. The rate-dependency of compliance and inspiratory resistance of the lungs suggests an heterogeneous distribution of inspiratory flow at rapid ventilatory rates. At these ventilatory rates, the high resistance of the respiratory system and the nonlinearity of the pressure-flow relationship decrease the tidal volume delivered to the lungs in a magnitude that can be predicted from the time course of the ventilatory pressure.

The frequency of bronchial symptoms and the alteration of respiratory function parameters were studied in a group of 63 workers of an industrial flour-mill, and in a control group matched according to age, social class, and tobacco intake. In the exposed group the answers to a questionnaire indicated a greater incidence of cough (p<0.01) and chronic expectoration (p<0.01) as well as clinical airway hyperreactivity (p<0.01). No differences were noted for either asthma or allergy. The respiratory function parameters did not differ between the two groups studied. These results suggest that workers exposed to the vegetable dust found in fluormills are subject to develop chronic bronchial irritation.

We have used a ruby Lidar to study the space and time variations of atmospheric aerosols on a horizontal level above a town site. It has allowed us to locate the main sources of industrial pollution and to evaluate the amplitude of retrodiffusion signals due to the town activity.

(1) Thymic weight loss in 14 hours offers an accurate quantitative endpoint by means of which to measure the action of cortisone when administered by different routes. (2) Under conditions of our experiment, cortisone was much more effective when administered by subcutaneous route as compared with the oral or intrasplenic route. The subcutaneous:oral ratio is about 1:15. (3) Sensitivity of adrenalectomized mice to the thymolytic action of cortisone did not differ from that of intact animals. (4) Administration of small doses of cortisone, which caused thymic involution when given by subcutaneous route, failed to do so when given by intrasplenic or oral route. This suggests that inactivation by the liver, previously found in in vitroexperiments, also plays a role in vivo.If the dose administered through the portal routes is large, sufficient amounts escape inactivation to produce a maximal effect upon the thymus.

Résumé Le radon (Rn86222) et les descendants du thoron (ThB ou Pb82212) sont utilisés comme traceurs pour l'étude des échanges verticaux de matière. Diverses méthodes permettant le calcul des coefficients de diffusion sont présentées soit dans l'hypothèse simplificatrice du régime stationnaire, soit dans le cas plus général du régime dépendant du temps. L'application de ces méthodes au calcul des coefficients de diffusion sur des données fournies à partir d'un modèle de simulation numérique permet de préciser le degré d'approximation représenté par les diverses hypothèses simplificatrices. Les méthodes de calcul présentées sont appliquées aux mesures expérimentales du radon et du ThB. Ces mesures ont été réalisées de manière continue durant deux ans en trois points de mesures, entre 0 et 100 m de hauteur. Une statistique est présentée sur la variation diurne des échanges et la variation saisonnière de cette variation diurne, ainsi qu'un exemple particulier du traitement des données en régime dépendant du temps.

Analysis of turbulent transfer inside a vegetative canopy can be realized by means of several methods. In our case, we have used principally the aerodynamic and the thoron methods. The thoron diffusivity profiles show an important distortion in the middle zone of the canopy, below the maximum of leaf area density. This distortion is associated with a maximum source of sensible heat flux at these levels, which partially invalidates the aerodynamic approach.

Electrical conductivity measurements for aqueous solutions of sodium 1-hexyl sulfate (SHS) have been carried out from (293.15 to 313.15) K. From the molar conductivity at infinite dilution values the transport numbers of SHS anions have been obtained for each temperature. Densities of the binary system water sodium 1-hexyl sulfate were measured at 298.15 K and 308.15 K. Excess volumes have been evaluated at concentrations above and below the critical micellar concentration.

Bilateral ureteral obstruction in a 54-year-old man was diagnosed as idiopathic retroperitoneal fibrosis (IRF) on the basis of surgical biopsy and treated with bilateral ureterolysis 8 years ago. 5 years later, the patient presented with symptoms of colonic partial obstruction and mild renal failure. Relapse involving the perivascular retroperitoneum and the pelvis extending to the mesosigmoid colon was evident on an abdominal computed tomography (CT) study.

CONCENTRATION of radon in the air above the Atlantic Ocean at the K (‘kilo’) point was measured during May 28–June 28, 1962, and now we are attempting to relate the values of natural radioactivity to meteorological conditions.