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Au Québec et en France, le milieu de la répartition demeure un lieu de pratique non traditionnelle puisque peu de pharmaciens exercent leurs responsabilités pharmaceutiques dans ce secteur. Concernant la formation et le rôle des pharmaciens œuvrant chez les grossistes-répartiteurs, l’historique de l’activité, le marché du médicament et le cadre juridique, des différences existent entre les deux pays. Summary In Quebec and in France, few pharmacists choose to practise in the distribution sector. With regard to the training and role of pharmacists working at wholesale distributors, the history of the activity, the drugs market and the legal framework, differences exist between the two countries. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate environmental contamination with methotrexate, cyclophosphamide, and ifosfamide in Quebec, Canada, community pharmacies and to describe hazardous drug handling practices in these pharmacies. Methods: Three standardized sites were sampled in each participating community pharmacy. Samples were analyzed for the presence of cyclophosphamide, ifosfamide, and methotrexate by high-performance liquid chromatography tandem mass spectrometry. The limits of detection were 0.10, 0.12, and 0.41 ng/mL for cyclophosphamide, ifosfamide, and methotrexate, respectively. Nine working practices were assessed. Results: 20 community pharmacies participated in the study, and 60 samples were analyzed. No traces of cyclophosphamide or ifosfamide were detected. Traces of methotrexate were found in 12 of 20 pharmacies (60%) Of the 20 pharmacies, 8 (40%) had a storage space reserved for hazardous drugs and none had a preparation area reserved for handling methotrexate tablets. All of the participating community pharmacies had a tablet counter reserved for the handling of hazardous drugs, and all pharmacies cleaned their tablet counter reserved for handling hazardous drugs after use. None of the pharmacies cut or crushed methotrexate tablets. Conclusion: The growing number of hazardous drug represents a challenge for community pharmacies. Community pharmacists must be made aware of their presence and the need to comply with personal protection measures to reduce staff occupational exposure to hazardous drugs. [ABSTRACT FROM AUTHOR]

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Study objective: The evidence supporting the use of analgesia in children with abdominal pain suggestive of appendicitis is limited. The objectives of the study are to evaluate the efficacy of morphine before surgical consultation in children presenting to the pediatric emergency department (ED) with right lower quadrant pain suggestive of appendicitis and determine whether it has an impact on the time between arrival in the ED and the surgical decision. Methods: All children between the ages of 8 and 18 years who presented to a pediatric ED with a presumptive diagnosis of appendicitis were eligible to be enrolled in a randomized double-blind placebo-controlled trial if the initial pain was at least 5 of 10 on a verbal numeric scale. Patients received either 0.1 mg/kg of intravenous morphine (maximum 5 mg) or placebo. The primary outcomes were (1) the difference in pain using a visual analog scale at baseline and 30 minutes after the completion of the intervention, analyzed by comparing the mean pain differences for the treatment versus placebo groups; and (2) the time between arrival in the ED and the surgical decision, analyzed by comparing the median delay for the 2 groups. Results: Ninety patients with a suspected diagnosis of appendicitis were randomized to receive morphine or placebo. Both groups were similar in terms of demographics, medical history, physical findings, emergency physician assessment of the probability of appendicitis, and initial pain score. There was no important difference in the decrease of pain between the morphine (n=45) and placebo (n=42) groups 30 minutes after the intervention: 24±23 mm and 20±18 mm, respectively (Δ 4 mm [95% confidence interval [CI] −5 to 12 mm]). There was also no important difference in the time between arrival in the ED and the surgical decision: median 269 minutes (95% CI 240 to 355 minutes) for morphine and 307 minutes (95% CI 239 to 415 minutes) for placebo (Δ −34 minutes [95% CI −105 to 40 minutes]). Conclusion: The use of morphine in children with a presumptive diagnosis of appendicitis did not delay the surgical decision. In our group of patients, however, morphine at a dose of 0.1 mg/kg was not more effective than placebo in diminishing their pain at 30 minutes. [Copyright &y& Elsevier]

Audits are essential for reviewing and improving the medication-use process. Identifying areas for improvement can limit the risk of errors when preparing and administering drugs. Pediatric centers face specific challenges in ensuring the safety of the medication-use process. The objective of this study was to observe and compare compliance with criteria for the preparation and administration of medications by nurses in a mother-and-child university hospital center over two consecutive years. This observational cross-sectional study was conducted in a Canadian mother-and-child university hospital center. Audits were conducted over a 1-month period in 16 and 18 nursing care sectors in 2021 and 2022, respectively. The standardized audit evaluated compliance with prespecified criteria related to the preparation and administration of medication by nursing staff (77 criteria for 2021 and 82 criteria for 2022). The auditors comprised nurses and a pharmacist trained by the research team. Compliance was compared between years and assessed through a chi-square test. The audit consisted of 522 observations in 2021 and 448 observations in 2022. Overall compliance was 76% in 2021 and 66% in 2022. The compliance rate by criterion ranged from 16% to 100%. In 2021 and 2022, 51 (84%) and 52 (87%) of the criteria, respectively, had compliance rates of more than 75%, and 12 (20%) and eight (13%), respectively, had 100% compliance. There were statistically significant decreases in compliance for nine of the 39 criteria for preparation of medications, notably prior hand hygiene (91%% vs. 84%, p = 0.002), and for six of the 17 criteria for administration of medications, including mentioning possible adverse effects to the patient (41% vs- 30%, p = 0.008). In this study, compliance was over 75% for most of the criteria. However, for a few criteria, we observed a decrease in compliance from 2021 to 2022. Various hypotheses are proposed to explain these decreases, such as the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Résumé Afin de relever les défis des nouvelles missions pharmaceutiques qui leur sont et seront confiées, les pharmaciens doivent chercher à améliorer leur pratique. Une revue et une analyse documentaire des preuves disponibles décrivant le rôle et l’impact de leurs activités ont été réalisées. Summary In order to meet the challenges of the new pharmaceutical missions which have been and will be entrusted to them, pharmacists must seek to improve their practice. A documentary review and analysis of available evidence describing the role and impact of their activities has been carried out. [ABSTRACT FROM AUTHOR]

Objective To describe the use of morphine at home for acute postoperative pain in children. Study design This was a prospective, descriptive study. Patients less than 12 years of age who underwent surgery and who received a discharge prescription for morphine between January and May 2014 were included. Parents were given a logbook to note their use of morphine at home. A follow-up call was performed 3 days after discharge. The primary outcome was whether or not parents administered morphine according to the discharge prescription. Prescription filling rates, storage at home, administration devices used, and disposal of remaining morphine were also evaluated. Results A total of 243 subjects were recruited; 56% (95% CI, 46%-66%) of participants with a regular basis prescription administered the medication as prescribed. This number was 85% (95% CI, 78%-92%) in subjects receiving an as-needed prescription, including those who did not administer any morphine because of an absence of pain. Although 76% (95% CI, 68%-84%) of parents filled the morphine prescription when prescribed as needed, most administered two doses or less. In a subset of 77 subjects for whom we obtained detailed prescription data, only 9.2% of prescribed doses were administered. Conclusion We observed that large amounts of morphine have been prescribed and dispensed into homes without being administered. This study identified a need to re-evaluate the quantity of morphine prescribed and dispensed after pediatric surgery. [ABSTRACT FROM AUTHOR]