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International audience; The main motivation of this work is to determine quantitatively the pore occupancy of water and oil in some source rocks. The pore occupancy might be imposed by differences in chemical composition, wettability behavior and sorption of fluids in organic and inorganic porosities and will dramatically affect the hydrocarbons flow through the porous medium. We address this issue using NMR cryoporometry in two phase situations complemented by other NMR measurements. Using oil-wet samples originating from the Vaca Muerta formation, oil saturation as large as 70% were obtained by simply immersing fully water saturated samples into decane. At 100% water saturation, the measured pore size distributions indicate two main peaks around 2 and 80 nm. After immersion into oil, the pores occupied by water in the presence of decane are mostly around 2 nm and less. The pore sizes occupied by decane in the presence of water can then be deduced by subtracting the distributions obtained at 100% water saturation and after spontaneous drainage. Oil is mainly located in pores around 80 nm. These measurements are confirmed by high resolution SEM images showing the presence of porosity in the organic matter (sponge-like structure). Most of the oil can be associated with the porous organic matter network. These observations are complemented by the determination of the porosity below 2 nm and the water connectivity. From D2O diffusion experiments at 100% water saturation, we observed that about 19% of the total porosity is non-exchangeable with D2O. From the measurements of the liquid signal at −29 °C, we observed that on average 58% of the total porosity is located in pores smaller than 2 nm.

Background As pharmacists, medical prescription plays a major part of our daily activity. However, management of personal treatment is left behind. Our action plan of the quality management system (QMS) focused on several themes, including medication reconciliation and continuity of treatments. Purpose Our objectives were to assess the following: conformity with the personal treatment procedure at admission; conformity of the initial medical prescription; and medication errors (ME). Material and methods Our work involved a 2 month prospective study in 28 care units of our hospital. Adult patients over 18 years of age were included if they were hospitalised for at least 24 hours in our hospital and agreed to answer our questions. We assessed 5 patients per unit each day, 28 units in total. ME were identified as a result of missing information on patients’ records (such as who their general practitioner was, the management of the patient’s other treatments). Improvement measures were suggested in order to reduce ME. Results 127 patients were included (sex ratio M/F: 0.6). Mean age was 60.5 years. Retired (A1) people represented 56% of the population. Only 15% of patients had no traceability of a general practitioner (GP) compared with 86% for a pharmacist, and 59% had no copy of their prescription in their medical file. Nurses transcribed medication prescriptions in 36.4% of cases (66.1% among nursing files with the patient’s own treatment traceability), which was the source of errors. The patient’s own treatment was not returned in 69% of cases. Therefore, it was stored in the patient room. These poor practices and/or standards could lead to ME. We found that 38.4% of unintentional discrepancies among patients’ prescriptions were mainly as a result of omission (40.5%), posology (35.7%) and timing errors (31%). Conclusion Previous studies on medication reconciliation have already shown we should focus on high risk drugs and patients to reduce ME. Improving communication between different health professionals can also help reduce ME. We cannot currently implement medication reconciliation among all units in need in our hospital, but we can focus on patients with a high risk of discrepancies, using the HAS tools. References and/or acknowledgements Arrete du 6 avril2011. HAS. Manuel de certification V2010. No conflict of interest

International audience; We present nuclear magnetic relaxation dispersion of longitudinal relaxation rates 1/T 1 (NMRD) and 2D spin-correlation T 1-T 2 at different frequencies for oil and brine confined in shale oil rocks. We describe the nuclear spin relaxation models used for obtaining important dynamical and structural parameters from these experiments. These models allow interpreting the very different T 1 /T 2 ratio observed for these petroleum fluids on the 2D spin-correlation T 1-T 2 observed at two frequencies. They give also new informations on the dynamics and wettability of the embedded fluids as well as some structural measurement on the kerogen pore size.

Objectif de l’etude Evaluer les pratiques professionnelles sur la prise en charge de la douleur sur le plateau technique de radiotherapie et caracteriser les douleurs ressenties par les patients durant le parcours de soins. Materiel et methode A partir d’un autoquestionnaire distribue en fin de radiotherapie aux patients ambulatoires, les caracteristiques (typologie, prevalence, prise en charge eventuellement recue) des douleurs ont ete relevees avant le traitement, lors des seances et durant les consultations en cours de traitement. Le nombre de sujets necessaires a ete estime a 139 a partir du pourcentage de patients douloureux observe dans les etudes, avec un intervalle de confiance a 95 %. Resultats Entre janvier et aout 2017, 130 questionnaires exploitables ont ete recueillis. La population etait a 54 % masculine avec un âge median de 60,5 ans. La moitie des patients avaient un traitement antalgique avant la prise en charge en radiotherapie, dont 35 % etaient incompletement soulages. La question de la douleur etait abordee dans plus de 75 % des cas lors des consultations medicales et a 21 % lors des seances. Le traitement antalgique preventif, s’il etait instaure (28 % des cas), faisait significativement baisser la prevalence (p = 0,0072) mais etait insuffisamment efficace (59 % avaient toujours mal). Par ailleurs, une douleur de fond avant la radiotherapie etait significativement associee a plus de douleurs lors des seances. Finalement, 82 % des patients declaraient etre satisfaits de leur prise en charge antalgique. Conclusion Il existe deux types de douleurs : la douleur provoquee par le cancer et la douleur induite par la radiotherapie, avec une forte prevalence, une intensite elevee et un important retentissement sur les activites de la vie quotidienne. Cette etude montre la necessite de rechercher, d’evaluer et d’anticiper la douleur des patients pris en charge en radiotherapie. La sensibilisation du personnel medical et paramedical est un vecteur d’amelioration du controle antalgique.

The fear-avoidance beliefs of patients with subacute low back pain (LBP) considered at risk for chronic disabling LBP are not well known. The objectives of this cross-sectional descriptive survey, conducted in secondary care practice, were to assess fear-avoidance beliefs about back pain in patients with subacute LBP and to seek an association between physician or patient characteristics and level of fear-avoidance beliefs. A total of 286 rheumatologists completed a self-administered questionnaire assessing physicians' demographic, professional data, personal history of back pain, and back pain fear-avoidance beliefs (on the Fear-Avoidance Belief Questionnaire [FABQ]) and 443 patients with sLBP completed one on pain, perceived handicap and disability (Quebec Back Pain Disability Scale), anxiety and depression (Hospital Anxiety Depression questionnaire), and back pain beliefs (FABQ). Mean FABQ scores for rheumatologists for physical activities (FABQ Phys) and occupational activities (FABQ Work) were 9.2+/-4.4 (range 0-21) and 16.7+/-6.9 (range 2-37), respectively, and patient scores were 16.7+/-5.2 and 19.3+/-12.4, respectively. A total of 68% of patients and 10% of physicians had a high rating on the FABQ Phys (>14). Patients' fear-avoidance beliefs about physical activity were associated with low level of education (odds ratio [OR] 4.19; 95% confidence interval [CI] 1.83-9.57), patients' perceived disability (OR 1.05; CI 1.03-1.07), and physicians' high FABQ Phys score (OR 5.92; CI 1.31-26.32). Here we show that fear-avoidance beliefs about back pain were high in patients with subacute LBP and their rheumatologists.

Objectives. To assess the outcome of subacute low back pain, to identify the characteristics of patients and physicians which were related to outcome and to evaluate the influence of rheumatologists’ beliefs about back pain on their following the guidelines for physical and occupational activity. Methods. Design: a longitudinal descriptive survey. Setting: a secondary care practice in France. Participants: 266 rheumatologists; 440 patients with subacute low back pain. Outcome measures: the main outcome measure was persistence of back pain 3 months after baseline evaluation. A self-administered questionnaire for physicians assessed attitudes and beliefs about back pain [Fear-Avoidance Beliefs Questionnaire (FABQ)], and one for patients assessed pain, perceived handicap and disability (Quebec Scale), anxiety and depression (Hospital Anxiety Depression Questionnaire), and beliefs about back pain (FABQ). Results. Forty per cent of patients had persistent low back pain at 3 months; 5.5% of these had sciatica. A total of 10% of rheumatologists and 68% of patients at baseline had a high FABQ physical score (phys; >14). Determinants of outcomes were work-related back pain [odds ratio (OR) ¼ 3.37; 95% confidence interval (CI) 1.08–5.17], anxiety (OR ¼ 2.41; 95% CI 1.44–4.09), sex (female OR ¼ 2.03; 95% CI 1.30–3.18) and patients’ beliefs about back pain at work (OR ¼ 1.02; 95% CI 1.00–1.05). Physicians with high FABQ physical scores were less likely to follow guidelines on prescribing rest and occupational activity for back pain. Conclusion. Back pain commonly persists 3 months later in patients with subacute low back pain. Patients and rheumatologists still have negative beliefs about back pain. Rheumatologists’ beliefs influence their following guidelines on physical and occupational activities. National education programmes about low back pain are needed in France.

Background Discrepancies between the usual medications of patients and the medications prescribed when patients are admitted to hospital could be associated with severe complications. Implementation of medication reconciliation at admission has been reported as a way to improve quality of care. Purpose The aim of the study was to evaluate the feasibility and additional contribution of a retroactive medication reconciliation process at admission in an acute cardiology unit. Material and methods Before any intervention, we included prospectively, in the first part of the study, 67 patients (mean age 64 years; 66% men). From the patient and/or family, retail pharmacist, doctor interviews, a senior and a pre-graduated pharmacist carefully collected the usual medications taken by the patient. These medications were compared with the actual medications prescribed during the hospital stay. The discrepancies were classified as justified or unjustified. In the second part of the study, the physicians in the unit were educated on the medication reconciliation process. In addition, a pre-graduated pharmacist was in charge during this period to check and discuss with the physician any medication discrepancies. The clinical impact of this intervention was evaluated prospectively on another population of 141 patients (mean age 68 years; 64% men). Results Medication reconciliation was feasible in all patients included in the study. The rate of medication discrepancies decreased dramatically from 33% in the first phase of the study to 14% after the educational intervention (p = 0.003). In addition, during the second phase of the study, the pharmacist informed the physician of any medication discrepancies. Among the 20 patients with a medication discrepancy, thanks to the pharmacist the prescription was appropriately corrected in 16 (80%) patients. Conclusion This study showed the feasibility of the medication reconciliation process in an acute cardiology unit. The rate of prescription errors was dramatically decreased after implementation of the process. Implementation of a medication reconciliation process could enhance quality of care. References and/or Acknowledgements World Health Organization. MEDREC Assuring medication accuracy at transitions in care: medication reconciliation. High 5s: action on patient safety getting started kit. 2010 No conflict of interest.

Background In less than 10 years, 2 antiaggregants and 4 direct oral anticoagulants (DOAC) were released in Europe, making antithrombotic therapy management more complicated. We considered nurses’ needs as mandatory as they play an everyday role in patient management and education. Purpose We planned to evaluate knowledge about antithrombotic therapy among nurses in our hospital in order to provide specific additional training. Material and methods A form with a set of 71 questions on 16 themes, all related to antithrombotic drugs and their management, was prepared and distributed to nurses in the heart institute (group A) or other services of the hospital (group B). Answers were analysed by a junior pharmacist using an Excel chart. Results From June to August 2014, 49 nurses in cardiology (group A) and from November 2014 to August 2015, 170 nurses from 38 others services (35% from intensive care units and 65% from adult conventional units (group B)) completed the questionnaire. In both groups, a large majority of nurses were aware that they should deliver information to patients (A, 93.9%; B, 93.5%) and that INR allows monitoring of antivitamin K (AVK) (A, 100%; B, 90.6%). Nevertheless, the results showed a lack of knowledge. For example in group A, 18.4%, and in group B, 19.4%, did not think there was any difference between heparin calcium and low molecular weight heparin; 44.9% (group A) and 51.2% (group B) did not identify acenocoumarol as an AVK. 87.7% (group A) and 85.8% (group B) ignored the fact that monitoring platelets is mandatory when using unfractionated heparin (UFH). Only 44.9% (group A) and 31.2% (group B) mentioned anti-Xa in UFH monitoring. DOAC were better identified (69.4%), and their related bleeding risk better known (73.5%) among nurses in group A than among nurses in group B (38.8% and 55.3%, respectively). Conclusion These results indicate a need for providing practical basic training on antithrombotics in our hospital. Furthermore, professional development should be encouraged to maintain and update knowledge which is essential in order to ensure safe and appropriate care. We have already scheduled a 1 day seminar in February 2016 in which training will be provided interactively with clinical cases and exchanges between caregivers and trainers. References and/or Acknowledgements Rapport ANSM Avril 2014 No conflict of interest.

Prostaglandin E1 (PGE1) was used to prevent veno-occlusive disease (VOD) of the liver after allogeneic bone marrow transplantation (BMT) for leukaemia. It was given in continuous i.v. infusion from day--8 to day 30 after BMT at a dose of 0.3 micrograms/kg/h. The patients were studied according to the risk factors for VOD: diagnosis, intensification of the conditioning and previous liver abnormalities. The diagnosis of VOD was made on at least two of the following factors: weight gain, hepatomegaly, jaundice, ascitis, pain of the right upper quadrant, increased platelet consumption. 109 patients were studied, 50 were treated by PGE1 and 59 did not receive it. The actuarial incidence of VOD was 12.2% in the PGE1 group and 25.5% in the non PGE1 group (P = 0.05). In acute leukaemia, the incidence was 39.1% in the non-treated group and 12.8% in the PGE1 treated group (P = 0.02). Patients with previous hepatitis had an incidence of 62.5% in the non treated group and 15.5% in the treated group (P = 0.05). A positive cytomegalovirus (CMV) serology seemed to increase the risk of VOD: the incidence of VOD was 31.4% in non-treated patients and 22% in PGE1 treated patients. The multivariate analysis of the risk factors for VOD shows that unfavourable factors were: recipient positive CMV serology (P = 0.06), hepatic disease prior to transplant (P = 0.02) and the absence of PGE1 treatment (P = 0.02). This study suggests that prophylactic PGE1 treatment may decrease the incidence of VOD in patients treated for leukaemia by allogeneic bone marrow transplantation.

The objective was to compare, during a 5-day therapy, the efficacy and tolerability of an antihistaminic antitussive syrup, oxomemazine, combining a small quantity of guaifenesine (T), with a centrally acting antitussive, clobutinol (S), in adult patients aged from 18 to 70 years and presenting with a dry cough of infectious origin. This study was performed by 22 general practitioners and 130 ambulatory patients were enrolled. The primary criterion of this multicenter, randomized, single blind study was to compare the evolution of cough intensity using a Visual Analog Squale (VAS) graduated from 0 to 10 cm. Nine secondary criteria including tolerability were also assessed. With regard to cough intensity, the treatments were not equivalent. A greater reduction was observed with T (-5.2 +/- 2.3 versus -4.3 +/- 2.3). This result was confirmed by a further reduction in cough intensity at days: 2 (p = 0.04), 4 (p = 0.05), and 5 (p = 0.02). The frequency of cough disappearance before the end of the study was significantly greater for T than for S: 46% versus 29% (p = 0.05). The time before disappearance of the cough was 4.0 + 1.1 days for both medicines. Induction of sleep and the frequency of nocturnal wakening were significantly better for T from day 4 (p = 0.02). The drowsiness induced by T meant that diurnal quality of life was better with S on days 1 (p = 0.002) and 2 (p = 0.01). Tolerability was similar for both medicines. In conclusion, as a symptomatic treatment of dry cough, T is efficient and well tolerated. Moreover, we have observed a tendency towards superior efficacy of T than S. T is therefore a useful alternative in the therapeutic armamentarium available to the general practitioner.

To compare the onset of action of the local antacid Maalox and the systemic H2-antagonist ranitidine, during 'on demand' ambulant treatment of a single heartburn episode, using a randomized, parallel group, double-blind, double-dummy design.Subjects with self-perceived heartburn without known gastrointestinal disease or interfering treatments were selected with questionnaires. The study was performed unsupervised, whenever heartburn required medication. An electronic patient diary gave instructions when to take study medication, and provided visual analogue scales and five-item relief ratings for heartburn, at frequent time intervals activated by an alarm-clock.After a study of the natural history of heartburn and the feasibility of the study procedures in 23 patients, 49 subjects took Maalox and 45 ranitidine. Half of these experienced meaningful heartburn relief within 19 min after Maalox, and within 70 min after ranitidine. One hour after intake, the average heartburn relief score was 3.43 in the Maalox group and 3.04 in the ranitidine group (3 means 'slight improvement' and 4 'strong improvement'). Heartburn was similar in both groups after 3 h.Maalox provides faster relief of heartburn than ranitidine. Heartburn can be assessed frequently and reliably under ambulant conditions using an electronic patient diary.

Prostaglandin E1 was used to prevent veno-occlusive disease of the liver after allogeneic bone marrow transplantation for leukemia. It was given in continuous IV infusion from day -8 to day 30 after BMT at the dose of 0.3 microgram/kg/h. The patients were studied according to the risk factors of VOD: diagnosis, intensification of the conditioning and previous liver abnormalities. The diagnosis of VOD was made on at least two of the following factors: weight gain, hepatomegaly, jaundice, ascitis, pain of the right upper quadrant, increased platelet consumption. One hundred and nine patients were studied, 50 were treated by PGE1 and 59 did not receive it. Univariate analysis shows that the actuarial incidence of VOD was 12.2% in the PGE1 group and 25.5% in the non PGE1 group (P = 0.05). In acute leukemia, it was 39.1% in the non treated group and 12.8% in the PGE1 treated group (P = 0.02). Patients with previous hepatitis had an incidence of 62.5% in the non treated group and 15.5% in the treated group (P = 0.05). A positive CMV serology seemed to increase the risk of VOD: the incidence of VOD was 31.4% in non treated patients and 22% in PGE1 treated patients. The multivariate analysis of the risk factors of VOD show that unfavorable factors were: recipient positive CMV serology (P = 0.06), hepatic disease prior to transplant (P = 0.02) and the absence of PGE1 treatment (P = 0.02). This study suggests that prophylactic PGE1 treatment may decrease the incidence of VOD in patients at risk treated for leukemia by allogeneic bone marrow transplantation.

Cytomegalovirus (CMV) infection is the leading infectious cause of death after bone marrow transplantation (BMT) because of the high mortality rate associated with CMV pneumonia. However, very interresting results were recently reported when treating CMV penumonia with the combination of ganciclovir and high doses of intravenous anti-CMV immunoglobulin. In order to achieve an even better therapeutic efficacy, we have conducted a pilot study consisting of early administration of the combination therapy, as soon as CMV was isolated from the material obtained by bronchoalveolar lavage (BAL). A BAL was performed when symptoms of severe CMV infection were present and sometimes also systematically when an asymptomatic CMV viremia was diagnosed. Out of 18 BMT patients with CMV isolated from BAL in the absence of pulmonary signs, 9 became long-term survivors without any episode of CMV pneumonia and 9 died. However, only 2 patients died because of CMV pneumonia. Early treatment with the combination of ganciclovir and anti CMV immunoglobulin seems thus to decrease the incidence of CMV pneumonia (2/18) as it is known that about half of the untreated patients with CMV viremia will develop CMV pneumonia. We have also used the combination therapy to treat 3 cases of CMV pneumonia. As 2 patients survived the CMV pneumonia episode, this confirms the possible effectiveness of the combination therapy for the treatment of established CMV pneumonia. However, our pilot study points out the usefulness of an early treatment. At such an early stage, application of the combination therapy could affect the intensity and length of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)