Pharmaceutical care in an inpatient pediatric intensive care unit: an international multicentric study

Introduction Pediatric intensive care patient represent a population athigh risk for drug-related problems. Our objective is to describe drugrelated problems and intervention of four decentralized pharmacists inpediatric and cardiac intensive care unit.Materials & Methods Multicentric, descriptive and prospectivestudy over a six-month period (August 1st 2009-January 31st 2010).Drug-related problems and clinical interventions were compiled infour pediatric centers using a tool developed by the Socie´te´ Franc¸aisede Pharmacie Clinique. Data concerning patients, drugs, intervention,documentation, approval (if needed), and estimated impact werecompiled. The four pharmacists participating were from Belgium (B),France (F), Quebec (Q) and Switzerland (S).Results A total of 996 interventions were collected: 129 (13%) in B,238 (24%) in F, 278 (28%) in Q and 351 (35%) in S. These interventionstargeted 269 patients (median 22 month-old, 52% male): 69(26%) in B, 88 (33%) in F, 56 (21%) in Q and in S. These data werecollected during 28 non consecutive days in the clinical unit in B, 59days in F, 42 days in Q and 63 days in S. The main drug-relatedproblems were inappropriate administration technique (293, 29%),untreated indication (254, 25%) and supra therapeutic dosage (106,11%). The pharmacist's interventions concerned mainly administrationmode optimization (223, 22%), dose adjustment (200, 20%) andtherapeutic monitoring (164, 16%). The three major drug classesleading to interventions were anti-infectives for systemic use (233,23%) and alimentary tract and metabolism drugs (218, 22%). Interventionsconcerned mainly residents and all clinical staff (209, 21%).Among the 879 (88%) interventions requiring a physician's approval,731 (83%) were accepted. Interventions were considered as having amoderate (51%) or major (17%) clinical impact. Among the interventionsprovided, 10% were considered to have an economicalpositive impact. Differences and similarities between countries willbe presented at the poster session.Discussion & Conclusion Decentralized pharmacist at patient bedsideis a pre-requisite for pharmaceutical care. There are limitedstudies comparing the activity of clinical pharmacists betweencountries. This descriptive study illustrates the ability of clinicalpharmacist to identify and solve drug-related problems in pediatricintensive care unit in four different francophone countries.

Comme une mode urbaine : projets de régénération urbaine et patrimonialisation à Porto et Marseille

Partant de deux études de cas, le projet de Frente Ribeirinha à Porto (Portugal) et celui d'Euroméditerranée à Marseille, ce projet de thèse a pour objectif l'étude des modalités de valorisation du tissu bâti (patrimonialisation) par les acteurs institutionnels dans les projets de régénération urbaine. Suivant l'hypothèse de l'entrée dans un nouveau régime de patrimonialité, l'analyse doit expliciter les stratégies à l'oeuvre ainsi que la manière dont les autorités publiques influent sur les représentations de l'espace construit. Abordant la question des échelles d'intervention des projets de régénération urbaine à partir des deux études de cas, mais également de littératures sur des projets anglo-saxons, la thèse cherche à voir, au prisme de la construction patrimoniale, comment ces projets sont directement connectés à l'économie internationale et au phénomène de globalisation et s'ils prennent en compte l'échelle du quotidien et de la domesticité. Il s'agit de montrer les limites d'une valorisation du tissu bâti dans un objectif de retombées économiques (ville consommable) au détriment des valeurs d'usage et de signifiants du quotidien. D'où l'hypothèse de l'importance d'une prise en compte des représentations de valeurs aux différentes échelles (dimensions socio-culturelles du projet de régénération) pour un équilibre qualitatif dans la fabrication du territoire et des projets sur le long terme. La volonté est sensiblement la compréhension des nouvelles constructions patrimoniales ainsi que des pratiques de conception et de mise en oeuvre du projet urbain. - Based on two case studies, the Frente Ribeirinha project in Porto (Portugal) and Euroméditerranée in Marseille, this research project aims at studying the modes of enhancement of the built fabric by institutional actors in urban regeneration projects. Posing the idea of a new heritage regime, this analysis attempts to explain the different strategies at work and how public authorities influence the built space's representations. Looking at the different scales of intervention of regeneration projects in our two case studies, as well as Anglo-Saxon literature on projects, it seeks at seeing, through heritage processes, how these projects are directly connected to the international economy and the phenomenon of globalization. Also, it aims at investigating whether policies take into account the scale of everyday life and domesticity. It attempts to show the limit of a built fabric's valuation with economic benefits objectives (consumable city) rather than taking into account values and meanings of everyday life. Hence, the thesis suggests taking into account representations and values at different scales (socio-cultural dimensions of the regeneration project) for a qualitative balance in urban planning and urban projects' manufacturing. The aim is to broaden the understanding on heritage construction, on urban design practices and on implementation of urban projects.

A new technique for simultaneous validation of two manual nonmercury auscultatory sphygmomanometers (A&D UM-101 and Accoson Greenlight 300) based on the International protocol.

INTRODUCTION: Auscultatory nonmercury manual devices seem good alternatives for the mercury sphygmomanometers in the clinic and for research settings, but individual internal validation of each device is time-consuming. The aim of this study was to validate a new technique capable of testing two devices simultaneously, based on the International protocol of the European Society of Hypertension. METHODS: The concept of the new technique is to measure blood pressure alternatively by two observers using a mercury sphygmomanometer and by two observers using the A&D UM-101 and Accoson Greenlight 300 devices, connected by Y-tube to obtain simultaneous readings with both nonmercury devices. Thirty-three participants were enrolled (mean age 47.2±14.0 years). Nine sequential blood pressure measurements were performed for each participant. RESULTS: Both devices passed phase 1 using 15 participants. In phase 2.1 (n=33), on a maximum of 99 measurements, the Accoson device produced 81/95/99 measurements within 5/10/15 mmHg for systolic blood pressure (SBP) and 87/98/99 for diastolic blood pressure (DBP). The A&D device produced 86/96/99 for SBP and 94/99/99 for DBP. In phase 2.2 (n=33), 30 participants had at least 2 out of 3 SBP obtained with Accoson device within 5 mmHg of the mercury device, as compared with 29 of 33 participants with the A&D device. For DBP, this was 33 of 33 participants for both devices. CONCLUSION: Both the nonmercury devices passed the International protocol. The new technique of simultaneous device testing using a Y-tube represents a time saving application of the International protocol.

International consensus guidelines on the management of cytomegalovirus in solid organ transplantation.

Cytomegalovirus (CMV) remains one of the most common infections after solid organ transplantation, resulting in significant morbidity, graft loss, and occasional mortality. Management of CMV varies considerably among transplant centers. A panel of experts on CMV and solid organ transplant was convened by The Infectious Diseases Section of The Transplantation Society to develop evidence and expert opinion-based consensus guidelines on CMV management including diagnostics, immunology, prevention, treatment, drug resistance, and pediatric issues.

Dermoscopy of acral melanoma: a multicenter study on behalf of the international dermoscopy society.

Background: Most studies on dermoscopy of acral lesions were conducted in Asian populations. In this study, we analyzed these features in a predominantly Caucasian population. Objective: Estimate the prevalence of dermoscopic features in acral lesions, and assess their level of agreement between observers. Methods: In this retrospective multicenter study, 167 acral lesions (66 melanomas) were evaluated for 13 dermoscopic patterns by 26 physicians, via a secured Internet platform. Results: Parallel furrow pattern, bizarre pattern, and diffuse pigmentation with variable shades of brown had the highest prevalence. The agreement for lesion patterns between physicians was variable. Agreement was dependent on the level of diagnostic difficulty. Conclusion: Lesions with a diameter >1 cm were more likely to be melanoma. We found as well that a benign pattern can be seen in parts of melanomas. For this reason one should evaluate an acral lesion for the presence of malignant patterns first. © 2013 S. Karger AG, Basel.

Early Iron Age Pottery: A Quantitative Approach, Proceedings of the International Round Table organized by the Swiss School of Archaeology in Greece (Athens, November 28-30, 2008)

Quantitative approaches in ceramology are gaining ground in excavation reports, archaeological publications and thematic studies. Hence, a wide variety of methods are being used depending on the researchers' theoretical premise, the type of material which is examined, the context of discovery and the questions that are addressed. The round table that took place in Athens on November 2008 was intended to offer the participants the opportunity to present a selection of case studies on the basis of which methodological approaches were discussed. The aim was to define a set of guidelines for quantification that would prove to be of use to all researchers. Contents: 1) Introduction (Samuel Verdan); 2) Isthmia and beyond. How can quantification help the analysis of EIA sanctuary deposits? (Catherine Morgan); 3) Approaching aspects of cult practice and ethnicity in Early Iron Age Ephesos using quantitative analysis of a Protogeometric deposit from the Artemision (Michael Kerschner); 4) Development of a ceramic cultic assemblage: Analyzing pottery from Late Helladic IIIC through Late Geometric Kalapodi (Ivonne Kaiser, Laura-Concetta Rizzotto, Sara Strack); 5) 'Erfahrungsbericht' of application of different quantitative methods at Kalapodi (Sara Strack); 6) The Early Iron Age sanctuary at Olympia: counting sherds from the Pelopion excavations (1987-1996) (Birgitta Eder); 7) L'aire du pilier des Rhodiens à Delphes: Essai de quantification du mobilier (Jean-Marc Luce); 8) A new approach in ceramic statistical analyses: Pit 13 on Xeropolis at Lefkandi (David A. Mitchell, Irene S. Lemos); 9) Households and workshops at Early Iron Age Oropos: A quantitative approach of the fine, wheel-made pottery (Vicky Vlachou); 10) Counting sherds at Sindos: Pottery consumption and construction of identities in the Iron Age (Stefanos Gimatzidis); 11) Analyse quantitative du mobilier céramique des fouilles de Xombourgo à Ténos et le cas des supports de caisson (Jean-Sébastien Gros); 12) Defining a typology of pottery from Gortyn: The material from a pottery workshop pit, (Emanuela Santaniello); 13) Quantification of ceramics from Early Iron Age tombs (Antonis Kotsonas); 14) Quantitative analysis of the pottery from the Early Iron Age necropolis of Tsikalario on Naxos (Xenia Charalambidou); 15) Finding the Early Iron Age in field survey: Two case studies from Boeotia and Magnesia (Vladimir Stissi); 16) Pottery quantification: Some guidelines (Samuel Verdan)

Body, Disease and Treatment in a Changing World. Latin texts and contexts in ancient and medieval medicine (Proceedings of the ninth International Conference «Ancient Latin Medical Texts», Hulme Hall, University of Manchester, 5th-8th September 2007),

This volume reflects a variegated and fruitful dialogue between classical and medieval philologists and historians of science, philosophy, literature and language as well as of medicine - the diverse range of interests that the history of medicine in the Graeco-Roman world and the medieval West continues to stimulate and draw on. A recurrent theme is the transformation of medical knowledge in different languages, literary forms and cultural milieux. Several papers concern editorial work in progress on unpublished texts, available only in manuscript or early printed editions. Ce recueil met en dialogue des spécialistes des textes médicaux latins de l'Antiquité et du Moyen Âge. Certaines analyses adoptent une approche sociolinguistique, d'autres s'intéressent à des questions de transmission et de réception, d'autres enfin livrent des études sur le lexique médical. Mais toutes concourent à éclairer une histoire culturelle de la médecine qui s'inscrit dans un monde en mutation. With a preface by D. R. Langslow, and contributions by M. Baldin, J. P. Barragán Nieto, P. P. Conde Parrado, D. Crismani, M. Cronier, C. de la Rosa Cubo, A. Ferraces Rodríguez, K.-D. Fischer, P. Gaillard-Seux, A. García González, V. Gitton-Ripoll, G. Haverling, F. Le Blay, B. Maire, G. Marasco, A. I. Martín Ferreira, I. Mazzini, F. Messina, Ph. Mudry, V. Nutton, M. Pardon-Labonnelie, R. Passarella, M. J. Pérez Ibáñez, S. Sconocchia, A. M. Urso, M. E. Vázquez Buján, and H. von Staden.