Background. Noncompliance with immunosuppressive medications after renal transplantation is believed to be a major cause of allograft rejection and graft loss, with the impressive costs of these agents considered a significant reason for noncompliance. Our purpose was to determine the compliance rates of renal transplant patients who received their immunosuppressant therapy free of charge and evaluate their patterns of compliance. Methods. All patients who received a renal transplant and received their immunosuppressant medications at our institution for their first year posttransplant were included in the study. Compliance rate was calculated and serum immunosuppressant concentrations were obtained to validate compliance assessments. Results. Eighteen patients were included in the study. Approximately 48% of noncompliant patients were found to have subtarget drug concentrations, although only 14% of compliant patients had subtarget levels (&khgr;2=12.9, P <0.001). At 5 months posttransplant, 95% of the patients remained compliant; however, by 12 months posttransplant, only 48% of the patients remained compliant. The mean time to the first noncompliant month was 9.8 months (95% confidence intervals=8.60–11.0). Conclusions. Patients who received their immunosuppressants free of charge were generally compliant within their first year of transplantation, however, compliance tended to decrease over time. This suggests that drug cost alone does not explain noncompliant behavior. Intensive efforts to increase medication compliance before month 8 posttransplantation should be implemented.

Renal transplant patient compliance with freeimmunosuppressive medications

Resume Introduction Le developpement des anticancereux oraux a modifie le parcours de soins du patient en oncologie au profit d’une prise en charge ambulatoire. Ces evolutions necessitent une excellente coordination entre professionnels afin de garantir la securite du circuit de ces therapeutiques. Methode Nous avons mene une enquete prospective sur les 18 centres de lutte contre le cancer francais, entre mars et avril 2016. L’objectif etait de recenser les differents modes d’accompagnement des patients sous anticancereux oraux et d’evaluer l’implication du pharmacien dans ces derniers. Resultats Plus de la moitie des centres ont developpe un programme d’education therapeutique du patient (ETP) et/ou pratiquent des consultations pharmaceutiques. Au total, 54,5 % disposent d’un programme specifique aux anticancereux oraux et le pharmacien est implique dans les equipes multidisciplinaires. Parmi des etablissements, 44,4 % ont mis en place des actions de coordination ville-hopital mais tous soulignent le caractere chronophage de ces projets. Discussion La lourdeur du cadre administratif freine le developpement des programmes d’ETP. Les consultations pluridisciplinaires peuvent constituer une alternative seduisante par sa plus grande facilite de mise en œuvre. Enfin, les actions de coordination ville-hopital semblent difficiles a mettre en place et necessitent une harmonisation des pratiques de communication et la mise a disposition de moyens techniques et financiers adaptes.

Implication du pharmacien dans l’accompagnement des patients sous anticancéreux oraux : état des lieux dans les centres de lutte contre le cancer (CLCC)

Therapeutic recommendations of the International Homeopathic Society of Supportive Care in Oncology (IHSSCO)

Vancomycin is one of the commonly used anti-microbial drugs in intensive care units (ICUs). Guidelines recommend maintaining therapeutic trough levels of vancomycin (10–20 mg/L). The success of achieving the recommended therapeutic concentration of vancomycin is influenced by several factors, and this is even more complex in children, particularly those admitted in the ICU. Hence, we carried out the present study in children admitted in the ICU who were administered vancomycin. We carried out a chart review of children admitted in the paediatric ICU unit of a tertiary care hospital over a period of 3 years. Information on their demographic factors, diagnoses, duration of hospital stay, vancomycin treatment (dose, frequency and time of administration) and concomitant drugs, and vancomycin trough levels were retrieved. Descriptive statistics were used for representing the demographic factors, and multivariable logistic regression analyses were carried out to assess the determining factors. One-hundred and two children were identified, of whom 13 had renal dysfunction. Two-hundred and fifty-two vancomycin trough levels were available, of which only 25% were observed in the recommended range (10–20 mg/L) amongst patients without any renal dysfunction and 22% amongst patients with renal dysfunction. Vancomycin was administered intravenously at an average [standard deviation (SD)] dose (mg/dose) of 13 (3.9) mostly either thrice or four times daily. Even in patients receiving vancomycin as a definitive therapy, only 40.9% achieved the recommended trough levels. Lower trough levels were associated with an increased risk of mortality. Nearly 4% of the levels were above 20 mg/L (toxic range). Seven children were suspected to have acute kidney injury (AKI) during the course of therapy where the cumulative vancomycin dose and mortality rate was higher. Only one serum vancomycin level during augmented renal clearance was observed in the recommended range. All the patients received at least one concomitant drug that either had nephrotoxic potential or predominant renal elimination, and use of a greater number of such drugs was associated with an increased risk of AKI. The current vancomycin dosing strategy is ineffective in achieving therapeutic trough levels in children admitted to the ICU. Sub-therapeutic vancomycin trough levels significantly increase the risk of mortality.

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Vancomycin Use in a Paediatric Intensive Care Unit of a Tertiary Care Hospital.

Aromatherapy for the management of cancer complications: A narrative review.

Background: Medication adherence is a major concern in public health. It is fully established that immunosuppressive therapy (IT) and concomitant medications affect transplant outcomes in the pediatric population, showing interest in adherence to this therapy. The aim of the present review was to report on medication adherence in pediatric population post-transplantation. This will enable us to know the situation in this particular population. Methods: A literature search was performed using the MEDLINE database. Studies that were published from January 1999 to January 2016 in English language and which investigated medication adherence in pediatric transplantation were included. The type of organ and the methods used to assess medication adherence were studied. Results: A total of 281 records were identified, from which 34 studies were selected: 38% (n=13) on kidney transplantation, 32% (n=11) on liver transplantation, and 23% (n=10) on the transplantation of other organs. Medication adherence was found to be lower than 80% in two-thirds of the studies (64%), and varied from 22% to 97%. This wide range was explained in part by the important heterogeneity of assessment methods among studies. The methods used were objective, non-objective, or combined both types. Most studies did not fully describe the data collected: the time since transplantation, the period over which adherence was assessed, the population, the medications, and the threshold discriminating adherence and non-adherence. Conclusion: The present study found poor medication adherence in the pediatric population post-transplantation. There was a wide range of medication adherence, explained largely by the heterogeneity of assessment methods. Future studies must consider the characteristics of each methodology, but also the threshold defining adherence should be chosen on the basis of clinical outcomes, and describe all data collected to gain precision. To improve adherence in this population, it is essential to identify factors influencing medication (IT and concomitant medications) adherence.

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Medication adherence in pediatric transplantation and assessment methods: a systematic review

Medication adherence after pediatric allogeneic stem cell transplantation: Barriers and facilitators.

Resume Introduction Le recours aux medecines alternatives et complementaires (MAC) orales est frequent chez les patients atteints de cancer, mais moins documente chez l’enfant. Une enquete a ete realisee dans une unite d’onco-hematologie pediatrique dans le but d’etudier la frequence et les circonstances d’utilisation des MAC. Methodes Cette etude prospective a inclus 50 familles dont l’enfant etait suivi pour un cancer. Un questionnaire a ete elabore et a ete rempli avec l’un des parents lors d’un entretien individuel. Resultats Presque la moitie des familles interrogees (48 %, n  = 24) utilisait une ou plusieurs MAC dans le cadre de la prise en charge du cancer de leur enfant. Le type de MAC le plus utilise etait l’homeopathie, suivie des complements alimentaires et de l’aromatherapie. Pour 75 % des parents, l’objectif etait de diminuer les effets indesirables des traitements anticancereux. Pour 87,5 % des utilisateurs, les MAC etaient jugees efficaces. Un tiers n’avaient pas informe les medecins oncologues. Le medecin traitant etait la principale source d’information pour l’utilisation des MAC. Pres de la moitie (48 %) des parents interroges exprimaient avoir besoin de plus d’information a propos des MAC et 96 % des parents se les procuraient en pharmacie d’officine. Conclusions Cette etude confirme que l’utilisation des MAC orale est frequente en onco-hematologie pediatrique, mais les medecins n’en sont pas systematiquement informes. Pourtant certaines MAC a base de plantes peuvent engendrer des interactions medicamenteuses avec les traitements conventionnels. Une meilleure information des familles sur l’utilisation des MAC en onco-hematologie pediatrique semble necessaire. Cependant, s’agissant d’une etude ouverte sur des informations orales, l’interpretation des resultats devra rester prudente.

Évaluation du recours aux médecines alternatives et complémentaires orales dans un service d’onco-hématologie pédiatrique

Iconographies supplémentaires de l'article : Évaluation du recours aux médecines alternatives et complémentaires orales dans un service d’onco-hématologie pédiatrique

Thanks to advancements in medical care, a majority of patients with sickle cell disease (SCD) worldwide live beyond 18 years of age, and therefore, patients initially followed in paediatric departments are then transferred to adult departments. This paediatric-adult care transition is a period with an increased risk of discontinuity of care and subsequent morbidity and mortality. During this period, the patient will have to manage new interlocutors and places of care, and personal issues related to the period of adolescence. To take into consideration all these aspects, an interesting approach is to use the whole system approach to the patient, as presented in the biopsychosocial approach. The aim of this trial is to evaluate the impact of the proposed biopsychosocial paediatric-adult transition programme. The DREPADO study is a multicentre randomised control trial comparing a control group (Arm A) to an interventional group with a paediatric-adult transition programme based on a biopsychosocial approach (Arm B). To be included, patients should have the SS, SC, or Sβ form of sickle cell disease and be aged between 16 and 17 years. The randomisation in a 1:1 ratio assigns to Arm A or B. The primary outcome is the number of hospital admissions and emergencies for complications in the index hospital, in the 2 years after the first consultation in the adult department of care. Secondary outcomes consider the quality of life, but also include coping skills such as sense of self-efficacy and disease knowledge. To provide patient and parent knowledge and coping skills, the transition programme is composed of three axes: educational, psychological, and social, conducted individually and in groups. By providing self-care knowledge and coping skills related to SCD and therapeutics, helping empower patientsin relation to pain management and emotions, and facilitating the relationship to oneself, others, and care in Arm B of the DREPADO study, we believe that the morbidity and mortality of patients with SCD may be reduced after the proposed paediatric-adult transition programme. ClinicalTrials.gov, ID: NCT03786549; registered on 17 December 2018; https://clinicaltrials.gov/.

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Impact of a paediatric-adult care transition programme on the health status of patients with sickle cell disease: study protocol for a randomised controlled trial (the DREPADO trial).

Delphine Hoegy

Papers

Medication adherence in pediatric transplantation and assessment methods: a systematic review

Medication adherence after pediatric allogeneic stem cell transplantation: Barriers and facilitators.

Évaluation du recours aux médecines alternatives et complémentaires orales dans un service d’onco-hématologie pédiatrique

Iconographies supplémentaires de l'article : Évaluation du recours aux médecines alternatives et complémentaires orales dans un service d’onco-hématologie pédiatrique

Impact of a paediatric-adult care transition programme on the health status of patients with sickle cell disease: study protocol for a randomised controlled trial (the DREPADO trial).