Eric Perrier

Frequency, types, and potential clinical significance of medication-dispensing errors

INTRODUCTION AND OBJECTIVES: Many dispensing errors occur in the hospital, and these can endanger patients. The purpose of this study was to assess the rate of dispensing errors by a unit dose drug dispensing system, to categorize the most frequent types of errors, and to evaluate their potential clinical significance. METHODS: A prospective study using a direct observation method to detect medication-dispensing errors was used. From March 2007 to April 2007, “errors detected by pharmacists” and “errors detected by nurses” were recorded under six categories: unauthorized drug, incorrect form of drug, improper dose, omission, incorrect time, and deteriorated drug errors. The potential clinical significance of the “errors detected by nurses” was evaluated. RESULTS: Among the 734 filled medication cassettes, 179 errors were detected corresponding to a total of 7249 correctly fulfilled and omitted unit doses. An overall error rate of 2.5% was found. Errors detected by pharmacists and nurses represented 155 (86.6%) and 24 (13.4%) of the 179 errors, respectively. The most frequent types of errors were improper dose (n = 57, 31.8%) and omission (n = 54, 30.2%). Nearly 45% of the 24 errors detected by nurses had the potential to cause a significant (n = 7, 29.2%) or serious (n = 4, 16.6%) adverse drug event. CONCLUSIONS: Even if none of the errors reached the patients in this study, a 2.5% error rate indicates the need for improving the unit dose drug-dispensing system. Furthermore, it is almost certain that this study failed to detect some medication errors, further arguing for strategies to prevent their recurrence.

Spine injuries related to high-performance aircraft ejections: A 9-year retrospective study

BACKGROUNDnDuring an aircraft ejection, the pilot is exposed to accelerations to the point of human tolerance, which may cause spinal injuries. Many nations have reported a spinal trauma rate of about 20-30%, with plain radiography as the first-line exam. Insofar as ejection seats and diagnostic imaging have improved, the objectives of this study are to describe the spine injuries among recently ejected French aircrew, to analyze the spinal imaging used, and, if necessary, to propose a better standardized radiological procedure.nnnMETHODSnA retrospective cohort study included all aircrews of the French forces who ejected from 2000 to 2008, with an authorized access to the technical reports of the investigations.nnnRESULTSnThere were 36 ejections collected, 75% with an MK-10 seat and an arrival on dry land. All pilots were alive, but 42% of them sustained 24 spinal fractures, most of the time with a simple compression of the thoracic segment, but also 4 ligamentous or discal lesions. Computed tomography or RMI was used in 64% of cases and four fractures were missed or underestimated on X-ray. One complex fracture required surgical treatment. A return to flying duties was frequently possible within a period of 6 mo.nnnCONCLUSIONSnNew generation ejection seats remain highly traumatic for the spine. It is recommended that all ejected aircrews be assessed with computed tomography to improve the sensitivity of the screening for fractures. The risk of asymptomatic lesions makes necessary the systematic use of a stretcher for initial evacuation when possible.

Progression of early repolarization patterns at a four year follow-up in a female flight crew population: Implications for aviation medicine

To assess the prevalence, the appearance, and the distribution, as well as the fluctuation over time of early repolarization patterns after four years in a female population derived from the French aviation sector.

Severe bleeding secondary to misuse of fondaparinux: a case report

Venous thromboembolism (VTE) remains a great challenge because of its frequency and of its potential severity. However, VTE treatment can also lead to iatrogenic complications. We report a case of thigh haematoma by a 83-year-old woman under fondaparinux for a solear thrombosis. Then we discuss the indications of Unfractionated Heparin (UFH), Low-Molecular-Weight Heparins (LMWH) and Fondaparinux, which are the three classes of rapidly acting anticoagulant treatments nowadays available. As their efficacy is comparable, the choice between these classes relies on the risk of adverse effects, which depends on some patient’s characteristics. LMWH and fondaparinux are contra-indicated by the patients with a renal clearance under 30xa0ml/min. Only UFH are authorised during the whole pregnancy even though LMWH are more and more used. Fondaparinux has proven its safety by patients over 100xa0kg. UFH requires a daily biological management whereas it is optional for LMWH and fondaparinux, as long as their contra-indications are taken into account. No Heparin-induced-thrombocytopenia Syndrome (HIT-Sd) has been proven yet under fondaparinux so that platelets management seems not necessary, contrary to UFH and LMWH which require a twice-weekly platelets count. The accuracy of the therapeutic indication should result in the best benefit/risk assessment.

Prevalence of benign epileptiform variants during initial EEG examination in French military aircrew

INTRODUCTIONnIn France, a systematic EEG is performed during initial examination in military aircrew applicants, which may provide an estimation of the prevalence of benign epileptiform variants in healthy adults.nnnMETHODSnWe analyzed standard EEG (21 scalp electrodes, 20minutes, 400Hz sampling rate) of military aircrew applicants examined in the French Main Aeromedical Center in 2016. EEGs were analyzed using both bipolar and referential montages. The collected data were EEG abnormalities and benign epileptiform variants. The kappa inter-observer index for the detection of benign epileptiform variants was calculated.nnnRESULTSnOur population was composed of 495 subjects (86.7% males, mean age 22.5±4.8 years), wishing to become a pilot in 69.7% of cases. None of the applicants reported any neurological disease and none was taking regular medication. EEG was considered as normal for 96.4% of them. Encountered EEG abnormalities were mainly asymmetric and sharp slow wave bursts. Drowsiness was recorded during 13.9% of these EEG. Benign epileptiform variants were present in 7.7% of our population: anterior theta activities (4%), posterior slow waves (2.8%), alpha variants (0.6%) and wicket spikes (0.2%). Hyperventilation induced EEG slowing in 14.1% of cases. During intermittent photic stimulation, physiological photic driving was observed in 15.2% of subjects.nnnDISCUSSIONnMany previous studies have been dedicated to the prevalence of benign epileptiform variants but results are often heterogeneous and based on patients in whom there was an indication for EEG. Our results thus bring data on benign epileptiform variants prevalence in a young adult population characterized by the absence of neurologic disorders. Our study demonstrates that anterior theta activities, posterior slow waves, alpha variants and wicket spikes are the most frequent benign EEG variants in such a young adult population.

0338 : Long-term evolution of ECG early repolarization pattern in a female population of navigant staff and implication in aeronautical medicine

In female, the prevalence of ER is lower but reported variously and has been poorly studied in aeronautical medicine. Our study described and evaluated the prevalence and long-term (4 years) evolution of ECG ER pattern in the female population of the French aeronautical staff. This is a retrospective single-center study, conducted over a period of 12 years (1998-2010) at the Centre of Medical Expertise in Navigant Personnel of Hospital of Percy, Clamart, France. The study was conducted from clinical data and through the systematic recording of ECG on a digital database (TRACE MASTER VIEW – PHILIPS ©). The study population included asymptomatic subjects aged >18 years and with no cardiovascular disease. An initial ECG (P1) was recorded in all patients at incorporation and a second 4 years later (P2). ECG were interpreted by 2 cardiologists. The presence of ER is rated “ER+” and its absence “ER-”. On each ECG were recorded: the heart rate (HR), the Sokolow-Lyon index and the corrected QT (QTc) interval. The study population included 306 women. The majority was stewardess (in 95.1% of cases; mean age 25.9±3.3 years). Only 170 subjects (56%) practiced sports up to one hour per week. At P1: PR + prevalence was 9.2%. The most common pattern was “slurring” in 64.3% of cases, in the inferior leads (28.3%). The ST segment is horizontal or descending in 53.6% of patients. At P2, the prevalence of RP+ was 7.5% (a loss of RP+ in 5 patients). At P1, the Sokolw-Lyon index was higher in RP+ patients (p The author hereby declares no conflict of interest

Pathologies du sommeil et contrôle aérien. Un exemple de réhabilitation

Objectif Nous presentons un controleur aerien civil, âge de 54xa0ans, porteur d’une surcharge ponderale qui presente un syndrome d’apnees du sommeil modere evoluant depuis plus de 10xa0ans sous traitement par orthese d’avancement mandibulaire. La survenue d’endormissements au volant associes a des crampes invalidantes plutot matinales principalement localisees dans les cuisses conduit a de nouvelles investigations conduisant a un diagnostic polysomnographique de maladie de Willis-Ekbom dans une forme clinique inhabituelle severe avec un nombre de mouvements periodiques des membres inferieurs a 23/h associe a un index de micro-eveils a 31/h. Un traitement par rotigotine, dispositif transdermique, est alors associe a la PPC. Se pose alors la question des criteres de restitution de son aptitude. Methodes Nous discutons des conditions de restitution d’une aptitude controleur aerien exigees par l’instance derogatoire, le comite medical de la navigation aerienne. Resultats Il est necessaire de s’assurer de l’efficacite des mesures therapeutiques et de leur absence d’effets deleteres sur la securite aerienne. Les traitements specifiques du SAS que sont l’OAM et la PPC dans ses formes moderees a severes remplissent ces conditions sous reserve de leur bonne tolerance et de leur efficacite clinique regulierement controlee. Dans les formes severes de la maladie de WE, seule la rotigotine (jusqu’a 3xa0mg/j) presente un profil compatible avec les exigences liees a la SA. Il lui est reconnu une efficacite chez 43xa0% des patients se maintenant au-dela de 5xa0ans avec des effets secondaires generalement mineurs (frequents erythemes sous le patch, quelques cephalees, nausees…) et un risque limite de syndrome d’aggravation (inferieur a 13xa0%). Conclusion La mise en route d’un traitement par PPC ou OAM dans un SAS modere ou severe et par rotigotine a faible posologie pour certaines formes severes de maladie de WE apporte une reponse therapeutique acceptable sur le plan de la securite aerienne.

240 Prevalence of intraventricular conduction distrubances in a large population of aircrew members

Methods: The multicenter observational Generation MVP study included 264 patients aged 77±10 years (men: 52%) implanted for sinus node dysfunction (SND) (n=141) or AVB (n=123). Programming function MVP has been left to discretion of the physician. Percentage of VP and percentage of patients with paroxystic or persistent AA was assessed on average at 2 and 10 months according to the indication of pacing and the state of programming MVP function.

Dissection d’une artère carotide chez un pilote de chasse

n syndrome inflammatoire biologique franc. Devant ces signes eu specifiques, l’imagerie a ete decisive en montrant un epaisissement evocateur de la paroi aortique au scanner dans deux bservations. Dans une observation, seul le TEP Scan a permis le iagnostic. Sur le plan etiologique une maladie de Horton a ete ffirmee par BAT ; dans les deux autres cas, aucune etiologie n’a te retrouvee. iscussion.– Parmi 1204aortes operees en 20ans, on denombre 68aortites dont 75 infectieuses ou attribuees a des remaniements ost-chirurgicaux ; 41 attribuees a une atherosclerose ; 36 aortites rimitives et 16 aortites associees a une maladie systemique Takayasu, Horton, Behcet, sarcoidose, polyarthrite rhumatoide, pondylarthropathie) [1]. Une aortite peut s’observer egalement au ours du syndrome de Cogan, de la maladie de Erdheim Chester, de a polychondrite atrophiante ou d’ enterocolopathies [2,3]. onclusion.– Le diagnostic d’aortite est peu frequent, a evoquer evant une clinique aspecifique. L’imagerie, non invasive, a un role rimordial ; le PET-scanner pallie les defaillances eventuelles du canner. Le bilan etiologique a la recherche d’une etiologie est souent negatif. eferences 1] Rojo-Leyva R, Ratliff NB, Cosgrove DMI, Hoffman GS. Study of 2patients with idiopathic aortitis from a cohort of 1,204 surgical ases. Arthritis Rheum 2000;43:901–7. 2] Herve F, Choussy V, Janvresse A, Cailleux N, Levesque H, Marie . Aortite inflammatoire et maladie de Horton. A propos du suivi volutif, scanographique prospectif d’une serie de 11patients. Rev ed Interne 2006;27:196–202. 3] Launay D, Hachulla E. Les aortites inflammatoires. Presse Med 004;33:1334–40.

Ground vasovagal presyncopes and fighter pilot fitness: aeromedical concerns.

BACKGROUNDnVasovagal episodes are common events but may have consequences for flight safety, particularly in high-performance aircrafts, where the autonomic nervous system is impacted during +G(z) accelerations. However, the risk is difficult to assess in the case of ground presyncopes.nnnCASE REPORTnA 27-yr-old fighter pilot experienced a feeling of faintness at a daily briefing. He had previously shown no medical history except for a single episode. The initial physical examination was normal. During vagal maneuvers, the pilot developed a cardiac pause and a tilt-table test was positive. Other investigations were normal.The pilot lost consciousness twice in centrifuge testing while previous tests had shown a good cardiovascular tolerance. He was declared unfit to fly fast jets but fit as a multicrew transport pilot with a waiver.nnnDISCUSSIONnThe epidemiology of vasovagal reactions is difficult to estimate in aircrew. A late occurrence in the career can be explained by either a newly acquired hypervagotonia, or an old predisposition with specific triggering factors in which psychosocial aspects are important. In such circumstances three steps are necessary to assess fitness: 1) to check for other etiologies; 2) to look for vasovagal predisposition; and 3) to check psychiatric condition. The studies about the predictive value of the tilt-test must be taken into account.nnnCONCLUSIONnIn the case of vasovagal presyncope in a fighter pilot, the aeromedical decision should consider the medical history of the pilot, the results of investigations, and the experience and motivation of the individual under review. Centrifuge testing may be useful in difficult situations.