François-Xavier Rose

Centre Hospitalier Universitaire de Rennes, Roazhon, Brittany, France

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Publications (8)8.14 Total impact

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    ABSTRACT: Surgery modifying digestive tract may alter drugs pharmacokinetics. To maintain concentrations of active substance in their therapeutic ranges, a dosage adjustment or change of drug may be necessary. This is particularly important when no pharmacological or pharmacodynamic parameter reflecting the medication effectiveness is easily measurable. Our objective was to gather the information and documentary tools that can guide prescription in these patients with rearranged digestive tract. We searched information on the documentary portals of French agencies, on gray literature, on MEDLINE and in the summaries product characteristics. No information was found on the website of French agencies, sparse data were identified in gray literature. Some document are discordant, most are imprecise. One hundred and ten studies or case reports referenced on MEDLINE describe 79 medications pharmacokinetics after gastrointestinal surgery. Four are not available in France. Six literature reviews were found. Four summaries of product characteristics provided information related to drug absorption. No documentary tool adapted to clinical routine exists. This unsatisfactory situation is a barrier to optimal patients care. Information is available. It is however necessary to gather under an ergonomic shape adapted to clinical routine, bringing the surgery type, pharmacokinetic changes induced and what to do about the dose adjustment.
    La Presse Médicale 09/2015; 44(11). DOI:10.1016/j.lpm.2015.03.024 · 1.08 Impact Factor
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    ABSTRACT: PURPOSE: This study aims to develop and validate a multidimensional scale for evaluating potential significance of pharmacist interventions (PIs). METHODS: Development of a scale was based from a systematic review of scales in PubMed, PsycINFO, PASCAL, and CINAHL from 1986 to 2013 and evaluation models of health care interventions. After content validation of the scale by a group of 7 experts of French Society of Clinical Pharmacy, the experts coded 50 scenarios extracted from the French database of PIs “Act-IP©” in order to test inter-rater reliability. Satisfaction on the content and structure of the scale by 4-level Likert (not satisfied = 0, somewhat satisfied = 2, satisfied = 4, very satisfied = 6) was questioned. RESULTS: A first version of a multidimensional scale, named “CLEO”, was developed according to evaluation models of health care interventions (“structure-process-outcome” by Donabedian and “economic-clinical-humanistic outcomes” by Kozma et al., and pharmacoeconomic models) and references from 81 distinct scales identified from 133 studies results of 873 citations screened. CLEO includes 3 dimensions: clinical (7 categories), economic (4 categories), and process-related dimension (4 categories) with assessment supports (definitions of keywords, an assessment algorithm). The inter-rater reliability showed fair agreement for clinical dimension (agreement 82%; kw = 0.34); moderate agreement for economic dimension (agreement 80%; kw = 0.53); and fair agreement for organizational dimension (agreement 76%; kw = 0.27). The average score of satisfaction on the whole scale, structure of scale, definitions of keywords, algorithms was 3.7; 4.9; 3.1; and 3.4, respectively. Many suggestions for improvement of the first version were provided. CONCLUSIONS: A multidimensional scale CLEO for assessing potential significance of PIs was developed and tested. However, the modification of the first version is necessary to improve reliability, particularly for organizational and clinical dimension. A second version will be definitely validated in September 2014.
    2014 American College of Clinical Pharmacy Annual Meeting, Austin, Texas, USA; 10/2014

  • Pharmacien Hospitalier et Clinicien 02/2012; 47:S5. DOI:10.1016/j.phclin.2011.12.011
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    ABSTRACT: The development of clinical pharmacy activities in most European countries is underway; however, data on these activities are still poorly reported. Multicenter studies are necessary to standardize and demonstrate the value of clinical pharmacy activities in these countries. To document clinical pharmacists' daily routine interventions (PIs) to identify trends of intervention, drugs, and situations most frequently associated with drug-related problems (DRPs) and to estimate physicians' acceptance of PI. A prospective study of PIs was conducted in 6 French hospitals. The sample consisted of 300 randomized PIs per hospital, recorded during the medication order validation process when a DRP was identified. We recorded patients' demographic characteristics, drugs involved, wards, DRP description, pharmacists' recommendations, and whether or not the recommendations were accepted by the physicians. A total of 38,626 medication orders were analyzed by 28 clinical pharmacists, leading to 1800 PIs (4.66 PIs per 100 medication orders). Of the 1800 PIs, 25.9% targeted psychotropic drugs, 15.9% targeted antithrombotic drugs, 15.5% targeted digestive and metabolic drugs, and 15.0% targeted cardiovascular drugs. The most commonly identified DRPs were nonconformity to guidelines or contraindication (21.3%), followed by improper administration (20.6%), supratherapeutic dose (19.2%), and drug interaction (12.6%). Nearly half (42.2%) of the pharmacists' recommendations were related to drug choice (drug switch 22.2%, drug discontinuation 16.3%, addition of a new drug 3.7%) followed by dose adjustment (23.8%), optimization of administration (21.9%; change of administration route 10.3%, administration modalities 11.6%), and need for drug monitoring (12.2%). The rate of physicians' acceptance was 73.4% (15.3% refusals, 11.3% not assessable). In French hospitals, pharmacists contribute to preventing DRPs during medication order validation. This study suggests that a few types of drugs and errors constitute a substantial proportion of PIs. Knowledge of the most frequent DRPs could significantly increase the efficiency of clinical PIs.
    Annals of Pharmacotherapy 07/2008; 42(7):1095-103. DOI:10.1345/aph.1L045 · 2.06 Impact Factor
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    ABSTRACT: The huge number of drug interactions makes it impossible to memorize them all. Detecting them and preventing adverse effects requires the use of reference works or databases. There are numerous discordances between the so-called "reference" books and databases. Nonexistent and unconfirmed interactions are published. The wording of the "drug interactions" section of the summary of product characteristics (SCP) sometimes sheds very little light on the risks involved. The delay by AFSSAPS in updating its drug interaction thesaurus may present problems in clinical practice. It is essential to know the limitations of the computerized systems for detecting and reporting drug interactions.
    La Presse Médicale 05/2008; 37(4 Pt 2):654-64. DOI:10.1016/j.lpm.2007.08.012 · 1.08 Impact Factor
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    ABSTRACT: To validate an instrument for documentation of clinical pharmacy interventions in French speaking hospitals in France and outside of France. A panel of 12 French speaking clinical pharmacists (six from France; six from French speaking countries) was asked to analyse a set of 60 pharmacist's interventions on drug prescription. They used a form including (1) the identification of the drug related problems (DRPs) (10 items), (2) the pharmacist's intervention (7 items). We assessed the level of agreement between the 12 pharmacists on the test DRPs and on the interventions. Kappa coefficient of concordance was used to assess the level of agreement between experts for DRPs and interventions. We also assessed the userfriendliness of the instrument using Likert scales. The level of concordance observed in the validation was 0.76 for DRPs and 0.89 for the type of intervention. Eleven experts out of 12 were "very satisfied" or "satisfied" and one "not satisfied" with the tool. Ten out of the 12 experts were ready to use it in daily practise. The present instrument proposed by the French Society of Clinical Pharmacy (SFPC) is the first coding system for pharmacist's interventions with a French interface. The validation process using a standard statistical methodology helps support the external validity of our tool. The level of concordance between users can be considered as satisfactory, allowing the use of the tool in daily clinical pharmacy practise. To enhance the diffusion of the instrument and of the general process of routine documentation of interventions, a spreadsheet is provided on the French Society of Clinical Pharmacy website.
    International Journal of Clinical Pharmacy 09/2006; 28(4):181-8. DOI:10.1007/s11096-006-9027-5 · 1.27 Impact Factor

Publication Stats

112 Citations
8.14 Total Impact Points

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  • 2006-2012
    • Centre Hospitalier Universitaire de Rennes
      Roazhon, Brittany, France
  • 2008
    • Centre Hospitalier Universitaire de Limoges
      Limages, Limousin, France