Introduction: In order to definitively integrate cryosurgery for the surgical treatment of atrial fibrillation (AF) into the therapeutic armamentarium, the medical and economic impact of its use on a population of patients with a high risk of recurrence of postoperative AF must be evaluated. Method: An observational study of patients who benefited from cryosurgery between July 2006 and December 2008 was performed. The cost of consumables and hospitalization was determined and compared to that of a control group of 27 patients with preoperative AF that had not benefited from cryosurgery. Results: Twenty-nine patients benefited from cryosurgery during a mitral (65.5%) or aortic intervention (37.9%) to treat a paroxystic (44.8%) or permanent AF (55.2%). More than half of them (58.6%) had a 12-month follow-up; 82.4% of these patients showed a permanent sinus rhythm and 32.6% had stopped their antiarrhythmic medication. There was no significant difference between the duration and cost of hospitalization for the 2 groups. Conclusion: Cryosurgery provides a clear clinical and economic advantage with no recurrence of AF, and it reduces antiarrhythmic medication treatment.

Background and ObjectivesFor optimal self-management of patients suffering from chronic inflammatory rheumatic diseases, a multidisciplinary team should be involved in organising patient follow up and therapeutic education. Our objective was to study the impact of adding a consultation by a clinical pharmacist to the routine physician consultation in our Rheumatology department.ProgrammePatients with rheumatoid arthritis or ankylosing spondylitis are offered clinical pharmacy consultations just before they are examined by the rheumatologist. The consultation covers the following: disease duration, drugs taken, satisfaction with current treatment and estimated compliance with treatment. The pharmacist is responsible for broaching the subject of therapeutic patient education and makes proposals for the patient to meet other health professionals. The results of the consultation are communicated directly to the rheumatologist. Any treatment modifications (introduction of drugs, discontinuations, switches to other drugs) are the joint decision of the clinical pharmacist and rheumatologist. Patient satisfaction was assessed using a self-administered questionnaire.Results303 patients attended a clinical pharmacy consultation. Overall, 65 treatment changes were proposed. These included folic acid supplementation (n=21), adjusting methotrexate dose (n=11), introduction of drugs acting on inflammation (another disease modifying antirheumatic drug (DMARD), glucocorticoids, nonsteroidal antiinflammatory drugs, biologics (n=16), and miscellaneous drugs (n=17). The main intervention was providing advice and information on the following: biologics, glucocorticoids, bisphosphonates, analgesics, pregnancy, vaccination and osteoporosis. There were 14 reports of adverse effects (biologic agents, n=11, DMARDs and other therapeutics, n=3) and 10 pharmacovigilance reports. 118 patients reported satisfaction with the pharmacy consultation.Discussion and ConclusionOur study has shown that a clinical pharmacist working in collaboration with a rheumatologist within a multidisciplinary team can help improve patient care by reducing risks through treatment adjustment and by providing tailored advice and information. On the whole, patients were satisfied with the consultation.Contexte et objectifNous présentons une expérience de conseil et d'éducation thérapeutique au sein d'un service de Rhumatologie grâce à la création d'une consultation pharmaceutique associée à la consultation médicale. L'objectif de cette consultation est l'organisation pluridisciplinaire du suivi et de l'éducation thérapeutique des patients souffrant de rhumatismes inflammatoires chroniques afin d'optimiser la prise en charge.ProgrammeLes consultations jumelées médecin-pharmacien concernent les malades atteints de polyarthrite rhumatoïde et de spondylarthrite ankylosante. Le temps de la consultation pharmaceutique est couplé à la consultation du rhumatologue.Les domaines considérés par la consultation pharmaceutique comprennent : la durée de la maladie, l'inventaire des...