Background In contrast with the setting of acute myocardial infarction, there are limited data regarding the impact of diabetes mellitus on clinical outcomes in contemporary cohorts of patients with chronic coronary syndromes. We aimed to investigate the prevalence and prognostic impact of diabetes according to geographical regions and ethnicity. Methods and results CLARIFY is an observational registry of patients with chronic coronary syndromes, enrolled across 45 countries in Europe, Asia, America, Middle East, Australia, and Africa in 2009–2010, and followed up yearly for 5 years. Chronic coronary syndromes were defined by ≥1 of the following criteria: prior myocardial infarction, evidence of coronary stenosis >50%, proven symptomatic myocardial ischaemia, or prior revascularization procedure. Among 32 694 patients, 9502 (29%) had diabetes, with a regional prevalence ranging from below 20% in Northern Europe to ∼60% in the Gulf countries. In a multivariable-adjusted Cox proportional hazards model, diabetes was associated with increased risks for the primary outcome (cardiovascular death, myocardial infarction, or stroke) with an adjusted hazard ratio of 1.28 (95% confidence interval 1.18, 1.39) and for all secondary outcomes (all-cause and cardiovascular mortality, myocardial infarction, stroke, heart failure, and coronary revascularization). Differences on outcomes according to geography and ethnicity were modest. Conclusion In patients with chronic coronary syndromes, diabetes is independently associated with mortality and cardiovascular events, including heart failure, which is not accounted by demographics, prior medical history, left ventricular ejection fraction, or use of secondary prevention medication. This is observed across multiple geographic regions and ethnicities, despite marked disparities in the prevalence of diabetes. ClinicalTrials identifier ISRCTN43070564

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BackgroundStandard Double Pigtail Stents (DPS) are commonly sterilisable medical devices (SMD). Their removal includes a flexible endoscope for male patients and a cystoscope for female ones. They are therefore removed by the surgeon and nurse. As this procedure may be painful for patients and often not easy to use, the Magnetic Black Star Kit (MBSK) was developed. It is composed of a DPS fitted with a magnet, a guide wire and a magnetic recovery system. This new device highlights a faster removal by a nurse only.PurposeThe aim of the study is to evaluate the cost of standard DPS and their removal in order to determine if MBSK could be economically viable.Material and methodsFor standard ablations, the average cost of staff is calculated according to the time spent on the procedure taking into account the surgeon’s and the nurse’s wages. Costs credited to SMD are determined by purchase or depreciation prices, disinfection, sterilisation and repairing costs. Then, costs of each single used medical devices (SUMD) required for the procedure are collected. Total costs for males and females are compared to costs associated with MBSK (including kit price and cost of its DPS removal procedure). Identical costs for both methods have not been considered.ResultsFor the ablation of DPS in males, the average cost of staff is €20 depending on procedure times. The cost of SMD rises to €85 due to the outsourcing of the sterilisation unit and the disinfection of the endoscope. SUMD cost €69. The total cost of a DPS and its classical removal in males is therefore €174. In females, the total cost is €137, with €12 for staff costs, €56 to the SMD and €69 to the SUMD. On the other side, the total cost of MBSK is €115, with €112 for the kit price and €3 for the procedure, according to feedback. All things considered, reductions in the cost reach 35% for males and 15% for females compared to the classical method.ConclusionUsing MBSK will be economically viable at the hospital and will avoid the use of fragile devices such as endoscopes.No conflict of interest

BackgroundIn order to plan the managemenet a cytotoxic drugs preparation unit (CPDU), pharmacists used a scientific reference source1 it recommended 5 pharmacy technicians for 26,000 preparations per year. 50% of technician effective working time should be spent to preparation and 50% on associated activities (AA).PurposeWhat about in practice? The aim of this study was to assess the technicians’ work load in real life.Material and methods5 technicians were hired in a CPDU in which 60% of the production was for use outside the hospital. Over one week, the times spent on the preparation and on 15 AAs was measured. The staff had to fill in a form giving the exact start and end times of the tasks. The different data collected were analysed and expressed in percentages.Results57% of technician effective working time was allocated to preparation. 9 AAs (36%) were fully done by technicians, the main ones being: preparation of sterilisation trays (17.4%), dressings, hygiene protocols (6%), managing orders (3.4%), schedule organisation (2%). The other AAs such as taking bacterial samples, inventory management, required the help of two additional logistics staff (47% of their working time). Without the help of logistics staff, all the AAs would need 58% of effective working time.ConclusionCompared with our data, the reference source underestimates the time required for preparation and AAs, by 7.4% and 8% respectively. The additional time needed for preparation is explained by the fact that reference data are not accurate for specific preparations. Furthermore, AAs need more time because of the large amount of work outsourced to our department, which isn’t mentioned in the reference source. This study showed that 6 technicians are necessary, instead of the 5 recommended by the guidelines. Moreover, with the new national law concerning hospital organisation, the CDPUs are going to change and the outsourced work they perform will increase; the guidelines need to be reviewed.ReferenceSociété Française de Pharmacie OncologiqueNo conflict of interest.

new therapeutic alternatives, represent a considerable economic saving and a significant reduction in pharmaceutical costs. It is important to improve patient recruitment in these types of studies.