Compliance in the Real World

AbstractUntil 1994, rates of noncompliance for lipid-lowering therapies were largely drawn from clinical trials and showed favorable risks for drug discontinuation, ranging from 4–15% for 1-year risk to 11–30% for 5-year risk. Although cross-study comparisons are difficult to make because of variations in study design and measures collected, when evaluating compliance to antihyperlipidemic drugs in primary care settings, results in general show substantially higher rates of discontinuation than those reported from randomized clinical trials. Recent studies from the United States, Australia, and Canada support the conclusion that adherence to lipid-lowering drugs is very poor in primary care settings

Pharmacoepidemiology and the Elderly

Summary: Pharmacoepidemiology employs the methods of epidemiology to study the frequency, determinants, and outcomes of drug therapy. Pharmacoepidemiology is becoming increasingly important with the aging of Western populations, due to the increased prevalence of medication use among older persons

IMPLANTAÇÃO DA GOVERNANÇA PÚBLICA EM UMA ORGANIZAÇÃO HIERARQUIZADA: ESTUDO DE CASO DO COMANDO DE PREPARO DA FORÇA AÉREA BRASILEIRA

Este estudo de caso se propõe a analisar a influência das particularidades da organização militar na implantação da governança pública na estrutura hierarquizada do Comando de Preparo da Força Aérea Brasileira. Encontrou-se equilíbrio entre os padrões administrativos, ligeiramente mais alto para o da Nova Gestão Pública, além de equilíbrio capacitante nos elementos de governança pública e um nível avançado de gestão para resultados. Para as organizações subordinadas, os processos de inovação e de atuação em redes e colaborativa estão em consolidação. Os indicadores de desempenho e o valor público demonstraram bons resultados, tanto para o cliente direto quanto para a sociedade. Os dados mostraram que as características militares influenciaram positivamente na implantação da governança pública, no que se refere aos elementos capacidade e qualidade institucional, inovação, desempenho e valor público, mas não exerceram influência sobre as redes e colaboração

Maternal exposure to angiotensin converting enzyme inhibitors in the first trimester and risk of malformations in offspring: a retrospective cohort study

OBJECTIVE: To examine a reported association between use of angiotensin converting enzyme (ACE) inhibitors during the first trimester and risk of malformations in offspring. DESIGN: A population based, retrospective cohort study linking automated clinical and pharmacy databases including comprehensive electronic medical records. PARTICIPANTS: Pregnant women and their live born offspring (465,754 mother-infant pairs) in the Kaiser Permanente Northern California region from 1995 to 2008. MAIN OUTCOME MEASURE: Congenital malformation in live births. RESULTS: The prevalence of ACE inhibitor use in the first trimester only was 0.9/1000, and the use of other antihypertensive medications was 2.4/1000. After adjustment for maternal age, ethnicity, parity, and obesity, use of ACE inhibitors during the first trimester only seemed to be associated with increased risk of congenital heart defects in offspring compared with normal controls (those with neither hypertension nor use of any antihypertensives during pregnancy) (15/381 (3.9%) v 6232/400,021 (1.6%) cases, odds ratio 1.54 (95% confidence interval 0.90 to 2.62)). A similar association was observed for use of other antihypertensives (28/1090 (2.6%) cases of congenital heart defects, odds ratio 1.52 (1.04 to 2.21)). However, compared with hypertension controls (those with a diagnosis of hypertension but without use of antihypertensives) (708/29,735 (2.4%) cases of congenital heart defects), neither use of ACE inhibitors or of other antihypertensives in the first trimester was associated with increased congenital heart defects risk (odds ratios 1.14 (0.65 to 1.98) and 1.12 (0.76 to 1.64) respectively). CONCLUSIONS: Maternal use of ACE inhibitors in the first trimester has a risk profile similar to the use of other antihypertensives regarding malformations in live born offspring. The apparent increased risk of malformations associated with use of ACE inhibitors (and other antihypertensives) in the first trimester is likely due to the underlying hypertension rather than the medications

Use of Antidiabetic drugs during pregnancy among U.S. women with Livebirth deliveries in the Mini-Sentinel system

BACKGROUND: As the prevalence of diabetes mellitus increases in the population, the exposure to antidiabetic drugs (ADDs) during pregnancies is expected to grow, as has been seen over the last decade. The objective of this study was to estimate the prevalence of ADD use during pregnancy among women in the Mini-Sentinel Distributed Database (MSDD) who delivered a liveborn infant. METHODS: We identified qualifying livebirth pregnancies among women aged 10 to 54 years in the MSDD from 2001 to 2013. ADD use was estimated using outpatient pharmacy dispensing claims and days-supplied among three cohorts: all livebirth pregnancies, pregnancies among women with pre-existing diabetes, and pregnancies among women without prior ADD use. RESULTS: Among the 1.9 million pregnancies in the MSDD that resulted in a livebirth from 2001 to 2013, 4.4% were exposed to an ADD. Of the 15,606 pregnancies (0.8%) with pre-existing diabetes, 92.8% were also exposed during the pregnancy period. The most commonly used product in these pregnancies was insulin (75.6% of pregnancies). In contrast, in pregnancies of women without prior ADD use, the most commonly used products were glyburide and insulin, and most of these users were diagnosed with gestational diabetes. CONCLUSIONS: Patterns of ADD use during pregnancy described here, along with changes in disease incidence and management, highlight the importance of continuing surveillance of ADD utilization patterns and examining the safety and effectiveness of these products in pregnancy

Aeromonas hydrophila flagella glycosylation: involvement of a lipid carrier.

Polar flagellin proteins from Aeromonas hydrophila strain AH-3 (serotype O34) were found to be O-glycosylated with a heterogeneous glycan. Mutants unable to produce WecP or Gne enzymes showed altered motility, and the study of their polar flagellin glycosylation showed that the patterns of glycosylation differed from that observed with wild type polar flagellin. This suggested the involvement of a lipid carrier in glycosylation. A gene coding for an enzyme linking sugar to a lipid carrier was identified in strain AH-3 (WecX) and subsequent mutation abolished completely motility, flagella production by EM, and flagellin glycosylation. This is the first report of a lipid carrier involved in flagella O-glycosylation. A molecular model has been proposed. The results obtained suggested that the N-acetylhexosamines are N-acetylgalactosamines and that the heptasaccharide is completely independent of the O34-antigen lipopolysaccharide. Furthermore, by comparing the mutants with differing degrees of polar flagellin glycosylation, we established their importance in A. hydrophila flagella formation and motility

Wet your Whistle with Water (W3) to improve water intake in seniors’ care

Context: Dehydration is a concern amongst older adults residing in retirement (RH) and long-term care (LTC) homes. Objectives: a) work with home team members to develop effective hydration strategies; b) implement these strategies; c) determine the capacity of home team members to provide process evaluation data on implementation, d) determine if administrative data is helpful in tracking dehydration-related events, and e) determine if a short, online education module can improve the hydration knowledge and attitudes of team members providing care. Methods: Wet your Whistle with Water (W3) included: voluntary online education module for team members; hydration reminders; water stations in common areas; and bi-monthly recreation activities providing beverages. Hydration-related administrative data from 56 LTC residents were analyzed for pre-post comparison. Findings: 218 individuals participated in the education and significant improvements in attitudes and knowledge noted. The LTC home held six hydration recreation programs with an average of 31 attendees and 15 beverages provided. Hydration station fluid intake was low (<120 oz per week). Bowel medications decreased non-signifcantly post-implementation; changes in other administrative variables were non-significant. Limitations: W3 could not be fully implemented in the RH due to challenges with staffing and collecting administrative data. Team member compliance with refilling water jugs, COVID-19 restrictions, and outbreak status impacted usability of the hydration station. Implications: W3 strategies were feasible but require home buy-in and a champion for implementation. Strategies (e.g., reminders) should be tailored to the home and be able to withstand outbreaks. Targeted education can improve confidence, attitudes, and knowledge

FATORES ASSOCIADOS AO MAIOR TEMPO DE PERMANÊNCIA EM UNIDADE DE TERAPIA INTENSIVA

Objetivo: identificar os fatores associados ao maior tempo de permanência dos pacientes na Unidade de Terapia Intensiva. Método: trata-se de estudo quantitativo do tipo corte transversal com 105 pacientes internados em Unidade de Terapia Intensiva de um hospital público de Salvador, Bahia. Os dados foram organizados no Stata, versão 12. Resultados: houve associação com significância estatística entre maior tempo de internação com: causas clínicas (RP=4,76 e IC95%: 1,86 – 12,19); uso de cateter venoso central (RP=5,08 e IC95%: 1,84 – 14,01); uso de ventilação mecânica (RP=3,03 e IC95%: 1,15 – 7,97); e desfecho clínico de óbito (RP=4,77 e IC95%: 1,47 – 15,42). Conclusão: os achados direcionam para ações preventivas para diminuição do tempo de internamento, como o controle de infecções mediante a utilização de técnicas assépticas no manejo de dispositivos invasivos. Descritores: Unidade de Terapia Intensiva. Hospitalização. Tempo de Internação. Enfermagem. Cuidados de Enfermagem