73 research outputs found
The medicine selection process in four large university hospitals in Brazil: Does the DTC have a role?
A produção de conhecimento sobre a seleção de medicamentos baseada em evidências e executada por Comissões de Farmácia e Terapêutica é ainda escassa no Brasil, apesar da ampla discussão sobre o tema em países desenvolvidos. Este estudo buscou conhecer e analisar os aspectos relacionados à seleção de medicamentos em quatro hospitais universitários de grande porte no Rio de Janeiro, por meio de abordagem qualitativa. Entrevistas, observação direta e análise documental instrumentaram a coleta de dados qualitativos e quantitativos. A análise considerou duas dimensões: (i) estrutura e organização para o processo de seleção e (ii) critérios e métodos utilizados para avaliação. Apenas dois hospitais possuíam Comissão de Farmácia e Terapêutica (CFT) ativa. A estrutura para a tomada de decisão era deficiente e os membros das Comissões apontaram pouca experiência e disponibilidade para a atividade. Os métodos de avaliação e critérios observados indicaram um processo de seleção acrítico nestes hospitais, comprometendo a assistência farmacêutica e potencialmente prejudicando o sistema de saúde. Apesar da metodologia qualitativa não permitir a extrapolação de resultados, é possível que este cenário seja parecido com o de outros hospitais universitários brasileiros.Knowledge about evidence-based medicine selection and the role of the Drug and Therapeutics Committee (DTC) is an important topic in the literature but is scarcely discussed in Brazil. Our objective, using a qualitative design, was to analyze the medicine selection process performed in four large university hospitals in the state of Rio de Janeiro. Information was collected from documents, interviews with key informants and direct observations. Two dimensions were analyzed: the structural and organizational aspects of the selection process and the criteria and methods used in medicine selection. The findings showed that the DTC was active in two hospitals. The structure for decision-making was weak. DTC members had little experience in evidence-based selection, and their everyday functions did not influence their participation in DTC activities. The methods used to evaluate evidence were inadequate. The uncritical adoption of new medicines in these complex hospital facilities may be hampering pharmaceutical services, with consequences for the entire health system. Although the qualitative approach considerably limits the extent to which the results can be extrapolated, we believe that our findings may be relevant to other university hospitals in the country
O OLHAR DO GESTOR SOBRE A CULTURA AVALIATIVA NO CONTEXTO ESCOLAR
The thematic educational assessment has often been taken as an object of reflection in the context of research on training and teaching. Recently, large-scale assessments imposed by federal and state governments in the late twentieth century, has been promoting the construction of an evaluation culture within schools. This culture takes the centrality of the evaluation process of the classroom and figures of teacher and students, expanding it to the school community and to educational management. The discussion on this issue finds fertile ground floor of the school, where the contradictions in the relationship between the written and the lived educational policies are presented more clearly. Thus is born the present study that aims to reflect on the limits and possibilities of the use of the results of internal and external evaluation of the work of school manager. To have so much support in the qualitative research approach, seeking access in the subject and the context in which the phenomenon manifests educational studied the information necessary to understand the problem. Strategies were used as approximation to reality participant observations, document analysis of reports evaluating the Permanent System of Evaluation of Basic Education in the state of Ceará the years 2009 to 2011 and interview with the manager of a local public school Ceará. The results point to the need to adopt a problem-solving attitude on the part of school administrators cores, taking the results of evaluations and their own institutional practices as references to the achievement of moments of training that supports the decision-making on the direction of the school critically and collaboratively.http://dx.doi.org/10.14572/nuances.v24i2.2483A temática avaliação educacional tem sido frequentemente tomada como objeto de reflexão nos contextos de pesquisa sobre formação e trabalho docente. Recentemente, as avaliações em larga escala instituídas pelos governos federal e estadual no final do século XX vem promovendo a construção de uma cultura avaliativa no interior das escolas. Tal cultura tira a centralidade do processo avaliativo da sala de aula e das figuras do professor e dos alunos, expandindo-a para a comunidade escolar e para a gestão pedagógica. A discussão sobre esta questão encontra terreno fértil no chão da escola, onde as contradições presentes na relação entre o escrito e o vivido nas políticas educacionais se apresentam de forma mais evidente. Assim, nasce o presente estudo que tem como objetivo refletir sobre os limites e as possibilidades da utilização dos resultados das avaliações externa e interna no trabalho do gestor escolar. Para tanto tem apoio na abordagem qualitativa de pesquisa, buscando acessar nos sujeitos e no contexto onde se manifesta o fenômeno educacional estudado as informações necessárias à compreensão do problema. Foram utilizadas como estratégias de aproximação com a realidade observações participantes, a análise documental dos relatórios de avaliação do Sistema Permanente de Avaliação da Educação Básica do estado do Ceará dos anos 2009 a 2011 e entrevista com a gestora de uma escola pública municipal cearense. Os resultados apontam para a necessidade de adoção de uma postura problematizadora por parte dos núcleos gestores escolares, tomando os resultados das avaliações e as próprias práticas institucionais como referências para a realização de momentos de formação contínua que fundamentem a tomada de decisões acerca dos rumos da escola de forma crítica e colaborativa.http://dx.doi.org/10.14572/nuances.v24i2.248
VIDA, TRABALHO E FORMAÇÃO COMO ELEMENTOS DA CONSTRUÇÃO DA IDENTIDADE LEITORA DOS PROFESSORES DA EDUCAÇÃO
Este estudo aborda a construção da identidade leitora de professores, partindo de elementos relacionados à vida, à formação e ao trabalho, que dialeticamente interferem neste processo. O objetivo geral foi compreender como, e a partir de que referenciais, são desenvolvidas as práticas de leitura dos professores nos anos iniciais do Ensino Fundamental. Metodologicamente optou-se pela pesquisa-ação crítico- colaborativa. Os resultados apontam para práticas profissionais e experiências formativas de leitura limitadas e limitantes por parte dos investigados.
Empirical antimicrobial therapy based on active surveillance cultures in ICU patients
Objective: To assess the predictive value of prior carbapenem-resistant Acinetobacter baumannii (CRAB) and Pseudomonas aeruginosa (CRPA) colonization established in surveillance cultures for subsequent infection by these pathogens in ICU patients. Methods: A cohort study was performed with patients admitted to the intensive care unit for at least 48 h. Negative and positive predictive values, sensitivity, and specificity of surveillance cultures in CRAB and CRPA were measured. Results: 693 infected patients were included. Patients previously colonized by CRAB and CRPA were more likely to be infected by these pathogens: adjusted OR: 10.34 (6.58 - 16.45; p < 0.001) and 2.30 (3.88 - 10.26; p < 0.001), respectively. We found high negative predictive values of surveillance cultures for CRAB (87.18%) and CRPA (88.30%) and high specificity 91.96% and 90.13%, respectively. Conclusions: Patients not colonized by CRAB and CRPA were less prone to infection by these pathogens. These findings may contribute to the choice of empirical antimicrobial therapy and discourage the prescription of antibiotics against these pathogens in patients without previous colonization
AVALIAÇÃO DIAGNÓSTICA E OS SABERES DA EXPERIÊNCIA NOS CURSOS DE FORMAÇÃO DE PROFESSORES
O ponto de partida deste estudo é o reconhecimento da avaliação diagnóstica comoelemento que colabora na identificação dos conhecimentos já consolidados pelosestudantes e, por consequência, nas tomadas de decisão que permeiam o planeja-mento do processo de ensino-aprendizagem. Quando tal questão se remete aosprofessores em processo de formação, o diagnóstico permite, ainda, o estabeleci-mento de um diálogo pedagógico entre os saberes da experiência e os demais sa-beres necessários à docência, em uma perspectiva de reflexão sobre a prática e defortalecimento da profissionalidade docente. O presente texto aborda uma investi-gação realizada junto a professores/alunos de um curso de especialização em en-sino da Matemática com o objetivo de identificar as concepções de avaliação pre-sentes neste grupo e sua relação com as práticas educativas desenvolvidas nocontexto da sala de aula. Metodologicamente, optou-se pela abordagem qualitativade pesquisa, tendo em vista a valorização dos sujeitos e seus universos de compre-ensão. Foram utilizados como instrumentos de coleta de dados o questionário se-miestruturado e o grupo focal. A fundamentação teórica contou com as contribui-ções de Hoffman (2003) e Luckesi (2002), dentre outros. Os resultados apontampara a apropriação teórica de concepções de avaliação que remetem às ideias deformação e emancipação, assim como para os desafios de materialização de taisconceitos no contexto das práticas avaliativas cotidianas.Palavras-chave: Avaliação. Avaliação diagnóstica. Formação de professores
Health education tools/resources with adolescents during the COVID-19 pandemic:an integrative review
ResumoObjetivo: Identificar ferramentas/recursos de educação em saúde utilizados com adolescentes durante a pandemia COVID-19. Métodos: Revisão integrativa, cuja busca ocorreu durante o mês de janeiro de 2022, nas bases de dados National Library of Medicine/PUBMED (PMC), Embase, Cochrane Library, Web of Science e Cumulative Index to Nursing and Allied Health Literature (CINAHL).Resultados: A amostra foi constituída por 22 artigos, cujos temas encontrados deram origem a quatro categorias: ferramentas/recursos de educação em saúde focados na prevenção e redução de agravos relacionados à saúde mental (oito estudos); ferramentas/recursos de educação em saúde focados na promoção de hábitos de vida saudáveis (cinco estudos); ferramentas/recursos de educação em saúde focados no estabelecimento de sentimentos ligados ao bem-estar (Dois estudos); e ferramentas/recursos de educação em saúde de temas variados (sete estudos). Conclusão: As ferramentas/recursos de educação em saúde voltadas para a saúde dos adolescentes foram abordadas, principalmente no contexto sobre prevenção e redução de agravos relativos à saúde mental, desencadeados pelo cenário da pandemia COVID-19.Objective: To identify Health Education tools/resources used with adolescents during the COVID-19 pandemic.Methods: An integrative review conducted during January 2022 in the following databases: National Library of Medicine National/PUBMED (PMC), Embase, Cochrane Library, Web of Science and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Results: The sample consisted of 22 articles, and the topics identified gave rise to four categories: Health Education tools/resources focused on preventing and reducing mental health-related problems (eight studies); Health Education tools/resources focused on promoting healthy lifestyle habits (five studies); Health Education tools/resources focused on establishing well-being-related feelings (two studies); and Health Education tools/resources on various topics (seven studies).Conclusion: The Health Education tools/resources focused on adolescents' health were mainly discussed in the context of preventing and reducing mental health-related problems triggered by the COVID-19 pandemic scenario
Serious Adverse Drug Reactions and Safety Signals in Children: A Nationwide Database Study
Children are more exposed to inappropriate medicine use and its consequent harms. Spontaneous reporting of suspected Serious Adverse Drug Reactions (SADR) increases knowledge and prevention of pharmacotherapy risk. Disproportionality measures are useful to quantify unexpected safety issues associated with a given drug-event pair (signals of disproportionality). This cross-sectional study aimed to assess SADR reporting and safety signals for Brazilian children from 0-12 years old, notified between January 2008 and December 2013 from the Brazilian Surveillance Agency (Notivisa). Information from serious reports (gender and age of the patient, event description, suspected drug) was included. Disproportionality analysis based on Reporting Odds Ratios with a confidence interval of 95% was conducted to identify possible signals of disproportionate reporting (SDR). Almost 30% of 1,977 suspected SADR was related to babies (0-1-year-old). 69% of reports happened with intravenous dosage forms, and 35% of suspected SADR involved off label use according to age. Laronidase, miglustat, imipenem/cilastatin, and clofarabine were involved in six or more suspected deaths among 75 deaths reported. There were 107 SDRs, of which 16 events (15%) were not described in the product labels. There was a relatively higher number of SADRs in Brazilian children compared with studies from other countries. SDRs found, (especially drug-event pairs 'imipenen/cilastatin-pneumonia' and 'laronidase-respiratory insufficiency') should be investigated more. The reports of SADR with IV dosage forms and OL drug use suggest the need for drug research and the use of better dosage forms for children in Brazil
Suspected adverse drug reactions reported for Brazilian children: cross‐sectional study
To assess spontaneous reports of suspected adverse drug reactions in children aged 0-12 years from the Brazilian Health Regulatory Agency between 2008 and 2013.A cross-sectional study on suspected adverse drug reactions reports related to medicines and health products in children was carried out for a six-year period (2008-2013). Year of report, origin of report by Brazilian state, gender, age, suspected drug, adverse reaction description and seriousness were included in the analysis. The data obtained was compared to the number of pediatric beds in health services and to global data from the VigiBase (World Health Organization).A total of 3330 adverse drug reactions were reported in children in Brazil in the investigated period (54% were in boys). About 28% of suspected adverse drug reactions reports involved 0 to 1-year-old children. Almost 40% of reports came from the Southeast region. Approximately 60% were classified as serious events. There was death in 75 cases. Nearly 30% of deaths involved off-label use; 3875 medicines (465 active substances) were considered suspected drugs. Anti-infective (vancomycin, ceftriaxone, oxacillin, and amphotericin), nervous system (metamizole) and alimentary tract and metabolism medicines were more frequent in reports.The distribution of suspected adverse drug reactions reports by sex and age group corresponded to the profile of children hospitalized in Brazil. Data about seriousness and medicines reported may be useful to encourage regulatory actions and improve the safe use of medicines in children
A Acessibilidade de Pessoas com Daltonismo: A Construção de um Protótipo de AVA Inclusivo
O presente estudo teve como finalidade desenvolver um protótipo de módulo digital que pudesse melhorar e/ou adequar o acesso de pessoas com daltonismo ao Ambiente Virtual de Aprendizagem (AVA) “Aprender Unoeste”. A pesquisa assumiu um caráter qualitativo, uma vez que a proposta de investigação focou o estudo a respeito da acessibilidade de pessoas com daltonismo aos AVAs. Os resultados obtidos contribuíram para o entendimento da necessidade de se considerar determinadas especificidades para se promover o acesso efetivo de pessoas com daltonismo aos AVAs, propiciando condições mais eficientes de leitura e visualização das informações gerais e dos materiais didáticos disponíveis
Multisystem inflammatory syndrome drug treatment in countries with different income profiles: a scoping review
Objective: The purpose of this study was to map and describe the studies that have investigated therapeutic alternatives for the management of paediatric multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19. Considering the origin of the studies performed (low-, middle- and high-income countries), a systematic scoping review was conducted with primary studies that reported the use of medications for the treatment of patients with MIS-C.Sources: The searches were performed in MEDLINE, Embase, Lilacs, Epistemonikos, CINAHL, and CENTRAL, in the grey literature (theses and dissertations from CAPES, ProQuest, and PROSPERO) and in clinical trial databases until May 2022. The selection and extraction of studies were performed independently by two reviewers.Summary of the findings: A total of 173 studies were included, most of which were published as case reports or series. No randomized controlled clinical trials (RCTs) were identified. The investigated drugs were immunoglobulins, glucocorticoids, monoclonal antibodies, anticoagulants, and antiplatelet agents.Conclusion: The dosages, when reported, were heterogeneous among the studies. The ethnicity and comorbidity of the participants were poorly reported. Monoclonal antibodies, drugs with higher costs, were mostly described in studies of high-income countries
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