Adherence to medication before and after the use of a Drug-Dispensing System with usage control

;O objetivo deste estudo foi avaliar a adesão ao tratamento medicamentoso de pacientes polimedicados antes e após o uso de um Sistema de Dispensação de Medicamentos e Controle de Uso (SDMCU) e comparar os níveis dos parâmetros clínicos - pressão arterial, glicemia pós-prandial, hemoglobina glicada, triglicérides e colesterol. O SDMCU foi constituído por uma embalagem mensal de dispensação de medicamentos, em forma de ;blister; com calendário. Este estudo, do tipo quase-experimental, foi realizado em uma Unidade Básica de Saúde. Selecionaram-se 24 pacientes para utilizar o SDMCU por 4 meses. A adesão medicamentosa foi avaliada através do Teste de Morisky e Green. Entre os participantes do estudo, 62,5% eram mulheres e a idade média foi de 67 anos. Antes do uso do SDMCU, 83,3% dos pacientes foram considerados "menos aderentes". Após o uso do sistema, 100% foram considerados "mais aderentes" (p;The aim of the present work was to assess the adherence to medication from polymedicated patients before and after the use of a Drug-dispensing System with Usage Control (DDSUC) and compare the levels of the clinical parameters - blood pressure, postprandial glycemia, glycated hemoglobin, triglycerides and cholesterol. DDSUC consisted of a monthly drug-dispensing package, in the shape of a blister with a calendar. This quasi-experimental study was performed in a Basic Health Unit. Twenty four patients were selected to use DDSUC for 4 months. Medication adherence was assessed through Morisky-Green test. Among the participants of the study, 62.5% were women and the average age was 67 years old. Before the use of DDSUC, 83.3% of the patients were considered as "less adherent". After the use of the system, 100% were considered as "more adherent" (p < 0.01), the means of the systolic blood pressure decreased 23.7 mmHg (p=0.000), the diastolic blood pressure decreased 12.1 mmHg (p=0.004) and glycemia diminished 79.3 mg/dl (p=0.000). The use of DDSUC improved the adherence to medication and decreased the values of the clinical parameters, making patients safer when it comes to respecting the correct use of their medication.

Processos de documentação 2D e 3D em obras académicas de Adriano de Sousa Lopes do acervo da FBAUL

info:eu-repo/semantics/draf

The diversity and evolution of pollination systems in large plant clades: Apocynaceae as a case study

Background and Aims Large clades of angiosperms are often characterized by diverse interactions with pollinators, but how these pollination systems are structured phylogenetically and biogeographically is still uncertain for most families. Apocynaceae is a clade of >5300 species with a worldwide distribution. A database representing >10 % of species in the family was used to explore the diversity of pollinators and evolutionary shifts in pollination systems across major clades and regions. Methods The database was compiled from published and unpublished reports. Plants were categorized into broad pollination systems and then subdivided to include bimodal systems. These were mapped against the five major divisions of the family, and against the smaller clades. Finally, pollination systems were mapped onto a phylogenetic reconstruction that included those species for which sequence data are available, and transition rates between pollination systems were calculated. Key Results Most Apocynaceae are insect pollinated with few records of bird pollination. Almost three-quarters of species are pollinated by a single higher taxon (e.g. flies or moths); 7 % have bimodal pollination systems, whilst the remaining approx. 20 % are insect generalists. The less phenotypically specialized flowers of the Rauvolfioids are pollinated by a more restricted set of pollinators than are more complex flowers within the Apocynoids + Periplocoideae + Secamonoideae + Asclepiadoideae (APSA) clade. Certain combinations of bimodal pollination systems are more common than others. Some pollination systems are missing from particular regions, whilst others are over-represented. Conclusions Within Apocynaceae, interactions with pollinators are highly structured both phylogenetically and biogeographically. Variation in transition rates between pollination systems suggest constraints on their evolution, whereas regional differences point to environmental effects such as filtering of certain pollinators from habitats. This is the most extensive analysis of its type so far attempted and gives important insights into the diversity and evolution of pollination systems in large clades

Study of a System for Medicines Dispensing and Control of Use (SDMCU).

Os medicamentos representam uma conquista revolucionária do homem para a prevenção de doenças crônicas e agudas. Os riscos superam os benefícios quando inadequadamente empregados. Utilização irracional e erros que podem causar eventos e reações adversas são responsáveis anualmente por mais de 100 mil mortes, de 4ª a 6ª causa de morte somente nos Estados Unidos. Com a implementação do sistema de dispensação de medicamentos por dose unitária em hospitais, a administração de doses erradas foi reduzida em mais de 80%. A inadequada adesão ao tratamento das doenças crônicas é um problema mundial de grande magnitude. Nos países desenvolvi¬dos a adesão média é de 50% e nos países em desenvolvimento, este percentual é ainda menor. O presente estudo teve como objetivo desenvolver um Sistema de Dispensação de Medicamentos com Controle de Uso (SDMCU) para pacientes do município de Luiz Antônio-SP que usam cinco ou mais medicamentos diferentes continuamente. Empregaram-se cartelas e sachês personalizados e individualizados visando a utilização racional dos medicamentos com efetiva adesão ao tratamento farmacológico. Esperou-se a prevenção e redução dos problemas relacionados aos medicamentos contribuindo para o aprimoramento da qualidade da assistência à saúde da população. Foram entrevistados e acompanhados 24 pacientes por um período de 4 meses. Neste período foram recolhidos as cartelas e os sachês usados. Foram também mensurados parâmetros clínicos antes e após a implantação do SDMCU como métodos de medida de aderência.. Os parâmetros clínicos mensurados foram pressão arterial, glicemia, hemoglobina glicosilada, colesterol e triglicérides. Teste de Morisky e Green foi usado antes e após o SDMCU para avaliar o grau de adesão ao tratamento farmacológico. Também foram aplicados instrumentos para avaliar o grau de satisfação dos usuários da farmácia municipal de Luiz Antônio SP e do SDMCU. Antes do SDMCU 100% dos pacientes foram considerados como não aderentes pelo Critério 2 do Teste de Morisky e Green. Após o SDMCU, do total de pacientes, 33,3% foram considerados como não aderentes e 66,7% foram considerados aderentes pelo Critério 2. Pelo Critério 1, os com menor adesão contaram 0% e os com maior adesão 100%. O grau de satisfação dos pacientes com a farmácia municipal foi baixo; numa escala de 0 a 8 pontos apenas 20,8% dos entrevistados tiveram a pontuação máxima de 5. Em relação ao SDMCU 87,5% (n=21) obtiveram pontuação máxima, ou seja, estavam muito satisfeitos com o novo método de dispensação de medicamentos. Antes da intervenção apenas 3 (12,5%) e 9 (37,5%) pacientes apresentavam pressão arterial sistólica e diastólica normal respectivamente; após o uso do SDMCU esses números passaram a 13 (54,2%) e 21 (87,5%) respectivamente. No total 10 (41,7%) pacientes obtiveram uma melhora na pressão arterial sistólica e 12 (50%) obtiveram uma melhora na pressão diastólica. A glicemia que estava normal (abaixo do limite) em 11 (45,8%) pacientes antes do SDMCU passou para 23 (95,8%) pacientes após a intervenção, ou seja, 12 (50%) obtiveram uma diminuição no nível glicêmico. Apenas 2 (15,4%) pacientes dos 9 (69,2%) apresentavam valores de hemoglobina glicosilada acima de 7% antes do SDMCU obtiveram um nível abaixo desse limite após o SDMCU, porém 5 (38,46%) pacientes dos 13 (100%) diabéticos tiveram uma redução de mais de 1% no valor da A1c. Dos 24 pacientes acompanhados apenas 4 (16,7%) tinham um valor de colesterol acima da referência; após a intervenção esse número passou a ser de 1 (4,17%) paciente. Os valores de triglicérides melhoraram em 10 (41,7%) pacientes; de 16 (66,7%) com valores acima da referência, antes do SDMCU, apenas 6 (25%) continuaram com os mesmos números após a intervenção. A simplificação da terapia com menos horários de tomadas ao dia ajudou os pacientes a lembrarem de tomar seus medicamentos e a serem menos descuidados quanto ao horário de tomá-los. O SDMCU mostrou-se eficaz na adesão ao tratamento farmacológico baixando os níveis dos parâmetros clínicos e satisfazendo as necessidades individuais dos pacientes.Medicines are a revolutionary conquest of man for the prevention of acute and chronic diseases. Risks outweigh benefits when used improperly. Irrational utilization and errors that can cause adverse reactions and/or events are responsible annually for more than 100 thousand deaths, been the 4th to 6th leading cause of death only in the United States. With the implementation of medication unit dosis dispensing systems in hospitals the administration of wrong dose was reduced by over 80%. The poor adherence to treatment of chronic diseases is a worldwide problem of great magnitude. In developed countries the mean average is around 50% and in developing countries, this percentage is even lower. This study aimed to develop a medication system for dispensing and controlling use (SDMCU) for patients that use five or more different drugs, continuously, in the municipality of Luiz Antônio-SP. Medications blisters and sachets personalized and individualized were prepared in order to accomplish rational use of medicines with an effective pharmacological treatment. It was expected prevention and reduction of drugs related problems (DRP) as a contribution to improve the population quality of healthcare. We have interviewed 24 patients with follow up for a 4-month period. At this time used blisters and sachets were collected. It was also measured clinical parameters before and after the implementation of SDMCU as a method to estimate adhesion. The clinical parameters determined were blood pressure, blood glucose, glycosylated hemoglobin, cholesterol and triglycerides. Morisky and Green Test was used before and after use of SDMCU to assess the grade of adherence to pharmacological treatment. Instruments were also used to assess the degree of satisfaction of SDMCU users and Luiz Antonio´s healthcare unit pharmacy. Before the SDMCU 100% of patients were considered as non-adherent by Criterion 2 of the Morisky and Green Test. After use of SDMCU, 33.3% out of total patients were considered as non-adherent and 66.7% were considered adherent by Criterion 2. By Criterion 1 patients with higher adherence accounted for 100%. The patients degree of satisfaction with local pharmacy was low, on a scale of 0 to 8 points, only 20.8% of respondents had scored the maximum of 5. On the SDMCU 87.5% (n = 21) have obtained maximum scores, ie were very pleased with the new system of medicines dispensing. Before the intervention only 3 (12.5%) and 9 (37.5%) had normal systolic and diastolic blood pressure respectively. After the use of SDMCU these numbers have reached 13 (54.2%) and 21 (87, 5%) respectively. Overall, 10 (41.7%) patients have achieved an improvement in systolic blood pressure and 12 (50%) have achieved an improvement in diastolic pressure. In 11 (45.8%) patients, before the use of SDMCU, the blood glucose was normal (below the limit). After the intervention, 23 (95.8%) patients had normal levels of glucose in the blood. It means that 12 (50%) have achieved a decrease in glucose level to the normal. Glycosylated hemoglobin in only 2 (15.4%) out of 9 patients (69.2%) had a value above 7% before the SDMCU had achieved a level below this limit after SDMCU. In 5 (38.46%) patients out of 13 (100%) had a reduction of more than 1% in the value of A1c. Only 4 (16.7%) out of 24 patients had a value of cholesterol above the reference at the beginning of the study. After the intervention it has rested only one (4.17%) patient with cholesterol above normal level. The values of triglycerides improved in 10 (41.7%) patients, 16 (66.7%) with values above the reference before the SDMCU, only 6 (25%) continued with the same numbers after the intervention. Simplification of medication use practice, with less frequency daily, for taken them, have helped patients to remember to take their medications and to be more careful about the time of taking them. The SDMCU was effective pharmacological treatment by normalizing the levels of clinical parameters and satisfying the needs of individual patients

Evaluation of adherence to drug therapy in elderly hypertensive patients before and after the development and the use of an Electronic System of Personal and Controlled Use of Medication (SUPERMED)

Considerando que a hipertensão arterial sistêmica tem alta prevalência, baixas taxas de controle e que o risco de desenvolver a doença aumenta com a idade, este estudo teve como propósito avaliar a adesão à terapêutica medicamentosa de um grupo de pacientes idosos, hipertensos e atendidos em uma Unidade Básica de Saúde do interior do estado de São Paulo, antes e após o desenvolvimento e a utilização de um Sistema Eletrônico de Uso Personalizado e Controlado de Medicamentos (SUPERMED). Com metodologia do tipo de estudo quase experimental, prospectivo e comparativo, foram acompanhados 32 idosos hipertensos, que utilizavam pelo menos quatro medicamentos diferentes continuamente, em períodos diferentes: \"antes da implantação do SUPERMED\", no \"dia da implantação\" e \"após a implantação do SUPERMED\". Para o acompanhamento dos idosos, foram utilizados os seguintes recursos do SUPERMED: as caixas organizadoras de medicamentos, identificadas com o horário correto de utilização, os sachês de doses unitárias e um relógio com alarme. A adesão foi avaliada através do Teste de Morisky e Green, aplicado antes e após o uso do SUPERMED. Durante todo o acompanhamento dos idosos, realizou-se o controle da pressão arterial, da glicemia pós-prandial, do índice de massa corporal e da circunferência abdominal. O projeto foi provado pelo Comitê de Ética em Pesquisa da Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo e foi solicitado aos participantes da pesquisa o seu consentimento, mediante a assinatura do Termo de Consentimento Livre e Esclarecido. Todas as análises foram conduzidas com software estatístico e com o programa Microsoft Excel ®. A média da idade dos participantes do estudo foi de 71,4 anos (DP 5,6); o predomínio foi do sexo feminino (65,6%); 18,8% eram analfabetos; a média do diagnóstico de hipertensão foi de 19,4 (DP 10,1) anos e a média de medicamentos utilizados foi de 8,0 por idoso. Além da hipertensão, 75% dos idosos apresentavam diabetes melito, 75% dislipidemia e 59,4% obesidade. Após o uso do SUPERMED, a média dos valores da pressão arterial sistólica diminuiu em 21,6 mmHg (p<0,0001) e da pressão arterial diastólica em 4,7 mmHg (p<0,0001). Os resultados do Teste de Morisky e Green mostraram uma baixa adesão dos idosos antes da implantação do SUPERMED, onde 81,2% foram considerados como \"menos aderentes\". Após a implantação do SUPERMED, 96,9% foram considerados como \"mais aderentes\" (p<0,01). O uso do SUPERMED melhorou a adesão medicamentosa e diminuiu os valores da pressão arterial, proporcionando ao idoso uma segurança e uma satisfação no que diz respeito à organização e à utilização correta de seus medicamentosConsidering that the arterial systemic hypertension has a high prevalence, low control taxes and that the risk to develop the disease increases with the aging, the objective of this study was to evaluate the adherence to the drug therapy in a group of elderly patients who have hypertension and are taken care of in a Basic Health Care Unit, in the country of São Paulo state, before and after the development and the utilization of an Electronic System of Personal and Controlled Use of Medication (SUPERMED). The study was almost experimental, prospective and comparative. 32 hypertensive elders were monitored, who used continually at least four different medications, in different periods: \"before the use of SUPERMED\", at \"the day that they started using it\" and \"after the use of SUPERMED\". To monitor the elderlies, the following SUPERMED resources were used: organizing medications boxes, identified with the suitable use time, the single dose pill packs and an alarm clock. The adherence was evaluated by the Morisky and Green Test, applied before and after the use of SUPERMED. During all the monitoring, the arterial pressure and the postprandial glycemia were controlled from the body mass index and the waist circumference. The project was approved by the Ethics Committee in Research from the College of Nursing from the University of São Paulo at Ribeirão Preto and approval from the research participants was asked, followed by the signing of the Statement of Consent. All the analysis was conducted with a statistics software application and the Microsoft Excel program. The elders´ average age in the study was 71.4 years old (DP 5.6); the female gender had the prevalence (65.6%); 18.8% were illiterate; the diagnosis average of hypertension was 19.4% (DP 10.1) years and the average of drugs used per elder was 8. Besides the hypertension, 75% of the elders showed diabetes mellitus, dyslipidemia rate was 75% and 59.4% were obese. After the use of SUPERMED, the systolic arterial pressure values\' average decreased in 21.6 mmHg (p<0.0001) and the diastolic arterial pressure in 4.7 mmHg (p<0.0001). The Morisky and Green Test results showed a low adherence before SUPERMED was implanted, where 81.2% of the elders were considered \"less adherent\". After it was implanted, 96.9% were considered \"more adherent\" (p<0.01). The use of SUPERMED improved the medication adherence and decreased the arterial pressure values, providing the elders with safety and satisfaction about the organization and the proper use of their medication

Adherence to medication before and after the use of a Drug-Dispensing System with usage control

The aim of the present work was to assess the adherence to medication from polymedicated patients before and after the use of a Drug-dispensing System with Usage Control (DDSUC) and compare the levels of the clinical parameters - blood pressure, postprandial glycemia, glycated hemoglobin, triglycerides and cholesterol. DDSUC consisted of a monthly drug-dispensing package, in the shape of a blister with a calendar. This quasi-experimental study was performed in a Basic Health Unit. Twenty four patients were selected to use DDSUC for 4 months. Medication adherence was assessed through Morisky-Green test. Among the participants of the study, 62.5% were women and the average age was 67 years old. Before the use of DDSUC, 83.3% of the patients were considered as "less adherent". After the use of the system, 100% were considered as "more adherent" (p < 0.01), the means of the systolic blood pressure decreased 23.7 mmHg (p=0.000), the diastolic blood pressure decreased 12.1 mmHg (p=0.004) and glycemia diminished 79.3 mg/dl (p=0.000). The use of DDSUC improved the adherence to medication and decreased the values of the clinical parameters, making patients safer when it comes to respecting the correct use of their medication.</p