Utilização de gentamicina no tratamento de neonatos atendidos em uma maternidade pública da região metropolitana de Belo Horizonte, Minas Gerais (1999)

Gentamicin is a low cost antimicrobian commonly used in the treatment of neonatal sepsis. Nevertheless, there is a potential risk of oto and nephrotoxicity. The objectives of the study were to characterize the hospitalized neonate in use of gentamicin and to evaluate the follow-up of the dosing protocol adopted. It is a cross sectional study of a total of 63 neonates who received assistence at a public maternity in August, October and December, 1999. It is a Brazilian public institution which plays a role of reference in the high risk pregnancy and delivery. Most patients were premature (85.7%) and low birth weight (90.5%). Only two (3.2%) sepse cases were confirmed by hemoculture. The protocol adopted recommends doses of 2.5mg/kg with a 24 hour dosing interval for neonates weighing less than 1200 g and a 12 hour dosing interval for those with a superior weight. Almost all doctors (96.7%) followed the protocol considering the dose and dosing interval. However, most patients (72.6%) with negative hemoculture were treated for more than the recommended time.A gentamicina é um antimicrobiano de baixo custo amplamente utilizado no tratamento da septicemia neonatal. Entretanto, existe um risco potencial de oto e nefrotoxicidade. Neste trabalho, buscou-se caracterizar o recém-nascido hospitalizado em uso de gentamicina e avaliar o cumprimento do protocolo de tratamento adotado em uma Instituição pública de Belo Horizonte, Minas Gerais. Trata-se de um estudo transversal incluindo 63 recém-nascidos atendidos em uma maternidade pública no período de agosto, outubro e dezembro de 1999. Essa maternidade é referência na assistência à gestação e ao parto de alto risco em Minais Gerais. A maioria dos recém-nascidos foi prematura (85,7%) e de baixo peso (90,5%). Apenas dois (3,2%) casos de septicemia foram confirmados por hemocultura. O protocolo adotado preconiza a administração de doses de 2,5 mg/kg a intervalos de 24 horas para neonatos com peso inferior a 1200 g e 12 horas para aqueles com peso superior a esse. Observou-se que o esquema terapêutico foi adotado em 96,7% dos casos. Contudo, constatou-se uma utilização por tempo superior ao recomendado, frente à hemocultura negativa, em mais de 70,0% dos casos

Building an antimicrobial stewardship program: A narrative of six years under the Donabedian perspective

Introduction: Antimicrobial resistance (AMR) is increasing and represents one of the world’s major challenges. AMR increase morbimortality, length of hospital stay and costs. Antimicrobial Stewardship Programs (ASP) are one of the key strategies to promote the rational use of antimicrobials since AMR is mostly driven by antimicrobial consumption.Objective: To describe the ASP implementation in a teaching hospital from the perspective of Donabedian quality assessment and the Brazilian regulatory requirements.Method: This was a descriptive study with secondary data collection, including document review of the ASP. The study setting was a general public 392-bed hospital. The ASP activities were performed by the hospital infection control committee (HICC), hospital pharmacy (HP) and diagnostic support laboratory (DSL). The description of the three services mainly involved in the ASP was based on a quality assessment model involving the dimensions of “structure”, “process” and “result” proposed by Donabedian. The distribution among dimensions was guided by the checklist of essential elements of the ASP that compose the Brazilian regulatory requirements. The checklist was applied in July, 2022, and the ASP results described from 2016 to 2021.Results: ASP actions have been gradually implemented since 2008 with the implementation of HICC and improved over the years. Regarding structure, the investments in technology were mapped, quantifying 26 computers and three software programs employed to computerize the ASP processes performed in specific physical areas by HICC, HP and DSL. Institutional guidelines used by HICC, HP and DSL guided clinical practices to operationalize ASP. The evaluation metrics improved for 10 indicators and worsened for four indicators. From the 60 items composing the checklist, the hospital met the requirements in 73.3% of the items (n = 44).Conclusion: This study described the implementation of ASP in a teaching hospital, applying the Donabedian perspective. Although the hospital still does not have a classic ASP model, there were investments to improve structure, processes and results, aiming to comply with international guidelines. A high proportion of key elements of ASP in the hospital were followed according to the Brazilian regulatory requirements. Aspects related to antimicrobial consumption and the emergence of microbial resistance deserve further investigations

Factors associated with the development of leprosy in Brazilian contacts: a systematic review

People who interact with leprosy patients in their environment, neighborhood, family, or social relationships are at risk to develop the disease. This systematic review investigated the risk and protective factors associated with the development of leprosy in Brazilian contacts. The studies were found in Cochrane Library, PubMed (MEDLINE), Embase, Virtual Health Library, grey literature and hand search until July 2021. The study selection, data extraction and quality assessment were independently performed by two investigators. The quality assessment was performed using the Newcastle-Ottawa Scale (NOS). This review was registered in PROSPERO (CRD42020160680). Seventeen articles fulfilled the inclusion criteria (n=544). The immunological and molecular factors, such as Anti-phenolic Glycolipid Antibodies (Anti-PGL-1) seropositivity, negative Mitsuda test, absence of Bacillus Calmette-Guérin (BCG) scar, positive Polymerase Chain Reaction (PCR) in blood; age and race; conviviality, education, contact time and type of contact, as well as elements related to the index case (bacilloscopic index; genetic conditions, family relationships), and some combined factors were shown to be relevant risk factors associated with the development of the disease in Brazilian leprosy contacts. The protective factors reported were the presence of one or more BCG scars, positive Mitsuda test, and education level. All selected studies were considered of high quality according to NOS. The knowledge of disease-related risk and protective factors provides the scientific basis for decision-making in the management of the disease in leprosy contacts

Staff Knowledge and Attitudes Towards COVID-19 New Biosafety Practices at a Brazilian Dental School

Objective: To evaluate knowledge and attitudes towards biosafety recommendations during the COVID-19 pandemic at a Brazilian dental school. Material and Methods: A cross-sectional study was performed in 2020 with the clinical staff of a Brazilian dental school. The whole clinical staff was sent pre-tested self-administered online questionnaires about knowledge and attitudes towards the recommendations for biosafety in dental settings in the context of the COVID-19 pandemic. Descriptive statistical analyses were carried out for proportion calculation. Results: Disposable head covering caps, isolation gowns, and gloves were the most frequently reported personal protective equipment (PPE). The rates ranged from 52.9% to 88.5% for N95 respirators, from 68.6% to 92.6% for face shields, from 47.4% to 67.5% for conventional eye protection shields, and 45.1% to 77.4% for eye protection with solid side shields. Chlorhexidine gluconate was the most frequent mouthwash indicated before clinical dental care. The percentage of agreement to provide clinical care to patients with suspected COVID-19 varied from 23.5% to 50.0%. The percentage of respondents who agreed that bioaerosol-generating procedures should be avoided was higher than 74.5%. Less than 50% knew the correct sequence for doffing of PPE. Conclusion: This study revealed important gaps in knowledge and attitudes towards prevention and control measures against infection in dental environments in the context of COVID-19, indicating the need for improvements

IMPLANTAÇÃO DE UM AMBULATÓRIO DE ANTICOAGULAÇÃO EM UM HOSPITAL DE ENSINO: ESTUDO DESCRITIVO

Apesar do descobrimento de novos anticoagulantes, o uso da varfarina para o tratamento e prevenção de distúrbios da anticoagulação, ainda é considerado o padrão ouro para os pacientes que necessitam desse tipo de tratamento. Entretanto, esse medicamento é classificado como um medicamento potencialmente perigoso, e o seu uso está associado ao risco de vários eventos, dentre eles a ocorrência de hemorragia e morte, principalmente quando mal utilizado. O presente estudo possui o objetivo de descrever aspectos relacionados à implantação de um ambulatório multiprofissional para abordagem ao paciente em tratamento com varfarina.Foram atendidos 335 pacientes, dos quais a maioria era do sexo feminino (177;53%), 177 pacientes (53%) apresentaram um tempo médio de retorno ao ambulatório maior do que 7 e menor do que 14 dias, 256 (77%) relataram dificuldade em acessar o medicamento varfarina na atenção primária a saúde, e identificou-se um aumento do percentual de pacientes com RNI na faixa terapêutica com o prolongamento do tempo de acompanhamento no ambulatório. O ambulatório apresenta-se como interessante estratégia de garantia da segurança dos pacientes acompanhados. Recomenda-se que os resultados desse estudo sejam utilizados para a implementação de ações que fortaleçam a efetividade e segurança da farmacoterapia anticoagulante oral, bem como a articulação na rede de cuidados desse perfil de pacientes.

Drug therapy and other factors associated with the development of acute kidney injury in critically ill patients: a cross-sectional study

Background Acute kidney injury (AKI) is associated with a significant increase in morbidity, mortality, and health care costs. In intensive care units (ICU), AKI is commonly multifactorial and frequently involves diverse factors, such as hypovolemia, sepsis, and the use of nephrotoxic drugs. We aimed to investigate drug therapy and other factors associated with the development of AKI in a Brazilian public hospital. Methods This is a cross-sectional study involving critically ill patients at an ICU of a tertiary hospital. All data on sequential serum creatinine (SCr) level, glomerular filtration rate (GFR), and urine output were collected during ICU stay. The primary outcome was the occurrence of AKI assessed by the Acute Kidney Injury Network (AKIN) criterion. Sociodemographics, clinical data and drug therapy were considered as covariates. Factors associated with AKI were assessed using logistic regression. Results Overall, 122 participants were included in the study. Median age was 46.0 (interquartile range, IQ = 29.0–69.0) years, with a predominance of men (58.2%). Mean number of prescribed drugs throughout ICU stay was 22.0 ± 9.4. The number of potentially nephrotoxic drugs ranged from two to 24 per patient. A total of 29 (23.8%) ICU patients developed AKI. In the AKI-group, patients were older and showed higher Acute Physiology and Chronic Health Evaluation II (APACHE II) scores at admission, higher rates of sedation, mechanical ventilation, and infection. More drugs in general and specifically more vasoactive drugs were prescribed for AKI group. Patients who developed AKI tended to have extended stays in the ICU and a lower probability of being discharged alive than patients with no AKI development. Model adjustments of logistic regression showed that the number of medications (OR 1.15; 95% CI [1.05–1.27]) was the only factor associated with AKI in this study. This association was independent of drug nephrotoxicity. Discussion Intensive care is characterized by its complexity that combines unstable patients, severe diseases, high density of medical interventions, and drug use. We found that typical risk factors for AKI showed statistical association on bivariate analysis. The contribution of drug therapy in the occurrence of AKI in medical ICUs reinforces the need for prevention strategies focused on early recognition of renal dysfunction and interventions in drug therapy. These actions would help improve the quality of patient care and ensure progress towards medication safety

Estímulo ao uso racional da varfarina: vídeo educativo como ferramenta de aprendizado

O objetivo deste trabalho foi avaliar o conhecimento sobre a terapia anticoagulante antes e depois da aplicação de um vídeo educativo em pacientes ambulatoriais em uso de varfarina atendidos por um hospital público. O conhecimento dos pacientes foi avaliado por seis perguntas, sendo calculado o percentual de respostas certas. Identificou-se os pacientes com percentual de acerto ≥ 60%, e para avaliar o conhecimento adquirido com o vídeo foi determinado o acerto antes e depois da visualização para a pergunta sobre qual é a indicação da varfarina. A análise estatística univariada e os testes MacNemer e Mann–Witney foram realizadas no SPSS 21.0. O vídeo foi avaliado por 62 pacientes, sendo que 41 (66,1%) tinham até seis meses de tratamento. O conhecimento sobre a indicação da varfarina aumentou após o vídeo (p = 0,006). Não houve diferença significativa entre o percentual de acertos considerando tempo de tratamento ≥ 6 meses ou < 6 meses (p = 0,775). O vídeo ajudou a esclarecer dúvidas sobre anticoagulação de 98,4% dos pacientes. Os resultados sugerem que o material audiovisual elaborado pode contribuir para ampliar o conhecimento sobre o tratamento com varfarina e, consequentemente, proporcionar aumento das taxas de adesão ao tratamento com anticoagulante e aumentar a segurança dos pacientes

Telemedicine-Based Management of Oral Anticoagulation Therapy:Systematic Review and Meta-analysis

BACKGROUND: Oral anticoagulation is the cornerstone treatment of several diseases. Its management is often challenging, and different telemedicine strategies have been implemented to support it. OBJECTIVE: The aim of the study is to systematically review the evidence on the impact of telemedicine-based oral anticoagulation management compared to usual care on thromboembolic and bleeding events. METHODS: Randomized controlled trials were searched in 5 databases from inception to September 2021. Two independent reviewers performed study selection and data extraction. Total thromboembolic events, major bleeding, mortality, and time in therapeutic range were assessed. Results were pooled using random effect models. RESULTS: In total, 25 randomized controlled trials were included (n=25,746 patients) and classified as moderate to high risk of bias by the Cochrane tool. Telemedicine resulted in lower rates of thromboembolic events, though not statistically significant (n=13 studies, relative risk [RR] 0.75, 95% CI 0.53-1.07; I2=42%), comparable rates of major bleeding (n=11 studies, RR 0.94, 95% CI 0.82-1.07; I2=0%) and mortality (n=12 studies, RR 0.96, 95% CI 0.78-1.20; I2=11%), and an improved time in therapeutic range (n=16 studies, mean difference 3.38, 95% CI 1.12-5.65; I2=90%). In the subgroup of the multitasking intervention, telemedicine resulted in an important reduction of thromboembolic events (RR 0.20, 95% CI 0.08-0.48). CONCLUSIONS: Telemedicine-based oral anticoagulation management resulted in similar rates of major bleeding and mortality, a trend for fewer thromboembolic events, and better anticoagulation quality compared to standard care. Given the potential benefits of telemedicine-based care, such as greater access to remote populations or people with ambulatory restrictions, these findings may encourage further implementation of eHealth strategies for anticoagulation management, particularly as part of multifaceted interventions for integrated care of chronic diseases. Meanwhile, researchers should develop higher-quality evidence focusing on hard clinical outcomes, cost-effectiveness, and quality of life. TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews CRD42020159208; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=159208.</p

Interações medicamentosas da Varfarina em cardiopatas chagásicos e não chagásicos atendidos em ambulatórios do Hospital das Clínicas da UFMG

Exportado OPUSMade available in DSpace on 2019-08-13T15:15:03Z (GMT). No. of bitstreams: 1 maria_auxiliadora_tese_intera__es_medicamentosas_da_varfarina_2012.pdf: 5215203 bytes, checksum: 6df32867c4ad25c69aeecc2279e2aa36 (MD5) Previous issue date: 13Introdução: As interações medicamentosas (IM) são causa importante de eventos adversos, que podem aumentar a morbimortalidade relacionada a medicamentos e ter impacto social e econômico significativo. A varfarina se destaca como fármaco de alto riscodevido ao índice terapêutico estreito, ampla variabilidade dose-reposta e potencial de IM. A identificação precoce das IM com varfarina pode auxiliar na prevenção de eventos adversos, principalmente sangramentos. Objetivos: Avaliar as IM potenciais da varfarina comparando diferentes fontes de informação e investigar a ocorrência de IM graves em cardiopatas chagásicos e não chagásicos atendidos no Hospital das Clínicas da Universidade Federal de Minas Gerais (UFMG). Métodos: As listas de interações da varfarina de três compêndios (Drug Interaction Facts, Drug Interactions: Analysis andManagement e DRUG-REAX), do formulário da Organização Mundial da Saúde (OMS) e da bula do Marevan® foram comparadas considerando: substâncias citadas, classificação de gravidade e nível de evidência científica. Realizou-se, ainda, estudo transversal envolvendo pacientes cardiopatas para avaliar IM da varfarina e sua frequência de acordocom as fontes. O coeficiente kappa foi calculado para avaliar a concordância entre as fontes de informação. Resultados: Foi listado um total de 537 interações. Apenas 13 (2,4%) interações da varfarina foram comuns às cinco fontes, sendo que a maioria citada nos compêndios e na lista da OMS não estava presente na bula. O coeficiente kappaFleiss foi -0.0080. Apenas duas interações foram classificadas como graves coincidentemente nos três compêndios e na lista da OMS. Foram estudados 280 pacientes (84 chagásicos e 196 não chagásicos), sendo a maioria do sexo feminino (54,6%) com média de idade de 56,8 (DP 13,1) anos. Não houve diferenças estatisticamente significantes em suas características sócio-demográficas, embora os não chagásicostenham apresentado mais co-morbidades. A frequência das interações graves da varfarina nesses pacientes foi variável entre os compêndios, com coeficiente kappa Fleiss de 0,295. A frequência de interações graves da varfarina se mostrou discordante e com ampla variabilidade entre as fontes ao se avaliar o histórico de sangramento e se compararchagásicos e não chagásicos. Conclusões: Houve baixa concordância entre as cinco fontes analisadas sobre interações da varfarina, sendo a bula a fonte mais incompleta de informações. A avaliação das interações da varfarina em pacientes cardiopatas revelou que a discordância encontrada nos compêndios se estende à prática clínica.Introduction: Drug interactions (DI) are an important cause of adverse events. They can increase drug related morbi-mortality and result in significant social and economic impact. Warfarin is a high risk drug due to its narrow therapeutic index, variability in dose-responseand potential for DI. The early identification of warfarin DI may help to prevent adverse events, especially hemorrhage. Objectives: To evaluate potential warfarin DI in different sources of drug information and to investigate the frequency of severe warfarin DI in Chagas and non-Chagas disease patients at the Hospital das Clínicas of the Universidade Federal de Minas Gerais (UFMG). Methods: The lists of warfarin interactions provided by three compendia (Drug Interaction Facts, Drug Interactions: Analysis and Management and DRUG-REAX), the World Health Organization (WHO) Model Formulary and the Marevan®package insert were all compared in terms of: cited substances, severity ratings and documentation levels. A cross-sectional study was carried out enrolling patients with heart diseases to evaluate warfarin DI and its frequency according to the sources. A kappa coefficient was used to calculate the agreement between the sources. Results: A total of537 interactions were listed. Only 13 (2.4%) were common to the five sources. Most critical interactions cited by the compendia were missing from the package insert. The global Fleiss kappa coefficient was -0.0080. Only two warfarin interactions were reported as critical coincidently by the three compendia and by the WHO. A total of 280 patients were studied (84 Chagas and 196 non-Chagas disease patients). Most patients were female (54.6%) with an average age of 56.8 (SD 13.1) years old. They showed no statistical differences in their sociodemographic characteristics. However, non-Chagas individualshad more comorbidities. The frequency of severe warfarin DI was variable among the sources resulting in a Fleiss kappa coefficient of 0.295. The frequency of severe warfarin DI showed disagreement with a wide variability between the sources when history of bleeding was assessed and Chagas and non-Chagas disease patients were compared.Conclusions: Poor agreement was found among five sources listing warfarin interactions. The package insert was the most incomplete source of drug information. The evaluation of warfarin DI in patients with heart diseases showed that the disagreement found in the compendia extends itself to the clinical practice