Vancomycin use in a brazilian teaching hospital: comparison with the Hospital Infection Controlpractices Advisory Committee Guidelines (HICPAC)

This study describes vancomycin prescribing patterns in an average complexity hospital and compare the guidelines proposed by the Hospital Infection Control Practices Advisory Committee (HICPAC). The study was conducted in a 256-bed secondary-care hospital. Data were collected of all patients given vancomycin from March 2003 to February 2004, using a standardized chart-extraction form designed. Appropriate and inappropriate use was reviewed according to the Hospital Infection Control Practices Advisory Committee (HICPAC) guidelines on prudent vancomycin use. Out of 118 prescriptions, 95 (80.5%) were considered appropriate. Out of these 95 orders, 77 (81.1%) were administered for empiric treatment of suspected Gram-positive infections, 17 (17.9%) were administered for treatment of proven Gram-positive infections (76.5% identified as Staphyloccocus aureus-like agents) and 1 (1.0%) for beta-lactam allergy. The majority of the patients (96.6%) had recently used an antimicrobial medication (3 months). The mean pre-treatment hospitalization period was 11±10 days. Out of the 118 treatments, 67 (56.8%) were for nosocomial infections. The more frequent indications for vancomycin use were pneumonia (48.3%) and primary sepsis (18.6%), accounting for more than 66% of all treatments. No restriction policy was suggested because vancomycin use was considered adequate in the majority of the treatment cases. The broad empiric use of this antimicrobial was greater than expected in the institution and its use should be revised.University of São Paulo (USP) - University Hospita

Analysis of reported adverse liver reactions associated with drugs used to treat patients with coronavirus disease 2019

Hepatic injury has been documented in patients with coronavirus disease 2019 (COVID-19). However, pharmacotherapy can frequently impact liver alterations, given the known hepatotoxic potential of drugs not effective to treat COVID-19. The objective of the present study was to evaluate reports of suspected liver reactions to drugs used for treating COVID-19, compare their use for other indications among patients with COVID-19, and assess possible interactions between them. We obtained reports on drugs used to treat COVID-19 (tocilizumab, remdesivir, hydroxychloroquine, and/or lopinavir/ritonavir), registered on June 30, 2020, from the Food and Drug Administration Adverse Event Reporting System (FAERS) Public Dashboard. We then analyzed the risk of developing liver events with these drugs by calculating the reported odds ratios (ROR). We identified 662, 744, and 1381 reports related to tocilizumab, lopinavir/ ritonavir, and hydroxychloroquine use, respectively. The RORs (95% confidence intervals) were 6.32 (5.28-7.56), 6.12 (5.22-7.17), and 9.07 (8.00-10.29), respectively, demonstrating an increased risk of liver events among patients with COVID-19 when compared with uninfected patients. The elevated risk of reporting adverse liver events in patients with COVID-19 who receive these drugs, alone or in combination, highlights the need for careful drug selection and efforts to reduce drug combinations without notable benefits. Similar to any other condition, the use of drugs without established efficacy should be avoided

Pharmacist's contribution to the promotion of access and rational use of essential medicines in SUS

Objective: to describe the pharmaceutical inclusion process in a Basic Health Unit multidisciplinary team and evaluate results related to rational use and promotion of access to essential medicines. Methods: This is a descriptive, cross-sectional study conducted in a primary care health unit in the city of Sao Paulo. Pharmacist's activities were evaluated regarding the service structure and organization and prescribing quality improvement, guidance method creation, and implementation of clinical pharmacy service. Data measured before and after the interventions and between 2010 and 2011 were analyzed using Pearson's chi-square test with a significance level of 5%, and odds ratio. Results: Pharmacist's activities had statistically significant result in drug shortage reductionprescribing quality improvement associated with an increased proportion of prescriptions metdecrease in the total of prescribed drugs among patients receiving pharmacotherapeutic follow-up and, comparing the years 2010 and 2011, changes in the pharmacotherapy recommendations have gained increased acceptance level. Conclusions: Pharmacist's activities may effectively provide rational use and promotion of access to essential medicines.O objetivo deste artigo é descrever o processo da inserção do farmacêutico na equipe de uma Unidade Básica de Saúde e os resultados na promoção do acesso e uso racional de medicamentos. Trata-se de estudo descritivo, transversal, realizado em unidade de atenção primária do município de São Paulo. As atividades do farmacêutico foram avaliadas em relação à estruturação e organização do serviço, melhoria do padrão de prescrição médica, elaboração de método de orientação e implantação de serviços farmacêuticos clínicos. A análise estatística foi realizada empregando o teste Qui-Quadrado de Pearson, com nível de significância de 5%, e o ODDs Ratio, quando comparados os períodos anterior e posterior à intervenções e resultados entre os anos de 2010 e 2011. A atuação do farmacêutico apresentou resultados estatisticamente significativos na redução da falta de medicamentos; melhora da qualidade da prescrição (com aumento do número de prescrições atendidas); redução do número de medicamentos prescritos entre os pacientes em seguimento farmacoterapêutico; e, comparando-se os anos 2010 e 2011, as recomendações de mudanças na farmacoterapia passaram a ter maior nível de aceitação. O farmacêutico contribuiu efetivamente para o acesso e a promoção do uso racional de medicamentos.Univ Fed Sao Paulo, Inst Ciencias Ambientais Quim & Farmaceut, R Prof Arthur Riedel 275, BR-09972270 Diadema, SP, BrazilUniv Fed Mato Grosso do Sul, Ctr Ciencias Biol & Saude, Campo Grande, MS USAInstituto de Ciências Ambientais, Químicas e Farmacêuticas, Universidade Federal de São Paulo. R. Professor Arthur Riedel 275, Eldorado. 09972-270 Diadema SP BrasilWeb of Scienc

Does hospital admission provide an opportunity for improving pharmacotherapy among elderly inpatients?

The purpose of the work was to assess the incidence of potential drug interactions (pDDI), major pDDI, and the use of potentially inappropriate medication (PIM) at hospital admission, during hospitalization, and at discharge to evaluate whether hospital admission provides an opportunity for improving pharmacotherapy in elderly patients at a University hospital that has a clinical pharmacist. A prospective cohort study was carried out using data from the medical records of patients admitted to an internal medicine ward. All admissions and prescriptions were monitored between March and August 2006. Micromedex(r) DrugReax(r) and Beers Criteria 2015 were used to identify pDDI, major pDDI, and PIMs, respectively. A comparison of admission and discharge prescriptions showed the following: an increase in the proportion of patients using antithrombotic agents (76 versus 144;

A atuação do orientador educacional na perspectiva do desenvolvimento da autoestima do educando

Trabalho de Conclusão de Curso (graduação)—Universidade de Brasília, Faculdade de Educação, 2019.Esse trabalho tem como foco a atuação do orientador educacional na perspectiva da construção da autoestima do educando, visto que a autoestima é capaz de determinar e ditar comportamentos que permeiam as atividades educacionais e este profissional é o mais preparado para lidar com essas questões pois tem uma figura central na escola, bem como trazer reflexões acerca do objeto de estudo e sua presença nas relações escolares. O método utilizado foi o método misto, um método que envolve aspectos do método quantitativo e qualitativo, foram aplicados questionários estruturados para dois professores, um de cada segmento (Educação Infantil e Ensino Fundamental anos iniciais), que mostraram que na Educação Infantil o assunto é melhor colocado, e para o Orientador Educacional onde constatou-se que o tema está presente em sua prática e sua ação é essencial para lidar com questões que envolvam a construção da autoestima. Dois alunos um de cada segmento foram entrevistados, um apresentou tendências a baixa autoestima e o outro a elevada autoestima, bem como questões externas como a influência da tecnologia nas questões educacionais e pessoais apareceram intimamente ligadas. As conclusões são que há a necessidade de formar orientadores e profissionais que trabalhem com o assunto, que é necessário um olhar voltado para a dinâmica pessoal dos alunos enquanto sujeitos participantes da escola, já que à medida que avançam na vida escolar menos se fala e menos se considera o trabalho com a autoestima, e com o passar do tempo mais ainda se espera que a escola resolva os problemas sociais, emocionais e pessoais.This work focuses on the role of the educational advisor in the perspective of building the self-esteem of the learner, because self-esteem is able to determine and dictate behaviors that pervade this professional and educational activities is more prepared to deal with these issues because it has a central figure at school, as well as bring reflections about the object of study and your presence in the school relations. The method used was the mixed method, a method that involves aspects of the quantitative and qualitative method, structured questionnaires were applied to two teachers, one of each segment (early childhood education and elementary school early years) that showed that in the initial years the subject is best placed, and to the guidance counselor where it was found that the theme is present in your practice and your action is essential for dealing with issues involving the construction of self-esteem. Two students from each segment were interviewed, one presented trends the low self-esteem and other high self-esteem as well as external issues like the influence of technology in the educational and personal issues appeared closely linked. The conclusions are that there is a need to train counselors and professionals who work with the subject, it is necessary a look back to the personal dynamics of pupils while subjects participating in the school, since as they advance in school life less If speech and less if you consider the work with self-esteem, and over time more school still expected to resolve social problems, emotional and personal

A importância e a história dos estudos de utilização de medicamentos

There is a worldwide concern about rational drug use and medical treatment approach. In developing countries, the rational drug use represents an alternative that allows cost reduction without loosing quality in treatment. Although appropriate use of drugs may be indeed of vital importance, drugs represent a double edged word due to their potential adverse effects. The drug utilization studies are tools for detection of possible abuses on its use or the occurrence of adverse events, preventing unappropriate use and unnecessary expenses (pharmacoepidemiology and pharmacoeconomy). However, a few resources are intended for monitoring rational drug use. Moreover, there are limited data on the use of therapeutic agents in hospitals. This research confirmed the importance of these studies, especially in hospitals, to cost reduction and more secure drug use. The observation of deviations, inefficacy and adverse events on the drug utilization makes possible the development of government political and of education interventions, with the aim of rational drug utilization.No mundo atual, onde há ampla necessidade de racionalização de recursos, sobretudo nos países mais pobres, esses estudos apresentam-se como alternativa que permite reduzir custos sem perda de qualidade nos tratamentos médicos, além de terem como função detectar possíveis abusos no uso dos medicamentos ou a ocorrência de eventos adversos. Os medicamentos representam boa parcela dos gastos públicos com saúde e não são substâncias inócuas. Essas são as duas principais razões pelas quais, cada vez mais, se reconhece a necessidade e a importância dos estudos que analisam os tratamentos medicamentosos, em especial nos hospitais, e os dados relativos ao consumo em si. Os últimos possibilitam a aplicação da farmacoeconomia e da farmacoepidemiologia como ferramentas no combate à utilização inadequada de medicamentos e a gastos desnecessários. A pesquisa tornou possível confirmar a importância da ocorrência desses estudos, especialmente em hospitais, visando à redução do gasto com medicamentos. A detecção de desvios, ineficácia e eventos adversos com a utilização inadequada de medicamentos possibilita, em nível macro, o desenvolvimento de políticas governamentais e, em nível micro, a realização de intervenções educativas - ambas as medidas tendo como objetivo a utilização dos medicamentos de forma racional

Flora of the Serra do Cipó, Minas Gerais: Solanaceae

We present the taxonomic treatment of the family Solanaceae as a contribution to the project “Flora of Serra do Cipó, Minas Gerais, Brazil”. The family is represented in the Serra do Cipó by eight genera and 31 species. The richest genus was Solanum, with 21 species, followed by Athenaea, Cestrum and Schwenckia, each one with two species. Brunfelsia, Capsicum, Datura and Physalis had one species each. Key to the genera and species, descriptions and illustrations, as well as comments on the geographic distribution and habitats of the species, are presented.Nós apresentamos o tratamento taxonômico das Solanaceae para o projeto "Flora da Serra do Cipó, Minas Gerais, Brasil". A família está representada na Serra do Cipó por oito gêneros e 31 espécies. O gênero mais rico foi Solanum, com 21 espécies, seguido por Athenaea, Cestrum e Schwenckia, cada um com duas espécies. Brunfelsia, Capsicum, Datura e Physalis foram registrados por uma espécie cada. São apresentadas chaves para gêneros e espécies, descrições e ilustrações, além de comentários sobre a distribuição geográfica e habitat das espécies. &nbsp

Non-Communicable Disease Clinical Practice Guidelines in Brazil: A Systematic Assessment of Methodological Quality and Transparency

Background Annually, non-communicable diseases (NCDs) kill 38 million people worldwide, with low and middle-income countries accounting for three-quarters of these deaths. High-quality clinical practice guidelines (CPGs) are fundamental to improving NCD management. The present study evaluated the methodological rigor and transparency of Brazilian CPGs that recommend pharmacological treatment for the most prevalent NCDs. Methods We conducted a systematic search for CPGs of the following NCDs: asthma, atrial fibrillation, benign prostatic hyperplasia, chronic obstructive pulmonary disease, congestive heart failure, coronary artery disease and/or stable angina, dementia, depression, diabetes, gastroesophageal reflux disease, hypercholesterolemia, hypertension, osteoarthritis, and osteoporosis. CPGs comprising pharmacological treatment recommendations were included. No language or year restrictions were applied. CPGs were excluded if they were merely for local use and referred to NCDs not listed above. CPG quality was independently assessed by two reviewers using the Appraisal of Guidelines Research and Evaluation instrument, version II (AGREE II). Main Findings "Scope and purpose" and "clarity and presentation" domains received the highest scores. Sixteen of 26 CPGs were classified as low quality, and none were classified as high overall quality. No CPG was recommended without modification (77% were not recommended at all). After 2009, 2 domain scores ("rigor of development" and "clarity and presentation") increased (61% and 73%, respectively). However, "rigor of development" was still rated <30%. Conclusion Brazilian healthcare professionals should be concerned with CPG quality for the treatment of selected NCDs. Features that undermined AGREE II scores included the lack of a multidisciplinary team for the development group, no consideration of patients' preferences, insufficient information regarding literature searches, lack of selection criteria, formulating recommendations, authors' conflict of interest disclosures, and funding body influence.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Univ Sao Paulo, Fac Pharmaceut Sci, Dept Pharm, Sao Paulo, BrazilUniv Sao Paulo, Sch Publ Hlth, Dept Publ Hlth Practice, Sao Paulo, BrazilUniv Sao Paulo, Fac Pharmaceut Sci, Dept Pharm, Univ Sao Paulo Hosp, Sao Paulo, BrazilUniv Fed Sao Paulo, Inst Environm Sci Chem & Pharmaceut, Dept Biol Sci, Sao Paulo, BrazilDepartment of Biological Sciences, Institute of Environmental Sciences, Chemical and Pharmaceutical, Universidade Federal de São Paulo (UNIFESP), Diadema, São Paulo, BrazilCNPq: 164700/2015-3Web of Scienc

Training of pharmacy technicians for dispensing drugs in Primary Health Care

Few Brazilian articles discuss the importance of pharmacy technicians who offer direct assistance to patients. This paper describes an experience of the training of pharmacy technicians in drug dispensing. A descriptive, cross-sectional study was conducted in the primary healthcare setting. The technicians were trained by the pharmacist to advise patients at the time of drug dispensing and to screen cases that needed pharmaceutical consultation. Problems were identified by verifying the prescription and return date for dispensing the medication as well as through direct questioning of the patients. Flowcharts for problem identification and intervention were created for use by the technicians. After training, pharmacy technicians identified 3944 problems, the most common of which were the use of a lower dosage than that prescribed (26%) and non-adherence to pharmacological treatment. The findings of the present study demonstrate the importance of training pharmacy technicians with regard to dispensing drugs so that they can assist pharmacists in the process of identifying and solving drug-related problems, thereby making them active members of the care process in the public health system.São escassos artigos científicos brasileiros que discutam a importância do trabalho do técnico em farmácia em assistência direta ao paciente. Este trabalho descreve uma experiência de capacitação de técnicos de farmácia para dispensação de medicamentos. Trata-se de estudo descritivo, transversal, realizado na atenção primária à saúde. Os técnicos foram capacitados pelo farmacêutico a orientar os pacientes no momento da dispensação e para triar casos que necessitavam atendimento farmacêutico. A identificação dos problemas foi feita por meio da observação da prescrição, data de retorno para dispensação ou do questionamento direto ao paciente. Foram elaborados fluxos de identificação de problemas e de intervenção, após os quais os técnicos identificaram 3.944 problemas, sendo os mais comuns: uso de medicamento em quantidade inferior à prescrita (26%) e não adesão ao tratamento farmacológico (25%). Os resultados demonstram a importância da capacitação dos técnicos na dispensação de medicamentos, fazendo deles um aliado do farmacêutico no processo de identificação e resolução de problemas relacionados a medicamentos, além de torná-los membros ativos do processo de cuidado no sistema de saúde pública.Univ Fed Sao Paulo, Inst Ciencias Ambientais Quim & Farmaceut, R Prof Arthur Riedel 275, BR-09972270 Diadema, SP, BrazilUniv Sao Paulo, Fac Ciencias Farmaceut, Sao Paulo, SP, BrazilUniv Sao Paulo, Fac Saude Publ, Sao Paulo, SP, BrazilInstituto de Ciências Ambientais, Químicas e Farmacêuticas, Universidade Federal de São Paulo. R. Professor Arthur Riedel 275, Eldorado. 09972–270 Diadema SP BrasilWeb of Scienc

Factores relacionados con la pérdida y reprogramación de citas de atención farmacéutica por los pacientes ambulatorio mayores en un servicio brasileño de salud pública

The authors thank Adilmo Henrique do Nascimento, Celina Marques Vichinsky and Sandra Cristina Neto for helping in collecting dataObjectives. To uncover reasons why patients missed pharmaceutical care (PC) appointments, identify predictive factors to miss at least one appointment and to reschedule after a miss, and compare the re­scheduling behavior of patients receiving different types of PC. Methods. All elderly patients who had at least one scheduled appointment in the PC service of a health setting of São Paulo city, Brazil, from January to December/2011 were included. Chi-square analysis compared categorical data between groups; multivariate logistic regression models predicted attendance and rescheduling behavior. Results. We identified 421 patients, being 221 (52.5%) non-attenders. Forgetting the appointment was the most common patient-related reason (56.3%). Illiteracy was a risk factor to be a non-attender [OR(95%CI)=2.27(1.17:4.40), p=0.015]. Patients having previous knowledge of the pharmacist pre­ sented more chance to rescheduled an appointment after the first miss compared to those who had not [OR(95%CI)=3.57(1.90:6.71), p<0.001]. Further, non-attenders who had knowledge of the phar­macist and received Medication Review with Follow-up resched­uled more than the ones receiving other types of PC (p=0.035). Conclusion. Illiteracy predicted non-attendance in PC to aged out­patients and forgetfulness was the main reason for that. The pre­vious acquaintance of the pharmacist and the provision of phar­maceotherapeutic follow-up explained the rescheduling behavior, which indicates the establishment of a patient-centered patient-pharmacist relationship plays a pivotal role in the continuity of the PC.Objetivos. Descubrir razones por las que los pacientes perdieron la cita en atención farmacéutica (AF), identificar los factores predictivos de perder al menos una cita y reprogramar después de una ausencia, y comparar el comportamiento de reprogramación de los pacientes recibiendo diferentes tipos de AF. Métodos. Se incluyeron todos los pacientes mayores que tenían al menos una cita programada en el ser­vicio de AF de un establecimiento de salud de la ciudad de São Paulo, Brasil, de enero a diciembre/2011. Análisis chi-cuadrado comparó datos categóricos entre los grupos; modelos de regresión logística multi­variante predijeron el comportamiento de presencia y de reprogramación. Resultados. Se identificaron 421 pacientes, siendo 221 (52,5%) ausentes. El olvido fue el motivo relacio­nado con el paciente más frecuente (56,3%). El analfabetismo fue un factor de riesgo para ser un ausente [OR (IC95%)=2,27(1,17:4,40), p=0,015]. Los pacientes que tenían conocimiento previo del farmacéutico presentaron más chance de reprogramar una cita después de la primera ausencia en comparación con los que no tenía [OR (IC95%)=3,57(1,90:6,71), p<0,001]. Además, ausentes que tenían conocimiento del farmacéutico y recibieron seguimiento farmacoterapéutico reprogramaron más de los que reciben otros tipos de PC (p=0,035). Conclusión. El analfabetismo predijo ausencia en pacientes ambulatorios mayores bajo PC y el olvido fue la principal razón para eso. El conocimiento previo del farmacéutico y la provisión del seguimiento farmacoterapéutico explicaron el comportamiento de reprogramación, lo que indica que el estableci­miento de una relación con el farmacéutico centrada en el paciente juega un papel fundamental en la continuidad de la AF