Aline Teotonio Rodrigues

Impact of pharmacist interventions on drug-related problems and laboratory markers in outpatients with human immunodeficiency virus infection.

Background Substantial complexity has been introduced into treatment regimens for patients with human immunodeficiency virus (HIV) infection. Many drug-related problems (DRPs) are detected in these patients, such as low adherence, therapeutic inefficacy, and safety issues. We evaluated the impact of pharmacist interventions on CD4+ T-lymphocyte count, HIV viral load, and DRPs in patients with HIV infection. Methods In this 18-month prospective controlled study, 90 outpatients were selected by convenience sampling from the Hospital Dia–University of Campinas Teaching Hospital (Brazil). Forty-five patients comprised the pharmacist intervention group and 45 the control group; all patients had HIV infection with or without acquired immunodeficiency syndrome. Pharmaceutical appointments were conducted based on the Pharmacotherapy Workup method, although DRPs and pharmacist intervention classifications were modified for applicability to institutional service limitations and research requirements. Pharmacist interventions were performed immediately after detection of DRPs. The main outcome measures were DRPs, CD4+ T-lymphocyte count, and HIV viral load. Results After pharmacist intervention, DRPs decreased from 5.2 (95% confidence interval [CI] =4.1–6.2) to 4.2 (95% CI =3.3–5.1) per patient (P=0.043). A total of 122 pharmacist interventions were proposed, with an average of 2.7 interventions per patient. All the pharmacist interventions were accepted by physicians, and among patients, the interventions were well accepted during the appointments, but compliance with the interventions was not measured. A statistically significant increase in CD4+ T-lymphocyte count in the intervention group was found (260.7 cells/mm3 [95% CI =175.8–345.6] to 312.0 cells/mm3 [95% CI =23.5–40.6], P=0.015), which was not observed in the control group. There was no statistical difference between the groups regarding HIV viral load. Conclusion This study suggests that pharmacist interventions in patients with HIV infection can cause an increase in CD4+ T-lymphocyte counts and a decrease in DRPs, demonstrating the importance of an optimal pharmaceutical care plan.

Clinical relevancy and risks of potential drug–drug interactions in intensive therapy

Purpose Evaluate the potential Drug–Drug Interactions (pDDI) found in prescription orders of adult Intensive Care Unit (ICU) of a Brazilian public health system hospital; quantify and qualify the pDDI regarding their severity and risks to the critical patient, using the database from Micromedex®. Methods Prospective study (January–December of 2011) collecting and evaluating 369 prescription orders (convenient sampling), one per patient. Results During the study 1844 pDDIs were identified and distributed in 405 pairs (medication A × medication B combination). There was an average of 5.00 ± 5.06 pDDIs per prescription order, the most prevalent being moderate and important interactions, present in 74% and 67% of prescription orders, respectively. In total, there were 9 contraindicated, 129 important and 204 moderate pDDIs. Among them 52 had as management recommendation to “avoid concomitant use” or “suspension of medication”, while 306 had as recommendation “continuous and adequate monitoring”. Conclusion The high number of pDDIs found in the study combined with the evaluation of the clinical relevancy of the most frequent pDDIs in the ICU shows that moderate and important interactions are highly incident. As the majority of them demand monitoring and adequate management, being aware of these interactions is major information for the safe and individualized risk management.

A simple and effective set of PCR-based molecular markers for the monitoring of the Saccharomyces cerevisiae cell population during bioethanol fermentation

One of the defining features of the fermentation process used in the production of bioethanol from sugarcane feedstock is the dynamic nature of the yeast population. Minisatellite molecular markers are particularly useful for monitoring yeast communities because they produce polymorphic PCR products that typically display wide size variations. We compared the coding sequences derived from the genome of the sugarcane bioethanol strain JAY270/PE-2 to those of the reference Saccharomyces cerevisiae laboratory strain S288c, and searched for genes containing insertion or deletion polymorphisms larger than 24 bp. We then designed oligonucleotide primers flanking nine of these sites, and used them to amplify differentially sized PCR products. We analyzed the banding patterns in the most widely adopted sugarcane bioethanol strains and in several indigenous yeast contaminants, and found that our marker set had very good discriminatory power. Subsequently, these markers were used to successfully monitor the yeast cell populations in six sugarcane bioethanol distilleries. Additionally, we showed that most of the markers described here are also polymorphic among strains unrelated to bioethanol production, suggesting that they may be applied universally in S. cerevisiae. Because the relatively large polymorphisms are detectable in conventional agarose gels, our method is well suited to modestly equipped on-site laboratories at bioethanol distilleries, therefore providing both cost and time savings.

Can polyacrylic acid treat sexual dysfunction in women with breast cancer receiving tamoxifen

Abstract Objective: There is a lack of safety data supporting the use of hormone therapy in women who have had breast cancer and who have complained of genitourinary syndrome of menopause (GSM). The objective was to test the efficacy of two non-hormonal therapies for vaginal dryness. Methods: This was a randomized trial with 52 women with breast cancer who were being treated with tamoxifen and who complained of vaginal dryness. The volunteers answered two questionnaires to evaluate sexual function (Female Sexual Function Index, FSFI) and a customized GSM questionnaire. The women were randomized into two groups: 25 (48.1%) in the polyacrylic acid group and 27 (51.9%) in the lubricant group, using either one of the treatments for 30 days, and after they were invited to answer the questionnaires again. Results: There was improvement in the FSFI after both treatments. The polyacrylic acid group showed a decrease in sexual dysfunction from 96% to 24% (p < 0.0001) and the lubricant group showed a decrease from 88.9% to 55.6% (p = 0.0027). Conclusions: The results of this study showed that both treatments improved sexual function; however, polyacrylic acid was superior to the lubricant in treating sexual dysfunction.

Potential Drug Interactions and Drug Risk during Pregnancy and Breastfeeding: An Observational Study in a Women’s Health Intensive Care Unit

Introduction In the pregnancy-puerperal cycle, women may develop complications that require admission to the Intensive Care Unit (ICU). Thus, special attention to pharmacotherapy is necessary, particularly to potential drug interactions (PDIs) and to the effect of the drugs on the fetus and newborn. Objective The aim of this study was to determine the profile of PDIs and the potential risk of drugs used during pregnancy and breastfeeding among patients admitted to the ICU. Methods We conducted an observational, cross-sectional and prospective study, including pregnant and breastfeeding women admitted to the ICU at the Womens Hospital of a university in the city of Campinas, Brazil, for one year. Online databases were used to identify and classify the PDIs and the potential risk of the drugs used during pregnancy and breastfeeding. Results We evaluated 305 prescriptions of 58 women, 31 pregnant and 27 breastfeeding, and 284 (91%) prescriptions presented PDIs. A total of 175 different combinations of PDIs were identified in the prescriptions, and adverse effects caused by the simultaneous use of drugs were not actually observed in the clinical practice. A total of 26 (1.4%) PDIs were classified as contraindicated. We identified 15 (13.8%) drugs prescribed with risk D, and 2 (1.8%) with risk X for pregnant women, as well as 4 (4.9%) drugs prescribed with high risk for breastfeeding women. Conclusions This study demonstrates that there is a high incidence of PDIs in prescriptions. Most drugs used by pregnant and breastfeeding women at the ICU did not present serious risks to their fetus and newborns, but sometimes drugs with risk D or X are necessary in the course of the treatment.

Analysis of information received during treatment and adherence to tamoxifen in breast cancer patients

This study examines whether women with breast cancer, who are adherent and non-adherent to tamoxifen, differ in their perceptions of information received during treatment. This cross-sectional study included women receiving tamoxifen as adjuvant treatment for breast cancer recruited from a teaching hospital specialised in women’s health in the state of São Paulo (Brazil). Women were interviewed and their records were reviewed for socio demographic data and clinical characteristics. We assessed tamoxifen adherence using the Morisky-Green Test, and the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire – Information module (EORTC QLQ-INFO25) was used to evaluate the information received by the women. The sample contained 31 women (mean age = 55.4; SD = 11.6 years). According to the Morisky-Green Test, 74.2% of the women had suboptimal tamoxifen adherence. The global score for women’s perceptions of information they received about the treatment and disease was 57.0 ±19.1 on a scale of 0 to 100, and no significant differences in scores were observed between adherents and non-adherents. A high prevalence of suboptimal tamoxifen adherence was observed. We found no significant differences between women with breast cancer who were adherent and non-adherent to tamoxifen.

HIV pharmaceutical care in primary healthcare: Improvement in CD4 count and reduction in drug-related problems

Background: Highly active antiretroviral therapy (HAART) is complex and many factors contribute to a patient’s response to initial therapy including adherence, drug effectiveness, and tolerance. Close HAART follow-up is needed, particularly when there are concurrent therapies such as prophylactic antibiotics and medications for the treatment of comorbidities. Objective: To assess the effectiveness of pharmacist intervention in reducing drug related problems in HIV/AIDS outpatients (intervention group) and in improving clinical parameters in the intervention group compared to the control group. Methods: We conducted a prospective controlled intervention study with patients paired by gender and initial T CD4+ lymphocyte (CD4) count. HIV-infected patients of a public outpatient service were enrolled for the study by consecutive and convenience sampling. Patients selected for the study were divided into a control group and an intervention group. Both groups were followed for one year; however, only the intervention group received pharmaceutical care. The primary outcome was the drug related problem (DRP) analysis for the intervention group. Secondary outcomes were CD4 count and viral load evaluation for both groups. Results: There was a total of 143 patients enrolled in this study, with 53 (37.06%) patients in the control group and 90 (62.94%) patients in the intervention group. A total of 202 pharmacist interventions with 193 pharmacist-patient and 9 pharmacist-physician interventions were proposed. After one year of pharmaceutical care, a reduction of 38.43% between the initial and final DRP was found (p = 0.0001). The most common DRPs found were related to medication safety. The intervention group showed a mean increase of 84% for the CD4 count in comparison with that observed in the control group. The viral load was not significantly different between the final and initial mean values for both groups. Conclusion: Pharmacist appointments enabled identification, prevention, and solving of drug related problems, especially those related to drug safety. Also, pharmacist interventions improved adherence and increased HAART effectiveness as suggested by the higher elevation in the CD4 count seen in the intervention group in comparison with the control group.

Prevented Prescribing Errors in an ICU of a Brazilian Teaching Hospital Specializing in Women's Health.

To the Editor: It is known that women require special attention during the pregnancy-puerperium cycle, and gynecological and oncological treatments, when they can develop complications, requiring admission to an intensive care unit (ICU). Drugs used in treatments in the ICU may have risks and should be continuously investigated and monitored for patient safety and better outcomes. Because of the large number of medications prescribed in the ICU, prescribing errors are frequent, severe, and expected, and pharmaceutical interventions can contribute to patient care. With that in mind, we conducted a study to demonstrate the influence of pharmaceutical interventions in preventing prescribing errors at a women’s health ICU. This was an interventional, prospective, and longitudinal study, during 13 months, at a 6-bed ICU of a referral teaching hospital specializing in women’s health care at the State University of Campinas. Patients are acutely ill women affected by clinical complications (obstetric, gynecological, and oncological) requiring intensive life support. A trained clinical pharmacist reviewed patients’ medical records, monitored patients’ exams, and analyzed electronic prescriptions. Prescribing errors and drugs most frequently involved were quantified and classified. In order to prevent errors from affecting patients, the pharmacist proposed pharmaceutical interventions, which were subsequently quantified and classified. The study included 222 patients, who were hospitalized for more than 24 hours in this ICU; most were obstetric (n = 108) and oncological (n = 95) patients. The clinical pharmacist detected 101 prescribing errors in 1259 prescriptions. The prevalent types of errors comprised too high a dosage (22; 21.8%), drugs that were unsafe because of potential for drug interactions (DIs; 20; 19.8%), and drugs that were unsafe for use during lactation (15; 14.9%). Errors involving too low a dosage were associated with drugs used to treat the blood and hematopoietic organs; errors involving drugs unsafe to use during lactation, because of safety issues related to the potential for DIs, were associated with drugs used to treat the nervous system, digestive tract, and metabolic disorders and these were statistically significant associations (P < .05). Eighty-seven (86.1%) errors were prevented. The clinical pharmacist performed 127 interventions, yielding an average of 0.6 ± 0.9 interventions per patient and 0.5 ± 0.7 interventions per day. The higher number of pharmaceutical interventions in relation to prescribing errors is explained by the presence of 2 types of interventions—“intravenous route to oral route” and “information drugs”—that are not directly related to prescribing errors but are suggestions that contribute to treatment and noninvasive methods for administration of the drug, aiming for patient safety. Most interventions were related to dosages (30; 23.6%) and DIs (20; 15.7%). Regarding acceptance, 113 (89.0%) were accepted, 5 (3.9%) were partially accepted, and 9 (7.1%) were not accepted. This study suggested that during admission at a women’s health ICU, prescribing errors can occur for obstetric, gynecologic, and oncologic patients. Thus, a good acceptance rate of pharmaceutical interventions by the medical team shows the contribution to prevention of prescribing errors associated with dosages of drugs and DIs, enhancing women’s health safety.