Iza Maria Fraga Lobo

Management of infection by the Zika virus

A panel of national experts was convened by the Brazilian Infectious Diseases Society in order to organize the national recommendations for the management of zika virus infection. The focus of this document is the diagnosis, both clinical and laboratorial, and appropriate treatment of the diverse manifestations of this infection, ranging from acute mild disease to Guillain-Barré syndrome and also microcephaly and congenital malformations.

Risk factors for adverse drug reactions in pediatric inpatients: a systematic review

Background: The main objective of the present systematic review is to identify potential risk factors for adverse drug reactions (ADRs) through prospective cohort studies in pediatric inpatients. Methods: The data search was done in the following electronic databases PubMed/MEDLINE; Scopus; LILACS and Web of Science from the earliest record until 31 May 2015. Two reviewers independently screened each study and one of them assessed the methodological quality according to the Newcastle–Ottawa scale for cohort studies. The data extraction was conducted according to Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) initiative for cohort studies. Results: The only risk factor observed in all studies was the increase in the number of prescription drugs. However, other factors were identified, such as the increase in the length of stay or the number of low- or high-risk drugs prescribed, use of general anesthesia and oncological diagnosis. The cumulative incidence of ADR was 16.4% (95% confidence interval: 15.6 to 17.2). The main professional responsible for ADR identification was the pharmacist and the dominant category among the ADRs were gastrointestinal disorders. In addition, analgesics, antibacterial agents and corticosteroids were the drug classes commonly associated with ADRs. The methodology used in this study was tried to homogenize the data extracted; however, this was not sufficient to correct the discrepancies so it was not possible to perform a meta-analysis. Conclusions: The increase in the number of prescription drugs was the main risk factor in this population. However, additional studies are required to identify the risk factors for ADRs in pediatric inpatients.

The cost of excessive postoperative use of antimicrobials: the context of a public hospital

OBJECTIVE To evaluate the improper use of antimicrobials during the postoperative period and its economic impact. METHODS We conducted a prospective cohort study by collecting data from medical records of 237 patients operated on between 01/11/08 and 31/12/08. RESULTS from the 237 patients with the information collected, 217 (91.56%) received antimicrobials. During the postoperative period, 125 (57.7%) patients received more than two antimicrobials. On average, 1.7 ± 0.6 antimicrobials were prescribed to patients, the most commonly prescribed antibiotic being cephalothin, in 41.5% (154) of cases. The direct cost of antimicrobial therapy accounted for 63.78% of all drug therapy, this large percentage being attributed in part to the extended antimicrobial prophylaxis. In the case of clean operations, where there was a mean duration of 5.2 days of antibiotics, antimicrobials represented 44.3% of the total therapy cost. CONCLUSION The data illustrate the impact of overuse of antimicrobials, with questionable indications, creating situations that compromise patient safety and increasing costs in the assessed hospital.

A institucionalização da seleção de medicamentos em hospitais públicos por meio do planejamento estratégico situacional

Desde a publicacao da 1a relacao de medicamentos essenciais da OMS, em 1977, este orgao e diversas instituicoes de saude em todo o mundo tem fomentado a importância da promocao de politicas de medicamentos essenciais para os servicos de saude. Apesar da inegavel contribuicao para a promocao do uso racional de medicamentos, a implantacao de comites que gerenciem a implantacao de listas de medicamentos essenciais ainda e um desafio para os gestores do SUS. Este trabalho teve como objetivo utilizar uma ferramenta de gestao, proposta pelo economista Carlos Matus, para a superacao das dificuldades de implantacao de CFT nos servicos hospitalares do estado de Sergipe. Para isso, a equipe de pesquisadores realizou em conjunto com os atores do servico a implantacao do Planejamento Estrategico Situacional por meio dos momentos explicativo, normativo, estrategico e tatico-operacional. Por meio deste trabalho, observou-se que o metodo PES caracteriza-se como uma ferramenta recomendada para a implantacao de atividades fundamentais da selecao de medicamentos, nesse estudo, agrupadas em tres objetivos gerais alcancados: 1) a regulamentacao de fluxos e procedimentos para a selecao de medicamentos; 2) a organizacao de comissoes de farmacia e terapeutica e 3) a elaboracao de listas de medicamentos essenciais.

Risk factors for unintentional medication discrepancies at hospital admission: A matched case-control study

Unintentional medication discrepancies (UMD) are defined as erroneous and unjustified medication changes between the medication use history and the admission medication orders. UMD (e.g., medication omissions, incorrect doses, incorrect frequencies of administration, therapeutic duplications, among others) are distinguished from intentionalmedication discrepancies inwhich adjustments guided by the patients clinical condition are made at the time of admission [1]. Previous studies observed that 14.7% to 66.2% of identified UMD at admission or discharge are able to cause potential damage to patients [1–3]. Discrepancies between the medications patients taken before admission and those listed in their admission orders range from 50% to 70% [1,4–6]. Several studies have investigated the prevalence of UMD, but few have focused on its causes [4,6,7]. Until this date, there are no casecontrol or cohort studies of risk factors for UMD. Therefore, using a prospective case–control study design, we examined potential risk factors for unintended medication discrepancies (UMD) identified at admission among a random sample of hospitalized adult and children patients in the Federal University of Sergipe teaching hospital HU/UFS, in Aracaju, Brazil, betweenApril and July 2013. Patients with at least 1UMD identified at admission were recruited as the case group. Patients without UMD at admission were recruited as the control group. The two groups were matched in terms of age (±2 years, for children;±5years, for adults). At least 1 control patientwas selected for each case patient andmatched on day of hospital admission. Our study included only patients admitted fromMonday to Friday in the surgical, medical and pediatric wards, which remained hospitalized for longer than 24 h. We excluded patients for whom it was not possible to conduct the interview (e.g., the patient was in isolation or unattended) and those whose medical records were not available at the time of evaluation. In the study hospital there were no admissions on weekends. The information collected for each participant included sociodemographic characteristics, medication use and hospitalization related data. A clinical pharmacist and three pharmacy students analysed the data and assessed the presence of UMD. If necessary, a second clinical pharmacist analysed the case until consensus was reached. The evaluation was made in the first 36 h after admission. We did not perform the medication reconciliation process in our study, once it aimed to identify risk factors for UMD. A total of 514 patients were selected for the study, of whom 358 eligible subjects were analysed for this report (113 patients were discharged in b24 h; 30 patients it was not possible to interview and 13 patients there were no access to their medical records). There were

Practices for rational use of blood components in a universitary hospital

OBJECTIVE to produce improvements in transfusion practices through the implementation of an educational program for health professionals in a university hospital. METHODS this is an interventional and prospective study, with pre- and postanalysis of an educational intervention. The research was developed at the University Hospital of the Universidade Federal de Sergipe, involving participation of health professionals in the stage of training, during the month of February 2011, in addition to the monitoring of blood transfusions performed in the pre- and post-intervention periods. Transfusion practices were investigated upon request for transfusion or devolution of unused blood components. Knowledge of health professionals was assessed based on the responses to a questionnaire about transfusion practices. RESULTS during the educative campaign, 63 professionals were trained, including 33 nurses or nursing technicians and 30 physicians. Among the doctors, there was a statistically significant gain of 20.1% in theoretical knowledge (p=0.037). Gain in the nursing group was even higher: 30.4% (p=0.016). The comparative analysis of transfusion request forms showed a non-significant decrease from 26.7 to 19.5% (p=0.31) in all forms with incomplete information. We also observed a statistically significant improvement in relation to the filling of four items of transfusion request. CONCLUSION there was a significant improvement of the entire process related to blood transfusions after interventional project conducted in February 2011.

Risk factors for adverse drug reactions in pediatric inpatients: A cohort study

Purpose The present study aims to identify the risk factors for adverse drug reactions (ADR) in pediatric inpatients. Methods A prospective cohort study in one general pediatric ward in a hospital in Northeast Brazil was conducted in two stages: the first stage was conducted between August 17th and November 6th, 2015, and the second one between March 1st and August 25th, 2016. We included children aged 0–14 years 11 months hospitalized with a minimum stay of 48 hours. Observed outcomes were the ADR occurrence and the time until the first ADR observed. In the univariate analysis, the time to the first ADR was compared among groups using a log-rank test. For the multivariate analysis, the Cox regression model was used. Results A total of 173 children (208 admissions) and 66 ADR classified as “definite” and “probable” were identified. The incidence rate was 3/100 patient days. The gastro-intestinal system disorders were the main ADR observed (28.8%). In addition, 22.7% of the ADR were related to antibacterials for systemic use and 15.2% to general anesthesia. Prior history of ADR of the child [hazard ratio (HR) 2.44; 95% confidence interval (CI) 1.19–5.00], the use of meglumine antimonate (HR 4.98; 95% CI 1.21–20.54), antibacterial for systemic use (HR 2.75; 95% CI 1.08–6.98) and antiepileptic drugs (HR 3.84; 95% CI 1.40–10.56) were identified risk factors for ADR. Conclusions We identified as risk factors the prior history of ADR of the child and the use of meglumine antimonate, antibacterial for systemic use and antiepileptic drugs.

Institutionalization of medicine selection in public hospitals through the situational strategic planning

Desde a publicacao da 1a relacao de medicamentos essenciais da OMS, em 1977, este orgao e diversas instituicoes de saude em todo o mundo tem fomentado a importância da promocao de politicas de medicamentos essenciais para os servicos de saude. Apesar da inegavel contribuicao para a promocao do uso racional de medicamentos, a implantacao de comites que gerenciem a implantacao de listas de medicamentos essenciais ainda e um desafio para os gestores do SUS. Este trabalho teve como objetivo utilizar uma ferramenta de gestao, proposta pelo economista Carlos Matus, para a superacao das dificuldades de implantacao de CFT nos servicos hospitalares do estado de Sergipe. Para isso, a equipe de pesquisadores realizou em conjunto com os atores do servico a implantacao do Planejamento Estrategico Situacional por meio dos momentos explicativo, normativo, estrategico e tatico-operacional. Por meio deste trabalho, observou-se que o metodo PES caracteriza-se como uma ferramenta recomendada para a implantacao de atividades fundamentais da selecao de medicamentos, nesse estudo, agrupadas em tres objetivos gerais alcancados: 1) a regulamentacao de fluxos e procedimentos para a selecao de medicamentos; 2) a organizacao de comissoes de farmacia e terapeutica e 3) a elaboracao de listas de medicamentos essenciais.

La institucionalización del proceso de selección de medicamentos en los hospitales públicos a través de planificación estratégica situacional

Desde a publicacao da 1a relacao de medicamentos essenciais da OMS, em 1977, este orgao e diversas instituicoes de saude em todo o mundo tem fomentado a importância da promocao de politicas de medicamentos essenciais para os servicos de saude. Apesar da inegavel contribuicao para a promocao do uso racional de medicamentos, a implantacao de comites que gerenciem a implantacao de listas de medicamentos essenciais ainda e um desafio para os gestores do SUS. Este trabalho teve como objetivo utilizar uma ferramenta de gestao, proposta pelo economista Carlos Matus, para a superacao das dificuldades de implantacao de CFT nos servicos hospitalares do estado de Sergipe. Para isso, a equipe de pesquisadores realizou em conjunto com os atores do servico a implantacao do Planejamento Estrategico Situacional por meio dos momentos explicativo, normativo, estrategico e tatico-operacional. Por meio deste trabalho, observou-se que o metodo PES caracteriza-se como uma ferramenta recomendada para a implantacao de atividades fundamentais da selecao de medicamentos, nesse estudo, agrupadas em tres objetivos gerais alcancados: 1) a regulamentacao de fluxos e procedimentos para a selecao de medicamentos; 2) a organizacao de comissoes de farmacia e terapeutica e 3) a elaboracao de listas de medicamentos essenciais.