Mauro Silveira de Castro

Tendências na utilização de antimicrobianos em um hospital universitário, 1990-1996

OBJETIVO: Uma das principais preocupacoes mundiais quanto ao uso de medicamentos esta relacionada a utilizacao de antimicrobianos. Nos paises em desenvolvimento, poucos recursos sao empregados na monitorizacao de acoes sobre o uso racional de medicamentos. Sao, tambem, limitados os dados sobre o uso daqueles agentes em hospitais. Assim realizou-se estudo para determinar os padroes de uso de antimicrobianos em hospital num periodo de sete anos (1990 a 1996). METODOS: O estudo foi realizado em um hospital universitario, terciario, com 690 leitos, localizado em Porto Alegre, RS. Os registros hospitalares foram revisados visando identificar o consumo de antimicrobianos por pacientes internados, sendo os resultados expressos em dose diaria definida (DDD) por 100 leitos-dia. A analise de conglomerados foi realizada para determinar as tendencias de consumo dos agentes individuais. RESULTADOS: O consumo de antimicrobianos aumentou com o correr dos anos, passando de 83,8 DDD por 100 leitos-dia, em 1990, a 124,58 DDD por 100 leitos-dia em 1996. O grupo de medicamentos mais utilizado foi de penicilinas (39,6%), seguido por cefalosporinas (15,0%), aminoglicosideos (14,4%), sulfonamidas (12,8%), glicopeptideos (3,6%) e lincosaminas (3,1%). Estes grupos foram responsaveis por cerca de 90% do consumo. A analise de conglomerados do uso de antimicrobianos mostrou 13 grupos principais de tendencia de consumo. CONCLUSOES: O consumo de antimicrobianos cresceu no periodo avaliado, sendo expressivamente mais alto em comparacao com o relatado em outros estudos. Quando novas alternativas terapeuticas foram disponibilizadas no hospital, o uso de medicamentos antigos decresceu e, em alguns casos, existiu manutencao dos niveis de consumo. Quando foi realizada intervencao especifica como uma campanha para o uso correto de cefoxitina, as mudancas esperadas ocorreram.

Causes of drug-related problems in the emergency room of a hospital in southern Brazil.

OBJECTIVE To assess the frequency and types of drug-related problems (DRPs) in patients seeking emergency care in a teaching hospital in southern Brazil and to identify the possible causes and drugs involved in these problems. METHOD A cross-sectional study was performed, using a structured questionnaire for data collection. Multivariate logistic regression was used to control for possible confounding factors and to establish an independent association between the presence of DRPs and the amount of medication, patients age and their educational level. RESULTS A total of 350 patients were interviewed. The frequency of DRPs was 31.6%. Quantitative ineffectiveness was observed in 30.9% of DRPs and the main cause of the DRP was an inadequate dosing regimen. Sixty-six DRPs (53.7%) were caused by the health system or the health professionals. Factors independently influencing the development of DRPs were educational level and the number of drugs being taken. CONCLUSIONS Our data suggest that one-third of the patients attending the emergency room of our hospital had a drug-related problem, highlighting the importance of considering drugs as a possible cause of health problems and the need for their more rational use.

Development and validity of a method for the evaluation of printed education material

Objectives To develop and study the validity of an instrument for evaluation of Printed Education Materials (PEM); to evaluate the use of acceptability indices; to identify possible influences of professional aspects. Methods An instrument for PEM evaluation was developed which included tree steps: domain identification, item generation and instrument design. A reading to easy PEM was developed for education of patient with systemic hypertension and its treatment with hydrochlorothiazide. Construct validity was measured based on previously established errors purposively introduced into the PEM, which served as extreme groups. An acceptability index was applied taking into account the rate of professionals who should approve each item. Participants were 10 physicians (9 men) and 5 nurses (all women). Results Many professionals identified intentional errors of crude character. Few participants identified errors that needed more careful evaluation, and no one detected the intentional error that required literature analysis. Physicians considered as acceptable 95.8% of the items of the PEM, and nurses 29.2%. The differences between the scoring were statistically significant in 27% of the items. In the overall evaluation, 66.6% were considered as acceptable. The analysis of each item revealed a behavioral pattern for each professional group. Conclusions The use of instruments for evaluation of printed education materials is required and may improve the quality of the PEM available for the patients. Not always are the acceptability indices totally correct or represent high quality of information. The professional experience, the practice pattern, and perhaps the gendre of the reviewers may influence their evaluation. An analysis of the PEM by professionals in communication, in drug information, and patients should be carried out to improve the quality of the proposed material.

Evidence of inappropriate use of vancomycin in a university affiliated hospital in Brazil

To evaluate the appropriateness of use of vancomycin in a University affiliated Hospital in Brazil.

Immunosuppressive serum levels in allogeneic hematopoietic stem cell transplantation: pharmaceutical care contribution

Background: Cyclosporine and tacrolimus are limited by a narrow therapeutic window. Maintaining immunosuppressive drugs at desired levels may be difficult. Pharmaceutical care emerges as a philosophy of practice that enhances medication use and leads to a better control of serum concentration. Objective: This study aims to evaluate the impact of pharmaceutical care in the maintaining of proper serum levels of immunosuppressive medications in patients who have undergone allo-HSCT. Methods: The study had a quasi-experimental design that included a comparison group. The service model used was pharmacotherapy follow-up, according to an adaptation of the Dader method. The pharmacist consultation was carried out at a day-hospital or at the outpatient hematology clinic as needed. The intervention group consisted of 22 patients seen by a clinical pharmacist. The control group consisted of 44 patients that received standard care. This study aims to evaluate the impact of pharmaceutical care on keeping patient serum levels of cyclosporine and tacrolimus within the desired range. Results: Control group displayed 65% of the proper serum levels of immunosuppressive agents. While In intervention group, the figure was 82% (p = 0.004). Conclusion: The role of the pharmacist in the multidisciplinary team may contribute to a greater success in attaining the patients’ therapeutic targets with regard to the use of immunosuppressant.

Impact of distance education on academic performance in a pharmaceutical care course

The objective of this study was to compare the performance of pharmacy students from a Pharmaceutical Care course, taught in both distance education (DE) and campus-based formats using active methodologies. For two semesters, students (n = 82) taking the course studied half the subject in the distance education format and half in person. Questionnaires were applied at the beginning of the semester aimed to outline the demographic profile of the students. Their grade in the course was evaluated to determine their performance. The Module 1 (Information on Medication) average on the campus-based was 7.1225 and on DE was 7.5519, (p = 0.117). The Module 2 (Pharmaceutical Services) average on the campus-based was 7.1595 and on distance education was 7.7025, (p = 0.027*). There was a difference in learning outcomes in the Pharmaceutical Care Course between face-to-face and distant education. Therefore, the student performance was better in the distance education module, indicating distance education can be satisfactorily used in Pharmacy Programs.

Adesão à farmacoterapia, que universo é esse? Uma revisão narrativa

A nao-adesao a farmacoterapia foi primeiramente identificada ha mais de 2000 anos e continua a ser um desafio, gerando intenso debate nos dias de hoje. Percebe-se que houve um aumento nas pesquisas que procuram elucidar a extensao, as causas e as consequencias da nao-adesao a farmacoterapia. No entanto, para entender a extensao de adesao e necessario compreender o seu conceito. Para tanto, e necessario esclarecer a diferenca dos diversos termos utilizados em pesquisas de adesao, tais como cumprimento, adesao, concordância e persistencia. Com o objetivo de elucidar essas e muitas outras questoes, conduziu-se um mapeamento da literatura existente sobre adesao a farmacoterapia. Esta revisao narrativa foi conduzida sem limitacao temporal, por meio de buscas realizadas nas bases de dados MEDLINE/PubMed e Scielo. Utilizaram-se os descritos em Ciencias da Saude (DeCS) (Medication Adherence e Adesao a Medicacao; Patient Compliance e Cooperacao do Paciente; Terminology e Terminologia); os termos MESH (drug therapy, medication adherence, medication therapy management, patient compliance, terminology); e outros termos gerais. Apesar de existir uma vasta literatura sobre o conceito de adesao a medicacao, nao ha um consenso padrao estabelecido. Os termos compliance, adherence e concordance tem sido utilizados erroneamente como termos intercambiaveis de adesao a medicacao. Alguns autores categorizam a nao-adesao em intencional e nao intencional; outros em repetida ou esporadica ou, ainda, em primaria ou secundaria. A adesao e um comportamento multifatorial complexo que e influenciado por diversos fatores, que muitas vezes sao controversos e inconsistentes nas publicacoes. Apesar de existir um universo rico e promissor no campo de adesao a farmacoterapia, ha muita complexidade e contradicao. Muito do que se reporta a adesao e de certa forma fragmentado e controverso, o que dificulta a analise deste processo como um todo. Palavras-chave: Revisao narrativa; adesao a medicacao; terminologia

Comorbidities, potentially dangerous and low therapeutic index medications: factors linked to emergency visits

This article aims to investigate the morbidities related to medications, their risk factors and causes detected in patients who seek the Hospital Emergency Service of a University in the South of Brazil. Data collection was based on application of a questionnaire to patients of a minimum age of 18 years, that signing the Term of Free and Informed Consent (TFIC), during the period from October 2013 to March 2014, and analysis of electronic record charts. Cases were evaluated by pharmacists and a doctor to define whether it was a case of medication related morbidity (MRM) and to establish its possible causes. Avoidability of MRM was verified based on criteria previously established in the literature. In total 535 patients were interviewed, and the frequency of MRM was 14.6%, Approximately 45% of MRMs were related to safety in the use of medications, and approximately 50% presented user-related questions as the possible cause. Hospitalization was required in 44.8% of MRM cases; 62.7% of cases were considered avoidable. Presence of chronic disease and use of potentially dangerous medication and low therapeutic index were considered independent factors associated with development of MRM, according to statistical analysis.

DINÂMICA DE GRUPO “JÚRI SIMULADO VIRTUAL” EM DISCIPLINA DO CURSO DE FARMÁCIA

dinâmica de grupo denominada “Juri Simulado”, desenvolvida para a disciplina de Atencao Farmaceutica II do Curso de Farmacia, foi aplicada e avaliada em duas modalidades distintas, a distância (EaD) e presencial. A estrategia pedagogica tem como objetivos estimular nos alunos uma reflexao dialogada e o desenvolvimento de argumentacao conjunta. A avaliacao foi realizada sobre os seguintes aspectos: uso do forum como ferramenta de debate; aprendizagem apoiada pela dinâmica; avaliacao da metodologia, material de apoio e tarefas utilizadas em aula. Conforme a analise das avaliacoes dos alunos envolvidos, os objetivos foram alcancados, mas a atividade necessita de ajustes.

Problemas relacionados con medicamentos en el servicio de urgencias de un hospital en el sur de Brasil

Objetivo Evaluar la frecuencia y el tipo de problemas relacionados con medicamentos que presentan los pacientes que acuden al servicio de urgencias en un hospital universitario del sur de Brasil, e identificar las posibles causas y los farmacos involucrados. Metodo La investigacion siguio el modelo de estudio transversal, con una encuesta estructurada para la recogida de los datos. Se empleo el analisis de regresion logistica multiple para controlar posibles factores de confusion y establecer una asociacion independiente entre la presencia de problemas relacionados con medicamentos y el numero de estos, la edad y el nivel educativo. Resultados Se entrevistaron 350 pacientes y la frecuencia de problemas relacionados con medicamentos fue del 31,6%. La inefectividad cuantitativa se observo en el 30,9% de los casos. La principal causa de los problemas fue el regimen de dosificacion inadecuado. El sistema de salud o los profesionales de la salud se identificaron como responsables en 66 casos (53,7%). El nivel educativo y el numero de farmacos contribuyeron de forma independiente a la aparicion de los problemas. Conclusion Los datos sugieren que un tercio de los pacientes que buscan atencion en el servicio de urgencias del hospital donde se ha realizado el estudio lo hicieron por problemas relacionados con medicamentos, lo que refuerza la importancia de considerar a los farmacos como una posible causa de problemas de salud y la necesidad de promover un uso mas racional de ellos.