Nice Maria Oliveira da Silva

Long-term decline of the Amazon carbon sink

Atmospheric carbon dioxide records indicate that the land surface has acted as a strong global carbon sink over recent decades, with a substantial fraction of this sink probably located in the tropics, particularly in the Amazon. Nevertheless, it is unclear how the terrestrial carbon sink will evolve as climate and atmospheric composition continue to change. Here we analyse the historical evolution of the biomass dynamics of the Amazon rainforest over three decades using a distributed network of 321 plots. While this analysis confirms that Amazon forests have acted as a long-term net biomass sink, we find a long-term decreasing trend of carbon accumulation. Rates of net increase in above-ground biomass declined by one-third during the past decade compared to the 1990s. This is a consequence of growth rate increases levelling off recently, while biomass mortality persistently increased throughout, leading to a shortening of carbon residence times. Potential drivers for the mortality increase include greater climate variability, and feedbacks of faster growth on mortality, resulting in shortened tree longevity. The observed decline of the Amazon sink diverges markedly from the recent increase in terrestrial carbon uptake at the global scale, and is contrary to expectations based on models.

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.

Pharmacist interventions in high-risk obstetric inpatient unit: a medication safety issue

Objectives The aim of this study was to report number, type and severity of prescribing errors and pharmacist interventions in high-risk pregnant and postpartum women. Design A prospective cross-sectional, observational study. Setting A high-risk obstetric inpatient unit of a Womens Hospital in Brazil. Participants About 1826 electronic prescriptions for 549 women in the high-risk obstetrics inpatient unit were included. Interventions When the pharmacist detected potential prescribing errors, interventions were suggested. Main Outcome Measures Prescriptions were evaluated by clinical pharmacist to identify the type, frequency and severity of prescribing errors and rate of clinical pharmacist intervention acceptance in a high-risk obstetric inpatient. Results A total of 1826 prescriptions were reviewed with 128 errors (7.0%). The most frequent errors were drug interaction (43.8%), incorrect frequency (21.5%) and improper dose (13.1%). One-hundred and sixty-eight interventions were made by pharmacists, 98.8% of which were accepted by prescribers. Higher maternal age (OR 1.0 (95%CI 1.0-1.1)), higher number of prescribed medications (OR 1.2 (95%CI 1.1-1.3)), obstetric conditions (OR 2.2 (95%CI 1.4-3.3)) and non-breastfeeding postpartum women (OR 3.9 (95% CI 2.5-6.1)) were the independent factors associated with prescribing errors identified through multivariate analysis. Conclusions The most common prescription errors related to drug interactions, incorrect frequency and higher number of prescribed medications. The rate of pharmacist acceptance intervention was high.

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.

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.