Selma Rodrigues de Castilho

Intervenção farmacêutica e prevenção de eventos adversos

No presente estudo, sao relatadas as intervencoes realizadas pelo servico de farmacia junto ao corpo clinico de uma instituicao publica federal, referencia nacional para cirurgias de alta complexidade em ortopedia no Rio de Janeiro. Realizou-se estudo retrospectivo no qual foram analisadas as intervencoes farmaceuticas realizadas entre junho de 2004 e junho de 2005. O servico de farmacia atendeu 13,6% dos 5476 pacientes internados neste periodo. Dos pacientes atendidos, 30,4% necessitaram de pelo menos uma intervencao deste profissional junto ao corpo clinico em algum momento da sua internacao, perfazendo um total de 227 intervencoes. Os medicos foram os profissionais mais contatados (71,1%), seguidos dos enfermeiros (16,9%) e auxiliares de enfermagem (4,6%). Dos problemas detectados, 84,1% correspondiam a erros, dos quais 49,5% foram prevenidos com as intervencoes. A analise dos erros encontrados nos permite sugerir alguns dos principais problemas relacionados a medicamentos apresentados pelos pacientes da instituicao. Das intervencoes realizadas, 70% foram aceitas, sendo este percentual de 60% para as intervencoes relacionadas a prescricao. Os resultados sugerem que as intervencoes farmaceuticas foram ferramentas efetivas para a prevencao de eventos adversos, reforcando a importância da assistencia farmaceutica para a qualidade da assistencia hospitalar.

Molecular characterization of multidrug-resistant (MDR) Pseudomonas aeruginosa isolated in a burn center

OBJECTIVE The aim of this study was to characterize molecularly multidrug-resistant (MDR) Pseudomonas aeruginosa isolates collected from burn center (BC) patients and environment in a hospital localized in Rio de Janeiro city, RJ, Brazil. METHODS Thirty-five P. aeruginosa isolates were studied. The antimicrobial resistance was tested by disk diffusion method as recommended by CLSI. The assessment of virulence (exoS and exoU) and resistance (blaPER-1, blaCTX-M, blaOXA-10, blaGES-1, blaVIM, blaIMP, blaSPM-1, blaKPC, blaNDM and blaSIM) genes were achieved through PCR and biofilm forming capacity was determined using a microtiter plates based-assay, as described previously. Genotyping was performed using Multilocus sequence typing (MLST). RESULTS High rate of P. aeruginosa (71.4%; 25/35) were classified as MDR, of them 64% (16/25) were related to clone A, the most prevalent clone found in the BC studied. A total of eight carbapenems resistant isolates were detected; three belonging to clone A and five carrying the exoU virulence gene. In addition, clone A isolates were also biofilm producers. Two new sequence types (ST) were detected in this study: ST2236, grouped in to clone A; and ST2237, classified in the different clones, displaying carbapenem resistance and exoU virulence gene. CONCLUSION The high prevalence of biofilm producers and multiresistant P. aeruginosa isolates in BC indicates that prevention programs need to be implemented to avoid infection in highly susceptible patients.

Revisão sistemática em fitoterapia: padronização internacional de qualidade

This work discusses the contribution of adopting more objective criteria and greater credibility in the selection and analysis of information sources, which would result in greater scientific rigour in this process. In this sense, the adoption of a previously tested methodology that is known to be efficient, such as Systematic Review (SR), is proposed as a basic methodology for systematic analysis of phytoterapeutics. The discussion on results shows the positive contribution of incorporating the RS methodology in the analysis of herbal medicines.

Evaluation of risk assessment scales for decubitus ulcer in intensive care patients

This study is about the effectiveness of the scales of Braden and Cubbin & Jackson in patients of intensive therapy. The objectives were to apply the scales, to compare sensibility and specificity and to discuss their application as a preventive strategy to minimize the development of ulcers. It is a prospective, quantitative research, which was accomplished in three units of intensive therapy. The collection of the data was made with 39 patients in the period of June to August of 2005, with which we used formularies and the scales mentioned previously. The data were stored in spreadsheet of Microsoft Excel, with which the sensibility and the specificity of the 2 scales were calculated and contingency tables were mounted, as well positive and negative preditive values. The results point that the two scales presented good sensibility, with the scale of Braden being more sensitive (0,93) than the Cubbin & Jackson’s (0,75). On the other hand, the scale of Cubbin & Jackson showed a larger specificity (0,83) than the Braden’s one (0,47). If we consider the two factors, the scale of Cubbin & Jackson is shown to be more appropriate to the patients of ICU because the sum of its sensibility and specificity is 1,58 against 1,40 for the scale of Braden. We concluded that the two scales have shown to be effective, and Cubbin & Jackson’s is more suitable, once it is more specific and presents less false-positive cases. The present study will contribute to the planning of caring with the patient in a critical stage of sickness, with committed mobility and in risk of pressure ulcer, resulting in the implementation of fast and effective actions for its prevention.

Changes in perinatal care as a determinant of the level and diversity of antiinfectives use in a neonatal intensive care unit in Rio de Janeiro Brazil

This study focuses on a five-year profile (1990-1994) in the utilization of antiinfectives in a neonatal intensive care unit (NICU) in Rio de Janeiro, Brazil. Total antiinfectives consumption, diversity, and possible determinants were analyzed. A descriptive, longitudinal, and retrospective drug utilization study design was adopted. Document research, observation, and semi-structured interviews provided information on the neonatal intensive care provided, and drug supply and daily hospital records provided data on antiinfectives use, based on the Anatomical Therapeutic Chemical (ATC) classification and the infant defined daily dose (DDDi) as units of measurement. The numerical results suggest an increase in total consumption of antiinfectives and a decrease in their diversity. Analyzed in view of the institutional profile and rational drug use, these results indicate that changes in the type of care provided during the study period were key determinants of antiinfectives use.

Análise de correspondência múltipla na avaliação de serviços de farmácia hospitalar no Brasil

O estudo objetivou avaliar a existencia de associacoes entre variaveis de servicos de farmacia hospitalar. Foram utilizadas 30 variaveis do projeto Diagnostico da Farmacia Hospitalar no Brasil relativas a caracterizacao geral do hospital, caracterizacao geral do servico de farmacia hospitalar e etapas da assistencia farmaceutica. A analise de correspondencia multipla e a analise de agrupamentos foram utilizadas. A dimensao 1 da analise de correspondencia multipla explicou 90,6% da variabilidade, diferenciando os servicos de farmacia hospitalar conforme a presenca de atividades, sugerindo assim um eixo de caracterizacao da estrutura dos servicos de farmacia hospitalar. Os resultados indicam relacao direta entre cumprimento das atividades e tipo de hospital e farmaceuticos com especializacao. A analise de agrupamentos identificou seis grupos relativos ao porte do hospital, tendo maior cumprimento de atividades os servicos de farmacia hospitalar em unidades de grande porte e com farmaceutico (maior tempo dedicado ao servico de farmacia hospitalar e maior nivel de treinamento). Conclui-se que as tecnicas foram capazes de identificar as associacoes e um elenco conciso de variaveis para uma avaliacao abrangente dos servicos de farmacia hospitalar no pais.

Medication reconciliation as a strategy for preventing medication errors

One of the current barriers proposed to avoid possible medication errors, and consequently harm to patients, is the medication reconciliation, a process in which drugs used by patients prior to hospitalization can be compared with those prescribed in the hospital. This study describes the results of a pharmacist based reconciliation conducted during six months in clinical units of a university hospital. Fourteen patients (23.33%) had some kind of problem related to medicine. The majority (80%) of medication errors were due to medication omission. Pharmaceutical interventions acceptance level was 90%. The results suggest that pharmacists based reconciliation can have a relevant role in preventing medication errors and adverse events. Moreover, the detailed interview, conducted by the pharmacist, is able to rescue important information regarding the use of drugs, allowing to avoid medications errors and patient injury.

Effectiveness Of 2% And 4% Papain Gels In The Healing Of Venous Ulcers

OBJECTIVE To analyze the effectiveness of 2% and 4% papain gels in tissue repair of venous ulcers. METHOD Quasi-experimental study with consecutive sample of 16 patients with 30 venous ulcers treated at the outpatient clinic of a teaching hospital, from April to November in 2011, using a form for clinical assessment of the patient and its lesion. Variables were analyzed by Wilcoxon and McNemar test (p < 0.05). RESULTS Most participants were female; aged between 51 and 59 years; obese; with hypertension. Regarding ulcers, there was an average decrease of 7.9 cm2 (50% of its original size) in 90 days; 20% of the ulcers completely healed within 56.67 days. There was an increase in epithelialization, significant reduction in the slough and edema, improved depth, in the type and amount of exudate (p < 0.0001). CONCLUSION 2% and 4% papain gels were effective in healing venous ulcers.OBJECTIVE To analyze the effectiveness of 2% and 4% papain gels in tissue repair of venous ulcers. METHOD Quasi-experimental study with consecutive sample of 16 patients with 30 venous ulcers treated at the outpatient clinic of a teaching hospital, from April to November in 2011, using a form for clinical assessment of the patient and its lesion. Variables were analyzed by Wilcoxon and McNemar test (p < 0.05). RESULTS Most participants were female; aged between 51 and 59 years; obese; with hypertension. Regarding ulcers, there was an average decrease of 7.9 cm2 (50% of its original size) in 90 days; 20% of the ulcers completely healed within 56.67 days. There was an increase in epithelialization, significant reduction in the slough and edema, improved depth, in the type and amount of exudate (p < 0.0001). CONCLUSION 2% and 4% papain gels were effective in healing venous ulcers.

Efetividade dos géis de papaína a 2% e 4% na cicatrização de úlceras venosas

OBJECTIVE To analyze the effectiveness of 2% and 4% papain gels in tissue repair of venous ulcers. METHOD Quasi-experimental study with consecutive sample of 16 patients with 30 venous ulcers treated at the outpatient clinic of a teaching hospital, from April to November in 2011, using a form for clinical assessment of the patient and its lesion. Variables were analyzed by Wilcoxon and McNemar test (p < 0.05). RESULTS Most participants were female; aged between 51 and 59 years; obese; with hypertension. Regarding ulcers, there was an average decrease of 7.9 cm2 (50% of its original size) in 90 days; 20% of the ulcers completely healed within 56.67 days. There was an increase in epithelialization, significant reduction in the slough and edema, improved depth, in the type and amount of exudate (p < 0.0001). CONCLUSION 2% and 4% papain gels were effective in healing venous ulcers.OBJECTIVE To analyze the effectiveness of 2% and 4% papain gels in tissue repair of venous ulcers. METHOD Quasi-experimental study with consecutive sample of 16 patients with 30 venous ulcers treated at the outpatient clinic of a teaching hospital, from April to November in 2011, using a form for clinical assessment of the patient and its lesion. Variables were analyzed by Wilcoxon and McNemar test (p < 0.05). RESULTS Most participants were female; aged between 51 and 59 years; obese; with hypertension. Regarding ulcers, there was an average decrease of 7.9 cm2 (50% of its original size) in 90 days; 20% of the ulcers completely healed within 56.67 days. There was an increase in epithelialization, significant reduction in the slough and edema, improved depth, in the type and amount of exudate (p < 0.0001). CONCLUSION 2% and 4% papain gels were effective in healing venous ulcers.

Magistral drugs in hospitalized newborns and children.

Abstract Objective: Study the use of magistral oral solutions and suspensions in infants and children at a university hospital. Methods: This is a descriptive study based on the analysis of the assessed hospitals magistral drug request forms regarding the patients in the neonatal ICU, Obstetrics, Pediatrics and Pediatric Emergency from January 2012 to December 2013. The frequency of drug requests and dispensation was evaluated and the consumption of each active ingredient of the preparations was expressed as number of “infant defined daily dose” (iDDD) and of iDDD/100 bed-days. Results: A total of 657 forms were analyzed - a monthly average of 27 pediatric preparations. The neonatal ICU accounted for 69.6% of these requests. Twenty-one drug items were used, of which the most common were folinic acid (88 requests), sulfadiazine (85) and captopril (73). The consumption of the active principle in these preparations varied in number of iDDD, from 7.5 (hydralazine) to 16,520.0 (folic acid), and in number of iDDD/100 bed-days in the neonatal ICU, from 0.1 (zinc sulfate) to 146.1 (folic acid). Conclusions: The constant consumption of magistral oral solutions and suspensions by newborns and children of the assessed hospital indicates the need for such preparations as a pediatric therapeutic alternative in this hospital.