ABSTRACT
Introduction: Pediatric oncology patients have a limited number of venous access routes and need a large number of drugs during hospitalization. This study evaluates potential medication incompatibilities (MI) in pediatric oncology prescriptions and identifies possible factors associated with the risk of their occurrence. Methods: This cross-sectional study evaluated prescriptions from a tertiary universitary hospital from December 2014 to December 2015. The association between variables and the risk of potential incompatibilities between drugs was determined by Student's t-test and Pearson's chi-square, considering p < 0.05 significant. The odds ratio was calculated considering a 95% confidence interval for each drug. Results: 385 prescriptions were evaluated. The mean age of 124 patients was 9.22 years old (SD = ± 5.10), and 50.65% were male. The most frequent diagnosis and reason for hospitalization were leukemia (27.30%) and chemotherapy (36.10%). The totally implantable catheter was the most commonly used venous access (61.30%). In 87.5% of prescriptions, there was the possibility of MI, and 2108 incompatibilities were found, considering 300 different combinations between two drugs. Age, diagnosis, reason for hospitalization, and type of venous access were risk factors for potential incompatibilities (p < 0.05). The following drugs present higher risk of potential incompatibilities: leucovorin, sodium bicarbonate, cefepime, diphenhydramine, dimenhydrinate, hydrocortisone, and ondansetron, with a significant odds ratio. Conclusion: The possibility of MI in prescriptions for pediatric oncology patients is frequent. Thus, the identification of risk factors may contribute to patient safety and to the rational use of drugs.
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Pediatrics , Drug Utilization/statistics & numerical data , Inappropriate Prescribing , Administration, Intravenous , Neoplasms/drug therapy , Cross-Sectional Studies , Drug-Related Side Effects and Adverse Reactions/epidemiologyABSTRACT
Introdução: O câncer infanto-juvenil é a segunda causa de mortes entre crianças e adolescentes no Brasil. Para o sucesso no tratamento oncológico são importantes a disponibilidade e o acesso aos medicamentos que compõe a terapia oncológica. Os municípios são responsáveis pela disponibilização dos medicamentos do Componente Básico e o Estado responsável pelos Componentes Especializado e Estratégico. O estudo objetivou analisar o acesso dos medicamentos prescritos nas orientações de alta de uma instituição hospitalar de referência no componente básico através das Remumes de sete municípios das Macrorregiões de Saúde do Rio Grande do Sul e também nos demais componentes da assistência farmacêutica através das Renames.Métodos: Realizou-se análise retrospectiva e descritiva de todas as orientações farmacêuticas de alta hospitalar em uma unidade de oncologia pediátrica de junho de 2014 a junho de 2018, e análise qualitativa da presença dos medicamentos prescritos nas listas de medicamentos dos municípios e dos Componentes Especializado e Estratégico do Estado.Resultados: Observa-se que 50,5% dos medicamentos prescritos não estavam disponíveis para acesso pelo setor público de saúde dos munícipios de referência nas macrorregiões de saúde. Considerando os três componentes de organização da Assistência Farmacêutica observa-se que 56% dos medicamentos prescritos são disponibilizados conforme Política Nacional de Assistência Farmacêutica.Conclusão: O acesso aos medicamentos é fator importante para um bom prognóstico de cura, e o conhecimento da Política Nacional de Assistência Farmacêutica por todos os profissionais da equipe de saúde pode favorecer que o usuário tenha acessibilidade ao medicamento.
Introduction: Childhood cancer is the second leading cause of death among children and adolescentes in Brazil. For the success of cancer treatment, availability and access to the medicines that compose cancer therapy are important. The municipalities responsability are providing the medicines in the Basic Component, and the State responsible for the Specialized and Strategic Components. The study aimed to analyze prescribed medications in discharge orientation at a reference hospital institution with the REMUMES of seven municipalities in Rio Grande do Sul, representing the Health Macro Regions from the State and also in the other components of pharmaceutical assistance through RENAMES. Methods: A retrospective descriptive analysis was performed with all hospital discharge pharmaceutical orientations in a pediatric oncology unit from June 2014 to June 2018, and a qualitative analysis of the presence of prescribed medicines in the cities medicines lists and the Specialized Components and State Strategic Plan.Results: It is observed that 50.5% of the prescription medicines were not available for access to the users by the public health sector of the reference cities in the health macro regions. Considering the three organizational components of Pharmaceutical Assistance, 56% of the prescribed medicines were made available according to the National Pharmaceutical Assistance Policy.Conclusion: Medicines access is an important factor for a good prognosis of cure, and the knowledge of the National Pharmaceutical Assistance Policy by the entire health team professionals might further that users have access to the medicine.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Young Adult , Access to Essential Medicines and Health Technologies , Health Services Accessibility/statistics & numerical data , Neoplasms/drug therapy , Patient Discharge , Pharmaceutical Services , National Policy of Pharmaceutical AssistanceABSTRACT
ABSTRACT Introduction: To assess the frequency of allergic reactions to asparaginase (ASP) and possible risk factors for reactions in a cohort of pediatric patients. Method: The study was performed based on retrospective data from patients under acute lymphoid leukemia treatment in a general university hospital located in southern Brazil. Information on patients who used ASP from 2010 to 2017 was collected. Allergic reactions were identified in electronic medical records. Results: Among the 98 patients included in the study, 16 (16.3 %) experienced an allergic reaction to native l-asparaginase (L-ASP). Of the 22 patients (22.4 %) that received only intravenous (IV) administration of l-ASP, 10 (62.5 %) had allergic reactions, while 48 patients (49 %) received intramuscular (IM) administration and 28 (28.6 %) received IV and IM administrations. The occurrence of allergic reactions differed between the groups (p < 0.001), and IV administration was associated with allergic reactions. Association was also observed between the severity of the reaction and the route of administration, with the IM route associated with grade 2 and IV route associated with grade 3. Occurrence of allergic reactions was higher when the commercial formulation of l-ASP, Leuginase®, was used (p = 0.0009 in the analysis per patient and p = 0.0003 in the analysis per administration). Conclusions: The IV administration and commercial Leuginase® presentation were associated with more allergic reactions in the study population, which corroborates the findings in the literature. The IV route was also associated with higher severity of reactions in the present study.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Asparaginase/toxicity , Child , Precursor Cell Lymphoblastic Leukemia-Lymphoma/diagnosis , Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy , HypersensitivityABSTRACT
Resumo Objetivo Descrever as orientações para a primeira transição do cuidado hospitalar para o domiciliar da criança com câncer sob a ótica da equipe multiprofissional. Método Estudo de abordagem qualitativa do tipo exploratório-descritivo realizado em um Hospital Universitário do Sul do Brasil, com nove profissionais da equipe multiprofissional de uma unidade de internação de oncologia pediátrica entre julho e setembro de 2018. Foram realizadas entrevistas semiestruturadas submetidas a análise de conteúdo temática. Resultados Foram identificadas três categorias temáticas: planejamento multiprofissional para a alta hospitalar da criança com câncer e sua família; a equipe multiprofissional frente ao processo de alta hospitalar; orientações para a primeira alta hospitalar a famílias de crianças com câncer recém diagnosticado. Conclusão/implicações para prática o planejamento e sistematização multiprofissional para as orientações da primeira alta hospitalar são fundamentais para contemplar as necessidades do paciente e suas famílias, tendo o enfermeiro papel central. Mostram-se necessárias melhorias nesse processo.
Resumen Objetivo Describir las principales pautas para la primera transición de la atención hospitalaria al contexto domiciliario de niños con cáncer bajo la óptica del equipo multidisciplinario. Método Estudio cualitativo de tipo exploratorio-descriptivo realizado en un hospital universitario en el sur de Brasil, con nueve profesionales del equipo multiprofesional de una unidad de hospitalización de oncología pediátrica entre julio y septiembre de 2018. Se realizaron entrevistas semiestructuradas que han sido sometidas a análisis de contenido temático. Resultados Se identificaron tres categorías temáticas: planificación multiprofesional para el alta hospitalaria de niños con cáncer y sus familias; el equipo multidisciplinario frente al proceso de alta hospitalaria; pautas para el primer alta hospitalaria para familias de niños con cáncer recién diagnosticado. Conclusión/implicaciones para la práctica la planificación y sistematización multiprofesional en relación a las pautas del primer alta hospitalaria son esenciales para contemplar las necesidades del paciente y sus familias, teniendo la enfermera un papel central. Es necesario implementar mejoras en este proceso.
Abstract Objective To describe the guidelines for the first transition from hospital care to home care of children with cancer from the multi-professional team's perspective. Method A qualitative exploratory-descriptive study conducted in a University Hospital in southern Brazil by nine professionals from the multi-professional team of a pediatric oncology inpatient unit between July and September 2018. Semi-structured interviews were carried out and submitted to thematic content analysis. Results Three theme categories were identified, namely: multi-professional planning for hospital discharge of children with cancer and their family; the multi-professional team facing the discharge process; guidelines for the first hospital discharge for families of children with newly diagnosed cancer. Conclusion/practical implications multi-professional planning and systematization for the guidelines of the first hospital discharge are essential to deliberate the needs of the patient and their families, with the nurse having a central role. Improvements are needed in this process.
Subject(s)
Humans , Child , Adult , Middle Aged , Patient Care Team , Transitional Care , Neoplasms/therapy , Patient Discharge , Qualitative ResearchABSTRACT
Resumo Nosso artigo, fundamentado na Pesquisa Apreciativa, apresenta e discute as melhores práticas de um grupo de preceptores de um programa de residência multiprofissional em Saúde. As melhores práticas identificadas são: a consulta multiprofissional, o acolhimento dos residentes e as ações integradas entre as diferentes ênfases da residência. Além dessas, identificaram-se as estratégias para desenvolver as práticas nos cenários de saúde que seguem os pressupostos da educação interprofissional, já que promovem a reflexão de diferentes atores do processo na construção de práticas que buscam maior atenção à saúde dos usuários do Sistema Único de Saúde (SUS).(AU)
Resumen Nuestro artículo, fundamentado en la investigación apreciativa, presenta y discute las mejores prácticas de un grupo de preceptores de un Programa de Residencia Multiprofesional en Salud. las mejores prácticas identificadas son: la consulta multiprofesional, la acogida de los residentes y las acciones integradas entre los diferentes énfasis de la residencia. Además de esas, se identificaron las estrategias para desarrollar las prácticas en los escenarios de Salud que siguen los supuestos de la educación interprofesional, puesto que promueven la reflexión de diferentes actores del proceso en la construcción de prácticas que buscan una mejor atención de la salud de los usuarios del Sistema Brasileño de Salud (SUS).(AU)
ABSTRACT In this article, based on Appreciative Inquiry, we present and discuss the best practices of a group of preceptors from a multiprofessional health residency program in Brazil. The best practices we identified are the multiprofessional consultation, the reception given to residents, and the integrated actions among different majors of the residency. In addition, we identified their strategies to develop the practices in health settings. The practices follow the presuppositions of interprofessional education, as they promote the reflection of different actors on the construction of practices that aim at the provision of better healthcare for users of the Brazilian National Health System (SUS).(AU)