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ABSTRACT BACKGROUND: The epidemiology of potentially inappropriate medications (PIMs) in critical care units remains limited, especially in terms of the factors associated with their use. OBJECTIVE: To estimate the incidence and factors associated with PIMs use in intensive care units. DESIGN AND SETTING: Historical cohort study was conducted in a high-complexity hospital in Brazil. METHODS: A retrospective chart review was conducted on 314 patients aged ≥ 60 years who were admitted to intensive care units (ICUs) at a high-complexity hospital in Brazil. The dates were extracted from a "Patient Safety Project" database. A Chi-square test, Student's t-test, and multivariable logistic regression analyses were performed to assess which factors were associated with PIMs. The statistical significance was set at 5%. RESULTS: According to Beers' criteria, 12.8% of the identified drugs were considered inappropriate for the elderly population. The incidence rate of PIMs use was 45.8%. The most frequently used PIMs were metoclopramide, insulin, antipsychotics, non-steroidal anti-inflammatory drugs, and benzodiazepines. Factors associated with PIMs use were the number of medications (odds ratio [OR] = 1.17), length of hospital stay (OR = 1.07), and excessive potential drug interactions (OR = 2.43). CONCLUSIONS: Approximately half of the older adults in ICUs received PIM. Patients taking PIMs had a longer length of stay in the ICU, higher numbers of medications, and higher numbers of potential drug interactions. In ICUs, the use of explicit methods combined with clinical judgment can contribute to the safety and quality of medication prescriptions.
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Colombia depende de la importación de medicamentos, así como de gran parte de los materiales (principios activos y excipientes) requeridos para su elaboración; problemática que genera consecuencias sanitarias y macroeconómicas, las cuales se agudizan en el contexto de desindustrialización nacional y de disrupción tecnológica. De esta manera, se acepta que la disponibilidad y acceso a medicamentos y otras tecnologías sanitarias esenciales son un requisito fundamental para alcanzar la autonomía sanitaria de un país. Por lo tanto, resulta imprescindible coordinar esfuerzos entre diversos sectores sociales para desarrollar una agenda pública enfocada a la creación de condiciones que fortalezcan las capacidades científicas y tecnológicas de la industria farmacéutica local, y con ello, mejorar el suministro farmacéutico del país. En el presente documento se presentan conceptos teóricos y prácticos que deberían ser considerados en la definición y materialización de una política pública encaminada a fortalecer la industria farmacéutica y favorecer la autonomía sanitaria de Colombia.
Colombia has a notorious dependency on the importation of medicines, as well as a large part of the materials (active ingredients and excipients) required for their manufacture. This problem generates health and macroeconomic consequences, which are exacerbated in the context of national deindustrialization and technological disruption. In this way, it is accepted that the availability and access to medicines and other essential health technologies are a fundamental requirement to achieve the health autonomy of a country. Therefore, it is crucial to coordinate efforts between several social sectors to develop a public agenda focused on creating conditions that allow strengthening the scientific and technological capabilities of the local pharmaceutical industry, thereby, improving the country's pharmaceutical supply. This document presents conceptual and practical topics that should be considered to defining and materializing a public policy aimed at strengthening the local pharmaceutical industry and favoring Colombia's sanitary autonomy.
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OBJECTIVE To analyze the implementation experience of France’s additional list system for innovative medical products， and to provide reference for China to support medical institutions to use innovative medical products. METHODS Taking France as a case study， using policy analysis method， this paper systematically studied the practice of establishing additional list system to compensate for innovative medical products in France under diagnosis-related group （DRG） payment， including the establishment background， selection procedure and implementation effect. The suggestions were provided on the medical insurance payment methods for innovative medical products in China. RESULTS & CONCLUSIONS The additional list system established a compensation and payment system for innovative medical products with significant clinical efficacy but high treatment cost， covering four stages： application， evaluation， payment and adjustment， which effectively reduced the drug burden on medical institutions， promoted the use of innovative pharmaceutical products by medical institutions， and stimulated the innovation drive of the pharmaceutical industry， but at the same time brought payment pressure to the medical insurance fund. With the rapid spread of our DRG/diagnosis-intervention packet payment reform of China， some regions have also explored the establishment of a compensation and payment mechanism for innovative medical products， but there are still imperfections. We can refer to the implementation experience of the French additional list system and establish an effective compensation and payment system for innovative medical products starting from the establishment of selection criteria， the selection of compensation mode and the implementation of dynamic adjustment.
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OBJECTIVE To provide suggestions and reference for enriching the selection of anti-infective medicines for children in China and promoting the establishment of the Essential Medicine List for Children in China. METHODS Descriptive analysis method was used to statistically compare the differences and similarities of anti-infective medicines included in the World Health Organization Model List of Essential Medicines for Children （EMLc）， World Health Organization Model List of Essential Medicines （EML） and National Essential Medicine List （NEML） in terms of drug category， variety， dosage form， specification， symbol mark， etc. RESULTS All anti-infective medicines of EMLc were covered by EML （85.3%）. NEML lacked the information of anti-infective medicines relatively， and contained few new categories； for example， the third-generation and above cephalosporins in EMLc were not included， and the drug dosage forms were also relatively limited （mainly tablets， capsules and injections）， but the specifications were relatively rich. CONCLUSIONS With reference to EMLc， the guidance on the use of essential medicines for children in China should be added from the aspects of age， body weight， combined medication， etc.， and the dosage forms suitable for children such as oral liquid preparations and scored tablets should be added to NEML； when updating the NEML the newer drugs suitable for children such as cefixime and dacatavir should be included. Finally， with reference to the continuity of EML and EMLc， the Essential Medicine List for Children in China should be established based on NEML to meet the drug needs of children and promote the safe use of drugs in children.
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OBJECTIVE To sort out the common presentation forms and components of the framework of domestic and foreign essential medicine lists （EMLs）， in order to provide reference for optimizing the framework of the Chinese EML. METHODS The latest edition of the EMLs of WHO， China， South Africa， India， Malaysia and other typical countries were compared， and the similarities and differences of the presentation form and constituent elements of the list framework were analyzed. RESULTS & CONCLUSIONS The common presentation forms of WHO and typical countries’ EMLs included version， classifications and symbols， of which management ideas， functions， and implementation difficulties varied； common framework elements included target population， hospital levels， drug use conditions， core and supplementary lists and procurement priority. Through comparison， it was found that the information covered by the Chinese EML was relatively thin， and the framework design had not yet fully played the ideal role in guiding clinical rational drug use and optimizing the allocation of health resources， and there was still some room for improvement. It is recommended that China clarify the characteristics and roles of different presentation forms of the EML， and reasonably set the EML framework based on national conditions and development needs； the multi-dimensional drug information should be supplemented， such as clinical use， economy， and policy attributes of drugs in the EML， to ensure the rational use of essential drugs； it is also necessary to add “the level of hospitals” in the framework of the EML， refine the management requirements for the allocation and use of essential medicine， and optimize the resource allocation of hospitals.
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OBJECTIVE To develop an individualized medication list for elderly patients by evidence-based pharmacy method， and to support clinical decisions on rational use of METHODS Firstly， drugs with risk genetic information were screened out by systematically reviewing evidence-based pharmacy information. Secondly， researchers investigated the included drugs in lists from different data E- sources. Drugs included in three or more data sources and drugs proposed by the expert committee were then included in the medication list. Thirdly， for the drugs included in two data sources， researchers designed questionnaires to investigate the necessity of drug-related gene testing. According to the scoring results of the expert questionnaire， drugs with higher scores were included in the list. Data sources included real-world data （list of high frequency medication in hospitals， high frequency medication for elderly outpatients and inpatients in National Health Care Claims Data， drugs related to frequent medication errors and so on） and evidence-based pharmacy evidence （the websites of Clinical Pharmacogenomics Implementation Consortium， Dutch Pharmacogenetics Working Group， Food and Drug Administration and so on）. RESULTS The study obtain 68 drugs with risk genetic information which were included in three data sources. Combined with 23 drugs proposed by the expert committee， a list containing 74 drugs was preliminarily formed after de-duplication. A total of 37 drugs included in two databases with risk genetic information were scored through the questionnaire survey to form a supplementary list of 26 drugs. This is the final composition of the list of 100 drugs developed in this study. Among them， there are 43 drugs for the central nervous system， 15 drugs for the cardiovascular system， 12 anti-tumor drugs and so on. Twelve drugs were included in six or more data sources， which mainly consisted of drugs for digestive system， all proton pump inhibitors. CONCLUSION In this study， a list of 100 commonly used drugs which require individualized medication for the elderly was developed by evidence-based pharmacy method. The drug list will be updated in time as available evidence changes， and can provide guidance for rational use of medicines for elderly patients.
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Objective:To explore the application of list nursing management combined with different artificial liver treatment modes in patients with liver failure.Methods:Fifty-three patients with liver failure hospitalized in Bethune Hospital of Shanxi Province from July 2020 to July 2021 were selected as the control group, 63 patients with liver failure hospitalized in Bethune Hospital of Shanxi Province from July 2021 to July 2022 were selected as the intervention group. According to the different treatment modes of artificial liver for patients, plasma exchange (PE), double plasma molecular adsorption system (DPMAS) and PE + DPMAS treatment were set up in the two groups. The control group received routine nursing care, while the intervention group received checklist nursing care in addition. The changes of albumin (ALB) and prothrombin time (PT) indexes before and after the different treatment modes were compared, together with the occurrence of complications between the two groups after the intervention.Results:The baseline data between the two groups was balanced, the difference had no statistical significant ( P>0.05). After the therapy, the level of ALB of patients who had accepted DPMAS and PE + DPMAS in the intervention group were 25.3(24.0, 27.9) and 23.2(22.4, 26.3) g/L, which were lower than the 28.2(26.3, 29.7) and 29.4(27.2, 30.0) g/L in the control group, the differences were significant ( Z = 2.47, 3.55, both P<0.05). After the therapy, the level of PT of patients in the intervention group under all three treatment modes were 15.8(14.8, 16.8), 22.7(19.2, 26.2) and 6.0(14.6, 20.0) s, which were lower than the 17.4(15.9, 20.9), 26.3(21.4, 36.4) and 21.2(16.9, 23.4) s in the control group, the differences were significant ( Z = 2.10, 2.07, 2.21, all P<0.05). In the intervention group, there were 6 cases of hypotension, anaphylaxis, bleeding, coagulation and infection under the DPMAS treatment mode, which was significant lower than the 11 cases in the control group ( χ2 = 4.97, P<0.05). There were 4 cases in the intervention group with the PE + DPMAS treatment mode occurred complications in above, which were significant lower than the 11 cases in the control group ( χ2 = 6.87, P<0.01). Conclusions:Artificial liver treatment can improve patients′ liver function and coagulation, and list nursing management may help to improve the effect of artificial liver treatment. It can improve nurses′ awareness of risk prejudgement, reduce various risks in the treatment process, reduce the incidence of adverse reactions, and enhance health care and patient satisfaction.
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Objective:To explore the clinical effect of daily target list of ICU patients with mechanical ventilation (hereinafter referred to as target list) for patients with mechanical ventilation in ICU based on multidisciplinary ward round design.Methods:A non contemporaneous controlled study with a quasi experimental design was conducted. One thousand and seventy-one patients with mechanical ventilation admitted to the comprehensive care unit of the First Affiliated Hospital of Medical College of Zhejiang University from January to December 2019 were selected as the experimental group. The target list was used to standardize the communication of multidisciplinary ward rounds and guide the clinical nursing process. Nine hundred and fifty patients with mechanical ventilation admitted from January to December 2018 were selected as the control group. Routine medical communication, ward rounds and nursing shift handover were used. The duration of mechanical ventilation and the length of stay in ICU, the utilization rate of catheter and related infection rate, the implementation rate of daily nursing measures, the incidence of nursing adverse events and the satisfaction of medical staff with multidisciplinary cooperation were compared.Results:Before the intervention, there was no significant difference in the basic data between the two groups ( P>0.05). After the intervention, the duration of mechanical ventilation and the length of stay in ICU were 4 (2, 9) h and 3 (3, 7) d in the experimental group, which were lower than those in the control group 6 (5, 35) h and 4 (3, 8) d, the differences were statistically significant ( Z=-13.76, -3.62, both P<0.01). The standard rate of sedation, the implementation rate of early activities and the implementation rate of venous thromboembolism preventive measures in the experimental group were 83.10% (4 435/5 337), 80.16% (3 155/3 936) and 93.97% (5 530/5 885) respectively, which were higher than the 81.42% (4 190/5 146), 68.83% (2 197/3 192) and 87.86% (5 839/6 646) in the control group, the differences were statistically significant( χ2=5.05, 120.93, 138.50, all P<0.05). The use rate of physical restraint, the incidence of incontinence-associated dermatitis, medical adhesive related skin injury, deep vein thrombosis and delirium in the experimental group were 39.75% (2 936/7 387), 3.64% (39/1 071), 4.11% (44/1 071), 5.23% (56/1 071), 6.54% (70/1 071), which were lower than the 43.50% (3 180/7 312), 5.90% (56/950), 8.53% (81/950), 9.26% (88/950), 12.42% (118 / 950) in the control group, the differences were statistically significant( χ2 values were 5.71-20.67, all P<0.05). The level of multidisciplinary cooperation was greatly improved, 3.83 ± 0.38 vs. 3.61 ± 0.51 ( t=-3.33, P<0.01). Conclusions:The use of target list can improve the implementation rate of treatment and nursing measures for critical patients, improve the level of multidisciplinary cooperation and team satisfaction, reduce the ICU hospitalization time, mechanical ventilation time, the incidence of nursing adverse events, and improve patient safety.
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The global morbidity of invasive fungal diseases (IFD) tends to increase, especially in immunocompromised people.Due to the atypical symptoms, unclear etiological mechanism, and emerging antifungal resistance, IFD challenge current clinical diagnosis and treatment.The World Health Organization (WHO) developed the first WHO fungal priority pathogens list in 2022.The most concerning fungal pathogens were listed and summarized to promote further understanding of the epidemiology of IFD and antifungal drug resistance.It is hoped to provide a basis for the prevention and interventions of IFD.
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Objectives: To estimate the anticholinergic burden in geriatric patients using two scales and to assess the degree of agreement between them. Methods: Data from an observational study conducted in a primary health care service were used. Anticholinergic burden was assessed using the Belgian Scale Muscarinic Acetylcholinergic Receptor ANTagonist Exposure Scale and the Brazilian Scale of Medicines with Anticholinergic Activity. The cumulative anticholinergic burden score was classified using a categorical approach: Brazilian scale (0: none; 1 2: low; ≥ 3: high) and Belgian scale (0: none; 0.5 1.5: low; ≥ 2: high). The degree of agreement between the two instruments was obtained through Cohen's kappa coefficient. Results: A total of 374 older people were included, most of them female and aged between 60 and 69 years. At least one potentially inappropriate drug with anticholinergic activity was used by 60.70% of patients according to the Brazilian scale and 32.89% by the Belgian scale. On average, 20.85% were under high anticholinergic exposure. Overall, on both scales, the most commonly recurrent medications were those indicated for the treatment of psychiatric disorders. Agreement between the scales was moderate (Kappa = 0.43). Conclusions: A high percentage of older adults was exposed to drugs with an anticholinergic burden, posing risks to health and quality of life. Consensus is needed on how anticholinergic burden is calculated by these scores, as well as standardization of the list of included drugs.
Objetivos: Estimar a carga anticolinérgica em idosos com base em duas escalas e avaliar o grau de concordância entre estas. Metodologia: Foram utilizados dados de um estudo observacional realizado em um serviço de atenção primária. A carga anticolinérgica foi avaliada pela escala belga Muscarinic Acetylcholinergic Receptor ANTagonist Exposure Scale e da Escala Brasileira de Medicamentos com Atividade Anticolinérgica. A pontuação da carga anticolinérgica cumulativa foi classificada utilizando uma abordagem categórica: escala brasileira (0: nenhuma, 1 2: baixa, ≥ 3: alta) e escala belga (0: nenhuma, 0,5 1,5: baixa, ≥ 2: alta). O grau de concordância entre as duas ferramentas foi obtido por meio do coeficiente Capa de Cohen. Resultados: Foram incluídos 374 idosos, a maioria do sexo feminino e com idade entre 60 a 69 anos. O uso de pelo menos um medicamento potencialmente inapropriado com atividade anticolinérgica foi verificado em 60,70% dos idosos com a aplicação da escala brasileira e em 32,89% com a escala belga. Em média, 20.85% estavam sob alta exposição anticolinérgica. De modo geral, os medicamentos mais recorrentes, para ambas as escalas, foram os indicados para o tratamento de transtornos psiquiátricos. A concordância entre as escalas foi moderada (Capa = 0,43). Conclusão: Um percentual elevado de idosos estava exposto a medicamentos com carga anticolinérgica, representando riscos para a saúde e a qualidade de vida. É necessário um consenso sobre como calcular a carga anticolinérgica nos diferentes escores, bem como a padronização da lista de medicamentos incluídos.
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Humans , Male , Female , Middle Aged , Aged , Health Centers , Cholinergic Antagonists/administration & dosage , Inappropriate Prescribing/statistics & numerical data , Health Services for the Aged , Retrospective StudiesABSTRACT
Abstract The Global South has witnessed increasing sampling of its immense biological diversity during the past century. However, the diversity of many regions remains unknown, even at pristine and highly threatened places, such as in the Atlantic Forest; and for bioindicator, umbrella, and flagship groups. The present study reports the first butterfly list of the Parque Estadual Intervales, São Paulo, Brazil and surroundings, a key protected area in the last massive continuous of the Atlantic Forest. We compiled data from museums and four years of field work, under three sampling methods. We also aimed at providing resources to support conservation efforts by analyzing 27 years of climatic data (detailed in the Supplementary Material, in English and in Portuguese), discussing our results also for non-academics, and producing scientific outreach and educational material. A companion article dealt with the experiences of science outreach and capacity development, and illustrated the butterfly catalogue of the species sampled in the park. We found 312 species that sum to 2,139 records. The museum had 229 species (432 records), and we sampled 142 species (1,682 individuals), in a total effort of 36,679 sampling hours (36,432 trap and 247 net and observation hours). The richest families were Nymphalidae (148 species) and Hesperiidae (100 species). Most species were sampled exclusively by active methods (79.8%), but other sources (passive sampling, citizen science, etc.) also found unique records. We found the highest diversity metrics from January to May, and we demonstrated that winter months had less richness and abundance. We illustrated the 20 species common to all regions, and listed those that were found more than seven months in the year, as well as the most abundant species in trap sampling, with forest dwellers as well as species common to open and fragmented areas. The dominant species in our trap datasets was the iridescent white morpho, Morpho epistrophus (Fabricius, 1796), and we suggest it to become the park butterfly mascot.
Resumo O Sul Global testemunhou crescente amostragem de sua imensa diversidade biológica durante o século passado. Entretanto, a diversidade de muitas regiões permanece desconhecida, mesmo em locais pristinos e altamente ameaçados, como na Mata Atlântica; e para grupos bioindicadores, guarda-chuva e emblemáticos. O presente estudo reporta a primeira lista de borboletas do Parque Estadual Intervales, São Paulo, Brasil e arredores, uma unidade de conservação chave no último maciço contínuo de Mata Atlântica. Compilamos dados de museus e quatro anos de campo, sob três métodos de amostragem. Também visamos oferecer recursos para apoiar os esforços de conservação, analisando 27 anos de dados climáticos (detalhados no Material Suplementar, em inglês e em português), discutindo nossos resultados numa linguagem também para não acadêmicos, e produzindo material de divulgação científica e educativos. Um artigo irmão tratou das experiências de divulgação científica e capacitação, e ilustrou o catálogo de borboletas das espécies amostradas no parque. Encontramos 312 espécies em 2.139 registros. O museu tinha 229 espécies (432 registros), e amostramos 142 espécies (1.682 indivíduos), em um esforço total de 36.679 horas de amostragem (36.432 armadilhas e 247 horas de rede e observação). As famílias mais ricas foram Nymphalidae (148 espécies) e Hesperiidae (100 espécies). A maioria das espécies foi amostrada exclusivamente por métodos ativos (79,8%), mas outras fontes (passiva, ciência cidadã, etc.) também encontraram registros únicos. Encontramos as maiores métricas de diversidade de janeiro a maio, e demonstramos que os meses de inverno tiveram menos riqueza e abundância. Ilustramos as 20 espécies comuns a todas as regiões, e listamos aquelas que foram encontradas em mais de sete meses no ano, bem como as espécies mais abundantes em armadilhas, com espécies florestais e também comuns em áreas abertas e fragmentadas. A espécie dominante em nossas armadilhas foi a morfo branca iridescente, Morpho epistrophus (Fabricius, 1796), e sugerimos que se torne a borboleta mascote do parque.
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Abstract The study aimed to estimate and compare the prevalence and type of potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) between the STOPP/START original (v1) and updated version (v2) among older patients in various settings, as well as associated factors. The study included 440 patients attending a community pharmacy, 200 outpatients and 140 nursing home users. An increase in the prevalence of STOPP v2 (57.9%) compared to v1 (56.2%) was not statistically significant in the total sample and within each setting (p>0.05). A decrease in the prevalence of START v1 (55.8%) to v2 (41.2%) was statistically significant (p<0.001) in the total sample and within each setting (p<0.05). Drug indication (32.9%) and fall-risk medications (32.2%) were most commonly identified for STOPP v2, while cardiovascular system criteria (30.5%) were the most frequently detected for START v2. The number of medications was the strongest predictor for both STOPP v1 and v2, with odds ratio values of 1.35 and 1.34, respectively. Patients' characteristics associated with the occurrence of STOPP and START criteria were identified. According to both STOPP/START versions, the results indicate a substantial rate of potentially inappropriate prescribing among elderly patients. The prevalence of PIMs was slightly higher with the updated version, while the prevalence of PPOs was significantly lower
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Humans , Male , Female , Aged , Underregistration/classification , Prescriptions/classification , Potentially Inappropriate Medication List/statistics & numerical data , Health Services for the Aged/organization & administration , Prevalence , Geriatrics/instrumentationABSTRACT
Abstract Canga is an environment of great natural and economic value because it harbours a considerable number of endemic species on a substrate that is rich in iron ore. In the Amazon, this open vegetation type grows on top of isolated outcrops in a dense forest matrix found in the Carajás region, in southeastern Pará. Of these outcrops, the Parque Nacional dos Campos Ferruginosos (PNCF) is the only area of Amazonian canga with a strict protection status. Therefore, industrial activity in the region needs to implement mitigation actions to ensure species and habitat conservation. The objective of this study is to complement and review the floristic list of this recently created protected area, enabling us to compare the floristic similarity between it and other 14 Amazonian canga outcrops found outside the conservation units of full protection in the region. This data provides a basis to understand the floristic and phylogenetic complementarity of those patches to support conservation action. For this, six field trips were carried out in the Serra da Bocaina and two in the Serra do Tarzan, respectively, in order to increase the sampling efforts in PNCF and to obtain a more comprehensive plant list. Floristic composition was investigated using multivariate analyses (non-metric multidimensional scaling and unweighted pair group method with arithmetic mean) and phylogenetic structure across studied areas. We added 159 species to the floristic list of the PNCF and the results of the analyses showed that all 16 areas (n.b. PNCF comprises two of these sites) have an overall floristic similarity of 42%, with the least similar areas at 35% and the most similar at 50%. The different micro-habitats found in each study site highlight the high beta diversity of the Amazonian canga sites, making each area unique. Therefore, even if the Parque Nacional dos Campos Ferruginosos does not harbour all the species found in the other Amazonian canga sites, it is strategic for the conservation of the vegetation on ferruginous outcrops in the Amazon, protecting its biodiversity, different habitats, and associated ecosystem services.
Resumo Canga é um ambiente de grande valor natural e econômico por abrigar um número considerável de espécies endêmicas sobre substrato rico em minério de ferro. Na Amazônia, esse tipo de vegetação aberta cresce sobre afloramentos isolados em uma matriz de floresta densa encontrada na região de Carajás, no sudeste do Pará. Dentre esses afloramentos, o Parque Nacional dos Campos Ferruginosos (PNCF) é a única área de canga Amazônica que apresenta o status de proteção integral permanente. Dessa forma, a atividade industrial presente na região necessita implementar ações de mitigação para assegurar a conservação de espécies e habitats relacionados às cangas. O objetivo deste estudo é complementar e revisar a lista florística dessa área protegida, recentemente criada, permitindo comparar a sua similaridade florística com outros 14 afloramentos de cangas Amazônicas localizados fora de unidades de conservação de proteção integral encontradas na região. Tais dados fornecem subsídio para entender a complementaridade florística e filogenética desses fragmentos para apoiar ações de conservação. Para isso, foram realizadas seis viagens de coleta à Serra da Bocaina e à Serra do Tarzan, respectivamente, para aumentar o esforço amostral no PNCF e obter uma lista de plantas mais abrangente. A composição florística foi investigada por meio de análises multivariadas (non-metric multidimensional scaling and unweighted pair group method with arithmetic mean) e estrutura filogenética nas áreas estudadas. Nós adicionamos 159 espécies na lista florística do PNCF e os resultados das análises demonstraram que todas as 16 áreas (n.b. o PNCF compreende duas dessas áreas) têm uma similaridade florística total de 42%, com áreas menos similares de 35% e as mais similares de 50%. Os micro-habitats encontrados em cada área de estudo evidenciam a alta diversidade beta das áreas de cangas Amazônicas, o que as tornam únicas. Portanto, ainda que o Parque Nacional dos Campos Ferruginosos não abrigue todas as espécies encontradas em outras áreas de cangas Amazônicas, ele é estratégico para a conservação dos afloramentos ferruginosos na Amazônia, protegendo a sua biodiversidade, os diferentes habitats e os serviços ecossistêmicos associados.
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OBJECTIVE: To compare information on the risks of potentially inappropriate medications (PIMs) for older adults in the Beers criteria with data in the package inserts made available by the Brazilian Health Regulatory Agency. METHODS: This is an observational, cross-sectional study that compared information on the package inserts of 33 brand-name drugs in the Brazilian market with specific recommendations for older adults contemplated in the Beers criteria, categorizing them into: complete, incomplete, absent, or discrepant. RESULTS: Among the analyzed package inserts, 21.21% did not present a specific section dedicated to the use of these drugs by older adults and data were scattered throughout the text; 63.64% were classified as incomplete; 33.33% lacked data; and 3.03% had discrepant information. CONCLUSION: The analyzed package inserts presented incomplete data or lacked information characterizing the drugs as PIMs for older adults. This study demonstrated that some package inserts of drugs used in Brazil are not satisfactory, warranting higher caution in the medical community when prescribing these medications and guiding patients
OBJETIVO: Comparar as informações sobre os riscos de medicamentos potencialmente inapropriados (MPIs) para idosos contidas nos critérios Beers com as informações presentes nas bulas para profissionais de saúde disponibilizadas pela Agência Nacional de Vigilância Sanitária no Brasil. METODOLOGIA: Estudo observacional e transversal que comparou informações das bulas para profissionais de saúde de 33 medicamentos de referência no mercado brasileiro com recomendações específicas para idosos contempladas nos critérios Beers e que foram categorizadas em: completas, incompletas, ausentes ou discrepantes. RESULTADOS: Dentre as bulas dos MPIs analisadas, 21,21% não apresentam seção específica destinada ao uso desses medicamentos por idosos, nas quais as informações estão dispersas pelo texto; 63,64% delas foram classificadas como incompletas; 33,33% tinham informações ausentes; e 3,03% com informações discrepantes. CONCLUSÃO: As bulas analisadas apresentaram dados incompletos ou não apresentam qualquer informação que caracterizasse o medicamento como MPI para idosos. Este estudo demonstra que algumas bulas de medicamentos utilizados no Brasil não estão satisfatórias, sugerindo maior cautela à comunidade médica na prescrição e na orientação aos seus pacientes
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Humans , Aged , Drug Prescriptions/standards , Health of the Elderly , Medicine Package Inserts , Brazil , Cross-Sectional Studies , Risk FactorsABSTRACT
OBJECTIVE To study the variety included in the List of Overseas New Drugs Urgently Needed in Clinic in China and optimization strategy， in order to better meet the needs of patients. METHODS The release process of List of Overseas New Drugs Urgently Needed in Clinic， the characteristics and attributes of the new drugs urgently needed abroad， and the problems in the implementation process were all analyzed to put forward some suggestions for optimizing the List of Overseas New Drugs Urgently Needed in Clinic. RESULTS & CONCLUSIONS The release process of the List of Overseas New Drugs Urgently Needed in Clinic was roughly divided into incubation stage， preparation stage and implementation stage. The treatment fields of 3 batches of overseas new drugs urgently needed in clinic were relatively concentrated on endocrine and metabolic diseases，tumor and skin diseases. Of included 73 varieties， 50 varieties have been approved for market，and 26 varieties have been included in the medical insurance， 4 varieties were included in the Catalogue of Encouraged Generic Drugs. At present， there are still some problems in our country， such as the shortage monitoring system needs to be established and improved； the linkage with medical insurance is weakened； the encouragement of generic drugs is insufficient. It is necessary to strengthen the cooperation of monitored departments in the shortage of new overseas drugs，establish a medical insurance payment system oriented by clinical value， and improve the incentive mechanism to encourage the imitation of overseas new drugs urgently needed in clinic.
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Pharmacoeconomic evaluation is the essential supporting information for the inclusion of rare disease drugs into medical insurance in China. The accurate measurement of the health state utility of rare diseas is of practical significance to the development of rare disease pharmacoeconomic evaluation. Based on the review of pharmacoeconomic evaluation requirements for rare diseases in some countries/regions, we systematically retrieved the published studies on the measurement of health state utility for 121 rare diseases in China and other countries and regions. We identified 17 591 papers in the initial review, and later selected 230 after screening. We also made a comprehensive analysis of the quality of literature, evaluation content and use of tools for measuring health state utility in rare diseases in China. Finally, we analyzed the challenges in measurement in terms of population, instruments use, and application of results and made recommendations based on analysis, hoping to provide reference for the development of rare disease health state utility measurement studies in China.
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Introduction@#Type 1 diabetes mellitus (T1DM) is an autoimmune disorder that requires a lifelong treatment regimen which may affect psychosocial development.@*Objective@#To identify behavioural and emotional problems in children and adolescents with T1DM.@*Methodology@#A cross-sectional study using the Child Behaviour Check List (CBCL) was conducted among all T1DM patients receiving treatment at the Paediatric Endocrine Unit, Hospital Tunku Azizah Kuala Lumpur, Malaysia.@*Results@#Forty T1DM patients were included. The mean age of the participants was 12.4 years (SD=2.69), with 52.5% males, and 75% Malay. The average duration of illness was 4.8 years, 9 were pre-pubertal, while mean HbA1c was 9.4%. Thirty-five percent of the respondents had parent-reported internalizing problems and 17.5% had parent-reported externalizing problems. Those >12 years old had more internalizing problems (p=0.004) compared to those ≤12 years old. The differences were in the anxious/depressed syndrome subscale (p=0.001) and withdrawn/depressed syndrome subscale (p=0.015). There were no statistically significant differences in the 3 main global scores by gender, glycaemic control, duration of illness and pubertal status by univariate analysis.@*Conclusion@#T1DM patients >12 years old were at higher risk of developing psychosocial difficulties. This highlighted the benefit of screening of behavioural and emotional issues in children and adolescents with T1DM.
Subject(s)
Diabetes Mellitus, Type 1ABSTRACT
@#Introduction: Donors per million population and transplantations per million population are standardized, widely used indicators to assess and compare countries’ performance in organ donation and transplantation. This study aims to investigate these two particular metrics of organ donation and transplantation performance, and to introduce a new index, namely, ‘transplantations per patients on the waiting list’. Methods: Secondary analyses of data on 23 countries in 2016 were used to construct the transplantations per patients on the waiting list indicator for kidney, liver, pancreas, heart, and lung transplantation, as well as for the transplantation of any of the five aforementioned organs. Results: According to the transplantations per patients on the waiting list, the best-performing countries in terms of organ donation and transplantation are Belarus for kidney transplantation, Finland for liver and pancreas transplantation, Australia for heart transplantation, and France for lung transplantation. Considering all five organs together, Sweden, Australia, Finland, Austria, and Poland were the top five best-performing countries, followed by Spain in the sixth position. Conclusion: The deceased transplantations per patients on the waiting list can be an alternative indicator to assess performance, along with the widely-used donors and transplantations per million population, but still has its limitations in certain scenarios.
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El presente trabajo se ocupa de evaluar posibilidades del método de observación aplicado al análisis de estrategias de resolución de problemas en niños con discapacidad mediante juegos y tareas estructuradas. El marco teórico de referencia de esta contribución está representado por la teoría de la resolución de problemas, que contiene los principales procesos que intervienen en la gestión de los problemas y que nosotros aplicamos al desarrollo cognitivo y metacognitivo atípico. Junto con tres tareas diferentes estructuradas(Torre de Hanoi, Tetris y Bloques de construcción), usamos dos listas de comportamientos para codificar estrategias de resolución de problemas adoptadas por niños y/o adolescentes con desarrollo atípico. La aplicación de este tipo de observación con el uso de listas de comportamientos podría ser útil para crear en relación entre la investigación cualitativa y cuantitativa para mejorar el conocimiento de las estrategias de resolución de problemas y competencias metacognitivas en niños desarrollados atípicos(AU)
This paper is concerned with evaluating the possibilities of the observational method applied to the analysis of problem-solving strategies in children with disabilities through structured tasks. The theoretical framework of reference for this contribution is represented by the theory of problem-solving, containing the main processes involved in problem management,which we apply to atypical cognitive and metacognitive development. Together with three different structured tasks (Tower of Hanoi, Tetris, and Building Blocks), we used two lists of behaviors to code problem-solving strategies adopted by children and/or adolescents with atypical development. The application of this type of observation with the use of lists of behaviors could be useful to create a link between qualitative and quantitative research to improve the knowledge of problem-solving strategies and metacognitive competencies in atypically developed children(AU)
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Humans , Male , Female , Child, Preschool , Child , Problem Solving , Developmental Disabilities/psychology , Observation/methods , Disabled Children , Play Therapy , Child Behavior , Qualitative ResearchABSTRACT
ABSTRACT Introduction: Since the coronavirus disease 2019 (COVID-19) pandemic, cardiac surgeries in patients with previous infection by COVID-19 were suspended or postponed, which led to surgeries performed in patients with an advanced stage of their disease and an increase in the waiting list. There is a heterogeneous attitude in Latin America on the optimal timing to cardiac surgery in patients with previous COVID-19 infection due to scarce data on its outcome. Two Latin American associations joined to establish common suggestions on the optimal timing of surgery in patients with previous COVID-19 infection. Methods: Data collection was performed using a pre-established form, which included year of publication, objective, type of study (prospective/retrospective, descriptive/analytical), number of patients, year of study, waiting time between infection and surgery, type of surgery, morbidity, mortality, and conclusions regarding the association between mortality and morbidity. Final recommendations were approved by the board of directors of Latin American Association of Cardiac and Endovascular Surgery (LACES) and Latin American Confederation of Anesthesia Societies (CLASA). Results: Of the initial 1,016 articles, 11 comprised the final selection. Only six of them included patients who underwent cardiac surgery. According to the analyzed literature, optimal timing for cardiac surgery needs to consider the following aspects: deferable surgery, symptomatic COVID-19 infection, completeness of COVID-19 vaccination. Conclusion: These recommendations derive from the analysis of the scarce literature published at present on outcomes after cardiac surgery in patients with previous COVID-19 infection. These are to be taken as a dynamic recommendation in which Latin American reality was taken into consideration.