Análise das prescrições de pacientes com covid-19 em uso de hidroxicloroquina em uma unidade de terapia intensiva / Analysis of prescriptions of patients with COVID-19 using hydroxychloroquine in an Intensive Care Unit / Análisis de las prescripciones de pacientes con COVID-19 en uso hidroxicloroquina en una unidad de terapia intensiva

Mesmo em emergências sanitárias, quando terapias experimentais são empregadas, é importante prezar pela segurança e eficácia no uso de medicamentos, e a análise de prescrições médicas é uma das maneiras de monitorar aspectos de segurança. Objetivo: Quantificar e classificar as interações medicamentosas potenciais com hidroxicloroquina de acordo com o riscoem prescrições de pacientes com COVID-19 em pacientes com COVID-19 em uso de hidroxicloroquina admitidos em uma unidade de terapia intensiva de um Hospital de Ensino.Metodologia:Este estudo transversal baseou-se na análise de 162 prescrições de 38 pacientes admitidos em uma unidade de terapia intensiva de um Hospital de ensino entre abril e junho de 2020.O Micromedex® e o UpToDate® foram as bases de dados de apoio à conduta clínica utilizadas para estabelecer as interações medicamentosas potenciais. Resultados:A média de dias de internamento foi de 16,1 ± 14,0 e a média de dias em uso de hidroxicloroquina foi de 4,26 ± 1,74. 87,14% das prescrições apresentaram interações medicamentosas potenciais e a mais comum foi entre hidroxicloroquina e azitromicina. 76,4% das prescrições analisadas apresentaram interações medicamentosas potenciais com hidroxicloroquina. 73,5% das prescrições tiverampelo menos uma interação medicamentosa potencial entre medicamentos que prolongam o intervalo QT. Conclusões: Tendo em vista os riscos da exposição de pacientes críticos às interações medicamentosas, este estudo demonstra a necessidade de fortalecer nas instituições hospitalares a cultura de monitoramento de parâmetros de segurança e eficáciano uso de medicamentos, inclusive em terapias experimentais com a utilização de medicamentos off-labelpara minimizar riscos e ampliar possíveis benefícios (AU).

Even in health emergencies, when experimental therapies are employed, it is important to ensure the safety and efficacy of medicines, and the analysis of medical prescriptions is one of the ways to monitor safety aspects.Objective: Quantify and rank potential drug interactions with hydroxychloroquine according to risk in prescriptions of COVID-19 patients taking hydroxychloroquine admitted to an intensive care unit of a TeachingHospital.Methodology: This cross-sectional study was based on the analysis of 162 prescriptions of 38 patients admitted to an intensive care unit of a teaching hospital between April and June 2020. Micromedex® and UpToDate® were the clinical practice support databases used to establish potential drug interactions. Results: The mean number of days of hospitalization was 16.1 ± 14.0 and the mean number of days of days on hydroxychloroquine was 4.26 ± 1.74. 87.14% of the prescriptions presented potential drug interactions and the most common was between hydroxychloroquine and azithromycin. 76.4% of the analyzed prescriptions had potential drug interactions with hydroxychloroquine. 73.5% of prescriptions had at least one potential drug interaction between drugs that prolong the QT interval. Conclusions: In view of the risks of exposure of critically ill patients to drug interactions, this study interactions, this study demonstrates the need to strengthen in hospital institutions the culture of institutions the culture of monitoring safety and efficacy parameters in the use of medicines, including experimental therapies with the use of off-label drugs to minimize risks and increase possible benefits (AU).

Aunque en médio aemergencias sanitarias, cuando son empleadas terapias experimentales, es importante estimar la seguridad y eficacia en el uso de los medicamentos, y el análisis de prescripciones es una de las formas de acompanhar los aspectos de seguridad. Objetivo:Cuantificar y clasificar las interaciones farmacologicas potenciales con hidroxicloroquina de acuerdo com el riesgo em prescripciones de pacientes com Covid-19 em uso de hidroxicloroquina andmitidos em unidad de terapia intensiva de um Hospital Docente. Metodología: Este estudio transversal se asienta en el análisis de 162 prescripciones de 38 pacientes admitidos em uma unidad de terapia intensiva de um Hospital Docente entre abril y junio de 2020. El Micromedex®ï¸y el UpToDate®ï¸fueron las bases de datos de apoyo a la actuación clínica utilizadas para establecer las interacciones farmacológicas potenciales. Resultados:El promedio de días de internamiento fue de 16,1 ± 14,0 y el promedio de días en uso hidroxicloroquina fuede 4,26 ± 1,74. 87,14% de las prescripciones presentaron interacciones farmacológicas potenciales y la más común fue entre hidroxicloroquina y azitromicina. 76,4% de las prescripciones analizadas presentaron interaciones farmacológicas com hidroxicloroquina. 73,5% de las prescripciones tuvierion por lo menos uma interacción farmacológica potencial entre medicamentos que prolongam el intervalo QT. Conclusiones:Tenendo a la vista los riesgos de la exposición de pacientes críticos a las interaciones farmacológicas, este estudio demuestra la necesidad de reforzar em las instituiciones hospitalarias la cultura de monitoreo de parâmetros de seguridade y eficacio em el uso de medicamentos, incluso en terapias experimentales con utilización de medicamentos off-label, para minorar riesgos y ampliar los posibles beneficios (AU).

As receitas médicas de Hannah Woolley: prática cotidiana e autoridade feminina na Inglaterra do século XVII / The medicinal recipes of Hannah Woolley: everyday practice and female authority in seventeenth-century England

Resumo O artigo retrata os interesses de uma escritora inglesa do século XVII sobre cuidados médicos, e as razões que a levaram a publicar textos sobre essa matéria. Hannah Woolley tecia orientações sobre diversos assuntos do âmbito doméstico, entre os quais receitas para preservar a beleza e a saúde. O artigo investiga os princípios que regiam o preparo dessas receitas, as intenções de Woolley ao escrever sobre o tema, e a maneira como a medicina acadêmica era traduzida e praticada por mulheres no cotidiano da época. O delineamento dessas questões ajudará a elucidar o cenário de atuação das curadoras letradas e a natureza das relações que teceram com os médicos eruditos.

Abstract This article describes a seventeenth-century English woman writer's interests in medical care and the reasons that led her to publish texts on this topic. Hannah Woolley offered guidance on a wide variety of topics in the domestic sphere, including recipes for health and beauty. Here we investigate the principles that governed the preparation of these recipes, Woolley's intentions in writing on this topic, and the way in which academic medicine was translated and practiced by women routinely during this period. Defining these issues will help shed light on the scenario in which literate female healers worked and the nature of their relationships with learned physicians.

Dialysis prescription: Determinants and relationship with intradialytic complications and the dialysis dose. A prospective study

Introduction: Dialysis still remains the most common modality for the treatment of end stage kidney disease and it could be maneuvered to augment its dose, minimize complications and improve outcome. Dialysis prescription is a brief of how dialysis is to be given and involves adjustments in patients' characteristics, disease or dialytic procedure. This study aimed to assess the determinants of the prescribed dialysis and its relationship with intradialytic complications and the dialysis dose. Methods: A prospective study in which 1248 sessions for 232 consented participants with end stage kidney disease on maintenance hemodialysis were studied from 2017-2020. Biodata was taken, participants were examined and blood samples were taken to determine electrolytes, urea/creatinine and hematocrit. Pearson's correlation was used to determine the strength of association between dialysis dose and some variables. Results: Determinants of the prescribed dose were dialysis frequency (P<0.001), and predialysis systolic blood pressure (P<0.001) and packed cell volume (P<0.001). Dialysis sessions without significant intradialytic blood pressure changes were most likely to be completed, as sessions with intra-dialysis hypotension were most likely to be terminated. Participants dialyzed with high flux dialyzers, via an arterovenous fistula, higher blood flow and ultrafiltration rates had higher dialysis doses (P<0.001 in all instances). Conclusion: Higher dialysis doses were achieved with higher blood flow and ultrafiltration rates. Intradialytic hypotension was common with dialysis termination, higher blood flow and ultrafiltration rates. Intradialytic hypertension was common with low flux dialyzers. An optimized dialysis prescription is needed to deliver an adequate dialysis dose and minimize complications

Antibiotic prescription patterns in paediatric wards of Rivers State university teaching hospital, southern Nigeria: a point prevalence survey

Antimicrobial resistance remains a threat to patient safety and healthcare outcomes and largely arises from inappropriate antimicrobial prescriptions. This study aimed to determine the pattern of antibiotic prescriptions in the Paediatrics department of Rivers State University Teaching Hospital, Port Harcourt.Method:A point prevalence survey was conducted in the Paediatric wards and Special Care Baby Unit (SCBU) on 13 November 2021. Records of all children admitted before or at 8:00a.m. on the day of the survey were descriptively analysed using the protocol and web-based management system of the Global Point Prevalence Survey of Antimicrobial Consumption and Resistance, University of Antwerp.Results: The antibiotic prevalence in this study was 77.4%. The most common indication(s) for antibiotic use in SCBU was infection prophylaxis (81.3%) and in paediatric wards: Pneumonia, Ear Nose Throat and Soft tissue infections accounted for (23.1%) each. Third-generation cephalosporins and aminoglycosides were predominantly used in all wards and were empirical-based prescriptions. Regarding antibiotic quality indicators of prescriptions: In SCBU: 19 (90.5%) had indication(s) for antibiotics documented, 10 (46.7%) were guideline compliant, and 1 (4.8%) had documented review/stop date. In the paediatric medical and surgical wards, 17(85.0%) vs. 4(100%) had indication(s) for antibiotics documented, 6(30.0%) vs. 0(0%) were guideline compliant, and 1(5.0%) vs. 4(100.0%) had a review/ stop date.Conclusion:High prevalence of antibiotic use, suboptimal antibiotic quality indicators and absence of laboratory evidence for antibiotic prescriptions were observed in the paediatric units. There is a need to reorientate prescribers and institute strategic measures to improve antimicrobial stewardship

Audit to assess the quality of 916 prosthetic prescriptions of removable partial dentures / 华西口腔医学杂志

OBJECTIVES@#The objectives of this study were to assess the quality of prosthetic prescriptions of removable partial dentures (RPDs) and to analyze the current situation of the communication and information delivery between clinicians and technicians.@*METHODS@#All RPD prosthetic prescriptions received by a major dental laboratory in 4 weeks were involved in a quality audit, and the prescriptions were divided into three groups in accordance with the grades of clients. The filling of prosthetic prescriptions was recorded. The items in the prescriptions for audit included the general information of the patient, the general information of the clinician, the design diagram information, other detailed information, and the return date. The prescriptions were categorized into four levels on the basis of their quality by two quality inspectors who have been working for more than 10 years.@*RESULTS@#A total of 916 prescriptions were collected and assessed. The names in the general information of the patient and the clinician were filled out best, both at the rate of 97.6% (n=894). The return date was filled out worst, only at the rate of 6.4% (n=59). Of those prescriptions, 86.8% (n=795) exhibited inadequate design diagram information. The results of the quality assessment demonstrated that 74.2% of prescriptions were assessed as noncompliant ones and failed to meet the acceptable clinical quality standard.@*CONCLUSIONS@#At present, the overall quality of RPD prosthetic prescriptions is poor. The responsibilities of clinicians and technicians are unclear, and the communication between them is not ideal.

Análise das intervenções farmacêuticas clínicas em Unidade de Terapia Intensiva de um hospital de urgência e trauma / Analysis of clinical pharmaceutical interventions in the Intensive Care Unit of an emergency and trauma hospital

Analisar o perfil das intervenções farmacêuticas providas pelos farmacêuticos clínicos por meio da análise de prescrições médicas em uma Unidade de Terapia Intensiva (UTI) adulto generalista. Metodologia: Trata-se de um estudo transversal, prospectivo e observacional, com abordagem quantitativa, realizado na UTI de um hospital público referência em urgência e trauma do estado de Goiás. Os dados foram coletados no período de junho a agosto do ano de 2022, por meio da análise diária das prescrições. Resultados: A população estudada compreendeu 74 pacientes, em sua maioria do sexo masculino (68,92%), hipertensos (27,03%), e diabéticos (14,86%). Foram analisadas 568 prescrições, e identificados 489 problemas relacionados a medicamentos, sendo os mais prevalentes: medicamento inapropriado/desnecessário ou contraindicado (30,67%) e necessidade de medicamento adicional (24,34%). As classes de medicamentos mais envolvidas nos problemas foram: anti-infecciosos gerais para uso sistêmico (23,72%), e agentes do sistema nervoso (23,11%). Das intervenções farmacêuticas promovidas, 84,25% foram aceitas, com maior frequência: suspender medicamento (30,67%) e iniciar terapia medicamentosa (23,72%). Conclusão: Diante dos resultados apresentados, nota-se a boa taxa de aceitabilidade das intervenções, destacando a importância da atuação do farmacêutico clínico dentro da UTI na prevenção de problemas relacionados à farmacoterapia, bem como na melhoria dos desfechos terapêuticos

To analyze the profile of pharmaceutical interventions provided by clinical pharmacists through the analysis of medical prescriptions in a generalist adult Intensive Care Unit (ICU). Methodology: This is a cross-sectional, prospective and observational study, with a quantitative approach, conducted in the ICU of a public hospital that is a reference in emergency and trauma in the state of Goiás. Data were collected from June to August of 2022, through the daily analysis of prescriptions. Results: The population being studied comprised 74 patients, mostly male (68.92%), hypertensive (27.03%), and diabetic (14.86%). 568 prescriptions were analyzed, and 489 problems related to medication were identified, the most prevalent being: inappropriate/unnecessary or contraindicated medication (30.67%) and need for additional medication (24.34%). The drug classes most involved in the problems were: general anti-infectives for systemic use (23.72%) and nervous system agents (23.11%). Of the promoted pharmaceutical interventions, 84.25% were accepted, most frequently: discontinuing medication (30.67%) and starting medication therapy (23.72%). Conclusion: In view of the results presented, there is a good rate of acceptability of the interventions, highlighting the importance of the role of the clinical pharmacist within the ICU in preventing problems related to pharmacotherapy, as well as in improving therapeutic outcomes

Short-acting β2-agonist prescription patterns in patients with asthma in the Philippines: Results from SABINA III

Objectives@#As asthma is a chronic inflammatory disease of the airways, anti-inflammatory treatment should be positioned at the forefront of guideline-directed asthma care. However, patients tend to rely on short-acting β2-agonists (SABAs) for rapid-onset symptom relief. The impact of SABA overuse and associated clinical outcomes have been investigated extensively in Europe and North America. Limited data are available from countries in Asia, Africa, Latin America, and the Middle East. The SABA use IN Asthma (SABINA) III program, a large multicountry, observational study, was undertaken to describe the global extent of SABA use and its potential contribution to suboptimal disease control. As part of the SABINA III study, we aimed to characterize SABA prescription collection and asthma-related clinical outcomes among patients in the Philippines.@*Methods@#This nationwide, observational, cross-sectional, SABINA III study included patients (aged ≥12 years) with a documented asthma diagnosis recruited between May 2019 and January 2020 from 10 sites in the Philippines. Demographics, disease characteristics and prescribed asthma treatments, including SABA and inhaled corticosteroids (ICS) in the 12 months preceding study start, were recorded during a single visit, and transcribed onto an electronic case report form (eCRF). Patients were classified by investigator-defined asthma severity, guided by the 2017 Global Initiative for Asthma (GINA) report and practice type, either primary or pulmonary medicine specialist care.@*Results@#Of 245 patients analyzed, 63.3% were classified as having moderate-to-severe asthma (GINA steps 3−5), and most patients (63.3%) were enrolled by pulmonary medicine specialists. Overall, 33.1% (n=81) of patients had experienced ≥1 severe exacerbation in the previous 12 months and 18.4% (n=45) of patients had uncontrolled asthma. With respect to asthma treatments, a total of 6.5% (n=16), 40.4% (n=99), and 2.4% (n=6) of patients were prescribed SABA monotherapy, SABA in addition to maintenance therapy, and ICS, respectively, in the 12 months prior to their study visit. Most patients (n=156 [63.7%]) received prescriptions of fixed-dose combina-tions of ICS and long-acting β2-agonists. SABA over-prescription, defined as ≥3 SABA canister prescriptions per year, was observed in 10.6% (n=21) of patients. Additionally, 25.6% (n=23) of patients classified as having mild asthma were prescribed either nebulized SABA (n=17) or oral SABA (n=6). Nearly one-third of patients (n=75 [30.6%]) had purchased over-the-counter (OTC) SABA, and 46.9% (n=115) were prescribed antibiotics.@*Conclusions@#In this SABINA III Philippines study cohort, more than 10% of patients were over-prescribed SABA canisters. Additionally, prescriptions for oral or nebulized SABA, the purchase of non-prescription (OTC) SABA, and the high percentage of prescriptions for antibiotics warrant country-wide improvements in asthma care and management.

Exploration and example interpretation of real-world herbal prescription classification based on similarity matching algorithm / 中国中药杂志

In observational studies, herbal prescriptions are usually studied in the form of "similar prescriptions". At present, the classification of prescriptions is mainly based on clinical experience judgment, but there are some problems in manual judgment, such as lack of unified criteria, labor consumption, and difficulty in verification. In the construction of a database of integrated traditional Chinese and western medicine for the treatment of coronavirus disease 2019(COVID-19), our research group tried to classify real-world herbal prescriptions using a similarity matching algorithm. The main steps include 78 target prescriptions are determined in advance; four levels of importance labeling shall be carried out for the drugs of each target prescription; the combination, format conversion, and standardization of drug names of the prescriptions to be identified in the herbal medicine database; calculate the similarity between the prescriptions to be identified and each target prescription one by one; prescription discrimination is performed based on the preset criteria; remove the name of the prescriptions with "large prescriptions cover the small". Through the similarity matching algorithm, 87.49% of the real prescriptions in the herbal medicine database of this study can be identified, which preliminarily proves that this method can complete the classification of herbal prescriptions. However, this method does not consider the influence of herbal dosage on the results, and there is no recognized standard for the weight of drug importance and criteria, so there are some limitations, which need to be further explored and improved in future research.

Network Meta-analysis of single Hirudo prescriptions in treatment of ischemic cerebrovascular disease / 中国中药杂志

This study intended to evaluate the efficacy and safety of single Hirudo prescriptions in the treatment of ischemic cerebrovascular disease(ICVD) by frequency network Meta-analysis and traditional Meta-analysis. CNKI, Wanfang, VIP, SinoMed, PubMed, EMbase, and Cochrane Library databases were searched to collect the randomized controlled trial(RCT) of single Hirudo prescriptions for ICVD from the inception of the databases to May 2022. The quality of the included literature was evaluated by Cochrane risk of bias tool. Finally, 54 RCTs and 3 single Hirudo prescriptions were included. Statistical analysis was conducted by RevMan 5.3 and Stata SE 15. Network Meta-analysis showed that in terms of the clinical effective rate, the surface under the cumulative ranking curve(SUCRA) of intervention measures was as follows: Huoxue Tongmai Capsules+conventional treatment>Maixuekang Capsules+conventional treatment>Naoxuekang Capsules+conventional treatment>conventional treatment. Traditional Meta-analysis revealed that in terms of the safety of ICVD treatment, Maixuekang Capsules+conventional treatment had higher safety than conventional treatment alone. According to the network Meta-analysis and traditional Meta-analysis, it was found that conventional treatment combined with single Hirudo prescriptions improved the clinical efficacy of ICVD patients, and compared with that of conventional treatment alone, the incidence of adverse reactions of combined treatment was low and the safety was high. However, the methodological quality of the articles included in this study was generally low and there were large differences in the number of articles on the three combined medication. Therefore, the conclusion of this study needed to be confirmed by subsequent RCT.

Systematic review and Meta-analysis of efficacy and safety of Fengliao Changweikang prescription in treatment of acute gastroenteritis / 中国中药杂志

This study systematically evaluated the clinical efficacy and safety of Fengliao Changweikang prescription for treating acute gastroenteritis(AGE). The databases of CNKI, Wanfang, VIP, SinoMed, Medline, Cochrane Library and two clinical trial registration platforms were retrieved from inception to August 30, 2022, to collect randomized controlled trial(RCT) on Fengliao Changweikang prescription treating AGE. Two researchers independently conducted literature screening, data extraction, and risk of bias assessment according to pre-established inclusion and exclusion criteria. RevMan 5.4.1 was used for data analysis. Finally, 18 RCTs were included, involving 3 489 patients. Meta-analysis showed that compared with conventional western medicine, Fengliao Changweikang prescription improved the relief rate of abdominal pain(RR=1.27, 95%CI[1.17, 1.38],P<0.000 01); Fengliao Changweikang prescription + conventional western medicine increased the cure rate(RR=1.43, 95%CI[1.12, 1.82], P=0.004), shortened the duration of diarrhoea(RR=-1.65, 95%CI[-2.44,-0.86], P<0.000 1), abdominal pain(RR=-1.46, 95%CI[-2.00,-0.92], P<0.000 01), vomiting(RR=-2.16, 95%CI[-2.51,-1.81], P<0.000 01) and fever(RR=-2.61, 95%CI[-4.00,-1.23], P=0.000 2), down-regulated the level of interleukin-8(IL-8)(RR=-1.07, 95%CI[-1.26,-0.88], P<0.000 01), IL-6(RR=-8.24, 95%CI[-8.99,-7.49], P<0.000 01) and hypersensitive C-reactive protein(hs-CRP)(RR=-3.04, 95%CI[-3.40,-2.69], P<0.000 01) and recurrence of AGE(RR=0.20, 95%CI[0.05, 0.90], P<0.04). In conclusion, Fengliao Changweikang prescription was safe in clinical application. It was beneficial to alleviate the clinical symptoms of diarrhea, abdominal pain, vomiting, and fever, and down-regulate the levels of some serum inflammatory factors in AGE patients. However, considering that few high-quality studies have evaluated the efficacy and safety of Fengliao Changweikang prescription in treatment of AGE, further evidence is needed in the future.

Classification optimization of traditional Chinese medicine materials based on additive physical properties of powder / 中国中药杂志

According to the method of predicting the physical properties of oily powder based on the additive physical properties of Chinese medicinal powder, Dioscoreae Rhizoma and calcined Ostreae Concha with high sieve rate and good fluidity were mixed and crushed with Persicae Semen, Platycladi Semen, Raphani Semen, Ziziphi Spinosae Semen, and other typical oily materials with high fatty oil content in proportion to obtain 23 mixed powders. Fifteen physical properties such as bulk density, water absorption, and maximum torque force were measured, and the physical properties of typical oily powders were predicted. When the mixing and grinding ratio was in the range of 5∶1-1∶1, the r value in the correlation equation between the weighted average score of the mixed powder and the powder proportion ranged from 0.801 to 0.986, and the linearity was good, indicating that the method of predicting the physical properties of oily powder based on the additive physical properties of traditional Chinese medicine(TCM)powder was feasible. The results of cluster analysis showed that the classification boundaries of the five kinds of TCM materials were clear, and the similarity of the physical fingerprints of powdery and oily materials decreased from 80.6% to 37.2%, which solved the problem of fuzzy classification boundaries of powdery and oily materials due to the lack of representativeness of oily material model drugs. The classification of TCM materials was optimized, laying a foundation for optimizing the prediction model of the prescription of personalized water-paste pills.

Mechanism of heat-clearing prescriptions in alleviating type 2 diabetes mellitus:a review / 中国中药杂志

Type 2 diabetes mellitus(T2DM), a common chronic metabolic disease, is often accompanied by internal heat syndrome. Heat-clearing prescriptions are widely used to treat different heat syndromes of T2DM from the aspects of clearing stagnant heat, excess heat, damp heat, phlegm heat, and heat toxin, demonstrating remarkable effects. The mechanism of blood sugar-lowering agents has always been a hotspot of research. Recently, the basic studies of heat-clearing prescriptions from different perspectives have been increasing year by year. To clarify the mechanisms of heat-clearing prescriptions and find specific mechanisms, we systematically reviewed the basic studies of heat-clearing prescriptions commonly used for the treatment of T2DM in the past decade, intending to provide a reference for related research.

Research ideas of core formulas-syndromes based on disease-syndrome-treatment combination / 中国中药杂志

The relationship between disease and syndrome is a research focus in integrated traditional Chinese and western medicine. Depending on the focus, the disease-syndrome combination for treatment is manifested as the different treatment methods for the same disease and the same treatment method for different diseases based on the syndrome, and different treatment methods for the same syndrome and the same treatment method for different syndromes based on the disease. The mainstream model is the combination of di-sease identification in modern medicine with syndrome identification and core pathogenesis in traditional Chinese medicine. However, current research on the combination of disease and syndrome and core pathogenesis tends to focus on the heterogeneity between disease and syndrome and the separation of syndrome and treatment. Therefore, the study proposed the research idea and model of core formulas-syndromes(CFS). According to the theory of formula-syndrome correspondence, the research idea of CFS deepens the research on core pathogenesis, which aims to summarize the core formulas and syndromes for diseases. The research fields include diagnostic criteria for the indications of formulas, distribution patterns of formulas and syndromes for diseases, the evolution of medicinal-syndrome based on formulas-syndromes, formula combination law based on formulas-syndromes, and the dynamic evolution of formulas-syndromes. Through the summary of ancient classics, clinical experience, and medical records, and with the methods of expert consultation, factor analysis, and clustering analysis, research on the diagnostic criteria for the indications of formulas aims to explore the diagnosis information such as the diseases, symptoms, signs, and pathophysiology. The research on the distribution patterns of formulas and syndromes for diseases tends to summarize the specific types of formulas and syndromes for the diseases through literature research and clinical cross-sectional studies based on the establishment of diagnostic criteria for the indications of formulas. The research on the evolution of medicinal-syndrome aims to clarify the medicinal-syndrome law through literature and clinical research. The formula combination law refers to the fact that the core prescriptions for a disease often appear in combination with other prescriptions on a regular basis. The dynamic evolution of formulas-syndromes refers to the continuous transformation and change of formulas and syndromes in the process of disease development with changes in time and space. The CFS is conducive to the unification of disease, syndrome and treatment and to the deepening of the research model of disease and syndrome integration.

Tareas fundamentales de la obstetricia: recomendaciones para la regulación de la prescripción, uso y dispensa de medicación / El Trabajo Obstétrico en la Salud Sexual y Reproductiva / Fundamental tasks of obstetrics: recommendations for the regulation of the prescription, use and dispensing of medication / Obstetric work in sexual and reproductive health

El objetivo es presentar una descripción general de las diferentes estrategias normativas para la autorización de la prescripción, el uso y la dispensa de medicamentos por parte de obstétricas. Para ello, se ofrece un breve panorama de las recomendaciones de organismos de rectoría sanitaria y profesional para ese fin, así como de las regulaciones de diferentes países del mundo. Además, se presenta un análisis comparado de las regulaciones existentes en la Argentina, enfocando en las estrategias regulatorias y, en particular, la revisión de los vademécums obstétricos vigentes. Ello, con el fin de aportar argumentos y observaciones sobre su alcance, estructura y contenido, y para indicar las fortalezas y desafíos que cada una de estas estrategias de regulación comporta. Finalmente, aportamos algunas breves recomendaciones para la formulación de una regulación nacional y de un vademécum obstétrico nacional en el marco de la aprobación de alguno de los proyectos de ley nacional de regulación de las competencias profesionales de la obstetricia que cursan en el Congreso de la Nación actualmente.

Potentially inappropriate prescribing among older patients and associated factors: comparison of two versions of STOPP/START criteria

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

Antibiotic prescription in the management of endodontic infections amongst Iraqi final-year undergraduate dental students

Aim This study aimed to examine the prescription of antibiotics for endodontic infections among undergraduate dental students. Methods Two government Iraqi dental schools [(the University of Baghdad (UOB) (n=99) and University of Babylon (UB) (n=70)], and one private dental school [Osouldeen University College (OUC) (n=103)] were included in this survey study. A paper-based questionnaire composed of seven questions was distributed to students, and collected. A chi-square test was used for data analysis, and the level of significance was set at 0.05 (P=0.05). Results A statistically significant difference (P<0.05) was identified between students' answers in the three dental schools regarding antibiotic selection for endodontic infections in which patients had no known allergies (P=0.001). In comparison to other dental schools, a statistically significantly higher proportion of respondents from UOB (32%) favored Azithromycin 500mg for treating patients with penicillin hypersensitivity (P=0.003). A high percentage of participants (62.1%) selected antibiotic prescription in cases with necrotic pulp and symptomatic apical periodontitis (with swelling and moderate/severe preoperative symptoms). However, there were no significant differences between the 3 dental schools (P>0.05). Conclusion In conclusion, a significantly greater percentage of UB chose amoxicillin for the treatment of endodontic infection in patients with no medical allergies. Azithromycin 500mg was selected by UOB as the preferred option in patients who were sensitive to penicillin. Our findings support the need for the implementation of strategies to raise awareness of good antibiotic prescribing practices among dentists in Iraq.

Construção e validação psicométrica de instrumento para rastreio de eventos adversos em unidades de pronto atendimento / Construction and psychometric validation of an instrument for screening adverse events in emergency care units

Resumo: A segurança do paciente é tema relevante de estudo nos diversos ambientes de atenção à saúde. Entre eles destaca-se, nesta pesquisa, as Unidade de Pronto Atendimento, principal porta de entrada dos pacientes ao sistema de saúde brasileiro. A alta demanda, diversidade e complexidade dos casos contribuem para o risco de incidentes com danos nestas unidades, que somadas à cultura de segurança não fortalecida gera pouca investigação, reconhecimento e notificação de casos. Considerando a ausência de instrumento para detecção de eventos adversos neste contexto assistencial, o objetivo desta pesquisa foi elaborar e validar um instrumento de gatilhos, utilizando a psicometria, para o rastreio de Eventos Adversos em Unidades de Pronto Atendimento. Para isso, foi realizada uma pesquisa metodológica, de cunho quantitativo, seguindo o referencial da Psicometria, e utilizando-se os pólos teórico, experimental e analítico como correspondentes etapas metodológicas. Para a primeira etapa, polo teórico, realizou-se revisão integrativa, com o intuito de identificar na literatura científica gatilhos utilizados em serviços de emergência para rastrear eventos adversos. A reunião e organização das evidências culminou na versão inicial do instrumento de rastreio, contendo gatilhos que indicam a ocorrência de potenciais eventos adversos. Esta foi submetida à análise e organização por grupo focal, composto por quatro especialistas, e validação por grupo de 10 juízes experts em segurança do paciente, urgência/emergência e unidade de pronto atendimento, utilizando-se técnica Delphi on line. Na segunda etapa, polo experimental, o instrumento foi aplicado para análise de 240 prontuários de pacientes, selecionados aleatoriamente entre os atendidos em uma unidade de pronto atendimento da capital paranaense. Informações sociodemográficas, de saúde e do atendimento, gatilhos detectados e correspondentes casos foram registrados. Os eventos adversos confirmados pela pesquisadora e um médico, foram classificados segundo o grau de evitabilidade e dano e categorizados em administração de medicamentos, gerenciamento de vagas, assistência e conduta profissional. A análise dos casos foi complementada com os testes t de Student, exato de Fisher, Kruskal-Wallis e teste de Dunn. O polo analítico se deu, transversalmente, nas primeira e segunda etapas metodológicas, por meio das análises e testes estatísticos. Como resultados, destaca-se que a revisão integrativa possibilitou a identificação e reunião de 54 gatilhos, 50 dos quais foram considerados aplicáveis e organizados em cinco módulos pelo grupo focal. Após três rodadas de julgamento o instrumento foi validado com Indice de Validade de Conteudo de 0,88 e Alfa de Cronbach 0,93, e cuja versão final contêm 48 gatilhos organizados em módulos clínico (n=20), trauma (n=02), procedimentos (n=04), medicamentos (n=07) e laboratorial (n=14). A leitura retrospectiva dos registros em prontuário, norteada pela versão final do instrumento, resultou na detecção de 23 diferentes gatilhos entre os 48 constantes no instrumento. Ao total 163 gatilhos foram registrados, sendo prevalentes administração de antialérgico (n=47), readmissão na UPA em 48 horas (n=23), hipoglicemia e/ou hiperglicemia (n=17);t otalizando 32 eventos adversos confirmados. A análise mostrou que os gatilhos identificados estiveram associados a eventos adversos (p<0,05), sendo 93,8% (n=30) fortemente evitáveis e associados (p<0,05) à idade, tempo de permanência e local para onde o paciente foi encaminhado após o atendimento. Conclui-se que o Instrumento para Rastreio de Eventos Adversos em Unidades de Pronto Atendimento reúne gatilhos válidos e eficazes para rastrear incidentes com danos; sua aplicação contribui para conhecer a epidemiologia desses agravos à saúde em Unidades de Pronto Atendimento, e para o direcionamento de ações com vistas à promoção da segurança do paciente e qualidade assistencial.

Abstract: Patient safety is a relevant topic of study in various health care environments. Among them, this research highlights the Emergency Care Unit, the main gateway for patients to the Brazilian health system. The high demand, diversity and complexity of cases contribute to the risk of incidents with damage in these units, which added to the unstrengthened safety culture generates little investigation, recognition and notification of cases. Considering the absence of an instrument for the detection of adverse events in this care context, the objective of this research was to elaborate and validate an instrument of triggers, using psychometrics, for the screening of Adverse Events in Emergency Units. For this, a methodological research was carried out, of quantitative nature, following the reference of Psychometrics, and using the theoretical, experimental and analytical poles as corresponding methodological steps. For the first stage, theoretical pole, an integrative review was carried out in order to identify in the scientific literature triggers used in emergency services to track adverse events. The gathering and organization of evidence culminated in the initial version of the screening instrument, containing triggers that indicate the occurrence of potential adverse events. This was submitted to analysis and organization by focus group, composed of four specialists, and validation by group of 10 expert judges in patient safety, urgency/emergency and emergency unit, using Delphi technique online. In the second stage, the experimental pole, the instrument was applied for analysis of 240 patient records, randomly selected among those attended in an emergency unit in the capital of Paraná. Sociodemographic, health and care information, triggers detected and corresponding cases were recorded. Adverse events confirmed by the researcher and a physician were classified according to the degree of avoidability and harm and categorized into drug administration, job management, care and professional conduct. Case analysis was complemented with Student's t-tests, Fisher's exact, Kruskal-Wallis and Dunn's test. The analytical pole occurred, transversally, in the first and second methodological stages, through the analysis and statistical tests. As a result, we highlight that the integrative review enabled the identification and meeting of 54 triggers, 50 of which were considered applicable and organized into five modules by the focus group. After three rounds of judgment the instrument was validated with Content Validity Index of 0.88 and Cronbach's Alpha 0.93, and whose final version contains 48 triggers organized in clinical modules (n=20), trauma (n=02), procedures (n=04), drugs (n=07) and laboratory (n=14). The retrospective reading of records in medical records, guided by the final version of the instrument, resulted in the detection of 23 different triggers among the 48 contained in the instrument. In total 163 triggers were registered, being prevalent administration of antiallergic (n=47), readmission to the UPA in 48 hours (n=23), hypoglycemia and/or hyperglycemia (n=17); totaling 32 confirmed adverse events. The analysis showed that the identified triggers were associated with adverse events (p<0.05), being 93.8% (n=30) strongly avoidable and associated (p<0.05) with age, length of stay and place where the patient was referred after care. It is concluded that the Instrument for Screening Adverse Events in Emergency Care Units brings together valid and effective triggers to track incidents with damage; its application contributes to knowing the epidemiology of these health problems in Emergency Care Units, and to direct actions aimed at promoting patient safety and quality of care.

Compreensão do paciente idoso sobre sua prescrição médica na Atenção Primária em Saúde na cidade de Fortaleza (CE) / Understanding of aged patients about medical prescriptions in Primary Health Care in the city of Fortaleza (CE) / Comprensión del paciente mayor sobre su receta médica en Atención Primaria de Salud en la ciudad de Fortaleza (CE)

Introdução: O envelhecimento é acompanhado por mudanças que colaboram para que os idosos precisem de farmacoterapia aumentada. Objetivo: Objetivou-se identificar a dificuldade de compreensão do paciente idoso quanto à prescrição de medicamentos na Atenção Primária na cidade de Fortaleza (CE). Métodos: Trata-se de um estudo descritivo e transversal com abordagem quantitativa, realizado em Unidade de Atenção Primaria à Saúde (UAPS) na cidade de Fortaleza/CE. Foi aplicado questionário estruturado em 105 idosos. As entrevistas aconteceram entre os meses de setembro e outubro de 2019. Resultados: Os resultados demonstraram que o sexo feminino foi prevalente em 88 (83%) participantes, a autopercepção da saúde predominante foi a regular com 39 (40,95%) membros e cem (95,2%) idosos fazem uso de medicamento contínuo. Uma parcela de 78 (74,28%) conhecia o nome do medicamento e 83 (79,04%) sua indicação. Quanto à posologia, 83 (80,95%) sabiam como tomar a medicação e 41 (39,05%) não sabiam como proceder em caso de esquecimento, 51 (53,54%) não conheciam os efeitos colaterais e 30 (28,58%) necessitavam de maiores informações sobre o tratamento. Conclusões: Conclui-se que existe uma lacuna entre o conhecimento do paciente idoso e o conhecimento a respeito dos seus medicamentos/tratamento, necessitando-se de maior atenção aos aspectos farmacológicos do tratamento e ao fornecimento de informação de forma clara, didática e objetiva.

Introduction: Aging is accompanied by changes that contribute to aged people needing increased pharmacotherapy. Objective: It was aimed to identify the difficulty of understanding by aged patients regarding the prescription of medicines in Primary Care in the city of Fortaleza (CE). Methods: This is a descriptive and cross-sectional study with a quantitative approach, carried out in a Primary Health Care Unit (UAPS) in the city of Fortaleza-CE. A structured questionnaire was applied to 105 aged people. The interviews took place between the months of September to October 2019. Results: The results showed that the female gender was prevalent in 88 (83%) participants, the self-perception of the predominant health was regular with 39 (40.95%) members and 100 (95.2%) aged individuals use continuous medication. A portion of 78 (74.28%) participants knew the name of the drug and 83 (79.04%) knew its indication. As for the dosage, 83 (80.95%) knew how to take the medication and 41 (39.05%) did not know how to proceed in case of forgetting to take it, 51 (53.54%) were unaware of the side effects, and 30 (28.58%) needed more information about the treatment. Conclusion: It is concluded that there is a gap between the knowledge of aged patients and the knowledge regarding their medicines/treatment, requiring greater attention to the pharmacological aspects of the treatment and information in a clear, didactic, and objective way.

Introducción: El envejecimiento se acompaña de cambios que contribuyen a que los ancianos necesitan una mayor farmacoterapia. Objetivo: Estaba destinado identificar la dificultad de comprensión del anciano en cuanto a la prescripción de medicamentos en Atención Primaria en la ciudad de Fortaleza (CE). Métodos: Esto es de un estudio descriptivo y transversal con enfoque cuantitativo, realizado en Unidad de Atención Primaria de Salud (UAPS) en la ciudad de Fortaleza-CE. Se aplicó un cuestionario estructurado a 105 adultos mayores. Las entrevistas se realizaron entre los meses de septiembre a octubre de 2019. Resultados: Los resultados arrojaron que el sexo femenino fue predominante en 88 (83%) participantes, la autopercepción de la salud predominante fue regular con 39 (40,95%) afiliados y 100 (95,2%) ancianos utilizan medicación continua. Una parte de 78 (74,28%) conocía el nombre del fármaco y 83 (79,04%) su indicación. En cuanto a la dosificación, 83 (80,95%) sabía tomar el medicamento y 41 (39,05%) no sabían cómo proceder en caso de olvido, 51 (53,54%) desconocían los efectos secundarios y 30 (28,58%) necesitaba más información sobre el tratamiento. Conclusión: Se concluye que existe un desfase entre el conocimiento del anciano y el conocimiento al respecto de sus medicamentos/tratamiento, requiriendo mayor atención a los aspectos farmacológicos del tratamiento e información de forma clara, didáctica y objetiva.

Uso práctico de inhibidores de bomba de protones / Practical use of proton pump inhibitors / Uso prático de inibidores da bomba de prótons

Los inhibidores de la bomba de protones (IBP) se encuentran entre los medicamentos más utilizados en el mundo por su bajo costo, extensa prescripción y efectividad. Sin embargo, su uso a largo plazo no es inocuo y aún hay vacíos en el conocimiento del empleo adecuado de estos medicamentos. Por lo tanto, en esta revisión se expone, además de sus propiedades generales, sus verdaderas indicaciones, el uso recomendado a largo plazo y las estrategias para lograr la deprescripción, con el fin de evitar el uso indiscriminado.

Proton pump inhibitors (PPIs) are among the most widely used drugs in the world, due to their low cost, extensive prescription and effectiveness. However, its long-term use is not safe and there are still certain gaps in the knowledge of the proper use of these drugs. Therefore, this review aims to expose their general properties as well as their true indications, the appropriate long-term use and strategies to achieve adequate deprescription of these drugs, seeking to avoid indiscriminate use.

Os inibidores da bomba de prótons (IBP) se encontram entre os medicamentos mais utilizados no mundo pelo seu baixo custo, extensa prescrição e efetividade. Embora, seu uso a longo prazo não é inócuo e ainda há vazios no conhecimento do uso adequado destes medicamentos. Por tanto, nesta revisão se expõe, além das suas propriedades gerais, suas verdadeiras indicações, o uso recomendado ao longo prazo e as estratégias para conseguir a deprescrição, com o fim de evitar o uso indiscriminado.

Prescription of DPP4 inhibitors: Indication and effect on glycosylated hemoglobin in a primary care institution of Colombia / Prescripción de inhibidores de la DPP-4: indicación y efecto sobre la hemoglobina glicosilada en un primer nivel de Colombia

Abstract Introduction and objective: In Colombia, Dipeptidyl-Peptidase IV (DPP4) inhibitors are recommended as second-best choice for type 2 diabetes mellitus treatment. However, no evaluation of the accomplishment or impact of this recommendation was performed. The objective was to determine the prescription of the DPP4 inhibitor according to the Colombian Clinicial Practice Guide regarding type 2 diabetes mellitus treatment, and its effects on glycosylated hemoglobin (HbAlc). Materials and methods: A descriptive study that included patients with type 2 diabetes mellitus who attended a first level between 2016 and 2018, had a prescription for DPP4 inhibitor and at least two control appointments. Variables included were sociodemographic, clinics, treatment and comorbidities. The unadjusted prescription was defined as the lack of accomplishment of Colombian guidelines. Descriptive statistics and X2 test were used for the comparison of categorical variables. A binary logistic regression model was applied. Results: 112 out of 207 patients accomplished inclusion criteria, of which 77 were women (68.8%). Also, 68.8% of the patients had an unadjusted prescription of the iDPP4. There was a 0.21% total reduction in HbA1c levels, with a mean of 198.2 ± 124 days between the first and second control measurement (reduction of 0.55% when the prescription was adjusted to the guidelines and 0.05% if it was unadjusted). Conclusion: There is a limited impact of DPP4 inhibitors regarding the reduction of HbA1c and metabolic control, and there is a slight follow-up to the Colombian guidelines in patients who attend a first level.

Resumen Introducción y Objetivo: En Colombia se recomiendan los inhibidores de la Dipeptidil Peptidasa-IV (iDPP4) como segunda opción para el manejo de la diabetes mellitus tipo 2. No se ha evaluado el cumplimiento e impacto de esta recomendación. Como objetivo se buscó determinar la prescripción de los iDPP4 según las recomendaciones de la Guía de Práctica Clínica colombiana, y su efecto sobre la hemoglobina glicosilada (HbA1c). Materiales y métodos: Estudio descriptivo que incluyó pacientes con diabetes mellitus tipo 2 que consultaron a un primer nivel entre 2016 y 2018, y tenían formulado un iDPP4, con al menos dos consultas de seguimiento. Se incluyeron variables sociodemográficas, clínicas, tratamiento y comorbilidades. La prescripción no ajustada se definió como la falta de cumplimento de la recomendación de la guía colombiana. Se empleó estadística descriptiva y pruebas X2 para la comparación de variables categóricas. Se aplicó un modelo de regresión logística binaria. Resultados: Hubo 207 pacientes de los cuales 112 cumplieron criterios de inclusión, 77 eran mujeres (68,8%). El 68,8% de los pacientes presentaron una prescripción no ajustada del iDPP4. Hubo una reducción total de 0,21%, con una media de 198,2±124 días entre la primera y segunda medición de HbA1c de control (reducción de 0,55% cuando la prescripción se ajustaba a la guía colombiana y 0,05% cuando no). Conclusión: Hay un limitado impacto de los iDPP4 frente a la reducción de HbA1c y poco seguimiento de la guía colombiana en pacientes de primer nivel de atención.