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1.
In. Soeiro, Alexandre de Matos; Leal, Tatiana de Carvalho Andreucci Torres; Accorsi, Tarso Augusto Duenhas; Gualandro, Danielle Menosi; Oliveira Junior, Múcio Tavares de; Caramelli, Bruno; Kalil Filho, Roberto. Manual da residência em cardiologia / Manual residence in cardiology. Santana de Parnaíba, Manole, 2 ed; 2022. p.830-834, tab.
Monography in Portuguese | LILACS | ID: biblio-1353529
2.
Rev. colomb. anestesiol ; 49(4): e300, Oct.-Dec. 2021. tab, graf
Article in English | LILACS, COLNAL | ID: biblio-1341239

ABSTRACT

Abstract Introduction A broad range of practices aimed at improving the effectives and safety of this process have been documented over the past few years. Objective To establish the effectiveness, safety and results of the implementation of these strategies in adult patients in university hospitals. Methodology A review of systematic reviews was conducted, in addition to a database search in the Cochrane Library of Systematic Reviews, Embase, Epistemonikos, LILACS and gray literature. Any strategy aimed at reducing prescription-associated risks was included as intervention. This review followed the protocol registered in the International Prospective Registry of Systematic Reviews (PROSPERO): CRD42020165143. Results 7,637 studies were identified, upon deleting duplicate references. After excluding records based on titles and abstracts, 111 full texts were assessed for eligibility. Fifteen studies were included in the review. Several interventions grouped into 5 strategies addressed to the prescription process were identified; the use of computerized medical order entry systems (CPOE), whether integrated or not with computerized decision support systems (CDSS), was the most effective approach. Conclusions The beneficial effects of the interventions intended to the prescription process in terms of efficacy were identified; however, safety and implementation results were not thoroughly assessed. The heterogeneity of the studies and the low quality of the reviews, preclude a meta-analysis.


Resumen Introducción En los últimos años se han documentado gran variedad de prácticas dirigidas a mejorar la efectividad y la seguridad de este proceso. Objetivo Establecer la efectividad, seguridad y resultados de implementación de estas estrategias en pacientes adultos en hospitales universitarios. Metodología Se realizó una revisión de revisiones sistemáticas. Igualmente, la búsqueda en las bases de datos de la Biblioteca Cochrane de Revisiones Sistemáticas, Medline, Embase, Epistemonikos, LILACS y literatura gris. Se incluyó como intervención cualquier estrategia dirigida a reducir el riesgo asociado a un error de prescripción. Esta revisión siguió el protocolo registrado en el Registro Prospectivo Internacional de Revisiones Sistemáticas (PROSPERO): CRD42020165143. Resultados Se identificaron 7.637 estudios después de eliminar las referencias duplicadas. Después de la exclusión de registros basados en títulos y resúmenes, se evaluaron 111 textos completos para elegibilidad. Se incluyeron quince estudios en la revisión. Se identificaron varias intervenciones agrupadas en 5 estrategias dirigidas al proceso de prescripción, de las cuales el uso de sistemas computarizados de entrada de órdenes médicas (CPOE) integrados o no a sistemas de soporte de decisión computarizados (CDSS) la estrategia más eficaz. Conclusiones Se identificaron efectos benéficos de las intervenciones dirigidas al proceso de prescripción en términos de eficacia; sin embargo, la seguridad y los resultados de implementación no fueron ampliamente evaluados. La heterogeneidad de los estudios y la baja calidad de las revisiones impiden la realización de un metaanálisis.


Subject(s)
Humans , Adult , Middle Aged , Aged , Drug Prescriptions , Preventive Health Services , Hospitals, University , Medication Errors , Outcome Assessment, Health Care , Medical Errors , Electronic Prescribing , Inappropriate Prescribing
5.
Arq. ciências saúde UNIPAR ; 25(3)set-out. 2021.
Article in Portuguese | LILACS | ID: biblio-1348200

ABSTRACT

Objetivo: Avaliar a prevalência dos fatores de risco e medidas de prevenção para trombose venosa profunda de pacientes cirúrgicos em Unidade de Terapia Intensiva. Métodos: Estudo transversal, conduzido em 2019, com utilização da escala de Caprini para classificação de cada paciente quanto ao risco para trombose venosa profunda, e análise das intervenções adotadas. Resultados: Foram avaliados 68 pacientes. Os fatores de risco mais prevalentes foram procedimento cirúrgico de grande porte (96%) e restrição ao leito (90%). O risco para tromboembolismo venoso foi alto (62/91%), moderado (5/7%) e baixo (1/2%). A mobilização de membros foi aplicada a todos os pacientes, deambulação precoce foi realizada em 62% e 56% foram submetidos à profilaxia medicamentosa. Conclusão: A alta prevalência dos fatores de risco para trombose venosa profunda em pacientes cirúrgicos e a baixa aplicabilidade de medidas preventivas demonstram a importância da implementação de programas de educação continuada e medidas de monitoramento desses eventos.


Objective: To assess the prevalence of the risk factors and preventive measures for deep venous thrombosis in surgical patients in the Intensive Care Unit. Methods: Cross-sectional study held in 2019 using the Caprini scale to classify each patient regarding their risk for deep venous thrombosis, and analysis of the actions taken. Results: A total of 68 patients were evaluated. The most prevalent risk factors were being submitted to major surgical procedures (96%) and bed restriction (90%). The risk for venous thromboembolism was high (62/91%), moderate (5/7%), and low (1/2%). Limb mobilization was applied on all patients; early ambulation was performed in 62%; and 56% were submitted to drug prophylaxis. Conclusion: The high prevalence of risk factors for deep vein thrombosis in surgical patients and the low applicability of preventive measures show the importance of implementing continuing education programs and measures to monitor such events.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Young Adult , Patients , General Surgery , Risk Factors , Venous Thrombosis/nursing , Intensive Care Units , Drug Prescriptions/nursing , Early Ambulation/nursing , Disease Prevention , Venous Thromboembolism/nursing , Ambulatory Care , Hospitalization , Nurses , Nursing Care
6.
Medisan ; 25(4): 868-881, 2021. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1340210

ABSTRACT

Introducción: El tema de la tensión arterial en niños y adolescentes ha cobrado un marcado interés en los últimos años, debido al incremento de su prevalencia en este grupo poblacional Objetivo: Evaluar la prescripción de medicamentos en niños y adolescentes con hipertensión arterial atendidos en el Hospital Infantil Norte Dr. Juan de la Cruz Martínez Maceira de Santiago de Cuba. Métodos: Se realizó una investigación observacional, descriptiva y transversal, que se corresponde con un estudio de utilización de medicamentos, del tipo indicación-prescripción, esquemas terapéuticos y consecuencias prácticas, de 39 pacientes con diagnóstico de hipertensión arterial atendidos en el Servicio de Cardiología del mencionado centro hospitalario, desde enero hasta diciembre de 2018, quienes cumplieron los criterios de selección establecidos. Se utilizaron variables principales (prescripción y reacciones adversas) y de control (edad, color de la piel, sexo y factores de riesgo). Resultados: Predominaron el sexo masculino (79,4 %), el grupo etario de 15-18 años (66,6 %), la hipertensión arterial primaria (estadio 1), los pacientes de piel negra y la obesidad como factor de riesgo mayormente identificado (58,9 %). Conclusiones: Las prescripciones fueron evaluadas en su mayoría como adecuadas, lo que demuestra el enfoque preventivo y el uso racional de los medicamentos.


Introduction: The topic of blood pressure in children and adolescents has taken a marked interest in the last years, due to the increment of its prevalence in this population group Objective: To evaluate the prescription of medications in children and adolescents with hypertension assisted in Dr. Juan de la Cruz Martínez Maceira Northern Children Hospital in Santiago de Cuba. Methods: An observational, descriptive and cross-sectional investigation that squared with a medications use study, of indication-prescription type, therapeutic outlines and practical consequences, of 39 patients with diagnosis of hypertension assisted in the Cardiology Service of the hospital abovementioned, was carried out from January to December, 2018, who fulfilled the established selection approaches. Main variables (prescription and adverse reactions) and control variables (age, skin colour, sex and risk factors) were used. Results: There was a prevalence of the male sex (79.4 %), 15-18 age group (66.6% ), primary hypertension (stage 1), black skin patients and obesity as the risk factor mostly identified (58.9 %). Conclusions: The prescriptions were evaluated in their majority as appropriate, what demonstrates the preventive approach and the rational use of medications.


Subject(s)
Drug Prescriptions , Adolescent , Hypertension/therapy , Child , Cardiology Service, Hospital
7.
Mali méd. (En ligne) ; 36(2): 1-7, 20210812.
Article in French | AIM, AIM | ID: biblio-1283654

ABSTRACT

La COVID-19 est une infection virale qui s'est propagé dans tout le monde. Pour la prise en charge des cas, le Mali a créé des sites de traitement dont celui du CHU Gabriel Touré. Objectif : C'était d'analyser les prescriptions médicamenteuses pour le traitement de la COVID-19 au CHU Gabriel Touré. Méthodologie : L'étude était rétrospective et descriptive et a concerné la période d'avril à septembre 2020. Elle s'est déroulée au Centre de Traitement COVID-19 du CHU Gabriel Touré et à la Pharmacie Hospitalière de cet hôpital. Les ordonnances et les registres d'hospitalisation ont servi à collecter les données. Résultats : Au total, 29 patients ont été hospitalisés. L'âge médian était de 44ans, 75,90% des patients présentaient au moins une pathologie associée à la COVID-19. Le nombre d'ordonnances était de 333 comportant 870 lignes de prescriptions dont 33,21% de traitements standards et 66,79% pour les pathologies associées avec 86,23% disponibles à la Pharmacie Hospitalière. Le phosphate de chloroquine, dosé à 250mg, était administré à 500mg deux fois quotidiennement. Dans les directives nationales le phosphate de chloroquine était à 100mg pour 200mg trois fois quotidienne. La vitamine C non prévue dans les directives a été prescrite à tous les patients. La classe des médicaments du sang et des organes hématopoïétiques a été les plus prescrits (31,49%). Le coût moyen des traitements était de 65602±106858 FCFA avec maximum de 567860 FCFA. Une évaluation des prescriptions dans les autres sites de traitement est nécessaire.


COVID-19 was declared a pandemic in March 2020. For case management, Mali has created several treatment sites including the site of the CHU Gabriel Touré. Aims: The objective of the study was to analyse drug prescriptions for the COVID-19 treatment at the CHU Gabriel Touré. Methods: We performed a retrospective and descriptive study from April to September 2020. Drug prescriptions and hospital records were used to collect data. Prescriptions and hospital records were used to collect data. Results: A total of 29 patients were hospitalized. The median age was 44 years, 75.90% of patients had at least one pathology associated with COVID-19. The number of prescriptions was 333 comprising 870 lines of prescriptions including 33.21% for standard treatments, and 66.79% for associated pathologies. with 86.23% available at the Hospital Pharmacy. Chloroquine, dosed at 250mg, was administered at 500mg twice a day. The national guidelines from the treatment of COVID19 recommends 200mg of chloroquine in two doses. Vitamin C was prescribed for all patients although not included in the national guidelines. The class of drugs for the blood and blood-forming organs was the most prescribed (31.49%). The average cost of treatments was 65,602 ± 106,858 FCFA with a maximum of 567,860 FCFA. An evaluation of prescriptions in other treatment sites is necessary.


Subject(s)
Drug Prescriptions , COVID-19 , Guideline , Cost of Illness
8.
Medicina (B.Aires) ; 81(2): 224-228, June 2021. graf
Article in Spanish | LILACS | ID: biblio-1287274

ABSTRACT

Resumen Los errores de prescripción representan un relevante problema en salud. Este trabajo se propone analizar el error de prescripción de medicación en pacientes hospitalizados antes y después de una intervención múltiple. Se trata de un estudio cuasi experimental de tipo antes-después no controlado. La intervención consistió en la estandarización del proceso de prescripción y el entrenamiento del personal que prescribe. El porcentaje de error de prescripción antes de la intervención fue del 28.8% (n = 182), es decir 28.8 prescripciones incorrectas cada 100 prescripciones médicas. El dominio más frecuente de error fue: dosis in adecuada 52.2% (n = 95), medicamento incorrecto 33% (n = 60), días de tratamiento inapropiado 4.4%(n = 8) y otros 10.4% (n = 19). Luego de la intervención el error descendió a 4.3% (n = 26): 4.3 prescripciones con error cada 100 efectuadas, siendo el error más frecuente la dosis incorrecta: 76.9% (n = 20), otros 23.1% (n = 6). El daño asociado a medicación inadecuadamente prescripta antes y después fue de 0.95 (n = 6) eventos y 0.33 (n = 2) eventos cada 100 admisiones, respectivamente. La intervención de mejora resultó útil para la reducción del error de prescripción en esta institución y muestra de pacientes.


Abstract Prescription errors represent a relevant health problem. This work aims to analyze the medication prescription error in hospitalized patients before and after a multiple intervention. This is a quasi-experimental study of the uncontrolled before-after type. The intervention consisted of the standardization of the prescription process and the training of the prescribing staff. The percentage of prescription error before the intervention was 28.8% (n = 182), that is, 28.8 incorrect prescriptions per 100 medical prescriptions. The most frequent domain of error was: inappropriate dose 52.2% (n = 95), followed by incorrect medication 33% (n = 60), by days of inappropriate treatment 4.4% (n = 8) and others 10.4% (n = 19 ). After the intervention, the error decreased to 4.3% (n = 26), that is, 4.3 pre scriptions with error every 100 prescriptions, the most frequent error being the incorrect dose: 76.9% (n = 20), another 23.1% (n = 6 ). The harm associated with inadequately prescribed medication before and after was 0.95 (n = 6) events and 0.33 (n = 2) events per 100 admissions respectively. The improvement intervention was useful for reducing the prescription error in this institution and patient sample.


Subject(s)
Humans , Drug Prescriptions , Medication Errors/prevention & control
9.
Int. j. med. surg. sci. (Print) ; 8(2): 1-14, jun. 2021. tab
Article in Spanish | LILACS | ID: biblio-1284430

ABSTRACT

En el nivel primario de atención se detectan errores en la prescripción del tratamiento farmacológico de la diabetes tipo 2. El objetivo de este estudio fue evaluar la calidad de la prescripción de hipoglucemiantes orales en pacientes atendidos en consultorios del médico de la familia del Policlínico Universitario Hermanos Cruz, municipio Pinar del Río, Cuba. Se realizó un estudio de utilización de medicamentos de tipo descriptivo y transversal clasificado dentro de estos como de indicación-prescripción con elementos de esquema terapéutico y de factores que condicionan los hábitos de prescripción. El universo estuvo conformado por 1575 pacientes con diagnóstico de diabetes mellitus tipo 2 tratados con hipoglucemiantes orales que pertenecían a los 20 consultorios médicos de la familia.La muestra de estudio se obtuvo por el método de muestreo no probabilístico (por conveniencia) (n=846). La información se obtuvo de la historia clínica y tarjeta control de los pacientes para adquirir estos medicamentos. Predominó la edad de 40-49 años, el sexo femenino y entre 5-10 años de evolución de la enfermedad. No se usó la primera línea de tratamiento en el 43,6 % de los casos, ningún caso tenía estudios de laboratorio para el uso de la Metformina. La prescripción y dosis fue adecuada no así su uso racional. Las interacciones más frecuentes fueron las farmacocinéticas.El uso racional de hipoglucemiantes orales fue deficiente lo que hace necesario ampliar la divulgación de un protocolo de tratamiento para mejorar el uso de estos fármacos en el nivel primario de atención.


Errors in the prescription of drug treatment for type 2 diabetes are detected at the primary level of care. the purpose of this study was to evaluate the quality of the prescription of oral hypoglycemic agents in patients attended in the family doctor's offices of the Hermanos Cruz University Polyclinic, Pinar del Río distrit, Cuba. A descriptive and cross-sectional study of the use of medications was carried out, classified within these as indication-prescription with elements of the therapeutic scheme and factors that condition prescription habits. The universe was made up of 1575 patients diagnosed with type 2 diabetes mellitus treated with oral hypoglycemic agents who belonged to the 20 family medical offices. The study sample was carried out by the non-probabilistic sampling method (for convenience) (n = 846). The information was obtained from the clinical history and control card of the patients to acquire these medications. The age of 40-49 years, the female sex and between 5-10 years of evolution of the disease predominated. The first line of treatment was not used in 43.6% of the cases; no case had laboratory studies for the use of Metformin. The prescription and dose was adequate, but not its rational use. The most frequent interactions were pharmacokinetic ones.The rational use of oral hypoglycemic agents was deficient, which makes it necessary to expand the dissemination of a treatment protocol to improve the use of these drugs at the primary level of care.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Drug Prescriptions , Primary Health Care , Diabetes Mellitus, Type 2/drug therapy , Hypoglycemic Agents/administration & dosage , Outcome and Process Assessment, Health Care , Socioeconomic Factors , Sex Factors , Cross-Sectional Studies , Administration, Oral , Age Factors , Cuba , Drug Interactions , Drug Utilization
10.
Rev. APS ; 22(3): 616-632, 20210601.
Article in Portuguese | LILACS | ID: biblio-1354145

ABSTRACT

O objetivo do presente estudo foi determinar o perfil dos medicamentos prescritos para pacientes idosos em atenção primária, buscando a ocorrência de medicamentos potencialmente inapropriados (MPI), segundo critérios de Beers e fatores associados. O método consistiu em estudo observacional retrospectivo no período de setembro a outubro de 2015, cujos critérios de inclusão foram prescrições de medicamentos de uso contínuo para pacientes com idade igual ou superior a 60 anos. Foram analisadas prescrições de 820 pacientes. A presença de MPI ocorreu em 35,4% das prescrições. Estas apresentaram maior ocorrência para o gênero feminino OR: 1,33 (0,97 - 1,80), pacientes com idade igual ou superior a 80 anos OR: 2,36 (1,62 - 3,43) e uso concomitante de 5 ou mais medicamentos OR: 4,74 (3,47 - 6,45). A glibenclamida foi o MPI mais prescrito para os idosos (36,6%), seguido do clonazepam (22,7%) e do ácido acetilsalicílico (10,2%). Assim, faz-se necessária a revisão periódica das listas de medicamentos padronizados, nessas unidades assistenciais, considerando o consenso brasileiro de medicamentos potencialmente inapropriados para os idosos, bem como investigações sistemáticas, a fim de detectar precocemente e evitar a ocorrência de prescrição de MPI nos grupos de maior vulnerabilidade para que se possa melhorar a qualidade da assistência ofertada.


The objective of the present study was to determine the profile of medications prescribed for elderly patients in primary care, seeking the occurrence of Potentially Inappropriate Medications (MPI), according to Beers' criteria and associated factors. The method consisted of a retrospective observational study from September to October in 2015 whose inclusion criteria were prescriptions of continuous medication for patients aged 60 years or older. The prescriptions of 820 patients were analyzed. The presence of MPI occurred in 35.4% of the prescriptions. These had the highest occurrence for the female gender OR: 1.33 (0.97 -1.80), patients aged 80 years and over OR: 2.36 (1.62 - 3.43) and concomitant use of 5 or more drugs OR: 4.74 (3.47-6.45). Glibenclamide was the most prescribed MPI for the elderly (36.6%), followed by clonazepam (22.7%) and acetylsalicylic acid (10.2%) of the prescriptions. Thus, it is necessary to periodically review the lists of standardized drugs in these assistential units, considering the Brazilian consensus on the list of inappropriate drugs for the elderly. As well as systematic investigations, in order to detect early and to prevent the occurrence of MPI prescription in the groups of greater vulnerability so that the quality of the offered assistance can be improved.


Subject(s)
Drug Prescriptions , Primary Health Care , Pharmaceutical Preparations , Potentially Inappropriate Medication List
11.
Int. j. med. surg. sci. (Print) ; 8(1): 1-12, mar. 2021. tab
Article in Spanish | LILACS | ID: biblio-1151620

ABSTRACT

El objetivo de este estudio fue caracterizar la prescripción de los medicamentos ansiolíticos utilizados en población de adultos mayores institucionalizados en el hogar de ancianos de Pinar del Río durante el año 2017.Se realizó un estudio descriptivo transversal, con recogida de datos retrospectiva, sobre prescripción de medicamentos ansiolíticos en la población de adultos mayores institucionalizados en el hogar de ancianos, se analizó la forma de utilización de los medicamentos, su indicación y prescripción con elementos de esquema terapéutico y factores que condicionan los hábitos de prescripción. Se trabajó con el universo (U= 98) de estudio el cual estuvo conformado por el total de pacientes institucionalizados, que estaban consumiendo ansiolíticos. Se revisaron las historias clínicas individuales y se confeccionó un modelo de recolección de datos.El medicamento más consumido por los adultos mayores fue el nitrazepam (41,8 %), siendo este a su vez el más consumido por el sexo masculino, no así para el femenino que resultó ser el clorodiazepóxido (64,6 %), el grupo de edad que más predominó fue el de 60-69 años, asimismo los viudos y el nivel educacional primario, el 79,5 % de los ancianos consume otros medicamentos que poseen interacción farmacocinética. El profesional que más indicó fue el médico de familia, la prescripción e intervalos entre dosis fue adecuada, la prescripción se consideró no racional.La prescripción de ansiolíticos en la población objeto de estudio, disminuye a medida que aumenta la edad, los más consumidores son los del sexo masculino y los institucionalizados por abandono familiar, esto apunta a la necesidad de continuar trabajando desde el nivel primario de atención dado que es de donde proceden estos ancianos.


The objective of this study was to characterize the prescription of anxiolytic medications used in the institutionalized elderly population at the Pinar del Río Nursing Home during 2017.A cross-sectional descriptive study was carried out, with retrospective data collection, on the prescription of anxiolytic medications in the population of institutionalized older adults in the Nursing Home, the form of use of the medications, their indication and prescription with elements of the therapeutic scheme was analyzed and factors that condition prescription habits. We worked with the universe (U = 98) of the study, which was made up of the total number of institutionalized patients who were consuming anxiolytics. Individual medical records were reviewed and a data collection model was created.The drug most consumed by older adults was nitrazepam (41.8%), this in turn being the most consumed by males, not so for females, which turned out to be chlorodiazepoxide (64.6%), the group The most prevalent age group was 60-69 years, likewise widowers and primary educational level, 79.5% of the elderly consume other drugs that have pharmacokinetic interaction. The professional who indicated the most was the family doctor, the prescription and intervals between doses were adequate, the prescription was considered non-rational.The prescription of anxiolytics in the population under study decreases as age increases, the most consumers are those of the male sex and those institutionalized due to family abandonment, this points to the need to continue working from the primary level of care since that is where these elders come from.


Subject(s)
Aged , Aged, 80 and over , Drug Prescriptions , Anti-Anxiety Agents/therapeutic use , Chlordiazepoxide/therapeutic use , Homes for the Aged , Nitrazepam/therapeutic use , Nursing Homes , Epidemiology, Descriptive , Cross-Sectional Studies , Retrospective Studies , Sex Distribution , Age Distribution
12.
Braz. dent. j ; 32(1): 3-8, Jan.-Feb. 2021. tab, graf
Article in English | LILACS, BBO | ID: biblio-1180729

ABSTRACT

Abstract Saliva is widely used for clinical and laboratory analysis. This study proposed to use DNA extracted from saliva for genotyping and pharmacokinetics of piroxicam. A fast and efficient genotyping method was used to determine relevant allelic variants of CYP2C9 (*2 and *3), since genetic factors can influence in non-steroidal anti-inflammatory drugs (NSAIDs) metabolization. DNA Extract All Reagents Kit® was used for DNA extraction and genotyping was performed using TaqMan® GTXpress™ Master Mix, SNP genotyping assays and a Viia7 Real-Time PCR system. Volunteers performed sequential collections of saliva samples before and after taking a single dose of piroxicam (0.25 to 72 h) which were used for pharmacokinetics assays. Piroxicam concentrations were analyzed using LC-MS/MS. Sixty-six percent of volunteers were ancestral homozygous (CYP2C9*1/*1), and 34% showed one or both polymorphisms. Of these 34%, 22 individuals showed CYP2C9*2 polymorphism, 8 CYP2C9*3, and 4 CYP2C9*2/*3. Piroxicam pharmacokinetics were performed in 5 subjects. Areas under the curve (AUC0-t(h*ng/mL)) for CYP2C9*1/*1, *1/*2 and *1/*3 were, respectively, 194.33±70.93, 166 and 303. Maximum concentrations (Cmax(ng/mL)) for these genotypes were respectively 6.46±2.56, 4.3 and 10.2. Saliva sampling was a very effective matrix for both pharmacogenetic and pharmacokinetic tests, ensuring the speed of the procedure and the well-being and agreement of the participants. Once having the knowledge about the slow and fast metabolizers, it is possible to make an adequate prescription in order to avoid the adverse effects of the medication and to guarantee greater analgesic comfort to the patients respectively.


Resumo Saliva é amplamente utilizada para análises clínicas e laboratoriais. Este estudo propôs o uso de DNA extraído da saliva para genotipagem e farmacocinética do piroxicam. Um método de genotipagem rápido e eficiente foi usado para determinar as variantes alélicas clinicamente relevantes de CYP2C9 (* 2 e * 3), uma vez que fatores genéticos podem influenciar nas respostas metabólicas individuais a medicamentos como anti-inflamatórios não esteroides (AINEs). DNA Extract All Reagents Kit® foi usado para extração de DNA e a genotipagem foi realizada usando TaqMan® GTXpress ™ Master Mix, ensaios de genotipagem SNP e um sistema Viia7 Real-Time PCR. Os voluntários realizaram coletas sequenciais de amostras de saliva antes e após a ingestão de uma única dose de piroxicam (0,25 a 72 h) que foram utilizadas para ensaios farmacocinéticos. As concentrações de piroxicam foram analisadas usando LC - MS / MS. Sessenta e seis por cento dos voluntários eram homozigotos ancestrais (CYP2C9 * 1 / * 1) e 34% apresentaram um ou ambos os polimorfismos. Destes 34%, 22 indivíduos apresentaram polimorfismo CYP2C9 * 2, 8 CYP2C9 * 3 e 4 CYP2C9 * 2 / * 3. A farmacocinética do piroxicam foi realizada em 5 indivíduos. As áreas sob a curva (AUC0-t (h * ng / mL)) para CYP2C9 * 1 / * 1, * 1 / * 2 e * 1 / * 3 foram, respectivamente, 194,33±70,93, 166 e 303. Concentrações máximas (Cmax (ng / mL)) para esses genótipos foram, respectivamente, 6,46±2,56, 4,3 e 10,2. A amostra de saliva foi uma matriz muito eficaz tanto para os testes farmacogenéticos quanto para os farmacocinéticos, garantindo a agilidade do procedimento e o bem-estar e concordância dos participantes. Com o conhecimento dos metabolizadores lentos e rápidos, é possível fazer uma prescrição adequada para evitar os efeitos adversos da medicação e garantir maior conforto analgésico aos pacientes respectivamente.


Subject(s)
Humans , Pharmacogenetics , Saliva , Drug Prescriptions , Chromatography, Liquid , Tandem Mass Spectrometry , Cytochrome P-450 CYP2C9/genetics
13.
REME rev. min. enferm ; 25: e1379, 2021. tab, graf
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1340535

ABSTRACT

RESUMO Objetivos: analisar as prescrições e o aprazamento de medicamentos endovenosos a crianças e adolescentes hospitalizados, de acordo com as recomendações do Protocolo de Segurança na Prescrição, Uso e Administração de Medicamentos. Métodos: estudo descritivo, documental, com análise de 352 prescrições de medicamentos endovenosos, em unidades de internação pediátrica. A faixa etária das crianças era de 29 dias até 16 anos de idade completos. Coleta dos dados ocorreu de agosto a novembro de 2017. Utilizou-se instrumento do tipo checklist. A análise foi realizada por meio da estatística descritiva, obedecendo aos preceitos éticos. Resultados: constatou-se que o desempenho foi satisfatório em relação às prescrições e estavam de acordo com o recomendado pelo Ministério da Saúde do Brasil. Os itens essenciais nas prescrições medicamentosas apresentaram as seguintes incidências: data (98%), nome genérico (95,2%), concentração (98,6%), dose (99,7%), via de administração (95,7%), posologia (98,9%), orientações (87,5%), assinatura do médico (99,1%), carimbo médico (97,7%), assinatura do enfermeiro (93,2%) e carimbo do enfermeiro (84,7%). Nas 352 prescrições, analisaram-se 1.069 medicamentos, dos quais 1.059 (99,06%) apresentaram dados satisfatórios quanto à checagem dos medicamentos endovenosos. Conclusões: a maioria dos itens da prescrição foi satisfatória, contudo, alguns itens foram considerados insatisfatórios, tendo ações não realizadas corretamente.


RESUMEN Objetivos: analizar la prescripción y programación de medicamentos endovenosos para niños y adolescentes hospitalizados, de acuerdo con las recomendaciones del Protocolo de Seguridad en la Prescripción, Uso y Administración de Medicamentos. Métodos: estudio descriptivo, documental, con análisis de 352 prescripciones de medicamentos endovenosos en unidades de hospitalización pediátrica. El rango de edad de los niños fue de 29 días a 16 años. La recolección de datos se llevó a cabo de agosto a noviembre de 2017. Se utilizó un instrumento tipo lista de verificación. El análisis se realizó mediante estadística descriptiva, cumpliendo con los preceptos éticos. Resultados: se encontró que el desempeño fue satisfactorio con relación a las prescripciones y estuvo de acuerdo con lo recomendado por el Ministerio de Salud de Brasil. Los ítems esenciales en la prescripción de medicamentos tuvieron las siguientes incidencias: fecha (98%), nombre genérico (95,2%), concentración (98,6%), dosis (99,7%), vía de administración (95,7%), posología (98,9%), directrices (87,5%), firma del médico (99,1%), sello médico (97,7%), firma de la enfermera (93,2%) y sello de la enfermera (84,7%). En las 352 prescripciones se analizaron 1.069 medicamentos, de los cuales 1.059 (99,06%) presentaron datos satisfactorios en cuanto a la verificación de medicamentos endovenosos. Conclusiones: la mayoría de los ítems de prescripción fueron satisfactorios, sin embargo, algunos ítems se consideraron insatisfactorios, con acciones no realizadas correctamente.


ABSTRACT Objectives: to analyze the prescriptions and scheduling of intravenous medications for hospitalized children and adolescents, following the recommendations of the Safety Protocol in the Prescription, Use, and Administration of Medicines. Methods: descriptive, documentary study, with analysis of 352 prescriptions for intravenous medications in pediatric inpatient units. The age range of the children was 29 days up to 16 years old. Data collection took place from August to November 2017. A checklist-type instrument was used. The analysis was performed using descriptive statistics, in compliance with ethical precepts. Results: we found that the performance was satisfactory concerning the prescriptions and followed the recommendations of the Ministry of Health of Brazil. The essential items in medication prescriptions had the following incidences: date (98%), generic name (95.2%), concentration (98.6%), dose (99.7%), route of administration (95.7% ), dosage (98.9%), guidelines (87.5%), physician's signature (99.1%), medical stamp (97.7%), nurse's signature (93.2%) and nurse's stamp (84.7%). In the 352 prescriptions, 1,069 medications were analyzed, of which 1,059 (99.06%) presented satisfactory data regarding the verification of intravenous medications. Conclusions: most of the prescription items were satisfactory; however, some items were considered unsatisfactory, with actions not performed correctly.


Subject(s)
Humans , Infant , Child, Preschool , Child , Adolescent , Drug Prescriptions , Security Measures , Patient Safety , Pediatric Nursing , Pharmacy Service, Hospital/standards , Checklist , Hospitalization
14.
Braz. J. Pharm. Sci. (Online) ; 57: e181060, 2021. tab
Article in English | LILACS | ID: biblio-1350238

ABSTRACT

The purpose of this study is to describe the frequency of potential drug prescribing omissions (PPOs) for elderly patients at the time of hospital discharge and to compare the frequency PPOs among different medical specialities. This cross-sectional study examined data from elderly patients when they were admitted for >24 h to a northeastern Brazil teaching hospital during June-December 2016. Were included in the study 227 patients, of whom 36.9% had at least one PPO. The highest number of PPOs was identified among those with at least 5 prescribed drugs. In total, 153 PPOs were identified at hospital discharge. In most cases (78.4%), patients were not evaluated by the specialist physician.The most commonly identified PPOs on discharge were: the omission of statin therapy in cases of diabetes mellitus plus one or more cardiovascular-associated factor; calcium and vitamin D supplements in patients with known osteoporosis; and angiotensin converting enzyme inhibitors in cases of chronic heart failure. The results of this study suggest that the frequency of prescribing omissions PPOs during patient discharge was high. This can be avoided by the careful evaluation by prescribers with experience in certain specialties where several prescribed omissions would be common.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Patient Discharge/standards , Patient Discharge/statistics & numerical data , Physicians , Drug Prescriptions/standards , Prescription Drug Misuse/statistics & numerical data , Potentially Inappropriate Medication List/classification , Health Services for the Aged/supply & distribution , Health Services for the Aged/ethics , Hospitals , Cross-Sectional Studies , Diabetes Mellitus/drug therapy , Patient Safety/standards , Geriatrics/classification
15.
Rev. panam. salud pública ; 45: e76, 2021. tab, graf
Article in English | LILACS | ID: biblio-1289870

ABSTRACT

ABSTRACT Objective. To describe bacterial resistance and antimicrobial consumption ratio at the subnational level in Argentina during 2018, considering beta-lactams group as a case-study. Methods. Antimicrobial consumption was expressed as defined daily doses (DDD)/1000 inhabitants. Resistance of Escherichia coli, Streptococcus pneumoniae, Pseudomonas aeruginosa, Klebsiella pneumoniae and Staphylococcus aureus to beta-lactams was recorded. Resistance/consumption ratio was estimated calculating "R" for each region of Argentina, and this data was compared with other countries. Results. The most widely consumed beta-lactams in Argentina were amoxicillin (3.64) for the penicillin sub-group, cephalexin (0.786) for first generation cephalosporins, cefuroxime (0.022) for second generation; cefixime (0.043) for third generation and cefepime (0.0001) for the fourth generation group. Comparison between beta-lactams consumption and bacterial resistance demonstrated great disparities between the six regions of the country. Conclusions. The case-study of Argentina shows that antimicrobial consumption and resistance of the most common pathogens differed among regions, reflecting different realities within the same country. Because this situation might also be occurring in other countries, this data should be taken into account to target local efforts towards better antimicrobial use, to improve antimicrobial stewardship programs and to propose more suitable sales strategies in order to prevent and control antimicrobial resistance.


RESUMEN Objetivo. Determinar la razón entre la resistencia bacteriana y el consumo de antimicrobianos a nivel subnacional en Argentina en el 2018, considerando el grupo de los betalactámicos como estudio de caso. Métodos. El consumo de antimicrobianos se expresó como una dosis diaria determinada (DDD) por 1000 habitantes. Se registró la resistencia de Escherichia coli, Streptococcus pneumoniae, Pseudomonas aeruginosa, Klebsiella pneumoniae y Staphylococcus aureus a los betalactámicos. Se determinó la razón entre la resistencia y el consumo calculando "R" para cada región de Argentina, y estos datos se compararon con los de otros países. Resultados. Los betalactámicos más consumidos en Argentina fueron la amoxicilina (3,64) para el subgrupo de la penicilina; la cefalexina (0,786) para las cefalosporinas de primera generación; la cefuroxima (0.022) para las de segunda generación; la cefixima (0.043) para las de tercera generación, y la cefepima (0.0001) para el grupo de la cuarta generación. La comparación entre el consumo de betalactámicos y la resistencia bacteriana demostró que había grandes disparidades entre las seis regiones del país. Conclusiones. El estudio de caso en Argentina indica que el consumo de antimicrobianos y la resistencia a los patógenos más comunes difería entre las regiones; esto demuestra que hay distintas realidades dentro del mismo país. Como esta situación también se puede dar en otros países, estos datos se deben tener en cuenta para definir las actividades locales destinadas a fomentar un mejor uso de los antimicrobianos, para mejorar los programas de manejo de los antimicrobianos y para proponer estrategias de venta más adecuadas con el fin de prevenir y controlar la resistencia a los antimicrobianos.


RESUMO Objetivo. Descrever a relação entre o consumo de antimicrobianos e a resistência bacteriana no nível subnacional na Argentina em 2018, considerando o grupo dos betalactâmicos no estudo de caso. Métodos. O consumo de antimicrobianos foi representado por doses diárias definidas (DDD) por 1.000 habitantes. Foi registrada a resistência de Escherichia coli, Streptococcus pneumoniae, Pseudomonas aeruginosa, Klebsiella pneumoniae e Staphylococcus aureus aos betalactâmicos. A relação entre consumo e resistência foi calculada com base no "R" para cada região do país e os dados da Argentina foram comparados aos de outros países. Resultados. Os betalactâmicos de maior consumo na Argentina foram amoxicilina (3,64) no grupo das penicilinas, cefalexina (0,786) no grupo das cefalosporinas de primeira geração, cefuroxima (0.022) no grupo das cefalosporinas de segunda geração, cefixima (0.043) no grupo das cefalosporinas de terceira geração e cefepima (0.0001) no grupo das cefalosporinas de quarta geração. Ao se comparar o consumo de betalactâmicos e a resistência bacteriana, observou-se grande disparidade entre as seis regiões do país. Conclusões. O estudo de caso revela diferenças no consumo de antimicrobianos e na resistência dos patógenos mais comuns entre as regiões da Argentina, refletindo realidades distintas dentro do mesmo país. Como esta mesma situação pode estar ocorrendo em outros países, estes achados devem servir para direcionar os esforços locais a uma melhor utilização dos antimicrobianos, aperfeiçoar os programas de gestão do uso destes medicamentos e propor estratégias de venda mais apropriadas, visando a prevenir e controlar a resistência aos antimicrobianos.


Subject(s)
Humans , Drug Prescriptions/statistics & numerical data , beta-Lactam Resistance , Gram-Negative Bacteria/drug effects , Gram-Positive Bacteria/drug effects , Anti-Bacterial Agents/administration & dosage , Argentina , Retrospective Studies
16.
Braz. oral res. (Online) ; 35: e011, 2021. tab, graf
Article in English | LILACS, BBO | ID: biblio-1142615

ABSTRACT

Abstract The objective of this study was to describe dental prescriptions of non-steroidal anti-inflammatory drugs (NSAID), opioids, and analgesics dispensed by the Brazilian National Health System (BNHS, SUS in Portuguese) of a Southeastern state from January to December 2017, and to analyze their association with socioeconomic and oral health care services' characteristics at municipal level. Data were collected from the Brazilian Integrated Pharmaceutical Care Management System. Medicines were grouped according to the Anatomical Therapeutic Chemical Classification System. The total number of Defined Daily Doses (DDD) and DDD per 1,000 inhabitants (inhab.) per year were presented and compared between groups of municipalities. Data analysis used the Classification and Regression Tree model performed with IBM SPSS 25.0. The total number of NSAID, opioids, and analgesics prescriptions was 70,747 and accounted for 354,221.13 DDD. The most frequently prescribed medicine was ibuprofen (n = 24,676; 34.88%). The number of dental practitioners in the BNHS per 1,000 inhab. (p < 0.001), first dental appointment coverage (p = 0.010), oral health teams per 1,000 inhab. (p=0.022), and the proportion of rural population (p = 0.014) were variables positively associated with the number of DDD of NSAID per 1,000 inhab. per year. Bolsa Família program coverage per 1,000 inhab. (p = 0.022) was negatively associated with NSAID prescription. Regarding analgesics, first dental appointment coverage (p=0.002) and Bolsa Família program coverage per 1,000 inhab. (p = 0.012) were positively associated with DDD per 1,000 inhab. per year. In conclusion, dental prescriptions of analgesics and NSAID in the BNHS were associated with socioeconomic and oral health care services' characteristics.


Subject(s)
Humans , Drug Prescriptions , Dentists , Brazil , Pharmaceutical Preparations , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Cities , Professional Role , Analgesics/therapeutic use , Analgesics, Opioid/therapeutic use
17.
Article in Chinese | WPRIM | ID: wpr-888128

ABSTRACT

The tumor prescriptions contained in Dictionary of Tumor Formulas, Compendium of Good Tumor Formulas, Chinese Pharmacopoeia, Ministry of Health Drug Standards for Chinese Medicine Formulas and National Compilation of Standards for Proprietary Chinese Medicines were selected and organized to construct a database for tumor prescriptions, and the data mining techniques were applied to investigate the prescription regularity of colorectal cancer prescriptions. The formula data were extracted after screening in strict accordance with the inclusion and exclusion criteria, and were then analyzed with Microsoft Excel 2010 for frequency statistics, Apriori block provided by SPSS Clementine 12.0 software for correlation rule analysis, and arules and arulesViz packages in R 4.0.2 software for correlation rule visualization. In addition, SPSS 18.0 software was used for cluster analysis and factor analysis, in which cluster analysis was performed by Ochiai algorithm with bicategorical variables in systematic clustering method and factor analysis was performed mainly with principal component analysis. A total of 285 prescriptions were included in the statistical analysis, and the frequency statistics showed that 43 herbs had been used more than 16 times. The association rules analysis showed that 26 high-frequency me-dicine pair rules were obtained, and the association rules for those dispelling evil spirits, strengthening the body, resolving stasis, dispelling dampness, etc. were visualized. In the cluster analysis, we generated a dendrogram from which 7 groups of traditional Chinese medicines with homogeneity were extracted. 10 common factors were obtained in the factor analysis. The types of herbal medicines involved in the colorectal cancer prescription included anti-cancer antidotes, strengthening and tonifying medicines, blood-regulating medicines, and expectorant medicines, corresponding to the treatment for eliminating evil spirits, strengthening, resolving stasis, and expectorating dampness. The prescriptions for anti-cancer detoxification were normally based on the pairs composed of Scutellaria barbata-Hedyotis diffusa and Sophora flavescens, Sargentodoxa cuneata, S. barbata, often combined with stasis relieving drug and dampness eliminating drug, reflecting the characteristics of treatment for both toxicity and stasis, dampness and toxicity simultaneously. The prescriptions for strengthening the righteousness and tonifying the deficiency were composed of Astragalus membranaceus and Atractylodes macrocephala mainly, exerting the effect of benefiting Qi, strengthening the spleen and drying dampness, tonifying kidney and essence, tonifying blood and invigorating blood. Meanwhile, anti-cancer detoxification medicines shall be reduced as much as possible. The compatibility of the medicines for the intestinal tract reflected the principle of using the right medicine for the right condition and eliminating evil spirits or strengthening the body, as appropriate.


Subject(s)
Colorectal Neoplasms/drug therapy , Data Mining , Drug Prescriptions , Drugs, Chinese Herbal/therapeutic use , Humans , Medicine, Chinese Traditional
18.
Rev. enferm. UERJ ; 28: e51482, jan.-dez. 2020.
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1146356

ABSTRACT

Objetivo: analisar o papel da enfermagem acerca da farmacoterapia da sífilis no âmbito da atenção primária em saúde. Método: investigação de abordagem qualitativa, com nove enfermeiros da atenção primária de município da Região Centro-Oeste do Brasil, realizada no período de agosto de 2018 a julho de 2019, por meio de entrevistas. A análise de dados apoiou-se na Teoria de Enfermagem Sócio-Humanista. Resultado: o papel da enfermagem esteve circunscrito à consulta de enfermagem, mediantes ações de acolhimento, escuta, detecção da sífilis, prescrição e administração de medicamento e práticas educativas. O aporte institucional caracterizou-se pela elaboração de protocolo sobre prescrição de medicamentos pelo enfermeiro e construção de fluxo de atenção ao usuário com sífilis. Conclusão: a enfermagem atua com autonomia na farmacoterapia da sífilis pautada em suas experiências e conhecimentos, aporte institucional, trabalho em equipe, procurando atender às necessidades de saúde do usuário.


Objective: to examine nursing's role in syphilis drug therapy in the primary health care context. Method: this qualitative study of nine primary care nurses in a municipality in Brazil's Midwest Region was conducted, by interview, from August 2018 to July 2019. Data analysis was based on the Social-Humanist Nursing Theory. Result: nursing's role was limited to nursing appointments, and took the form of welcoming reception, listening, syphilis detection, medication prescription and administration, and educational activities. The institutional contribution was characterized by preparation of a protocol on medication prescription by nurses and construction of the care flow for users with syphilis. Conclusion: nursing operates autonomously in syphilis drug therapy, seeking to meet user health needs based on its experience and knowledge, institutional support, and teamwork.


Objetivo: examinar el papel de la enfermería en la terapia con medicamentos para la sífilis en el contexto de la atención primaria de salud. Método: este estudio cualitativo de nueve enfermeras de atención primaria en un municipio de la Región Medio Oeste de Brasil se realizó, por entrevista, de agosto de 2018 a julio de 2019. El análisis de datos se basó en la Teoría de Enfermería Social-Humanista. Resultado: la función de la enfermería se limitó a las citas de enfermería y se concretó en la recepción de bienvenida, la escucha, la detección de la sífilis, la prescripción y administración de medicamentos y actividades educativas. El aporte institucional se caracterizó por la elaboración de un protocolo de prescripción de medicamentos por enfermeras y la construcción del flujo de atención a usuarios con sífilis. Conclusión: la enfermería opera de manera autónoma en la terapia con medicamentos para la sífilis, buscando satisfacer las necesidades de salud de los usuarios a partir de su experiencia y conocimiento, apoyo institucional y trabajo en equipo.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Drug Prescriptions/nursing , Primary Health Care , Syphilis/nursing , Nurse's Role , Nursing Theory , Brazil , Syphilis/drug therapy , Qualitative Research , User Embracement , Nurse-Patient Relations
19.
Geriatr., Gerontol. Aging (Impr.) ; 14(4): 294-297, 31-12-2020.
Article in English | LILACS | ID: biblio-1151617

ABSTRACT

Prescribing medications involves complex cognitive processes, and mistakes in prescription can cause serious adverse events. Deprescribing is one of the last opportunities to prevent patient harm from the use of drugs that should be avoided, especially among older patients. This viewpoint article aims to discuss the prescription process and some essential concepts, such as polypharmacy, prescription of potentially inappropriate medications, and, particularly, the relevance of deprescribing and its relationship with the appropriate prescription of medications in older people.


A prescrição de medicamentos envolve processos cognitivos complexos e erros na prescrição podem causar eventos adversos graves. A desprescrição é uma das últimas oportunidades de prevenir danos ao paciente decorrentes do uso de medicamentos que devem ser evitados, principalmente entre pacientes mais velhos. Este artigo teve como objetivo discutir o processo de prescrição e alguns conceitos essenciais, como a polifarmácia, a prescrição de medicamentos potencialmente inadequados e, particularmente, a relevância da desprescrição e sua relação com a prescrição adequada de medicamentos em idosos.


Subject(s)
Humans , Polypharmacy , Prescription Drugs/administration & dosage , Deprescriptions , Drug Prescriptions , Pharmaceutical Preparations
20.
Gac. méd. Méx ; 156(6): 615-617, nov.-dic. 2020.
Article in Spanish | LILACS | ID: biblio-1249976

ABSTRACT

Resumen Extender una receta o indicar un tratamiento suele ser la última parte de la consulta médica. Este proceso crucial puede desvirtuarse debido a múltiples factores como capacidad prescriptiva limitada, exceso de trabajo y falta de reflexión o tiempo. La información insuficiente acerca del paciente o del tratamiento afecta el proceso prescriptivo y propicia errores que pueden ser graves para la salud del enfermo. La Academia Nacional de Medicina, en consonancia con la Organización Mundial de la Salud, hace énfasis en hacer del proceso prescriptivo un ejercicio de reflexión.


Abstract Writing a prescription or indicating a treatment is usually the last part of medical consultation. This crucial process can be undermined by multiple factors such as limited prescriptive ability, overwork, and lack of reflection or time. Insufficient information about the patient or the treatment affects the prescriptive process and leads to errors that can be serious for patient health. The National Academy of Medicine, in line with the World Health Organization, emphasizes the relevance of making the prescriptive process a reflective exercise.


Subject(s)
Humans , Drug Prescriptions , Reflex , Practice Patterns, Physicians' , Conditioning, Psychological
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