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1.
Rev. colomb. anestesiol ; 49(4): e200, Oct.-Dec. 2021. tab, graf
Article in English | LILACS, COLNAL | ID: biblio-1341236

ABSTRACT

Abstract Introduction Vasopressors are essential in the management of various types of shock. Objective To establish the trend of vasopressors use in the intensive care units (ICU) in a population of patients affiliated with the Colombian Health System, 2010-2017. Methods Observational trial using a population database of patients hospitalized in eleven ICUs in various cities in Colombia. The drugs dispensed to hospitalized patients over 18 years old, from January 2010 until December 2017 were considered. A review and analysis of the vasopressors dispensed per month was conducted, taking into account sociodemographic and pharmacological variables (vasopressor used and daily doses defined per 100/beds/day (DBD). Results 81,348 dispensations of vasopressors, equivalent to 26,414 treatments in 19,186 patients receiving care in 11 hospitals from 7 cities were reviewed. The mean age of patients was 66.3±18.1 years and 52.6 % were males. Of the total number of treatments recorded, 17,658 (66.8 %) were with just one vasopressor. Norepinephrine was the most frequently prescribed drug (75.9 % of the prescriptions dispensed; 60.5 DBD), followed by adrenaline (26.6 %; 41.6 DBD), dopamine (19.4%), dobutamine (16.0 %), vasopressin (8.5 %) and phenylephrine (0.9 %). The use of norepinephrine increased from 2010 to 2017 (+6.19 DBD), whilst the use of other drugs decreased, particularly the use of adrenaline (-60.6 DBD) and dopamine (-10.8 DBD). Conclusions Norepinephrine is the most widely used vasopressor showing a growing trend in terms of its use during the study period, which is supported by evidence in favor of its effectiveness and safety in patients with shock.


Resumen Introducción Los fármacos vasopresores son fundamentales en el manejo de los diferentes tipos de choque. Objetivo Determinar la tendencia de utilización de fármacos vasopresores en unidades de cuidados intensivos (UCI) en una población de pacientes afiliados al Sistema de Salud de Colombia, 2010-2017. Métodos Estudio observacional, a partir de una base de datos poblacional con pacientes hospitalizados en once UCI de diferentes ciudades de Colombia. Se obtuvieron las dispensaciones de pacientes mayores de 18 años hospitalizados desde enero de 2010 hasta diciembre de 2017. Se hizo revisión y análisis de la dispensación mensual de vasopresores. Se consideraron variables sociodemográficas y farmacológicas (medicamento vasopresor usado y dosis diarias definidas por 100 camas/día [DCD]). Resultados Se revisaron 81.348 dispensaciones de vasopresores, equivalentes a 26.414 terapias en 19.186 pacientes atendidos en 11 hospitales de 7 ciudades, cuya edad promedio fue 66,3±18,1 años y el 52,6 % eran hombres. Del total de terapias registradas, 17.658 (66,8 %) fueron con un solo vasopresor. La norepinefrina fue el más comúnmente prescrito (75,9 % de las dispensaciones; 60,5 DCD), seguido por adrenalina (26,6 %; 41,6 DCD), dopamina (19,4 %), dobutamina (16,0 %), vasopresina (8,5 %) y fenilefrina (0,9 %). El uso de norepinefrina se incrementó de 2010 a 2017 (+6,19 DCD), mientras que el de otros fármacos disminuyó, especialmente adrenalina (-60,6 DCD) y dopamina (-10,8 DCD). Conclusiones La norepinefrina es el fármaco vasopresor más utilizado y el que ha demostrado una tendencia de uso incremental durante el periodo de estudio, lo cual está respaldado por evidencia a favor de su efectividad y seguridad en pacientes con choque.


Subject(s)
Humans , Male , Middle Aged , Aged , Shock , Vasoconstrictor Agents , Vasopressins , Intensive Care Units , Phenylephrine , Pharmaceutical Preparations , Dopamine , Epinephrine , Norepinephrine , Dobutamine , Drug Utilization , Dosage , Prescriptions
2.
Iatreia ; 34(1): 15-24, ene.-mar. 2021. tab, graf
Article in Spanish | LILACS | ID: biblio-1154354

ABSTRACT

RESUMEN Objetivos: medir el impacto en la calidad de la prescripción antibiótica empírica en los médicos generales luego de la implementación de un sistema de evaluación y retroalimentación. Métodos: estudio cuasiexperimental con pre y postintervención en una clínica de tercer nivel en Medellín. Se revisó las prescripciones de un grupo de antibióticos por un médico internista, un epidemiólogo y un infectólogo. Se midió el consumo de antibióticos, las retroalimentaciones realizadas, el diagnóstico de la sepsis, tiempo de inicio de los antibióticos en el servicio de urgencias y la prevalencia de Escherichia coli productora de betalactamasa de espectro extendido. Resultados: el número de retroalimentaciones descendió de 10,9 a 2 %. Se redujo el consumo de ceftriaxona (p = 0,04), piperacilina tazobactam (p = 0,01), cefepime (p = 0,04) y ciprofloxacina (p = 0,01). Se evidenció una tendencia a la reducción en la prevalencia de E. coli BLEE (p = 0,3). La intervención no produjo un retraso en el inicio de antibióticos en el servicio de urgencias. Conclusión: una estrategia de auditoría y retroalimentación a los médicos generales, referente a la calidad de la prescripción antibiótica, reduce el consumo de antibióticos sin afectar la oportunidad del diagnóstico de sepsis o el inicio de su tratamiento y puede impactar favorablemente en el perfil de resistencia de la flora microbiana institucional.


SUMMARY Objectives: To measure the impact on the quality of the empirical antibiotic prescription in general practitioners, after the implementation of an evaluation and feedback system. Methods: Quasi-experimental study with pre- and post-intervention in a tertiary care center in Medellín. The prescriptions of a group of antibiotics were reviewed by an internist, an epidemiologist and an infectologist. When failures were found, prescribing doctors were informed. Subsequently, antibiotic consumption, feedbacks, sepsis diagnosis, start time of antibiotics in the emergency department and monthly incidence of Escherichia coli producing extended spectrum betalactamase were measured. Results: The numbers of feedbacks decreased from 10.9% to 2%. Consumption of ceftriaxone (p = 0.04), piperacillin tazobactam (p = 0.01), cefepime (p = 0.04) and ciprofloxacin (p = 0.01) was reduced. There was a tendency to reduce the prevalence of E. coli ESBL. The intervention did not cause a delay in the start of antibiotics in the emergency department. Conclusions: A strategy of continuous feedback to general practitioners regarding the quality of antibiotic prescription reduces consumption of antibiotics without causing changes in diagnosis opportunity or the beginning of antibiotics in sepsis and can impact favorably the resistance profile of the institutional microbial flora.


Subject(s)
Humans , Prescriptions , Anti-Bacterial Agents , Feedback , General Practitioners
3.
Nursing (Säo Paulo) ; 24(273): 5279-5288, fev.2021.
Article in Portuguese | LILACS, BDENF | ID: biblio-1148512

ABSTRACT

Objetivo: Identificar as evidências sobre os incidentes near miss em serviços de atenção primária à saúde. Método: Revisão integrativa de literatura a partir de artigos primários publicados em sete bases de dados. Utilizou-se os descritores "near miss", "atenção primária à saúde" e "gestão da segurança" sem limitações quanto ao ano de publicação e idiomas. Resultados: Os tipos de incidentes near miss notificados com maior frequência estavam relacionados a erros de medicação, com variação entre 6,2% e 96%, e o processo de prescrição foi o mais recorrente. Os profissionais de saúde foram os responsáveis por interceptar entre 66% a 83% dos incidentes. Conclusão: A notificação de incidentes near miss deve ser incentivada e incorporada nas práticas gerenciais. Conhecer precocemente os erros e seu potencial de dano possibilita ações de melhorias para segurança do paciente.(AU)


Objective: To identify the evidence about near miss incidents in primary health care services. Method: Integrative literature review based on primary articles published in seven databases. The descriptors "near miss", "primary health care" and "safety management" were used without limitations regarding the year of publication and languages. Results: The types of near miss incidents most frequently reported were related to medication errors, ranging from 6.2% to 96%, and the prescription process was the most recurrent. Health professionals were responsible for intercepting between 66% to 83% of incidents. Conclusion: Reporting of near miss incidents should be encouraged and incorporated into management practices. Knowing the errors early and their potential for damage enables improvement actions for patient safety.(AU)


Objetivo: identificar la evidencia sobre incidentes near miss en los servicios de atención primaria de salud. Método: revisión bibliográfica basada en artículos primarios publicados en siete bases de datos. Los descriptores "near miss salud", "atención primaria de salud" y "gestión de seguridad" se utilizaron sin limitaciones con respecto al año de publicación y los idiomas. Resultados: los tipos de incidentes cercanos a fallas más frecuentes se relacionaron con errores de medicación, que oscilaron entre 6.2% y 96%, y el proceso de prescripción fue el más recurrente. Los profesionales de la salud fueron responsables de interceptar entre el 66% y el 83% de los incidentes. Conclusión: Se debe alentar e incorporar a las prácticas de gestión la notificación de incidentes cercanos. Conocer los errores temprano y su potencial de daño permite acciones de mejora para la seguridad del paciente.(AU)


Subject(s)
Humans , Primary Health Care , Primary Care Nursing , Patient Safety , Near Miss, Healthcare , Health Personnel , Safety Management/methods , Prescriptions
4.
Article in Chinese | WPRIM | ID: wpr-879122

ABSTRACT

Classic prescriptions, hospital preparations and famous traditional Chinese medicine(TCM) experience prescriptions are the main sources of new drug development and innovation. The multi-components and multi-targets treatment characteristics of TCM are advantages, but at the same time, broad indications, unclear clinical positioning and lack of evidence-based evidence support are the key problems affecting the play of TCM efficacy and restricting its promotion and application. The hot in recent research was to how to break through the bottleneck, precise clinical positioning, highlight the advantages of the classic TCM prescriptions, and complete the transformation from clinical practice, clinical research to clinical evidence, but at the same time, it is also the difficulty. The clinical research model of the combination of disease and syndrome can fully reflect the ancient medical case evidence of classic TCM prescriptions, the historical experience of human used and the characteristics of syndrome differentiation and treatment, and highlight the advantages of Chinese medicine. At the same time, under the modern disease classification system and research mode, is conducive to established the standardized clinical evidence report and evaluation system, is conducive to promote the integration of clinical research evidence, and avoids excessive attenuation of information. Based on the previous work of our team, the intention of this study was to make a comment about the key points of the post-marketing evaluation of the classic TCM prescriptions under the combination of disease and syndrome and includes key points:(1)With the syndrome as the carrier, connected with the classical prescription and clinical diseases, focused on the clinical positioning on macroscopically.(2)The combination of syndrome visualization, standardization and pharmacological molecular basis, focus on clinical precise positioning in microscopic.(3)Innovating therapeutic effect evaluation methods, reflecting the curative effect characteristics based on syndrome differentiation.(4)The combination of "randomized controlled evidence-based studies" and "real world evidence-based evaluation", focusing on clinical advantages, fully evidence-based evidence.(5)Make full use of clinical registration studies and pay attention to safety.


Subject(s)
Drugs, Chinese Herbal/therapeutic use , Humans , Marketing , Medicine, Chinese Traditional , Prescriptions , Reference Standards
5.
Article in Chinese | WPRIM | ID: wpr-879100

ABSTRACT

Indication and functions is an important key information in the research and development of the ancient classical formulas, which directly affects the clinical positioning of the compound formulas and their reasonable, effective and safe use after marke-ting. It is also the embodiment of the ultimate vitality of ancient classical formulas. Due to the particularity of ancient classical formulas, it is of great significance to accurately define and describe the functions and indications of classical formulas to exert their unqiue advantages. Based on the analysis of the provenances, classification of clinical indications, and functions of 100 prescriptions in the Catalogue of Ancient Classical Formulas(First Batch), this paper summarized the incompleteness, irregularity and inconsistency in the original text, the differences in terminology between ancient and modern times, and the evolution of the meanings of prescriptions in different dynasties. In addition, under the guidance of the general principle of textual researh on ancient classical formulas, which is to inherit the essence, make the past serve the present, link up the past and the present, and bulid consensus, this paper proposed the following ideas: respecting the original meanings and provenances of ancient classical formulas, taking full consideration of the development and evolution, serving the current clinical application and health needs, accurately linking up the ancient and modern terminologies, standardizing the expression of traditional Chinese medicine(TCM) terminology, highlighting the characteristics of TCM, attaching importance to the textual research principles and suggestions of post-marketing evidence-based and clinical positioning research, so as to determine the the functions and indications of the ancient classical formulas in a scientific, standardized and reasonable way and better guide the clinical application of the classical formulas.


Subject(s)
Drugs, Chinese Herbal , Medicine, Chinese Traditional , Oils, Volatile , Prescriptions
6.
Article in Chinese | WPRIM | ID: wpr-879078

ABSTRACT

Collecting and summarizing human use experience(HUE) data, forming high-quality data and evidences that can be used for evaluation are the key links of HUE research on traditional Chinese medicine(TCM). The collection, collation and summary of human experience data were discussed in this paper. It is pointed out that the collection of HUE should be focus on the source of prescription of new traditional Chinese medicines, and be summarized based on dialectical thinking, experience in medication, characte-ristics of prescription and clinical application. The collected contents include prescription, process, clinical location and applicable population, efficacy data and safety data, etc. The methods include interview, clinical data summary and data mining. When the data formed based on HUE information is used as drug registration information, it is necessary to ensure that the data source is legal and compliant, and the ownership of intellectual property is clear.Data sources should meet the requirements of medical ethics. To avoid conflict of interest, data analysis should be conducted by an independent third party. It is necessary to develop the quality control measures of HUE data to ensure the data traceability, integrity, consistency and accuracy, and avoid data bias.The data of HUE should include the key data such as accurate clinical location and applicable population, recognized clinical efficacy and safety.After the formation of HUE, the statistical analysis plan of empirical data of human use should be formulated. Through strict data processing, statistical analysis and clinical interpretation, HUE can be produced for evaluation.


Subject(s)
Data Collection , Drugs, Chinese Herbal , Humans , Medicine, Chinese Traditional , Prescriptions , Quality Control
7.
Article in Chinese | WPRIM | ID: wpr-879061

ABSTRACT

To explore prescription medication regularity in the treatment of Alzheimer's disease with traditional Chinese medicine(TCM). With Alzheimer's disease or senile dementia as the subject, collecting and sorting out the journal papers in CNKI were collected as the data source to establish the literature research database of Alzheimer's disease prescriptions, and then the association rule analysis, factor analysis and systematic cluster analysis on the included TCM were conducted. Among the 113 prescriptions included in the standard, the single herb Acori Tatarinowii Rhizoma was the most common. The herbs were mainly warm and flat among four pro-perties, mainly sweet, bitter and spicy among five flavors. The drugs were mainly distributed in five internal organs, and the most commonly used drugs were deficiency tonifying drugs as well as blood activating and stasis removing drugs. In the association rule analysis, it was found that there were 6 drug pairs with the highest association strength. Eight common factors were extracted from the factor analysis, and they were classified into 6 categories in the systematic cluster analysis. The results have shown that the overall principles in treating Alzheimer's disease with modern Chinese medicine are tonifying deficiency, invigorating circulation, activating blood and dispelling phlegm.


Subject(s)
Alzheimer Disease/drug therapy , Data Mining , Drugs, Chinese Herbal/therapeutic use , Humans , Medicine, Chinese Traditional , Prescriptions
8.
Article in Chinese | WPRIM | ID: wpr-879033

ABSTRACT

Zaoren Anshen prescription preparations(ZRASs), which are prepared from three traditional Chinese herb medicines, namely fried Zizyphi Spinosae Semen, Salvia Miltiorrhizae Radix et Rhizoma and vinegar-processed Schisandrae Chinensis Fructus, are a series of proprietary Chinese medicines for the treatment of insomnia, amnesia and dizzy in clinic. In recent years, pharmacodynamic effect, chemical constituents and quality control of ZRASs had been extensively studied for the purpose of ensuring their safety, efficacy and stability, and a great progress had been made. However, there is no review of the research advance of ZRASs up to date. The present review summarized the research advance of ZRASs in quality control standards, chemical constituents, pharmacodynamic effects, and chemical analysis for the first time, with the aim to provide a reference for further studies on the effective constituents and quality control of ZRASs.


Subject(s)
Drugs, Chinese Herbal/pharmacology , Medicine, Chinese Traditional , Prescriptions , Rhizome , Salvia miltiorrhiza
10.
Article in Chinese | WPRIM | ID: wpr-880077

ABSTRACT

OBJECTIVE@#To explore the regulation effect of myeloid leukemia No.1 Chinese herb medicine prescription combined with chemotherapy on Th17 cells in bone marrow fluid of AML patients, so as to provide guidance for improving AML treatment effect and patients' long-term survival.@*METHODS@#Seventy patients with AML who were hospitalized in Department of Hematology, Wuwei People's Hospital from April 2017 to August 2019 were selected and enrolled in AML group, 25 healthy volunteers were selected and enrolled in control group; then according to therapeutic regimen, AML patients were divided into 2 groups: combined therapy group (myeloid leukemia NO.1 Chinese herb medicine prescription combined with chemotherapy) and non-combined therapy group (chemotherapy alone). Flow cytometry was used to detect the ratio of CD3@*RESULTS@#The ratio of CD3@*CONCLUSION@#Th17 cells expression in bone marrow of newly diagnoses and relapsed AML patients significantly increase, and decrease significantly after treatment. Myeloid leukemia No.1 Chinese herb prescription combined with chemotherapy can significantly increase the CR rate and reduce the RL rate for AML.


Subject(s)
Bone Marrow , China , Humans , Leukemia, Myeloid, Acute/drug therapy , Medicine , Prescriptions , Th17 Cells , Vascular Endothelial Growth Factor A
11.
Enferm. foco (Brasília) ; 11(5): 67-72, dez. 2020. ilus, tab
Article in Portuguese | LILACS, BDENF | ID: biblio-1177216

ABSTRACT

Objetivo: Analisar as prescrições de curativo realizadas por enfermeiros e médicos quanto a clareza e a adequabilidade do produto prescrito as características da ferida, bem como analisar as implicações éticas desse contexto. Metodologia: Estudo descritivo quantitativo, realizado em um hospital universitário do Centro-Oeste brasileiro. Compuseram a amostra 180 prescrições de curativos obtidas em prontuários de pacientes com feridas, e as características das feridas foram coletadas por meio de instrumento tipo checklist. Resultados: 92,2% dos registros apresentavam prescrições para a realização dos curativos. Em 7,8% dos registros não havia prescrição de curativos. 93,9% das prescrições estavam incompletas, sendo que em 31,4% foi encontrado divergência entre prescrições de enfermagem e médica no mesmo registro diário. Em 32,3% não havia especificação do produto a ser utilizado no curativo. Em 38,3% a prescrição do produto foi inadequada às características das feridas. Conclusão: Foram evidenciadas fragilidades nas prescrições de curativo que implicam infrações éticas. Os achados reforçam a necessidade de capacitação da equipe e maiores investimentos na formação do profissional em tratamento de feridas. (AU)


Objective: To analyze the dressing prescriptions made by nurses and doctors regarding the clarity and suitability of the prescribed product to the characteristics of the wound, as well as to analyze the ethical implications of this context. Methods: Quantitative descriptive study, carried out in a university hospital in the Brazilian Midwest. The sample comprised 180 dressing prescriptions obtained from medical records of patients with wounds, and the characteristics of the wounds were collected using a checklist-type instrument. Results: 92.2% of the records had prescriptions for dressing. In 7.8% of the records there was no prescription for dressings. 93.9% of prescriptions were incomplete, and in 31.4% there was a divergence between nursing and medical prescriptions in the same daily record. In 32.3% there was no specification of the product to be used in the dressing. In 38.3% the prescription of the product was inadequate to the characteristics of the wounds. Conclusion: Weaknesses in dressing prescriptions that imply ethical infractions were evidenced. The findings reinforce the need for staff training and greater investments in training professionals in wound care. (AU)


Objetivo: Analizar las prescripciones de apósitos realizadas por enfermeras y médicos sobre la claridad e idoneidad del producto prescrito a las características de la herida, así como analizar las implicaciones éticas de este contexto. Métodos: Estudio descriptivo cuantitativo, realizado en un hospital universitario del Medio Oeste brasileño. La muestra estuvo fue compuesta por 180 prescripciones de apósitos obtenidas de historias clínicas de pacientes con heridas, y las características de las heridas se recolectaron mediante un instrumento tipo checklist. Resultados: el 92,2% de los registros tenía prescripción de aposito. En el 7,8% de los registros no había prescripción de apósitos. El 93,9% de las prescripciones estaban incompletas y en el 31,4% había divergencia entre las prescripciones médicas y de enfermería en un mismo registro diario. En el 32,3% no se especificó el producto a utilizar en el apósito. En el 38,3% la prescripción del producto fue inadecuada a las características de las heridas. Conclusión: Se evidenciaron debilidades en la preparación de prescripciones que implican infracciones éticas. Los hallazgos refuerzan la necesidad de capacitación del personal y mayores inversiones en la capacitación de profesionales en el cuidado de heridas. (AU)


Subject(s)
Occlusive Dressings , Wounds and Injuries , Medical Records , Prescriptions , Wound Closure Techniques
12.
Medwave ; 20(10): e8064, 30-11-2020.
Article in English, Spanish | LILACS | ID: biblio-1145807

ABSTRACT

Introducción La psoriasis es una enfermedad crónica que compromete la piel, padecida por cerca de 125 millones de personas en todo el mundo. En un grupo determinado de pacientes, también puede afectar el sistema articular. Para el control y seguimiento de los pacientes con psoriasis se estableció la aplicación de los índices de severidad del área de psoriasis y de calidad de vida dermatológica. Ambos parámetros son necesarios para el inicio de terapia biológica, según lo establecido en la guía de manejo de psoriasis (2015) del comité nacional de enfermedades reumatológicas, inmunológicas y de metabolismo óseo del Instituto Venezolano de los Seguros Sociales. Objetivo Caracterizar las variables clínicas, epidemiológicas y la prescripción de terapia biológica en los pacientes con psoriasis que acceden al programa de dispensación de alto costo de la farmacia del Instituto Venezolano de los Seguros Sociales. Método Es un estudio descriptivo, transversal. Resultados Se evaluaron 374 expedientes, donde el sexo masculino fue más frecuente con 56,1% (p < 0,001), provenientes en su mayoría de la ciudad de Caracas, en la comparación de los grupos de edad con el sexo, se observó que existía una diferencia entre estos (p < 0,05). El 57,5% usó previamente metotrexato; 6,68% biológicos; 3,2% esteroides tópicos y 31% no reportó qué tipo de terapia previa recibía. Dentro de las presentaciones clínicas, 70% correspondió a la psoriasis en placa. El 79% de los pacientes presentaba actividad moderada según el índice de la severidad del área de psoriasis, y al 11% se les realizó el índice de calidad de vida dermatológica, de los cuales 39% presentaban un efecto extremadamente importante. El rango anérgico de la prueba de Mantoux representó 70,9% de los casos, donde al 0,3% le fue realizado la prueba de Booster, y la radiografía de tórax se reportó normal en 95%. El medicamento biológico más demandado fue el etanercept con 52% de los casos. Conclusiones El sexo masculino y su relación con la psoriasis fue un hallazgo de importancia, como también se evidenció la necesidad de mejorar los componentes administrativos en la gestión de los formatos de solicitud de medicamentos y fortalecer la aplicación de la clinimetría con elemento de buena práctica médica.


Introduction Psoriasis is a chronic disease that affects the skin. One hundred twenty-five million people around the world suffer from this condition. In specific groups of patients, the joints may also be involved. To control and follow-up patients with psoriasis, psoriasis area severity and dermatological quality of life measurements were established. Both parameters are necessary for the initiation of biological therapy, as specified in the psoriasis management guide (2015) of the national committee of rheumatological, immunological, and bone metabolism diseases of the Venezuelan Institute of Social Security. Objective To characterize the clinical and epidemiological variables and the prescription of biological therapy in patients with psoriasis who access the high-cost dispensing program of the Venezuelan Institute Social Security (IVSS) pharmacy. Methods This is a descriptive, cross-sectional study. Results A total of 374 patient records were assessed. The male gender was more frequent, with 56.1% (p <0.001), mostly from Caracas city. In comparing age groups with sex, a difference among these was observed (p <0.05). 57.5% previously used methotrexate, 6.68% biological, 3.2% topical steroids, and 31% did not report which type of previous therapy they had received. Amongst the clinical presentations, 70% corresponded to plaque psoriasis. 79% of the patients presented moderate activity according to the Psoriasis Area and Severity Index (PASI): Eleven percent were assessed with the Dermatology Life Quality Index (DLQI); 39% of them reported an extremely important effect. The anergic range of the Mantoux test represented 70.9% of the cases, and 0.3% took the booster evaluation. Chest X-ray was reported normal in 95% of the cases. The most demanded biological medicine was etanercept, in 52% of the cases. Conclusions Male gender and its association with psoriasis was an important finding. The need to improve the administrative components in completing the medication request formats and strengthen clinical measurements and good medical practice was also found.


Subject(s)
Humans , Male , Psoriasis/drug therapy , Psoriasis/epidemiology , Quality of Life , Biological Therapy , Venezuela/epidemiology , Severity of Illness Index , Cross-Sectional Studies , Prescriptions
13.
Rev. colomb. psiquiatr ; 49(3): 199-201, jul.-set. 2020.
Article in English | LILACS, COLNAL | ID: biblio-1149827

ABSTRACT

ABSTRACT Trazodone is used as an antidepressant in doses between 150 and 600 mg. At lower doses, it is commonly used to treat insomnia. There are few case reports about confusional symptoms as an undesirable side effect of this drug. We report a case of a patient who presented with delirium after prescription of trazodone 100 mg. She required hospitalisation but, shortly after discontinuation of trazodone, the symptoms disappeared without antipsychotic medication. Seven months after the episode, the patient remains asymptomatic.


RESUMEN La trazodona se usa como antidepresivo en dosis de 150-600 mg. En dosis más bajas, se usa comúnmente para tratar el insomnio. Hay pocos reportes de caso sobre síntomas confusionales como un efecto secundario indeseable de este medicamento. Se presenta el caso de una paciente que acudió con delirio después de la prescripción de trazodona 100 mg. La paciente requirió hospitalización pero, poco después de la interrupción de la trazodona, los síntomas desaparecieron sin medicación antipsicótica. A los 7 meses del episodio, la paciente permanecía asintomática.


Subject(s)
Humans , Female , Adult , Trazodone , Delirium , Secondary Effect , Dosage , Prescriptions , Sleep Initiation and Maintenance Disorders , Antidepressive Agents
14.
Int. j interdiscip. dent. (Print) ; 13(2): 67-70, ago. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1134343

ABSTRACT

RESUMEN: Antecedentes: El consumo de antibióticos se ha convertido en un problema de salud pública. Aproximadamente un 10% de los antibióticos son indicados por odontólogos. Algunos países han identificado las prácticas clínicas relacionadas con su indicación por medio de cuestionarios de auto-reporte. En Chile no existe información respecto al uso e indicación de antibióticos de los odontólogos. Objetivo: Diseñar y validar un instrumento para el levantamiento de información sobre la indicación de antibióticos por los odontólogos en Chile. Método: Se diseñó una investigación en dos etapas: 1) Creación de un cuestionario de auto-reporte como instrumento de levantamiento de información. 2) Pilotaje del cuestionario y análisis descriptivo sobre los hábitos de prescripción. Resultados: Se creó un cuestionario de 88 preguntas, organizadas principalmente en matrices. El Content Validity Index fue 0.88. En el pilotaje se analizaron 418 respuestas. El 51,67% fueron de la Región Metropolitana, 43% de odontólogos tiene más de 10 años de experiencia, 50% declara tener estudios de postítulo, 81% señaló prescribir antibióticos entre 1% y 25% de sus pacientes en un mes de trabajo. Amoxicilina es el antibiótico más indicado. Conclusión: Se valida el instrumento diseñado para levantar información respecto a la indicación de antibióticos por los odontólogos en Chile.


ABSTRACT: Background: Antibiotic consumption has become a public health problem. Dentists prescribe approximately 10% of the antibiotics. Some countries have identified clinical practices related to their prescription through self-report questionnaires. In Chile, there is no information regarding the prescription of antibiotics by dentists. Aim: Design and validate an instrument that allows for collecting information about antibiotic prescription by dentists in Chile. Method: An investigation was designed in two stages: 1) Creation of a self-report questionnaire as an information-gathering instrument. 2) A pilot study of the questionnaire to perform a descriptive analysis of prescription habits. Results: A questionnaire of 88 questions was created, organized mainly in matrices. The Content Validity Index was 0.88. During the pilot, 418 responses were analyzed. 51.67% of the dentists were from the Metropolitan Region, 43% had more than ten years of experience, 50% declared having postgraduate studies, 81% indicated that they prescribed antibiotics to between 1% and 25% of their patients in one month of work. Amoxicillin is the most prescribed antibiotic. Conclusion: The instrument designed was validated to evaluate the antibiotic prescription habits by dentists in Chile.


Subject(s)
Humans , Dentists , Prescriptions , Habits , Anti-Bacterial Agents , Chile , Surveys and Questionnaires
15.
Rev. méd. Chile ; 148(6): 740-745, jun. 2020. tab
Article in English | LILACS | ID: biblio-1139366

ABSTRACT

ABSTRACT Background: Hypothyroidism occurs in 1-2% of the general population, is associated with significant morbidity and requires continuous treatment with levothyroxine. Aim: To determine the effectiveness, adherence and safety of levothyroxine therapy in patients with hypothyroidism. Material and Methods: The Morisky-Green adherence test was applied, and effectiveness was determined by measuring thyroid-stimulating hormone (TSH) in 330 patients with with hypothyroidism; the mean age was 64+-15 years and 76% was women. Results: Median TSH was 2.09 mIU/L (interquartile range: 1.16-3.61 mIU/L). Two hundred thirty-five (71%) patients had TSH levels in the euthyroid range, 64 (19%) in the hypothyroid range and 31 (9%) in the hyperthyroid range. Complete, moderate and lack of adherence with levothyroxine was reported in 283 (86%), 29 (9%) and 18 (5%) of patients, respectively. The presence of anemia (odds ratio (OR): 0.37, 95% confidence intervals (CI): 0.15-0.98) or the need of doses over 100 µg/day (OR: 0.47, 95%CI: 0.28-0.80) increased the probability of having an abnormal TSH level. Conclusions: In a large proportion of these patients, TSH levels were controlled, and most patients were adherent to levothyroxine therapy.


Antecedentes: El hipotiroidismo se presenta entre el 1-2% de la población general, genera importante morbilidad y requiere tratamiento con levotiroxina de manera continua. Objetivo: Determinar la efectividad, adherencia y seguridad de la terapia con levotiroxina en pacientes con hipotiroidismo. Material y Métodos: Se aplicó test de adherencia de Morisky-Green y se determinó efectividad mediante medición de TSH en 330 pacientes con edad promedio 63 ± 15 años (76% mujeres). Resultados: La mediana de TSH fue 2,09 mUI/l, (rango intercuartílico: 1,16mUI/l-3,61mUI/l). Un total de 235 (71,2%) tenían cifras de TSH en rango de estado eutiroideo, 64 (19,4%) se catalogaron hipotiroideos y 31 (9,4%) hipertiroideos. El 86% (n = 283) manifestó tener adherencia completa al medicamento, 29 (9%) moderada y 18 (5%) se clasificaron poco adherentes. Tener diagnóstico de anemia (razón de riesgo (RR): 0,37; intervalos de confianza (IC) 95%: 0,15-0,98) o necesitar dosis mayores de 100 µg/día (RR: 0,47; IC95%: 0,28-0,80) elevaron la probabilidad de no controlar el hipotiroidismo. Conclusiones. Una alta proporción de pacientes se encuentran controlados y con mucha frecuencia son adherentes a la terapia con levotiroxina.


Subject(s)
Humans , Female , Middle Aged , Aged , Thyroxine/therapeutic use , Hyperthyroidism , Hyperthyroidism/drug therapy , Thyrotropin , Prescriptions
16.
Rev. méd. Chile ; 148(6): 849-851, jun. 2020.
Article in Spanish | LILACS | ID: biblio-1139380

ABSTRACT

The extinctive prescription allows the extinction of the compensatory action against doctors. Its interest lies in understanding how this defence of doctors is manifested in contractual liability, law of torts and public medical-health liability. For tortuous and contractual liability, the time period limitation of the extinctive prescription can only run from the manifestation of the damage, a necessary element for there to be liability for the doctor and compensatory action against him. However, law n° 19.996 applicable to public medical-health liability establishes a different rule. In this case the time period limitation runs from the execution of the medical act. This difference has been corrected by the Supreme Court, unifying the criteria for the calculation of the limitation action period in medical matters.


Subject(s)
Humans , Male , Prescriptions , Physicians , Liability, Legal , Malpractice
17.
Arch. argent. pediatr ; 118(3): 209-: I-213, I, jun. 2020. tab
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1116903

ABSTRACT

Introducción. Existen discrepancias en el abordaje de la fiebre por parte de los pediatras. El objetivo fue describir conocimientos, hábitos de prescripción e indicaciones de tratamiento farmacológico y no farmacológico de la fiebre por parte de los médicos de un hospital pediátrico de la Ciudad de Buenos Aires.Material y métodos. Estudio observacional, descriptivo, analítico, de corte transversal, realizado en el Hospital de Niños Ricardo Gutiérrez durante 2018.Resultados. Se realizaron 100 encuestas. El 37 % de los pediatras siempre indicaba medios físicos, mientras que el 54 %, ocasionalmente. El 68 % alternaba antitérmicos, aunque el 72 % consideraba que esta práctica aumentaba el riesgo de toxicidad. El 32 % respondió que el tratamiento precoz disminuía el riesgo de convulsiones.Conclusiones. Existen hábitos de prescripción e indicaciones de tratamiento farmacológico y no farmacológico de la fiebre por parte de los pediatras con escasa evidencia de su eficacia.


Introduction. There are discrepancies in relation to pediatricians' approach to fever. Our objective was to describe the knowledge, prescription habits, and drug and non-drug treatment indications for fever among physicians at a children's hospital in the Autonomous City of Buenos Aires.Material and methods. Observational, descriptive, analytical, cross-sectional study conducted at Hospital de Niños Ricardo Gutiérrez in 2018.Results. A total of 100 surveys were completed: 37 % of pediatricians always indicated physical methods, whereas 54 % did so occasionally; 68 % alternated antipyretic agents, while 72 % considered this practice increased the risk for toxicity; and 32 % stated that early management reduced the risk for seizures.Conclusions. Pediatricians have prescription habits and indicate drug and non-drug treatments for fever that have demonstrated little effectivenes


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Fever , Cross-Sectional Studies , Surveys and Questionnaires , Prescriptions , Antipyretics , Pediatricians
18.
Psicol. ciênc. prof ; 40: e190411, jan.-maio 2020.
Article in Portuguese | LILACS, INDEXPSI | ID: biblio-1135846

ABSTRACT

Resumo O artigo investigou os efeitos de uso da versão brasileira do Guia da Gestão Autônoma da Medicação (GAM-BR) em grupos de intervenção em serviços públicos saúde mental. Objetiva-se analisar narrativas de usuários, psiquiatras e demais profissionais a partir da relação de cada um deles com a prescrição medicamentosa, mote do trabalho com o Guia. Participaram da pesquisa três CAPS do sul do país, integrantes da pesquisa multicêntrica GAM-BR. O áudio das falas produzidas nos grupos focais e nas entrevistas foi gravado, transcrito e transformado em narrativas por meio da extração dos núcleos argumentais. Os resultados apontam para a ampliação da concepção de autonomia e maior reconhecimento dos direitos dos usuários. Sugere, porém, dificuldades no exercício desses direitos, especialmente com relação ao tratamento medicamentoso, visto como condição para manutenção do vínculo com os serviços. Ressalta a importância de maior reflexão, tendo em vista a manutenção da lógica da escolha, privatizante e individualista, em detrimento da lógica do cuidado que valoriza o trabalho em rede e a corresponsabilização.


Abstract This article analyzed the effects of using the Brazilian version of the Autonomous Medication Management Guide (GAM-BR) in intervention groups in mental health services. Users, psychiatrists and other professionals' narratives were verified to check the relationship of each one with the prescription, the main principle of the guide. Three CAPS (mental health care services) from the south of the country have participated in this research, all members of the multicentric research GAM-BR. The material was audio-recorded, transcribed and transformed in narratives. The results show increase of the conception of autonomy and wider acknowledgment of users' rights. A broadening concept of users' autonomy and a greater recognition of their rights was observed. However, issues were found in the exercise of rights, especially regarding drug treatment, which was seen as a condition for their bond maintenance with services. Further reflection on this subject is emphasized, owing to maintaining the logic of choice, which focuses on privatization and individualism, instead of the care that enhances network and co-responsibility.


Resumen El artículo investiga los efectos de uso de la Guía de Gestión Autónoma de la Medicación (GAM-BR), versión brasileña, en grupos de intervención en servicios de salud mental. El objetivo fue analizar narrativas de usuarios, psiquiatras y otros profesionales a partir de su relación con la prescripción de medicamentos, principio del trabajo con la Guía. Participaron en la investigación tres CAPS (Centros de atención psicosocial) del Sur del país, todos miembros de la investigación multicéntrica acerca de la GAM. Todo el material de audio fue grabado, transcrito y transformado en narrativas por medio de la extracción de los núcleos de significación. Se señala la expansión de la noción de autonomía de los usuarios y un mayor reconocimiento de sus derechos. Se presentaron dificultades para avanzar en el ejercicio de esos derechos, especialmente en cuanto al tratamiento farmacológico, que todavía se ve como una condición a la manutención del vínculo con los servicios. Es necesaria una mayor reflexión acerca del tema, considerando la manutención de la lógica de la elección, privatizante e individualista, en lugar de una lógica del cuidado que valorice el trabajo en la red y la corresponsabilización.


Subject(s)
Humans , Male , Female , Psychiatry , Personal Autonomy , Drug Therapy , Prescriptions , Research , Audiovisual Aids , Therapeutics , Pharmaceutical Preparations , Focus Groups , Mental Health Services
19.
Sahel medical journal (Print) ; 23(2): 103-108, 2020. ilus
Article in English | AIM | ID: biblio-1271717

ABSTRACT

Background: Antimicrobials are nonreplaceable in the treatment of bacterial infections and thus should be used judiciously. In Nigeria, there is currently no restriction on the prescription and sale of antimicrobials. This study was conducted to assess the antimicrobial prescription pattern of physicians at a tertiary hospital in Northwestern Nigeria. Materials and Methods: A point prevalence survey was carried out among all inpatients at Ahmadu Bello University Teaching Hospital in June 2015. Those receiving an antimicrobial agent during the survey period were included in the study while patients admitted on the day of the survey were excluded from the study. Data were obtained using a structured interviewer­administered questionnaire and abstraction from patient records. Information obtained included demographic data, antimicrobial agents prescribed, indication for treatment, laboratory data, and stop/review dates of prescriptions. Data were analyzed using SPSS version 20.0. Results: Twenty­three wards with a total number of 318 inpatients were enlisted. Of these, 210 (66%) patients were on treatment with antimicrobials. Male: female ratio of patients on antimicrobials was 1.2:1, and age of respondents ranged from 1 day (0.0027 years) to 75 years. The overall antimicrobial prevalence rate was 210 (66%) with surgical prophylaxis 100 (47.6%) as the most common indication. Overall, 332 antimicrobials were prescribed with cephalosporins as the most common class prescribed 96 (28.9%). Majority of the prescriptions (328, 98.8%) were based on empirical treatment, 288 (86.7%) were open prescriptions, and only 4 (1.2%) were according to treatment guidelines. Conclusion: The high prevalence of antimicrobial use highlights the need for an antimicrobial stewardship program in this facility


Subject(s)
Anti-Infective Agents , Antimicrobial Stewardship , Contraceptive Prevalence Surveys , Nigeria , Prescriptions , Tertiary Care Centers
20.
Article in English | AIM | ID: biblio-1257716

ABSTRACT

Background: Medical prescription writing is legally and professionally regulated in order to prevent errors that can result in patients being harmed. This study assesses prescriber adherence to such regulations in primary care settings. Methods: A cross-sectional study of 412 prescriptions from four district hospital outpatient departments (OPDs) was conducted in March 2015. Primary outcome data were obtained by scoring prescriptions for accuracy across four categories: completion of essential elements, use of generic names of medications, use of recommended abbreviations and decimals and legibility. Secondary outcome data sought associations between accuracy scores and characteristics of the OPDs that might influence prescriber adherence. Results: Completion of the essential elements, including patient identifiers, prescriber identifiers, treatment regimen and date scored 44%, 77%, 99% and 99% respectively. Legibility, the use of generic names of medications and the use of recommended abbreviations and decimals scored 90%, 39% and 35%, respectively. Only 38% of prescriptions achieved a global accuracy score (GAS) of between 80% and 100%. A significant association was found between lower GAS and the number of prescriptions written per day (p = 0.001) as well as with the number of prescribers working on that day (p = 0.005), suggesting a negative impact on prescribers' performance because of workload pressures. Conclusion: Low GAS values indicate poor adherence to prescription-writing regulations. Elements requiring substantial improvement include completion of patient and prescriber identifiers, use of generic medication names and the use of recommended abbreviations and decimals. This study provides baseline data for future initiatives for improvement in prescription-writing quality


Subject(s)
Guideline Adherence , Guidelines as Topic , Prescriptions , Primary Health Care , South Africa
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