The effects of pharmacist interventions on adult outpatients with cancer: A systematic review.

WHAT IS KNOWN AND OBJECTIVES: Most antineoplastic drugs are highly toxic and have low therapeutic indexes, which can result in drug-related problems. In this context, pharmacist interventions may play an important role in the success of the treatment. The objective of this study was to examine the effects of pharmacist interventions on adult outpatients with cancer using antineoplastic drugs. METHODS: A literature search was performed using PubMed, ISI Web of Science and LILACS databases from January 1990 to April 2016, using MeSH terms or text words related to pharmacist interventions, cancer and outpatient care. Studies published in English, Portuguese or Spanish on the effects of pharmacist interventions in outcome measures in adult outpatients with cancer were included. Two independent authors performed study selection and data extraction with a consensus process. The articles were analysed according to previously established criteria, such as country, study design, setting, population, type of cancer, description of the intervention and control groups, outcomes, main conclusions and study limitations. RESULTS AND DISCUSSION: A total of 874 records were identified, of which 11 satisfied the inclusion criteria. The studies were conducted mainly in the United States and included patients aged >50 years. Most studies had a before-after design. Pharmacist interventions primarily included educating and counselling patients on the management of adverse events. Rates of nausea and vomiting control, medication adherence and patient satisfaction were the most common outcome measures; a significant benefit in these parameters as a result of pharmacist interventions was noted in most studies. WHAT IS NEW AND CONCLUSION: The findings from this systematic review indicate that pharmacist interventions can improve outcome measures in outpatients with cancer. However, the collective quality of the studies was poor and gaps identified indicate that further research is needed to provide more robust results.

Systematic review of the economic evaluations of novel therapeutic agents in multiple myeloma: what is the reporting quality?

WHAT IS KNOWN AND OBJECTIVE: Given the increasing healthcare costs and the recent introduction of novel agents in the treatment for multiple myeloma (MM), an incurable haematologic malignancy, more efficient use of existing resources is fundamental. The objective of this study was to systematically review economic evaluations of the use of novel agents in MM and assess their reporting quality. METHODS: A literature search was performed in PubMed/Medline, Latin American and Caribbean Health Sciences Literature, Cost-Effectiveness Analysis Registry and the National Health Services Economic Evaluation Database for economic evaluations up to June 2015. The search strategy included Medical Subject Headings terms or text words related to MM, economic evaluations and drugs. Full economic evaluations of bortezomib, thalidomide or lenalidomide in patients with MM that were published in English, Portuguese or Spanish were included. Two independent authors performed study selection, data extraction and quality assessment using 24 items from the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. RESULTS AND DISCUSSION: Of the 132 potentially relevant records identified, eight satisfied the inclusion criteria. Most studies were cost-effectiveness analyses combined with cost-utility analyses (n = 6) from the public payer perspective (n = 4) and were performed in Europe (n = 6) on patients with refractory or relapsed MM (n = 5). All studies were based on economic models, with four of them using discrete event simulation. We found bortezomib-based therapies to be one of the more commonly selected treatment strategies for comparison (n = 7). Overall, the intervention was more effective and costlier than the alternative strategy (average of $54 630 per life year; $68 261 per quality-adjusted life year-QALY). The CHEERS' total score was 14·6 (SD = 2·6) with the most frequent problems being the lack of precision measures for all model parameters, no evaluation of heterogeneity of the results by subgroup analyses and no description of the role the funder in the identification, design, conduct and reporting of the analysis. WHAT IS NEW AND CONCLUSION: Most analyses of the novel therapeutic agents determined that they were cost-effective in MM at a threshold of up to $100 000/QALY. Nevertheless, the poor reporting quality of the economic studies requires improvement to ensure greater transparency.

Avaliação da aplicação da técnica de administração de colírios por pacientes idosos de um centro de especialidades médicas / Evaluation of the application of the eyedrops administration technique by elderly patients of a health care center

The aim of this study was to evaluate the application of the eye drop administration technique by elderly. This is a transversal study conducted in the of ophthalmology in the Medical Specialties Center of Aracaju. The study included 90 patients using eye drops, aged between 60 and 75 years old. First, the patient eye drop instillation technique was observed; after, an interview was performed with questions about the same aspects related to the administration of eye drops. The semi-structured questionnaire also included sociodemographic data and information on guidance received regarding the technique of administration. It was found that the majority of the elderly showed deviations from the proper technique of application of eyedrops in the observation and interview, respectively: they did not compressed the lacrimal region (97.8%, 96.7%), they did not keep their eyes closed for about two minutes (94.4%, 82.2%), they did not instilled the drops into the conjunctival sac (75.4%, 77.8%) and they allowed the eyedropper tip touch the eye (44.4%, 31.1%). We observed a statistically significant correlation between educational level and contact of the eyedropper tip with the eye (p = 0.010) during the observation. Among those who consulted with the doctor, only 28.2% had received information and those of whom were attended at the pharmacy, only 2.3% received counseling. Thus, it is important that health professionals instruct their patients, especially the elderly, about the correct eye drop instillation technique regardless how long it has been used and also according to the educational level of each patient...

O objetivo do presente trabalho foi avaliar a aplicação da técnica de administração de colírios por idosos, Trata-se de um estudo transversal realizado no setor de oftalmologia do Centro de Especialidades Médicas de Aracaju, Participaram do estudo 90 usuários de colírios, com faixa etária entre 60 e 75 anos, Primeiramente, fez-se a observação da técnica de administração do colírio realizada pelo paciente, em seguida, fez-se uma entrevista com perguntas sobre os mesmos aspectos referentes à administração do colírio, O questionário semiestruturado utilizado incluiu também dados sócio-demográficos e informação sobre orientação recebida quanto à técnica de administração, Constatou-se que a maior parte dos idosos apresentou desvios da técnica adequada de aplicação do colírio na observação e entrevista, respectivamente: não comprimiram a região lacrimal (97,8%, 96,7%), não mantiveram os olhos fechados por cerca de dois minutos (94,4%, 82,2%), não instilaram o colírio no saco conjuntival (75,4%, 77,8%) e fizeram contato da extremidade do frasco com o olho (44,4%, 31,1%), Foi observada associação estatisticamente significativa entre a escolaridade e o contato da extremidade do frasco com o olho (p = 0,010) durante a observação, Dentre aqueles que consultaram o médico, somente 28,2% relataram terem recebido orientação e dentre os que foram atendidos na farmácia, apenas 2,3% foram orientados, Diante do exposto, é importante que os profissionais da saúde orientem os pacientes, em especial os idosos, a respeito do modo correto de administração de colírio independentemente do tempo de uso do mesmo e de forma apropriada ao nível de instrução de cada paciente...

Motor performance after posteroventral pallidotomy and VIM-thalamotomy in Parkinson's disease: a 1-year follow-up study.

Twenty-three patients with Parkinson's disease underwent stereotactic surgery. To study the long-term motor performance, the patients were evaluated at the pre-operative period and at the 1st, 3rd, 6th, and 12th post-operative months, with the following scales: Unified Parkinson's Disease Rating Scale (UPDRS) motor score and Larsen's Scale for Dyskinesias. The patients under levodopa therapy were assessed both in "on" and "off" periods. Fourteen unilateral ventrolateral thalamotomies (VLT), 4 unilateral posteroventral pallidotomies (PVP), 2 bilateral PVP, and 3 VLT with contralateral PVP were performed. The motor improvement was significant and long-lasting in the "off" period, except for 2 patients. The "on" period quality improved, mainly due to the control of dyskinesias. The improvement of dyskinesias was long-lasting for the majority of the patients. There was no significant decrease in the levodopa dose. Three patients showed permanent complications, but none was severe.

[Stereotaxic thalamotomy and pallidotomy with computerized planning in Parkinson's disease: short-term evaluation of motor function in 50 patients]. / Talamotomia e palidotomia estereotáxica com planejamento computadorizado no tratamento da doença de Parkinson. Avaliação do desempenho motor a curto prazo de 50 pacientes.

We evaluated the motor function of 50 patients with Parkinson's disease, who underwent stereotaxic surgery with computerized planning, without ventriculography (ventrolateral thalamotomy- VLT- and/or posteroventral pallidotomy- PVP) before and one month after surgery. 27 unilateral TVL, 10 unilateral PVP, 6 bilateral PVP, and 7 TVL with PVP were performed. The motor evaluation was performed with the Unified Parkinson's Disease Rating Scale, motor score, during on and off periods. We observed a global motor improvement in all groups. The improvement of dyskinesias was obtained in the contralateral side of the body, in the PVP groups. From the 50 patients, 16 (32%) presented post-operative complications, 9 of these (56.25%) improved completely, 6 (37.25%) improved partially, and 1 (6.25%) did not improve during the first month. These results were considered satisfactory, and a long term analysis will show whether these benefits are long lasting or not.

Tecnicas extracapsulares para a extracao da catarata senil. / Extracapsular technics in senile cataract extraction

Os AA. procuram definir o que entendem por extracao extracapsular da catarata e descrevem a extracao extracapsular programada. Dao particular enfase a necessidade da remocao completa das massas cristalinas o que exige a utilizacao de aparelhagem de aspiracao/irrigacao com controle da pressao positiva e da pressao negativa e tambem a utilizacao do microscopio cirurgico

Lentes intra-oculares. Nossa experiencia com as primeiras 160 cirurgias. / Intraocular lenses. Experience with the first 160 surgeries

Os autores descrevem os resultados obtidos nas primeiras 160 cirurgias realizadas pelo grupo, ja anteriormente treinado em facoemulsificacao e em cirurgia extracapsular. Nesta serie analizada, foram utilizadas principalmente em lentes de camara posterior (131 lentes) e apenas 7 lentes de fixacao angular (lentes de Choyce). As restantes 22 lentes foram de 2 e de 4 alcas, de Binkhorst