Use of nitrous oxide in the treatment of major depressive disorder and treatment-resistant major depressive disorder: A systematic review and meta-analysis nitrous oxide in depressive disorders.

Major Depressive Disorder (MDD) has, as a conventional treatment, pharmacological therapy with selective monoamine reuptake inhibitors. However, the medication does not always have a rapid action for exacerbated cases, and moreover, it is estimated that 15 to 30% of patients do not respond effectively to conventional treatment, leading to 'treatment-resistant depressive mood disorder' (TRD). Thus, it is necessary to search for new therapeutic methods for exacerbated and resistant cases. The objective of the study was to evaluate the therapeutic effects of nitrous oxide (N2O) in patients with MDD and TRD. The study was characterized as a systematic review of randomized clinical trials. Search strategy was developed using the keywords "nitrous oxide," "treatment-resistant depression," "Depression disorder," and their synonyms, searched in the databases MEDLINE, EMBASE, LILACS, and American Psychological Association. Four articles were included in the systematic review, with two of them being utilized for the meta-analysis, which comprised a total of 23 patients with MDD and 86 with TRD. A standardized mean difference (SMD) for the HDRS score at 24 h of -2.36 was found, with a 95% confidence interval (CI) of -3.37 to -1.34 (p < 0.0001; I2 = 46%). For the evaluation of the score after one week, an SMD of -0.60, 95% CI of -1.13 to -0.07 (p = 0.03; I2 = 0%) was found. In conclusion, N2O has a rapid action for managing decompensated patients, with a potential therapeutic effect for TRD. However, more studies needed to determine N2O's effectiveness duration.

Efficacy of infliximab in treatment-resistant depression: A systematic review and meta-analysis.

BACKGROUND: Treatment-resistant depression (TRD) denotes the therapeutic failure of at least two evidence-based, dose-based, and time-appropriate treatment regiments for major depressive disorder (MDD). Studies have suggested that alterations in proinflammatory cytokines play an important role in the pathophysiology of TRD, as well as a significant relationship between the number of failed treatment and the levels of tumor necrosis factor-alpha (TNF-α). OBJECTIVE: Performed a systematic review and meta-analysis to evaluate the potential effect of the TNF-inhibitor Infliximab adjunct treatment in MDD, through randomized controlled trials (RCT). METHODS: A search in the electronic databases was proceeded, on MEDLINE, EMBASE, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), Biomed Central, Web of Science, IBECS, LILACS, PsycINFO, Congress Abstracts, and Grey literature (Google Scholar and the British Library) for studies published until April 2019. A search strategy was developed using the terms: "Mood disorder" OR "Depressive Disorder" OR "Bipolar disorder" AND "Infliximab" OR "tumor necrosis factor antagonist" as text words and Medical Subject Headings (i.e., MeSH and EMTREE). The therapeutic effects of adjunctive treatment with Infliximab were analyzed. The meta-analysis was performed including the results of the Hamilton Scale for Depression (HAM-D). RESULTS: Four primary studies were included in the systematic review, with a total of 152 patients. The meta-analysis did not show a statistically significant effect of Infliximab as an adjuvant treatment for TRD. LIMITATIONS: Articles in this meta-analysis originate from the same country. The main treatments used were different among the included studies. CONCLUSION: Infliximab was not efficient in reducing depressive symptoms according to the HAM-D, only when the patients already had increased inflammatory genes, including TNF and C-reactive protein (CRP).

Atuação ética do enfermeiro frente aos erros de medicação / Ethical role nurses face with medication errors

Objetivo: identificar a atuação ética do enfermeiro frente aos erros de medicação. Pesquisa qualitativa, descritiva, exploratória e de campo. Realizou-se entrevista semiestruturada com 10 enfermeiros. A análise dos dados foi realizada a partir da análise de conteúdo. Resultados: a atuação ética do enfermeiro frente aos erros de medicação inclui a tomada de decisão em relação às intercorrências com o paciente; ações educativas com a equipe de enfermagem; registro do erro e aplicação de penalidades. Conclusão: considera-se imprescindível a educação permanente dos profissionais para a prevenção e redução de erros de medicamentos, possibilitando a segurança do paciente e qualificação do serviço.

Objective: to identify the work ethics of nurse facing medication errors. Qualitative, descriptive, exploratory field research. Semi-structured interview was held with 10 nurses. Data analysis was carried out from the analysis of content. Results: the ethic of the nurse facing medication errors include decision-making in relation to complications with the patient; educational activities with the nursing staff; error log and the application of penalties. Conclusion: it is considered vital the permanent education of professionals for the prevention and reduction of medication errors, patient safety and service qualification.

Objetivo: identificar la ética de trabajo de la enfermera frente a errores de medicación. Investigación cualitativa, descriptiva, exploratoria y campo. Entrevista semiestructurada se realizó con 10 enfermeras. Análisis de datos se llevó a cabo a partir del análisis de contenido. Resultados: la ética de la enfermera frente a errores de medicación incluyen la toma de decisiones en relación con las complicaciones con el paciente; actividades educativas con el personal de enfermería; registro de errores y la aplicación de sanciones. Conclusión: se considera imprencíndivel la formación permanente de profesionales para la prevención y reducción de errores de medicación, seguridad del paciente y calificación de servicio.

Knowledge, attitudes and adherence to treatment in individuals with hypertension and diabetes mellitus / Conhecimento atitudes e adesão ao tratamento em indivíduos com hipertensão e diabetes

Chronic Noncommunicable Diseases (NCD) constitute a major health problem in Brazil and corresponds to about 70% of the causes of death. The most common are systemic arterial hypertension and diabetes mellitus, which require the patients to be more closely controlled for its treatment and management². This study aimed to analyze the knowledge, attitudes and adherence to the treatment of individuals with arterial hypertension and associated type 2 diabetes mellitus, accompanied by a Family Health team. This was a cross-sectional, descriptive and prospective quantitative approach. The population consisted of patients diagnosed with hypertension and type 2 diabetes mellitus, enrolled in the HIPERDIA program. Data were collected from August to November of 2014 through the Diabetes Knowledge Scale Questionnaire (DKN-A); Diabetes Attitudes Questionnaire (ATT-19) and Martín-Bayarre-Grade (MBG). 102 individuals were interviewed, the majority of whom were women, married, white, with low schooling, and with a median age of 68.5 years. Everyone was on medication and most of them did not practice any kind of physical activity. An unsatisfactory result was found in relation to the knowledge about the disease, negative attitude regarding the management of the disease, and partial adherence to the treatment. It is thus considered that individuals with hypertension and diabetes mellitus did not modify their attitudes regarding the adoption of healthy life habits for the more adequate coping of the disease.

As Doenças Crônicas Não Transmissíveis (DCNT) se constituem no maior problema de saúde do Brasil e correspondem a cerca de 70% das causas de morte, sendo as mais comuns delas a hipertensão arterial sistêmica e a diabetes mellitus tipo 2, que exigem dos pacientes acometidos maior controle em relação ao seu tratamento e manejo². Assim, este estudo teve como objetivo analisar o conhecimento, as atitudes e a adesão ao tratamento de indivíduos com hipertensão arterial e diabetes mellitus tipo 2, os quais foram acompanhados por uma equipe do programa Saúde da Família. Trata-se, portanto, de um estudo transversal, descritivo e prospectivo de abordagem quantitativa. O quadro de indivíduos analisados foi constituído por pacientes com diagnóstico de hipertensão arterial e diabetes mellitus tipo 2 cadastrados no programa HIPERDIA. Os dados foram coletados no período de agosto a novembro de 2014, por meio dos questionários Diabetes Knowledge Scale Questionnaire (DKN-A), Attitudes Questionnaire (ATT-19) e MartínBayarre-Grau (MBG). Foram entrevistados 102 indivíduos, sendo a maioria composta por mulheres casadas, brancas, de baixa escolaridade, com idade mediana de 68,5 anos. Ao longo da pesquisa, verificou-se que todos faziam uso de medicamentos e a maioria não praticava nenhum tipo de atividade física. Constatou-se também resultado insatisfatório com relação ao conhecimento sobre a doença, atitude negativa relacionada ao manejo da doença e adesão parcial ao tratamento. Verificou-se, assim, que a maior parte dos indivíduos com hipertensão e diabetes mellitus envolvidos na pesquisa, apesar de cientes de seu quadro, escolheram não modificar suas atitudes ou adotar hábitos de vida mais saudáveis que lhes garantissem o enfrentamento mais adequado da doença.

Planejamento das ações educativas pela equipemultiprofissional da Estratégia Saúde da Família / Planning of Educational Actions by the Multidisciplinary Teamof the Family Health Strategy

O objetivo da pesquisa foi identificar como são planejadas as ações de educação em saúde pela equipe multiprofissionalna Estratégia Saúde da Família. Estudo de abordagem qualitativa realizado nas Estratégias Saúde da Família pertencentea uma regional de saúde com uma amostra de oito enfermeiras gerentes dessas unidades. As dificuldades para desenvolveras ações educativas estão relacionadas ao comprometimento da equipe, adesão da comunidade, falta de recursoshumanos, materiais e financeiros e falta de apoio por parte dos gestores. É imprescindível o constante aprimoramento doconhecimento e prática dos profissionais para desenvolver as ações de educação em saúde.

The objective of the research was to identify how the health education actions are planned by the multidisciplinary team atthe Family Health Strategy. A qualitative study was conducted in the Family Health Strategies belonging to a health regionalwith a sample of eight nurses who are managers of these units. The difficulties to develop educational activities are relatedto team commitment, community membership, lack of human, material and financial resources and lack of support frommanagers. Constant improvement of knowledge and professional practice to develop health education actions is essential.

Utilização de medicamentos: limites e possibilidades das orientações dos Agentes Comunitários de Saúde às famílias / Drug use: limits and possibilities of the instructions Communitarian Health Agents give to families

presente estudo objetivou conhecer os limites e possibilidades referentes às orientações realizadas pelos Agentes Comunitários de Saúde – ACS sobre a utilização de medicamentos pelas famílias atendidas pelas Estratégias de Saúde da Família– ESF. Trata-se de uma pesquisa qualitativa, descritivo-exploratória e de campo. Aplicou-se entrevista semiestruturada com15 ACS de oito unidades da Estratégia de Saúde da Família de um município do extremo sul de Santa Catarina. Os dados foram analisados pela categorização de dados. Os maiores problemas relatados pelas ACS na utilização das medicações pelas famílias foram relacionados a: armazenamento de medicação; automedicação; horário e quantidades incorretas;interação e reação adversa dos medicamentos; dificuldade de entendimento e adesão das famílias às orientações; e uso associado de plantas medicinais com medicações de uso contínuo. Sugere-se a partir dos resultados da pesquisa a capacitação das ACS para o uso racional de medicamentos, sendo que essa atividade poderá ser desenvolvida pelos farmacêuticos dos Núcleos de Apoio à Saúde da Família – NASF. A assistência farmacêutica na ESF pressupõe uma mediação entre o saber das ACS e o saber das famílias assistidas, o que implica a escuta atenta, diálogo mútuo, identificando as necessidades dos familiares e busca da formação de vínculos com a comunidade e o uso racional de medicamentos.

The present study aims to know the limits and possibilities on the instructions given by Community Health Agents – ACSon the use of drugs by families assisted by the Family Health Strategy – ESF. This is a qualitative, descriptive, exploratoryand field work. We applied half-structured interviews with 15 ACS from eight units of the Family Health Strategy in a cityin the southern end of Santa Catarina. Data were analysed and classified in categories. The major problems reported by ACS in the use of medications by families were related to: storage of medication; self-medication; schedule and incorrec amounts; interaction and adverse reaction of medicines; families having difficulties understanding instructions and adhesion to treatment; and the use of plant based drugs with continuous use medicine. It is suggested from the results of the research that ACS be trained for the rational use of medicines by families, and this activity may be developed by pharmacists from Family Health Support Nuclei – NASF. Pharmaceutical care in FHS requires mediation between ACS knowledge and the knowledge of families assisted, which implies attentive listening, a real dialogue, identifying the needs of families and making efforts to create bonds with the community, and the rational use of medicines.