Abstract Objective: The purpose of this study is to evaluate the pharmaceutical interventions (PI) performed in PRM and the factors associated with their acceptance. Method: This is a descriptive and ...cross-sectional study that analyzed PIs performed on adult patients from two ICUs in Fortaleza, Brazil, in 2019. PIs were analyzed in the categories quantity of drug and pharmacological strategy, using the classification proposed by Sabater et al. The drugs were also classified by the Anatomical, Therapeutic, and Chemical Classification System and by the High Surveillance Drugs (FAV) classification. Results: 305 patients were included, most of them male (55.1 %), elderly (52.8 %) and treated in the surgical ICU (51.4 %). 1,317 PIs were analyzed and 88.0 % were accepted, being to replace one or more drugs (28.0 %), to add one or more drugs (27.7 %) and to change the dose (24.8 %) the most frequent types. The most prevalent therapeutic class was anti-infectives for systemic use (24.1 %) and AVFs were involved in 21.7 % of the PIs. An association was observed between PIs accepted and admission to the clinical ICU (p<0.0001), AVF (p=0.0013), substitution of one or more drugs (p=0.0062) and the class of blood substitutes and perfusion solutions. (p= 0.0187). Conclusions: A high number of PIs were performed and accepted, which reinforces the importance of the pharmacist in the review of medical prescriptions in the ICU.
El objetivo del estudio fue identificar el nivel de conocimiento que tienen los profesionales de Enfermería sobre la atención a Personas con Discapacidad (PCD) Física en parcial abandono. Los ...participantes del estudio los constituyeron las PCD Física en parcial abandono y el Personal de Enfermería de los Centros de Salud San Antonio, Centro Nro.1 y Centro de Salud la Esperanza de la Provincia de Imbabura. Se aplicó el Cuestionario con base al cuestionario de Discapacidades del Instituto Nacional de Estadística-España, que mide tres categorías: Discapacidad, Autonomía personal y situaciones de Desentendencia. Se dio énfasis a las respuestas dicotómicas. Se utilizó el coeficiente de correlación de Spearman para relacionar las variables en base a las categorías de estudio. Se aplicó el test Chi cuadrado y la prueba exacta de Fisher para las hipótesis de estudio. Los principales resultados al relacionar las variables dicotómicas en las matrices de correlación de Spearman, sugieren la necesidad de implementar estrategias de mejora enfocadas en la comunicación y en la eficacia de la práctica de enfermería, destacando áreas específicas para el desarrollo profesional y la capacitación. Como conclusión se menciona el desconocimiento en algunos casos por parte del Personal de Enfermería de la situación de Discapacidad, Autonomía Personal y Situaciones de Dependencia de las PCD en Parcial abandono, y la necesidad de actualizar los conocimientos por parte del Personal de Enfermería para brindar una atención oportuna y de calidad.
Introdução: Os avanços na medicina proporcionaram a possibilidade do transplante de órgãos e tecidos para fins terapêuticos. Os pacientes transplantados, além da terapia imunossupressora, fazem, em ...sua maioria, tratamento para outras comorbidade e essa polifarmácia faz com que o papel do farmacêutico seja de extrema importância para garantir a segurança e a adesão do paciente. Por meio das recomendações farmacêuticas (RF), o profissional consegue reduzir a morbimortalidade e o tempo de internação, assim como os custos de saúde. Métodos: Trata-se de estudo observacional, descritivo retrospectivo, realizado no período de janeiro de 2021 a dezembro de 2022, que tem por objetivo analisar o impacto econômico das recomendações farmacêuticas realizadas em uma unidade de transplante hepático de um hospital universitário. A coleta de dados ocorreu no período de maio a agosto de 2023 com auxílio do banco de dados da farmácia clínica da instituição. O impacto econômico foi classificado como aumento de efetividade (AE), redução de custo (RC) e risco evitado (RE), calculados por uma metodologia desenvolvida e adaptada à realidade do estudo. Os custos relacionados à aquisição dos medicamentos foram verificados mediante o sistema próprio do hospital e os valores foram ajustados de acordo com a inflação de junho de 2023. Resultados: Foram realizadas 363 RF, das quais o AE representou 64% (n = 231), seguido por RC (20%, n = 72) e RE (16%, n = 60). O valor total resultante corrigido pelo Índice Nacional de Preços ao Consumidor Amplo (IPCA) foi de R$ 179.223,31, sendo o valor do RE de R$ 140.414,04 e da RC de R$ 38.809,27. Conclusão: A importância do farmacêutico clínico na equipe multidisciplinar é evidente por meio da melhoria do acompanhamento dos pacientes, da monitorização e da gestão da condição de saúde. Por intermédio deste estudo podemos perceber que as RF apresentadas obtiveram impacto financeiro considerável e obteve-se, pela otimização da farmacoterapia dos pacientes transplantados, uma AE terapêutica. Percebe-se, ainda, a importância de se desenvolverem mais estudos que mostrem o impacto da qualidade assistencial proporcionada pela atuação da farmácia clínica, para que seja possível destacar a importância dessa seara para a assistência em saúde.
Objective: To evaluate the application of the Antimicrobial (ATM) treatment time reduction strategy in Intensive Care Units (ICU) in an Antimicrobial Stewardship Program (ASP).
Method: This is a ...descriptive and cross-sectional study, carried out in two ICU of a university hospital in Fortaleza, Brazil, from January/2017 to January/2019. Adult patients were included, accompanied by a pharmacist, and using ATM, in which the treatment time reduction strategy was applied. The evaluation of the strategy was made through the difference between the predicted time established at the beginning of the treatment and the effective days of use of each ATM.
Results: Of the 100 patients included, 51.0 % were male and 64.0 % were elderly. The respiratory system was the most frequently affected by the infections (37.4 %) and the most prevalent classes of ATM were carbapenems (23.0 %) and glycopeptides (20.1 %). There was a decrease from 831 unnecessary days of antimicrobial therapy and from an average of 13.7 to 8.9 days of treatment. The greatest reductions in days were observed for meropenem, with 202 days reduced. The study also allowed the identification of associations between the reduction > 8 days of treatment and the variables length of stay > 22 days and patients in exclusive palliative care, and associations between hospital discharge and reductions of up to 7 days of therapy.
Conclusions: The data obtained suggest that the presence of an ASP influences the practices of ATM use and its treatment time and emphasize the role of pharmaceutical professionals in these programs.
Human appropriation analysis allows interrelating ecological and socioeconomic dimensions to be applied during the development of management strategies for increasing the sustainability of land uses. ...However, the design of such management strategies requires data reflecting site-specific conditions at sub-national levels. In this study, we assessed the dynamics of human appropriation using an exergy-based net primary production (HANPPEX) indicator. The results depicted positive (5–10 MJex/m2.y) HANPPEX changes for cropland areas in both regions. The harvested biomass and land-use changes were identified as responsible for high HANPPEX, which varied significantly between land cover types. In particular, cropland and urban/industrial yielded the highest HANPPEX compared to other land cover types. Accordingly, the land cover transition toward urban and agriculture land uses increased the HANPPEX for Ñuble and Biobío. The main HANPP differences found between regions were related to their socioeconomic characteristics as well as to the heterogeneity of land-use types, biomass structure, and regional biomass demand. Our findings provide insights on the magnitude and direction of NPP changes associated with human appropriation at the regional level, allowing a more detailed understanding of the efficiency with which humans utilize terrestrial natural resources.
Display omitted
•Strategies for better land use sustainability need regional human appropriation data.•We used the exergy-based net primary production (HANPPEX) indicator for HA dynamics.•Urban and croplands had high HANPPEX upon spatial analysis of two Chilean regions.•Regional differences were from socioeconomic, land-use type, and biomass features.•Understanding regional HA-related NPP profiles may optimize natural resource use.
The self-administered Kidney AlloTransplant Immunosuppressive Therapy Adherence (KATITA-25) questionnaire is a multidimensional scale for use in the pretransplant setting that evaluates the ...predisposition to nonadherence of patients who are candidates to kidney transplant. The scale has shown adequate internal consistency and test-retest reliability. This study presents the results of an external validation study of the KATITA-25 scale.
Patients >18 y old scheduled for kidney transplant were included in this multicenter study. The KATITA-25 scale was administered before surgery and then at 3-mo posttransplantation for evaluation of scale sensitivity to change. At this time, 2 validated medication adherence scales were applied for assessment of concurrent validity. For evaluation of predictive validity, nonadherence to immunosuppressive medication was assessed at 6 and 12 mo after transplantation by 3 independent methods: patient self-report of nonadherence using the Morisky-Green-Levine Medication Assessment Questionnaire scale, serum trough levels of immunosuppressants, and pharmacy refills.
Three twenty-two patients were available for evaluation of concurrent validity and 311 patients of predictive validity. After kidney transplant, the median KATITA-25 score decreased from 20 to 8 (P < 0.001), demonstrating scale sensitivity to change, and the KATITA-25 score showed correlation with the Basel Assessment of Adherence to Immunosuppressive Medication Scale score (Spearman's ρ 0.18, P = 0.002) and the Cuestionario para la Evaluación de la Adhesión al Tratamiento Antiretroviral scores (ρ -0.17, P = 0.002), confirming concurrent validity. The nonadherence rate was 57.6%. The scale predictive validity was demonstrated by the area under the receiver operating characteristics curve (0.68), sensitivity (59.8%), specificity (68.2%), and positive predictive value (71.8%).
This external validation study of KATITA-25 scale provided evidence of sensitivity to change, and structural, criterion, and predictive validity.
INTRODUCTIONThis study evaluated the epidemiology of American cutaneous leishmaniasis in the immediate region of Ji-Paraná, Rondônia State. METHODSSamples and epidemiological data were collected from ...105 patients. RESULTSLeishmania infection was observed in 58 (55.2%) patients, and Leishmania braziliensis was present in 82.9% of the 41 sequenced samples. Infected patients were predominantly male (93.1%). Leishmania infection was twice as prevalent among rural inhabitants versus urban inhabitants. Lesions were more frequent in the upper limbs (arms/hands, 41.82%). CONCLUSIONSThe present data corroborate the zoonotic profile of cutaneous leishmaniasis; this information could help to improve surveillance and control strategies.
Introduction: Advances in medicine have provided the possibility of organs and tissues transplantation for therapeutic purposes. Transplant patients, in addition to immunosuppressive therapy, mostly ...undergo treatment for other comorbidities, and this polypharmacy makes the role of the pharmacist extremely important to ensure patient safety and adherence. Through pharmaceutical recommendations, the professional can reduce morbidity and mortality and thus reduce healthcare costs. Methods: This is an observational, retrospective descriptive study, carried out from January 2021 to December 2022, aiming to analyze the economic impact of pharmaceutical recommendations made in a liver transplant unit of an university hospital. Data collection took place from May to August 2023 through the institution’s clinical pharmacy database. The economic impact was classified as effectiveness increased (EI), cost reduction (RC), and avoided risk (AR) calculated through a methodology developed and adapted to the study’s reality. Medication acquisition costs were verified through the hospital’s own system, and the values were adjusted according to inflation in June 2023. Results: A total of363 pharmaceutical recommendations (PR) were conducted, of which the EI represented 64% (n = 231), followed by RC (20%, n = 72) and risk avoided (16%, n = 60). The total resulting value corrected by the Índice Nacional de Preços ao Consumidor Amplo (IPCA) was R$ 179,223.31, with the AE at R$ 140,414.04 and the RC at R$ 38,809.27. Conclusion: The importance of the clinical pharmacist in the multidisciplinary team is evident through the improvement of patient monitoring and health condition management. Through this study, we can perceive that the PR presented had a considerable financial impact, and, through the optimization of pharmacotherapy for transplant patients, an increase in therapeutic EI was obtained. The importance of developing further studies showing the impact of the quality of care provided by the pharmacy’s performance is clear, to further highlight the importance of this field for healthcare assistance.
Objetivo: El propósito de este estudio es evaluar las intervenciones farmacéuticas (IF) realizadas sobre PRM y los factores asociados a su aceptación.
Método: Se trata de un estudio descriptivo y ...transversal que analizó las IF realizadas a pacientes adultos de dos UCI de Fortaleza, Brasil, en 2019. Las IF se analizaron en las categorías cantidad de fármaco y estrategia farmacológica, utilizando la clasificación propuesta por Sabater et al. Los fármacos se clasificaron además por el Sistema de Clasificación Anatómica, Terapéutica, Química y por la clasificación de Fármacos de Alta Vigilancia (FAV).
Resultados: Se incluyeron 305 pacientes, siendo la mayoría del sexo masculino (55,1 %), ancianos (52,8 %) y atendidos en la UCI quirúrgica (51,4 %). Se analizaron 1.317 IF y se aceptaron el 88,0 %, siendo la sustitución de uno o más fármacos (28,0 %) y la adición de uno o más fármacos (27,7 %) las más frecuentes. La clase terapéutica más prevalente fue antiinfeccioso de uso sistémico (24,1 %) y los FAV estuvieron implicados en el 21,7 % de las IF. Se observó asociación entre las IF aceptadas e ingreso en UCI clínica (p<0,0001), FAV (p=0,0013), sustitución de uno o más fármacos (p=0,0062) y la clase sustitutos sanguíneos y soluciones de perfusión (p= 0,0187).
Conclusiones: Se realizaron y aceptaron un elevado número de IF, lo que refuerza la importancia del farmacéutico en la revisión de las prescripciones médicas en UCI.
PDF
