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Assad Lemos C, Zago Oliveira T, Alves Cunha JP, Vieira Medeiros Costa D, Barboza Zanetti MO, Aparecida Spadoti Dantas R, Rossi Varallo F, Régis Leira Pereira L. Instruments to assess diabetes knowledge, skills and attitudes of people living with diabetes mellitus: A COSMIN-based systematic review. Diabetes Metab Syndr 2024; 18:102974. [PMID: 38520910 DOI: 10.1016/j.dsx.2024.102974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 03/25/2024]
Abstract
AIMS Since knowledge, skills, and attitudes influence the adherence to self-care behaviours, the purpose of this review was to identify available instruments that measure diabetes knowledge, skills or attitudes of people living with this health condition and to evaluate their measurement properties. METHODS A systematic search was conducted in PubMed, EMBASE, SCOPUS, Web of Science and CINAHL databases. The methodological quality of the included studies was assessed by the Consensus-based Standards for the selection of health Measurement Instruments. Risk of Bias checklist. The results of each study were rated by the updated criteria for good measurement properties and the quality of evidence was graded using a modified Grading of Recommendations Assessment, Development, and Evaluation approach. RESULTS This review included 38 instruments that assess diabetes knowledge (n = 26) or skills (n = 6) or attitudes (n = 5) or both three constructs (n = 1). About 40% had satisfactory results for relevance, comprehensiveness, and comprehensibility, and about 30% had unsatisfactory results for comprehensiveness, but these results were supported by very low evidence. Most studies showed indeterminate results for structural validity (50%), internal consistency (98%) and reliability (84%). Instruments that had satisfactory results for construct validity and reliability were supported by low to very low evidence. One responsiveness study was identified, and the result was satisfactory, but supported by low evidence. The Diabetes Knowledge Questionnaire is the instrument with best evidence for use. CONCLUSIONS To plan more assertive interventions, researchers need to follow up guidelines to develop instruments with good quality of the measurement proprieties.
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Affiliation(s)
- Carla Assad Lemos
- Department of Pharmaceutical Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, Ribeirão Preto, SP, Brazil.
| | - Thalita Zago Oliveira
- Department of Pharmaceutical Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - João Paulo Alves Cunha
- Department of Pharmaceutical Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - Daiane Vieira Medeiros Costa
- Department of General and Specialized Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, SP, Brazil
| | - Maria Olívia Barboza Zanetti
- Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, SP, Brazil
| | - Rosana Aparecida Spadoti Dantas
- Department of General and Specialized Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, SP, Brazil
| | - Fabiana Rossi Varallo
- Department of Pharmaceutical Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - Leonardo Régis Leira Pereira
- Department of Pharmaceutical Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, Ribeirão Preto, SP, Brazil
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de Andrade FK, Ignacio Nunes RP, Barboza Zanetti MO, Barboza Zanetti AC, Dos Santos M, de Oliveira AM, Carson-Stevens A, Leira Pereira LR, Rossi Varallo F. Validated medication deprescribing instruments for patients with palliative care needs palliative care: A systematic review. Farm Hosp 2024; 48:T83-T89. [PMID: 38016841 DOI: 10.1016/j.farma.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 08/01/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVES Patients with life-limiting illnesses are prone to unnecessary polypharmacy. Deprescribing tools may contribute to minimizing negative outcomes. Thus, the aims of the study were to identify validated instruments for deprescribing inappropriate medications for patients with palliative care needs and to assess the impact on clinical, humanistic, and economic outcomes. METHODS A systematic review was conducted in LILACS, PUBMED, EMBASE, COCHRANE, and WEB OF SCIENCE databases (until May 2021). A manual search was performed in the references of enrolled articles. The screening, eligibility, extraction, and bias risk assessment were carried out by two independent researchers. Experimental and observational studies were eligible for inclusion. RESULTS Out of the 5,791 studies retrieved, after excluding duplicates (n = 1,050), conducting title/abstract screening (n = 4,741), and full reading (n = 41), only one study met the inclusion criteria. In this included study, a randomized controlled trial was conducted, which showed a high level of bias risk overall. Adults 75 years or older (n = 130) with limited life expectancy and polypharmacy were allocated to two groups [intervention arm (deprescribing); and control arm (usual care)]. Deprescribing was performed with the aid of the STOPPFrail tool. The mean number of inappropriate medications and monthly medication costs were significantly lower in the intervention arm. No statistically significant differences were found in terms of unscheduled hospital presentations, falls, fractures, mortality, and quality of life. CONCLUSIONS Despite the availability of several instruments to support deprescribing in patients with palliative care needs, only one of them has undergone validation and robust assessment for effectiveness in clinical practice. The STOPPFrail tool appears to reduce the number of inappropriate medications for older people with limited life expectancy (and probably palliative care needs) and decrease the monthly costs of pharmacotherapy. Nevertheless, the impact on patient safety and humanistic outcomes remain unclear.
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Affiliation(s)
- Frangie Kallas de Andrade
- Facultad de Ciencias Farmacéuticas de Ribeirão Preto, Universidad de São Paulo (USP), São Paulo, Brasil
| | | | | | | | - Márcia Dos Santos
- Biblioteca Central, Universidad de São Paulo (USP), Ribeirão Preto, São Paulo, Brasil
| | - Alan Maicon de Oliveira
- Facultad de Ciencias Farmacéuticas de Ribeirão Preto, Universidad de São Paulo (USP), São Paulo, Brasil.
| | - Andrew Carson-Stevens
- Centro PRIME de Gales, División de Medicina de la Población, Facultad de Medicina, Universidad de Cardiff, Cardiff, Reino Unido
| | | | - Fabiana Rossi Varallo
- Facultad de Ciencias Farmacéuticas de Ribeirão Preto, Universidad de São Paulo (USP), São Paulo, Brasil
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de Andrade FK, Nunes RPI, Zanetti MOB, Zanetti ACB, Dos Santos M, de Oliveira AM, Carson-Stevens A, Pereira LRL, Varallo FR. Validated medication deprescribing instruments for patients with palliative care needs: a systematic review. Farm Hosp 2024; 48:83-89. [PMID: 37770284 DOI: 10.1016/j.farma.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 09/30/2023] Open
Abstract
OBJECTIVES Patients with life-limiting illnesses are prone to unnecessary polypharmacy. Deprescribing tools may contribute to minimizing negative outcomes. Thus, the aims of the study were to identify validated instruments for deprescribing inappropriate medications for patients with palliative care needs and to assess the impact on clinical, humanistic, and economic outcomes. METHODS A systematic review was conducted in LILACS, PUBMED, EMBASE, COCHRANE, and WEB OF SCIENCE databases (until May 2021). A manual search was performed in the references of enrolled articles. The screening, eligibility, extraction, and bias risk assessment were carried out by 2 independent researchers. Experimental and observational studies were eligible for inclusion. RESULTS Out of the 5791 studies retrieved, after excluding duplicates (n = 1050), conducting title/abstract screening (n = 4741), and full reading (n = 41), only 1 study met the inclusion criteria. In this included study, a randomized controlled trial was conducted, which showed a high level of bias risk overall. Adults 75 years or older (n = 130) with limited life expectancy and polypharmacy were allocated to 2 groups [intervention arm (deprescribing); and control arm (usual care)]. Deprescribing was performed with the aid of the STOPPFrail tool. The mean number of inappropriate medications and monthly medication costs were significantly lower in the intervention arm. No statistically significant differences were found in terms of unscheduled hospital presentations, falls, fractures, mortality, and quality of life. CONCLUSIONS Despite the availability of several instruments to support deprescribing in patients with palliative care needs, only 1 of them has undergone validation and robust assessment for effectiveness in clinical practice. The STOPPFrail tool appears to reduce the number of inappropriate medications for older people with limited life expectancy (and probably palliative care needs) and decrease the monthly costs of pharmacotherapy. Nevertheless, the impact on patient safety and humanistic outcomes remain unclear.
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Affiliation(s)
- Frangie Kallas de Andrade
- University of São Paulo (USP), School of Pharmaceutical Sciences of Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil
| | - Raziel Prado Ignacio Nunes
- University of São Paulo (USP), School of Pharmaceutical Sciences of Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil
| | | | | | - Márcia Dos Santos
- University of São Paulo (USP), Central Library, Ribeirão Preto, Brazil
| | - Alan Maicon de Oliveira
- University of São Paulo (USP), School of Pharmaceutical Sciences of Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil.
| | - Andrew Carson-Stevens
- PRIME Centre Wales, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Leonardo Régis Leira Pereira
- University of São Paulo (USP), School of Pharmaceutical Sciences of Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil
| | - Fabiana Rossi Varallo
- University of São Paulo (USP), School of Pharmaceutical Sciences of Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil
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Oliveira TZ, de Rezende CZ, Cardoso HW, Nascimento SF, Cunha JPA, Lemos CA, Varallo FR, Pereira LRL. A Scoping Review of Pharmacists' and Pharmacy Students' Knowledge, Skills, and Attitudes in Medical Emergencies. Am J Pharm Educ 2024; 88:100606. [PMID: 37839555 DOI: 10.1016/j.ajpe.2023.100606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 09/28/2023] [Accepted: 10/09/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVES Competence can be defined as a set of knowledge, skills, and attitudes. In a medical emergency scenario, competent pharmacists are increasingly required, mainly as a result of the expansion of professional functions in this context. Therefore, the objective of this study was to map the scientific evidence that shows the development of knowledge and/or skills, and/or attitudes in the training of pharmacists and pharmacy students to work in emergency care. FINDINGS The scoping review was conducted in the PubMed, Embase, Latin American and Caribbean Health Sciences Literature, Scopus, Web of Science, and Cumulative Index to Nursing and Allied Health Literature databases in January 2021, as recommended by the Joanna Briggs Institute. Our study retrieved 6276 files, and 31 articles met the inclusion criteria. It was observed that the studies were developed mainly in the United States of America and addressed the development and/or assessment of knowledge and skills, and training in cardiac emergencies. The most used teaching strategy was simulation, and the most used assessment strategy was feedback and/or debriefing. SUMMARY Publications involving the development of at least 1 domain of clinical competence have increased in the last decade. Thus, the mapping of studies has provided subsidies for identifying gaps in the teaching-learning process, as well as the identification of methodologies applied in the development and assessment of clinical competence for the referred population.
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Affiliation(s)
- Thalita Zago Oliveira
- University of São Paulo, School of Pharmaceutical Sciences of Ribeirão Preto, Department of Pharmaceutical Sciences, Ribeirão Preto, São Paulo, Brazil.
| | - Clara Zambon de Rezende
- University of São Paulo, School of Pharmaceutical Sciences of Ribeirão Preto, Department of Pharmaceutical Sciences, Ribeirão Preto, São Paulo, Brazil
| | - Higor Weslley Cardoso
- University of São Paulo, School of Pharmaceutical Sciences of Ribeirão Preto, Department of Pharmaceutical Sciences, Ribeirão Preto, São Paulo, Brazil
| | - Sofia Fernandes Nascimento
- University of São Paulo, School of Pharmaceutical Sciences of Ribeirão Preto, Department of Pharmaceutical Sciences, Ribeirão Preto, São Paulo, Brazil
| | - João Paulo Alves Cunha
- University of São Paulo, School of Pharmaceutical Sciences of Ribeirão Preto, Department of Pharmaceutical Sciences, Ribeirão Preto, São Paulo, Brazil
| | - Carla Assad Lemos
- University of São Paulo, School of Pharmaceutical Sciences of Ribeirão Preto, Department of Pharmaceutical Sciences, Ribeirão Preto, São Paulo, Brazil
| | - Fabiana Rossi Varallo
- University of São Paulo, School of Pharmaceutical Sciences of Ribeirão Preto, Department of Pharmaceutical Sciences, Ribeirão Preto, São Paulo, Brazil
| | - Leonardo Régis Leira Pereira
- University of São Paulo, School of Pharmaceutical Sciences of Ribeirão Preto, Department of Pharmaceutical Sciences, Ribeirão Preto, São Paulo, Brazil
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Cavalcante-Santos LM, Guarnieri AC, Conegundes FSDL, Giardini MH, Pereira LRL, Varallo FR. Clinical pharmacy in hospital palliative medicine: non-randomised clinical trial. BMJ Support Palliat Care 2023:spcare-2023-004620. [PMID: 38129106 DOI: 10.1136/spcare-2023-004620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE To assess the impact of pharmaceutical care on hospital indicators and clinical outcomes of palliative care (PC) patients admitted to a secondary hospital. METHODS A non-randomised clinical trial was carried out in the PC ward of a secondary hospital in São Paulo, Brazil. Pharmaceutical care for all patients aged 18 and above, admitted between October 2021 and March 2022, with stays exceeding 48 hours, was provided. The interventions required were performed in collaboration with healthcare teams, patients and caregivers. Assessments occurred at admission and discharge, using PC performance scales and pharmacotherapy tools, with Research Ethics Committee approval. RESULTS Over 6 months, 120 hospitalisations were analysed, primarily involving women (58.9%), averaging 71.0 years, with neoplasm diagnoses (20.5%). A total of 170 drug-related problems were identified in 68.3% of patients. Following assessment, 361 interventions were performed, with a 78.1% acceptance rate, including medication dose adjustments, additions and discontinuations. Addressing unintentional pharmacotherapy discrepancies at admission led to reduced hospital stays (p<0.05). Pharmaceutical interventions also decreased pharmacotherapy complexity (p<0.001), inappropriate medications for the older people (p<0.001) and improved symptom management, such as pain (p<0.05). CONCLUSIONS Pharmaceutical care services integrated within the multiprofessional health team contributed to reducing drug-related problems associated with polypharmacy as well as improved the management PC symptoms in end-of-life patients, which reduced hospitalisation time.
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Affiliation(s)
- Lincoln Marques Cavalcante-Santos
- Department of Pharmaceutical Sciences, Pharmaceutical Care and Clinical Pharmacy Research Center, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Ana Carolina Guarnieri
- Department of Pharmaceutical Sciences, Pharmaceutical Care and Clinical Pharmacy Research Center, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Fernanda Silva de Lima Conegundes
- Department of Pharmaceutical Sciences, Pharmaceutical Care and Clinical Pharmacy Research Center, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | | | - Leonardo Régis Leira Pereira
- Department of Pharmaceutical Sciences, Pharmaceutical Care and Clinical Pharmacy Research Center, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Fabiana Rossi Varallo
- Department of Pharmaceutical Sciences, Pharmaceutical Care and Clinical Pharmacy Research Center, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
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Pereira LB, Rodrigues JPV, Varallo FR, Pereira LRL. Health-related Quality of Life and Long-term Outcomes after Mildly Symptomatic COVID-19: Exploring the Protocol. Arq Bras Cardiol 2023; 120:e20230639. [PMID: 37878882 PMCID: PMC10567079 DOI: 10.36660/abc.20230639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 09/13/2023] [Accepted: 09/13/2023] [Indexed: 10/27/2023] Open
Affiliation(s)
- Lucas Borges Pereira
- Faculdade de Ciências Farmacêuticas de Ribeirão PretoUniversidade de São PauloRibeirão PretoSPBrasil Faculdade de Ciências Farmacêuticas de Ribeirão Preto , Universidade de São Paulo , Ribeirão Preto , SP - Brasil
- Faculdade de Ciências da Saúde de Barretos Dr. Paulo PrataBarretosSPBrasil Faculdade de Ciências da Saúde de Barretos Dr. Paulo Prata , Barretos , SP - Brasil
| | - João Paulo Vilela Rodrigues
- Faculdade de Ciências Farmacêuticas de Ribeirão PretoUniversidade de São PauloRibeirão PretoSPBrasil Faculdade de Ciências Farmacêuticas de Ribeirão Preto , Universidade de São Paulo , Ribeirão Preto , SP - Brasil
| | - Fabiana Rossi Varallo
- Faculdade de Ciências Farmacêuticas de Ribeirão PretoUniversidade de São PauloRibeirão PretoSPBrasil Faculdade de Ciências Farmacêuticas de Ribeirão Preto , Universidade de São Paulo , Ribeirão Preto , SP - Brasil
| | - Leonardo Régis Leira Pereira
- Faculdade de Ciências Farmacêuticas de Ribeirão PretoUniversidade de São PauloRibeirão PretoSPBrasil Faculdade de Ciências Farmacêuticas de Ribeirão Preto , Universidade de São Paulo , Ribeirão Preto , SP - Brasil
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de Oliveira AM, Varallo FR, Pereira LRL. Experiences and strategies adopted for the implementation of pharmaceutical services in hospital geriatric units: A scoping review protocol. Exploratory Research in Clinical and Social Pharmacy 2023; 10:100262. [PMID: 37181499 PMCID: PMC10172926 DOI: 10.1016/j.rcsop.2023.100262] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 04/03/2023] [Indexed: 04/08/2023] Open
Abstract
Background Pharmaceutical care is considered an important pillar for promoting the rational and safe use of medicines. Consequently, it constitutes actions of practices capable of reducing morbidity and mortality induced by pharmacotherapy. On the other hand, pharmaceutical services may face several barriers related to the implementation of these practices. These difficulties are associated with management, availability of an appropriate physical environment, integration with the multidisciplinary team, and acceptance of pharmaceutical interventions by health professionals. Objectives This study aims to map and summarize the scientific evidence on the experiences and strategies used to implement pharmaceutical services in hospital geriatric units. Methods The scoping review will be based on three electronic databases (PubMed, EMBASE, and Web of Science). Studies that met the inclusion criteria and are published by December 2022 will be selected. The screening, eligibility, extraction, and assessment of studies will be carried out by two independent researchers. Experimental and observational studies will be eligible for inclusion. Discussion The experiences of incorporating pharmaceutical care into geriatric hospital units need to be better disseminated. Our review could support the performance of pharmaceutical care in other geriatric wards and has the potential to be a reference for multidisciplinary training. In addition, the study is related to the global challenge of the World Alliance for Patient Safety as it is a survey that will demonstrate strategies for safety in the use of medicines.
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Zanetti MOB, Rodrigues JPV, Varallo FR, Cunha RLG, Simões BP, Pereira LRL. Impact of the insertion of the clinical pharmacist in the Allogeneic Hematopoietic Stem Cells Transplantation team. J Oncol Pharm Pract 2023; 29:375-385. [PMID: 35037789 DOI: 10.1177/10781552211073797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Allogeneic Hematopoietic Stem Cells Transplantation (allo-HSCT) is capable of curing patients with neoplastic or non-neoplastic hematologic disorders or of prolonging their survival. This study assessed if the insertion of the clinical pharmacist in the allo-HSCT team modified the outcomes: transplantation-related mortality, grafting failure, incidence of Graft versus Host Disease, hospitalization time, time for grafting, number of readmissions, number of drug-related problems (DRPs), adherence and knowledge about pharmacotherapy. METHODS Interventional study with historical control carried out in an allo-HSCT unit, in which the intervention group (IG) included 33 individuals who received pharmacotherapy follow-up. Control Group (CG) consisted of 28 individuals. RESULTS A total of 250 DRPs were identified, 59 team's doubts were clarified, and 309 interventions were conducted in the IG. The DRPs mainly arose from safety (51.60%) and effectiveness (38.40%) problems. A mean of 9.36 (SD = 6.97) interventions per patient was obtained, mainly including dose reductions (19.09%), adjustments in administration time (18.12%), educational activities (15.21%) and drug removal (10.68%). Clinical significance of the interventions was considered high (75.7% extremely significant, very significant or significant), as well as their acceptability (89.7% accepted). Each patient attended a mean of 4.68 pharmaceutical consultations (SD = 1.91) after hospital discharge, presenting increase in knowledge (p = 0.0001) and in adherence (p = 0.0115). There was no evidence of differences between the groups in the other outcomes analyzed. CONCLUSIONS The pharmacotherapy follow-up allowed detecting several DRPs and performing interventions of high clinical relevance and acceptability, in addition to improving adherence and individualizing the pharmacotherapy.
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Affiliation(s)
| | - João Paulo Vilela Rodrigues
- School of Pharmaceutical Sciences of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - Fabiana Rossi Varallo
- School of Pharmaceutical Sciences of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | | | - Belinda Pinto Simões
- Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
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Zanetti MOB, Rodrigues JPV, Varallo FR, Cunha RLG, Simões BP, Pereira LRL. Can pharmacotherapeutic follow-up after allogeneic hematopoietic stem cell transplantation improve medication compliance? J Oncol Pharm Pract 2023; 29:348-357. [PMID: 35038928 DOI: 10.1177/10781552211073469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Allogeneic Hematopoietic Stem Cell Transplantation (allo-HSCT) is currently one of the most effective therapies in onco-hematology. For the treatment of the disease and prevention of such complications, a complex pharmacotherapeutic regimen is employed. Non-compliance is prevalent among adolescents and young adults with chronic hematological diseases, being reported by up to 50% of the patients. OBJECTIVE To evaluate the results of pharmacotherapeutic follow-up on medication compliance and on the knowledge about pharmacotherapy of patients who underwent allo-HSCT. METHODS A single-arm, open-label and non-randomized intervention study developed in an allo-HSCT outpatient clinic. The participants attended pharmaceutical consultations and had their knowledge about pharmacotherapy and medication compliance measured by MedTake and Brief Medication Questionnaire (BMQ), respectively. RESULTS A total of 27 patients attended pharmaceutical consultations (4.81 consultations/patient; SD = 1.80). There was an improvement in medication compliance and in knowledge between the first and last consultations (p < 0.05). In the final consultation, 70.37% of the patients showed compliance, with a knowledge rate of 98.35% (SD = 3.63). Non-compliant individuals presented a greater tendency to hospital readmissions. There was no relationship between medication compliance and sociodemographic variables, graft-versus-host disease, and knowledge about pharmacotherapy. CONCLUSIONS Pharmacotherapeutic follow-up contributed to improving medication compliance. Knowledge about pharmacotherapy alone does not translate into behaviors, which corroborates the complexity of the biopsychosocial factors associated with medication compliance.
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Affiliation(s)
- Maria Olívia Barboza Zanetti
- Department of Pharmaceutical Sciences, School of Pharmaceutical Sciences of Ribeirao Preto - University of Sao Paulo, Ribeirao Preto, Brazil
| | - João Paulo Vilela Rodrigues
- Department of Pharmaceutical Sciences, School of Pharmaceutical Sciences of Ribeirao Preto - University of Sao Paulo, Ribeirao Preto, Brazil
| | - Fabiana Rossi Varallo
- Department of Pharmaceutical Sciences, School of Pharmaceutical Sciences of Ribeirao Preto - University of Sao Paulo, Ribeirao Preto, Brazil
| | - Renato Luiz Guerrino Cunha
- Department of Internal Medicine, Ribeirao Preto Medical School - University of Sao Paulo, Ribeirao Preto, Brazil
| | - Belinda Pinto Simões
- Department of Internal Medicine, Ribeirao Preto Medical School - University of Sao Paulo, Ribeirao Preto, Brazil
| | - Leonardo Régis Leira Pereira
- Department of Pharmaceutical Sciences, School of Pharmaceutical Sciences of Ribeirao Preto - University of Sao Paulo, Ribeirao Preto, Brazil
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de Oliveira AM, Varallo FR, Rodrigues JPV, Aguilar GJ, da Costa Lima NK, Leira Pereira LR. Contribution of Pharmaceutical Care to Person-centered Health Care and the Safety of Pharmacotherapy for Hospitalized Older Individuals in Brazil: An Investigative Single-arm Intervention Trial. Curr Drug Saf 2023; 18:253-263. [PMID: 35702788 DOI: 10.2174/1574886317666220614140433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/28/2022] [Accepted: 05/07/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Adverse drug events (ADE) and medication errors (ME) provide large numbers of victims. Older people are more susceptible to these events, due to the continuing search for several chronic degenerative disease treatments. The Third Global Patient Safety Challenge announced the objective of reducing unnecessary polypharmacy, encouraging deprescription, and aiming to ensure the prescription of medications in an appropriate manner, based on the best evidence and taking into account the individual factors of people. OBJECTIVE To evaluate whether Pharmaceutical Care (PC), when inserted in a geriatric ward and the context of person-centered health care, cooperates with the safety of pharmacotherapy in older individuals in Brazil. METHODS This is an investigative, single-arm, preliminary study. INCLUSION CRITERIA individuals aged ≥60 years and admitted to the geriatric ward between August 2019 to January 2020. The PC (with the practice of pharmacotherapeutic follow-up, medication reconciliation, and pharmacotherapy review) was made available to identify ADE and ME, as well as the associated factors and clinical outcomes, were analyzed. RESULTS 60 participants were included. It was found that, on hospital admission, 93.3% of them were polymedicated and 86.7% had a history of using potentially inappropriate medications (PIM). ADE and ME were detected in 43 individuals (71.7%) and, in total, 115 incidents were identified, with drugs that act on the nervous system associated with them (31.9%). Acceptance of the PC's recommendations reached the rate of 85.2%. Polypharmacy (p=0.03) and the presence of multiple diseases (p=0.03) had an effect on the presentation of ADE and ME. The number of medications in use decreased in the comparison between admission and hospital discharge (p<0.0001). CONCLUSION This investigative study indicated that ADE and ME are linked to the polypharmacy in use at the beginning of hospitalization. On the other hand, we showed that the PC (inserted in the multidisciplinary team) contributed to the deprescribing of medications at hospital discharge. Therefore, the PC can provide improvements in this scenario.
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Affiliation(s)
- Alan Maicon de Oliveira
- School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
| | - Fabiana Rossi Varallo
- School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
| | - João Paulo Vilela Rodrigues
- School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
| | - Guilherme José Aguilar
- Faculty of Philosophy, Sciences and Letters, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
| | | | - Leonardo Régis Leira Pereira
- School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
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Mello VD, Pereira VDP, Rodrigues JPV, Penteado STDS, Pereira LRL, Varallo FR. Eventos adversos no sistema nervoso central potencialmente relacionados aos medicamentos utilizados na COVID-19: revisão de escopo. Rev Panam Salud Publica 2022; 46:e166. [DOI: 10.26633/rpsp.2022.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 05/23/2022] [Indexed: 12/15/2022] Open
Abstract
Objetivo.
Identificar eventos adversos no sistema nervoso central (SNC) potencialmente associados ao uso de medicamentos para profilaxia ou tratamento da COVID-19, bem como caracterizar os indivíduos acometidos.
Métodos.
Desenvolveu-se uma revisão de escopo a partir de estratégia de busca nas bases de dados PubMed, EMBASE, SciELO, Scopus, Cummulative Index to Nursing and Allied Health Literature (CINAHL) e Biblioteca Virtual em Saúde (BVS). Foram incluídos estudos com indivíduos que utilizaram medicamentos como medida profilática ou curativa para COVID-19 e que apresentaram ao menos um evento adverso no SNC. Foram excluídos os artigos que reportaram eventos adversos no SNC potencialmente associados a medicamentos para outras condições de saúde.
Resultados.
Recuperaram-se 1 547 artigos, dos quais oito atenderam aos critérios de elegibilidade. Em sete estudos, o desenho foi do tipo observacional. Foram analisados 3 035 indivíduos, dos quais 1 701 eram profissionais da saúde e 1 978, mulheres. A terapia mais utilizada foi a curativa (n = 5), com hidroxicloroquina, cloroquina, lopinavir/ritonavir e azitromicina. Os eventos adversos comumente descritos foram dor de cabeça, tontura, distúrbios de humor e sonolência. Suicídio foi o evento grave mais frequente. Seis eventos foram inesperados para hidroxicloroquina, cloroquina e doxiciclina (mioclonias, tremor, distúrbio de marcha, disgeusia, hiperidrose e inquietação).
Conclusão.
Os eventos adversos no SNC foram inespecíficos e, geralmente, potencialmente associados ao uso de hidroxicloroquina em monoterapia ou em associação para tratamento curativo da COVID-19. Os dados corroboram a relação desfavorável de risco/benefício desses medicamentos na prevenção e no manejo dos sinais e sintomas da infecção por SARS-CoV-2.
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Affiliation(s)
- Vinícius de Mello
- Universidade de São Paulo (USP), Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Ribeirão Preto (SP), Brasil
| | - Vinícius de Paula Pereira
- Universidade de São Paulo (USP), Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Ribeirão Preto (SP), Brasil
| | - João Paulo Vilela Rodrigues
- Universidade de São Paulo (USP), Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Ribeirão Preto (SP), Brasil
| | | | - Leonardo Régis Leira Pereira
- Universidade de São Paulo (USP), Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Ribeirão Preto (SP), Brasil
| | - Fabiana Rossi Varallo
- Universidade de São Paulo (USP), Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Ribeirão Preto (SP), Brasil
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Oliveira AMD, Varallo FR, Rodrigues JPV, Pereira LRL. Protocol for the implementation of pharmaceutical care in geriatrics: strategy for safety in health care. Rev Gaucha Enferm 2022; 43:e20210236. [PMID: 36043645 DOI: 10.1590/1983-1447.2022.20210236.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 12/16/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To describe the experience of the implementation of pharmaceutical care in a geriatric hospital unit and to propose an instructional protocol for the practice. METHODS Experience report that became the practice manual of pharmaceutical care in geriatrics (MaP-CFarmaGeri) of a Brazilian hospital and was structured in three topics (1. Situational diagnosis; 2. Adequacy of the procedure and service provision; 3. Practice exercise). RESULTS The situational diagnosis comprised the collection of data on the structure of the ward and the epidemiological profile. The pharmaceutical services provided included pharmacotherapeutic follow-up, medication reconciliation and pharmacotherapy review. The certification of the content of this procedure was attested by specialists from a multiprofessional team and the technique served more than 60 patients in practice, with good acceptance by the participants. FINAL CONSIDERATIONS The MaP-CFarmaGeri proved to be a satisfactory strategy in the implementation of pharmaceutical care in geriatrics and can support this insertion in similar locations.
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Affiliation(s)
- Alan Maicon de Oliveira
- University of São Paulo (USP), School of Pharmaceutical Sciences of Ribeirão Preto. Ribeirão Preto, São Paulo, Brazil
| | - Fabiana Rossi Varallo
- University of São Paulo (USP), School of Pharmaceutical Sciences of Ribeirão Preto. Ribeirão Preto, São Paulo, Brazil
| | - João Paulo Vilela Rodrigues
- University of São Paulo (USP), School of Pharmaceutical Sciences of Ribeirão Preto. Ribeirão Preto, São Paulo, Brazil
| | - Leonardo Régis Leira Pereira
- University of São Paulo (USP), School of Pharmaceutical Sciences of Ribeirão Preto. Ribeirão Preto, São Paulo, Brazil
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13
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Lucchetta RC, Lemos IH, Gini ALR, Cavicchioli SDA, Forgerini M, Varallo FR, de Nadai MN, Fernandez-Llimos F, Mastroianni PDC. Deficiency and Insufficiency of Vitamin D in Women of Childbearing Age: A Systematic Review and Meta-analysis. Rev Bras Ginecol Obstet 2022; 44:409-424. [PMID: 35211934 PMCID: PMC9948108 DOI: 10.1055/s-0042-1742409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 11/03/2021] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE To estimate the prevalence of inadequate vitamin D level and its associated factors for women of childbearing age in Brazil. METHODS A systematic review was conducted (last updated May 2020). Meta-analyses were performed using the inverse-variance for fixed models with summary proportion calculation by Freeman-Tukey double arcsine. Reporting and methodological quality were assessed using the Joanna Briggs Institute tool for prevalence studies. RESULTS Our review identified 31 studies, comprising 4,006 participants. All the studies had at least one weakness, mainly due to the use of convenience sampling and small sample size. The overall prevalence of vitamin D deficiency, insufficiency, and both deficiency and insufficiency were 35% (confidence interval, 95%CI: 34-37%), 42% (95%CI: 41-44%), and 72% (95%CI: 71-74%), respectively. CONCLUSION Although the magnitude of the prevalence of inadequate levels of vitamin D is uncertain, the evidence suggests that presence of vitamin D deficiency or insufficiency in women of reproductive age can cause moderate to severe problems.
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Affiliation(s)
- Rosa Camila Lucchetta
- Department of Drugs and Medicines, School of Pharmaceutical Sciences, Universidade Estadual de São Paulo, São Paulo, SP, Brazil
| | - Isabele Held Lemos
- Department of Drugs and Medicines, School of Pharmaceutical Sciences, Universidade Estadual de São Paulo, São Paulo, SP, Brazil
| | - Ana Luísa Rodriguez Gini
- Department of Drugs and Medicines, School of Pharmaceutical Sciences, Universidade Estadual de São Paulo, São Paulo, SP, Brazil
| | | | - Marcela Forgerini
- Department of Drugs and Medicines, School of Pharmaceutical Sciences, Universidade Estadual de São Paulo, São Paulo, SP, Brazil
| | - Fabiana Rossi Varallo
- Department of Pharmaceutical Sciences, Faculty of Pharmaceutical Sciences of Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Mariane Nunes de Nadai
- Department of Dentistry, Pediatric Dentistry and Public Health, Bauru School of Dentistry, Universidade de São Paulo, Bauru, SP, Brazil
| | - Fernando Fernandez-Llimos
- Department of Drug Sciences, Laboratory of Pharmacology, Faculty of Pharmacy, Universidade do Porto, Porto, Portugal
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14
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Raso J, Santos LMC, Reis DA, Frangiotti MAC, Zanetti ACB, Capucho HC, Herdeiro MT, Roque F, Pereira LRL, Varallo FR. Hospitalizations of older people in an emergency department related to potential medication-induced hyperactive delirium: a cross-sectional study. Int J Clin Pharm 2022; 44:548-556. [PMID: 35083658 DOI: 10.1007/s11096-022-01378-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 01/13/2022] [Indexed: 11/05/2022]
Abstract
Background Although delirium is one of the most common adverse drug reactions observed in hospitalized older people, it remains underdiagnosed. Aim To estimate the prevalence of hospitalization of older people with potential medication-induced hyperactive delirium in the emergency department (ED); to identify the risk factors and the medicines frequently associated with the occurrence of the syndrome. Method A cross-sectional, retrospective study was performed with older people (age ≥ 60) admitted in 2018 to a Brazilian ED. The hospitalizations with suspected hyperactive delirium were screened with the aid of trigger-tools: International Code of Diseases-10th Revision, intra-hospital prescriptions of antipsychotics, and trigger-words related to the syndrome. A chart-review and medication review were developed to establish the causality assessment between adverse event and medicine. Logistic regression was used to determine risk factors for occurrence. Results Among the hospitalizations included, 67.5% (193/286) were screened by at least one trigger-tool. Of these, potential medication-induced hyperactive delirium was observed in 26.0% (50/193). The prevalence estimated in the ward was 17.5% (50/286). Opioids (31.9%), benzodiazepines (18.8%) and corticosteroids (10.6%) were the commonest medicines associated with delirium. Long-lived patients (p = 0.005), potentially inappropriate medicines (PIMs) (p = 0.025), and high weighted deliriogenic load (p = 0.014) were associated with potential medication-induced hyperactive delirium. Conclusion Approximately one in six hospitalizations of older people in the ED showed potential medication-induced hyperactive delirium. Data suggest PIMs and high weighted deliriogenic load, rather than polypharmacy or anticholinergic burden, are considered the most important characteristics of pharmacotherapy associated with avoidable hyperactive delirium among long-lived patients.
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Affiliation(s)
- Júlia Raso
- Department of Pharmaceutical Sciences, Research Center for Pharmaceutical Care and Clinical Pharmacy, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Av. do Café, s/n - Vila Monte Alegre, Ribeirão Preto, SP, 14040-900, Brazil
| | - Lincoln Marques Cavalcante Santos
- Department of Pharmaceutical Sciences, Research Center for Pharmaceutical Care and Clinical Pharmacy, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Av. do Café, s/n - Vila Monte Alegre, Ribeirão Preto, SP, 14040-900, Brazil
| | - Débora Alves Reis
- Emergency Unit of the University Hospital of the Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Ariane Cristina Barboza Zanetti
- Department of Pharmaceutical Sciences, Research Center for Pharmaceutical Care and Clinical Pharmacy, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Av. do Café, s/n - Vila Monte Alegre, Ribeirão Preto, SP, 14040-900, Brazil
| | | | - Maria Teresa Herdeiro
- Department of Medical Sciences, iBiMED-Institute of Biomedicine, University of Aveiro, 3800, Aveiro, Portugal
| | - Fátima Roque
- Research Unit for Inland Development, Polytechnic of Guarda (UDI-IPG), 6300, Guarda, Portugal.,Health Sciences Research Centre, University of Beira Interior (CICS-UBI), 6200, Covilhã, Portugal
| | - Leonardo Régis Leira Pereira
- Department of Pharmaceutical Sciences, Research Center for Pharmaceutical Care and Clinical Pharmacy, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Av. do Café, s/n - Vila Monte Alegre, Ribeirão Preto, SP, 14040-900, Brazil
| | - Fabiana Rossi Varallo
- Department of Pharmaceutical Sciences, Research Center for Pharmaceutical Care and Clinical Pharmacy, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Av. do Café, s/n - Vila Monte Alegre, Ribeirão Preto, SP, 14040-900, Brazil.
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Oliveira AMD, Varallo FR, Rodrigues JPV, Pereira LRL. Protocolo da implantação do cuidado farmacêutico na geriatria: estratégia para segurança na assistência à saúde. Rev Gaucha Enferm 2022. [DOI: 10.1590/1983-1447.2022.20210236.pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivo: Descrever a experiência da implantação do cuidado farmacêutico em uma unidade hospitalar de geriatria e propor um protocolo instrutivo da prática. Métodos: Relato de experiência que se converteu no manual da prática do cuidado farmacêutico na geriatria (MaP-CFarmaGeri) de um hospital brasileiro e foi estruturado em três tópicos (1. Diagnóstico situacional; 2. Adequação do procedimento e oferta do serviço; 3. Exercício da prática). Resultados: O diagnóstico situacional compreendeu o levantamento dos dados sobre a estrutura da enfermaria e o perfil epidemiológico. Os serviços farmacêuticos ofertados incluíram o acompanhamento farmacoterapêutico, com a conciliação de medicamentos e a revisão da farmacoterapia. A certificação do conteúdo desse procedimento foi atestada por especialistas de uma equipe multiprofissional e a técnica atendeu mais de 60 pacientes na prática, com boa aceitação dos participantes. Considerações finais: O MaP-CFarmaGeri mostrou ser uma estratégia satisfatória na implantação do cuidado farmacêutico na geriatria e pode amparar essa inserção em locais semelhantes.
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de Souza Joao Luiz MV, Varallo FR, Melgarejo CRV, de Nadai TR, de Carvalho Mastroianni P. Traditional Lectures Actually Improve the Body of Knowledge, Skills, and Attitudes of Health Care Professional for Health Incident Reporting System. Hosp Pharm 2021; 56:436-443. [PMID: 34720143 DOI: 10.1177/0018578720918553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: A solid patient safety culture lies at the core of an effective event reporting system in a health care setting requiring a professional commitment for event reporting identification. Therefore, health care settings should provide strategies in which continuous health care education comes up as a good alternative. Traditional lectures are usually more convenient in terms of costs, and they allow us to disseminate data, information, and knowledge through a large number of people in the same room. Taking in consideration the tight money budgets in Brazil and other countries, it is relevant to investigate the impact of traditional lectures on the knowledge, skills, and attitudes to incident reporting system and patient safety culture. Objective: The study aim was to assess the traditional lecture impact on the improvement of health care professional competency dimensions (knowledge, skills, and attitudes) and on the number of health care incident reports for better patient safety culture. Participants and Methods: An open-label, nonrandomized trial was conducted in ninety-nine health care professionals who were assessed in terms of their competencies (knowledge, skills, and attitudes) related to the health incident reporting system, before and after education intervention (traditional lectures given over 3 months). Results: All dimensions of professional competencies were improved after traditional lectures (P < .05, 95% confidence interval). Conclusions: traditional lectures are helpful strategy for the improvement of the competencies for health care incident reporting system and patient safety.
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Toma MM, de Freitas Santana G, de Nadai TR, Varallo FR, de Lima Benzi JR, de Carvalho Mastroianni P. Extemporaneous Compounding: A Possible Trigger Tool to Detect potentially health incidents. Curr Drug Saf 2021; 17:183-192. [PMID: 34649491 DOI: 10.2174/1574886316666211014155946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/21/2021] [Accepted: 08/29/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Extemporaneous compounding (EC) involves preparation of a therapeutic product to a specific-patient need. However, there is a potential relation between this procedure and the occurrence of health incidents (HI). The use of triggers tool increases HI identification. OBJECTIVE This study assessed the performance of EC as trigger to detect potentially health incidents arising from this procedure. METHOD A one-month observational and cross-sectional study was performed in internal medicine ward and intensive care unit of medium-sized hospital. Data collection was carried out in 5 stages: all triggered patients with dysphagia or enteral feeding tube with prescription of EC were included; it was observed all EC executed in standardized drugs prescribed; the procedure was compared with the hospital guide and scientific literature; HI monitoring and their evaluation using WHO and NCC MERP algorithms; a search for pharmaceutical alternatives (PA) that would avoid the observed EC. RESULTS 197 patients were recruited. Almost half of them were triggered by EC from 84 standardized drugs. 48 patients met inclusion criteria. It was identified 28 adverse drug reactions, 01 therapeutic ineffectiveness and 29 medication errors. EC as trigger tool showed a PPV value of 0.38. Finally, only 24 drugs have PA available in the market, that could avoid one third of all observed EC. CONCLUSION It was possible to detect potentially HI in one of two patients with enteral feeding tube using EC as trigger tool. The use of EC as a trigger tool contributes to identify potentially HI arising from drugs, which have not gotten pharmaceutical alternatives to be administered via enteral feeding tube.
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Affiliation(s)
- Marina Massae Toma
- Department of Drugs and Medicines, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara. Brazil
| | - Gabriel de Freitas Santana
- Department of Drugs and Medicines, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara. Brazil
| | - Tales Rubens de Nadai
- Department of Surgery and Anatomy. School of Medicine, University of São Paulo, Bauru. Brazil
| | - Fabiana Rossi Varallo
- Pharmaceutical Assistance and Clinical Pharmacy Research Center, Department of Pharmaceutical Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo (USP), Ribeirão Preto. Brazil
| | - Jhohann Richard de Lima Benzi
- Department of Clinical, Toxicological and Bromatological Analyses, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto. Brazil
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Pereira LB, Zanetti MOB, Sponchiado LP, Rodrigues JPV, Campos MSDA, Varallo FR, Pereira LRL. Antibiotic use in Brazilian hospitals in the 21st century: a systematic review. Rev Soc Bras Med Trop 2021; 54:e08612020. [PMID: 34133621 PMCID: PMC8282254 DOI: 10.1590/0037-8682-0861-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 04/29/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION This systematic review aimed to assess antibiotic use in Brazilian hospitals in the 21st century, as well as to understand the different drug utilization metrics adopted to assess the consumption of these drugs. METHODS We systematically reviewed five databases (MEDLINE [Medical Literature Analysis and Retrieval System Online], CENTRAL [The Cochrane Central Register of Controlled Trials], EMBASE® [Excerpta Medica Database], Scopus [Elsevier's abstract and citation database], and LILACS [Literatura Latino-Americana e do Caribe em Ciências da Saúde]) for observational or experimental studies that assessed antibiotic utilization in Brazilian hospitals. The main outcomes were the drug utilization metrics and the consumption of antibiotics. RESULTS We included 23 studies, of which 43.5% were carried out in adult and pediatric care units, 39.1% in adult units, and 17.4% in pediatric units. Regarding the complexity of healthcare, 26.1% of the studies were performed in intensive care units. Two drug utilization metrics were used in these studies: the defined daily dose (DDD) and the percentage of antibiotic prescriptions. The most commonly used antibiotic classes were third-generation cephalosporins, carbapenems, fluoroquinolones, and combinations of penicillins when the DDD was the adopted drug utilization metric. CONCLUSIONS Although few studies have been conducted, existing data indicate a high use of broad-spectrum antibiotics. We found that the lack of standardized antibiotic utilization metrics impaired the mapping of drug consumption at the national level.
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Affiliation(s)
- Lucas Borges Pereira
- Universidade de São Paulo, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Departamento de Ciências Farmacêuticas, Ribeirão Preto, SP, Brasil
| | - Maria Olívia Barboza Zanetti
- Universidade de São Paulo, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Departamento de Ciências Farmacêuticas, Ribeirão Preto, SP, Brasil
| | - Larissa Pombeiro Sponchiado
- Universidade de São Paulo, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Departamento de Ciências Farmacêuticas, Ribeirão Preto, SP, Brasil
| | - João Paulo Vilela Rodrigues
- Universidade de São Paulo, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Departamento de Ciências Farmacêuticas, Ribeirão Preto, SP, Brasil
| | - Marília Silveira de Almeida Campos
- Universidade de São Paulo, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Departamento de Ciências Farmacêuticas, Ribeirão Preto, SP, Brasil
| | - Fabiana Rossi Varallo
- Universidade de São Paulo, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Departamento de Ciências Farmacêuticas, Ribeirão Preto, SP, Brasil
| | - Leonardo Régis Leira Pereira
- Universidade de São Paulo, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Departamento de Ciências Farmacêuticas, Ribeirão Preto, SP, Brasil
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Oliveira JRFD, Varallo FR, Jirón M, Ferreira IMDL, Siani-Morello MR, Lopes VD, Pereira LRL. [Consumption of psychotropic medications in primary healthcare in Ribeirão Preto, São Paulo State, Brazil]. CAD SAUDE PUBLICA 2021; 37:e00060520. [PMID: 33440408 DOI: 10.1590/0102-311x00060520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/12/2020] [Indexed: 11/21/2022] Open
Abstract
The consumption of psychotropic drugs is considered a public health problem, due to the potential for addiction and the occurrence of adverse events. In this context, the current study aimed to characterize the consumption of psychotropic medications dispensed in primary healthcare units in Ribeirão Preto, São Paulo State, Brazil. This ecological study consulted the Hygia database from 2008 to 2012. The following variables were extracted: psychotropic drugs dispensed, amount dispensed per year, and patients' sex and age bracket. For each psychotropic drug, we calculated the defined daily dose per 1,000 inhabitants/day (DDD/1,000PD), defined daily dose per 1,000 inhabitants/day considering 75% of the population (DDD75%/1,000PD) who withdrew medicines through the Brazilian Unified National Health System (SUS), and the prescribed daily dose (PDD). The study compared the population growth rate to the growth in the medicines' consumption. A total of 1,577,241 patients were identified who withdrew medications during the study period, of whom 287,373 (18.2%) used at least one drug subject to special control. There was an increase in the total consumption of psychotropic drugs (DDD/1,000PD), but comparison to the population growth rate showed that only sertraline (p = 0.021), risperidone (p = 0.034), and clonazepam (p = 0.043) presented higher growth rates. The PDD for seven drugs were higher than the World Health Organization (WHO) DDD. Identifying discrepancies between DDD and PDD can be useful as a strategy for screening patients eligible for pharmaceutical care, since they can contribute to the prevention of morbidity and mortality related to medications.
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Affiliation(s)
| | - Fabiana Rossi Varallo
- Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brasil
| | - Marcela Jirón
- Facultad de Ciencias Químicas y Farmacéuticas, Universidad de Chile, Santiago, Chile
| | | | | | - Vinícius Detoni Lopes
- Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brasil
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20
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Lucchetta RC, Cavicchioli SDA, Gini ALR, Forgerini M, Varallo FR, de Nadai MN, Fernandez-Llimos F, Mastroianni PDC. Deficiency of vitamins C and E in women of childbearing age in Brazil: a systematic review and meta-analysis. SAO PAULO MED J 2021; 139:545-555. [PMID: 34586287 PMCID: PMC9634837 DOI: 10.1590/1516-3180.2020.0799.r1.0904221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 04/09/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Despite the several options available for supplements containing vitamins C and E, evidence regarding the prevalence of deficiency or insufficiency of these vitamins is weak. OBJECTIVES To estimate the prevalence of deficiency or insufficiency of vitamins C and E and associated factors among women of childbearing age, in Brazil. DESIGN AND SETTING Systematic review and meta-analysis conducted at a Brazilian public university. METHODS A search from index inception until May 2020 was conducted. Meta-analyses were performed using inverse variance for fixed models, with summary proportions calculation using Freeman-Tukey double arcsine (base case). Reporting and methodological quality were assessed using the Joanna Briggs Institute tool for prevalence studies. RESULTS Our review identified 12 studies, comprising 1,316 participants, especially breastfeeding women. There was at least one quality weakness in all studies, mainly regarding sampling method (i.e. convenience sampling) and small sample size. The prevalence of vitamin C deficiency ranged from 0% to 40%. Only vitamin E deficiency was synthetized in meta-analyses, with mean prevalences of 6% regardless of the alpha-tocopherol cutoff in plasma, and 5% and 16% for cutoffs of < 1.6-12.0 mmol/l and < 16.2 mmol/l, respectively. The cumulative meta-analysis suggested that a trend to lower prevalence of vitamin E deficiency occurred in recent studies. CONCLUSIONS Although the studies identified in this systematic review had poor methodological and reporting quality, mild-moderate vitamin C and E deficiencies were identified, especially in breastfeeding women. Thus, designing and implementing policies does not seem to be a priority, because the need has not been properly dimensioned among women of childbearing age in Brazil. REGISTRATION NUMBER IN PROSPERO CRD42020221605.
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Affiliation(s)
- Rosa Camila Lucchetta
- PhD. Pharmacist and Postdoctoral Researcher, Department of Drugs and Medicines, School of Pharmaceutical Sciences, Universidade Estadual Paulista (UNESP), São Paulo (SP), Brazil.
| | | | - Ana Luísa Rodriguez Gini
- Undergraduate Student, Department of Drugs and Medicines, School of Pharmaceutical Sciences, Universidade Estadual Paulista (UNESP), São Paulo (SP), Brazil.
| | - Marcela Forgerini
- Pharmacist and Doctoral Student, Department of Drugs and Medicines, School of Pharmaceutical Sciences, Universidade Estadual Paulista (UNESP), São Paulo (SP), Brazil.
| | - Fabiana Rossi Varallo
- PhD. Pharmacist and Professor, Department of Pharmaceutical Sciences, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo (FCFRP-USP), Ribeirão Preto (SP), Brazil.
| | - Mariane Nunes de Nadai
- MD, PhD. Professor, Faculdade de Odontologia de Bauru, Universidade de São Paulo (FOB-USP), Bauru (SP), Brazil.
| | - Fernando Fernandez-Llimos
- PhD. Pharmacist and Professor, CINTESIS - Center for Health Technology and Services Research, Laboratory of Pharmacology, Department of Drug Sciences, Faculty of Pharmacy, Universidade do Porto, Porto, Portugal.
| | - Patricia de Carvalho Mastroianni
- PhD. Pharmacist and Professor, Department of Drugs and Medicines, School of Pharmaceutical Sciences, Universidade Estadual Paulista (UNESP), São Paulo (SP), Brazil.
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Varallo FR, Forgerini M, Herdeiro MT, de Carvalho Mastroianni P. Harmonization of Pharmacovigilance Regulation in Brazil: Opportunities to Improve Risk Communication. Clin Ther 2019; 41:598-603. [PMID: 30792075 DOI: 10.1016/j.clinthera.2019.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/14/2019] [Accepted: 01/19/2019] [Indexed: 11/18/2022]
Abstract
Brazilian pharmacovigilance regulations involve 3 spheres: health services, Marketing Authorization Holders (MAHs), and sanitary agency. Drug tolerability began to be effectively assessed in Brazil after the founding of the National Agency of Sanitary Surveillance, which developed the Sentinel Network Project. The objective of the Sentinel Network Project is to increase the adverse drug reaction (ADR) reporting rate by health care professionals in the hospital setting. Pharmacovigilance practices became mandatory for MAHs, and patient tolerability issues were considered in drug policy in Brazil only as recently as 2000. However, despite recent events, the regulatory advancements in pharmacovigilance in Brazil are only equivalent to international practices (ie, those of the European Union). The pharmacovigilance system in the European Union integrates the national authorities, the European Commission, and the European Medicines Agency, which is responsible for the scientific evaluation, supervision, and safety monitoring of medicines for human and veterinary use in the European Union. Furthermore, ADR patient reporting is included in the new EU pharmacovigilance regulations. Numerous possible ways are available to improve the Brazilian pharmacovigilance system, mainly through regulations of biosimilar, nanotechnology, and veterinary medicines or by training health care professionals and patients to report nonserious cases and quality deviations. It is necessary to encourage and develop strategies for decentralizing pharmacovigilance actions in the whole country, as is common practice in several EU countries. Motivating and considering ADR reports by patients and improving feedback and audit practices in health care services and MAHs are also necessary measures. With the inclusion of Brazil as a member of the International Conference of Harmonization, significant changes in pharmacovigilance regulation are expected; these updates, which will consider international standards, will improve signal detection and risk communication.
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Affiliation(s)
| | - Marcela Forgerini
- Department of Drugs and Medicines, School of Pharmaceutical Sciences, São Paulo State University, Araraquara, Brazil
| | - Maria Teresa Herdeiro
- Institute of Biomedicine - iBiMED, Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
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Varallo FR, Lucchetta RC, Forgerini M, Mastroianni PDC. What would be a trigger tool with better performance for detecting drug-induced hyperkalemia? SAO PAULO MED J 2019; 137:386-387. [PMID: 31531593 PMCID: PMC9744011 DOI: 10.1590/1516-3180.2019.0081050719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 07/05/2019] [Indexed: 12/15/2022] Open
Affiliation(s)
- Fabiana Rossi Varallo
- PhD. Pharmacist and Professor, Faculdade de Ciências Farmacêuticas de Ribeirão Preto (FCFRP), Universidade de São Paulo (USP), Ribeirão Preto (SP), Brazil
| | - Rosa Camila Lucchetta
- PhD. Pharmacist, Department of Pharmacy, Universidade Federal do Paraná (UFPR), Curitiba (PR), Brazil
| | - Marcela Forgerini
- BSc. Doctoral Student and Pharmacist, Department of Drugs and Medicines, School of Pharmaceutical Sciences, Universidade Estadual Paulista (UNESP), Araraquara (SP), Brazil
| | - Patricia de Carvalho Mastroianni
- PhD. Pharmacist and Adjunct Professor, Department of Drugs and Medicines, School of Pharmaceutical Sciences, Universidade Estadual Paulista (UNESP), Araraquara (SP), Brazil
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Forgerini M, Varallo FR, de Oliveira ARA, de Nadai TR, de Carvalho Mastroianni P. Assessment of the adherence to and costs of the prophylaxis protocol for venous thromboembolism. Clinics (Sao Paulo) 2019; 74:e1143. [PMID: 31433043 PMCID: PMC6691834 DOI: 10.6061/clinics/2019/e1143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 05/29/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Evaluate adherence to the therapeutic prophylaxis protocol for venous thromboembolism (VTE) as well as the costs of this practice. METHODS A descriptive and cross-sectional study was conducted at a State General Hospital in Brazil through reports of drug dispensions, prescriptions and risk stratification of patients. Adherence to the VTE prophylaxis protocol was monitored. The tests for VTE diagnosis measured the adherence to therapeutic prophylaxis treatment, and the purchase prices of the drugs went into the calculation of drug therapy costs. The level of adherence to prescriptions for VTE prophylaxis in the hospital was classified as "adherence", "non-adherence" and "justified non-adherence" when compared with the protocol. RESULTS Protocol adherence was observed for 50 (30.9%) patients, and non-adherence was observed for 63 (38.9%) patients, generating an additional cost of $180.40/month. Justified non-adherence in 49 (30.2%) patients generated $514.71/month in savings due to a reduction in the number of daily administrations of unfractionated heparin while still providing an effective method for preventing VTE. Twenty-six patients stratified as having medium to high risk of VTE who did not receive prophylaxis were identified, generating $154.41 in savings. However, these data should be evaluated with caution since the risks and outcomes associated with not preventing VTE outweigh the economy achieved from not prescribing a drug when a patient needs it. The only case of VTE identified during the study period was related to justified non-adherence to the protocol. CONCLUSION The protocol is based on scientific evidence that describes an effective therapy to prevent VTE. However, the protocol should be updated because the justifications for non-adherence are based on scientific evidence, and this justified non-adherence generates savings and yields effective disease prevention.
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Affiliation(s)
- Marcela Forgerini
- Departamento de Farmacos e Medicamentos, Faculdade de Ciencias Farmaceuticas, Universidade Estadual de Sao Paulo (UNESP), Araraquara, SP, BR
| | - Fabiana Rossi Varallo
- Departamento de Ciencias Farmaceuticas, Faculdade de Ciencias Farmaceuticas de Ribeirao Preto, Universidade de Sao Paulo, Ribeirao Preto, SP, BR
| | - Alice Rosa Alves de Oliveira
- Departamento de Farmacos e Medicamentos, Faculdade de Ciencias Farmaceuticas, Universidade Estadual de Sao Paulo (UNESP), Araraquara, SP, BR
| | - Tales Rubens de Nadai
- Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirao Preto, Universidade de Sao Paulo, Ribeirao Preto, SP, BR
| | - Patrícia de Carvalho Mastroianni
- Departamento de Farmacos e Medicamentos, Faculdade de Ciencias Farmaceuticas, Universidade Estadual de Sao Paulo (UNESP), Araraquara, SP, BR
- *Corresponding author. E-mail:
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Varallo FR, Passos AC, Nadai TRD, Mastroianni PDC. Incidents reporting: barriers and strategies to promote safety culture. Rev Esc Enferm USP 2018; 52:e03346. [PMID: 30304197 DOI: 10.1590/s1980-220x2017026403346] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 01/31/2018] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The purpose was to identify the barriers of underreporting, the factors that promote motivation of health professionals to report, and strategies to enhance incidents reporting. METHOD Group conversations were carried out within a hospital multidisciplinary team. A mediator stimulated reflection among the subjects about the theme. Sixty-five health professionals were enrolled. RESULTS Complacency and ambition were barriers exceeded. Lack of responsibility about culture of reporting was the new barrier observed. There is a belief only nurses should report incidents. The strategies related to motivation reported were: feedback; educational intervention with hospital staff; and simplified tools for reporting (electronic or manual), which allow filling critical information and traceability of management risk team to improve the quality of report. CONCLUSION Ordinary and practical strategies should be developed to optimize incidents reporting, to make people aware about their responsibilities about the culture of reporting and to improve the risk communication and the quality of healthcare and patient safety.
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Affiliation(s)
- Fabiana Rossi Varallo
- Universidade Estadual Paulista, Faculdade de Ciências Farmacêuticas, Campus Araraquara, Araraquara, SP, Brazil
| | - Aline Cristina Passos
- Universidade Estadual Paulista, Faculdade de Ciências Farmacêuticas, Campus Araraquara, Araraquara, SP, Brazil
| | - Tales Rubens de Nadai
- Hospital Estadual Américo Brasiliense, Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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Abstract
Patient: Female, 65 Final Diagnosis: Clavicle Kirschner wire migration into left lung Symptoms: No symptoms Medication: — Clinical Procedure: Thoracotomy Specialty: Surgery
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Affiliation(s)
| | | | | | | | - Paulo Roberto Barbosa Évora
- Department of Surgery and Anatomy, Ribeirão Preto School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Tales Rubens de Nadai
- Américo Brasiliense State Hospital, São Paulo, SP, Brazil.,Department of Surgery and Anatomy, Ribeirão Preto School of Medicine, University of São Paulo, São Paulo, SP, Brazil
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Varallo FR, Dagli-Hernandez C, Pagotto C, de Nadai TR, Herdeiro MT, de Carvalho Mastroianni P. Confounding Variables and the Performance of Triggers in Detecting Unreported Adverse Drug Reactions. Clin Ther 2017; 39:686-696. [DOI: 10.1016/j.clinthera.2016.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 11/02/2016] [Accepted: 11/03/2016] [Indexed: 10/20/2022]
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Varallo FR, Planeta CS, Herdeiro MT, Mastroianni PDC. Imputation of adverse drug reactions: Causality assessment in hospitals. PLoS One 2017; 12:e0171470. [PMID: 28166274 PMCID: PMC5293251 DOI: 10.1371/journal.pone.0171470] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 01/20/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND & OBJECTIVES Different algorithms have been developed to standardize the causality assessment of adverse drug reactions (ADR). Although most share common characteristics, the results of the causality assessment are variable depending on the algorithm used. Therefore, using 10 different algorithms, the study aimed to compare inter-rater and multi-rater agreement for ADR causality assessment and identify the most consistent to hospitals. METHODS Using ten causality algorithms, four judges independently assessed the first 44 cases of ADRs reported during the first year of implementation of a risk management service in a medium complexity hospital in the state of Sao Paulo (Brazil). Owing to variations in the terminology used for causality, the equivalent imputation terms were grouped into four categories: definite, probable, possible and unlikely. Inter-rater and multi-rater agreement analysis was performed by calculating the Cohen´s and Light´s kappa coefficients, respectively. RESULTS None of the algorithms showed 100% reproducibility in the causal imputation. Fair inter-rater and multi-rater agreement was found. Emanuele (1984) and WHO-UMC (2010) algorithms showed a fair rate of agreement between the judges (k = 0.36). INTERPRETATION & CONCLUSIONS Although the ADR causality assessment algorithms were poorly reproducible, our data suggest that WHO-UMC algorithm is the most consistent for imputation in hospitals, since it allows evaluating the quality of the report. However, to improve the ability of assessing the causality using algorithms, it is necessary to include criteria for the evaluation of drug-related problems, which may be related to confounding variables that underestimate the causal association.
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Affiliation(s)
- Fabiana Rossi Varallo
- São Paulo State University (UNESP), School of Pharmaceutical Sciences, Araraquara, São Paulo, Brazil
- CAPES Foundation, Ministry of Education of Brazil, Brasília—DF, Brazil
| | - Cleopatra S. Planeta
- São Paulo State University (UNESP), School of Pharmaceutical Sciences, Araraquara, São Paulo, Brazil
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Varallo FR, Planeta CS, de Carvalho Mastroianni P. Effectiveness of pharmacovigilance: multifaceted educational intervention related to the knowledge, skills and attitudes of multidisciplinary hospital staff. Clinics (Sao Paulo) 2017; 72:51-57. [PMID: 28226033 PMCID: PMC5251201 DOI: 10.6061/clinics/2017(01)09] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 11/04/2016] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES: Most educational interventions in pharmacovigilance are designed to encourage physicians to report adverse drug reactions. However, multidisciplinary teams may play an important role in reporting drug-related problems. This study assessed the impact of a multifaceted educational intervention in pharmacovigilance on the knowledge, skills and attitudes of hospital professionals. METHOD: This prospective, open-label, non-randomized study was performed in a medium-complexity hospital in São Paulo, Brazil. The intervention involved four activities: 1) an interactive lecture, 2) a practical class, 3) a pre-post questionnaire administered to professionals on a multidisciplinary team, and 4) educational material. The intervention's impact on the professionals' knowledge and skills was assessed using the World Health Organization's definitions. The intervention's effect on the professionals' attitudes was analysed by the prevalence of adverse drug event reports (adverse drug reactions, medication errors, therapeutic failure and drug quality deviations) and the relevance (seriousness and expectancy) of the events. RESULTS: One hundred seventy-three professionals were enrolled. A 70-fold increase in the number of adverse drug event reports was observed during the 12 months post-intervention. The intervention improved the professionals' form-completion skills (p<0.0001) and their knowledge of pharmacovigilance (p<0.0001). The intervention also contributed to detecting serious drug-induced events. The nursing staff reported medication errors, and pharmacists and physiotherapists recognized serious adverse drug reactions. Physicians communicated suspicions of therapeutic failure. CONCLUSIONS: A multidisciplinary approach to drug-safety assessments contributes to identifying new, relevant drug-related problems and improving the rate of adverse drug event reporting. This strategy may therefore be applied to improve risk communication in hospitals.
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Affiliation(s)
- Fabiana Rossi Varallo
- Universidade Estadual Paulista – UNESP, Departamento de Fármacos e Medicamentos, Araraquara/SP, Brazil
- Ministério da Educação do Brasil, Fundação CAPES, Brasília/DF, Brazil
| | - Cleopatra S Planeta
- Universidade Estadual Paulista – UNESP, Faculdade de Ciências Farmacêuticas, Laboratório de Farmacologia, Araraquara/SP, Brazil
| | - Patricia de Carvalho Mastroianni
- Universidade Estadual Paulista – UNESP, Departamento de Fármacos e Medicamentos, Araraquara/SP, Brazil
- *Corresponding author. E-mail:
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Varallo FR, Guimarães SDOP, Abjaude SAR, Mastroianni PDC. [Causes for the underreporting of adverse drug events by health professionals: a systematic review]. Rev Esc Enferm USP 2015; 48:739-47. [PMID: 25338257 DOI: 10.1590/s0080-623420140000400023] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 05/18/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Identifying the main causes for underreporting of Adverse Drug Reaction (ADR) by health professionals. METHOD A systematic review carried out in the following databases: LILACS, PAHO, SciELO, EMBASE and PubMed in the period between 1992 and 2012. Descriptors were used in the search for articles, and the identified causes of underreporting were analyzed according to the classification of Inman. RESULTS In total, were identified 149 articles, among which 29 were selected. Most studies were carried out in hospitals (24/29) for physicians (22/29), and pharmacists (10/29). The main causes related to underreporting were ignorance (24/29), insecurity (24/29) and indifference (23/29). CONCLUSION The data show the eighth sin in underreporting, which is the lack of training in pharmacovigilance. Therefore, continuing education can increase adherence of professionals to the service and improve knowledge and communication of risks due to drug use.
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Affiliation(s)
- Fabiana Rossi Varallo
- Faculty of Pharmaceutical Sciences, São Paulo State University "Júlio de Mesquita Filho", Araraquara, SP, Brazil
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Abstract
Certain medicines are considered potentially inappropriate (PIM) for elderly people as they increase the risk of adverse drug events (ADE) and because safer alternative therapies are available on the market. In this context, in order to identify the instruments that assess the quality of medical prescriptions for elderly and to determine which drugs are considered PIM, a bibliographic survey was conducted in PUBMED, LILACS and PAHO databases, in February and March/2010. The search strategy included the use of health descriptors and a manual search in the references cited by selected papers. During the period of data collection, 15 instruments were identified. In 2012, with the publication of the update of Beers criteria, this instrument was included in the study. We identified 163 PIM of 25 therapeutic classes, of which 125 (76.7%) are marketed in Brazil. Of these, 31 (24.8%) are essential medicines (RENAME 2012), of which 13 have safer therapeutic equivalents and 19 (15.2%) are over-the-counter drugs. Data suggest the need for inclusion of safer alternatives for the elderly in the national list of essential medicines and the pharmaceutical care for early detection of ADE in this age group, in order to contribute to the safe use of medicines.
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Varallo FR, Capucho HC, Silva Planeta CD, Carvalho Mastroianni PD. Possible adverse drug events leading to hospital admission in a Brazilian teaching hospital. Clinics (Sao Paulo) 2014; 69:163-7. [PMID: 24626940 PMCID: PMC3935128 DOI: 10.6061/clinics/2014(03)03] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 08/15/2013] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Drug safety problems can lead to hospital admission. In Brazil, the prevalence of hospitalization due to adverse drug events is unknown. This study aims to estimate the prevalence of hospitalization due to adverse drug events and to identify the drugs, the adverse drug events, and the risk factors associated with hospital admissions. METHOD A cross-sectional study was performed in the internal medicine ward of a teaching hospital in São Paulo State, Brazil, from August to December 2008. All patients aged ≥18 years with a length of stay ≥24 hours were interviewed about the drugs used prior to hospital admission and their symptoms/complaints/causes of hospitalization. RESULTS In total, 248 patients were considered eligible. The prevalence of hospitalization due to potential adverse drug events in the ward was 46.4%. Overprescribed drugs and those indicated for prophylactic treatments were frequently associated with possible adverse drug events. Frequently reported symptoms were breathlessness (15.2%), fatigue (12.3%), and chest pain (9.0%). Polypharmacy was a risk factor for the occurrence of possible adverse drug events. CONCLUSION Possible adverse drug events led to hospitalization in a high-complexity hospital, mainly in polymedicated patients. The clinical outcomes of adverse drug events are nonspecific, which delays treatment, hinders causality analysis, and contributes to the underreporting of cases.
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Affiliation(s)
- Fabiana Rossi Varallo
- Universidade Estadual Paulista Júlio de Mesquita Filho, School of Pharmaceutical Sciences, Department of Drugs and Medications, AraraquaraSP, Brazil, Universidade Estadual Paulista Júlio de Mesquita Filho (UNESP), School of Pharmaceutical Sciences, Department of Drugs and Medications, Araraquara/SP, Brazil
| | - Helaine Carneiro Capucho
- Ministério da Saúde, Comissão Nacional de Incorporação de Tecnologias, BrasíliaDF, Brazil, Ministério da Saúde, Comissão Nacional de Incorporação de Tecnologias, Brasília/DF, Brazil
| | - Cleópatra da Silva Planeta
- Universidade Estadual Paulista Júlio de Mesquita Filho, School of Pharmaceutical Sciences, Department of Natural Active Principles and Toxicology, AraraquaraSP, Brazil, Universidade Estadual Paulista Júlio de Mesquita Filho (UNESP), School of Pharmaceutical Sciences, Department of Natural Active Principles and Toxicology, Araraquara/SP, Brazil
| | - Patrícia de Carvalho Mastroianni
- Universidade Estadual Paulista Júlio de Mesquita Filho, School of Pharmaceutical Sciences, Department of Drugs and Medications, AraraquaraSP, Brazil, Universidade Estadual Paulista Júlio de Mesquita Filho (UNESP), School of Pharmaceutical Sciences, Department of Drugs and Medications, Araraquara/SP, Brazil
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Varallo FR, Ambiel ISS, Nanci LO, Galduróz JCF, Mastroianni PDC. Assessment of pharmacotherapeutic safety of medical prescriptions for elderly residents in a long-term care facility. BRAZ J PHARM SCI 2012. [DOI: 10.1590/s1984-82502012000300015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The present study aimed to estimate the prevalence of elderly using potentially inappropriate medications (PIM) and with occurrence of potentially hazardous drug interactions (PHDI); to identify the risk factors for the prescription of PIM and to evaluate the impact of pharmaceutical intervention (PI) for the prescription of safer therapeutic alternatives. Therefore, a cross-sectional study was performed in a long-term care facility in São Paulo State, between December/2010 and January/2011. The medical records of the patients >60 years old who took any drugs were consulted to assess the pharmacotherapeutic safety of the medical prescriptions, in order to identify PIM and PHDI, according to the Beers (2003) and World Health Organization criteria, respectively. PI consisted of a guidance letter to the physician responsible for the institution, with the suggestions of safer equivalent therapeutics. Approximately 88% of the elderly took at least one drug, and for 30% of them the PIM had been prescribed. Most of the PIM identified (53.4%) act on the central nervous system. Among the 13 different DI detected, 6 are considered PHDI. Polypharmacy was detected as a risk factor for PIM prescription. After the PI there was no change in medical prescriptions of patients who had been prescribed PIM or PHDI. The data suggests that PI performed by letter, as the only interventional, method was ineffective. To contribute it a wide dissemination of PIM and PHDI among prescriber professionals is necessary for the selection of safer treatment for elderly. Additionally, a pharmacist should be part of the health care team in order to help promote rational use of medicines.
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Varallo FR, Capucho HC, Planeta CS, Mastroianni PDC. Safety assessment of potentially inappropriate medications use in older people and the factors associated with hospital admission. J Pharm Pharm Sci 2012; 14:283-90. [PMID: 21733416 DOI: 10.18433/j3p01j] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE Potentially Inappropriate Medications (PIM) use in elderly people may be responsible for the development of Adverse Drug Reaction (ADR) which, when severe, leads to hospital admissions. OBJECTIVES to estimate the prevalence of elderly who had used PIM before being admitted to hospital admission and to identify the risk factors and the hospitalizations related to ADR arising from PIM. METHODS A descriptive and cross-sectional study was performed in the internal medicine ward of a teaching hospital (Brazil), in 2008. With the aid of a validated form, patients aged ≥ 60 years, with length of hospital stay ≥ 24 hours, were interviewed about drugs taken prior to the hospital admission and the complaints/reasons for hospitalization. RESULTS 19.1% (59/308) of older patients had taken PIM before hospital admission and in 4.9%; there were a causal relation between the PIM taken and the complaint reported. PIM responsible for admissions were: amiodarone, amitriptyline, cimetidine, clonidine, diazepam, digoxin, estrogen, fluoxetine, lorazepam, short-acting nifedipine and propranolol. 47.0% of the clinical manifestations of PIM-related ADR were: dizziness, fatigue, digoxin toxicity and erythema. Only polypharmacy was detected as a risk factor for the occurrence of ADR of PIM (p = 0.02). CONCLUSION PIM use in elderly people is not a risk factor for ADR-related hospital admission. Probably, severe ADR, which lead to hospitalizations of older people, can be explained by idiosyncratic response or the predisposition of these patients to develop adverse drug events, whether or not drugs are classed as PIM.
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Affiliation(s)
- Fabiana Rossi Varallo
- School of Pharmaceutical Sciences of the Universidade Estadual Paulista Júlio de Mesquita Filho, Araraquara (SP), Brazil
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Abstract
As Reações Adversas a Medicamentos (RAM) podem ser responsáveis por 2,4% a 11,5% das admissões hospitalares. O estudo objetivou conhecer o perfil demográfico dos pacientes internados por possíveis RAM, identificar os medicamentos e as queixas mais freqüentemente relacionadas e estimar a incidência de admissão hospitalar pelo uso de medicamentos. Durante um mês, os pacientes internados em um hospital geral foram entrevistados quanto ao uso de medicamentos antes da internação e as queixas que o levaram ao hospital; as informações foram analisadas, usando-se a base de dados MICROMEDEX® e outras bases oficiais. Observou-se que as admissões por uso de medicamentos ocorreram predominantemente em idosos [47,5% (66/139)] e mulheres [62% (87/139)]. Os medicamentos mais freqüentes foram: omeprazol (16), analgésicos (31), antihipertensivos (31), sinvastatina (7) e formoterol (6); e normalmente os sintomas associados foram do sistema digestório (20,5%), circulatório (20,2%), respiratório (18,2%) e SNC (13,9%). Estima-se que em 15,5% (139/897) das internações, possivelmente, a razão foi o uso de medicamentos. Os dados sugerem medidas de prevenção, como o acompanhamento farmacoterapêutico dos pacientes no âmbito da assistência primária à saúde, principalmente aos idosos, aos portadores de doenças crônicas e aos polimedicados, além da orientação farmacêutica na compra e dispensação de medicamentos, principalmente os isentos de prescrição.
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