Bladder Self-management in the Transition to Adulthood With Spina Bifida in 3 Countries: A Comparative Study.

PURPOSE: The purpose of this study was to evaluate bladder self-management in transition to adult care for patients with spina bifida (SB) in 3 countries with similar clinical practice and different social, cultural, and economic milieu. STUDY DESIGN: Cross-sectional study. SUBJECTS AND SETTING: The sample comprised 90 participants: 27 reside in Brazil, 36 reside in Germany, and 27 reside in the United States. Demographic characteristics of the sample are based on country. The distribution of sex in the Brazilian sample was 18 males and 9 females, the German group had 11 males and 25 females, and the United States group had 8 males and 19 females. The age range of the cumulative sample was 13 to 29 years. The age of the German sample (mean 23.56, standard deviation [SD] 4.60 years) was significantly higher (analysis of variance, F(2, 87) = 13.62, P < .001) than the other 2 groups (Brazil mean 20.56 years, SD 5.24; US mean 19.44 years, SD 4.70). METHODS: Demographic, clinical, and social variable data were collected via an online questionnaire distributed to multiple regions of Germany and a multidisciplinary myelomeningocele clinic at the University of Michigan in the Midwestern United States. In Brazil, participants completed a printed version of the survey. In Germany and the United States, an electronic version of the survey was made available online. German and English versions of the survey, originally developed in Portuguese for persons residing in Brazil, were translated and validated. RESULTS: The majority of participants (94.4%) performed intermittent catheterization (IC), 76.5% performed IC independently, whereas 23.5% required assistance with IC or catheterized with aids (handles, leg spreaders, and penis or labia holder). There were no statistically significant group differences in independent self-catheterization by gender. There were significant national group differences in level of lesion (P = .016), use of shunt (P = .012), and medication for bladder management (P < .001). Among participants 18 years and older, there were significantly higher levels of education in the German and the US samples than in the Brazilian sample (P < .001). CONCLUSIONS: Although there were national group differences in medical characteristics and management of SB, differences in independent self-catheterization were not significant. Findings suggest that support from family/caregivers and health care providers appears to facilitate transition to independent self-care, regardless of national context.

Analysis and detection of dental prescribing errors at primary health care units in Brazil.

AIM OF STUDY: To analyze dental prescribing errors in Aracaju, Brazil, and to suggest feasible improvements for patient safety. METHODS: A descriptive study was conducted at nine Primary Health Care Units (PHCUs) in the northeast region of Brazil. A convenience sample of 300 dental prescriptions was selected during the period February-May 2007. The World Health Organization (WHO) prescribing criteria were used to measure the quality of the prescriptions. MAIN OUTCOME MEASURES: All medications were prescribed by generic name; 98.3% of prescription information contained abbreviations and 26% of them were classified as having low legibility or as being illegible. The most commonly prescribed medications were diclofenac (35%), both sodium and potassium, and amoxicillin (26%). CONCLUSIONS: Dental prescribing errors should be considered as a potential area for improvement in the medication management process and patient safety. We suggest that a pharmacist should be available for medication dispensing at all units and that dentists are trained continuously so that medication orders may become more legible and complete. Improving the quality of dental prescriptions will reduce the risks for medication errors and will promote the rational use of pharmacotherapy, and patient safety.

Influence of Pharmaceutical Care intervention and communication skills on the improvement of pharmacotherapeutic outcomes with elderly Brazilian outpatients.

OBJECTIVE: The goal of this study was to evaluate the influence of Pharmaceutical Care intervention on the results obtained with a group of elderly outpatients and to analyze the communication skills used by healthcare professionals (research pharmacists, dispensing pharmacists, and physicians) during counseling about healthcare and drug therapy. METHODS: The instruments were applied to 30 elderly outpatients assisted at the pharmacy of a primary healthcare unit in Ribeirão Preto (SP), Brazil. The group of patients received follow-up for a period of 12 months. RESULTS: It was observed that Pharmaceutical Care intervention and humanized communication, of an educational nature, optimized the use of medication, reduced symptoms caused by drug therapy, and improved the health conditions of the patients. CONCLUSION: Pharmaceutical Care intervention was essential for the establishment of therapeutic relationships and influenced the care given to elderly people as well as the achievement of positive health outcomes. PRACTICE IMPLICATIONS: After this study, Pharmaceutical Care programs were implemented in different PHCU's of Ribeirão Preto and pharmacists are following-up 300 elderly patients.