El modelo GAM (Gestión Autónoma de la Medicación) como generador de autonomía en salud mental / O modelo GAM (Gestão Autônoma da Medicação) como gerador de autonomia em saúde mental / The autonomous medication management (AMM) model as a generator of autonomy in mental health care

En este texto presentamos una aproximación al concepto de autonomía aplicado al campo de la salud mental tomando como marco la "Guía para la gestión autónoma de la medicación" (GAM) y su despliegue en Brasil y España. La estrategia GAM plantea una comprensión de la autonomía alejada de una visión individualista para aproximarse a una perspectiva social y colectiva. En este artículo vamos a evidenciar los posibles desplazamientos y las tensiones generadas, así como los efectos de autonomización que conlleva su implementación en salud mental. En la experiencia brasileña, se observa ese desplazamiento desde el lugar del saber-poder, propio de los profesionales, mientras la experiencia española muestra cómo la adaptación de la herramienta parte de la necesaria implicación de los profesionales, de los usuarios/as, sus familias y su red social en un proceso conjunto de trabajo y cuidado colectivo. (AU)

Neste texto apresentamos o conceito de autonomia aplicado ao campo da saúde mental. Para isso tomaremos como referencial uma experiência denominada "Guia para a gestão autônoma de medicamentos" (GAM) e sua implantação em dois contextos geográficos: Brasil e Espanha. A estratégia GAM propõe uma compreensão da autonomia afastando-se de uma visão individualista para se aproximar de uma perspectiva social e coletiva. Neste artigo iremos evidenciar os possíveis deslocamentos e tensões presentes, bem como os possíveis efeitos da autonomização que sua implementação produziu no contexto do cuidado em saúde mental. Assim, na experiência brasileira, observamos como esse deslocamento se produz a partir desse lugar do poder-saber, típico da experiência do profissional, enquanto a experiência espanhola mostra como a adaptação da ferramenta decorre da implicação necessária dos profissionais, usuários, familiares e rede social em um processo conjunto de trabalho e cuidado coletivo. (AU)

In this article we present the concept of autonomy applied to the field of mental health drawing on experiences of the implementation of the "Autonomous Medication Management Guide" in two different contexts: Brazil and Spain. Autonomous medication management proposes an understanding of autonomy that moves away from an individualistic view towards a social and collective perspective. This article highlights potential shifts and tensions and the possible effects of "autonomization" in the context of mental health care. In the Brazilian experience, we observed how this shift is produced from the place of power-knowledge typical of professional practice, while the Spanish experience shows how the adaptation of the tool derives from the necessary involvement of professionals, service users, families and social networks through a joint process of collective working and care. (AU)

First do no 'pharm': Educating medical and pharmacy students on the essentials of medication management.

BACKGROUND: Polypharmacy is a dilemma in modern medical practice and presents an opportunity for interprofessional collaboration. Our pilot project evaluated whether implementing an interprofessional education (IPE) session would influence awareness of interprofessional values/ethics, roles/responsibilities, communication, and teams/teamwork. INTERPROFESSIONAL EDUCATION ACTIVITY: A dual-institution, multi-part IPE session on medication management was implemented with medicine and pharmacy students. Part 1 consisted of a pillbox exercise whereby students simulated the patient experience of taking medications. Part 2 was an interprofessional medication reconciliation exercise with a standardized patient. After completing the session, students were asked to reflect on their experience in response to a prompt. Reflections were analyzed qualitatively for overarching themes. DISCUSSION: This pilot uniquely captured the interaction between medical and pharmacy students from neighboring institutions. After completing the IPE session, both groups of students felt they were better equipped to take a medication history, perform medication reconciliation, and understand the value of a community pharmacist. Major themes elicited from reflections included: (1) increased awareness of barriers to medication adherence, (2) increased empathy towards adults with polypharmacy, (3) appreciation for the interprofessional team, and (4) realization of the importance of medication reconciliation and patient understanding of their medications. IMPLICATIONS: The collaboration between institutions, located at a distance from one another, demonstrates a novel approach that can be used by others to facilitate IPE. All students gained experience interacting in an interprofessional setting simulating their future practice(s). Future studies are needed to evaluate the extent of those interactions and potential outcomes.

Nurses' Perspectives on Family Caregiver Medication Management Support and Deprescribing.

Nurses who care for patients with life-limiting illness operate at the interface of family caregivers (FCGs), patients, and prescribers and are uniquely positioned to guide late-life medication management, including challenging discussions about deprescribing. The study objective was to describe nurses' perspectives about their role in hospice FCG medication management. Content analysis was used to analyze qualitative interviews with nurses from a parent study exploring views on medication management and deprescribing for advanced cancer patients. Ten home and inpatient hospice nurses, drawn from 3 hospice agencies and their referring hospital systems in New England, were asked to describe current practices of medication management and deprescribing and to evaluate a pilot tool to standardize hospice medication review. Analysis of the 10 interviews revealed that hospice nurses are receptive to a standardized approach for comprehensive medication review upon hospice transition and responded favorably to opportunities to discuss medication discontinuation with FCGs and prescribers. Effective framing for discussions included focus on reducing harmful and nonessential medications and reducing caregiver burden. Results indicate that nurses who care for hospice-eligible and enrolled patients are willing to discuss deprescribing with FCGs and prescribers when conversations are framed around medication harms and their impact on quality of life.

Medications and patient safety in the trauma setting: a systematic review.

Background: Medication errors account for the most common adverse events and a significant cause of mortality in the USA. The Joint Commission has required medication reconciliation since 2006. We aimed to survey the literature and determine the challenges and effectiveness of medication reconciliation in the trauma patient population. Materials and methods: We conducted a systematic review of the literature to determine the effectiveness of medication reconciliation in trauma patients. English language articles were retrieved from PubMed/Medline, CINAHL, and Cochrane Review databases with search terms "trauma OR injury, AND medication reconciliation OR med rec OR med rek, AND effectiveness OR errors OR intervention OR improvements." Results: The search resulted in 82 articles. After screening for relevance and duplicates, the 43 remaining were further reviewed, and only four articles, which presented results on medication reconciliation in 3041 trauma patients, were included. Two were retrospective and two were prospective. Two showed only 4% accuracy at time of admission with 48% of medication reconciliations having at least one medication discrepancy. There were major differences across the studies prohibiting comparative statistical analysis. Conclusions: Trauma medication reconciliation is important because of the potential for adverse outcomes given the emergent nature of the illness. The few articles published at this time on medication reconciliation in trauma suggest poor accuracy. Numerous strategies have been implemented in general medicine to improve its accuracy, but these have not yet been studied in trauma. This topic is an important but unrecognized area of research in this field.

Medication administration - nursing workload and patient safety in clinical wards / Administração de medicamentos - carga de trabalho de enfermagem e segurança do paciente em unidades clínicas hospitalares / Administración de medicamentos - carga de trabajo de enfermería y seguridad del paciente en unidades clínicas

ABSTRACT Objective: to analyze the characteristics of the work organization performed by nursing staff regarding medication administration procedures and their implications on the workload of these professionals and on patient safety. Method: the study design is exploratory, with mixed method research and an ecological restorative approach. Data were collected between January 2014 and March 2015, in three inpatient units of a teaching hospital in the south of Brazil, by means of photo walkabout and focus groups, in the qualitative step. In the quantitative phase data were collected from the 162 lists of patients assigned to nursing technicians during their work shifts. Results: the administration of medications has an impact on the professionals' workload and patient safety. Final considerations: there are weaknesses in the process that may contribute to medication administration errors, which are related to the number of doses and the number of patients assigned to each professional.

RESUMO Objetivo: analisar as características da organização do trabalho da equipe de enfermagem quanto aos procedimentos de administração de medicamentos e suas implicações na carga de trabalho desses profissionais e na segurança do paciente. Método: estudo exploratório, com método misto de pesquisa e abordagem restaurativa ecológica. Os dados foram coletados entre janeiro de 2014 e março de 2015, em três unidades de internação de um hospital universitário do sul do Brasil, por meio de caminhada fotográfica (CF) e grupos focais (GF) na etapa qualitativa. Na fase quantitativa, foram coletados dados das 162 listas de pacientes atribuídos aos técnicos de enfermagem durante seus turnos de trabalho. Resultados: a administração de medicamentos impacta na carga de trabalho dos profissionais e na segurança dos pacientes. Considerações finais: as fragilidades existentes no processo podem contribuir para erros na administração de medicamentos, que estão relacionados com o número de doses e ao número de pacientes atribuídos a cada profissional.

RESUMEN Objetivo: analizar las características de la organización del trabajo real del equipo de enfermería en cuanto a los procedimientos de administración de medicamentos y sus implicaciones en la carga de trabajo de estos profesionales y en la seguridad del paciente. Método: investigación exploratoria con método mixto y enfoque ecológico y restaurativo. Los datos fueron recolectados entre enero de 2014 y marzo de 2015 en tres unidades de internación de un hospital universitario del sur de Brasil, por medio de caminada fotográfica (CF) y grupos focales (GF) en la etapa cualitativa. En la fase cuantitativa, se recogieron datos de las 162 listas de pacientes asignados a los técnicos de enfermería durante sus turnos de trabajo. Resultados: la administración de medicamentos tiene un impacto en la carga de trabajo de los profesionales y en la seguridad del paciente. Consideraciones finales: hay debilidades en el proceso que pueden contribuir a los errores de administración de medicamentos, que están relacionados con el número de dosis y el número de pacientes asignados a cada profesional.

Overview of the First Natural Language Processing Challenge for Extracting Medication, Indication, and Adverse Drug Events from Electronic Health Record Notes (MADE 1.0).

INTRODUCTION: This work describes the Medication and Adverse Drug Events from Electronic Health Records (MADE 1.0) corpus and provides an overview of the MADE 1.0 2018 challenge for extracting medication, indication, and adverse drug events (ADEs) from electronic health record (EHR) notes. OBJECTIVE: The goal of MADE is to provide a set of common evaluation tasks to assess the state of the art for natural language processing (NLP) systems applied to EHRs supporting drug safety surveillance and pharmacovigilance. We also provide benchmarks on the MADE dataset using the system submissions received in the MADE 2018 challenge. METHODS: The MADE 1.0 challenge has released an expert-annotated cohort of medication and ADE information comprising 1089 fully de-identified longitudinal EHR notes from 21 randomly selected patients with cancer at the University of Massachusetts Memorial Hospital. Using this cohort as a benchmark, the MADE 1.0 challenge designed three shared NLP tasks. The named entity recognition (NER) task identifies medications and their attributes (dosage, route, duration, and frequency), indications, ADEs, and severity. The relation identification (RI) task identifies relations between the named entities: medication-indication, medication-ADE, and attribute relations. The third shared task (NER-RI) evaluates NLP models that perform the NER and RI tasks jointly. In total, 11 teams from four countries participated in at least one of the three shared tasks, and 41 system submissions were received in total. RESULTS: The best systems F1 scores for NER, RI, and NER-RI were 0.82, 0.86, and 0.61, respectively. Ensemble classifiers using the team submissions improved the performance further, with an F1 score of 0.85, 0.87, and 0.66 for the three tasks, respectively. CONCLUSION: MADE results show that recent progress in NLP has led to remarkable improvements in NER and RI tasks for the clinical domain. However, some room for improvement remains, particularly in the NER-RI task.

First Successful Pre-Distribution of Stable Iodine Tablets Under Japan's New Policy After the Fukushima Daiichi Nuclear Accident.

Stable iodine tablets are effective in reducing internal exposure to radioactive iodine, which poses a risk for thyroid cancer and other conditions. After the Fukushima Daiichi nuclear power plant accident, the Japanese government shifted its policy on stable iodine tablet distribution from "after-the-fact" to "before-the-fact" and instructed local governments to pre-distribute stable iodine tablets to residents living within a 5-km radius of nuclear facilities. The nation's first pre-distribution of stable iodine tablets was carried out in June and July of 2014 in Kagoshima Prefecture. Health surveys were conducted so that the medication would not be handed out to people with the possibility of side effects. Of the 4715 inhabitants in the area, 132 were found to require a physician's judgment, mostly to exclude risks of side effects. This was considered important to prevent the misuse of the tablets in the event of a disaster. The importance of collective and individualized risk communication between physicians and inhabitants at the community health level was apparent through this study. Involvement of physicians through the regional Sendai City Medical Association was an important component of the pre-distribution. Physicians of the Sendai City Medical Association were successfully educated by using the Guidebook on Distributing and Administering Stable Iodine Tablets prepared by the Japan Medical Association and Japan Medical Association Research Institute with the collaboration of the National Institute of Radiological Sciences and the Japanese government. Thus, the physicians managed to make decisions on the dispensing of stable iodine tablets according to the health conditions of the inhabitants. All physicians nationwide should be provided continuing medical education on stable iodine tablets. (Disaster Med Public Health Preparedness. 2017;11:365-369).

Improving medication adherence: moving from intention and motivation to a personal systems approach.

Medication nonadherence is a challenging and prevalent problem in older adults. Effective medication management involves successfully completing a complex group of behaviors. Meta-analyses and narrative review findings support limited benefits to medication adherence with interventions preoccupied with personal characteristics, intention, and motivation. Evidence supports a paradigm shift toward changing personal systems in which the person lives to improve and maintain medication adherence behavior. Personal-systems change systematically improves individual systems through collaboratively shaping routines, involving supportive-others in routines, and using medication self-monitoring to improve and maintain behavior. Other advances that support personal systems change are also presented.

Quest for the ideal: a redesign of the medication use system.

Medication use systems in hospitals are complex and prone to error. A redesign of the system using idealized design methodology is a starting point in preventing patient harm from medication errors. An interdisciplinary team identified system properties, proposed and gathered feedback on an ideal design, and established a structure to plan changes in the system and monitor their impact.

Formulacion e implantacion de politicas farmaceuticas: El caso de Chile / Pharmaceutical policies formulation and settlement: Chile's case

Se describe la politica farmaceutica vigente en Chile que acoge a la industria farmaceutica sin muchos obstaculos de importacion, fabricacion, precios y patentes. Se elaboran formas farmaceuticas a partir de principios activos de paises extranjeros que mueven aproximadamente 150 millones de dolares como inversion. la competencia generada y la libre comercializacion, respaldada por las politicas farmaceuticas pretende hacer mas accesible el medicamento. Se cuenta con un formulario nacional de medicamentos genericos y una lista de alternativas farmaceuticas de monodrogas comercializadas en el pais con un total de 653 principios activos y 2300 especialidades farmaceuticas. El consumo de medicamentos sigue el perfil de morbilidad nacional prevaleciendo el consumo de antibioticos, psicofarmacos, analgesicos y antiinflamatorios. Los precios son fijados libremente por los laboratorios, incrementados en un 20 por ciento por los mayoristas y un 25 a 35 por ciento por las farmacias. Se cuentan con medio para el uso racional de medicamentos