Avaliação da profilaxia da trombose venosa profunda em um hospital geral / Evaluation of deep vein thrombosis prophylaxis in a general hospita

Contexto: O tromboembolismo venoso (TEV) representa uma preocupação crescente nas instituições hospitalares, tem grande impacto sobre a morbimortalidade em pacientes clínicos e cirúrgicos, e é a principal causa de morte evitável hospitalar. Embora existam modelos de avaliação de risco para pacientes hospitalizados, a profilaxia ainda é subutilizada ou é feita de forma incorreta. Objetivos: Avaliar o perfil de risco para TEV de pacientes clínicos e cirúrgicos recém-internados, bem como as medidas tromboprofiláticas aplicadas nas primeiras 24 horas de internação. Métodos: Este estudo transversal foi realizado em um hospital geral de grande porte do interior do estado de São Paulo entre março e julho de 2015. Os escores de Pádua e Caprini foram utilizados para estratificação de risco dos pacientes clínicos e cirúrgicos, respectivamente, enquanto a análise das medidas tromboprofiláticas baseou-se nas recomendações do 8º e 9º Consenso do American College of Chest Physicians. Resultados: Foram analisados 592 pacientes (62% clínicos e 38% cirúrgicos). A estratificação de risco revelou necessidade de quimioprofilaxia em 42% dos pacientes clínicos e 81% dos cirúrgicos (51% de alto risco e 30% de moderado risco). Por outro lado, receberam profilaxia adequada nas primeiras 24 horas de internação 54% dos pacientes clínicos de alto risco, 85% dos cirúrgicos de alto risco e 4% dos cirúrgicos de moderado risco, todos sem contraindicação. Conclusões: Há necessidade de aprimoramento da segurança do paciente em relação ao TEV já nas primeiras horas de internação. Existe uma subutilização da quimioprofilaxia especialmente nos pacientes clínicos de alto risco e cirúrgicos de moderado risco

Background: Venous thromboembolism (VTE) is a cause for growing concern in hospitals, has great impact on morbidity and mortality in clinical and surgical patients, and is the leading cause of preventable hospital deaths. Although there are risk assessment models for hospital inpatients, prophylaxis is still underused or is administered incorrectly. Objectives: To assess the risk profile for VTE in recently hospitalized clinical and surgical patients and evaluate the thromboprophylactic measures implemented in the first 24 hours of hospitalization. Methods: Cross-sectional study conducted in a large general hospital in the state of São Paulo, Brazil, between March and July 2015. Padua and Caprini scores were used for risk stratification of clinical and surgical patients, respectively, while thromboprophylactic measures were analyzed for compliance with the recommendations contained in the 8th and 9th Consensus of the American College of Chest Physicians. Results: A total of 592 patients (62% clinical and 38% surgical) were assessed. Risk stratification revealed a need for chemoprophylaxis in 42% of clinical patients and 81% of surgical patients (51% high risk and 30% moderate risk). However, 54% of high-risk clinical patients, 85% of high-risk surgical patients, and 4% of moderate-risk surgical patients, who were free from contraindications, were actually given the correct prophylaxis in the first 24 hours of hospitalization. Conclusions: There is a need to improve patient safety in relation to VTE in the first hours of hospitalization, since there is underutilization of chemoprophylaxis, especially in high-risk clinical patients and moderate-risk surgical patients

Evaluation of deep vein thrombosis prophylaxis in a general hospital.

BACKGROUND: Venous thromboembolism (VTE) is a cause for growing concern in hospitals, has great impact on morbidity and mortality in clinical and surgical patients, and is the leading cause of preventable hospital deaths. Although there are risk assessment models for hospital inpatients, prophylaxis is still underused or is administered incorrectly. OBJECTIVES: To assess the risk profile for VTE in recently hospitalized clinical and surgical patients and evaluate the thromboprophylactic measures implemented in the first 24 hours of hospitalization. METHODS: Cross-sectional study conducted in a large general hospital in the state of São Paulo, Brazil, between March and July 2015. Padua and Caprini scores were used for risk stratification of clinical and surgical patients, respectively, while thromboprophylactic measures were analyzed for compliance with the recommendations contained in the 8th and 9th Consensus of the American College of Chest Physicians. RESULTS: A total of 592 patients (62% clinical and 38% surgical) were assessed. Risk stratification revealed a need for chemoprophylaxis in 42% of clinical patients and 81% of surgical patients (51% high risk and 30% moderate risk). However, 54% of high-risk clinical patients, 85% of high-risk surgical patients, and 4% of moderate-risk surgical patients, who were free from contraindications, were actually given the correct prophylaxis in the first 24 hours of hospitalization. CONCLUSIONS: There is a need to improve patient safety in relation to VTE in the first hours of hospitalization, since there is underutilization of chemoprophylaxis, especially in high-risk clinical patients and moderate-risk surgical patients.

O problema da dose em homeopatia: avaliação do efeito de altas diluições de arsenicum album 30ch em ratos intoxicados com arsênico / The problem of dose in homeopathy: evaluation of the effect of high dilutions of Arsenicum album 30cH on rats intoxicated with arsenic

Background: Although scientific studies have confirmed the action of homeopathic high dilutions in living organisms an endless debate on the choice of the most fitting dilution, the frequency of administration and the dose (amount of medicine) still remains. Aims: This study sought to assess the in vivo effect of 2 different concentrations of Arsenicum album 30cH in order to elucidate some problems in the homeopathic notion of dose. Methods: Male Wistar rats previously intoxicated with sodium arsenate by peritoneal injection were treated with undiluted Ars 30cH and Ars 30cH in 1% solution administered by oral route. Atomic absorption spectroscopy was employed to measure the levels of arsenic retained in the animals as well as the amounts eliminated through urine. Urine samples were collected before and after and during treatment. A positive control group (intoxicated animals) and negative control group (nonintoxicated animals) were administered only the vehicle used to prepare the medicine (ethanol). Results: The groups treated with undiluted Ars 30cH and Ars 30cH in 1% solution eliminated significant amounts of arsenic through urine when compared to the control groups. The group treated with undiluted Ars 30cH eliminated significantly higher amounts of arsenic than the group treated with the same medicine in 1% solution. Conclusion: These results suggest that undiluted Ars 30cH was more effective than in 1% solution in this experimental model.(AU)

Background: Although scientific studies have confirmed the action of homeopathic high dilutions in living organisms an endless debate on the choice of the most fitting dilution, the frequency of administration and the dose (amount of medicine) still remains. Aims: This study sought to assess the in vivo effect of 2 different concentrations of Arsenicum album 30cH in order to elucidate some problems in the homeopathic notion of dose. Methods: Male Wistar rats previously intoxicated with sodium arsenate by peritoneal injection were treated with undiluted Ars 30cH and Ars 30cH in 1% solution administered by oral route. Atomic absorption spectroscopy was employed to measure the levels of arsenic retained in the animals as well as the amounts eliminated through urine. Urine samples were collected before and after and during treatment. A positive control group (intoxicated animals) and negative control group (nonintoxicated animals) were administered only the vehicle used to prepare the medicine (ethanol). Results: The groups treated with undiluted Ars 30cH and Ars 30cH in 1% solution eliminated significant amounts of arsenic through urine when compared to the control groups. The group treated with undiluted Ars 30cH eliminated significantly higher amounts of arsenic than the group treated with the same medicine in 1% solution. Conclusion: These results suggest that undiluted Ars 30cH was more effective than in 1% solution in this experimental model.(AU)

Evaluation of the effect of different concentrations of Arsenicum album 6cH on intoxicated rats / Avaliação do efeito de diferentes concentrações de Arsenicum album 6cH em ratos intoxicados

Aims: Homeopaths diverge on the concept of dose, i.e. the amount of drug that a patient must take to alter his or her state of disease. In order to stimulate reflections on this concept, this study sought to evaluate in vivo the effect of different concentrations of Arsenicum album 6cH prepared according to homeopathic pharmacotechnics. Methods: male Wistar rats were intoxicated with arsenic and then treated with Arsenicum album 6cH and Arsenicum album 6cH diluted at 1%, administered orally. The amount of arsenic retained in the animals’ organism and that eliminated by urine were measured through atomic absorption spectroscopy. Samples of urine were collected before and after intoxication and during treatment. The positive control group (intoxicated animals) and the negative control group (non-intoxicated animals) received only the vehicle used in the preparation of the medicine. Results: Groups treated with Arsenicum album 6cH and Arsenicum album 6cH diluted at 1% eliminated significant amounts of arsenic when compared to the control groups. The group treated with Arsenicum album 6cH eliminated significantly higher amounts of arsenic than the group treated with the diluted medicine at 1%. Conclusion: results suggest that Arsenicum album 6cH should not be diluted as not to compromise its effectiveness in the treatment of rats intoxicated with arsenic.(AU)

Objetivos: Há divergência entre os homeopatas a respeito do conceito de dose, entendida como a quantidade de medicamento que o paciente deve ingerir para modificar o estado de doença. Para estimular a reflexão sobre este tópico, o presente estudo procurou avaliar o efeito in vivo de diferentes concentrações de Arsenicum album 6cH preparado segundo a farmacotécnica homeopática. Métodos: ratos Wistar machos foram intoxicados com arsênico e após, medicados com Arsenicum album 6cH e o mesmo diluído a 1% por via oral. O arsênico retido no organismo dos animais assim como o eliminado através da urina foi quantificado através de espectroscopia de absorção atômica. Amostras de urina foram colhidas antes e após a intoxicação e durante o tratamento. O grupo controle positivo (animais intoxicados) e o grupo controle negativo (animais não intoxicados) receberam apenas o veículo utilizado no preparo do medicamento. Resultados: os grupos tratados com Arsenicum album 6cH e Arsenicum album 6cH 1% eliminaram quantidades significativas de arsênico por comparação com os grupos controle. O grupo tratado com Arsenicum album 6cH eliminou quantidades significativamente maiores de arsênico que o grupo tratado com o mesmo medicamento diluído a 1%. Conclusão: os resultados sugerem que Arsenicum album 6cH não deve ser diluído a fim de não comprometer sua efetividade no tratamento de ratos intoxicados com arsênico.(AU)

Evaluation of the effect of different concentrations of Arsenicum album 6cH on intoxicated rats / Avaliação do efeito de diferentes concentrações de Arsenicum album 6cH em ratos intoxicados

Aims: Homeopaths diverge on the concept of dose, i.e. the amount of drug that a patient must take to alter his or her state of disease. In order to stimulate reflections on this concept, this study sought to evaluate in vivo the effect of different concentrations of Arsenicum album 6cH prepared according to homeopathic pharmacotechnics. Methods: male Wistar rats were intoxicated with arsenic and then treated with Arsenicum album 6cH and Arsenicum album 6cH diluted at 1%, administered orally. The amount of arsenic retained in the animals’ organism and that eliminated by urine were measured through atomic absorption spectroscopy. Samples of urine were collected before and after intoxication and during treatment. The positive control group (intoxicated animals) and the negative control group (non-intoxicated animals) received only the vehicle used in the preparation of the medicine. Results: Groups treated with Arsenicum album 6cH and Arsenicum album 6cH diluted at 1% eliminated significant amounts of arsenic when compared to the control groups. The group treated with Arsenicum album 6cH eliminated significantly higher amounts of arsenic than the group treated with the diluted medicine at 1%. Conclusion: results suggest that Arsenicum album 6cH should not be diluted as not to compromise its effectiveness in the treatment of rats intoxicated with arsenic.

Objetivos: Há divergência entre os homeopatas a respeito do conceito de dose, entendida como a quantidade de medicamento que o paciente deve ingerir para modificar o estado de doença. Para estimular a reflexão sobre este tópico, o presente estudo procurou avaliar o efeito in vivo de diferentes concentrações de Arsenicum album 6cH preparado segundo a farmacotécnica homeopática. Métodos: ratos Wistar machos foram intoxicados com arsênico e após, medicados com Arsenicum album 6cH e o mesmo diluído a 1% por via oral. O arsênico retido no organismo dos animais assim como o eliminado através da urina foi quantificado através de espectroscopia de absorção atômica. Amostras de urina foram colhidas antes e após a intoxicação e durante o tratamento. O grupo controle positivo (animais intoxicados) e o grupo controle negativo (animais não intoxicados) receberam apenas o veículo utilizado no preparo do medicamento. Resultados: os grupos tratados com Arsenicum album 6cH e Arsenicum album 6cH 1% eliminaram quantidades significativas de arsênico por comparação com os grupos controle. O grupo tratado com Arsenicum album 6cH eliminou quantidades significativamente maiores de arsênico que o grupo tratado com o mesmo medicamento diluído a 1%. Conclusão: os resultados sugerem que Arsenicum album 6cH não deve ser diluído a fim de não comprometer sua efetividade no tratamento de ratos intoxicados com arsênico.

[A literature review on pharmacists' interventions in the use of medication by elderly patients]. / Revisão dos estudos de intervenção do farmacêutico no uso de medicamentos por pacientes idosos.

The total proportional geriatric population in Brazil is projected to increase from 9.05% in 1999 to approximately 13% in 2020. Non-communicable diseases are common in this age group, and medication is used frequently. Inadequate prescription and improper use of drugs can produce undesirable outcomes, leading to avoidable hospitalization and increasing health care costs. The objective of this paper was to conduct a literature review of pharmacists' interventions and their influence on use of medication by elderly patients, based on five databases from 1970 to 1999. The sample consisted of 76 studies, of which 15 were analyzed and discussed. Research on this subject is scarce, and limited to developed countries. In general, the interventions presented favorable outcomes. Most actions were limited to counseling patients and their physicians, and there was a lack of interventions to adjust the medication to the user.

Revisäo dos estudos de intervençäo do farmacêutico no uso de medicamentos por pacientes idosos / A literature review on pharmacists' interventions in the use of medication by elderly patients

No Brasil, os idosos representavam 9,05 por cento em 1999 e, em 2020, poderäo totalizar 13 por cento da populaçäo. Nessa faixa etária as doenças crônicas e degenerativas säo comuns e freqüentemente se utiliza muitos medicamentos. A prescriçäo e o uso inadequado dos mesmos podem levar a resultados indesejados, acarretando internaçöes hospitalares evitáveis e elevando os custos do sistema de saúde. O objetivo deste trabalho foi conhecer os estudos de intervençäo do farmacêutico e sua influência no uso de medicamentos pelo paciente idoso, listados em cinco bases de dados, no período entre 1970 e 1999. Foram localizados 76 artigos, resultando em 15 trabalhos para análise e discussäo. Os estudos sobre o tema säo escassos e limitados aos países de economia avançada. De uma forma geral, as intervençöes apresentaram resultado positivo. A maioria das intervençöes limitou-se ao aconselhamento ao usuário e/ou ao prescritor, notando-se falta de açöes que levem à adequaçäo do medicamento ao usuário

Farmacoeconomia: conceitos e aspectos operacionais / Pharmacoeconomy: concepts and operational aspects

Farmacoeconomia é a aplicação da economia ao estudo dos medicamentos, visando à otimização do uso de recursos financeiros sem que ocorra prejuizo na qualidade do tratamento. Seu estudo pode envolver aspectos "macro", aplicando técnicas de epidemiologia, bem como estudo de grupo de especialistas, em que são tomadas decisões por consenso, após avaliação de risco/benefício/custo de equivalentes terapêuticos. Na área "micro" da farmacoeconomia, a atenção visa apenas a um ou poucos medicamentos, focalizando uma doença ou um sintoma, e utiliza técnicas e termos derivados da economia, como avaliação custo-benefício, custo-efetividade, custo-utilidade e minimização de custos com o uso de medicamentos...

Contribuiçäo ao estudo de utilizaçäo de medicamentos em enfermaria de clínica médica e à organizaçäo de informações técnicas sobre medicamentos na instituiçäo hospitalar / Contribution to drug utilization study in general ward and to the organization of hospital drug information

Visando o desenvolvimento de metodologia para organizaçäo e disponibilizaçäo de informações técnicas atualizadas sobre medicamentos padronizados no Hospital, desenvolveu-se banco de dados computadorizado com informações sobre a nomenclatura do medicamento, suas diferentes especialidades farmacêuticas, restrições de prescriçäo, orientaçäo de receituário e classes terapêuticas. Esse foi adotado pela institutiçäo e resultou na ediçäo do novo Guia Farmacoterapêutico do HC-FMUSP. Desenvolveu-se estudo de utilizaçäo de medicamentos em Enfermaria de Clínica Geral para identificaçäo do perfil de prescriçäo e de gasto em medicamentos, visando apontar possíveis intervenções para racionalizaçäo...