Methodological - Theoretical approach to phenomenological studies on the experience of medication use: A systematic review.

BACKGROUND: The study of medication use should include pharmacological, family, and social dimensions to explain how the lived experiences, beliefs, and perceptions of everyone, and their social and cultural environment affects consumption, using for this purpose the qualitative approach. OBJECTIVE: To conduct a systematic review of the theoretical-methodological approaches to phenomenology to identify studies that allow an understanding of patients' experiences with the use of medications.a. METHODS: A systematic literature search was conducted following the PRISMA guidelines to identify studies that address phenomenological research on patients' experiences of medications used and to apply them in subsequent studies. A thematic analysis was performed using ATLAS.ti software to facilitate data management. RESULTS: Twenty-six articles were identified, most of them including adult patients diagnosed with chronic degenerative diseases. The semantic network obtained places Phenomenology at the center as the interpretative referential framework, with three theoretical approaches: descriptive, interpretative, and perceptual under the philosophies of Husserl, Heidegger, and Merleau-Ponty respectively; two techniques to collect data which are in-depth interview and focus groups; and to explore the life experiences of patients and understand the meaning in the context of their lives, thematic analysis, content analysis, and interpretative phenomenological analysis were identified. CONCLUSIONS: It was evidenced that Qualitative Research approaches, methodologies, and techniques are applicable to describe people's experiences towards the use of medications. Phenomenology constitutes a useful referential framework in qualitative research to explain the experiences and perceptions about the disease and the use of medicines.

Design and validation of quality indicators for drug dispensing in a pediatric hospital.

OBJECTIVES: This article presents a methodological strategy to design and validate quality indicators for drug dispensing in a pediatric hospital. SETTING: The literature evaluation, design, and validation of indicators by experts were carried out from September 2017 to March 2018 in the pharmaceutical services of a pediatric hospital at the Autonomous University of the State of Hidalgo, Mexico. PRACTICE DESCRIPTION: The design and validation of quality indicators for dispensing allow the evaluation, planning, and follow-up of this activity. PRACTICE INNOVATION: The development of the indicators follows a holistic vision considering the relationship between the structure on which the pediatric dispensation is based, the involved processes, and the outcomes and provide a simple tool to improve the quality of the dispensing service. EVALUATION: A methodological investigation for the development of systems and health services in drug dispensing was performed. For the indicator's design, the Mexican standards for establishments dedicated to the sale and supply of drugs, the Good Dispensation Practices, and the Donabedian model were considered. The validation of such indicators was carried out using the Delphi method and the Torgerson mathematical model. RESULTS: Indicators of structure, process, and results were designed; of the 16 indicators designed, 15 reached the average score of greater than 3.5, and the percentage of experts who qualified each indicator in the highest categories was greater than 50%. CONCLUSION: The design of indicators guarantees the quality of the dispensing service and can be extrapolated to the pharmaceutical services of any pediatric hospital.

Farmacovigilancia en pacientes geriátricos con neumonía / Pharmacosurveillance in elderly patients with pneumonia

Objetivo: evaluar las reacciones adversas detectadas en los tratamientos aplicados a pacientes ancianos con neumonía.Métodos: se realizó un estudio descriptivo, prospectivo, de farmacovigilancia empleando el método de monitoreo intensivo al paciente hospitalizado, en el Servicio de Geriatría del Hospital Provincial Saturnino Lora Torres de Santiago de Cuba, en el período comprendido desde enero a diciembre de 2008.Resultados: se obtuvo que las reacciones adversas más frecuentes fueron atribuidas a los antimicrobianos. Predominaron la nefrotoxicidad y el prurito, y de acuerdo con su causalidad y significación clínica, las reacciones adversas medicamentosas probables y leves, respectivamente.Conclusiones: los pacientes geriátricos tienen una serie de condiciones que los hace más propensos a la aparición de reacciones adversas medicamentosas, de ahí que cobre gran importancia en la actualidad la vigilancia de las sospechas de estas en aras de contribuir a la mejora de su calidad de vida(AU)

Objective: to evaluate the adverse effects detected in the treatments for the elderly patients with pneumonia. Methods: a prospective and descriptive study of pharmacosurveillance was conducted by using the intensive monitoring to hospitalized patient method at the Geriatric Service of Saturnino Lora Torres hospital in Santiago de Cuba municipality, from January to December 2008. Results: the most frequent adverse reactions were attributed to the antimicrobials. Nephrotoxicity and pruritus were predominant, and probable and slight adverse drugs reactions predominated according to their causality and clinical significance. Conclusions: the elderly patients carry a group of conditions that make them more prone to adverse drug reactions, hence the great importance of surveillance of suspected reactions in order to contribute to their better quality of life(AU)

Caracterización de la práctica de la atención farmacéutica en instituciones hospitalarias de Santiago de Cuba / Characterization of the pharmaceutical care practice in hospital institutions located in Santiago de Cuba

Introducción: el panorama de los países de América Latina en la actualidad revela que a nivel hospitalario hay una adopción del concepto de atención farmacéutica, sin embargo, la práctica demuestra que se mantiene el centro de la actividad en el medicamento y su dispensación. El uso de indicadores fácilmente mensurables que permitan conocer las características de las funciones relacionadas con este ejercicio, puede constituirse en una forma de constatar esta realidad.Objetivo: caracterizar la práctica de la atención farmacéutica en instituciones hospitalarias.Métodos: se realizó una investigación retrospectiva que incluyó los años 2005-2007, en instituciones hospitalarias de Santiago de Cuba. Se establecieron indicadores a partir de los criterios normados para la actividad de atención farmacéutica en el Manual de normas y procedimientos de farmacias hospitalarias y criterios establecidos en la literatura internacional. Se partió de los registros informados de dicha actividad a la Dirección Provincial de Salud.Resultados: los indicadores reflejaron que se realizan más las actividades de seguimiento farmacoterapéutico (algunos indicadores relacionados superiores al 70 por ciento), que las de educación sanitaria (no alcanza nunca más del 5 por ciento) e información sobre medicamentos a pacientes y profesionales (no alcanza nunca más del 13 por ciento); pero no se desarrollan de forma normalizada, ni continua. Además, las intervenciones farmacéuticas son bien aceptadas por los equipos de salud (más del 70 por ciento de aceptación), sin embrago, no son suficientes en función del número de problemas relacionados con los medicamentos detectados.Conclusiones: el ejercicio de la atención farmacéutica no es una práctica habitual del profesional farmacéutico en las instituciones estudiadas y no se desarrolla de forma normalizada; esto indica la necesidad de establecer estrategias para el perfeccionamiento de este ejercicio profesional(AU)

Introduction: the panorama of the Latin American countries at present shows that at hospital setting, the concept of pharmaceutical care is adopted, but the practice proves that it continues being focused in drugs and dispensation. The use of easy-to-measure indications to find out the characteristics of the functions related to this exercise may represent the confirmation these realities. Objective: to characterize the practice of pharmaceutical care in hospital institutions. Methods: a retrospective research study was carried out and covered years 2005 through 2007 in hospital institutions of Santiago de Cuba. Some indicators were set on the basis of the criteria for the pharmaceutical care activity included in the Manual de normas y procedimientos de farmacias hospitalarias and of the criteria found in the international literature. The reported registers of pharmaceutical care sent to the provincial health division were also taken into consideration. Results: the indicators revealed that the pharmacotherapeutic follow-up activities (some indicators over 70 percent) exceeded those of health education (barely reaching 5 percent) and information about drugs for patients and health professionals (never over 13 percent); however, they are not either standardized or permanent. Additionally, the pharmaceutical interventions were well-accepted by the health teams (over 70 percent acceptance rate) but they are still insufficient to deal with the number of problems connected with the detected medications. Conclusions: the implementation of the pharmaceutical care is not a regular and standardized practice by the pharmaceutical professional in the studied institutions. The aforementioned points to the need of drawing up strategies to improve this professional endeavor(AU)

Farmacovigilancia en pacientes geriátricos con neumonía / Pharmacosurveillance in elderly patients with pneumonia

Objetivo: evaluar las reacciones adversas detectadas en los tratamientos aplicados a pacientes ancianos con neumonía.Métodos: se realizó un estudio descriptivo, prospectivo, de farmacovigilancia empleando el método de monitoreo intensivo al paciente hospitalizado, en el Servicio de Geriatría del Hospital Provincial Saturnino Lora Torres de Santiago de Cuba, en el período comprendido desde enero a diciembre de 2008.Resultados: se obtuvo que las reacciones adversas más frecuentes fueron atribuidas a los antimicrobianos. Predominaron la nefrotoxicidad y el prurito, y de acuerdo con su causalidad y significación clínica, las reacciones adversas medicamentosas probables y leves, respectivamente.Conclusiones: los pacientes geriátricos tienen una serie de condiciones que los hace más propensos a la aparición de reacciones adversas medicamentosas, de ahí que cobre gran importancia en la actualidad la vigilancia de las sospechas de estas en aras de contribuir a la mejora de su calidad de vida

Objective: to evaluate the adverse effects detected in the treatments for the elderly patients with pneumonia. Methods: a prospective and descriptive study of pharmacosurveillance was conducted by using the intensive monitoring to hospitalized patient method at the Geriatric Service of Saturnino Lora Torres hospital in Santiago de Cuba municipality, from January to December 2008. Results: the most frequent adverse reactions were attributed to the antimicrobials. Nephrotoxicity and pruritus were predominant, and probable and slight adverse drugs reactions predominated according to their causality and clinical significance. Conclusions: the elderly patients carry a group of conditions that make them more prone to adverse drug reactions, hence the great importance of surveillance of suspected reactions in order to contribute to their better quality of life

Caracterización de la práctica de la atención farmacéutica en instituciones hospitalarias de Santiago de Cuba / Characterization of the pharmaceutical care practice in hospital institutions located in Santiago de Cuba

Introducción: el panorama de los países de América Latina en la actualidad revela que a nivel hospitalario hay una adopción del concepto de atención farmacéutica, sin embargo, la práctica demuestra que se mantiene el centro de la actividad en el medicamento y su dispensación. El uso de indicadores fácilmente mensurables que permitan conocer las características de las funciones relacionadas con este ejercicio, puede constituirse en una forma de constatar esta realidad.Objetivo: caracterizar la práctica de la atención farmacéutica en instituciones hospitalarias.Métodos: se realizó una investigación retrospectiva que incluyó los años 2005-2007, en instituciones hospitalarias de Santiago de Cuba. Se establecieron indicadores a partir de los criterios normados para la actividad de atención farmacéutica en el Manual de normas y procedimientos de farmacias hospitalarias y criterios establecidos en la literatura internacional. Se partió de los registros informados de dicha actividad a la Dirección Provincial de Salud.Resultados: los indicadores reflejaron que se realizan más las actividades de seguimiento farmacoterapéutico (algunos indicadores relacionados superiores al 70 por ciento), que las de educación sanitaria (no alcanza nunca más del 5 por ciento) e información sobre medicamentos a pacientes y profesionales (no alcanza nunca más del 13 por ciento); pero no se desarrollan de forma normalizada, ni continua. Además, las intervenciones farmacéuticas son bien aceptadas por los equipos de salud (más del 70 por ciento de aceptación), sin embrago, no son suficientes en función del número de problemas relacionados con los medicamentos detectados.Conclusiones: el ejercicio de la atención farmacéutica no es una práctica habitual del profesional farmacéutico en las instituciones estudiadas y no se desarrolla de forma normalizada; esto indica la necesidad de establecer estrategias para el perfeccionamiento de este ejercicio profesional

Introduction: the panorama of the Latin American countries at present shows that at hospital setting, the concept of pharmaceutical care is adopted, but the practice proves that it continues being focused in drugs and dispensation. The use of easy-to-measure indications to find out the characteristics of the functions related to this exercise may represent the confirmation these realities. Objective: to characterize the practice of pharmaceutical care in hospital institutions. Methods: a retrospective research study was carried out and covered years 2005 through 2007 in hospital institutions of Santiago de Cuba. Some indicators were set on the basis of the criteria for the pharmaceutical care activity included in the Manual de normas y procedimientos de farmacias hospitalarias and of the criteria found in the international literature. The reported registers of pharmaceutical care sent to the provincial health division were also taken into consideration. Results: the indicators revealed that the pharmacotherapeutic follow-up activities (some indicators over 70 percent) exceeded those of health education (barely reaching 5 percent) and information about drugs for patients and health professionals (never over 13 percent); however, they are not either standardized or permanent. Additionally, the pharmaceutical interventions were well-accepted by the health teams (over 70 percent acceptance rate) but they are still insufficient to deal with the number of problems connected with the detected medications. Conclusions: the implementation of the pharmaceutical care is not a regular and standardized practice by the pharmaceutical professional in the studied institutions. The aforementioned points to the need of drawing up strategies to improve this professional endeavor

Contradicciones sociales expresadas en la práctica de la Atención Farmacéutica Hospitalaria en Cuba / Social contradictions in pharmaceutical care practice at hospital setting in Cuba

Introducción: en Cuba el ejercicio de las funciones clínicas y la práctica de la Atención Farmacéutica a nivel hospitalario son limitadas pues, aunque existe un acercamiento a la concepción de estas funciones en los actuales manuales de procedimientos, los profesionales farmacéuticos realizan mayormente funciones administrativas y de dirección, además de las relacionadas con el suministro de medicamentos. Objetivo: analizar las contradicciones sociales (causas) que repercuten en la práctica de la Atención Farmacéutica Hospitalaria, específicamente en Santiago de Cuba, para trazar líneas estratégicas que permitan el perfeccionamiento de esta actividad. Métodos: se aplicó una herramienta que facilita el análisis de problemas y sus soluciones, el diagrama de causa-efecto, así como el método de consenso de votación ponderada, para determinar las causas principales y secundarias que frenan dicho ejercicio a nivel hospitalario. Las principales causas analizadas fueron los recursos humanos, los métodos y estilos de dirección, los recursos materiales, los medios y las condiciones de trabajo. Resultados: los resultados de la votación ponderada mostraron que las causas de mayor ponderación en orden descendente fueron las relacionadas con los métodos y estilos de dirección con 37 puntos, los recursos humanos con 33 puntos y los recursos materiales con 18,5 puntos. Conclusiones: las contradicciones identificadas marcan caminos de investigación para resolver las problemáticas planteadas, lo que permitirá desarrollar un modelo que establezca principios para el desarrollo de la Atención Farmacéutica a nivel hospitalario diseñado sobre la base de las evaluaciones y las valoraciones realizadas y los principios de las Buenas Prácticas de Farmacia

Introduction: the clinical functions and the practice of pharmaceutical care at hospital setting are limited in Cuba. Although there is an approach to the conception of these functions in the current manuals of procedures, the pharmacists mostly carry out administrative and managing functions in addition to those of drug supply. Objective: to analyze the social contradictions (causes) that have an effect on the practice of pharmaceutical care at hospital, particularly in Santiago de Cuba, in order to draw up strategies for improvement of this activity. Methods: a tool facilitating the analysis of problems and their solutions, the cause-effect diagram and the weighed voting consensus method were applied to determine the main and secondary causes that hinder the above-mentioned practice at hospital. The main analyzed causes were human resources, methods, management styles, material resources, working means and conditions. Results: the results of the weighed voting revealed that the highly weighed causes in descending order were managing methods and styles with 37 points, the human resources with 33 points and the material resources with 18.5 points. Conclusions: the identified contradictions mark paths of research to solving the stated problems, which will allow creating a model of principles for the development of pharmaceutical care at hospital setting, on the basis of evaluations and assessments carried out and on the principles of the Good Practice of Pharmacy

Contradicciones sociales expresadas en la práctica de la Atención Farmacéutica Hospitalaria en Cuba / Social contradictions in pharmaceutical care practice at hospital setting in Cuba

Introducción: en Cuba el ejercicio de las funciones clínicas y la práctica de la Atención Farmacéutica a nivel hospitalario son limitadas pues, aunque existe un acercamiento a la concepción de estas funciones en los actuales manuales de procedimientos, los profesionales farmacéuticos realizan mayormente funciones administrativas y de dirección, además de las relacionadas con el suministro de medicamentos. Objetivo: analizar las contradicciones sociales (causas) que repercuten en la práctica de la Atención Farmacéutica Hospitalaria, específicamente en Santiago de Cuba, para trazar líneas estratégicas que permitan el perfeccionamiento de esta actividad. Métodos: se aplicó una herramienta que facilita el análisis de problemas y sus soluciones, el diagrama de causa-efecto, así como el método de consenso de votación ponderada, para determinar las causas principales y secundarias que frenan dicho ejercicio a nivel hospitalario. Las principales causas analizadas fueron los recursos humanos, los métodos y estilos de dirección, los recursos materiales, los medios y las condiciones de trabajo. Resultados: los resultados de la votación ponderada mostraron que las causas de mayor ponderación en orden descendente fueron las relacionadas con los métodos y estilos de dirección con 37 puntos, los recursos humanos con 33 puntos y los recursos materiales con 18,5 puntos. Conclusiones: las contradicciones identificadas marcan caminos de investigación para resolver las problemáticas planteadas, lo que permitirá desarrollar un modelo que establezca principios para el desarrollo de la Atención Farmacéutica a nivel hospitalario diseñado sobre la base de las evaluaciones y las valoraciones realizadas y los principios de las Buenas Prácticas de Farmacia(AU)

Introduction: the clinical functions and the practice of pharmaceutical care at hospital setting are limited in Cuba. Although there is an approach to the conception of these functions in the current manuals of procedures, the pharmacists mostly carry out administrative and managing functions in addition to those of drug supply. Objective: to analyze the social contradictions (causes) that have an effect on the practice of pharmaceutical care at hospital, particularly in Santiago de Cuba, in order to draw up strategies for improvement of this activity. Methods: a tool facilitating the analysis of problems and their solutions, the cause-effect diagram and the weighed voting consensus method were applied to determine the main and secondary causes that hinder the above-mentioned practice at hospital. The main analyzed causes were human resources, methods, management styles, material resources, working means and conditions. Results: the results of the weighed voting revealed that the highly weighed causes in descending order were managing methods and styles with 37 points, the human resources with 33 points and the material resources with 18.5 points. Conclusions: the identified contradictions mark paths of research to solving the stated problems, which will allow creating a model of principles for the development of pharmaceutical care at hospital setting, on the basis of evaluations and assessments carried out and on the principles of the Good Practice of Pharmacy(AU)

Perfil profesional del Licenciado en Farmacia de la Universidad de Oriente, Cuba / Professional profile of the Bachelor of Pharmacy in Universidad de Oriente, Cuba

Teniendo en cuenta la necesidad de un currículo que garantice una formación universitaria universal, contextual, flexible y comprometida con la realidad social y profesional, en el presente trabajo se diseñó el perfil profesional que caracterizará al egresado de la Licenciatura en Ciencias Farmacéuticas de la Universidad de Oriente, Cuba. Se utilizó para ello el Modelo de Actuación Profesional; se precisó el problema profesional, el objeto de la profesión y el objetivo profesional, y sobre la base del sentido articulador entre estas configuraciones se definieron los campos, esferas y modos de actuación, dejando explícito, además, los objetivos educativos e instructivos que se aspiran alcanzar

Taking into account the need of a curriculum assuring universal, contextual and flexible university formation that is committed to the social and professional realities of the country, the present paper designed the professional profile of the Pharmaceutical Sciences graduate in the University of Oriente, Cuba. To this end, the Professional Performance Model was used; the professional problem, the object of the profession and the professional objectives were defined. On the basis of the articulation of these configurations, the various fields, spheres and modes of performance were established, thus clearly stating the educational and learning objectives that are expected to be attained

Perfil profesional del Licenciado en Farmacia de la Universidad de Oriente, Cuba / Professional profile of the Bachelor of Pharmacy in Universidad de Oriente, Cuba

Teniendo en cuenta la necesidad de un currículo que garantice una formación universitaria universal, contextual, flexible y comprometida con la realidad social y profesional, en el presente trabajo se diseñó el perfil profesional que caracterizará al egresado de la Licenciatura en Ciencias Farmacéuticas de la Universidad de Oriente, Cuba. Se utilizó para ello el Modelo de Actuación Profesional; se precisó el problema profesional, el objeto de la profesión y el objetivo profesional, y sobre la base del sentido articulador entre estas configuraciones se definieron los campos, esferas y modos de actuación, dejando explícito, además, los objetivos educativos e instructivos que se aspiran alcanzar(AU)

Taking into account the need of a curriculum assuring universal, contextual and flexible university formation that is committed to the social and professional realities of the country, the present paper designed the professional profile of the Pharmaceutical Sciences graduate in the University of Oriente, Cuba. To this end, the Professional Performance Model was used; the professional problem, the object of the profession and the professional objectives were defined. On the basis of the articulation of these configurations, the various fields, spheres and modes of performance were established, thus clearly stating the educational and learning objectives that are expected to be attained(AU)

Prescription errors in a primary care university unit: urgency of pharmaceutical care in Mexico / Erros de prescrição no Centro de Saúde de uma Universidade: urgência de implementar Atenção Farmacêutica no México

The purpose of this study was to assess prescription rationality and most common prescription errors at the primary care clinic of a Mexican university.A retrospective drug utilization review of indication-prescription type was carried out. A random sample of 370 medical records of patients assisted over a year period, were reviewed. Prescription appropriateness was evaluated according to the variables: indication, dosage regimen, administration route, contraindications, interactions, medication duplicity, unnecessary or missing medications. Prescriptions were rated as appropriate (no prescription errors found) or inappropriate (at least one prescription error found). The benefit-risk ratio was calculated for each prescription. This study revealed a 58 percent of inappropriate prescriptions in the Mexican primary care university clinic, mostly due to errors on dosage regimen and innapropiate drug selection. As a result of chi2 analysis, it was found that the pharmacotherapeutic variables chosen for the prescription assessment in this study, were determinant in prescription appropriateness rating. Nimesulide, ciprofloxacin, ranitidine, ketorolac and paracetamol were the most prescribed drugs as well as the most common cause of errors found. The prescription error rate revealed by this study addresses the need for strategies to improve prescription's quality. Introducing pharmacists as a key part of health care team is a mean proposed to prevent medication errors and to solve the urgency of pharmaceutical care implementation in all primary care facilities in Mexico.

O objetivo deste trabalho foi avaliar a racionalidade das prescrições como também os erros mais comuns nas prescrições emitidas pelo Centro de Saúde de uma Universidade no México. Foi realizado um estudo retrospectivo de utilização de medicamentos que requeria prescrição médica. 370 expedientes médicos foram aleatoriamente selecionados e revisados, obtendo uma mostra estatísticamente representativa do total de consultas médicas realizadas no período de um ano. A validade da prescrição médica foi feita utilizando as seguintes variáveis: indicação, doses recomendada, via de administração, contra-indicações, interações, duplicação de medicamentos, medicamentos desnecessários ou faltantes. As prescrições médicas foram classificadas como: apropriada (se não foram encontrados erros nas prescrições) ou inapropriada (se foram encontradas ao menos um erro na prescrição). A razão risco-beneficio foi calculada para cada prescrição médica. O estudo revelou alta incidência de prescrições inapropriadas no Centro de Saúde da Universidade do México (58 por cento), causada pelos erros nas doses recomendadas e na seleção do medicamento relacionado com a necessidade do paciente. Como resultado da análise chi2 , foi encontrado que as variáveis fármaco-terapêuticas escolhidas neste estudo para avaliar a prescrição médica, foram determinantes para classificar as prescrições como apropriadas. Nimesulide, ciprofloxacin, ranitidine, ketorolac e paracetamol representaram o maior número de medicamentos prescritos assim como a maior causa de erros encontradas nas prescrições. É importante que um farmacêutico valide os medicamentos prescritos no Centro de Saúde. Este estudo justifica o papel que os farmacêuticos mexicanos deveriam desempenhar para evitar erros na prescrição, como parte importante da equipe médica, assim como a urgência de implementar os cuidados farmacêuticos em todos os estabelecimentos dos Centros de Saúde no México.

Prescription errors in a primary care university unit: urgency of pharmaceutical care in Mexico

The purpose of this study was to assess prescription rationality and most common prescription errors at the primary care clinic of a Mexican university.A retrospective drug utilization review of indication-prescription type was carried out. A random sample of 370 medical records of patients assisted over a year period, were reviewed. Prescription appropriateness was evaluated according to the variables: indication, dosage regimen, administration route, contraindications, interactions, medication duplicity, unnecessary or missing medications. Prescriptions were rated as appropriate (no prescription errors found) or inappropriate (at least one prescription error found). The benefit-risk ratio was calculated for each prescription. This study revealed a 58 percent of inappropriate prescriptions in the Mexican primary care university clinic, mostly due to errors on dosage regimen and innapropiate drug selection. As a result of chi2 analysis, it was found that the pharmacotherapeutic variables chosen for the prescription assessment in this study, were determinant in prescription appropriateness rating. Nimesulide, ciprofloxacin, ranitidine, ketorolac and paracetamol were the most prescribed drugs as well as the most common cause of errors found. The prescription error rate revealed by this study addresses the need for strategies to improve prescription's quality. Introducing pharmacists as a key part of health care team is a mean proposed to prevent medication errors and to solve the urgency of pharmaceutical care implementation in all primary care facilities in Mexico(AU)

O objetivo deste trabalho foi avaliar a racionalidade das prescrições como também os erros mais comuns nas prescrições emitidas pelo Centro de Saúde de uma Universidade no México. Foi realizado um estudo retrospectivo de utilização de medicamentos que requeria prescrição médica. 370 expedientes médicos foram aleatoriamente selecionados e revisados, obtendo uma mostra estatísticamente representativa do total de consultas médicas realizadas no período de um ano. A validade da prescrição médica foi feita utilizando as seguintes variáveis: indicação, doses recomendada, via de administração, contra-indicações, interações, duplicação de medicamentos, medicamentos desnecessários ou faltantes. As prescrições médicas foram classificadas como: apropriada (se não foram encontrados erros nas prescrições) ou inapropriada (se foram encontradas ao menos um erro na prescrição). A razão risco-beneficio foi calculada para cada prescrição médica. O estudo revelou alta incidência de prescrições inapropriadas no Centro de Saúde da Universidade do México (58 por cento), causada pelos erros nas doses recomendadas e na seleção do medicamento relacionado com a necessidade do paciente. Como resultado da análise chi2 , foi encontrado que as variáveis fármaco-terapêuticas escolhidas neste estudo para avaliar a prescrição médica, foram determinantes para classificar as prescrições como apropriadas. Nimesulide, ciprofloxacin, ranitidine, ketorolac e paracetamol representaram o maior número de medicamentos prescritos assim como a maior causa de erros encontradas nas prescrições. É importante que um farmacêutico valide os medicamentos prescritos no Centro de Saúde. Este estudo justifica o papel que os farmacêuticos mexicanos deveriam desempenhar para evitar erros na prescrição, como parte importante da equipe médica, assim como a urgência de implementar os cuidados farmacêuticos em todos os estabelecimentos dos Centros de Saúde no México(AU)

Análisis Costo-Eficacia de la Terapia con Cremas de Propóleos para el Pie Diabético en Cuba / Analysis Efficacy Cost of the Therapy with Propolis Creams for the Diabetic Foot in Cuba

Se desarrolló un estudio clínico con el objetivo de demostrar las ventajas económicas y socia- les del uso de una crema elaborada con el propóleos recolectado en la región de Manzanillo en Cuba, en una muestra de 120 pacientes diabéticos atendidos en los servicios de Angiología de dos hospitales de la provincia de Santiago de Cuba, y uno de Ciudad de La Habana. Se realizó un diseño experimental de com- paración inter-individual o en grupos paralelos, a doble ciego, controlado y con asignación aleatorizada del tratamiento. La relación costo-eficacia se desarrolló a partir de la técnica de evaluación económica de medicamentos denominada Análisis Costo-Efectividad, cuya única diferencia con la seleccionada para la presente investigación, es el nivel de efectos en términos de salud que tiene en consideración, que refleja condiciones reales para la intervención médica. La relación costo-eficacia obtenida con la nueva formula-ción, a ambas concentraciones fue mejor que la alcanzada con la medicación habitualmente empleada para tratar al paciente con pie diabético, alcanzándose una reducción de dicho costo, con respecto a la terapia habitual de un 41.8 por ciento con la formulación al 10por ciento y de un 43.2 por ciento con la preparada al 15 por ciento, con una mayor efectividad terapéutica que el tratamiento convencional, por lo que incuestionablemente la crema de propóleos sometida al estudio, constituye una terapia mucho más ventajosa desde el punto de vista económico que la habitual(AU)

The clinic study was made with the objective to demonstrated the economic and clinical benefit of the use of a cream with Cuban propolis collected in the Manzanillo area, Granma province. The study was realized in 120 diabetic patients who were assisted by the Service of Angiology in 3 Cuban hospitals, two hospitals of the Santiago de Cuba and one hospital of Havana city. The clinic assay was carried out according to the Helsinki Declaration 13, in Phase II, enclosure, double blind, controlled, contingent, stratified according to the size of the hurt and in several centers, with interindividual or in parallel comparison. The relation efficacy-cost was calculated through of the technique to economic evaluation of drugs, known as analysis cost- effectiveness. This analysis has a difference with the relation used in this study that it is to reflect the real conditions for the medical intervention. The relation efficacy-cost obtained with the new formulation, to both concentrations it was better that the obtained with the habitual therapy used for treatment to patients with diabetic foot. We obtained a reduction of the cost with respect to habitual therapy to 41.8 percent with the formulation to 10 percentil and 43.2 percent with the elaborated to 15 percent, with a greatest therapeutic efficacy what the conventional therapy, by that the propolis cream is a therapy with advantage clinical and economic(AU)