Early economic evaluation of the digital gait analysis system for fall prevention-Preliminary analysis of the GaitSmart system.

Objective: To develop an early economics evaluation (EEE) to assess the cost-effectiveness of the GS in reducing the RoF and FoF. Methods: A cost-effectiveness analysis (CEA) with a return on investment (RoI) estimation was performed. CEA used the most relevant parameters, such as increased gait speed and decreased FoF, to estimate the reduction in the RoF, the impact on health care resources used and financial implications for the National Health System in the United Kingdom. Outcomes were measured as incremental cost-effectiveness ratio per quality-adjusted life years (QALYs) gained based on the reduction of the RoF and FoF. Uncertainties around the main parameters used were evaluated by probabilistic sensitivity analysis. Results: The CEA results showed that the GS is a dominant strategy over the standard of care to improve the movements of older persons who have suffered a fall or are afraid of falling (incremental QALYs based on FoF = 0.77 and QALYs based on RoF = 1.07, cost of FoF = -£4479.57 and cost of RoF = -£2901.79). By implementing the GS, the ROI results suggest that every pound invested in the GS could result in cost savings of £1.85/patient based on the RoF reduction and £11.16/patient based on the FoF reduction. The probability of being cost saving based on the number of iterations were 79.4 percent (based on FoF) and 100 percent (based on RoF). Conclusion: The EEE supports the main hypothesis that the GS is an effective intervention to avoid falls and is potentially cost saving.

Cost-Effectiveness Analysis of Digital Breast Tomosynthesis Added to Synthetic Mammography in Breast Cancer Screening in Brazil.

BACKGROUND: Literature meta-analysis results show that digital breast tomosynthesis (DBT) combined with synthesized two-dimensional (s2D) mammograms can reduce recalls and improve breast cancer detection. Uncertainty regarding the screening of patients with breast cancer presents a health economic challenge, both in terms of healthcare resource use and quality of life impact on patients. OBJECTIVE: This study aims to estimate the cost effectiveness of DBT + s2D versus digital mammography (DM) used in a biennial breast cancer screening setting of women aged 40-69 years with scattered areas of fibroglandular breast density and heterogeneous dense breasts in the Brazilian supplementary health system. METHODS: A cost-effectiveness analysis was performed on the basis of clinical data obtained from a systematic review with meta-analysis performed to evaluate the analytical validity and clinical utility of DBT + s2D compared with DM. The search was conducted in the PubMed, Cochrane Library and Embase databases, with the main descriptors of the technology, a comparator, and the clinical condition in question, on 9 June 2022. The hybrid economic model (decision tree plus Markov model) simulated costs and outcomes over a lifetime for women aged 40-69 years with scattered areas of fibroglandular breast density and heterogeneous dense breasts. We analyzed incremental cost-effectiveness ratio (ICER) to measure the incremental cost difference per quality-adjusted life year (QALY) of adding DBT + s2D to breast cancer screening. RESULTS: DBT + s2D incurred a cost saving of € 954.02 per patient, in the time horizon of 30 years, compared with DM, and gained 5.1989 QALYs, which would be considered a dominant intervention. These results were confirmed in sensitivity analyses. CONCLUSION: Switching from DM to biennial DBT + s2D was cost effective. Furthermore, reductions in false-positive recall rates should also be considered in decision making.

Comparing the effects of docosahexaenoic and eicosapentaenoic acids on cardiovascular risk factors: Pairwise and network meta-analyses of randomized controlled trials.

BACKGROUND: Evidence from clinical trial studies suggests that docosahexaenoic acids (DHA) may have greater potential effects on improving cardiovascular risk factors than eicosapentaenoic acid (EPA). However, this evidence has not yet been meta-analyzed and quantified. The aim of this study was to evaluate and compare the effect of DHA and EPA monotherapy on cardiovascular risk factors based on paired and network meta-analysis. METHODS: Relevant articles published up to January 2022 were systematically retrieved from relevant databases. We included all Randomized Controlled Trials (RCTs) on adults that directly compared the effects of DHA with EPA and RCTs of indirect comparisons (DHA and EPA monotherapy compared to control groups). Data were pooled by pairwise and network meta-analysis and expressed as mean differences (MDs) with 95% CIs. The study protocol was registered with PROSPERO (Registration ID: CRD42022328630). RESULTS: Network meta-analysis of comparisons of DHA and EPA suggested significant comparable effects only on LDL-C (MD EPA versus DHA = -8.51 mg/L; 95% CI: -16.67; -0.35). However, the Network meta-analysis not show a significant effect for other risk factors. Furthermore, pairwise meta-analysis of direct comparisons of DHA and EPA showed significant difference in their effects on plasma glucose (MD EPA versus DHA = -0.31 mg/L; 95% CI: -0.60, -0.02), Insulin (MD EPA versus DHA = -2.14 mg/L; 95% CI: -3.26, -1.02), but the results were not significant for risk factors. CONCLUSION: Our findings suggest that both EPA and DHA act similarly on the markers under study, with slight changes in plasma glucose, insulin, and LDL-C.

A systematic review and meta-analysis on the accuracy of rapid immunochromatographic tests for dengue diagnosis.

Rapid immunochromatographic tests are frequently used to diagnose dengue due to their easy use, low cost, and fast response. A high level of accuracy is essential for rapid diagnostic tests to support their large-scale use. Thus, this systematic review aims to evaluate the accuracy of rapid dengue diagnostic tests. The investigation was run through the following databases: LILACS, Medline (Pubmed), CRD, The Cochrane Library, Trip Medical Database, and Google Scholar. To solve difficulties, two independent reviewers performed document screening and selection. ELISA assay was adopted as a reference test because of several methodologic advantages. Seventeen articles were included accordingly, reckoning 6837 participating individuals. The receiver operating characteristic (ROC) and Forest Plot were conducted to evaluate the sensitivity and specificity for each analyzed parameter (anti-dengue IgM, IgG, and NS1 antigen). The risk of bias and quality of evidence were assessed as moderate using QUADAS-2 and Grading of Recommendations Assessment, Development, and Evaluation (GRADE), respectively. The sensitivity of IgM concerning the studied tests ranged from 13.8 to 90%, while that of NS1 ranged from 14.7 to 100% (95% CI). The antibodies with NS1 presented increased sensitivity; pooled data show that the association of the three analytes bestows the best result, with a combined sensitivity of 90% (CI 95%: 87-92%) and a pooled specificity of 89% (CI 95%: 87-92%). Thus, the present review provides relevant knowledge for decision-making between available rapid diagnostic tests.

Strategies for the implementation of clinical practice guidelines in public health: an overview of systematic reviews.

BACKGROUND: As a source of readily available evidence, rigorously synthesized and interpreted by expert clinicians and methodologists, clinical guidelines are part of an evidence-based practice toolkit, which, transformed into practice recommendations, have the potential to improve both the process of care and patient outcomes. In Brazil, the process of development and updating of the clinical guidelines for the Brazilian Unified Health System (Sistema Único de Saúde, SUS) is already well systematized by the Ministry of Health. However, the implementation process of those guidelines has not yet been discussed and well structured. Therefore, the first step of this project and the primary objective of this study was to summarize the evidence on the effectiveness of strategies used to promote clinical practice guideline implementation and dissemination. METHODS: This overview used systematic review methodology to locate and evaluate published systematic reviews regarding strategies for clinical practice guideline implementation and adhered to the PRISMA guidelines for systematic review (PRISMA). RESULTS: This overview identified 36 systematic reviews regarding 30 strategies targeting healthcare organizations, healthcare providers and patients to promote guideline implementation. The most reported interventions were educational materials, educational meetings, reminders, academic detailing and audit and feedback. Care pathways-single intervention, educational meeting-single intervention, organizational culture, and audit and feedback-both strategies implemented in combination with others-were strategies categorized as generally effective from the systematic reviews. In the meta-analyses, when used alone, organizational culture, educational intervention and reminders proved to be effective in promoting physicians' adherence to the guidelines. When used in conjunction with other strategies, organizational culture also proved to be effective. For patient-related outcomes, education intervention showed effective results for disease target results at a short and long term. CONCLUSION: This overview provides a broad summary of the best evidence on guideline implementation. Even if the included literature highlights the various limitations related to the lack of standardization, the methodological quality of the studies, and especially the lack of conclusion about the superiority of one strategy over another, the summary of the results provided by this study provides information on strategies that have been most widely studied in the last few years and their effectiveness in the context in which they were applied. Therefore, this panorama can support strategy decision-making adequate for SUS and other health systems, seeking to positively impact on the appropriate use of guidelines, healthcare outcomes and the sustainability of the SUS.

The effects of tocotrienols intake on obesity, blood pressure, inflammation, liver and glucose biomarkers: a meta-analysis of randomized controlled trials.

The objective of this study is to accomplish a systematic review and meta-analysis of all randomized controlled trials that dissected the influence of tocotrienol supplementation on various anthropometric and cardiometabolic indices in all individuals, irrespective of health condition. This research was carried out in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement guidelines. 17 eligible articles were included in the final quantitative analysis. Current study revealed that tocotrienol consumption was not associated with CRP, WC, MDA, BMI, IL-6, HbA1C, ALT, AST, creatinine TNF-α, FPG, BW, DBP, and SBP. We did observe an overall increase in BW (SMD: 0.063 kg, 95% CI: -0.200, 0.327, p = 0.637) and DBP (SMD: 0.249 mmHg, 95% CI: 0.053, 0.446, p = 0.013). In addition, a significant reduction in SBP was observed (SMD: -0.616 mmHg, 95% CI: -1.123, -0.110, p = 0.017). In summary, our meta-analysis revealed that tocotrienol consumption was associated with increase in BW and DBP and decrease in SBP. Significant associations were not observed for other outcomes.

The effect of tibolone treatment on fasting blood sugar, insulin, insulin resistance and endothelial function in postmenopausal women: A meta-analysis of randomized controlled trials.

BACKGROUND AND AIM: The menopause is associated in females with the presence of dysglycemia, insulin resistance and with the development of endothelial dysfunction. Tibolone (TIB) is a synthetic steroid compound with selective oestrogenic and, to a lesser extent, progestogenic and androgenic properties prescribed to postmenopausal women to alleviate the symptoms of the climaterium and to prevent the development of osteoporosis. However, the impact of TIB on fasting blood sugar (FBS), insulin, Homeostatic Model Assessment-Insulin Resistance (HOMA-IR) index and flow-mediated dilation (FMD) in women has not been evaluated so far. Thus, to investigate this research question, we conducted the present systematic review and meta-analysis. METHODS: Two independent reviewers searched the Scopus, Web of Science, PubMed/Medline and Embase databases up to 20 December 2020. The weighted mean differences (WMDs) and the 95% confidence intervals (CI) were calculated using the DerSimonian and Laird random effects models between the TIB and control groups and included in the forest plot. RESULTS: The overall findings were generated from 12 eligible randomized controlled trials. As compared to controls, TIB administration resulted in a significant reduction of FBS (WMD: -3.06 mg/dL, 95% CI: -5.30 to -0.82, P = 0.007), and of the HOMA-IR index (WMD: -0.61, 95% CI: -1.11 to -0.11, P = 0.01). However, treatment with TIB did not lead to significant changes of the FMD (WMD: 0.78%, 95% CI: -0.20 to 1.77, P = 0.12) or of insulin levels (WMD: -0.10 mIU/L, 95% CI: -2.04 to 1.83, P = 0.91). CONCLUSION: TIB administration can decrease FBS and the HOMA-IR index in postmenopausal women. However, the use of TIB does not influence insulin levels or FMD.

The effect of fasting and energy restricting diets on markers of glucose and insulin controls: a systematic review and meta-analysis of randomized controlled trials.

Inconsistencies exist with regard to influence of fasting and energy-restricting diets on markers of glucose and insulin controls. To address these controversial, this study was conducted to determine the impact of fasting diets on fasting blood sugars (FBSs), insulin, homeostatic model assessment insulin resistance (HOMA-IR) and hemoglobin A1c (HbA1c) levels. A comprehensive systematic search was carried out in electronic databases, i.e., Scopus, PubMed, and Web of Science through June 2019 for RCTs that investigated the impact of fasting and energy-restricting diets on circulating FBS, insulin, HOMA-IR and HbA1c levels from. Weighted mean difference (WMD) with the 95% CI were used for estimating combined effect size. The subgroup analysis was applied to specify the source of heterogeneity among articles. Pooled results from 30 eligible articles with 35 arms demonstrated a significant decrease in FBS (WMD): -3.376 mg/dl, 95% CI: -5.159, -1.594, p < 0.001), insulin (WMD: -1.288 µU/ml, 95% CI: -2.385, -0.191, p = 0.021), HOMA-IR (WMD: -0.41 mg/dl, 95% CI: -0.71, -0.10, p = 0.01) levels following fasting or energy-restricting diets. Nevertheless, no significant changes were observed in serum HbA1c levels. The subgroup analyses showed that overweight or obese people with energy restricting diets and treatment duration >8 weeks had a greater reduction in FBS, insulin and HOMA-IR level compared with other subgroups. The evidence from available studies suggests that the fasting or energy-restricting diets leads to significant reductions in FBS, insulin and HOMA-IR level and has modest, but, non-significant effects on HbA1c levels.

Cost-Effectiveness Analysis and Budget Impact: Antimuscarinics and Mirabegron for the Treatment of Patients With Urge Urinary Incontinence: The Brazilian Public Health System Perspective.

OBJECTIVES: The Brazilian public health system does not cover pharmacotherapy for urge urinary incontinence (UUI). The aim of this study was to estimate the cost-effectiveness and budget impact of providing tolterodine, solifenacin, oxybutynin (OXY), darifenacin, and mirabegron for the treatment of UUI in Brazilian public health system. METHODS: A cost-effectiveness analysis with budget impact was performed. Six scenarios were assessed: in one scenario, all 5 therapeutic alternatives approved for coverage, and in the remaining 5 scenarios, only 1 alternative is approved for adoption for all patients. Clinical data were derived from a rapid systematic review conducted in several databases. One-way sensitivity analysis was also performed. The time horizon was 12 months. RESULTS: The cost-effectiveness analysis showed that patients treated with OXY had the lowest incremental cost-effectiveness ratio (ICER) per outcomes assessed (change in urinary incontinence episodes (UIE): R$1180.08; change in urge incontinence episodes: R$757.85 and change in micturition frequency: R$907.75), corresponding to a budget impact of R$17.9 billion over 5 years. The change in effectiveness measures was the parameter that most influenced the results of the ICER per patient-year. CONCLUSION: The results of the study have shown that OXY and solifenacin had the lowest ICER per patient-year and the lowest budget impact when compared with other drugs.

The Influence of Fasting and Energy Restricting Diets on Blood Pressure in Humans: A Systematic Review and Meta-Analysis.

INTRODUCTION: To the best of our knowledge, no comprehensive meta-analysis has been carried out to investigate the effect of different approaches of fasting and calorie restriction on blood pressure.  AIM: Thus, the present systematic review and meta-analysis was designed to examine the effect of fasting and energy restricting diets on blood pressure in adult subjects. METHODS: We searched PubMed/Medline, Scopus, the Cochrane Library, and Google Scholar up to June 2019. The clinical trials that examined the effects of fasting and energy restricting diets on Blood Pressure was identified using MESH and non-MESH terms. RESULTS: 23 studies, including a total of 1397 participants, reported SBP and DBP as an outcome measure. Overall results from the random-effects model indicated that fasting and energy restricting administration elicited significant changes in SBP (weight mean difference (WMD): - 1.88 mmHg, 95% CI - 2.50, - 1.25) and DBP (WMD - 1.32 mmHg, 95% CI - 1.81, - 0.84, p = 0.000). Subgroup analyses displayed that intervention duration ≤ 12 weeks more effectively reduced SBP (WMD: -3.26 mmHg) and DBP (WMD - 1.32 mmHg). In addition, these analyses showed that fasting regimens (WMD - 3.26 mmHg) more effectively reduced SBP than energy restricting diets (WMD - 1.09 mmHg). CONCLUSION: The principal finding of this study was that fasting and energy restricting diets elicited, overall, significant reductions in SBP and DBP. Subsequent subgroup analyses revealed that intervention duration ≤ 12 weeks and fasting regimens more effectively reduced SBP and DBP.

Effects of walnut intake on anthropometric characteristics: A systematic review and dose-response meta-analysis of randomized controlled trials.

BACKGROUND & OBJECTIVE: Effects of walnut intake on anthropometric measurements have been inconsistent among clinical studies. Thus, we conducted a meta-analysis of randomized clinical trials (RCTs) to evaluate and quantify the effects of walnut intake on anthropometric characteristics. METHODS: We carried out a systematic search of all available RCTs up to June 2019 in the following electronic databases: PubMed, Scopus, Web of Science and Google Scholar. Pooled weight mean difference (WMD) of the included studies was estimated using random-effects model. RESULTS: A total of 27 articles were included in this meta-analysis, with walnuts dosage ranging from 15 to 108 g/d for 2 wk to 2 y. Overall, interventions with walnut intake did not alter waist circumference (WC) (WMD: -0.193 cm, 95 % CI: -1.03, 0.64, p = 0.651), body weight (BW) (0.083 kg, 95 % CI: -0.032, 0.198, p = 0.159), body mass index (BMI) (WMD: -0.40 kg/m,295 % CI: -0.244, 0.164, p = 0.703), and fat mass (FM) (WMD: 0.28 %, 95 % CI: -0.49, 1.06, p = 0.476). Following dose-response evaluation, reduced BW (Coef.= -1.62, p = 0.001), BMI (Coef.= -1.24, p = 0.041) and WC (Coef.= -5.39, p = 0.038) were significantly observed through walnut intake up to 35 g/day. However, the number of studies can be limited as to the individual analysis of the measures through the dose-response fashion. CONCLUSIONS: Overall, results from this meta-analysis suggest that interventions with walnut intake does not alter BW, BMI, FM, and WC. To date, there is no discernible evidence to support walnut intake for improving anthropometric indicators of weight loss.

The influence of metformin on IGF-1 levels in humans: A systematic review and meta-analysis.

BACKGROUND: A meta-analysis is needed to comprehensively consolidate findings from the influence of metformin on IGF-1 levels. The present study was conducted with the objective to accurately evaluate the influence of metformin intake on IGF-1 levels via a meta-analysis of randomized controlled trials. METHODS: A comprehensive systematic search was carried out in PubMed/MEDLINE, Web of Science, SCOPUS and Embase from inception until June 2019. Weighted mean difference (WMD) with the 95 % CI were applied for estimating the effects of metformin on serum IGF-1 levels. RESULTS: 11 studies involving a total of 569 individuals reported changes in IGF-1 plasma concentrations as an outcome measure. Pooled results demonstrated an overall non-significant decline in IGF-1 following metformin intake (WMD: -8.292 ng/ml, 95 % CI: -20.248, 3.664, p = 0.174) with heterogeneity among (p = 0.000,I2 = 87.1 %). The subgroup analyses displayed that intervention duration <12 weeks on children (WMD:-55.402 ng/ml, 95 % CI: -79.845, -30.960, I2 = 0.0 %) significantly reduced IGF-1. Moreover, in age 18 < years older metformin intake (WMD: 15.125 ng/ml, 95 % CI: 5.522, 24.729, I2 = 92.5 %) significantly increased IGF-1 than 18 ≤ years older (WMD:-1.038 ng/ml, 95 % CI: -3.578,1.502,I2 = 78.0 %). Following dose-response evaluation, metformin intake reduced IGF-1 (coefficient for dose-response analysis= -13.14, P = 0.041 and coefficient for liner analysis= -0.066, P = 0.038) significantly based on treatment duration. CONCLUSION: We found in children, intervention duration <12 weeks yielded significant reductions in IGF-1, whilst paradoxically, in participants >18 years old, metformin intake significantly increased IGF-1. We suggest that caution be taken when interpreting the findings of this review, particularly given the discordant supplementation practices between children and adults.

The different clinical guideline standards in Brazil: High cost treatment diseases versus poverty-related diseases.

Each year, evidence-based clinical guidelines gain more space in the health professionals' practice and in services organization. Due to the scarcity of scientific publications focused on diseases of poverty, the development of well-founded clinical guidelines becomes more and more important. In view of that, this paper aims to evaluate the quality of Brazilian guidelines for those diseases. The AGREE II method was used to evaluate 16 guidelines for poverty-related diseases (PRD) and 16 guidelines for global diseases whose treatment require high-cost technologies (HCD), with the ultimate aim of comparing the results. It was found that, in general, the guideline development quality standard is higher for the HCD guidelines than for the PRD guidelines, with emphasis on the "rigour of development" (48% and 7%) and "editorial independence" (43% and 1%) domains, respectively, which had the greatest discrepancies. The HCD guidelines showed results close to or above international averages, whereas the PRD guidelines showed lower results in the 6 domains evaluated. It can be concluded that clinical protocol development priorities need some redirecting in order to qualify the guidelines that define the healthcare organization and the care of vulnerable populations.

Biosensing breast cancer cells based on a three-dimensional TIO2 nanomembrane transducer.

The early diagnosis of breast cancer is crucial for the successful treatment and recovery phases of the patients suffering from the disease. Although mammography is considered the gold standard for diagnosis, it fails to detect some cancers in high-density breasts. In this work, we propose for the first time a tridimensional biosensor platform, to be used on an electrochemical point-of-care device. The bioconjugated platform is constructed on a series of covalent linkages between lectin molecules and a cysteine layer immobilized over gold-coated TiO2 butterfly-like tridimensional nanomembranes. Through the use of vegetal lectins, we managed to take advantage of the markedly atypical glycomic profile of the cancerous mammalian cell membrane and successfully made a distinction between highly invasive (T47D) and less invasive (MCF7) cancer cell lines. The selectivity of the biosensor was tested by using normal human skin-fibroblast. The proposed cytosensor demonstrated limits of detection as low as 10 cells mL-1 for every cell line and a linear range from 10 to 1.0×106 cells mL-1. Considering that electrochemical impedance values can be correlated with the number of breast cancer cells present in the sample, we suggest that the proposed platform could be useful in facilitating the diagnosis of cancer.

Effectiveness evaluation of public policy incentive R&D in technological innovation in Brazil: a focus on law of the well / Avaliação da efetividade das políticas públicas de incentivo a p & d na inovação tecnológica no Brasil: um enfoque na lei do bem

The present paper will address pharmaceutical industries that carry out research, development and innovation (RD&I) Brazil and their consequent adherence to tax incentives based on 'Law of the Well' (Brazilian, Law No. 11,196 / 2005). Our hypothesis evaluates if public policies of incentives for transformation of technological knowledge could encourage firms to invest in RD&I. Our research was based on Government Annual Reports that reported the use of tax incentives during a period between 2006 and 2012; and legal framework destined for supporting research, both provided by Ministry of Science, Technology and Innovation of Brazil. During the studied period, an increase of 800% of the participating companies of the 'Law of the Well' was observed, demonstrating a need to invest in R&D. The sum of the expenditure of defrayal for the computation of the incentives the companies that operated in real income regime and have chosen to take advantage of tax incentives 'Law of the Well' amounted to R $ 40.52 billion. Well although one of the purposes of the 'Law of the Well' is to subsidize the establishment of researchers in companies, the total value of capital expenditure does not exceed 4% of the total amount invested in R & D activities. Similarly it is observed that the percentage of encouraging the development and patenting did not exceed 1%. In spite of Good Law be used as institutional apparatus for improvement of the efficiency and competitivity of the companies for the global market, recent indicators of spending on R&D in Brazil demonstrate stagnation of investments in various sectors.

O presente artigo abordará sobre as indústrias farmacêuticas que realizam atividades de pesquisa, desenvolvimento e inovação (PD&I) no Brasil, e sua consequente adesão aos incentivos fiscais da Lei do Bem (Brasil, Lei nº 11.196/2005). Nossa hipótese avalia se as políticas públicas de incentivo para transformação do conhecimento tecnológico poderiam incentivar as empresas investirem em PD&I. Nossa pesquisa foi baseada em relatórios do governo que relataram o uso de incentivos fiscais durante o período de 2006 e 2012; e o arcabouço legal de amparo à pesquisa, ambos fornecidos pelo Ministério de Ciência, Tecnologia e Inovação do Brasil. Durante o período estudado, observou-se um aumento de 800% das empresas participantes do Lei do Bem, demonstrando a necessidade de investir em P & D. A soma das despesas com custeio para efeito do cálculo dos incentivos as empresas que operaram em regime de lucro real e que optaram por usufruir dos incentivos fiscais da Lei do Bem atingiram o valor de R$ 40,52 bilhões. Embora um dos propósitos da Lei do Bem seja subsidiar a fixação de pesquisadores nas empresas, os valores totais das despesas capitais não ultrapassam a 4% do valor total investido em atividades de P&D. Semelhantemente observa-se que os percentuais de incentivo ao desenvolvimento e registro de patentes também não ultrapassam a 1%. Embora a Lei do Bem se apresente como um aparato institucional que contribui para as empresas se tornarem eficientes e competitivas para enfrentar o acirrado mercado globalizado, indicadores recentes sobre os gastos com P&D no Brasil demonstram certa estagnação nos investimentos nos diversos setores.

Impacto da atenção farmacêutica na função pulmonar de pacientes com asma grave / Impact of pharmaceutical care on lung function in patients with severe asthma

O estudo avaliou a influência do serviço de Atenção Farmacêutica na otimização dos resultados terapêuticos de pacientes com asma grave não controlada, em uso de formoterol associado à budesonida. Utilizou-se o Método Dáder de Seguimento Farmacoterapêutico e o Teste do Controle de Asma (ACT™) para avaliação de resultados, assim como a espirometria. Foram acompanhados 26 pacientes por um período não inferior a seis meses, cuja média de idade foi 55 ± 11 anos, destes, 22 (84%) foram do gênero feminino. Na pesquisa verificou-se que 22 (84,6%) pacientes apresentaram mais de uma enfermidade associada à asma grave e 24 (92%) faziam uso de dois ou mais fármacos. Foram detectados 58 resultados negativos associados aos medicamentos (RNM), com incidência de 2,2 ± 0,99 RNM por usuário. O RNM mais frequente foi insegurança não quantitativa identificada em 11 usuários (43%), sendo 31% desses devido às reações adversas ao medicamento. Foram realizadas 65 intervenções farmacêuticas para resolver os RNM, com média de 2,5 ± 1,2 por paciente, das quais 85% ocorreram na farmácia sem a necessidade de voltar ao médico. Dos resultados clínicos, após as intervenções farmacêuticas, todos os usuários tiveram melhora significativa da asma (p<0,05), porém 2 deles (7,6%) ainda apresentaram asma não controlada. Assim, o estudo sinalizou a necessidade do acompanhamento farmacoterapêutico aos usuários com asma grave não controlada para otimização dos resultados clínicos.

The aim of the present study was to analyze the influence of pharmaceutical care on the optimization of therapeutic results in patients with severe asthma using formoterol combined with budesonide. Evaluations were performed with spirometry, the Dáder Pharmacotherapeutic Follow Up method and Asthma Control Test (ACT™). Twenty-six patients (mean age: 55 ± 11 years; 22 females) were monitored for not less than six months. Twenty-two patients (84.6%) had more than one health condition associated with severe asthma and 24 (92%) made use of two or more drugs. The research identified 58 negative results associated with medication (NRM), corresponding to an individual incidence of 2.2 ± 0.99 NRMs per patient. The most frequent NRM was a non-quantitative uncertainty identified in 11 patients (43%), with 31% of cases due to adverse reactions to the drug. Sixty-five pharmaceutical interventions were carried out to resolve the NRMs, with a mean of 2.5 ± 1.2 per patient, 85% of which occurred in the pharmacy without the need to see a doctor. Subsequently to medical treatment following pharmaceutical intervention, all patients experienced a clear improvement in symptoms (p < 0.05). However, two subjects (7.6%) continued to experience uncontrolled asthma. The present findings reveal a need for the pharmacotherapeutic monitoring of patients with severe uncontrolled asthma in order to optimize clinical outcomes.