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1.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde | ID: lis-47930

RESUMO

A Sociedade Brasileira de Pediatria (SBP) promoveu a live “Amamentação e uso de medicamentos e cosméticos”. A transmissão, que foi aberta aos pediatras e público em geral no site, página do Facebook e canal do Youtube da instituição.


Assuntos
Aleitamento Materno , Uso de Medicamentos , Cosméticos
3.
Medicine (Baltimore) ; 99(37): e21896, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925724

RESUMO

This study aimed to determine the differences in antibiotic usage patterns in the treatment of acute pyelonephritis according to hospital type and region in Korea.The claims database of the Health Insurance Review and Assessment Service in Korea was used to select patients with the International Classification of Diseases, Tenth Revision code N10 (acute tubulo-interstitial nephritis) or N12 (tubulo-interstitial nephritis, neither acute nor chronic) as the primary discharge diagnosis in 2010-2014. Usage of each class of antibiotics was expressed as the defined daily dose (DDD)/event.The average antibiotic usage per inpatient event was 11.3 DDD. The average antibiotic usage was the highest among patients admitted to tertiary hospitals (13.8 DDD), followed by those admitted to secondary hospitals (11.5 DDD), clinics (10.0 DDD), and primary hospitals (9.8 DDD). According to the geographic analyses, third-generation cephalosporins were highly prescribed in some southern regions; fluoroquinolones and aminoglycosides were highly prescribed in some centrally located regions of the Korean peninsula. The hotspots for carbapenem usage included Seoul and Gyeonggi province cluster and Busan cluster: these regions include the capital city and the second biggest city in Korea, respectively.In conclusion, the antibiotic usage patterns for acute pyelonephritis in Korea differ according to the hospital type and region.


Assuntos
Antibacterianos/uso terapêutico , Uso de Medicamentos/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Pielonefrite/tratamento farmacológico , Doença Aguda , Adolescente , Adulto , Aminoglicosídeos/uso terapêutico , Cefalosporinas/uso terapêutico , Bases de Dados Factuais , Feminino , Fluoroquinolonas/uso terapêutico , Geografia , Humanos , Masculino , Pessoa de Meia-Idade , República da Coreia , Centros de Cuidados de Saúde Secundários/estatística & dados numéricos , Centros de Atenção Terciária/estatística & dados numéricos , Adulto Jovem
4.
Rev Panam Salud Publica ; 44, sept. 2020
Artigo em Inglês | PAHO-IRIS | ID: phr-52325

RESUMO

[ABSTRACT]. Objective. To measure the impact generated by the implementation of the pharmacy-driven antimicrobial stewardship program of the Clínica Bíblica Hospital. Methods. This is a retrospective observational study that evaluates the consumption of antibiotics for the periods before and during implementation of the Clínica Bíblica Hospital antimicrobial stewardship program, calculated by means of defined daily dose per 1 000 patient-days and days of therapy per 1 000 patient-days. In addition, bacterial resistance patterns for the periods 2014–2015 and 2016–2017 were compared. Results. Consumption of most-used antibiotics was calculated, looking for trends that might be associated with the activities implemented by the Clínica Bíblica Hospital antimicrobial stewardship program. Comparing some of the antibiotics with the highest consumption in periods I and II, use of levofloxacin and ceftriaxone showed a decrease of 54.0% (p < 0.001) and 14.6% (p = 0.003), respectively, whereas there was an increase in the use of cefazolin of 4 539.3% (p < 0.001). Regarding percentage of bacterial resistance, in most bacterial isolates no statistically significant changes were observed between the two periods. Conclusions. A reduction in the overall consumption of antibiotics has been achieved over time, most likely attributable to the antimicrobial stewardship program. However, this trend was not observed for all the antibiotics studied. The pattern of resistance among the commonly isolated microorganisms did not vary greatly between the periods studied, which suggests that either the antimicrobial stewardship program may have prevented an increase in bacterial resistance since its implementation, or that it is too soon to see impact on bacterial resistance.


[RESUMEN]. Objetivo. Medir el impacto de la ejecución de un programa de optimización del uso de antimicrobianos conducido por la farmacia del Hospital Clínica Bíblica. Métodos. En este estudio retrospectivo y de observación se evaluó el consumo de antibióticos antes y después de la ejecución del programa de optimización del uso de antimicrobianos en el Hospital Clínica Bíblica. El consumo se calculó tomando como base la dosis diaria por 1.000 días-paciente y los días de tratamiento por 1.000 días-paciente. Además, se compararon los perfiles de resistencia bacteriana en los períodos 2014-2015 y 2016-2017. Resultados. Se calculó el consumo de los antibióticos más usados para establecer las tendencias que podrían estar relacionados con las actividades ejecutadas por el programa de optimización del uso de antimicrobianos del Hospital Clínica Bíblica. Se compararon algunos de los antibióticos de mayor consumo en los períodos I y II, el uso de la levofloxacina y la ceftriaxona mostró una disminución de 54,0% (p < 0,001) y 14,6% (p = 0,003), respectivamente, mientras que se evidenció un aumento en el uso de la cefazolina de 4.539,3% (p < 0,001). Con respecto al porcentaje de resistencia bacteriana, no se encontró ningún cambio estadísticamente significativo entre los dos períodos para la mayoría de las cepas bacterianas aisladas. Conclusiones. Con el transcurso del tiempo se ha logrado una disminución en el consumo de antibióticos en general, probablemente relacionada con el programa de optimización del uso de antimicrobianos. Sin embargo, esta tendencia no se observó en todos los antimicrobianos analizados. No se evidenció una variación significativa en los patrones de resistencia entre los microorganismos aislados comúnmente entre los períodos comparados, lo que puede significar dos cosas: que el programa de optimización del uso de antimicrobianos podría haber evitado un aumento de resistencia bacteriana desde que se puso en marcha o que es demasiado pronto para que se evidencie un impacto en la resistencia bacteriana.


[RESUMO]. Objetivo. Mensurar o impacto da implantação de um programa de gerenciamento do uso de antimicrobianos por profissionais farmacêuticos em um hospital particular. Métodos. Trata-se de um estudo observacional retrospectivo para avaliar o uso de antibióticos no período anterior e posterior à implantação do programa de gerenciamento do uso de antimicrobianos no Hospital Bíblica Clínica, em San José, Costa Rica. O consumo dos medicamentos foi calculado com base na dose diária definida por 1.000 pacientes-dia e dias de tratamento por 1.000 pacientes-dia. Foi realizada uma comparação dos padrões de resistência bacteriana entre os períodos 2014–2015 e 2016–2017. Resultados. O consumo dos antibióticos mais utilizados foi calculado visando identificar possíveis tendências associadas às ações do programa de gerenciamento do uso de antimicrobianos implantado no hospital. A comparação do consumo de alguns dos antibióticos mais utilizados no primeiro e no segundo períodos considerados apontou uma redução de 54,0% no uso de levofloxacina (p < 0,001) e 14,6% no uso de ceftriaxona (p = 0,003), com um aumento de 4.539,3% no uso de cefazolina (p < 0,001). Com relação à resistência bacteriana, não se observou variação estatisticamente significativa na maioria dos isolados bacterianos entre os dois períodos. Conclusões. Houve redução no consumo de antibióticos em geral, provavelmente atribuível ao programa de gerenciamento do uso de antimicrobianos. Porém, esta mesma tendência não foi observada para todos os antibióticos estudados. Não houve variação importante no padrão da resistência dos microrganismos mais frequentemente isolados entre os períodos estudados. Isso indica que o programa de gerenciamento do uso de antimicrobianos implantado possivelmente evitou o aumento da resistência bacteriana ou que é ainda muito cedo para se observar o impacto na resistência bacteriana.


Assuntos
Gestão de Antimicrobianos , Anti-Infecciosos , Uso de Medicamentos , Resistência Microbiana a Medicamentos , Costa Rica , Gestão de Antimicrobianos , Anti-Infecciosos , Uso de Medicamentos , Resistência Microbiana a Medicamentos , Gestão de Antimicrobianos , Anti-Infecciosos , Resistência Microbiana a Medicamentos
6.
PLoS One ; 15(7): e0235848, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32735623

RESUMO

BACKGROUND: Second-line treatments boost overall survival in advanced gastric cancer (AGC). However, there is a paucity of information as to patterns of use and the results achieved in actual clinical practice. MATERIALS AND METHODS: The study population comprised patients with AGC in the AGAMENON registry who had received second-line. The objective was to describe the pattern of second-line therapies administered, progression-free survival following second-line (PFS-2), and post-progression survival since first-line (PPS). RESULTS: 2311 cases with 2066 progression events since first-line (89.3%) were recorded; 245 (10.6%) patients died during first-line treatment and 1326/2066 (64.1%) received a second-line. Median PFS-2 and PPS were 3.1 (95% CI, 2.9-3.3) and 5.8 months (5.5-6.3), respectively. The most widely used strategies were monoCT (56.9%), polyCT (15.0%), ramucirumab+CT (12.6%), platinum-reintroduction (8.3%), trastuzumab+CT (6.1%), and ramucirumab (1.1%). PFS-2/PPS medians gradually increased in monoCT, 2.6/5.1 months; polyCT 3.4/6.3 months; ramucirumab+CT, 4.1/6.5 months; platinum-reintroduction, 4.2/6.7 months, and for the HER2+ subgroup in particular, trastuzumab+CT, 5.2/11.7 months. Correlation between PFS since first-line and OS was moderate in the series as a whole (Kendall's τ = 0.613), lower in those subjects who received second-line (Kendall's τ = 0.539), especially with ramucirumab+CT (Kendall's τ = 0.413). CONCLUSION: This analysis reveals the diversity in second-line treatment for AGC, highlighting the effectiveness of paclitaxel-ramucirumab and, for a selected subgroup of patients, platinum reintroduction; both strategies endorsed by recent clinical guidelines.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Sistema de Registros/estatística & dados numéricos , Neoplasias Gástricas/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos Imunológicos/administração & dosagem , Antineoplásicos Imunológicos/uso terapêutico , Antineoplásicos Fitogênicos/administração & dosagem , Antineoplásicos Fitogênicos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Uso de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Compostos de Platina/administração & dosagem , Compostos de Platina/uso terapêutico , Neoplasias Gástricas/patologia , Análise de Sobrevida
7.
PLoS One ; 15(8): e0237175, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32790757

RESUMO

Patients' vitamin intake is often not documented and is therefore not considered sufficiently in studies of prescribed medication in patients with amyotrophic lateral sclerosis (ALS). We aimed to determine the prevalence of vitamin use by participants in ALS clinical trials. Data about demographics, disease severity (ALS Functional Rating Scale) and concomitant medication were obtained from the Pooled Resource Open-Access ALS Clinical Trials Database, which contains records from more than 6000 ALS patients who participated in 23 phase II/III clinical trials. Information about vitamin intake for all study subjects was coded into major categories. Clinical data of vitamin users and nonusers were compared, and regression analysis was used to explore the associations among clinical parameters, vitamin use and two measures of disease progression. From the 40.996 available medication records from 6274 subjects, 7338 (17.9%) concerned vitamins. One or more vitamins were used by 3331 subjects (53.1%). Most common was vitamin E, vitamin C and multivitamins. Patients who did and did not take vitamins did not differ in terms of disease progression and ALS Functional Rating Scale score. Patients who took vitamins were younger, were more often female, had a shorter time between onset and diagnosis, had shorter disease duration and more frequently had limb-onset types. Disease progression rate and disease aggressiveness were not associated with vitamin use. Despite unclear evidence, the use of vitamins in ALS is common. However, rapid progression was not observed to be associated with vitamin use.


Assuntos
Esclerose Amiotrófica Lateral/tratamento farmacológico , Uso de Medicamentos/estatística & dados numéricos , Vitaminas/administração & dosagem , Adulto , Idoso , Esclerose Amiotrófica Lateral/epidemiologia , Ensaios Clínicos Fase II como Assunto , Ensaios Clínicos Fase III como Assunto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Vitaminas/uso terapêutico
8.
Am Surg ; 86(8): 950-954, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32762466

RESUMO

BACKGROUND: There is an opioid epidemic in the United States. With the increased concern of over-prescribing opioids, physicians are seeking alternative pain management strategies. The purpose of this study is to review the impact of instituting a multimodal analgesia (MMA) guideline on decreasing opioid use in trauma patients at a Level 1 trauma center. METHODS: In 2017, an MMA guideline was developed and included anti-inflammatories, muscle relaxants, neuropathic agents, and local analgesics in addition to opioids. Staff were educated and the guideline was implemented. A retrospective review of medications prescribed to patients admitted from 2016 through 2018 was performed. Patients admitted in 2016 served as the control group (before MMA). In 2018, all patients received multimodal pain therapy as standard practice, and served as the comparison group. RESULTS: A total of 10 340 patients were admitted to the trauma service from 2016 through 2018. There were 3013 and 3249 patients for review in 2016 and 2018, respectively. Total morphine milligram equivalents were 2 402 329 and 1 975 935 in 2016 and 2018, respectively, a 17.7% decrease (P < .001). Concurrently, there was a statistically significant increase in the use of multimodal pain medications. A secondary endpoint was studied to evaluate for changes in acute kidney injury; there was not a statistically significant increase (0.56% versus 0.68%, P = .55). DISCUSSION: Implementation of an MMA guideline significantly reduced opioid use in trauma patients. The use of nonopioid MMA medications increased without an increased incidence of acute kidney injury.


Assuntos
Analgesia/métodos , Analgésicos não Entorpecentes/uso terapêutico , Analgésicos Opioides/uso terapêutico , Uso de Medicamentos/tendências , Prescrição Inadequada/prevenção & controle , Padrões de Prática Médica/tendências , Ferimentos e Lesões/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Analgesia/normas , Feminino , Humanos , Prescrição Inadequada/tendências , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Resultado do Tratamento , Estados Unidos
9.
Am Surg ; 86(8): 965-970, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32779472

RESUMO

BACKGROUND: Recent data on opioid consumption indicate that patients typically require far less than is prescribed. Prisma Health Upstate Hernia Center adopted standardized postoperative prescribing after hernia repair and began tracking patient-reported opioid utilization. The aim of this study is to evaluate patient opioid use after hernia repair in order to guide future prescribing. METHODS: All patients who underwent primary ventral (umbilical and epigastric), incisional, and inguinal hernia repair between February and May 2019 were reviewed. Patients reported the number of opioid pills taken at their first postoperative visit and documented either in the progress note or in the Americas Hernia Society Quality Collaborative (AHSQC) patient-reported outcomes (PRO) questionnaire. All demographic, operative, and outcomes data were captured prospectively in the AHSQC. Opioid use reported as milligram morphine equivalents (MME). RESULTS: A total of 162 surgeries were performed during the study period, and 107 had patient-reported opioid use for analysis. Inguinal hernia repair was performed in 36 patients, 10 primary ventral hernia repairs, and 61 incisional hernia repairs. No opioid use was reported in 63.9% of inguinal hernias, 60% of primary ventral hernias, and 20% of incisional hernias. Inguinal hernia patients consumed a mean of 10.5 MME, primary ventral patients 11 MME, and incisional hernia patients 78.5 MME. CONCLUSION: Patients require little to no opioid after primary ventral or inguinal hernia repair and opioid-free surgery is feasible. Incisional hernia is more heterogenous, but the majority of patients still required less opioid than previously thought.


Assuntos
Analgésicos Opioides/uso terapêutico , Uso de Medicamentos/estatística & dados numéricos , Hérnia Inguinal/cirurgia , Hérnia Ventral/cirurgia , Herniorrafia , Dor Pós-Operatória/tratamento farmacológico , Padrões de Prática Médica/tendências , Protocolos Clínicos , Humanos , Prescrição Inadequada/prevenção & controle , Prescrição Inadequada/tendências , Guias de Prática Clínica como Assunto , Estudos Prospectivos , Autorrelato , Estados Unidos
10.
PLoS One ; 15(8): e0237790, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32810185

RESUMO

This study determined the frequency and factors associated with EGFR testing rates and erlotinib treatment as well as associated survival outcomes in patients with non small cell lung cancer in Kentucky. Data from the Kentucky Cancer Registry (KCR) linked with health claims from Medicaid, Medicare and private insurance groups were evaluated. EGFR testing and erlotinib prescribing were identified using ICD-9 procedure codes and national drug codes in claims, respectively. Logistic regression analysis was performed to determine factors associated with EGFR testing and erlotinib prescribing. Cox-regression analysis was performed to determine factors associated with survival. EGFR mutation testing rates rose from 0.1% to 10.6% over the evaluated period while erlotinib use ranged from 3.4% to 5.4%. Factors associated with no EGFR testing were older age, male gender, enrollment in Medicaid or Medicare, smoking, and geographic region. Factors associated with not receiving erlotinib included older age, male gender, enrollment in Medicare or Medicaid, and living in moderate to high poverty. Survival analysis demonstrated EGFR testing or erlotinib use was associated with a higher likelihood of survival. EGFR testing and erlotinib prescribing were slow to be implemented in our predominantly rural state. While population-level factors likely contributed, patient factors, including geographic location (areas with high poverty rates and rural regions) and insurance type, were associated with lack of use, highlighting rural disparities in the implementation of cancer precision medicine.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Cloridrato de Erlotinib/uso terapêutico , Testes Genéticos/estatística & dados numéricos , Neoplasias Pulmonares/tratamento farmacológico , Demandas Administrativas em Assistência à Saúde/estatística & dados numéricos , Adulto , Fatores Etários , Idoso , Carcinoma Pulmonar de Células não Pequenas/genética , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Análise Mutacional de DNA/economia , Análise Mutacional de DNA/estatística & dados numéricos , Prescrições de Medicamentos/economia , Prescrições de Medicamentos/estatística & dados numéricos , Uso de Medicamentos/economia , Uso de Medicamentos/estatística & dados numéricos , Receptores ErbB/antagonistas & inibidores , Receptores ErbB/genética , Feminino , Testes Genéticos/economia , Disparidades em Assistência à Saúde/economia , Humanos , Kentucky/epidemiologia , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/mortalidade , Masculino , Medicaid/economia , Medicaid/estatística & dados numéricos , Medicare/economia , Medicare/estatística & dados numéricos , Pessoa de Meia-Idade , Mutação , Pobreza/estatística & dados numéricos , Medicina de Precisão/economia , Medicina de Precisão/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Fatores Sexuais , Análise de Sobrevida , Estados Unidos , Adulto Jovem
11.
PLoS One ; 15(8): e0237212, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32760140

RESUMO

INTRODUCTION: Contraception can help to meet family planning goals for women living with HIV (WLHIV) as well as to support the prevention of mother to child transmission of HIV (PMTCT). However, there is little research into the contraceptive practice among sexually active WLHIV in Ethiopia. Therefore, we aimed to examine contraceptive practice among sexually active WLHIV in western Ethiopia and identify the factors that influenced such practice using the Health Belief Model (HBM). METHODS: A facility-based cross-sectional survey of 360 sexually active WLHIV was conducted from 19th March to 22nd June 2018 in western Ethiopia. The eligible participants were WLHIV aged between 18 and 49 years who reported being fecund and sexually active within the previous six months but were not pregnant and not wanting to have another child within two years. Modified Poisson regression analyses were conducted to identify factors that influenced contraceptive practice among sexually active WLHIV in western Ethiopia. RESULTS: Among sexually active WLHIV (n = 360), 75% used contraception with 25% having unmet needs. Of the contraceptive users, 44.8% used injectables, 37.4% used condoms and 28.5% used implants. Among 152 recorded births in the last five years, 17.8% were reported as mistimed and 25.7% as unwanted. Compared to WLHIV having no child after HIV diagnosis, having two or more children after HIV diagnosis (Adjusted Prevalence Ratio [APR] = 1.31; 95%CI 1.09-1.58) was associated with increased risk of contraceptive practice. However, sexually active unmarried WLHIV (APR = 0.69; 95%CI 0.50-0.95) were less likely to use any contraception compared to their sexually active married counterparts. Importantly, high perceived susceptibility (APR = 1.49; 95%CI 1.20-1.86) and medium perceived susceptibility (APR = 1.55; 95%CI 1.28-1.87) towards unintended pregnancy were associated with higher risk of contraceptive use than WLHIV with low perceived susceptibility. CONCLUSIONS: Although contraceptive use amongst sexually active WLHIV was found to be high, our findings highlight the need for strengthening family planning services given the high rate of unintended pregnancies, the high rate of unmet needs for contraception, as well as the lower efficacy with some of the methods. Our findings also suggest that the HBM would be a valuable framework for healthcare providers, programme planners and policymakers to develop guidelines and policies for contraceptive counselling and choices.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Infecções por HIV/epidemiologia , Comportamento Sexual/estatística & dados numéricos , Adulto , Anticoncepcionais/uso terapêutico , Uso de Medicamentos/estatística & dados numéricos , Etiópia , Feminino , Humanos , Pessoa de Meia-Idade
12.
Am Heart J ; 228: 44-46, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32771699

RESUMO

Recent results from the ISCHEMIA trial highlight the importance of medical management for patients with stable ischemic heart disease. We determine the prevalence of angina in the United States, as well as the use of first-line goal directed therapy by US patients with angina. We used individual patient level data from the National Health and Nutrition Examination Survey (NHANES), 2007-2016. Using the complex survey weights, we create projections for the US population with angina as well as those using ß-blockers, antiplatelet agents, or statins-3 first-line medications for patients with angina. Among adults ≥40 years old, 4,469,934 US adults are estimated to have physician-diagnosed angina. Of the patients with angina, 2,757,171 (61.7%) were on ß-blockers, 2,984,902 (66.8%) were on statins, and 2,433,088 (54.4%) were on any antiplatelet medication; 1,457,983 patients were on all 3 medications, for an overall proportion of 32.6% of angina patients taking all three first-line medications in the United States. While the prevalence of angina in the US is high, the use of goal-directed medical therapy remains low. Strategies to improve the use of medications for preventing secondary events are urgently needed.


Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Angina Estável , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Inibidores da Agregação de Plaquetas/uso terapêutico , Prevenção Secundária , Adulto , Angina Estável/tratamento farmacológico , Angina Estável/epidemiologia , Uso de Medicamentos/normas , Uso de Medicamentos/estatística & dados numéricos , Feminino , Mau Uso de Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde , Inquéritos Nutricionais/estatística & dados numéricos , Prevalência , Prevenção Secundária/métodos , Prevenção Secundária/normas , Estados Unidos/epidemiologia
13.
Einstein (Sao Paulo) ; 18: eAO5314, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32785451

RESUMO

Objective To estimate the prevalence of use of drugs to treat gastrointestinal disorders, according to demographic, socioeconomic, and health characteristics of the Brazilian population. Methods This is a population-based survey that interviewed individuals residing in cities of the five regions in Brazil. The study sample was composed of 32,348 individuals aged 20 or more years. The profile of use of drugs for gastrointestinal disorders was evaluated considering the variables sex, age, healthcare plan, region, and number of chronic diseases. We also analyzed the frequency of individuals who declared using other drugs, besides those already employed for treatment of gastrointestinal disorders. Additionally, the estimated frequencies of the drug classes used were determined. Results The prevalence of use of drugs for gastrointestinal disorders in Brazil was 6.9% (95% confidence interval - 6.4-7.6), higher in females, among persons aged over 60 years, in those who had a private healthcare insurance, and presented with two or more chronic diseases. It was noted that 42.9% of the aged who used drugs for gastrointestinal disorders were also on polypharmacy. As to the classes of drugs, 82% corresponded to drugs for the food tract and metabolism, particularly proton pumps inhibitors. Conclusion The use of drugs for treatment of gastrointestinal disorders was significant among women and elderly. In this age group, consumption may be linked to gastric protection due to polypharmacy. This study is an unprecedented opportunity to observe the self-reported consumption profile of these drugs in Brazil and, therefore, could subsidize strategies to promote their rational use.


Assuntos
Uso de Medicamentos/estatística & dados numéricos , Medicamentos Essenciais/uso terapêutico , Gastroenteropatias/tratamento farmacológico , Acesso aos Serviços de Saúde/estatística & dados numéricos , Adulto , Idoso , Brasil , Cidades , Estudos Transversais , Medicamentos Essenciais/provisão & distribução , Feminino , Inquéritos Epidemiológicos , Humanos , Pessoa de Meia-Idade , Preparações Farmacêuticas/provisão & distribução , Medicamentos sob Prescrição/provisão & distribução , Fatores Socioeconômicos , Adulto Jovem
14.
N Z Med J ; 133(1518): 33-42, 2020 07 17.
Artigo em Inglês | MEDLINE | ID: mdl-32683430

RESUMO

AIMS: The overall rate of community antibiotic dispensing in New Zealand in recent decades has been high when compared with many other nations, but since 2015 has consistently declined each year. We aimed to determine whether the magnitude of reductions in community antibiotic dispensing in New Zealand between 2015 and 2018 differed in relation either to the patient's demographic features or in relation to the primary health organisation of the patient's registered general practitioner. METHODS: Demographic data on all patients registered with a general practice in New Zealand, and on all community pharmacy antibiotic dispensing for these patients during 2013-2018 were obtained from national healthcare databases. The rates of dispensing for patients registered with a general practitioner were measured as antibiotic courses dispensed per 1,000 population per day, and as defined daily doses per 1,000 population per day. RESULTS: Total community antibiotic dispensing in New Zealand, measured as defined daily doses per 1,000 inhabitants per day, decreased by 13.8% during 2015-2018, an average annual reduction of 4.6% per year, with especially large reductions in dispensing of amoxicillin/clavulanate, fluoroquinolones and macrolides. The reductions in dispensing were greatest in children aged 0-4 years old, but lesser reductions were seen in all age groups. Antibiotic dispensing declined regardless of patient ethnicity or level of socioeconomic deprivation. There were marked differences between primary health organisations in the size of the reductions in antibiotic dispensing during 2015-2018, which ranged between 4.8% for the Te Tai Tokerau PHO to 21.5% for the Ngati Porou Hauora Charitable Trust PHO. CONCLUSIONS: Total community antibiotic dispensing has reduced significantly in New Zealand between 2015 and 2018, with large disparities between primary health organisations in the size of the reductions. The overall rates of antibiotic dispensing remain high for non-Maori and non-Pacific people, and prescribers should aim to further reduce inappropriate antibiotic prescribing for these populations. However, the overall rate of antibiotic dispensing for Maori and Pacific people may now approximate an optimal level. Prescribers should aim to further reduce inappropriate antibiotic prescribing, but also to increase appropriate antibiotic prescribing for these populations.


Assuntos
Antibacterianos/farmacologia , Prescrições de Medicamentos/estatística & dados numéricos , Uso de Medicamentos/tendências , Medicina de Família e Comunidade/estatística & dados numéricos , Farmácias/estatística & dados numéricos , Padrões de Prática Médica , Humanos , Nova Zelândia , Estudos Retrospectivos
16.
Pediatrics ; 146(2)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32661190

RESUMO

BACKGROUND AND OBJECTIVES: International patterns of antibiotic use and laboratory testing in bronchiolitis in emergency departments are unknown. Our objective is to evaluate variation in the use of antibiotics and nonindicated tests in infants with bronchiolitis in 38 emergency departments in Pediatric Emergency Research Networks in Canada, the United States, Australia and New Zealand, the United Kingdom and Ireland, and Spain and Portugal. We hypothesized there would be significant variation, adjusted for patient characteristics. METHODS: We analyzed a retrospective cohort study of previously healthy infants aged 2 to 12 months with bronchiolitis. Variables examined included network, poor feeding, dehydration, nasal flaring, chest retractions, apnea, saturation, respiratory rate, fever, and suspected bacterial infection. Outcomes included systemic antibiotic administration and urine, blood, or viral testing or chest radiography (CXR). RESULTS: In total, 180 of 2359 (7.6%) infants received antibiotics, ranging from 3.5% in the United Kingdom and Ireland to 11.1% in the United States. CXR (adjusted odds ratio [aOR] 2.3; 95% confidence interval 1.6-3.2), apnea (aOR 2.2; 1.1-3.5), and fever (aOR 2.4; 1.7-3.4) were associated with antibiotic use, which did not vary across networks (P = .15). In total, 768 of 2359 infants (32.6%) had ≥1 nonindicated test, ranging from 12.7% in the United Kingdom and Ireland to 50% in Spain and Portugal. Compared to the United Kingdom and Ireland, the aOR (confidence interval) results for testing were Canada 5.75 (2.24-14.76), United States 4.14 (1.70-10.10), Australia and New Zealand 2.25 (0.86-5.74), and Spain and Portugal 3.96 (0.96-16.36). Testing varied across networks (P < .0001) and was associated with suspected bacterial infections (aOR 2.12; 1.30-2.39) and most respiratory distress parameters. Viral testing (591 of 768 [77%]) and CXR (507 of 768 [66%]) were obtained most frequently. CONCLUSIONS: The rate of antibiotic use in bronchiolitis was low across networks and was associated with CXR, fever, and apnea. Nonindicated testing was common outside of the United Kingdom and Ireland and varied across networks irrespective of patient characteristics.


Assuntos
Antibacterianos/uso terapêutico , Gestão de Antimicrobianos/estatística & dados numéricos , Bronquiolite/tratamento farmacológico , Técnicas de Laboratório Clínico/estatística & dados numéricos , Técnicas de Diagnóstico do Sistema Respiratório/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Apneia/etiologia , Australásia , Bronquiolite/complicações , Bronquiolite/diagnóstico , Criança , Pré-Escolar , Uso de Medicamentos/estatística & dados numéricos , Europa (Continente) , Feminino , Febre/etiologia , Humanos , Internacionalidade , Masculino , América do Norte , Utilização de Procedimentos e Técnicas , Estudos Retrospectivos
18.
Eur J Hosp Pharm ; 27(5): 263-266, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32661105

RESUMO

OBJECTIVES: The main aim was to develop a process to estimate critical care drug requirements to robustly inform regional procurement planning and preparedness in response to the COVID-19 pandemic. The objectives were to identify critical care drugs required, obtain patient usage data and consider current regional practice to establish the requirement. METHOD: Health and Social Care (HSC) Trusts across Northern Ireland (NI) identified critical care drugs required and an estimation of average daily usage data. The Microsoft Excel database was constructed to compile Trust data and establish regional requirement. The database was refined further according to real-world data from NI HSC Trusts, Intensive Care National Audit and Research Centre report on COVID-19 in critical care, daily regional COVID-19 figures and other available National data. Components of a tool originally developed for H1N1 and updated for COVID-19 were adapted to reflect the NI context and used in the regional database. The database was clinically reviewed to ensure that it accurately reflected current regional practice given the evolving nature of the pandemic. RESULTS: The critical care drugs required in the pandemic, usage data and current regional practice were identified to establish requirement. A regional database was constructed and used to produce a model for calculating approximate critical drug requirements. The model was used to map critical drug requirements to available stock in Trusts and wholesalers/suppliers, enabling the identification of treatment capacity for these medicines regionally, both currently and for projected surges. Data have also been used in the preparation of weekly regional situation reports provided to both the HSC Board and the Department of Health. CONCLUSION: The process developed is a robust approach to assist in informing regional critical care drug requirements in response to the COVID-19 pandemic. Further application has been demonstrated in regional procurement planning and preparedness.


Assuntos
Infecções por Coronavirus , Cuidados Críticos/organização & administração , Pandemias , Pneumonia Viral , Bases de Dados Factuais , Uso de Medicamentos , Humanos , Vírus da Influenza A Subtipo H1N1 , Influenza Humana , Auditoria Administrativa , Irlanda do Norte , Inquéritos e Questionários
19.
PLoS One ; 15(7): e0235513, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32645026

RESUMO

BACKGROUND: Rational medicines use (RMU) is the prescribing/dispensing of good quality medicines to meet individual patient's clinical needs. Policy-makers, managers and frontline providers play critical roles in safeguarding medicine usage thus ensuring their rational use. This study investigated perspectives of key health system actors on prescribing practices and factors influencing these in Eswatini. Public sector healthcare service delivery is through health facilities (public sector, not-for-profit faith-based, industrial) and community-based care. METHODS: A qualitative, exploratory study using semi-structured in-depth interviews with seven policymakers and managers, and 32 facility-based actors was conducted. Drawing on Social Practice Theory, material (health system context), competence (provider) and cultural (patient and provider) factors influencing prescribing practices were explored. RESULTS: Participants were aged between 21-57years, had been practicing for 1-30 years, and were a mix of doctors, nurses, pharmacists and pharmacy-technicians. Factors contributing to irrational medicines use included: poor use of treatment guidelines, lack of RMU policies, poorly-functioning pharmaceutical and therapeutics committees, stock-outs of medicines, lack of pharmacy personnel in primary healthcare facilities, and restrictions of medicines by level of care. Provider-related factors included: knowledge, experience and practice ethic, symptomatic prescribing, high patient numbers. Patient-related factors included late presentation, language, and the need to be prescribed many medicines. CONCLUSION: In Eswatini, prescribing practices are influenced by the interaction of factors (health system, provider and patient) that span levels (facility, region, and policy-making) of the health system. Promoting RMU thus goes beyond the availability of guidelines and provider training and requires concerted efforts of multiple stakeholders.


Assuntos
Prescrições de Medicamentos , Uso de Medicamentos , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/psicologia , Adulto , Essuatíni , Feminino , Pessoal de Saúde/normas , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto
20.
JAMA ; 324(1): 47-56, 2020 07 07.
Artigo em Inglês | MEDLINE | ID: mdl-32633801

RESUMO

Importance: Probiotics are frequently used by residents in care homes (residential homes or nursing homes that provide residents with 24-hour support for personal care or nursing care), although the evidence on whether probiotics prevent infections and reduce antibiotic use in these settings is limited. Objective: To determine whether a daily oral probiotic combination of Lactobacillus rhamnosus GG and Bifidobacterium animalis subsp lactis BB-12 compared with placebo reduces antibiotic administration in care home residents. Design, Setting, and Participants: Placebo-controlled randomized clinical trial of 310 care home residents, aged 65 years and older, recruited from 23 care homes in the United Kingdom between December 2016 and May 2018, with last follow-up on October 31, 2018. Interventions: Study participants were randomized to receive a daily capsule containing a probiotic combination of Lactobacillus rhamnosus GG and Bifidobacterium animalis subsp lactis BB-12 (total cell count per capsule, 1.3 × 1010 to 1.6 × 1010) (n = 155), or daily matched placebo (n = 155), for up to 1 year. Main Outcomes and Measures: The primary outcome was cumulative antibiotic administration days for all-cause infections measured from randomization for up to 1 year. Results: Among 310 randomized care home residents (mean age, 85.3 years; 66.8% women), 195 (62.9%) remained alive and completed the trial. Participant diary data (daily data including study product use, antibiotic administration, and signs of infection) were available for 98.7% randomized to the probiotic group and 97.4% randomized to placebo. Care home residents randomized to the probiotic group had a mean of 12.9 cumulative systemic antibiotic administration days (95% CI, 0 to 18.05), and residents randomized to placebo had a mean of 12.0 days (95% CI, 0 to 16.95) (absolute difference, 0.9 days [95% CI, -3.25 to 5.05]; adjusted incidence rate ratio, 1.13 [95% CI, 0.79 to 1.63]; P = .50). A total of 120 care home residents experienced 283 adverse events (150 adverse events in the probiotic group and 133 in the placebo group). Hospitalizations accounted for 94 of the events in probiotic group and 78 events in the placebo group, and deaths accounted for 33 of the events in the probiotic group and 32 of the events in the placebo group. Conclusions and Relevance: Among care home residents in the United Kingdom, a daily dose of a probiotic combination of Lactobacillus rhamnosus GG and Bifidobacterium animalis subsp lactis BB-12 did not significantly reduce antibiotic administration for all-cause infections. These findings do not support the use of probiotics in this setting. Trial Registration: ISRCTN Identifier:16392920.


Assuntos
Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Bifidobacterium animalis , Uso de Medicamentos/estatística & dados numéricos , Lactobacillus rhamnosus , Probióticos/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Moradias Assistidas , Infecções Bacterianas/prevenção & controle , Bifidobacterium animalis/isolamento & purificação , Método Duplo-Cego , Fezes/microbiologia , Feminino , Humanos , Lactobacillus rhamnosus/isolamento & purificação , Masculino , Casas de Saúde , Reino Unido
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