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1.
Medicine (Baltimore) ; 98(32): e16775, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31393400

RESUMO

BACKGROUND: The benefit of a procalcitonin (PCT)-guided antibiotic strategy in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) remains uncertain. OBJECTIVES: This updated meta-analysis was performed to reevaluate the therapeutic potential of PCT-guided antibiotic therapy in AECOPD. DATA SOURCES: We searched PubMed, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov up to February 2019 to identify randomized controlled trials (RCTs) investigating the role of PCT-guided antibiotic strategies in treating adult patients with AECOPD. Relative risk (RR) or mean differences (MD) with accompanying 95% confidence intervals (CIs) were calculated with a random-effects model. RESULTS: Eight RCTs with a total of 1376 participants were included. The results suggested that a PCT-guided antibiotic strategy reduced antibiotic prescriptions (RR: 0.55; 95% CI: 0.39-0.76; P = .0003). However, antibiotic exposure duration (MD: -1.34; 95% CI: -2.83-0.16; P = .08), antibiotic use after discharge (RR: 1.61; 95% CI: 0.61-4.23; P = .34), clinical success (RR: 1.02; 95% CI: 0.96-1.08; P = .47), all-cause mortality (RR: 1.05; 95% CI: 0.72-1.55; P = .79), exacerbation at follow-up (RR: 0.97; 95% CI: 0.80-1.18; P = .78), readmission at follow-up (RR: 1.12; 95% CI: 0.82-1.53; P = .49), length of hospital stay (MD: -0.36; 95% CI: -1.36-0.64; P = .48), and adverse events (RR: 1.33; 95% CI: 0.79-2.23; P = .28) were similar in both groups. IMPLICATIONS OF KEY FINDINGS: A PCT-guided antibiotic strategy is associated with fewer antibiotic prescriptions, and has similar efficacy and safety compared with standard antibiotic therapy in AECOPD patients.


Assuntos
Antibacterianos/uso terapêutico , Pró-Calcitonina/sangue , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Antibacterianos/administração & dosagem , Antibacterianos/efeitos adversos , Protocolos Clínicos , Esquema de Medicação , Uso de Medicamentos , Humanos , Readmissão do Paciente , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/mortalidade , Ensaios Clínicos Controlados Aleatórios como Assunto
2.
Braz Oral Res ; 33: e076, 2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31432927

RESUMO

The aim of this study was to assess the frequency of opioid analgesics prescribed by Brazilian dentists, potential regional differences and their association with socioeconomic and health-related factors. Data for all opioid prescriptions by dentists was obtained from the 2012 database of the National Controlled Substances Management System, regulated by the Brazilian Health Surveillance Agency. The number of defined daily doses (DDD) and DDDs per 1,000 inhabitants per day for each Brazilian state were calculated as the primary outcomes. DDDs were compared by regions and Brazilian states. Spearman's rho correlation coefficient was used to determine the influence of the states' characteristics, such as the Human Development Index; poverty; education; number of dentists per 100,000 inhabitants; visit to the dentist; dental care plan; good or very good oral health; number of pharmaceutical establishments per 100,000/inhabitants; and ability to get all prescribed medications. Data analysis was performed using IBM SPSS Statistics 25.0. A total of 141,161 prescriptions for opioids analgesics by 36,929 dentists were recorded, corresponding to 658,855 doses of opioids dispensed in 2012. The most commonly dispensed opioids were codeine associated with paracetamol (83.2%; n = 117,493). The national DDDs per 1,000 inhabitants per day was 0.0093 (range: 0.0002-0.0216). DDD per 1,000 inhabitants per day was positively associated to visits to dentists (rs = 0.630; P < 0.001) and inversely associated to poverty (rs = -0.624; p = 0.001). There are significant differences in opioid prescriptions in dentistry among the Brazilian states. These differences may be associated with non-clinical factors.


Assuntos
Analgésicos Opioides/uso terapêutico , Assistência Odontológica/estatística & dados numéricos , Prescrições de Medicamentos/estatística & dados numéricos , Padrões de Prática Odontológica/estatística & dados numéricos , Acetaminofen/uso terapêutico , Brasil , Codeína/uso terapêutico , Estudos Transversais , Uso de Medicamentos/estatística & dados numéricos , Humanos , Farmácias/estatística & dados numéricos , Valores de Referência , Fatores Socioeconômicos , Estatísticas não Paramétricas , Tramadol/uso terapêutico
3.
Rev Saude Publica ; 53: 68, 2019 Aug 19.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31432930

RESUMO

OBJECTIVE: To assess whether the incidence of hospital infection by a resistant microorganism decreased after the implementation of the restrictive measure of the National Health Surveillance Agency for the commercialization of antimicrobials. METHODS: A historical cohort study of medical records of adult patients admitted to a general and public hospital from May 2010 to July 2011. A cohort was formed with patients admitted in the period before the restrictive measure for the commercialization of antimicrobials (Phase I) and a second cohort was formed with patients admitted after the implementation of the restrictive measure (Phase II). RESULTS: The instantaneous risk of hospital infection by a resistant microorganism was estimated at seven by 1,000 people-time (95%CI 0.006-0.008) in Phase I, and four by 1,000 people-time (95%CI 0.003-0.005) in Phase II of the study. The differences between the survival curves in the different phases of the study and stratified by age group were also significant (p < 0.05). CONCLUSIONS: The results suggest that the implementation of the restrictive measure of the commercialization of antimicrobials by the National Health Surveillance Agency reduced the incidence of hospital infection by a resistant microorganism.


Assuntos
Antibacterianos/administração & dosagem , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/prevenção & controle , Resistência Microbiana a Medicamentos , Uso Excessivo de Medicamentos Prescritos/legislação & jurisprudência , Brasil , Estudos de Coortes , Monitoramento de Medicamentos , Uso de Medicamentos/legislação & jurisprudência , Feminino , Humanos , Controle de Infecções/métodos , Masculino , Pessoa de Meia-Idade , Uso Excessivo de Medicamentos Prescritos/efeitos adversos , Uso Excessivo de Medicamentos Prescritos/estatística & dados numéricos , beta-Lactamases/efeitos dos fármacos
4.
Am Surg ; 85(6): 567-571, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31267895

RESUMO

In the past 30 years, opioid prescription rates have quadrupled and hospital admissions for overdose are rising. Previous studies have focused on alcohol use and trauma recidivism, however rarely evaluating recidivism and opioid use. We hypothesized there is an association between opioid use and trauma recidivism. This is a retrospective review of patients with multiple admissions for traumatic injury. Demographics, opioid toxicology screen (TS) results, and injury characteristics were collected. Statistical analysis was performed with chi-squared and Poisson regression models. One thousand six hundred forty-nine patients (age ≥18 years) had multiple trauma admissions. Seven hundred nine patients had TS data for both admissions. Thirty-one per cent (218) were TS positive on the 1st admission compared with 34 per cent (244) on their 2nd admission. Fifty-five per cent of patients who were TS positive on the 1st admission were positive on their 2nd admission, whereas 25 per cent who were TS negative on the 1st admission were subsequently positive on their 2nd admission (P < 0.0001). Patients who were TS positive on the subsequent admission were less severely injured than TS negative patients (Injury Severity Score > 15, 26.3% vs 22.3%, P = 0.04). The only significant risk factor for being TS positive on the 2nd admission was being TS positive on the 1st admission (relative risk = 2.18, P < 0.001). A previous history of opioid use is the strongest predictor of recurrent use in recidivists.


Assuntos
Analgésicos Opioides/efeitos adversos , Uso de Medicamentos/estatística & dados numéricos , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Ferimentos e Lesões/induzido quimicamente , Ferimentos e Lesões/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Analgésicos Opioides/uso terapêutico , Análise Química do Sangue , Estudos de Coortes , Intervalos de Confiança , Bases de Dados Factuais , Feminino , Humanos , Incidência , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/induzido quimicamente , Traumatismo Múltiplo/epidemiologia , Traumatismo Múltiplo/terapia , Determinação de Necessidades de Cuidados de Saúde , Transtornos Relacionados ao Uso de Opioides/complicações , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Distribuição por Sexo , Estatísticas não Paramétricas , Taxa de Sobrevida , Centros de Traumatologia/estatística & dados numéricos , Estados Unidos/epidemiologia , Ferimentos e Lesões/terapia , Adulto Jovem
5.
Bone Joint J ; 101-B(7_Supple_C): 22-27, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31256653

RESUMO

AIMS: Unicompartmental knee arthroplasty (UKA) provides improved early functional outcomes and less postoperative morbidity and pain compared with total knee arthroplasty (TKA). Opioid prescribing has increased in the last two decades, and recently states in the USA have developed online Prescription Drug Monitoring Programs to prevent overprescribing of controlled substances. This study evaluates differences in opioid requirements between patients undergoing TKA and UKA. PATIENTS AND METHODS: We retrospectively reviewed 676 consecutive TKAs and 241 UKAs. Opioid prescriptions in morphine milligram equivalents (MMEs), sedatives, benzodiazepines, and stimulants were collected from State Controlled Substance Monitoring websites six months before and nine months after the initial procedures. Bivariate and multivariate analysis were performed for patients who had a second prescription and continued use. RESULTS: Patients undergoing UKA had a second opioid prescription filled 50.2% of the time, compared with 60.5% for TKA (p = 0.006). After controlling for potential confounders, patients undergoing UKA were still less likely to require a second prescription than those undergoing TKA (adjusted odds ratio (OR) 0.58, 95% confidence interval (CI) 0.42 to 0.81; p = 0.001). Continued opioid use requiring more than five prescriptions occurred in 13.7% of those undergoing TKA and 5.8% for those undergoing UKA (p = 0.001), and was also reduced in UKA patients compared with TKA patients (adjusted OR 0.33, 95% CI 0.16 to 0.67; p = 0.022) in multivariate analysis. The continued use of opioids after six months was 11.8% in those undergoing TKA and 8.3% in those undergoing UKA (p = 0.149). The multivariate models for second prescriptions, continued use with more than five, and continued use beyond six months yielded concordance scores of 0.70, 0.86, and 0.83, respectively. CONCLUSION: Compared with TKA, patients undergoing UKA are less likely to require a second opioid prescription and use significantly fewer opioid prescriptions. Thus, orthopaedic surgeons should adjust their patterns of prescription and educate patients about the reduced expected analgesic requirements after UKA compared with TKA. Cite this article: Bone Joint J 2019;101-B(7 Supple C):22-27.


Assuntos
Analgésicos Opioides/uso terapêutico , Artroplastia do Joelho/métodos , Uso de Medicamentos/tendências , Osteoartrite do Joelho/cirurgia , Dor Pós-Operatória/tratamento farmacológico , Idoso , Feminino , Seguimentos , Humanos , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Morbidade/tendências , Dor Pós-Operatória/epidemiologia , Padrões de Prática Médica , Reoperação , Estudos Retrospectivos , Fatores de Tempo , Estados Unidos/epidemiologia
6.
Cornea ; 38(8): 933-937, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31276456

RESUMO

PURPOSE: To understand medication use and patient burden for treatment of bacterial keratitis (BK). METHODS: A retrospective study was conducted examining medical records of adult patients with BK in an academic cornea practice. Data collected included medications used in the treatment of BK, dosing of medications, and the number and total duration of clinical encounters. Costs of medications were estimated using the average wholesale pharmacy price. Linear regression analysis was used to investigate associations of medication use with patient demographics and corneal culture results and reported with beta estimates (ß) and 95% confidence intervals (95% CIs). RESULTS: Forty-eight patients with BK (56% female) were studied. Patients were treated for a median of 54 days with 10 visits, 5 unique medications, 587 drops, and 7 prescriptions. The estimated median medication cost was $933 (interquartile range: $457-$1422) US dollars. Positive bacterial growth was significantly associated with more visits (ß: 6.16, 95% CI: 1.75-10.6, P = 0.007), more days of treatment (ß: 86.8, 95% CI: 10.8-163, P = 0.026), more prescribed medications (ß: 2.86, 95% CI: 1.04-4.67, P = 0.003), and more doses of medications (ß: 796, 95% CI: 818-1412, P = 0.012) compared with patients who did not undergo corneal scraping. Patients were prescribed 132 more drops of medication for every 10 years of older age (ß: 132, 95% CI: 18.2-246, P = 0.024). Sex and income were not associated with medication burden or treatment length. CONCLUSIONS: Older patients and those with positive cultures incur the most medication burden in treatment of BK. Providers should be aware of medication usage and cost burden as it may affect compliance with treatment.


Assuntos
Antibacterianos/economia , Antibacterianos/uso terapêutico , Úlcera da Córnea/tratamento farmacológico , Custos e Análise de Custo , Custos de Medicamentos , Uso de Medicamentos/estatística & dados numéricos , Infecções Oculares Bacterianas/tratamento farmacológico , Administração Oftálmica , Bactérias/isolamento & purificação , Úlcera da Córnea/microbiologia , Prescrições de Medicamentos/estatística & dados numéricos , Infecções Oculares Bacterianas/microbiologia , Feminino , Glucocorticoides/economia , Glucocorticoides/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Midriáticos/economia , Midriáticos/uso terapêutico , Soluções Oftálmicas , Estudos Retrospectivos
7.
Implement Sci ; 14(1): 75, 2019 07 24.
Artigo em Inglês | MEDLINE | ID: mdl-31340835

RESUMO

BACKGROUND: The study covered in- and out-of-hospital care in a region in north-western Spain. The intervention evaluated took the form of a change in the hospital drugs formulary. Before the intervention, the formulary contained four of the five low molecular weight heparins (LMWHs) marketed in Spain. The intervention consisted of withdrawing two LMWHs (bemiparin and dalteparin) from the formulary and restricting the use of another (tinzaparin), leaving only enoxaparin as an unrestricted prescription LMWH. Accordingly, the aim of this study was to evaluate the effect on in- and outpatient drug prescriptions of removing and restricting the use of several LMWHs in a hospital drugs formulary. METHODS: We used a natural, before-after, quasi-experimental design with a control group and monthly data from January 2011 to December 2016. Based on data drawn from official Public Health Service sources, the following dependent variables were extracted: defined daily doses (DDD) per 1000 inhabitants per day (DDD/TID), DDD per 100 stays per day, and expenditure per DDD. RESULTS: The two compounds that were removed from the formulary registered an immediate decrease at both an intra- and out-of-hospital level (66.6% and 55.6% for bemiparin and 73.0% and 92.2% for dalteparin, respectively); similarly, the compound that was restricted also registered an immediate decrease (36.1% and 9.0% at the in- and outpatient levels, respectively); in contrast, the remaining LMWH (enoxaparin) registered an immediate, significant increase at both levels (44.9% and 32.6%, respectively). The intervention led to an immediate reduction of 6.8% and a change in trend in out-of-hospital cost/DDD; it also avoided an expenditure of €477,317.1 in the 21 months following the intervention. CONCLUSIONS: The results indicate that changes made in a hospital drugs formulary towards more efficient medications may lead to better use of pharmacotherapeutic resources in its health catchment area.


Assuntos
Prescrições de Medicamentos/estatística & dados numéricos , Uso de Medicamentos/estatística & dados numéricos , Enoxaparina/uso terapêutico , Formulários de Hospitais como Assunto , Heparina de Baixo Peso Molecular/uso terapêutico , Análise de Séries Temporais Interrompida , Dalteparina/provisão & distribução , Enoxaparina/economia , Enoxaparina/provisão & distribução , Heparina de Baixo Peso Molecular/economia , Heparina de Baixo Peso Molecular/provisão & distribução , Humanos , Espanha , Tinzaparina/provisão & distribução
8.
Rev Saude Publica ; 53: 51, 2019 May 30.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31166379

RESUMO

OBJECTIVE: Trace the pattern of drug use during delivery hospitalization. METHOD: Cross-sectional study carried out from June to October 2015, included in the 2015 Pelotas births cohort. All women living in the urban area of the city who were hospitalized for delivery were part of the sample. We collected information regarding drug prescription and drug use by mothers during the whole period of hospitalization. Sociodemographic data were obtained in interview after delivery, and other data were obtained from medical charts. The drugs were classified according to the Anatomical Therapeutic Chemical system. RESULTS: All study participants (1,392 women) used at least one drug, with the mean amount being larger the higher the age of the mother, both prepartum/during delivery and postpartum. It was also higher in cases of spinal anesthesia or general anesthesia, cesarean deliveries, school hospitals, and longer hospitalizations. Analysis of the sample as a whole showed no significant difference in the number of drugs used according to hospitalization type, but when stratified by length of hospital stay the mean was higher in SUS hospitalizations than in private and health insurance hospitalizations. Drugs for the nervous system were the most used (30.5%), followed by drugs for the alimentary tract and metabolism (13.8%). The use of anti-infective agents and drugs that act on the cardiovascular and respiratory systems was higher in mothers who underwent cesarean delivery. This study showed high drug consumption in the delivery hospitalization period, and showed cesarean delivery and epidural anesthesia as the main factors related to high drug consumption in this period. CONCLUSIONS: We found high drug consumption in the delivery hospitalization period, and the main factors were cesarean delivery and epidural anesthesia. Drugs that act on the nervous system were the most used.


Assuntos
Cesárea/estatística & dados numéricos , Parto Obstétrico/estatística & dados numéricos , Prescrições de Medicamentos/estatística & dados numéricos , Uso de Medicamentos/estatística & dados numéricos , Adolescente , Adulto , Anestesia Epidural , Anestesia Geral , Raquianestesia , Brasil , Estudos de Coortes , Estudos Transversais , Prescrições de Medicamentos/classificação , Feminino , Hospitalização , Humanos , Pessoa de Meia-Idade , Período Pós-Parto , Gravidez , Fatores de Risco , Fatores Socioeconômicos , Adulto Jovem
10.
BMC Infect Dis ; 19(1): 554, 2019 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-31238896

RESUMO

BACKGROUND: The objective of this study is to describe the changes in prescribing practices of antibiotics to treat acute pyelonephritis (APN) in Korea. METHODS: The claim data base of the Health Insurance Review and Assessment Service in Korea was used to select patients with ICD-10 codes N10 (acute tubulo-interstitial nephritis) or N12 (tubulo-interstitial nephritis, not specified as acute nor chronic) as the primary discharge diagnosis during 2010-2014. Consumption of each class of antibiotics was converted to Defined Daily Dose (DDD)/event. RESULTS: Throughout the five-year period, the average antibiotic consumption were 11.3 DDD per inpatient event and 6.0 DDD per outpatient event. The annual average antibiotic consumption increased for inpatients (P = 0.002), but remained stable for outpatients (P = 0.066). The use of parenteral antibiotics increased for inpatients (P < 0.001), but decreased for outpatients (P = 0.017). As for the the antibiotic classes, 3rd generation cephalosporins (3rd CEPs) was the most commonly prescribed (41.4%) for inpatients, followed by fluoroquinolones (FQs) (28.5%); for outpatient, FQs (54.8%) was the most commonly prescribed, followed by 3rd CEPs (13.1%). The use of 3rd CEPs (P < 0.001), beta-lactam/beta-lactamase inhibitors (P = 0.007), and carbapenems (P < 0.001) increased substantially for the treatment of hospitalized APN patients. In particular, carbapenems use increased 3.1-fold over the 5 years. CONCLUSIONS: Prescription of broad-spectrum antibiotics increased much for the treatment of APN in Korea during 2010-2014.


Assuntos
Antibacterianos/uso terapêutico , Uso de Medicamentos/tendências , Pielonefrite/tratamento farmacológico , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Gestão de Antimicrobianos/tendências , Cefalosporinas/uso terapêutico , Bases de Dados Factuais , Feminino , Fluoroquinolonas/uso terapêutico , Humanos , Revisão da Utilização de Seguros , Infecções Intra-Abdominais/tratamento farmacológico , Infecções Intra-Abdominais/epidemiologia , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Padrões de Prática Médica/tendências , Pielonefrite/epidemiologia , República da Coreia/epidemiologia , Adulto Jovem , Inibidores de beta-Lactamases/uso terapêutico
12.
BMC Infect Dis ; 19(1): 465, 2019 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-31126242

RESUMO

BACKGROUND: Antibiotic resistance due to overuse of antimicrobials is an issue that has been of concern to many health institutions and society in general. Resistant infections have high impact in low income countries since they can't afford more recent and expensive antibiotics. Studies that evaluate antibiotic use in hospitals are scarce in Eritrea. Ceftriaxone is commonly available in Halibet National Referral and teaching hospital (HNRTH). Resistance to this antibiotic would have a great impact on the hospital since there is no other available third generation cephalosporin or higher classes of antibiotics. METHOD: A retrospective cross sectional design was used to evaluate the use of ceftriaxone in patients admitted to the medical ward in 2017. Clinical card number of inpatients who took ceftriaxone was extracted from the database of the Satellite Pharmacy Department of HNRTH and collected using a standardized data collection form. A descriptive analysis was employed and the Statistical package for social sciences (SPSS), version 20 was used for analysis. RESULTS: A total of 120 patients were taking ceftriaxone for various indications. There were 55 (50.5%) males and 54 (49.5%) females. 59.8% of the patients were treated in the range of 0-7 days. The mean age was 56 (SD: 20.7). On average patients were under treatment for 6 days. The proportion of patients taking ceftriaxone was 11.43% out of all admissions in the medical ward. One, two or three antibiotics were co-prescribed with ceftriaxone in 39.4%. The most commonly co-prescribed antibiotic was gentamycin, accounting for 16.4% of the co-administered antibiotics. The most common indications for ceftriaxone were pneumonia, sepsis, TB, and CHF. Ceftriaxone therapy was appropriate in 30 (27.5%) cases and 68 (62.4%) cases were inappropriate in any of the four parameters of assessment used. CONCLUSION: Inappropriate use of ceftriaxone was found to be high in the hospital. This calls for establishment of hospital and national guidelines of antimicrobial treatment. Moreover drug restriction and antibiotic stewardship implementation in the hospital should be sought to prolong the lives of important drugs like ceftriaxone.


Assuntos
Antibacterianos/uso terapêutico , Ceftriaxona/uso terapêutico , Uso de Medicamentos/estatística & dados numéricos , Adolescente , Adulto , Idoso , Estudos Transversais , Eritreia , Feminino , Hospitalização/estatística & dados numéricos , Hospitais de Ensino/estatística & dados numéricos , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
14.
Infect Dis Poverty ; 8(1): 38, 2019 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-31130143

RESUMO

BACKGROUND: Lymphatic filariasis is endemic in nine of the eleven Member States of the World Health Organization South East Asia Region. This article describes the intensive interventions with the National Programme for Elimination of Lymphatic Filariasis in Thailand since its launch in 2001 till the validation of its elimination in 2017. METHODS: A baseline epidemiological survey was initiated in 2001 to identify both brugian and bancroftian filarial areas and delineate its endemicity. Mass drug administration (MDA) with diethylcarbamazine citrate (DEC) and albendazole (ALB) was implemented in a total of 357 implementation units (IUs) in 11 lymphatic filariasis (LF) endemic provinces. The implementing unit (IU) was a sub-village. Stop-MDA surveys were conducted in 2006 in the 11 LF endemic provinces among population over 6 years of age and children of ≤6 years using immunochromatographic test (ICT) for Wuchereria bancrofti antigen and microfilariae (mf) detection for Brugia malayi. In Narathiwat province, Stop-MDA surveys were done in 2011 using ELISA. Transmission assessment surveys (TAS) were conducted in 2012-2013, 2015 and 2016-2017 among school students in the 6-7-year age-group. Surveillance of migrant populations through the national migrant health checkup were intensified in seven provinces over 2002-2017 for LF antigenaemia using ICT test cards. In four B. malayi endemic provinces, annual surveys to detect LF reservoir in domestic cats commenced in 1994. A 2001 survey of the chronic disease burden for LF established a register of the cumulative number of people with lymphedema/elephantiasis. RESULTS: A total of five rounds of MDA annually were implemented over 2002-2006 in all IUs. Additional annual rounds of MDA were required in 87 IUs of Narathiwat province from 2007 to 2011 due to persistent infection. The annual national drug coverage with MDA over 2002-2012 was in the range of 68.0 to 95.4%. Stop-MDA surveys in 2006 in the 11 LF endemic provinces found nine mf positive cases in seven IUs in Narathiwat province with the highest prevalence of 0.8% (range: 0.1-0.8%). In Narathiwat TAS-1, TAS-2 and TAS-3 detected below transmission threshold rates for B. malayi mf among antibody positive children (0.3, 0.2 and 0.7% respectively). Contact tracing both all mf cases in all three TAS yielded no positive cases. Through the migrant health checkup, a total of 23 477 persons were tested, showing a positive rate of 0.7% (range: 0.1-2.7%) over years 2002-2017. In Narathiwat province, annual ivermectin treatment among cats commenced in 2003 resulting in a decline of mf prevalence among cats from 8.0% in 1995 to 0.8% in 2015. As of April 2017, a total of 99 lymphoedema/elephantiasis patients were registered and followed-up under 34 health facilities. CONCLUSIONS: Thailand over the years 2002 to 2011 conducted extensive MDA with high coverage rates. Through periodic and regular monitoring surveys it delineated LF transmission areas at sub-village level and demonstrated through its evaluation surveys - the Stop-MDA surveys and TAS, below transmission threshold rates that enabled its validation of LF elimination. In September 2017, World Health Organization acknowledged the Ministry of Health Thailand had eliminated lymphatic filariasis as a public health problem.


Assuntos
Albendazol/uso terapêutico , Anti-Helmínticos/uso terapêutico , Dietilcarbamazina/uso terapêutico , Filariose Linfática/tratamento farmacológico , Filariose Linfática/prevenção & controle , Administração Massiva de Medicamentos/métodos , Adolescente , Adulto , Animais , Anticorpos Anti-Helmínticos , Antígenos de Helmintos , Doenças do Gato/parasitologia , Gatos , Criança , Pré-Escolar , Erradicação de Doenças/métodos , Reservatórios de Doenças/parasitologia , Uso de Medicamentos , Doenças Endêmicas , Feminino , Filaricidas/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Prática de Saúde Pública , Inquéritos e Questionários , Tailândia , Migrantes , Wuchereria bancrofti/efeitos dos fármacos , Wuchereria bancrofti/imunologia , Adulto Jovem
15.
Can J Vet Res ; 83(2): 80-89, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31097869

RESUMO

The objectives of this study were to describe the frequency of antimicrobial resistance (AMR) in Escherichia coli and Campylobacter spp. isolates in fecal samples from beef cow-calf herds and to examine the associations between herd management practices, reported antimicrobial use, and AMR. Baseline prevalence data are needed to evaluate the effectiveness of antimicrobial stewardship programs. A pooled fecal sample, representing 20 cows, was collected from each of 107 herds during pregnancy testing. In the 305 recovered E. coli isolates (maximum 3 per herd), resistance to ≥ 1 antimicrobial was identified in 12 isolates [4%, 95% confidence interval (CI): 2% to 7%] from 105 herds (11%, 95% CI: 7% to 19%). The most common resistances identified in E. coli isolates were to tetracycline (3%) and to both streptomycin and sulfisoxazole (3%). Only 1 E. coli isolate was resistant to an antimicrobial of very high importance to human health - amoxicillin/clavulanic acid. However, 2 E. coli isolates had intermediate susceptibility to ciprofloxacin. Resistance to 1 antimicrobial was identified in 16 of 87 Campylobacter spp. isolates (18%, 95% CI: 11% to 28%) from 87 herds. Resistance to tetracycline was reported in 15% of Campylobacter spp. isolates and to nalidixic acid in 3.4%. Herds in which cows were treated with florfenicol were more likely to have E. coli resistance to ≥ 2 antimicrobials (OR 7.1, 95% CI: 1.1 to 57, P = 0.03). Herds with calf mortality of > 5% were more likely to have E. coli with resistance to streptomycin and sulfisoxazole [odds ratio (OR): 7.8, P = 0.03]. The results of this study are consistent with previous reports from western Canada and provide a starting point for designing an ongoing antimicrobial surveillance program.


Assuntos
Antibacterianos/farmacologia , Bovinos/microbiologia , Farmacorresistência Bacteriana , Escherichia coli/efeitos dos fármacos , Fezes/microbiologia , Alberta , Animais , Antibacterianos/administração & dosagem , Uso de Medicamentos , Feminino , Manitoba , Testes de Sensibilidade Microbiana , Saskatchewan
16.
BMC Public Health ; 19(1): 449, 2019 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-31035968

RESUMO

BACKGROUND: Electronic clinical decision algorithms (eCDAs) that guide clinicians during patient management are being deployed in resource-limited settings to improve the quality of care and rational use of medicines (especially antimicrobials). Little is known on how local clinicians perceive the use and impact of these tools in their daily practice. This study investigates clinician insights on an eIMCI tool. Specifically, we report their views on its medical content, assess their knowledge on microbes, antimicrobials and the development of resistance. METHODS: This qualitative study was conducted in the frame of a large-scale implementation in Burkina Faso of an eIMCI tool developed by the Swiss NGO Terre des hommes. Twelve in-depth interviews and 2 focus-group discussions were conducted including 21 health workers from 10 primary care facilities. Emerging themes were identified using qualitative data analysis software. RESULTS: eIMCI users expressed a high level of satisfaction, slowness of the tablet was perceived as the major inconvenience limiting uptake. Several frequent illnesses were identified as missing in the algorithm along with guidance for fever without focus. When asked about existing types of microbes, 9 and 4 out of 21 participants could mention bacteria and virus respectively; only 5 correctly answered that antibiotics had no action on viral disease and 6 mentioned the risk of antibiotic resistance. Level of knowledge was higher in nurses than in less trained health workers. The tool was perceived as improving patient management and the rational use of antibiotics. Positive changes in health facility organisation were reported, such as task shifting and improved triage. eIMCI was also perceived as a learning tool, and users expressed a strong desire to expand the geographic and temporal scope of the intervention. CONCLUSION: The use of eICMI was widely accepted and perceived as a powerful tool guiding daily practice. Findings suggest that it has positive effects on the health care system beyond the quality of consultation. To support large uptake and sustainability, better training of health workers in infectiology is essential and the medical content of eIMCI should be optimized to include frequent diseases and, for each of them, the appropriate management plan.


Assuntos
Antibacterianos/uso terapêutico , Atitude do Pessoal de Saúde , Sistemas de Apoio a Decisões Clínicas/organização & administração , Atenção Primária à Saúde/organização & administração , Adulto , Algoritmos , Antibacterianos/administração & dosagem , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/microbiologia , Burkina Faso/epidemiologia , Criança , Computadores de Mão/normas , Comportamento do Consumidor , Sistemas de Apoio a Decisões Clínicas/normas , Farmacorresistência Bacteriana , Uso de Medicamentos , Feminino , Febre/tratamento farmacológico , Febre/microbiologia , Instalações de Saúde , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde/normas , Pesquisa Qualitativa , Viroses/tratamento farmacológico , Viroses/microbiologia
17.
BMC Health Serv Res ; 19(1): 282, 2019 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-31053135

RESUMO

BACKGROUND: Pharmaceutical care is the pharmacist's contribution to the care of individuals to optimize medicines use and improve health outcomes. The primary tool of pharmaceutical care is medication review. Defining and classifying Drug-Related Problems (DRPs) is an essential pillar of the medication review. Our objectives were to perform a pilot of medication review in Hungarian community pharmacies, a DRP classification was applied for the first time. Also, our goal was the qualitative and quantitative description of the discovered DRPs, and of the interventions for their solution in order to prove the safety relevance of the service and to map out the competence limits of GPs and community pharmacists to drug therapy. METHODS: The project took place in Hungarian community pharmacies. The study was performed with patients taking vitamin K antagonist (VKA) and/or ACE inhibitor and NSAID simultaneously (ACEI-NSAID). 61 pharmacists and 606 patients participated in the project. Pharmacists reviewed the medication for 3 months and the classification of DRPs was performed (category of DRP1 - DRP6). Patient data were statistically analyzed. RESULTS: Patients consumed on average 7.9 ± 3.1 medications and other products. 571 DRPs were detected in 540 patients, averaging 1.06 DRPs per patient (SD = 1.07). The highest frequency category was DRP5 (non-quantitative safety problem; 51.0%). The most common root cause was an interaction (42.0%) and non-adherence (19.4%.). The most commonly used intervention was education (25.4%) and medication replacement by the pharmacist (20.1%). The changing of the frequency and dosage in any direction were negligible. CONCLUSIONS: Patients are struggling with many DRPs that can be assessed and categorized by this system and which remain unrecognizable without pharmacists. Further projects need to be developed to assist in the development of physician-pharmacist cooperation and the widespread dissemination of pharmaceutical care.


Assuntos
Serviços Comunitários de Farmácia/organização & administração , Uso de Medicamentos/estatística & dados numéricos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Farmacêuticos/organização & administração , Idoso , Estudos de Avaliação como Assunto , Feminino , Humanos , Hungria , Masculino , Auditoria Médica , Pessoa de Meia-Idade , Projetos Piloto , Pesquisa Qualitativa
18.
Minerva Med ; 110(5): 410-418, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31081301

RESUMO

BACKGROUND: Patients with acute coronary syndrome (ACS) and previous cardiovascular disease (CVD) (stroke, peripheral arterial disease [PAD] or coronary artery disease [CAD]) are at high risk of serious events and mortality. Current clinical guidelines recommend new antiplatelet drugs (NADs) for high cardiovascular risk patients with ACS; however, these drugs are underused in different scenarios. METHODS: This study included 1717 ACS patients from 3 tertiary hospitals. Of them, 641 (37.33%) suffered from previous CVD: 149 patients with stroke, 154 patients with PAD and 541 patients with CAD. Bleeding, mortality and major adverse cardiac events (MACE) at 1 year of follow-up after hospital discharge were analyzed. RESULTS: NADs administration during hospital stay and at discharge was less frequent in patients with previous CVDs (P<0.001, for both). Cox analysis in this cohort of patients showed that clopidogrel prescription at discharge was independently associated with MACEs (HR: 1.59 [95% CI: 1.03-2.45]; P=0.036) and with death (HR: 1.99 [95% CI: 1.00-3.98]; P=0.049) in multivariate analysis. More specifically, when ticagrelor prescription at discharge was compared with clopidogrel, a significant death reduction was found in both, the univariate and the multivariate Cox analysis (HR: 4.54 [95% CI: 2.26-9.13]; P<0.001 and HR: 2.61 [95% CI: 1.16-5.90]; P=0.021, respectively). CONCLUSIONS: New antiplatelet drugs, especially ticagrelor, showed lower rates of mortality in patients with CVD without differences for bleeding. Despite the recommendations of current clinical guidelines for high risk patients with ACS, the use of NADs is very low in "real-life" patients with previous CVD.


Assuntos
Síndrome Coronariana Aguda/tratamento farmacológico , Doença das Coronárias/complicações , Doença Arterial Periférica/complicações , Inibidores da Agregação de Plaquetas/uso terapêutico , Acidente Vascular Cerebral/complicações , Síndrome Coronariana Aguda/etiologia , Síndrome Coronariana Aguda/mortalidade , Assistência ao Convalescente , Clopidogrel/efeitos adversos , Clopidogrel/uso terapêutico , Comorbidade , Uso de Medicamentos/estatística & dados numéricos , Feminino , Seguimentos , Hemorragia/induzido quimicamente , Hemorragia/epidemiologia , Humanos , Estimativa de Kaplan-Meier , Masculino , Síndrome Metabólica/epidemiologia , Inibidores da Agregação de Plaquetas/efeitos adversos , Cloridrato de Prasugrel/uso terapêutico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fumar/epidemiologia , Espanha , Centros de Atenção Terciária/estatística & dados numéricos , Ticagrelor/efeitos adversos , Ticagrelor/uso terapêutico
19.
RECIIS (Online) ; 13(1): 191-207, jan.-mar. 2019. ilus
Artigo em Português | LILACS | ID: biblio-987702

RESUMO

A inserção dos medicamentos nas práticas de consumo consciente representa um potencial de aliada na promoção da saúde global; assim, objetivou-se mapear a aplicação da terminologia uso consciente de medicamentos. Realizou-se uma revisão documental integrativa quantitativa com a categorização de 124 textos científicos e 400 conteúdos digitais. Os resultados atestaram incompatibilidade de sinonímia com a terminologia uso racional de medicamentos, uma vez que esta não contempla as dimensões econômicas, sociais, psicológicas, ambientais, de comunicação e de valores éticos na decisão de como usufruir dos medicamentos. A implementação e consolidação da terminologia deve subsidiar políticas educacionais e de comunicação e, consequentemente, a instrumentalização para a prática do autocuidado e cuidado com o outro e com o ambiente, ao ressignificar o mecanismo saúde/doença e compreender os processos envolvidos na pesquisa, produção, distribuição e descarte de medicamentos.


The insertion of the medicines in the practices of conscious consumption represents a potential ally of the global health improvement; thus we searched for mapping the employment of the terminology conscious use of medicines. An integrative and quantitative documentary analysis was carried out categorizing 124 scientific texts and 400 digital contents. The results attested that its use as a synonymy for the terminology rational use of medicines is incompatible, since the latter does not contemplate the economic, social, psychological, environmental, ethical values in the moment of decision about how to use the medicines.The implementation and consolidation of terminology may support educational and communication policies and, consequently, the instruments for achieving the self-care and the care of others and look after the environment by giving a new meaning to the health/disease mechanism and by understanding the processes involved in the researches, production, distribution and discard of medicines.


La inserción de los medicamentos en las prácticas del consumo consciente representa un potencial de aliada en la promoción de la salud global; así tuvimos el objetivo de mapear la aplicación de la terminología uso consciente de medicamentos. Se realizó una revisión documental integrativa cuantitativa categorizando 124 textos científicos y 400 contenidos digitales. Los resultados atestaron incompatibilidad de sinonimia con la terminología uso racional de medicamentos, ya que el último no contempla las dimensiones económicas, sociales, psicológicas, ambientales, de comunicación y de valores éticos en la decisión de cómo disfrutar los medicamentos. La implementación y consolidación de la terminología puede subsidiar políticas educativas y de comunicación y en consecuencia la instrumentación para la práctica del autocuidado y del cuidado del otro y del ambiente al dar nueva significación para el mecanismo salud/enfermedad y comprender los procesos involucrados en la investigación, producción, distribución y descarte de medicamentos.


Assuntos
Humanos , Autocuidado , Saúde Global , Terminologia , Uso de Medicamentos , Promoção da Saúde , Automedicação , Educação em Saúde , Meio Ambiente , Indústria Farmacêutica
20.
Prev Vet Med ; 167: 146-157, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-30948232

RESUMO

To assess the effects of transport, management factors and barn climate on calf health, 43 Swiss veal farms (11 large farms fattening ≥100 calves and 32 small farms fattening >20 but <100 calves per year) were monitored in a prospective cohort study over a period of one year. Detailed questionnaires on farm structure, management, housing system and animal health were filled out with the farmers during bimonthly visits, and barn temperature, humidity, ammonia and CO2 concentrations were measured. Temperature and humidity were also measured continuously over 72 h once each in winter and summer. In addition, calf purchase and transport from birth farm to fattening unit were documented by the farmers, and the study team accompanied one transport per farm whenever possible. Antimicrobial treatment incidence was calculated from the used daily dose (TIUDD). Risk factors for mortality, average daily weight gain (ADG) and antimicrobial use, as well as factors related to transport and barn climate measures were evaluated with mixed regression models. The overall mortality rate was 5.1% (6.2% in large herds and 3.1% in small ones). Identified risk factors for mortality >3% included a lower number of calves fattened per year and a good hygiene of the feeder. This surprising result was likely due to the fact that the threshold of 3% mortality was rather exceeded in smaller farms. Furthemore, higher temperature variation (range between maximal and minimal temperature over 3 measurement days) in the calf pen was associated with mortality >3% in the univariable analysis. The overall mean ADG was 1.40 ± 0.16 kg. Calf purchase was significantly associated with decreased ADG. The median overall TIUDD was eight daily doses per calf and year (2.1 in small farms and 26 in large farms, respectively); the main indication for treatment was respiratory disease (81.1%). Risk factors for increased TI were no quarantine upon arrival, access to an outside pen, higher numbers of calves per drinking nipple, mechanical ventilation, vaccination against bovine respiratory disease, and a maximum ammonia value >10 ppm in the calf pen. In addition, a higher number of birth farms and calf purchase from markets were associated with increased TI in the univariable analysis. The identified risk factors associated with increased TI and mortality and with decreased ADG should be addressed in priority in veal calf operations to improve calf health and reduce antimicrobial use.


Assuntos
Criação de Animais Domésticos , Anti-Infecciosos/uso terapêutico , Doenças dos Bovinos/prevenção & controle , Abrigo para Animais , Animais , Bovinos , Doenças dos Bovinos/epidemiologia , Doenças dos Bovinos/mortalidade , Uso de Medicamentos , Humanos , Fatores de Risco , Inquéritos e Questionários , Suíça , Transportes
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