ABSTRACT Introduction: Oral anticoagulants are the treatment of choice for diverse types of coagulation disorders. Warfarin is widely used by the Brazilian population, possibly due to its lower cost than other oral anticoagulants. However, it has a high risk of serious adverse effects if used incorrectly. The Anticoagulation Knowledge Tool (AKT) can assess a patient’s knowledge about her/his oral anticoagulant therapy and can assist health professionals in identifying patients with difficulties in adherence. This study aimed to translate, culturally adapt, and validate the AKT into Brazilian Portuguese. Methods: After a standard forward-backward procedure to translate the AKT into Brazilian Portuguese (AKT-Br), a version of the instrument was applied in three groups (patients, pharmacists, and the general population). The reliability of the AKT-Br was tested using an internal consistency measure and test-retest. The validity of the instrument was confirmed with data from the contrasted groups. All statistical analyses were performed with RStudio. Results: The median scores obtained with the AKT-Br were 29.0, 17.0, and 7.5 for pharmacists, patients, and the general population, respectively (maximum score of 35 points). There was moderate internal consistency for the instrument and test-retest reliability was satisfactory. Analysis of variance for validity of the groups revealed a significant relationship between the total score and the evaluated groups. Conclusion: The ATK-Br is a reliable and valid tool to assess knowledge about oral anticoagulants. AKT-Br can be used in clinical practice as an auxiliary tool to improve patient care through personalised educational interventions.

Objective: The purpose of this overview (systematic review of systematic reviews) is to evaluate the impact of clinical decision support systems (CDSS) applied to medication use in the care process. Methods: A search for systematic reviews that address CDSS was performed on Medline following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Cochrane recommendations. Terms related to CDSS and systematic reviews were used in combination with Boolean operators and search field tags to build the electronic search strategy. There was no limitation of date or language for inclusion. We included revisions that investigated, as a main or secondary objective, changes in process outcomes. The Revised Assessment of Multiple Systematic Reviews (R-AMSTAR) score was used to evaluate the quality of the studies. Results: The search retrieved 954 articles. Five articles were added through manual search, totaling an initial sample of 959 articles. After screening and reading in full, 44 systematic reviews met the inclusion criteria. In the medication-use processes where CDSS was used, the most common stages were prescribing (n=38 (86.36%) and administering (n=12 (27.27%)). Most of the systematic reviews demonstrated improvement in the health care process (30/44 – 68.2%). The main positive results were related to improvement of the quality of prescription by the physicians (14/30 – 46.6%) and reduction of errors in prescribing (5/30 - 16.6%). However, the quality of the studies was poor, according to the score used. Conclusion: CDSSs represent a promising technology to optimize the medication-use process, especially related to improvement in the quality of prescriptions and reduction of prescribing errors, although higher quality studies are needed to establish the predictors of success in these systems.

Objective: To measure length of hospital stay (LHS) in patients receiving medication reconciliation. Secondary characteristics included analysis of number of preadmission medications, medications prescribed at admission, number of discrepancies, and pharmacists interventions done and accepted by the attending physician. Methods: A 6 month, randomized, controlled trial conducted at a public teaching hospital in southern Brazil. Patients admitted to general wards were randomized to receive usual care or medication reconciliation, performed within the first 72 hours of hospital admission. Results: The randomization process assigned 68 patients to UC and 65 to MR. LHS was 10±15 days in usual care and 9±16 days in medication reconciliation (p=0.620). The total number of discrepancies was 327 in the medication reconciliation group, comprising 52.6% of unintentional discrepancies. Physicians accepted approximately 75.0% of the interventions. Conclusion: These results highlight weakness at patient transition care levels in a public teaching hospital. LHS, the primary outcome, should be further investigated in larger studies. Medication reconciliation was well accepted by physicians and it is a useful tool to find and correct discrepancies, minimizing the risk of adverse drug events and improving patient safety.

Background: Learning styles are cognitive, emotional, and physiological traits, as well as indicators of how learners perceive, interact, and respond to their learning environments. According to Honey-Mumford, learning styles are classified as active, reflexive, theoretical, and pragmatic. Objective: The purpose of this study was to identify the predominant learning styles among pharmacy students at the Federal University of Paraná, Brazil. Methods: An observational, cross-sectional, and descriptive study was conducted using the Honey-Alonso Learning Style Questionnaire. Students in the Bachelor of Pharmacy program were invited to participate in this study. The questionnaire comprised 80 randomized questions, 20 for each of the four learning styles. The maximum possible score was 20 points for each learning style, and cumulative scores indicated the predominant learning styles among the participants. Honey-Mumford (1986) proposed five preference levels for each style (very low, low, moderate, high, and very high), called a general interpretation scale, to avoid student identification with one learning style and ignoring the characteristics of the other styles. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 20.0. Results: This study included 297 students (70% of all pharmacy students at the time) with a median age of 21 years old. Women comprised 77.1% of participants. The predominant style among pharmacy students at the Federal University of Paraná was the pragmatist, with a median of 14 (high preference). The pragmatist style prevails in people who are able to discover techniques related to their daily learning because such people are curious to discover new strategies and attempt to verify whether the strategies are efficient and valid. Because these people are direct and objective in their actions, pragmatists prefer to focus on practical issues that are validated and on problem situations. There was no statistically significant difference between genders with regard to learning styles. Conclusion: The pragmatist style is the prevailing style among pharmacy students at the Federal University of Paraná. Although students may have a learning preference that preference is not the only manner in which students can learn, neither their preference is the only manner in which students can be taught. Awareness of students’ learning styles can be used to adapt the methodology used by teachers to render the teaching-learning process effective and long lasting. The content taught to students should be presented in different manners because varying teaching methods can develop learning skills in students.

Background: In order to provide appropriate advice to the patient at the time of dispensing and over-the-counter (OTC) medication counseling, community pharmacists need access to current and reliable information about medicines. Brazilian pharmacists have assumed new functions such as prescribing medication, in a dependent model, based in protocols. Objective: To examine the practice of community pharmacists in a Brazilian State, focusing on OTC recommendation. Method: A cross-sectional survey of community pharmacists in a state of Brazil was conducted from October 2013 to January 2014, with data collection through a pre-piloted self-administered anonymous survey via Survey Monkey® platform. Following ethical approval, the online instrument was sent to 8,885 pharmacists registered in Parana State, Brazil, focusing on professionals working in community pharmacies. The questionnaire assessed the community pharmacy setting, the search for information, the knowledge of the evidence-based practice, the important factors to consider when recommending an OTC medicine, and the pharmacist prescribing. Responses were imported into SPSS® (version 22.0) for analysis. Nonparametric tests were used to assess the association between responses and demographic information with a significance level less than 5% (p<0.05). Results: Of the pharmacists, 97.4% dispensed medications and counseled patients for a median of six hours per day. Product's efficacy (97%) and adverse effects (62.3%) were the most important factors taken into account when counseling a nonprescription medicine. Few pharmacists knew the meaning of terms related to evidence-based health. Most respondents agreed that pharmacists have the necessary training to prescribe. Conclusion: Over-the-counter medication counseling is a daily practice among Brazilian pharmacists. Learning needs exist for community pharmacists in relation to evidence-based practice. Thus, sources of information with good evidence could be used daily by community pharmacists, especially as regards nonprescription medication counseling.

Antecedentes: Para proporcionar asesoramiento adecuado al paciente en la dispensación de medicamentos over-the-counter (OTC), los farmacéuticos comunitarios necesitan acceso a información actual y fiable sobre medicamentos. Los farmacéuticos brasileños han asumido nuevas funciones, tales como la prescripción de la medicación, en un modelo independiente basado en protocolos. Objetivo: Examinar la práctica de los farmacéuticos comunitarios en un estado de Brasil, centrándose en las recomendaciones de OTC. Métodos: Se realizó un estudio transversal de farmacéuticos comunitarios en un estado de Brasil entre octubre 2013 y enero 2014, con recogida de datos mediante un cuestionario auto-administrado, pre-pilotado y anónimo en una plataforma Survey Monkey®. Después de la aprobación ética, se envió el instrumento online a 8.885 farmacéuticos registrados en el estado de Paraná (Brasil), centrándose en los profesionales que trabajan en farmacia comunitaria. El cuestionario evaluaba el establecimiento de la farmacia comunitaria, la busca de información, el conocimiento de las prácticas basadas en la evidencia, los factores importantes a considerar cuando se recomienda un medicamento OTC, y la prescripción del farmacéutico. Las respuestas se importaron a SPSS® (versión 22.0) para su análisis. Se usaron pruebas no paramétricas para evaluar la asociación entre respuestas y la información demográfica con un nivel de significancia de menos del 5% (p<0,05). Resultados: El 97,4% de los farmacéuticos dispensaba medicamentos y aconsejaba a pacientes durante una mediana de seis horas por día. Los factores más importantes a tener en cuenta cuando se aconsejaba un medicamento sin receta eran la eficacia del producto (97%) y los efectos adversos (62,3%). Pocos farmacéuticos conocían el significado de los términos relacionados con la práctica basada en la evidencia. La mayoría de los respondentes estaban de acuerdo con que los farmacéuticos tienen la formación necesaria para prescribir medicamentos. Conclusión: El asesoramiento en medicamentos over-the-counter es una práctica diaria entre los farmacéuticos brasileños. Existen necesidades formativas de los farmacéuticos comunitarios en relación a la práctica basada en la evidencia. Así, los farmacéuticos comunitarios podrían usar a diario las fuentes de información con buena evidencia, especialmente relativas al asesoramiento de medicación sin receta.

Objective: to evaluate the relation between patient adherence and therapeutic effectiveness of hypolipidemic agents in clinical practice. Methods: A retrospective cohort study of 417 patients using hypolipidemic drugs (simvastatin, atorvastatin) between 2003 and 2010 was performed. The population studied consists of patients assisted by the Public Health Service in the far-west region of the State of Santa Catarina, Brazil. The Medication Possession Ratio obtained from pharmacy refill data was used to measure patient adherence. Therapeutic effectiveness was evaluated based on the difference obtained in the serum levels of total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides, before and after taking the drug, in an average time of 8.3 months. Results: Following the treatment with hypolipidemic agents, it has been observed a reduction of 14.3% for total cholesterol, 19.6% for LDL-cholesterol, and 14.4% for triglycerides. HDL-cholesterol increased by an 8.0% average. The major changes in lipid profile were promoted by atorvastatin 20 mg daily. The medication adherence rate decreased over the monitoring period. Adherence rates below 60% were associated with therapeutic failure, while rates equal to 80% or higher were associated with the best response to the lipid-lowering drugs. Conclusion: Adherence to hypolipidemic agents is higher at the beginning of the treatment, but it decreases over time, affecting the achievement of therapeutic goals.

Objetivo: Evaluar la relación entre la adherencia del paciente y la efectividad terapéutica de los hipolipemiantes en la práctica clínica. Métodos: Se realizó un estudio retrospectivo de 417 pacientes que usaban hipolipemiantes (simvastatina, atorvastatina) entre 2003 y 2010. La población estudiada estaba compuesta de pacientes atendidos en el Servicio Público de Salud de la región del oeste lejano del estado de Santa Catarina, Brasil. Se usó como medida de adherencia el ratio de posesión de medicación obtenido de los datos de consumo en la farmacia. La efectividad terapéutica se evaluó en base a la diferencia obtenida en los niveles séricos de colesterol total, colesterol-LDL, colesterol-HDL y triglicéridos antes y después de tomar el medicamento en una media de tiempo de 8,3 meses. Resultados: Después del tratamiento con hipolipemiantes, se observó una reducción del 14,3% para el colesterol total, 19,6% para el LDL, y 14,4% para los triglicéridos. El HDL aumentó en una media del 8,0%. Los mayores cambios del perfil lipídico fueron promovidos por la atorvastatina 20 mg diarios. La tasa de adherencia a la medicación disminuyó durante el periodo seguido. Las tasas de adherencia por debajo del 60% estaban asociadas con fracaso terapéutico, mientras que las tasas del 80% o superiores estaban asociadas a la mejor respuesta a los hipolipemiantes. Conclusión: La adherencia a los hipolipemiantes fue mayor al principio del tratamiento, pero disminuye a lo largo de éste, afectando a la consecución de los objetivos terapéuticos. Los procedimientos sistemáticos de monitorización de la tasa de adherencia y la evaluación del perfil lipídico por el farmacéutico.

FUNDAMENTO: A avaliação da qualidade de vida tem sido considerada um parâmetro fundamental na compreensão do impacto causado pela hipertensão arterial. OBJETIVO: Traduzir, adaptar culturalmente e validar para a língua portuguesa o questionário específico para avaliação de qualidade de vida em hipertensão denominado "Mini-Cuestionario de Calidad de Vida em Hipertensión Arterial" (MINICHAL). MÉTODOS: Foram realizadas duas traduções independentes do MINICHAL para o português do Brasil. Posteriormente, as duas traduções foram harmonizadas gerando uma versão que foi retrotraduzida. Essa versão foi revisada por um comitê de juízes e a versão gerada foi testada em um ensaio piloto. Após a adaptação transcultural, a versão final do instrumento foi aplicada em uma amostra de 300 pacientes. Foram analisadas as propriedades psicométricas do questionário, como confiabilidade e validade de constructo. A consistência interna do instrumento foi verificada pelo coeficiente Alpha de Cronbach. RESULTADOS: A versão brasileira do MINICHAL apresentou na análise da consistência interna valores de Alpha de Cronbach de 0,88 para o domínio Estado Mental e 0,86 para Manifestações Somáticas. Na análise de validade de conteúdo a avaliação dos juízes apresentou alto índice de concordância (75,44%). A análise fatorial confirmou os dois fatores, com diferenças em um item, o qual foi incluído no fator 2. O grupo controle apresentou diferenças significativas com relação aos hipertensos t=4,86, gl=276,8, p<0,001. CONCLUSÃO: A versão brasileira do MINICHAL foi validada com sucesso e representa um instrumento útil para avaliação da qualidade de vida de pacientes hipertensos brasileiros.

BACKGRAOUND: The assessment of quality of life has been considered an essential parameter in understanding the impact of arterial hypertension. OBJECTIVE: To translate into portuguese, cross-culturally adapt and validate the questionnaire specific for the assessment of quality of life known as "Mini Cuestionario de Calidad de Vida en Hipertensión Arterial" (MINICHAL). METHODS: Two independent translations of MINICHAL were made into brazilian portuguese. Later, these two translations were harmonized yielding a version that was back-translated into the source language. This version was revised by a committee of judges and the new version was tested in a pilot study. After the cross-cultural adaptation, the final version of the instrument was administered to a sample of 300 patients. The psychometric properties of the questionnaire such as reliability and construct validity were analyzed. The internal consistency of the instrument was measured by Cronbach’s alpha coefficient. RESULTS: In the brazilian version of MINICHAL, Cronbach’s alpha coefficients of internal consistency reliability were 0.88 for the Mental Status domain and 0.85 for the Somatic Manifestations domain. As to content validity, the judges’ assessment attained a high level of agreement (75.44%). The factor analysis confirmed both domains, with differences in one item which was included in factor 2. The control group presented significant differences relative to hypertensive patients (t=4.86, gl=276.8, p< 0.001). CONCLUSION: The brazilian version of MINICHAL was successfully validated and represents a useful and reliable instrument for assessing the quality of life of brazilian hypertensive patients.

The objective of this study was to develop and validate an analytical method for quantification of glucosamine and chondroitin in pharmaceutical formulations. Multivariate calibration combined with infrared spectrophotometry allowed this analysis. 25 mixtures of glucosamine-6-sulphate and chondroitin-6-sulphate were used for calibration. Average errors found with this model during external validation were 1.37% for glucosamine sulphate and 1.30% for chondroitin sulphate. This method presented satisfactory results for assessed variables, what indicating that it is suitable for simultaneous quantification of glucosamine and chondroitin.

Objective: To analyze the compliance of drug advertisements with regulations in Brazil, subject to Resolution RDC No. 102/2000 since 2000, which abides by the WHO's (World Health Organization) Ethical Criteria for Medicinal Drug Promotion, published in 1988. Methods: Drug advertisements running within the period of October 2002 to October 2003 were collected and recorded. Media sources included various AM and FM radio stations, television channels, newspapers, and magazines, as well as printed material distributed in doctors' offices, hospitals, drugstores, conferences, billboards, and bus doors. All sources were located in Curitiba City, Brazil, and its surrounding area. Advertisement content was analyzed according to a conformity checklist prepared based on the legal requirements of RDC No. 102/00. Results: A total of 827 advertisements for 517 different products, 83.91% regularly registered as medicinal drugs and 16.09% unregistered products that should be registered according to the Brazilian regulations, were recorded and collected. Approximately 74.73% of the advertisements did not comply with regulations; on average, such advertisements had 4.6 infractions each. Conclusions: The results of this research suggest that RDC No. 102/00 is not followed, which strengthens the need to adopt new forms of regulation to prohibit excesses of the pharmaceutical industry and to protect the population from abusive and misleading drug advertising.

Objetivo: Analizar el cumplimiento de los reglamentos de publicidad de medicamentos en Brasil, sujetos a la Resolución RDC No. 102/2000 desde el 2000, que desarrolla los Criterios Éticos para la Promoción de Medicamentos de la OMS (Organización Mundial del a Salud) publicados en 1988. Métodos: Se recogieron y grabaron los anuncios de medicamentos que aparecieron entre octubre de 2002 y octubre de 2003. Los medios incluyeron varias emisoras de radio de AM y FM, canales de televisión, periódicos y revistas, así como material impreso distribuido en las consultas médicas, hospitales, droguerías, conferencias, billares y paradas de autobús. Todas las fuentes se localizaron en la ciudad de Curitiba, Brasil y su entorno. El contenido de los anuncios se analizó de acuerdo a una lista de conformidad preparada en base al os requisitos legales del RDCN o. 102/00. Resultados: Se recogieron y grabaron 827 anuncios de 517 productos diferentes, el 83,91% registrados como medicamentos, y el 16,09% productos no registrados, pero que deberían estar registrados según la legislación brasileña. Aproximadamente el 74,73% de los anuncios no cumplió la legislación; de media cada anuncio tenía 4,6 infracciones. Conclusiones: El resultado de esta investigación sugiere que el RDCN o. 102/00 no se está siguiendo, lo que refuerza la necesidad de adoptar nuevas formas de regulación para prohibir los excesos de la industria farmacéutica y proteger a la población de la publicidad abusiva y engañosa.

The present study aimed to assess knowledge and attitudes of the pharmacists on dispensing drugs to pregnant women. Methods: Cross-sectional study in 150 community pharmacies randomly selected in Curitiba (Brazil). A closed end questionnaire with 25 questions were used, including dispensing scenarios containing risk types A, B, D or X and questions on pharmacist interaction with pregnant women, physicians, and information sources availability. Results: Pharmacists performed appropriately in 53% of the encounters. Lower success were associated to prednison and captopril (24.8% in both), end cases producing more doubts were captopril (31.7%) and simvastatin (30.7%). Most of the pharmacists state have advised drugs to pregnant women or contact to the physician to discuss about a prescription related with this issue. A Majority (64.4%) did not feel able to understand FDA risk classification and did not have trustable information sources in pharmacy. Conclusions: Pharmacists dispensing drugs in Curitiba are not able to interpret information on the use of drugs in pregnant women, and they don have reliable information sources on the use of dugs in pregnancy. However, they advice and counsel drugs to pregnant women and discuss with physicians therapeutic strategies.

Este trabalho teve por objetivo avaliar conhecimentos e atitudes dos farmacêuticos durante a dispensação de medicamentos para gestantes. Métodos: Estudo transversal em 150 farmácias comunitárias selecionadas aleatoriamente de Curitiba-Brasil. Foi aplicado um questionário fechado contendo 25 perguntas, incluindo cenários de dispensação contendo medicamentos de risco A, B, D ou X e perguntas sobre a interação do farmacêutico com gestantes, médicos e a disponibilidade de fontes de informação. Resultados: Os farmacêuticos decidiram pela opção correta na interpretação dos casos em 53%. Os menores índices de acerto estiveram relacionados às prescrições da Prednisona e Captopril (24,8% em ambos) e os casos que geraram maior indecisão foram relativos ao uso do Captopril (31,7%) e Sinvastatina (30,7%). A maioria deles afirma já ter indicado medicamentos para gestantes ou contatado o médico para discutir algo a respeito de uma prescrição envolvendo o tema. A maior parte dos farmacêuticos (64,4%) disse não se sentir capaz de interpretar a classificação de risco do FDA e não dispunha de fontes de informação confiáveis na farmácia. Conclusões: Os farmacêuticos atuantes na dispensação de medicamentos em Curitiba não se encontram aptos a interpretar informações sobre o uso de medicamentos em gestantes e não dispõe de fontes confiáveis a respeito. Ainda assim, atuam na orientação e indicação de medicamentos para gestantes e discutem com o prescritor estratégias terapêuticas.

Este trabajo tuvo como objetivo evaluar los conocimientos y actitudes de los farmacéuticos durante la dispensación de medicamentos a gestantes. Métodos: Estudio transversal en 150 farmacias comunitarias aleatoriamente seleccionadas de Curitiba (Brasil). Se aplicó un cuestionario cerrado con 25 preguntas, incluyendo escenarios de dispensación que contenían medicamento de riesgo A, B, D o X y preguntas sobre la interacción del farmacéutico con las gestantes, médicos y la disponibilidad de fuentes de información. Resultados: Los farmacéuticos decidieron la opción correcta en el 53% en la interpretación de los casos. Los menores índices de acierto estaban relacionados con la prednisona y el captopril (24,8% en ambos) y los casos que generaron mayor indecisión fueron relativos al captopril (31,7%) y simvastatina (30,7%). La mayoría de Afirmó haber indicado medicamentos para gestantes o contactado con el médico para discutir algo al respecto de una prescripción relativa a este tema. La mayor parte de los farmacéuticos (64,4%) dijo que no se sentía capaz de interpretar la clasificación de riesgo de la FDA y no disponía de fuentes de información fiables en la farmacia. Concusiones: Los farmacéuticos actuando en la dispensación de medicamentos en Curitiba no se sienten aptos para interpretar informaciones sobre el uso de medicamentos en gestantes y no disponen e fuentes de información fiables sobre el tema. Aún así, actúan en la orientación e indicación de medicamentos para embarazadas y discuten con el prescriptor estrategias terapéuticas.