Abstract Trust in institutions and democracy. The cases of young Spanish and Latin Americans This article examines data from the Jóvenes en Iberoamérica 2021 survey, coordinated by the SM Foundation of Spain, which interviewed 13,500 young people aged between 15 and 29 from Argentina, Brazil, Chile, Colombia, Ecuador, Spain, Mexico, Peru and the Dominican Republic between March 2019 and April 2020. The study aimed to measure the perception of these young people regarding the determinants of trust in relation to political and social institutions that constitute, in contemporary societies, the fundamental bases for the exercise of democratic life. The data shows, in general, a low level of trust in institutions among young people in these countries.

Resumo Confiança nas instituições e democracia. Os casos dos jovens espanhóis e latinoamericanos Este artigo examina dados da pesquisa Jóvenes en Iberoamérica 2021, coordenada pela Fundação SM da Espanha, que entrevistou 13.500 jovens com idade entre 15 e 29 anos da Argentina, Brasil, Chile, Colômbia, Equador, Espanha, México, Peru e República Dominicana entre março de 2019 e abril de 2020. O estudo teve como objetivo medir a percepção desses jovens a respeito dos determinantes da confiança em relação a instituições políticas e sociais que constituem, nas sociedades contemporâneas, as bases fundamentais para o exercício da vida democrática. Os dados mostram, em geral, um baixo nível de confiança nas instituições entre os jovens desses países.

Resumen Este artículo examina datos de la encuesta Jóvenes en Iberoamérica 2021, coordinada por la Fundación SM, de España, que entrevistó a 13.500 jóvenes de entre 15 y 29 años de Argentina, Brasil, Chile, Colombia, Ecuador, España, México, Perú y República Dominicana, entre marzo de 2019 y abril de 2020. El estudio tuvo como objetivo medir la percepción de estos jóvenes sobre los determinantes de la confianza en relación con las instituciones políticas y sociales que constituyen, en las sociedades contemporáneas, las bases fundamentales para el ejercicio de la vida democrática. Los datos muestran, en general, un bajo nivel de confianza en las instituciones entre los jóvenes de estos países.

Abstract Venous thromboembolism is a complex multifactorial disease considered the most common cause of preventable deaths in hospitalized patients. Recommendations about pharmacological venous thromboembolism prophylaxis in adult hospitalized patients are available in clinical practice guidelines for optimization of healthcare delivery and improvement of patient outcomes. We conducted a systematic review of clinical practice guidelines using ADAPTE to synthesize recommendations for pharmacological prophylaxis of venous thromboembolism in hospitalized medical patients at a medium complexity university hospital. Recommendations for pharmacological prophylaxis were extracted from seven clinical practice guidelines considered of high quality after assessment with the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. These recommendations will support discussion with specialists and implementation of practices in the setting of the hospital studied.

Resumo O tromboembolismo venoso é uma doença multifatorial complexa, considerada uma causa comum de óbitos evitáveis em pacientes hospitalizados. Recomendações sobre profilaxia farmacológica de tromboembolismo venoso em pacientes adultos hospitalizados estão disponíveis em diretrizes clínicas para otimizar os cuidados à saúde e contribuir com a melhora do desfecho do paciente. Dessa forma, foi conduzida uma revisão sistemática de diretrizes clínicas utilizando a metodologia ADAPTE para sintetizar as recomendações para profilaxia farmacológica de tromboembolismo venoso em pacientes clínicos adultos hospitalizados em um hospital universitário de média complexidade. As recomendações para profilaxia farmacológica foram extraídas de sete diretrizes clínicas consideradas de alta qualidade após avaliação pelo Appraisal of Guidelines for Research and Evaluation (AGREE II). Essas recomendações servirão de apoio para discussão com especialistas e implementação de práticas dentro do contexto do hospital estudado.

Abstract Obesity and depression, disorders associated with inflammation, have high incidences in women. Understanding the derangements present in the initial phase of obesity may point to factors that could help avoiding disease aggravation. The present study aimed at investigating the effects of a 6-months interdisciplinary therapy for weight loss in women with grade I obesity. Before and after the therapy, 37 middle-aged women donated blood and responded to questionnaires for depression and anxiety symptoms. Inflammatory parameters were evaluated in serum and a preliminary screening of the plasma proteome was performed. The therapy decreased anthropometric, psychological scores, and serum levels of inflammatory parameters. Depression and anxiety scores correlated positively with some inflammatory parameters. The proteomic analysis showed changes in proteins related to cholesterol metabolism and inflammatory response. Interdisciplinary therapy improves anthropometric and inflammatory statuses and ameliorating psychological symptoms. The decrease of MCP-1 levels after interdisciplinary therapy has not been reported so far, at the best of our knowledge. The present demonstration of positive associations of inflammatory markers and psychological scores indicate that these mediators may be useful to monitor psychological status in obesity. The present proteome data, although preliminary, pointed to plasma alterations indicative of improvement of inflammation after interdisciplinary therapy.

Glutathione S-transferase (GST) is one of the enzymes used to evaluate the effects caused by environmental contaminants. The aim of this work was to study the effects of four pyrethroid compounds (allethrin, cypermethrin, deltamethrin and fenpropathrin) on the catalytic activity of GST and to estimate the potential for environmental contamination in silico of these insecticides. Spectrophotometric analyses showed that the activity of the GST enzyme was inhibited by the four pesticides, with the values for the inhibition constant (Ki) varying from 0.12 to 20 µmol L-1, with the following order of inhibition from the highest to the lowest Ki value: deltamethrin > cypermethrin > allethrin > fenpropathrin. They presented a competitive and non-competitive inhibition mechanism depending on the compound. The IC50 values (concentration that inhibits 50% of the enzyme activity) showed the insecticide deltamethrin with greater inhibitory capacity, since it reduced the activity of the GST enzyme by half, even though it was in a lower concentration in relation to the other analyzed compounds. The in silico evaluation indicated the possibility of most of the insecticides contaminating the surface waters (rivers and lakes) adhered to the suspended sediment, but did not show any potential for contamination of groundwater through leaching.

Abstract Clinical pharmacists have been increasing their participation mainly through actions aimed at patient care, with international studies demonstrating favorable cost-benefit ratio from pharmacists interventions. However, there are few studies carried out in Brazil about the subject. This study aims to assess the economic impact of pharmaceutical interventions (PIs) in a hospital setting performed in October 2018. Each performed PI was registered and associated with the direct cost of drugs for economic impact analysis. A total of 185 PIs were evaluated, comprising 106 patients. The most intervened drugs were antibiotics, presenting the greatest economic impact, R$2,370. The total economic impact was R$2,578, mainly in the Pediatric Intensive Care Unit that represented R$1,701. Regarding the economic impact by PI as the “Suspension of drug without indication” saved R$1,360 while the “Inclusion of required drugs” cost R$807. It was estimated that the savings would be R$30,936 and, if PIs were performed at day zero, the savings would be R$79,728 per year. An average of 1.75 PI per patient was performed with an economic impact of R$14 per PI. Our results showed that clinical pharmacist’s role in the evaluation of pharmacotherapy is important for patients’ health and represents a positive economic impact.

Abstract Safety culture is a product of values, attitudes, skills, and behavioral patterns, and it determines the commitment of the management to a secure organization. The evaluation of safety culture in hospitals helps to identify and manage the relevant patient safety issues in hospital routines and working conditions proactively. Thus, this study is aimed to evaluate patient safety culture in all the departments of a university hospital of medium complexity. This study employed a cross-sectional and analytical design employed in the Portuguese version of the Hospital Survey on Patient Safety Culture. A sample of all hospital staff participated in this study, which was conducted from December 2016 to May 2017. The percentage of positive responses was calculated to identify the strong and weak areas in patient safety. Of the 413 questionnaires distributed, 368 valid responses were returned. The response rate was, therefore, 89%. The overall percentage of positive responses was 50.3%. The “Supervisor/manager expectations and actions promoting patient safety” dimension obtained the highest percentage of positive responses (67.1%). The “Nonpunitive response to error” dimension was considered the weakest for safety culture, with only 22.9% positive responses. Furthermore, most professionals (70.6%) did not report any events in the previous 12 months. Nevertheless, 69.5% of participants considered patient safety within their unit/work area as “very good” or “great.” The results showed that the employees’ perception of patient safety diverged from the reality within the institution. Therefore, efforts should be made to promote an acceptable safety culture in all hospital areas.

Resumo Objetivo Identificar preditores do conhecimento inadequado sobre medicamentos prescritos a pacientes ambulatoriais muito idosos e seus cuidadores. Método O conhecimento sobre os medicamentos prescritos para 80 pacientes com 80 anos ou mais de idade foi avaliado por meio de um questionário validado, em uma entrevista realizada com os pacientes ou seus cuidadores (quando os pacientes apresentavam dificuldades de comunicação, demência ou qualquer necessidade de assistência para ajudá-los a usar medicamentos). Dois modelos de regressão logística hierárquica avaliaram a associação entre conhecimento inadequado sobre medicamentos e variáveis sociodemográficas e medicamentosas. Resultados Trinta e nove (48,8%) entrevistados eram cuidadores. Conhecimento inadequado foi encontrado em 81,5% (404/496) dos medicamentos prescritos. Forma de administração, Dose, Frequência e Duração do Tratamento foram os aspectos de maior conhecimento, enquanto Reações Adversas, Precauções, Interações e Contraindicações, os de menor. No primeiro modelo, o conhecimento inadequado foi associado à escolaridade do ensino fundamental completo ao médio incompleto (Razão de Chances (RC):0,12; p=0,018), do médio ao superior incompleto (RC:0,12; p<0,001), superior completo (RC:0,13; p<0,001), agentes que atuam no sistema renina-angiotensina (SRA) (RC:0,30; p=0,001), diuréticos (RC:0,31; p=0,013) e antitrombóticos (RC:12,59; p=0,027). No segundo modelo, os preditores foram cuidadores (RC:0,17; p<0,001), agentes que atuam no SRA (RC:0,33; p=0,002), diuréticos (RC:0,35; p=0,024) e antitrombóticos (RC:12,57; p=0,026). Conclusão A maioria dos medicamentos prescritos para pessoas muito idosas é pouco conhecida. Além disso, o aconselhamento acerca de informações sobre medicamentos deve ser mais intensivo para os pacientes do que para seus cuidadores, com foco em informações de segurança e ser direcionado a antitrombóticos.

Abstract Objective Identify predictors of inadequate knowledge about the medication prescribed to very old outpatients and their caregivers. Method The knowledge on the medication prescribed for 80 patients aged 80 years and over was assessed using a validated questionnaire to interview patients or their caregivers (when patients had communication difficulties, dementia, or any need for care to help them take the medication). Two hierarchical logistic regression models assessed the association between inadequate knowledge of the medication and sociodemographic and drug variables. Results Thirty-nine (48.8%) respondents were caregivers. Inadequate knowledge was found in 81.5% (404/496) of medication prescribed. Route of Administration, Dose, Frequency, and Duration of Treatment were the aspects of greatest knowledge, whereas Adverse Effects, Precautions, Interactions, and Contraindications were the least known ones. In the first model, inadequate knowledge was associated to the level of education from complete elementary school to incomplete high school (Odds Ratio (OR): 0.12; p=0.018), from high school to incomplete higher education (OR: 0.12; p<0.001), complete higher education (OR: 0.13; p<0.001), agents acting on the renin-angiotensin system (RAS) (OR: 0.30; p=0.001), diuretics (OR: 0.31; p=0.013) and antithrombotic (OR: 12.59; p=0.027). In the second model, the predictors were caregivers (OR: 0.17; p<0.001), agents working in the RAS (OR: 0.33; p=0.002), diuretics (OR: 0.35; p=0.024) and antithrombotic (OR: 12.57; p=0.026). Conclusion Most of the medication prescribed for very old people is not very well known. Also, advice on drug information should be more intensive to patients than to their caregivers, with a focus on safety information and targeted at antithrombotics.

Resumo Introdução Pessoas com Deficiência (PcD) são aquelas que possuem alteração física, intelectual, social ou emocional. Podem ter impedimentos que duram um curto período de tempo ou por toda sua vida. Objetivo Descrever o perfil clínico dos pacientes com deficiência internados no Instituto de Saúde da Criança do Amazonas (ICAM). Material e método Foram analisados 34 pacientes e coletados dados, como gênero, faixa etária, procedência, patologia de base e condição de saúde bucal. Os dados obtidos foram organizados e tabulados no Microsoft Excel 2013. Resultado Na distribuição por gênero, verificou-se 70% do gênero masculino (mais prevalente) e 30% do feminino. Quanto à faixa etária, a idade predominante foi 8 anos. A maioria dos pacientes (60%) era do interior do Amazonas e 40% eram da capital. No que diz respeito à patologia, a Doença Neurológica teve prevalência em 44% dos casos, seguida das seguintes patologias: Síndrome de Down 18%, Transtorno de Espectro Autista 12%, Mielomeningocele 12%, Surdez 3%, Diabetes 3%, Síndrome de Prader Willi 3%, Síndrome Moebius 3% e Síndrome de Lennox 3%. Na condição bucal, 44% da amostra teve condição precária, 32% deficiente e 24% satisfatória. Conclusão A maioria das crianças era do gênero masculino, faixa etária de 8 anos, procedentes do interior do Amazonas, com deficiência neurológica e condição bucal precária, sugerindo que a presença do cirurgião-dentista, compondo a equipe multidisciplinar hospitalar, auxilia a traçar um plano de tratamento preventivo e curativo adequado a esses indivíduos.

Abstract Introduction Disabled people is anybody that has physical, intellectual, social or emotional alteration. They can have impediments that last for a short period of time or for the entire life. Objective Describe the clinical profile of disabled patients admitted to Instituto de Saúde da Criança do Amazonas (ICAM). Material and method Thirty-four patients were analyzed, data such as gender, age, origin, basis pathology and oral health condition were collected. The data obtained were organized and tabulated in Microsoft Excel 2013. Result There was a prevalence of males with 70% and 30% females. The age group had a predominance of 8 years. Most of the patients 60% were from Amazonas inland cities and 40% from the capital. Regarding to the pathology, Neurological Disease was prevalent in 44% of the cases, followed by the following: Down Syndrome 18%, Autistic Spectrum Disorder 12%, Myelomeningocele 12%, Deafness 3%, Diabetes 3%, Prader Willi Syndrome 3%, Moebius Syndrome 3% and Lenox Syndrome 3%. Concerning to oral condition, 44% showed a poor oral condition, 32% deficient and 24% satisfactory. Conclusion Most of the children were male, 8 years old, from Amazonas inland cities, with neurological deficiency and poor oral condition, suggesting that the presence of the dental surgeon composing the multidisciplinary hospital team helps to outline a preventive and curative treatment plan suitable for these individuals.

Resumo O objetivo deste estudo é comparar as diferenças entre as guias de prática clínica (GPCs) do Ministério da Saúde (MS) e as de outras instituições de saúde brasileiras. Foi realizada uma revisão sistemática das GPCs brasileiras. Foram incluídas GPCs com recomendações para o tratamento farmacológico de doenças crônicas não transmissíveis elencadas (DCNTs). A qualidade metodológica e a transparência das GPCs foram avaliadas de forma independente por 2 revisores utilizando o AGREE II. As GPCs foram classificadas como alta, moderada e baixa qualidade (variando de A a C). Vinte e seis GPCs foram avaliadas quanto à qualidade. As GPCs do MS foram publicadas mais recentemente, e apresentaram melhor qualidade do que as outras: 6/6 (100%) foram classificadas como Moderada-A. Embora as GPCs tenham apresentado uma ampla gama de qualidade metodológica e transparência, as GPCs do MS apresentaram melhor consistência no desenvolvimento. Para evitar confusão e melhorar a qualidade do cuidado com os recursos limitados no Brasil e, para evitar viés, conflitos de interesse, GPCs nacionais usadas no SUS devem ser desenvolvidas, sobretudo, pela Conitec e parceiros sem conflitos de interesse.

Abstract This study aims to compare the differences between clinical practice guidelines (CPGs) of the Ministry of Health (MoH) and those of other Brazilian health institutions. A systematic review of Brazilian CPGs was carried out. CPGs with recommendations for the pharmacological treatment of non-communicable disease (NCDs) were included. CPG methodological quality and transparency was independently assessed by 2 reviewers using the AGREE II. CPGs were rated as high, moderate, and low quality (ranging from A to C). Twenty-six CPGs were assessed for quality. MoH CPGs were published more recently, and were of better quality than the others: 6/6 (100%) were rated as Moderate-A. Although CPGs presented a wide range of methodological quality and transparency, MoH CPGs presented better consistency in the preparation method. To avoid confusion and to improve the quality of care within finite resources in Brazil, and to avoid potential bias, conflicts of interest, national CPGs used within SUS should be developed by Conitec with partners who have no conflict of interest.

Resumo O objetivo deste estudo é comparar as diferenças entre as guias de prática clínica (GPCs) do Ministério da Saúde (MS) e as de outras instituições de saúde brasileiras. Foi realizada uma revisão sistemática das GPCs brasileiras. Foram incluídas GPCs com recomendações para o tratamento farmacológico de doenças crônicas não transmissíveis elencadas (DCNTs). A qualidade metodológica e a transparência das GPCs foram avaliadas de forma independente por 2 revisores utilizando o AGREE II. As GPCs foram classificadas como alta, moderada e baixa qualidade (variando de A a C). Vinte e seis GPCs foram avaliadas quanto à qualidade. As GPCs do MS foram publicadas mais recentemente, e apresentaram melhor qualidade do que as outras: 6/6 (100%) foram classificadas como Moderada-A. Embora as GPCs tenham apresentado uma ampla gama de qualidade metodológica e transparência, as GPCs do MS apresentaram melhor consistência no desenvolvimento. Para evitar confusão e melhorar a qualidade do cuidado com os recursos limitados no Brasil e, para evitar viés, conflitos de interesse, GPCs nacionais usadas no SUS devem ser desenvolvidas, sobretudo, pela Conitec e parceiros sem conflitos de interesse.

Abstract This study aims to compare the differences between clinical practice guidelines (CPGs) of the Ministry of Health (MoH) and those of other Brazilian health institutions. A systematic review of Brazilian CPGs was carried out. CPGs with recommendations for the pharmacological treatment of non-communicable disease (NCDs) were included. CPG methodological quality and transparency was independently assessed by 2 reviewers using the AGREE II. CPGs were rated as high, moderate, and low quality (ranging from A to C). Twenty-six CPGs were assessed for quality. MoH CPGs were published more recently, and were of better quality than the others: 6/6 (100%) were rated as Moderate-A. Although CPGs presented a wide range of methodological quality and transparency, MoH CPGs presented better consistency in the preparation method. To avoid confusion and to improve the quality of care within finite resources in Brazil, and to avoid potential bias, conflicts of interest, national CPGs used within SUS should be developed by Conitec with partners who have no conflict of interest.

Resumo Este trabalho adaptou transculturalmente o questionário espanhol “Conocimiento del Paciente sobre sus Medicamentos” (CPM-ES-ES) para uso no Brasil. Ele mede o grau de conhecimento sobre medicamentos por meio de 11 perguntas. Oitenta pacientes ≥ 80 anos foram investigados e com 39 também foi entrevistado o cuidador. A avaliação das equivalências conceitual e de item considerou o conceito de conhecimento e as perguntas que o medem como pertinentes. A equivalência semântica foi obtida pela correspondência de significado denotativo e conotativo dos itens. O estudo da equivalência de mensuração incluiu análise fatorial e o cálculo de estimativas de validade e confiabilidade. Semelhante ao questionário original, a análise de componentes principais identificou 4 componentes, porém, em 2 deles houve diferenças nos itens incluídos. Uma pergunta foi removida desta análise devido à sua inadequação amostral. O conhecimento sobre medicamentos esteve correlacionado à complexidade da prescrição r = -0,22, p = 0,046. O conhecimento sobre anti-hipertensivos esteve correlacionado à sua adesão r = 0,70, p < 0,001, e ao controle da pressão arterial rb = 0,46, p = 0,029. A versão adaptada apresentou equivalência funcional de modo que pode ser usada no contexto brasileiro.

Abstract This work cross-culturally adapted the Spanish questionnaire `Patients’ knowledge about their medications (“Conocimiento del Paciente sobre sus Medicamentos” - CPM-ES-ES) for use in Brazil. It measures the level of medication knowledge by means of 11 questions. Eighty patients ≥ 80 years were investigated and in 39 cases the caregivers were interviewed. The evaluation of conceptual and item equivalences considered the concept of knowledge and the questions that assess it as pertinent. Semantic equivalence was obtained by the correspondence in the denotative and connotative meaning of items. The study of measurement equivalence included factorial analysis and the calculation of validity and reliability estimates. As with the original questionnaire, principal component analysis identified 4 components, however, in 2 of them there were differences regarding included items. One question was removed from this analysis due to its sample inadequacy. Medication knowledge was correlated with medication regimen complexity r = -.22, p = .046. Medication knowledge of antihypertensives was correlated with their adherence r = .70, p < .001, and blood pressure control rb = .46, p = .029. The adapted version revealed functional equivalence, therefore it can be used in the Brazilian context.

Resumo Este trabalho adaptou transculturalmente o questionário espanhol “Conocimiento del Paciente sobre sus Medicamentos” (CPM-ES-ES) para uso no Brasil. Ele mede o grau de conhecimento sobre medicamentos por meio de 11 perguntas. Oitenta pacientes ≥ 80 anos foram investigados e com 39 também foi entrevistado o cuidador. A avaliação das equivalências conceitual e de item considerou o conceito de conhecimento e as perguntas que o medem como pertinentes. A equivalência semântica foi obtida pela correspondência de significado denotativo e conotativo dos itens. O estudo da equivalência de mensuração incluiu análise fatorial e o cálculo de estimativas de validade e confiabilidade. Semelhante ao questionário original, a análise de componentes principais identificou 4 componentes, porém, em 2 deles houve diferenças nos itens incluídos. Uma pergunta foi removida desta análise devido à sua inadequação amostral. O conhecimento sobre medicamentos esteve correlacionado à complexidade da prescrição r = -0,22, p = 0,046. O conhecimento sobre anti-hipertensivos esteve correlacionado à sua adesão r = 0,70, p < 0,001, e ao controle da pressão arterial rb = 0,46, p = 0,029. A versão adaptada apresentou equivalência funcional de modo que pode ser usada no contexto brasileiro.

Abstract This work cross-culturally adapted the Spanish questionnaire `Patients’ knowledge about their medications (“Conocimiento del Paciente sobre sus Medicamentos” - CPM-ES-ES) for use in Brazil. It measures the level of medication knowledge by means of 11 questions. Eighty patients ≥ 80 years were investigated and in 39 cases the caregivers were interviewed. The evaluation of conceptual and item equivalences considered the concept of knowledge and the questions that assess it as pertinent. Semantic equivalence was obtained by the correspondence in the denotative and connotative meaning of items. The study of measurement equivalence included factorial analysis and the calculation of validity and reliability estimates. As with the original questionnaire, principal component analysis identified 4 components, however, in 2 of them there were differences regarding included items. One question was removed from this analysis due to its sample inadequacy. Medication knowledge was correlated with medication regimen complexity r = -.22, p = .046. Medication knowledge of antihypertensives was correlated with their adherence r = .70, p < .001, and blood pressure control rb = .46, p = .029. The adapted version revealed functional equivalence, therefore it can be used in the Brazilian context.

Abstract This article reflects about what has been called the cycle of public policies for youth in Brazil, which began around the year 2005 and was interrupted in 2015, based on the impeachment process of the president. The analysis works on the assumption that public policy is the “State in Action”, with the responsibility of promote and implement a government project, normally by programs and actions for specific sectors of society. The text was produced based on the studies Youth Brazil Agenda and Reflections: Survey of public youth policies, which created a large database of quantitative and qualitative information.

Resumo O presente artigo busca realizar uma leitura do que tem sido chamado de ciclo de políticas públicas de juventude no Brasil, que se inicia por volta do ano de 2005 e é interrompido em 2015, no âmbito no processo de impeachment da presidenta eleita. A análise trabalha com a compreensão de que política pública é o “Estado em Ação”, com a responsabilidade de fomentar e implantar um projeto de governo, por meio de programas e ações voltadas para setores específicos da sociedade. O texto foi produzido com base nos estudos: Agenda Juventude Brasil e Reflexões: levantamento das políticas públicas de juventude, que buscam organizar uma ampla base de dados, com informações quantitativas e qualitativas, destacando conquistas, avanços, tensões e riscos que ameaçam as políticas de juventude no Brasil.

Abstract Falls are the second leading cause of accidental and unintentional injury deaths worldwide. Inpatient falls in hospital settings are likely to prolong the length of stay of patients in nearly 6.3 days, leading to increased hospitalization costs. The causes of fall incidents in healthcare facilities are multifactorial in nature and certain medications use could be associated with these incidents. This review seeks to critically evaluate the available literature regarding the relationship between inpatient falls and medication use. A comprehensive search was performed on MEDLINE, EMBASE and Lilacs with no time restriction. The search was filtered using English, Spanish or Portuguese languages. Our study evaluated medication use and inpatients falls that effectively happen, considering all ages and populations. An assessment of bias and quality of the studies was carried out using an adapted tool from the literature. The drugs were classified according to the Anatomic Therapeutics Chemical Code. The search strategy retrieved 563 records, among which 23 met the eligibility criteria; ninety three different pharmacological subgroups were associated with fall incidents. Our critical review suggests that the use of central nervous system drugs (including anxiolytics; hypnotics and sedatives; antipsychotics; opioids; antiepileptics and antidepressants) has a greater likelihood of causing inpatient falls. A weak relationship was found between other pharmacological subgroups, such as diuretics, cardiovascular system-related medications, and inpatient fall. Remarkably, several problems of quality were encountered with regard to the eligible studies. Among such quality problems included retrospective design, the grouping of more than one medication in the same statistical analysis, limited external validity, problems related to medication classifications and description of potential confounders.

Resumo A varfarina é o anticoagulante oral mais prescrito. Novos anticoagulantes orais foram recentemente aprovados; porém, o uso é restrito e as técnicas de reversibilidade do efeito anticoagulante ainda são pouco conhecidas. Assim, este estudo propõe o desenvolvimento de um algoritmo para o monitoramento terapêutico de pacientes em uso de varfarina, com base na opinião de médicos que utilizam esse fármaco na prática clínica. O desenvolvimento do algoritmo foi realizado em dois estágios: (i) revisão da literatura e (ii) avaliação do algoritmo por médicos, segundo o método Delphi. Com base na análise dos artigos, dois algoritmos foram desenvolvidos: “Recomendações para o uso de varfarina na terapia anticoagulante” e “Recomendações para o uso de varfarina na terapia anticoagulante: ajuste de dose e controle de sangramento”. Posteriormente, os algoritmos foram analisados por 19 médicos que responderam ao convite e aceitaram participar da pesquisa. Desses, 16 responderam a primeira rodada, 11, a segunda e oito, a terceira. Houve um consenso de 70% ou mais na maioria das questões e 50% para seis questões. Assim, foi possível desenvolver algoritmos para o monitoramento do uso de varfarina por médicos, utilizando o método Delphi. O método proposto é de baixo custo e envolve a participação de médicos especialistas, revelando-se adequado para o fim pretendido. Mais estudos são necessários para validar esses algoritmos, permitindo que eles sejam usados na prática clínica.

Summary Warfarin stands as the most prescribed oral anticoagulant. New oral anticoagulants have been approved recently; however, their use is limited and the reversibility techniques of the anticoagulation effect are little known. Thus, our study’s purpose was to develop algorithms for therapeutic monitoring of patients taking warfarin based on the opinion of physicians who prescribe this medicine in their clinical practice. The development of the algorithm was performed in two stages, namely: (i) literature review and (ii) algorithm evaluation by physicians using a Delphi Method. Based on the articles analyzed, two algorithms were developed: “Recommendations for the use of warfarin in anticoagulation therapy” and “Recommendations for the use of warfarin in anticoagulation therapy: dose adjustment and bleeding control.” Later, these algorithms were analyzed by 19 medical doctors that responded to the invitation and agreed to participate in the study. Of these, 16 responded to the first round, 11 to the second and eight to the third round. A 70% consensus or higher was reached for most issues and at least 50% for six questions. We were able to develop algorithms to monitor the use of warfarin by physicians using a Delphi Method. The proposed method is inexpensive and involves the participation of specialists, and it has proved adequate for the intended purpose. Further studies are needed to validate these algorithms, enabling them to be used in clinical practice.