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ABSTRACT BACKGROUND: Use of inhaled corticosteroids for managing acute asthma exacerbations has been tested since the 1990s. OBJECTIVE: To compare high doses of inhaled ciclesonide with systemic hydrocortisone for managing acute asthma exacerbations in the emergency department. DESIGN AND SETTING: Double-blind, randomized clinical trial in the public healthcare system of the city of São Paulo. METHODS: Fifty-eight patients with moderate or severe asthma with peak flow < 50% of predicted were randomized into two groups. Over the course of four hours, one group received 1440 mcg of inhaled ciclesonide plus hydrocortisone-identical placebo (ciclesonide + placebo), while the other received 500 mg of intravenous hydrocortisone plus ciclesonide-identical placebo (hydrocortisone + placebo). Both groups received short-acting bronchodilators (fenoterol hydrobromide and ipratropium bromide). The research protocol included spirometry, clinical evaluation, vital signs and electrocardiogram monitoring. Data were obtained at 30 (baseline), 60, 90, 120, 180, and 240 minutes. We compared data from baseline to hour 4, between and within groups. RESULTS: Overall, 31 patients received ciclesonide + placebo and 27 received hydrocortisone + placebo. Inhaled ciclesonide was as effective as intravenous hydrocortisone for improving clinical parameters (Borg-scored dyspnea, P = 0.95; sternocleidomastoid muscle use, P = 0.55; wheezing, P = 0.55; respiratory effort, P = 0.95); and spirometric parameters (forced vital capacity, P = 0.50; forced expiratory volume in the first second, P = 0.83; peak expiratory flow, P = 0.51). CONCLUSIONS: Inhaled ciclesonide was not inferior to systemic hydrocortisone for managing acute asthma exacerbations, and it improved both clinical and spirometric parameters. TRIAL REGISTRATION: RBR-6XWC26 - Registro Brasileiro de Ensaios Clínicos (http://www.ensaiosclinicos.gov.br/rg/RBR-6xwc26/).

https://doi.org/10.1590/1516-3180.2021.0542.r1.15092021

Analysis on mental-insanity and cessation-of-dangerousness examinations in three Brazilian custodial institutions: a retrospective cross-sectional study
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Marchewka, Tania Maria Nava

; Atallah, Alvaro Nagib

; Valente, Nathalia Marchewka

; Melnik, Tamara

Sao Paulo Medical Journal

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Dic 2021, Volumen 139 Nº 6 Paginas 624 - 634

Resumen: En | Texto: En | PDF: En

ABSTRACT BACKGROUND: In Brazil, the right to healthcare and the incorporation of best scientific evidence in public health are universally guaranteed by law. However, the treatment offered to patients with mental disorders in custodial hospitals in this country has not been rigorously evaluated. OBJECTIVES: To analyze the psychiatric diagnoses and treatments implemented in three Brazilian custodial institutions. DESIGN AND SETTING: This was a retrospective, cross-sectional and descriptive study on patients held in custody in three Brazilian institutions, as judicially-determined safety measures due to their mental disorders, and the tools used in diagnoses and treatments. These institutions are in Rio de Janeiro and the Federal District. METHODS: The data from medical and judicial records that were made available were assessed regarding the diagnoses that were made and the instruments that were used. RESULTS: None of these inpatients were evaluated using validated tools, and only a few medical records presented clear descriptions of the cases. No patient with substance involvement had undergone laboratory toxicological assays. It was not possible to verify the adequacy of treatments because the procedures were inadequately described in the records. CONCLUSIONS: No standardized protocols or instruments for diagnosing mental health disorders or assessing use of psychoactive substances had been applied among the inpatients at these custodial institutions in Rio de Janeiro and the Federal District. The treatments that were prescribed to these inpatients consisted mainly of drugs.

https://doi.org/10.1590/1516-3180.2020.0450.r1.22042021

[SciELO Preprints] - Intervention with ivermectin for of COVID-19: synopsis of evidence
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Person, Osmar Clayton Puga, Maria Eduarda dos Santos Atallah, Alvaro Nagib Amaral, José Luiz Gomes do

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Fecha de publicación: 2021-03-01

Resumen: En Pt

Context: COVID-19 is a viral disease that has recently emerged and is associated with severe respiratory distress syndrome (SARS). Its potential for severity and impact on the health of the population and the global economy is a prime object in the search for effective therapy and ivermectin has been recommended for prevention and treatment. Objective: To evaluate the evidence in the literature regarding the use of ivermectin for the prevention and treatment of cases of COVID-19. Study design: This is a synopsis of evidence. Methods: We searched the electronic databases PubMed (1966-2021), EMBASE (1974-2021) and Clinical Trials (2021) and two evidence megabusers: Turning Research Into Practice (TRIP) database (2021) and Epstemonikos (2021). There was no geographic or language restriction, using DeCS descriptors and terms (Health Sciences Descriptors). The synthesis method involved the combination of similar studies in a narrative review. Results: 527 citations were identified and 5 studies were included. There are few completed clinical trials, all of which have a small sample size. Discussion: Most of the studies available in the literature are based on in vitro therapeutic responses and the recommendation for use in humans has been based on the findings of these studies. The question cannot be answered with current studies, and quality clinical trials are recommended. Conclusions: There is currently no support in the literature for the use of ivermectin in the prevention or treatment of COVID-19.

Contexto: A COVID-19 é uma doença viral que surgiu recentemente e associada à síndrome da angústia respiratória severa (SARS). Seu potencial de gravidade e impacto na saúde da população e economia global é objeto primordial na busca por uma terapêutica eficaz ea ivermectina tem sido recomendada para prevenção e tratamento da COVID-19. Objetivo: avaliar como evidências na literatura relativa ao uso de ivermectina para prevenção e tratamento de casos de COVID-19. Desenho de estudo: Trata-se de sinopse de evidências. Métodos:Procedeu-se à busca de bases eletrônicas de dados PubMed (1966-2021), EMBASE (1974-2021) e Clinical Trials (2021) e em dois megabuscadores de evidências: Turning Research Into Practice (TRIP) database (2021) e Epstemonikos ( 2021). Não houve restrição geográfica e de idioma, sendo utilizados descritores e termos do DeCS (Descritores em Ciências da Saúde). O método de síntese envolveu uma combinação de estudos semelhantes em uma revisão narrativa. Resultados: Foram identificados 527 citações e 5 estudos foram incluídos. Há poucos ensaios clínicos concluídos todos apresentam pequena. Discussão: A maioria dos estudos disponíveis na literatura respalda-se em respostas terapêuticas in vitroea recomendação para uso em humanos tem-se baseado nos achados desses estudos. A questão não pode ser respondida com os estudos atuais, sendo recomendada a realização de ensaios de qualidade. Conclusões: Não há suporte atualmente na literatura para uso da ivermectina na prevenção ou tratamento COVID-19.

https://doi.org/10.1590/SciELOPreprints.1871

SARS-CoV-2 and arbovirus infection: a rapid systematic review
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Milby, Keilla Martins

; Atallah, Alvaro Nagib

; Rocha-Filho, César Ramos

; Pinto, Ana Carolina Pereira Nunes

; Rocha, Aline Pereira da

; Reis, Felipe Sebastião de Assis

; Carvas Junior, Nelson

; Civile, Vinicius Tassoni

; Santos, Rodolfo Rodrigo Pereira

; Ferla, Laura Jantsch

; Trevisani, Giulia Fernandes Moça

; Ramalho, Gabriel Sodré

; Puga, Maria Eduarda dos Santos

; Trevisani, Virgínia Fernandes Moça

Sao Paulo Medical Journal

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Dic 2020, Volumen 138 Nº 6 Paginas 498 - 504

Resumen: En | Texto: En | PDF: En

ABSTRACT BACKGROUND: The numbers of cases of arboviral diseases have increased in tropical and subtropical regions while the coronavirus disease (COVID-19) pandemic overwhelms healthcare systems worldwide. The clinical manifestations of arboviral diseases, especially dengue fever, can be very similar to COVID-19, and misdiagnoses are still a reality. In the meantime, outcomes for patients and healthcare systems in situations of possible syndemic have not yet been clarified. OBJECTIVE: We set out to conduct a systematic review to understand and summarize the evidence relating to clinical manifestations, disease severity and prognoses among patients coinfected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and arboviruses. METHODS: We conducted a rapid systematic review with meta-analysis, on prospective and retrospective cohorts, case-control studies and case series of patients with confirmed diagnoses of SARS-CoV-2 and arboviral infection. We followed the Cochrane Handbook recommendations. We searched EMBASE, MEDLINE, Cochrane Library, LILACS, Scopus and Web of Science to identify published, ongoing and unpublished studies. We planned to extract data and assess the risk of bias and the certainty of evidence of the studies included, using the Quality in Prognosis Studies tool and the Grading of Recommendations Assessment. RESULTS: We were able to retrieve 2,407 citations using the search strategy, but none of the studies fulfilled the inclusion criteria. CONCLUSION: The clinical presentations, disease severity and prognoses of patients coinfected with SARS-CoV-2 and arboviruses remain unclear. Further prospective studies are necessary in order to provide useful information for clinical decision-making processes. Protocol registration number in the PROSPERO database: CRD42020183460

https://doi.org/10.1590/1516-3180.2020.0422.08092020 1325 descargas

[SciELO Preprints] - Evidence from Cochrane systematic reviews for the dissemination control of the COVID-19 infection
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Flumignan, Ronald Nakano, Luis Pascoal, Patricia Santos, Brena Correia, Rebeca Silveira, Beatriz Takihi, Fabio Flumignan, Carolina Amorim, Jorge Atallah, Alvaro

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Fecha de publicación: 2020-06-04

Resumen: En

Introduction: The COVID-19 infection has high transmissibility and several measures have been adopted for dissemination control. Objective: To identify and summarize the evidence from the Cochrane systematic reviews (SR) on measures to control the dissemination of the COVID-19 infection. Study design: This review of Cochrane SR has carried out in the Division of Vascular and Endovascular Surgery and in the Division of Emergency Medicine and Evidence-Based Medicine of the Universidade Federal de São Paulo, Brazil. Methods: A comprehensive search in the Cochrane Database of Systematic Reviews retrieved all Cochrane SR directly related to control measures for the COVID-19 dissemination. The main characteristics and results of all included SR were summarized and discussed. Results: Three Cochrane SRs were included in the qualitative synthesis and they evaluated populational and individual measures to control the dissemination of COVID-19. Conclusion: Low-certainty evidence show that quarantine of people exposed to those confirmed or suspected COVID-19 cases prevented 44% - 81% of incident cases and 31% - 63% of deaths compared to no measures and as sooner the quarantine measures are implemented, greater costs are saved. High-confidence evidence showed that clear communication about infection control and prevention guidelines was vital to its implementation. Low-certainty evidence showed that people with a long gown had less contamination than those with a coverall, and the coverall was more difficult to doff. Other SRs are desirable for controlling the dissemination of the COVID-19 infection.

https://doi.org/10.1590/SciELOPreprints.709

[SciELO Preprints] - SARS-COV-2 AND ARBOVIRUS INFECTIONS: PROTOCOL FOR A RAPID LIVING SYSTEMATIC REVIEW
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Milby, Keilla Martins Atallah, Alvaro Nagib Rocha-Filho, César Ramos Pinto, Ana Carolina Pereira Nunes Rocha, Aline Pereira da Reis, Felipe Sebastião de Assis Carvas Junior, Nelson Civile, Vinicius Tassoni Santos, Rodolfo Rodrigo Pereira Ferla, Laura Jantsch Trevisani, Giulia Fernandes Moça Ramalho, Gabriel Sodré Trevisani, Virgínia Fernandes Moça

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Fecha de publicación: 2020-05-09

Resumen: En

Context and objective: While cases of COVID-19 disease increase daily worldwide, outbreaks of arboviral infections have affected health systems of countries in tropical regions. The outcomes for patients and health systems of a possible syndemic are not clarified yet. Thus, we aim to systematically review the literature searching for evidence that describes the clinical presentation, severity and prognostic of SARS-CoV-2 and Arboviral coinfection. Design and setting: Protocol for a rapid living systematic review, that will follow the Cochrane Handbook for Systematic Reviews recommendations. We will include prospective and retrospective cohort, case-control studies and case series of patients with confirmed diagnosis of SARS-CoV-2 and Arboviral infection. We will perform the search strategy with no language restrictions on Medline via PubMed, Embase via Elsevier, Cochrane Library - Cochrane Central Register of Controlled Trials (CENTRAL), Portal Regional BVS - LILACS, Scopus and WebOfScience to identify published, ongoing, and unpublished studies. The selection and extraction will be performed by two authors. We will perform the critical appraisal of included studies with the Newcastle-Ottawa Scale and the certainty of evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE).    

https://doi.org/10.1590/SciELOPreprints.346

[SciELO Preprints] - Telehealth interventions in the context of the COVID-19 pandemic: Protocol for a scoping review
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Puga, Maria Eduarda dos Santos Reis, Felipe Sebastião de Assis Milby, Keilla Martins Pinto, Ana Carolina Pereira Nunes Rocha-Filho, César Ramos Rocha, Aline Pereira da Carvas Junior, Nelson Civile, Vinicius Tassoni Santos, Rodolfo Rodrigo Pereira Ramalho, Gabriel Sodré Trevisani, Giulia Fernandes Moça Ferla, Laura Jantsch Puga, Maria Eduarda dos Santos Atallah, Alvaro Nagib Trevisani, Virgínia Fernandes Moça

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Fecha de publicación: 2020-05-06

Resumen: En

CONTEXT AND OBJECTIVE: The current health crisis due to COVID-19 is forcing us to profoundly rethink our social organizations and practices in health. While there is no effective treatment for the virus, staying home and social isolation are the control measures recommended by health authorities. The aim of this study is to perform a scoping review in order to summarize the current evidence in telehealth for COVID-19. METHODS: This study is a protocol to describe the rationale, hypothesis and planned methods of our scoping review. We will include randomized controlled trials (RCTs), observational cohort studies, case-control studies, cross-sectional studies, qualitative studies, and/or case series that describe telehealth interventions applied or developed to respond to COVID-19. We will search Medline via PubMed, Embase via Elsevier, Cochrane Library - Cochrane Central Register of Controlled Trials (CENTRAL), Portal Regional BVS - LILACS, and Scopus. We will include studies performed since December 2019 with no language restrictions. We will use the Risk of Bias tool and the Newcastle-Ottawa Scale to perform the critical appraisal of included studies. We will assess the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE).

https://doi.org/10.1590/SciELOPreprints.353

[SciELO Preprints] - Pharmacological interventions for COVID-19: Protocol for a Rapid Living Systematic Review with network meta-analysis
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Puga, Maria Eduarda dos Santos Pinto, Ana Carolina Pereira Nunes Rocha, Aline Pereira da Milby, Keilla Martins Rocha-Filho, César Ramos Reis, Felipe Sebastião de Assis Carvas Junior, Nelson Civile, Vinicius Tassoni Santos, Rodolfo Rodrigo Pereira Trevisani, Giulia Fernandes Moça Ferla, Laura Jantsch Ramalho, Gabriel Sodré Puga, Maria Eduarda dos Santos Trevisani, Virgínia Fernandes Moça Atallah, Alvaro Nagib

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Fecha de publicación: 2020-05-06

Resumen: En

CONTEXT AND OBJECTIVE: Coronavirus disease 2019 (COVID-19) has emerged in China in December 2019 and rapidly spread. Although extraordinary efforts have been made on research regarding pharmacological interventions, none have proven effective. This is the protocol for a rapid living systematic review that aims to compare the effectiveness and safety of different pharmacological interventions for the treatment of COVID-19. METHODS: rapid living systematic review methodology with Network Meta-Analysis following the recommendations of Cochrane Handbook. We will include randomized controlled trials (RCT) and quasi-RCTs that evaluate single and/or combined pharmacological interventions at any dose for the treatment of COVID-19. We will search Medline via PubMed, Embase via Elsevier, Cochrane Library - Cochrane Central Register of Controlled Trials (CENTRAL), Portal Regional BVS - LILACS, Scopus and WebofScience to identify potentially eligible studies. No language restrictions will be used in the selection. We will perform the critical appraisal of included studies with the Risk of Bias tool and the certainty of evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE).

https://doi.org/10.1590/SciELOPreprints.348

[SciELO Preprints] - PROGNOSTIC FACTORS FOR CLINICAL COURSE OF PATIENTS WITH COVID-19: PROTOCOL FOR A RAPID LIVING SYSTEMATIC REVIEW
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Puga, Maria Eduarda dos Santos Rocha-Filho, César Ramos Pinto, Ana Carolina Pereira Nunes Rocha, Aline Pereira da Milby, Keilla Martins Reis, Felipe Sebastião de Assis Civile, Vinicius Tassoni Carvas Junior, Nelson Santos, Rodolfo Rodrigo Pereira Ramalho, Gabriel Sodré Trevisani, Giulia Fernandes Moça Ferla, Laura Jantsch Puga, Maria Eduarda dos Santos Trevisani, Virgínia Fernandes Moça Atallah, Alvaro Nagib

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Fecha de publicación: 2020-05-06

Resumen: En

CONTEXT AND OBJECTIVE: Determining prognostic factors in a context of health crises such as the COVID-19 scenario may provide the best possible care for patients and optimize the management and the resource utilization of the health system. Thus, we aim to systematically review the prognostic factors for different outcomes of patients with COVID-19. DESIGN AND SETTING: Protocol for a rapid living systematic review methodology following the recommendations proposed by the Cochrane Handbook. METHODS: We will include cohorts and case‐control studies. We will search Medline via PubMed, Embase via Elsevier, Cochrane Library - Cochrane Central Register of Controlled Trials (CENTRAL), Portal Regional BVS- LILACS, Scopus and WebofScience to identify studies. No language restrictions will be applied. We will perform the critical appraisal of included studies with the Quality in Prognosis Studies (QUIPS) tool and the certainty of evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE).

https://doi.org/10.1590/SciELOPreprints.351

10.

[SciELO Preprints] - COVID-19 AND PATIENTS UNDERGOING PHARMACOLOGICAL TREATMENTS FOR IMMUNE-MEDIATED INFLAMMATORY DISEASES: PROTOCOL FOR A RAPID LIVING SYSTEMATIC REVIEW
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Puga, Maria Eduarda dos Santos Rocha, Aline Pereira da Atallah, Alvaro Nagib Pinto, Ana Carolina Pereira Nunes Rocha-Filho, César Ramos Reis, Felipe Sebastião de Assis Milby, Keilla Martins Civile, Vinicius Tassoni Carvas Junior, Nelson Santos, Rodolfo Rodrigo Pereira Ferla, Laura Jantsch Trevisani, Giulia Fernandes Moça Ramalho, Gabriel Sodré Puga, Maria Eduarda dos Santos Trevisani, Virgínia Fernandes Moça

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Fecha de publicación: 2020-05-06

Resumen: En

CONTEXT AND OBJECTIVE: We propose to systematically review the available evidence to evaluate if patients with immune mediated or inflammatory diseases under pharmacological treatment with immunosuppressants, immunobiologics, DMARDs or targeted synthetic DMARDs have better or worse outcomes when infected by SARS-CoV-2. This study is a protocol for our rapid living systematic review. METHODS: Protocol for a rapid living systematic review methodology following the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) guidance. To conduct the rapid systematic review, we will employ abbreviated systematic review methods, including: not performing independent screens of abstracts and not searching grey literature. As this will be a living review, it will be continuously updated.

https://doi.org/10.1590/SciELOPreprints.349

11.

What do Cochrane systematic reviews say about new practices on integrative medicine?
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Riera, Rachel

; Braga, Vinícius Lopes

; Rocha, Luana Pompeu dos Santos

; Bernardo, Daniel Damasceno

; Andrade, Luísa Avelar Fernandes de

; Hsu, Jessica Chiu

; Silva, Luciana Di Giovanni Marques da

; Suetsugu, Rodrigo Cesar de Sá

; Dittrich, Nicole Hosni

; Lima, Lucas Riguete Pereira de

; Silveira, Vicente Penido da

; Kruglensky, Barbara Caon

; Leonel, Letícia de Freitas

; Barros, Edivando de Moura

; Costa, Anderson Adriano Leal Freitas da

; Quintella, Miguel Lins

; Pacheco, Rafael Leite

; Cruz, Carolina de Oliveira

; Martimbianco, Ana Luiza Cabrera

; Pachito, Daniela Vianna

; Mozetic, Vania

; Teixeira, Tatiana de Bruyn Ferraz

; Torloni, Maria Regina

; Atallah, Alvaro Nagib

Sao Paulo Medical Journal

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May 2018, Volumen 136 Nº 3 Paginas 251 - 261

Resumen: En | Texto: En | PDF: En

ABSTRACT BACKGROUND: This study identified and summarized all Cochrane systematic reviews (SRs) on the effects of ten integrative practices that were recently added to the Brazilian public healthcare system (SUS). DESIGN AND SETTING: Review of systematic reviews, conducted in the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (Unifesp). METHODS: Review of Cochrane SRs on the following interventions were identified, summarized and critically assessed: apitherapy, aromatherapy, bioenergetics, family constellation, flower therapy, chromotherapy, geotherapy, hypnotherapy, hand imposition or ozone therapy. RESULTS: We included a total of 16 SRs: 4 on apitherapy, 4 on aromatherapy, 6 on hypnotherapy and 2 on ozone therapy. No Cochrane SR was found regarding bioenergetics, family constellation, chromotherapy, clay therapy, flower therapy or hand imposition. The only high-quality evidence was in relation to the potential benefit of apitherapy, specifically regarding some benefits from honey dressings for partial healing of burn wounds, for reduction of coughing among children with acute coughs and for preventing allergic reactions to insect stings. CONCLUSION: Except for some specific uses of apitherapy (honey for burn wounds and for acute coughs and bee venom for allergic reactions to insect stings), the use of ten integrative practices that have recently been incorporated into SUS does not seem to be supported by evidence from Cochrane SRs.

https://doi.org/10.1590/1516-3180.2018.0172170418 2326 descargas

12.

Validity of Qualis database as a predictor of evidence hierarchy and risk of bias in randomized controlled trials: a case study in dentistry
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Ferreira, Christiane Alves

; Loureiro, Carlos Alfredo Salles

; Saconato, Humberto

; Atallah, Alvaro

Clinics

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2011, Volumen 66 Nº 2 Paginas 337 - 342

Resumen: En | Texto: En | PDF: En

OBJECTIVE: To evaluate the validity of the Qualis database in identifying the levels of scientific evidence and the quality of randomized controlled trials indexed in the Lilacs database. METHODS: We selected 40 open-access journals and performed a page-by-page hand search, to identify published articles according to the type of study during a period of six years. Classification of studies was performed by independent reviewers assessed for their reliability. Randomized controlled trials were identified for separate evaluation of risk of bias using four dimensions: generation of allocation sequence, allocation concealment, blinding, and incomplete outcome data. The Qualis classification was considered to be the outcome variable. The statistical tests used included Kappa, Spearman's correlation, Kendall-tau and ordinal regressions. RESULTS: Studies with low levels of scientific evidence received similar Qualis classifications when compared to studies with high levels of evidence. In addition, randomized controlled trials with a high risk of bias for the generation of allocation sequences and allocation concealment were more likely to be published in journals with higher Qualis levels. DISCUSSION: The hierarchy level of the scientific evidence as classified by type of research design, as well as by the validity of studies according to the bias control level, was not correlated or associated with Qualis stratification. CONCLUSION: Qualis classifications for journals are not an approximate or indirect predictor of the validity of randomized controlled trials published in these journals and are therefore not a legitimate or appropriate indicator of the validity of randomized controlled trials.

https://doi.org/10.1590/S1807-59322011000200025 2404 descargas Citado 4 veces en SciELO

13.

Efeito da implementação de diretriz para profilaxia de tromboembolismo venoso em pacientes cirúrgicos
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Maffei, Francisco Humberto de Abreu

; Sato, Ana Claudia

; Torggler Filho, Francisco

; Silva, Sandra Cristina da

; Atallah, Alvaro

Revista da Associação Médica Brasileira

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2009, Volumen 55 Nº 5 Paginas 587 - 592

Resumen: Pt En | Texto: Pt En | PDF: Pt | PDF: En

INTRODUÇÃO: Estratégias efetivas para profilaxia do tromboembolismo venoso (TEV) são amplamente disponíveis, mas são ainda subutilizadas, principalmente no nosso meio. OBJETIVO: Avaliar o efeito da implementação de diretriz para profilaxia do TEV, em pacientes cirúrgicos, sobre a conduta da equipe de saúde na prescrição dessa profilaxia. Método. Estudo retrospectivo pré-intervenção - pós-intervenção. Prontuários de 150 pacientes antes e 150 depois da implementação de uma diretriz para a profilaxia (AID e DID) foram sorteados dentre pacientes de mais de 40 anos internados para cirurgia maior abdominal ou ortopédica. Foram registrados dados demográficos, referência a risco de TEV no prontuário, prescrição de profilaxia para TEV e diagnóstico de TEV durante a internação. RESULTADOS: Não houve diferença entre os dois grupos, AID e DID, quanto aos dados demográficos e ao tempo de profilaxia (5,6 x 6,6 dias). A frequência de profilaxia AID x DID antes da cirurgia foi: profilaxia farmacológica (PF), 6% x 9%; meias de compressão graduada (MCG), 4% x 3%; compressão pneumática intermitente (CPI), 2% x 3%. Após cirurgia: PF 53% x 53%; MCG, 23% x 40% (P<0,05); CPI, 26% x 32% . No total, AP, foi prescrita profilaxia para 60,5% dos pacientes AID e para 66,5% DID, mas a profilaxia foi considerada adequada em 34% dos pacientes AID e em 32% DID. Conclusão. A adoção do protocolo, embora com maior a preocupação com a profilaxia, traduzida pelo aumento na prescrição de MCG, melhorou minimamente sua qualidade, indicando a necessidade de outras intervenções ativas e contínuas para aumentar a aderência ao mesmo.

INTRODUCTION: Effective strategies for prevention of venous thromboembolism (VTE) are widely available, but still remain underused, mainly in our country. OBJECTIVE: Our aim was to verify whether the implementation of a guideline for VTE prophylaxis for surgical patients influenced the prescription of prophylaxis by the medical staff. METHODS: This was a retrospective preintervention-postintervention study. Charts of 150 patients before guideline implementation (BGI) and 150 after (AGI) were randomized among all patients admitted during one year in each period. Inclusion criteria: >40 years-old, major abdominal or orthopedic surgeries. Exclusion criteria: Incomplete files and use of anticoagulants for any reason at admission. Data registered: demographic data, reference to VTE risk factors, VTE prophylaxis prescription, diagnosis of deep venous thrombosis or pulmonary embolism during hospitalization. Results. The two groups, BGI and AGI were similar for demographic data and duration of prophylaxis (5.6 x 6.6 days). Frequency of prophylaxis in percentages was BGI x AGI respectively, before surgery: pharmacologic prophylaxis (PP), 6 x 9; graduated compression stockings (GCS), 4 x 3; intermittent pneumatic compression (IPC), 2 x 3. After surgery: PP, 53 x 53; GCS, 23 x 40 (P<0.05); IPC, 26 x 32. Including all patients, prophylaxis was prescribed for 60.5% BGI and 66.5% AGI, but was considered adequate only in 34% BGI and 32% AGI. CONCLUSION: Adoption of a guideline, although increasing concern about prophylaxis, expressed by greater use of GCS, only minimally improved quality of prophylaxis , indicating that other active and continuous interventions are necessary to enforce compliance.

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14.

Risk of drug interaction: combination of antidepressants and other drugs
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Miyasaka, Lincoln Sakiara

; Atallah, Alvaro Nagib

Revista de Saúde Pública

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Abr 2003, Volumen 37 Nº 2 Paginas 212 - 215

Resumen: Pt En | Texto: Pt En | PDF: Pt | PDF: En

OBJETIVO: Verificar a freqüência de combinações de antidepressivos com outros medicamentos e o risco de interações medicamentosas em um hospital público no Brasil. MÉTODOS: Prescrições de todos os pacientes internados em um hospital público, em São Paulo, SP, de novembro de 1996 a fevereiro de 1997 foram analisadas pelo centro de processamento de dados do hospital. Foi realizada busca manual de todos os prontuários de pacientes internados na enfermaria de psiquiatria do hospital de janeiro de 1993 a dezembro de 1995, assim como de todos os pacientes registrados no ambulatório de doenças afetivas em dezembro de 1996. Foram identificados os pacientes que usaram algum antidepressivo e as drogas utilizadas concomitantemente. Foram identificadas pelo programa Micromedex® as interações medicamentosas. RESULTADOS: Dentre os 6.844 pacientes internados nas enfermarias gerais (não psiquiátricas) do hospital, 63 usaram antidepressivos (0,9%) e 16 (25,3%) usavam medicações com risco de interação. Dentre os 311 pacientes da enfermaria de psiquiatria, 63 (20,2%) usavam antidepressivos e 13 (20,6%) apresentavam risco de interação. Dos 87 pacientes do ambulatório de doenças afetivas, 43 (49,4%) usavam antidepressivos e 7 (16,2%) apresentavam risco. Em geral, o uso de antidepressivos foi encontrado em 169 pacientes e 36 (21,3%) estavam em risco de interação medicamentosa. Vinte diferentes tipos de interações foram identificados, sendo 4 leves, 15 moderados e um grave. CONCLUSÕES: Nas enfermarias gerais o número de interações medicamentosas foi superior em relação à enfermaria de psiquiatria; e o número de prescrições de antidepressivos foi menor do que o esperado.

OBJECTIVE: To assess the frequency of combination of antidepressants with other drugs and risk of drug interactions in the setting public hospital units in Brazil. METHODS: Prescriptions of all patients admitted to a public hospital from November 1996 to February 1997 were surveyed from the hospital's data processing center in São Paulo, Brazil. A manual search of case notes of all patients admitted to the psychiatric unit from January 1993 to December 1995 and all patients registered in the affective disorders outpatient clinic in December 1996 was carried out. Patients taking any antidepressant were identified and concomitant use of drugs was checked. By means of a software program (Micromedex®) drug interactions were identified. RESULTS: Out of 6,844 patients admitted to the hospital, 63 (0.9%) used antidepressants and 16 (25.3%) were at risk of drug interaction. Out of 311 patients in the psychiatric unit, 63 (20.2%) used antidepressants and 13 of them (20.6%) were at risk. Out of 87 patients in the affective disorders outpatient clinic, 43 (49.4%) took antidepressants and 7 (16.2%) were at risk. In general, the use of antidepressants was recorded in 169 patients and 36 (21.3%) were at risk of drug interactions. Twenty different forms of combinations at risk of drug interactions were identified: four were classified as mild, 15 moderate and one severe interaction. CONCLUSION: In the hospital general units the number of drug interactions per patient was higher than in the psychiatric unit; and prescription for depression was lower than expected.

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15.

Risk of drug interaction: combination of antidepressants and other drugs
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- SciELO Analytics

Miyasaka, Lincoln Sakiara

; Atallah, Alvaro Nagib

Revista de Saúde Pública

Métricas del periódico
- Sobre o periódico
- SciELO Analytics

Abr 2003, Volumen 37 Nº 2 Paginas 212 - 215

Resumen: Pt En | Texto: Pt En | PDF: Pt | PDF: En

1573 descargas Citado 4 veces en SciELO

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