Assessment of pharmacotherapeutic safety of medical prescriptions for elderly residents in a long-term care facility

The present study aimed to estimate the prevalence of elderly using potentially inappropriate medications (PIM) and with occurrence of potentially hazardous drug interactions (PHDI), to identify the risk factors for the prescription of PIM and to evaluate the impact of pharmaceutical intervention (PI) for the prescription of safer therapeutic alternatives. Therefore, a cross-sectional study was performed in a long-term care facility in São Paulo State, between December/2010 and January/2011. The medical records of the patients >= 60 years old who took any drugs were consulted to assess the pharmacotherapeutic safety of the medical prescriptions, in order to identify PIM and PHDI, according to the Beers (2003) and World Health Organization criteria, respectively. PI consisted of a guidance letter to the physician responsible for the institution, with the suggestions of safer equivalent therapeutics. Approximately 88% of the elderly took at least one drug, and for 30% of them the PIM had been prescribed. Most of the PIM identified (53.4%) act on the central nervous system. Among the 13 different DI detected, 6 are considered PHDI. Polypharmacy was detected as a risk factor for PIM prescription. After the PI there was no change in medical prescriptions of patients who had been prescribed PIM or PHDI. The data suggests that PI performed by letter, as the only interventional, method was ineffective. To contribute it a wide dissemination of PIM and PHDI among prescriber professionals is necessary for the selection of safer treatment for elderly. Additionally, a pharmacist should be part of the health care team in order to help promote rational use of medicines.

Systematic review of randomized controlled trials of new anticoagulants for venous thromboembolism prophylaxis in major orthopedic surgeries, compared with enoxaparin

Background: In the past 10 years, new anticoagulants (NACs) have been studied for venous thromboembolism (VTE) prophylaxis. Objective: To evaluate the risk/benefit profile of NACs versus enoxaparin for VTE prophylaxis in major orthopedic surgery. Methods: A systematic review of double-blind randomized phase III studies was performed. The search strategy was run from 2000 to 2011 in the main medical electronic databases in any language. Independent extraction of articles was performed by 2 authors using predefined data fields, including study quality indicators. Results: Fifteen published clinical trials evaluating fondaparinux, rivaroxaban, dabigatran, and apixaban were included. Primary efficacy (any deep vein thrombosis [DVT], nonfatal pulmonary embolism, or all-cause mortality) favored fondaparinux (relative risk [RR] 0.50; 95% CI, 0.39, 0.63) and rivaroxaban (RR, 0.50; 95% CI, 0.34, 0.73) over enoxaparin, although significant heterogeneity was observed in both series. The primary efficacy of dabigatran at 220 mg, apixaban, and bemiparin were similar, with RRs of 1.02 (95% CI, 0.86, 1.20), 0.63 (95% CI, 0.39, 1.01), and 0.87 (95% CI, 0.65, 1.17), respectively. The primary efficacy of dabigatran at 150 mg (RR, 1.20; 95% CI, 1.03, 1.41), was inferior to enoxaparin. The incidence of proximal DVT favored apixaban (RR, 0.45; 95% CI, 0.27, 0.75) only. Rivaroxaban (RR, 0.45; 95% CI, 0.27, 0,77) and apixaban (RR, 0.38; 95% CI, 0.16, 0.90) produced significantly lower frequencies of symptomatic DVT. The incidence of major VTE favored rivaroxaban (RR, 0.44; 95% CI, 0.25, 0.81), only. Bleeding risk was similar for all NACs, except fondaparinux (RR, 1.27; 95% CI, 1.04, 1.55), which exhibited a significantly higher any-bleeding risk compared with enoxaparin, and apixaban (RR, 0.88; 95% CI, 0.79, 0.99), which was associated with a reduced risk of any bleeding. Alanine amino transferase was significantly lower with 220 mg of dabigatran, (RR, 0.67; 95% CI, 0.79, 0.99) than with enoxaparin. Conclusions: NACs can be considered alternatives to conventional thromboprophylaxis regimens in patients undergoing elective major orthopedic surgery, depending on clinical characteristics and cost-effectiveness. The knowledge of some differences concerning efficacy or safety profile, pointed out in this systematic review, along with the respective limitations, may be useful in clinical practice. © 2013 Elsevier Inc. All rights reserved.

As ticas de matema de cegos sob o viés institucional: da integração à inclusão

Pós-graduação em Educação Matemática - IGCE

A time series sequestration and storage model of atmospheric carbon dioxide

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Formação de professores: as diretrizes nacionais e o poder local

Coming as a result from a comprehensive research based on Lima’s studies (2008), this article is intended for investigating the process of reorganization of the Pedagogy course offered by a state public university since 2006, when the new National Curricular Guides were instituted. The subject matter brings up as one of its purposes to identify the main difficulties and the possible answers given in order to cause the changes to happen, taking in consideration both the external and internal interests of the institution. To further these aims, actual instruments were applied to the research: documents related to the Pedagogy course that were kept in the Council of the university and interviews with the members who took part in the process of readjustment. Because it is a public university, at first there was a mistaken presumption of the primacy of an administration founded upon democratic principles, in which the divergent opinions do not turn out to be taken as mere pretexts, but as an opportunity of dialogue and to establish collective projects. However, the results of the analysis shook that basic assumption and proved the opposite: the process was led to a rational/bureaucratic pattern of administration, the goals of which intended to adjust the institution to the external precepts and to establish the consensus — understood here as an absolute lack of conflicts. Nevertheless, it was chosen to conciliate the Pedagogy course to the national guides, without causing any harm to the departmental interests. These are reasons that justify satisfactorily the fact of this article being supposed to raise and quicken new and revitalized debate whenever there is an engagement of those who are most concerned for the duty of student teachers’ instruction, but mainly that of being expected to participate in the effective discussion/decision — making process of creating ends which to strive and work for.

Tests of fed and unfed Amblyomma cajennense ticks (Acari: Ixodidae): first morphological data

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Cultura, Comunicação e cidadania: o caso do Centro Cultural do Banco do Brasil de São Paulo

O artigo analisa as atuais políticas culturais e analisa empiricamente as ações da unidade paulistana do Centro Cultural Banco do Brasil (CCBB). O objetivo é interpretar como esta instituição opera o fomento à cultura no contexto da normatização cultural no Brasil. A articulação institucional entre Banco do Brasil e seu Centro Cultural enseja algumas particularidades no campo da difusão cultural, pois o status institucional do CCBB condiciona de maneira decisiva as formas como transcorrem as relações com produtores culturais, público consumidor e com seu respectivo mantenedor. Trata-se de estudo baseado em pesquisa bibliográfica, levantamento de campo e na abordagem dialética de análise. Conclui-se que, ao consentir um laissez-faire cultural, o Estado admite que o mercado imponha sua lógica à cultura, de modo que o objeto empírico pode ser caracterizado como um exemplo dessa dinâmica.

O internato escolar como instituição total: violência e subjetividade

Neste artigo, apresentamos um caso da literatura relativo ao internato escolar por meio do qual exemplificamos e discutimos alguns aspectos da violência e subjetividade na instituição total. Utilizamos as análises de Goffman sobre as instituições totais e algumas hipóteses psicanalíticas a respeito da agressividade para a leitura de O Jovem Törless , de Robert Musil. Instituições totais parecem ultrapassadas, mas elas persistem na atualidade: FEBENS, asilos, orfanatos, conventos, prisões, quartéis, manicômios, seminários para formação de padres, etc. Nossa pesquisa visa ao desvelamento do modo de funcionamento dessas instituições e a explicitação de seus efeitos na produção da subjetividade daqueles que delas participam. Concluímos que no paralelo que podemos estabelecer entre os fins educativos do internato escolar e os objetivos terapêutico-correcionais do hospital psiquiátrico e da prisão, existe mais do que uma simples analogia.

O psiquiatra na atenção psicossocial: entre o luto e a liberdade

No Brasil, vemos surgir, a partir da década de setenta, diversas propostas inovadoras no campo da atenção à saúde mental. A partir de então, multiplicam-se no país ambulatórios de psicologia e psiquiatria, hospitais-dia, residências terapêuticas e diversos núcleos/centros de atenção psicossocial. Transformados em política pública, os centros de atenção psicossocial espalham-se pelo país, preconizando um atendimento ambulatorial, interdisciplinar e de orientação territorial. Geralmente formado sob os auspícios de um grande hospital, o psiquiatra que se propõe a trabalhar, a partir da ótica psicossocial, imerso em uma pequena cidade, vê-se exposto às diversas contradições e ilogicidades do discurso psiquiátrico clássico. Os variados saberes locais são uma ameaça ao saber psiquiátrico medicamente constituído. Respostas, antes fáceis no interior do hospital, têm variadas implicações no território e adquirem uma complexidade para a qual o psiquiatra não se encontra preparado. Assim, este trabalho tenta demonstrar a dissonância entre essas duas espécies de psiquiatria: a clássica (afinada com a biologia, com a normatividade e com a instituição) e a psicossocial (que se volta para respostas localmente construídas e que se afina com o homem, em uma dimensão muito além do seu corpo).