Factors predictive of inappropriateness in requests for parenteral antimicrobials for therapeutic purposes: A study in a small teaching hospital in Brazil

Background: The identification of patterns of inappropriate antimicrobial prescriptions in hospitals contributes to the improvement of antimicrobial stewardship programs (ASP). Methods: We conducted a cross-sectional study to identify predictors of inappropriateness in requests for parenteral antimicrobials (RPAs) in a teaching hospital with 285 beds. We reviewed 25% of RPAs for therapeutic purposes from y 2005. Appropriateness was evaluated according to current guidelines for antimicrobial therapy. We assessed predictors of inappropriateness through univariate and multivariate models. RPAs classified as 'appropriate' or 'probably appropriate' were selected as controls. Case groups comprised inappropriate RPAs, either in general or for specific errors. Results: Nine hundred and sixty-three RPAs were evaluated, 34.6% of which were considered inappropriate. In the multivariate analysis, general predictors of inappropriateness were: prescription on week-ends/holidays (odds ratio (OR) 1.67, 95% confidence interval (CI) 1.20-2.28, p = 0.002), patient in the intensive care unit (OR 1.57, 95% CI 1.11-2.23, p = 0.01), peritoneal infection (OR 2.15, 95% CI 1.27-3.65, p = 0.004), urinary tract infection (OR 1.89, 95% CI 1.25 -2.87, p = 0.01), combination therapy with 2 or more antimicrobials (OR 1.72, 95% CI 1.15-2.57, p = 0.008) and prescriptions including penicillins (OR 2.12, 95% CI 1.39-3.25, p = 0.001) or 1(st) generation cephalosporins (OR 1.74, 95% CI 1.01-3.00, p = 0.048). Previous consultation with an infectious diseases (ID) specialist had a protective effect against inappropriate prescription (OR 0.34, 95% CI 0.24-0.50, p < 0.001). Factors independently associated with specific prescription errors varied. However, consultation with an ID specialist was protective against both unnecessary antimicrobial use (OR 0.04, 95% CI 0.01-0.26, p = 0.001) and requests for agents with an insufficient antimicrobial spectrum (OR 0.14, 95% CI 0.03-0.30, p = 0.01). Conclusions: Our results demonstrate the importance of previous consultation with an ID specialist in assuring the quality of prescriptions. Also, they highlight prescription patterns that should be approached by ASP policies.

Predictors of incorrectness in antimicrobial prescription in the Bauru State Hospital (Bauru city, São Paulo State, Brazil)

The inappropriate use of antimicrobials in hospitals presents a negative impact on patient outcome and is associated with the emergence and spread of multidrug-resistant microorganisms. Antimicrobial stewardship programs (ASPs) have been instituted in order to improve the quality of prescriptions in hospitals. In this setting, the identification of patterns of inappropriate antimicrobial prescription is a valuable tool that allows ASPs to identify priorities for directing educative/restrictive policies. With this purpose, a study was conducted in the Bauru State Hospital, a teaching hospital with 285 beds affiliated to the Botucatu Medical School, São Paulo State University. The hospital maintains an active ASP since it was opened, in 2002. We selected 25% of the requests for parenteral antimicrobials (RPAs) from 2005 for analysis. Prescriptions for prophylactic purposes were excluded. All other RPAs were classified according to a modified Kunin and Jones categories. Univariate and multivariable analyses were performed to identify predictors of general inappropriateness and of specific prescription errors. Prescriptions classified as "appropriate'' or "probably appropriate" were selected as controls in all stages of the study. Among 963 RPAs included in our study, 34.6% were inappropriate. General predictors of inappropriateness were: prescription on weekends/holidays (OR = 1.67, 95% CI = 1.20-2.28, p = 0.002), patient from intensive care unit (OR = 1.57, 95% CI = 1.11-2.23, p = 0.01), peritoneal (OR = 2.15, 95% CI = 1.27-3.65, p = 0.004) or urinary tract infection (OR = 1.89, 95% CI = 1.25-2.87, p = 0.002), combined therapy with two or more antimicrobials (OR = 1.72, 95% CI = 1.15-2.57, p = 0.008) and prescriptions including penicillin (OR = 2.12, 95% CI = 1.39-3.25, p = 0.001) or first-generation cephalosporins (OR = 1.74, 95% CI = 1.01-3.00, p = 0.048). Previous consultation with an infectious diseases (ID) specialist had a protective effect against inappropriate prescription (OR = 0.34, 95% CI = 0.24-0.50, p < 0.001). Factors independently associated with specific prescription errors varied. However, consultation with an ID specialist was protective against both unnecessary antimicrobial use (OR = 0.04, 95% CI = 0.01-0.26, p = 0.001) and requests for agents with insufficient spectrum (OR = 0.14, 95% CI = 0.03-0.30, p = 0.01). In conclusion, the analysis of factors predictive of inappropriateness in antimicrobial prescription allowed us to identify issues requiring intervention. Also, it provided a positive feedback of the ASP efficacy, demonstrating the importance of previous consultation with an ID specialist to assure the quality of antimicrobial prescriptions.

Epidemiology of the Cnidarian Physalia physalis stings attended at a health care center in beaches of Adicora, Venezuela

Stings caused by jellyfish and jellyfish-like colonies are common all around the world, with serious manifestations and occasional deaths reported in some countries. Between December 2006 and 2007, epidemiological, clinical and treatment aspects of stings caused by the Portuguese man-of-war (Physalia physalis) in 59 patients consulting the ambulatory emergency in Adicora, Falcon State, Venezuela, were studied. Most of the stings occurred in males (59%) preschool and school-aged children (49%), visitors from other areas of the country (92%) during holidays when bathing or diving at the beach (97%). Injuries presented linear erythematous plaques at the point of contact with the animal, located in several anatomical sites. Most clinical manifestations observed were: intense burning pain, urticaria, erythema and inflammation (100%), as well dyspnea with laryngeal edema and fever (19%). Patients were treated with topical drugs, including antihistamine and antipyretic drugs, but also with systemic hydrocortisone. P. physalis stings in Adicora appeared to have a seasonal pattern, with systemic complications potentially life-threatening. Thus, epidemiological surveillance program is recommended, particularly in travelers. (C) 2012 Elsevier Ltd. All rights reserved.

Capacidade de carga real (ccr) da caverna de santana, parque estadual turístico do alto ribeira (Petar) - sp, e indicações para o seu manejo turístico

The tourist use of Santana cave provides a row of environmental damages, compromising partially the pristine conditions. Among the measures adopted to avoid this situation, this issue presents a contribution for the physical limits to tourist visitation and the indications for speleotouristic management. It was used the Cifuentes Carrying Capacity method and some basic principles of Visitors Impact Management Framework - VIM. The results show a Real Carrying Capacity (CCR) about 120 visits daily on the cave. The discussions raise a few hypotheses about the alteration in the method used and the temporal frequency between visitors groups, suggesting a provisional CCR of 117 and 135 visitors daily, respectively, during the week and in the weekends and holidays. The conclusions appoint the necessity of a conceptual revision in the Carrying Capacity methods, mainly about its adaptation for tourist management in caves. In the case studied, it is suggested the immediate beginning of environmental monitoring of the cave, to verify the plausibility from proposed visitation limits and the possible contributions for to mitigate the environmental impacts from speleotourism.

Preditores de incorreçao na prescrição de antimicrobianos no Hospital Estadual Bauru (Bauru, São Paulo)

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

O absenteísmo em enfermagem em um hospital do interior do Estado de São Paulo

Pós-graduação em Enfermagem (mestrado profissional) - FMB

No contorno da serra: campesinato, cultura e turismo em Guaramiranga - CE

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

As festas escolares no Brasil: uma análise a partir da literatura sobre a temática e à luz da teoria crítica

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

As festas no ambiente escolar e sua relação com as aulas de educação física

One of the interests of leisure is social and involves the festival. The holidays can be of different types and occur in different places, having lots of functions as the union of those involved, the development of creativity, fun and identification with the culture. The festivities are part of the play culture. The school, being an environment that deals directly and indirectly with the culture of organized behavior and appreciation of the discipline, often in second person through the formation of relationships, cultural transmission and access to the traditions of the groups around it. The entertainment component of culture in the school also finds himself sidelined in a society of work and a school that educates more to the labor market. The parties almost do not occur at school and when they happen, are given in order to make profits and sell consumer goods, apart from values that are intrinsic. In this study the objective was to deepen the study of parties, given that these are elements provides the establishment of the identity of a group of groups and of each individuals. When it comes to educating people, parties contributed to the emancipation of the human being which is cultural. Was developed a study in the field about the theme parties at the school, to understand whether and how it is being taught in schools, and what is its real importance for teachers and students, since we consider it fundamental to the development of culture and leisure culture of individuals. For this, we conducted a qualitative study based on a field research, using as a tool for collecting a semi-structured interviews with 52 students from 6th grade (7 years) from two schools at Ibitinga-SP, since one of them was a public school and the other a private school. Based on data collected from interviews and analysis, we found that the parties do not happen in schools, students do not learn what is leisure, and do not study or folklore festivals in physical...

Minha terra tem palmeiras onde canta o sabiá...: sobre o Projeto Inajá e a formação de professores no médio Araguaia

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)