Teaching the Rational Use of Medicines to medical students: a qualitative research

Background: Prescribing is a complex and challenging task that must be part of a logical deductive process based on accurate and objective information and not an automated action, without critical thinking or a response to commercial pressure. The objectives of this study were 1) develop and implement a discipline based on the WHO's Guide to Good Prescribing; 2) evaluate the course acceptance by students; 3) assess the impact that the Rational Use of Medicines (RUM) knowledge had on the students habits of prescribing medication in the University Hospital.Methods: In 2003, the RUM principal, based in the WHO's Guide to Good Prescribing, was included in the official curriculum of the Botucatu School of Medicine, Brazil, to be taught over a total of 24 hours to students in the 4th year. We analyzed the students' feedback forms about content and teaching methodology filled out immediately after the end of the discipline from 2003 to 2010. In 2010, the use of RUM by past students in their medical practice was assessed through a qualitative approach by a questionnaire with closed-ended rank scaling questions distributed at random and a single semistructured interview for content analysis.Results: The discipline teaches future prescribers to use a logical deductive process, based on accurate and objective information, to adopt strict criteria (efficacy, safety, convenience and cost) on selecting drugs and to write a complete prescription. At the end of it, most students considered the discipline very good due to the opportunity to reflect on different actions involved in the prescribing process and liked the teaching methodology. However, former students report that although they are aware of the RUM concepts they cannot regularly use this knowledge in their daily practice because they are not stimulated or even allowed to do so by neither older residents nor senior medical staff.Conclusions: This discipline is useful to teach RUM to medical students who become aware of the importance of this subject, but the assimilation of the RUM principles in the institution seems to be a long-term process which requires the involvement of a greater number of the academic members.

Use of Medicines Among a Brazilian Elderly Sample: A Cross-sectional Study

Background: The use of multiple medicines is very frequent among the elderly, allowing them to perceive more often adverse side effects from drugs and present undesirable drug interactions.Methods: This article presents a cross-sectional survey about the use of medicines among 300 elderly Brazilians, equally divided into institutionalized and community-dwelling groups.Results: The average daily intake of medicines is 3.2 among institutionalized elderly, a higher (p < 0.001) number when compared with community-dwelling elderly, who takes an average of 1.8 medicines daily. The most commonly used medications are antihypertensives (58.0%), diuretics (23.0%), nonsteroidal anti-inflammatory drugs (22.7%), supplements (21.7%), antidiabetics (16.3%), and antiulcerants (14.0%). Antiulcerants, diuretics, supplements, and central nervous system drugs are more frequently used by institutionalized than by community-dwelling elderly.Conclusion: In this Brazilian elderly sample, the most widely used medicines were antihypertensives, diuretics, and nonsteroidal anti-inflammatory drugs, and institutionalized used more medications than community-dwelling elderly. Copyright (C) 2011, Taiwan Society of Geriatric Emergency & Critical Care Medicine. Published by Elsevier Taiwan LLC. All rights reserved.

Rational use of antimicrobials in dentistry during pregnancy

The use of medicines during pregnancy deserves special attention from dentists due to the potential risks to fetal development. The prescription of antimicrobial drugs during this period must be based not only on the etiology of the disease but also on the drug's effect on the embryo, which may be toxic, possibly leading to irreversible lesions. Interest in studies of the teratogenic effects of drugs increased in response to reports of the high incidence of phocomelia in patients treated with thalidomide. Although teratogenicity has long been known, pregnant women today are still exposed to this risk. The effects of drugs depend on the level of susceptibility of the fetus and on the period of exposure during pregnancy. In this context, and considering the paucity of studies on this subject in dentistry, the aim of this review was to offer an up-to-date compilation of data on the antimicrobial drugs most frequently used during pregnancy and the effects of their use.

Use of radiograph optical densitometry to monitor bone quality in broiler breeders

This study was carried out at Faculdade de Medicina Veterinária e Zootecnia, Universidade Estadual Paulista, Botucatu, SP, Brazil, and evaluated bone quality in broiler breeders. Twenty-three families of Ross broiler breeders were housed in 5.0-m² pens. The families were comprised of 13 females and one male at the onset of the experimental period. The mean number of females per family was 9.34 at the end of the trial. The feeding program and management followed strain guidelines (Agroceres Ross, 2003). Bone analyses were performed in the right tibia and femur using optical radiographic densitometry at 4, 8, 12, 15, 20, 24, 30, 35, 42, 47 and 52 weeks of rearing. Trap nests were used to collect eggs from the breeders two weeks before and after the evaluation weeks. At each evaluation day, five birds were sacrificed after radiographs were taken and the tibias and femurs were collected to perform the following analyses: fatfree dry matter, ash percentage, bone resistance and Seedor index. Therefore, it was possible to establish correlations between bone quality and eggshell quality. Characteristics of bone quality were highly correlated to each other; on the other hand, there were no correlations between bone quality and external egg quality. In conclusion, there was no effect of egg production on egg quality, possibly because there was no reabsorption of bone minerals.

The Use of Headspace Solid-Phase Microextraction (HS-SPME) to Assess the Quality and Stability of Fruit Products: An Example Using Red Mombin Pulp (Spondias purpurea L.)

The present study aimed to evaluate the volatiles profile of red mombin (Spondias purpurea) pulp and its powder produced by spray-drying (SD) as an example to show utility of headspace solid-phase microextraction (HS-SPME) in the analysis of parameters such as the quality and stability of fruit products. Volatiles profiles of the pulp were identified by gas chromatography-mass spectrometry (GC-MS), quantified by gas chromatography-flame ionization detector (GC-FID) and compared to the profile of the powder stored at 0, 60 and 120 days in plastic (PP) or laminated packages (LP). The results showed that the technique was able to identify 36 compounds in the red mombin pulp, 17 out of which have been described for the first time in this fruit, showing that red mombin fresh pulp appears to be unique in terms of volatiles composition. However, only 24 compounds were detected in the powder. This decrease is highly correlated (r(2) = 0.99), at least for the majority of compounds, to the degree of volatility of compounds. Furthermore, the powder stored in PP or LP showed no statistical differences in the amounts of its components for a period of 120 days of storage. Finally, this work shows how HS-SPME analysis can be a valuable tool to assess the quality and stability of fruit products.

Use of anatomical, chemical, and molecular genetic characteristics in the quality control of medicinal species: a case study of sarsaparilla (Smilax spp.)

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Safety assessment of essential medicines for elderly people: a bibliographic survey

Certain medicines are considered potentially inappropriate (PIM) for elderly people as they increase the risk of adverse drug events (ADE) and because safer alternative therapies are available on the market. In this context, in order to identify the instruments that assess the quality of medical prescriptions for elderly and to determine which drugs are considered PIM, a bibliographic survey was conducted in PUBMED, LILACS and PAHO databases, in February and March/2010. The search strategy included the use of health descriptors and a manual search in the references cited by selected papers. During the period of data collection, 15 instruments were identified. In 2012, with the publication of the update of Beers criteria, this instrument was included in the study. We identified 163 PIM of 25 therapeutic classes, of which 125 (76.7%) are marketed in Brazil. Of these, 31 (24.8%) are essential medicines (RENAME 2012), of which 13 have safer therapeutic equivalents and 19 (15.2%) are over-the-counter drugs. Data suggest the need for inclusion of safer alternatives for the elderly in the national list of essential medicines and the pharmaceutical care for early detection of ADE in this age group, in order to contribute to the safe use of medicines.

Assessment of the quality evaluation of compounded fluconazole capsules marketed in the region of Araraquara (SP, Brazil)

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

Assessment of field fertility and several in vitro sperm characteristics following the use of different Angus sires in a timed-AI program with suckled Nelore cows

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Candida parapsilosis complex water isolates from a haemodialysis unit: biofilm production and in vitro evaluation of the use of clinical antifungals

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Use of herbicides on turfgrass

Nas culturas agrícolas as plantas daninhas devem ser controladas de modo a não afetar negativamente o rendimento e a qualidade do produto colhido. Deste modo, quantidades pequenas de plantas daninhas em um campo, na maioria dos casos, não é um problema, exceto na produção de sementes. Ressalta-se que em gramados não existe um componente de produção a se colhido. O valor do gramado é a sua qualidade inerente a estética e usabilidade. Qualidade estética é a beleza e o valor que acrescenta ao gramado em uma paisagem gerenciada. Usabilidade pode ser a durabilidade de um campo de esporte ou a redução na perda de solo pela erosão da água ou do vento. A presença de qualquer planta daninha em gramados pode diminuir a qualidade estética e usabilidade do gramado. Enquanto for possível reduzir a população de plantas daninhas utilizando práticas culturais ou mecânicas, não se poderá eliminá-las completamente. A utilização de herbicidas é a única maneira de controlar completamente as plantas daninhas em áreas de gramados. Esta revisão irá rever os principais herbicidas utilizados em gramados nos Estados Unidos com relação a seus modos de ação, a família de herbicidas e uso primário no gramado.

The limits of human development and the use of energy and natural resources

The development of nations is an unquestionable requirement. A lot of challenges concerning health, education and economy are present. A discussion on these development models has occupied the minds of decision makers in recent years. When energy supply and demand is considered, the situation becomes critical and the crucial question is: how to improve the quality of life of developing countries based on available models of development that are related to the life style of developed countries, for which the necessary use and waste of energy are present? How much energy is essential to humanity for not so as to endangering the survival conditions of future generations? the human development index (HDI) establishes the relationship among energy use, economic growth and social growth. Here it can be seen that 75% of the world population has a significant energy consumption potential. This is a strong reason to consider that the sustainable development concepts on energy policies are strategic to the future of the planet. This paper deals with the importance of seeking alternative development models for human development balance, natural resources conservation and environment through rational energy use concepts. (c) 2004 Elsevier Ltd. All rights reserved.

Use of bispectral index to monitor depth of anesthesia in isoflurane-anesthetized dogs

Objective-To evaluate the correlation between the bispectral index (BIS) and end-tidal isoflurane (ETISO) concentration and compare the use of 3 BIS sensor positions in dogs.Animals-6 adult dogs.Procedures-Mechanically ventilated dogs received pancuronium, and depth of anesthesia was altered by increasing ETISO concentration from 1.5% to 2.3% and 3.0%. The BIS, suppression ratio (relative percentage of isoelectric electroencephalographic waveforms), and signal quality index (SQI) were recorded at each ET, so concentration for each of 3 BIS sensor positions (frontal-occipital, bifrontal, and frontal-temporal positions).Results-The BIS and ETISO concentration were poorly correlated-, regardless of sensor positioning, mean BIS values did not change significantly as ETISO was increased. At 3% isoflurane, regardless of sensor positioning, there was an increase in suppression ratio coincident with BIS < 40 in some dogs, whereas paradoxic increases in BIS (> 60) were recorded in others. Furthermore, at 3.0% isoflurane, the SQI was significantly lower for the bifrontal sensor position (compared with values for the other positions), but low SQI values prevented recording of BIS values from the frontal-occipital sensor position in 2 dogs. Overall, BIS values derived from the 3 sensor positions did not differ.Conclusions and Clinical Relevance-In dogs, BIS values may not reflect changes in depth of isoflurane anesthesia in the absence of noxious stimulation. of the 3 sensor positions, frontal-temporal positioning provided better correlation with changes in depth of anesthesia induced via changes in isoflurane concentrations. However, the sensor placements yielded similar results at SQI values > 50.

Use of prebiotics and probiotics of bacterial and yeast origin for free-range broiler chickens

This study aimed to evaluate the effects of probiotics and prebiotics of bacterial and yeast origin on the performance, development of the digestive system, carcass yield and meat quality of free-range broiler chickens. Five hundred and sixty male chicks of the strain ISA S757-N were reared from one to 84 days old. The birds were distributed in four treatments according to a completely randomized block design: T1 = Control, T2 = Probiotics and Prebiotics of bacterial origin, T3 = Probiotics and prebiotics of yeast origin, T4 = Probiotics and prebiotics of bacterial origin + probiotics and prebiotics of yeast origin. There were four repetitions with 35 birds per repetition, and the birds had access to a pasture area after 35 days of age. Characteristics evaluated were performance, development of the digestive system, carcass and parts yield, abdominal fat, breast meat physical measurements (length, width and height) and meat quality parameters (pH from breast and leg meat, cooking loss and shearing force from breast meat). Lower mortality (p<0.05) and higher weight gain from 64 to 77 and 64 to 84 days of age were seen in birds supplemented with probiotics and prebiotics of bacterial origin compared to the non-supplemented birds (control). There were significant differences (p<0.05) among treatments for carcass yield. Birds supplemented with both probiotics and prebiotics of microbial and yeast origin (T4) showed higher carcass yield than control birds. Supplementation with probiotics and prebiotics of bacterial origin (T2) or the supplementation of these together with those of yeast origin (T4) reduced mortality and increased the carcass yield in free-range broiler chickens.

Use of Adipose Tissue-Derived Mesenchymal Stem Cells for Experimental Tendinitis Therapy in Equines

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