Protocol for the PINCER trial: a cluster randomised trial comparing the effectiveness of a pharmacist-led IT-based intervention with simple feedback in reducing rates of clinically important errors in medicines management in general practices

Background: Medication errors are an important cause of morbidity and mortality in primary care. The aims of this study are to determine the effectiveness, cost effectiveness and acceptability of a pharmacist-led information-technology-based complex intervention compared with simple feedback in reducing proportions of patients at risk from potentially hazardous prescribing and medicines management in general (family) practice. Methods: Research subject group: "At-risk" patients registered with computerised general practices in two geographical regions in England. Design: Parallel group pragmatic cluster randomised trial. Interventions: Practices will be randomised to either: (i) Computer-generated feedback; or (ii) Pharmacist-led intervention comprising of computer-generated feedback, educational outreach and dedicated support. Primary outcome measures: The proportion of patients in each practice at six and 12 months post intervention: - with a computer-recorded history of peptic ulcer being prescribed non-selective non-steroidal anti-inflammatory drugs - with a computer-recorded diagnosis of asthma being prescribed beta-blockers - aged 75 years and older receiving long-term prescriptions for angiotensin converting enzyme inhibitors or loop diuretics without a recorded assessment of renal function and electrolytes in the preceding 15 months. Secondary outcome measures; These relate to a number of other examples of potentially hazardous prescribing and medicines management. Economic analysis: An economic evaluation will be done of the cost per error avoided, from the perspective of the UK National Health Service (NHS), comparing the pharmacist-led intervention with simple feedback. Qualitative analysis: A qualitative study will be conducted to explore the views and experiences of health care professionals and NHS managers concerning the interventions, and investigate possible reasons why the interventions prove effective, or conversely prove ineffective. Sample size: 34 practices in each of the two treatment arms would provide at least 80% power (two-tailed alpha of 0.05) to demonstrate a 50% reduction in error rates for each of the three primary outcome measures in the pharmacist-led intervention arm compared with a 11% reduction in the simple feedback arm. Discussion: At the time of submission of this article, 72 general practices have been recruited (36 in each arm of the trial) and the interventions have been delivered. Analysis has not yet been undertaken.

Crescimento in vitro e aclimatização de Cattleya loddigesii Lindley (Orchidaceae) com carvão ativado sob dois espectros luminosos

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

Chromosomal studies on five species of the genus Leptodactylus Fitzinger, 1826 (Amphibia, Anura) using differential staining

Cytogenetic studies were carried out on five species of Leptodactylus, namely L. fuscus, L, notoaktites, L. labyrinthicus, L. ocellatus, and L. podicipinus, after standard staining, Ag-NOR and C-banding as well as BrdU incorporation for three of them. The species had 2n = 22 chromosomes and two basic karyotype patterns. Chromosome 8 was a marker bearing a secondary constriction. In all species, this secondary constriction corresponded to the Ag-NOR site. The species had centromeric C-bands in all chromosomes of the complement, but some interstitial or telomeric bands seemed to differentiate some karyotypes, either at the species or the population level. In L. ocellatus, the C-banding pattern confirmed the occurrence of a heteromorphic pericentric inversion in chromosome 8 in specimens from one of the populations. The BrdU incorporation technique showed no detectable difference in the replication patterns of the major bands in the chromosomes of L. noroaktites, L. labyrinthicus, and L. ocellatus.

Seleção de agentes alternativos ao ágar para propagação de plântulas de Cattleya loddigesii Lindley (Orchidaceae)

The aim of this study was to evaluate the in vitro growth of Cattleya loddigesii in alternative agents to agar with starch and physical matrix with acclimatization of regenerated plants. Protocorms with 90 days after sowing (0.5 cm of length) were subcultured in 1/2 MS culture medium among the treatments consisting of: agar 7 g L-1 (T1, which corresponds the control), agar 3,5 g L-1 with cassava starch 30 g L-1 (T2), cassava starch 60 g L-1 (T3), cotton fiber (T4) and chopped polyurethane foam (T5). Plantlets were retained in these treatments for over 150 days, and at the end of in vitro culture, were analyzed by their biometric data and acclimatized in a greenhouse during 120 days and evaluated the survival and relative growth rate (RGR). The substrate comprising of chopped polyurethane foam (T5) showed greater efficiency for growth in vitro and also increased survival rate, while substrate cassava starch (T3) provided delay for plantlet growth. Therefore, chopped polyurethane foam is recommended because of low cost and suitable characteristics for the propagation of Cattleya loddigesii.

Concentrações de sacarose no desenvolvimento in vitro e na aclimatização de Cattleya loddigesii Lindley

This work aimed to study the influence of sucrose in the culture medium for in vitro growth and acclimatization of the epiphytic orchid Cattleya loddigesii. Five sucrose treatments (absence, 10, 20, 30 and 40g L-1) were used in a randomic experimental design. Mature seeds were sowed in 1/2 MS culture medium and after 90 days the plantlets (1.0 +/-0.2 cm) were inoculated between the treatments, whereby they were remained more 90 days. After 180 days of the beginning of the experiment the plantlets were removed from the flasks and evaluated the number of roots, shoot length, number of leafs, total dry weight and photosynthetic pigments. Survival percentage was evaluated after 75 days of acclimatization. The data of biometric variables were analyzed by Anovaand polynomial regression (p<0.05). Theothers data were submitted to the Anova and the means compared by the Tukey test (p<0.05). The sucrose concentration of 20g L-1 favored the in vitro growth in all evaluated parameters, showed higher production of chlorophyll a, total chlorophyll and carotenoids, in addition to increased survival under ex vitro condition. The sucrose concentration of 20g L-1 in the culture medium was the most efficient among the tested concentrations both for in vitro growth and ex vitro establishment of Cattleya loddigesii.

Pigmentação testicular e ciclo reprodutivo anual de Physalaemus cuvieri Fitzinger, 1826 em populações de biomas distintos

Pós-graduação em Biologia Animal - IBILCE

Análise morfométrica em cinco espécies do gênero Mabuya Fitzinger, 1826 (Squamata : Scincidae)

O presente trabalho tem como objetivo analisar a variação da forma do corpo ao longo da ontogenia em Mabuya agilis Boulenger, 1887; M. bistriata (Spix, 1825); M. guaporicola Dunn, 1936; M. macrorkyncha Hoge, 1946 e M. nigropunctata (Spix, 1825), espécies sul-americana de lagartos, buscando definir as diferenças interespecíficas em termos de suas proporções corporais, qual o papel de um possível crescimento alométrico no desenvolvimento da forma adulta de cada espécie, e se as diferenças observadas poderiam estar associadas às diferenças nos hábitats ocupados por cada espécie. Para isso foi utilizado a análise de componentes principais (PCA), para estimar tanto as trajetórias ontogenéticas como o crescimento alométrico de cada espécie. Dados sobre os hábitats ocupados por cada espécie foram compilados da literatura. A inclinação da reta indicando a trajetória ontogenética foi significativamente diferente entre Mabuya guaporicola e todas as demais espécies, e entre M. bistriata e M. nigropunctata. A análise dos coeficientes alométricos permitiram constatar que: a redução relativa dos membros, associado com um alongamento do corpo em Mabuya guaporicola, foi alcançada através da redução das mãos, pés e, especialmente, dos dígitos; em M. agi/is houve um alongamento do corpo; M. macrorhyncha apresentou a região da cintura escapular robusta, especialmente alta, e as mãos com uma redução acentuada; em M. bistriata os braços são relativamente curtos e coxa e tíbia alongados; e M. nigmpunctata, comparado com as demais espécies estudadas, foi a espécie cuja forma do corpo menos se alterou ao longo do crescimento. Através desses resultados, juntamente com os dados obtidos da literatura sobre o hábitat ocupado por cada espécie estudada, foi concluído que algumas especializações morfológicas encontradas poderiam ser explicadas como adaptações funcionais ao uso de seus hábitats.