Resultados das intervenções educativas em farmacovigilância: uma revisão sistemática

A notificação espontânea por profissionais da saúde é o principal método de avaliação do risco/benefício da utilização de medicamentos, pois permite a análise da frequência, gravidade e expectativa dos eventos adversos a medicamentos (EAMs). No entanto, a principal limitação deste método é a subnotificação dos casos, causando grandes impactos na saúde pública, tais como gastos desnecessários para as instituições e diminuição da segurança do paciente. A fim de identificar técnicas de intervenção educativa efetivas no incentivo à notificação espontânea por profissionais da saúde nos diferentes níveis de atenção, realizou-se revisão sistemática nas bases de dados PUBMED, PAHO, LILACS e EMBASE no período de novembro de 2011 a janeiro de 2012, com posterior atualização em março de 2013, por meio da utilização de descritores científicos em farmacovigilância, buscando-se identificar estudos originais que avaliaram o impacto da intervenção educativa desenvolvida. Pela estratégia elaborada, foram identificados 101 artigos, dos quais 16 contemplaram os critérios de inclusão. A maioria dos estudos inclusos foram conduzidos na Europa (14), e a maioria das intervenções foi destinada ao nível terciário de atenção à saúde (11) e principalmente aos médicos (12). As técnicas efetivas de intervenção educativa identificadas foram multifacetadas, resultando no aumento do número absoluto, porcentagem ou taxa de notificação espontânea, além de melhorar a qualidade dos relatos de reações adversas a medicamentos (RAM): graves, inesperadas, relacionadas a medicamentos novos e com alta causalidade. Ademais, faz-se necessária educação permanente dos profissionais para maior adesão à farmacovigilância e contribuição para o gerenciamento de riscos

Práticas alternativas e complementares no tratamento do câncer: revisão integrativa da literatura

O interesse no tema pela praticas alternativa e complementar na saúde vem aumentado, principalmente entre pacientes oncológicos, que buscam uma melhor qualidade de vida e algumas alternativas para amenizar os efeitos colaterais do tratamento convencional. Fazer uma revisão integrativa da produção científica em periódicos nacionais e internacionais, acerca das praticas integrativas e complementares no tratamento do paciente com câncer. Trata-se de uma revisão integrativa da literatura, indexada nas bases de dados MEDLINE e LILACS, no período de 2000 a 2010. Após exclusão daqueles que se repetiam entre as bases de dados e dos que não se encaixam nos critérios de inclusão, resultaram 19 artigos. A coleta de dados foi realizada nos meses de janeiro a março de 2011 por meio de um instrumento elaborado pela pesquisadora. Utilizou-se do aplicativo Microsoft Excel 2007 para organizar o banco referente aos dados quantitativos. Os dados quantitativos, referentes às variáveis da caracterização da produção científica, foram apresentados em tabelas e submetidos à análise estatística descritiva. A análise de conteúdo, na abordagem representacional e do tipo temática (Bardin, 1977) foi utilizada como estratégia metodológica qualitativa para organizar, sistematicamente, a produção do conhecimento. A caracterização do corpus de análise aponta uma produção majoritária de publicações internacionais (94,74%). A maior parte das publicações é oriunda dos Estados Unidos da América (EUA), correspondendo a 36,86% da amostra. O método qualitativo foi predominante (84,21%). Da análise temática emergiram quatro temas: Tema 1. Relação médico-paciente com o profissional da Medicina alternativa e complementar (MAC); Tema 2. Crenças e costumes relacionados ao uso das MACs; Tema 3. Variedades das MACs e suas interações...(Resumo completo, clicar acesso eletrônico abaixo)

Efeito de intervenções não farmacológicas nos níveis de estresse em cuidadores de pacientes com doença de Alzheimer: uma revisão sistemática

Beside aging process comes the incidence of dementia and, among them Alzheimer's disease (AD) accounts for approximately 60% of cases. This disease is characterized as a neuropathology with unknown etiology that causes cognitive deficits and behavioral disorders. Caring for patients with AD can cause an overload, both physical and psychological, which can cause high levels of stress on the primary caregiver. It is necessary that the caregiver also receives attention and develop activities that promote health benefits, while providing moments of distraction from the task of caring. Nonpharmacological interventions may be favorable for improving health with consequent decreased on the levels of stress. The objective of this study was to conduct a systematic review of scientific papers that aimed to verify the effect of nonpharmacological interventions on stress levels in caregivers of patients with AD. To contamplate this goal was accomplished a systematic search in the following databases: Biological Abstracts, PsycINFO, PubMed/Medline, Web of Science, LILACS and SciELO. The following keywords and Boolean operators was used: “caregivers” OR “family” and “nonpharmacological interventions” OR “support groups” OR “therapies” AND “Alzheimer's disease” OR “Alzheimer's dementia” OR “Alzheimer” OR “elderly” AND “stress”. There were found 3studies that met inclusion criteria adopted for the present work, and none showed significant results for the variable stress. It is not possible to affirm, according to the studies, that nonpharmacologial interventions programs for caregivers of patients with AD are effective to influence and to control the stress. However, studies show benefits for other variables such as self-efficacy and confidence in relation to care... (Complete abstract click electronic access below)

Enfermagem e o gerenciamento de custos: revisão sistemática nacional e internacional

Objectives: conduct a systematic review of national and international literature, to classify the types of production, comparing the two literatures and synthesize knowledge in the area. Method: Systematic Review of Literature, in the databases LILACS, CINAHL and MEDLINE for selection of articles in their entirety, the data extracted from the articles selected were: the study of bibliographic information (title, author, journal, place of study and year of publication), and general information (multidisciplinary production or specific area, language, type of study, type of population and contributions of the study). The categories established for classification of publications were: raising the cost of procedures/ interventions, economic evaluation of specific intervention, inclusion of nursing in the economic context, using cost as an important variable in the study. Results: The study included 39 publications, with 31% of national production and the remaining 69%, internationally. Most publications were classified according to category of economic evaluation of specific intervention, followed by the category of raising the cost of procedure / intervention, which fits the majority of national production. Human resources is shaped as an important variable for obtaining cost studies that proposed to make this calculation. Conclusion: The production of literature in nursing cost management is relevant in number of publications within the proposed period and is directed to different areas within this theme. There are significant differences in national and international literature: these last use more accurate methods, have more content theorized, use more the economic evaluation tools and related more costs with a amplified context. The production of such knowledge should continue as far as possible and putting that knowledge relating the current reality, in order to amplify the field of nursing and add value

Efeitos de diferentes estímulos auditivos musicais sobre a regulação autonômica cardíaca

Pós-graduação em Fisioterapia - FCT

Estimulação elétrica com eletrodos não implantáveis no tratamento da bexiga hiperativa em adultos: revisão sistemática de ensaios clínicos randonizados

Pós-graduação em Bases Gerais da Cirurgia - FMB

Conhecimento de diferentes populações sobre as leishmanioses

As leishmanioses são enfermidades infecciosas que costumam afetar populações de países de clima tropical e subtropical, em sua maioria subdesenvolvidos, uma vez que seus principais vetores necessitam de condições ambientais e climáticas adequadas facilmente encontradas nessas regiões, para se proliferar. Há diferentes formas clínicas que se caracterizam por sua evolução crônica, sendo a forma visceral (LV) uma das mais graves. Neste caso, a disseminação é relativamente rápida uma vez que existe também a abundância de um dos seus principais reservatórios domésticos, o cão, que vive bem próximo ao homem, o qual é também acometido por esta zoonose. Dessa maneira é preciso que as populações, principalmente aquelas localizadas em áreas endêmicas, saibam identificar os pontos principais dessa doença como a transmissão, sinais clínicos e prevenção. Por esse motivo, essa revisão sistemática objetivou procurar saber qual o conhecimento de diferentes populações sobre as leishmanioses. Foram utilizados os seguintes descritores: (knowledge) AND (population) AND (leishmaniasis), através de um levantamento bibliográfico em três bases de dados, LILACS, SCIELO e PUBMED. Foi possível concluir, através da análise de sete artigos, que o conhecimento das leishmanioses ainda se encontra muito superficial dentro das populações e que a principal fonte de informação ainda é a informal, de pessoa a pessoa

Avaliação da qualidade de vida de pacientes portadores de hepatopatias

Pós-graduação em Odontologia Preventiva e Social - FOA

Avaliação das alterações dentárias e esqueléticas induzidas pelo uso do aparelho de Herbst no tratamento da classe II na dentadura mista: Revisão sistemática

Objective: evaluate the immediate dental and skeletal changes induced by the Herbst appliance on early treatment of Angle´s Class II malocclusion. Material and Method: several electronic databases such as Scopus, Pub Med, Medline, Cochrane Library, Lilacs and Scielo were searched. The abstracts that fullfilled the selection criteria were selected and those that did not provide enough information about these criteria were selected but the final decision of including them or not on the research, was taken after the complete reading of the article. The selection criteria were: clinical studies with Class II individuals, both male and female, with initial age of 7 to 10 years, treated with the Herbst appliance that analysed the dental and/or skeletal changes evaluated on lateral cephalometric radiographs; researches where the treatment performed did not involve extractions or surgical interventions; studies that included patients without syndromes or health concerns and articles published in English or Portuguese. Results and Conclusions: five articles were selected. The articles showed that significant changes happened in the mandibular sagittal lenght, on facial convexity angle, on maxillo-mandibular relationship, on retroclination of the upper incisors and on distal movement of the upper molars, on proclination of the lower incisors and on extrusion of the lower molars. The appliance exerted a limited effect on the anterior relocation of the maxillary complex and on facial heights. However, more studies about the performance of the Herbst appliance on early treatment of Class II are needed.

Extensão universitária e trabalho voluntário na formação do acadêmico em odontologia

The aim of the present study was to point out the importance of the experience of undergraduate dental students in extra-curricular activities and volunteer work, as a means through which to gain essential knowledge and abilities for their professional lives. A literature review of the Medline, Scielo, and Lilacs databases was carried out in an attempt to select articles related to the university extension and volunteer work of undergraduate dental students. It is still extremely difficult to include university extension and volunteer work as an important activity in Dentistry courses. However, the presentday work market demands professionals who have expertise not only in dental techniques, but also in the socio-cultural characteristics of communities, considering that people need to be comprehensive in their psychosocial aspects in order to be treated as a complete professional. Therefore, university dentistry courses should give equal consideration to both oral rehabilitation skills and the promotion of general healthcare, acquired mainly through extracurricular activities, in an attempt to redeem the integral education of the healthcare professional. Moreover, students should pay closer attention to the opportunities offered during their undergraduate courses, as the work market for dentists is becoming more and more competitive. Moreover, the dentist whose professional life is limited to the dental office will most certainly forgo the opportunity to act in other social areas as well as the recognition that comes with such acts.

Tratamento biológico de fraturas ósseas com placa minimamente invasiva em pequenos animais: revisão sistemática

Objetivo: revisar sistematicamente a eficácia da técnica denominada osteossíntese com placa minimamente invasiva (MIPO), recentemente utilizada em medicina veterinária, em pequenos animais, em relação ao tempo de união óssea, alinhamento do membro e complicações no trans e pós-operatório. Material e Métodos: análise e comparação de artigos científicos retrospectivos e prospectivos sobre a técnica MIPO, publicados nas bases de dados informatizadas PUBMED, LILACS, Scielo e ScienceDirect. Resultados: foram selecionados cinco artigos adequados aos critérios de inclusão proposto, dois prospectivos e três retrospectivos, todos publicados nos últimos seis anos e em língua inglesa. Com esses trabalhos realizou-se uma discussão e conclusão a respeito da aplicação da MIPO em pequenos animais. Conclusão: A hipótese de que a MIPO é eficaz é aceita. A MIPO é uma técnica segura e sua aplicação em pequenos animais tem demonstrado resultados satisfatórios. Porém, com os estudos realizados até o momento não é possível afirmar que a aplicação da MIPO é estatisticamente mais eficaz que as técnicas convencionais quando aplicada em cães e gatos

Atenção Psicossocial e Psicologia: um mapeamento da produção científica

By the end of the 1970´s, begins the Psychiatric Reform Movement, whose development was the beginning of the construction of a new model, here termed Psychosocial Attention, to substitute the traditional psychiatric model. As such, aspires to be a process of paradigm shift and, therefore, requires transformations in the fields: theoretical-conceptual, technical-assistance, legal-political e sociocultural. This qualitative study composes a research which sought to ascertain the scientific production on the topic conducted by psychology, from the implementation of the Brazilian National Health System and the creation of new services to mental health care. In this sense, it proposed to investigate how the papers published in journals of psychology found in the database LILACS, since 1990, contribute to the process of building a new model that actually replace the so-called traditional psychiatric model.

Zinc supplementation for the prevention of type 2 diabetes mellitus in adults with insulin resistance

BackgroundDiabetes is associated with long-term damage, dysfunction and failure of various organs, especially the eyes, kidneys, nerves, heart and blood vessels. The risk of developing type 2 diabetes increases with age, obesity and lack of physical activity. Insulin resistance is a fundamental aspect of the aetiology of type 2 diabetes. Insulin resistance has been shown to be associated with atherosclerosis, dyslipidaemia, glucose intolerance, hyperuricaemia, hypertension and polycystic ovary syndrome. The mineral zinc plays a key role in the synthesis and action of insulin, both physiologically and in diabetes mellitus. Zinc seems to stimulate insulin action and insulin receptor tyrosine kinase activity.ObjectivesTo assess the effects of zinc supplementation for the prevention of type 2 diabetes mellitus in adults with insulin resistance.Search methodsThis review is an update of a previous Cochrane systematic review published in 2007. We searched the Cochrane Library (2015, Issue 3), MEDLINE, EMBASE, LILACS and the ICTRP trial register (frominception toMarch 2015). There were no language restrictions. We conducted citation searches and screened reference lists of included studies.Selection criteriaWe included studies if they had a randomised or quasi-randomised design and if they investigated zinc supplementation compared with placebo or no intervention in adults with insulin resistance living in the community.Data collection and analysisTwo review authors selected relevant trials, assessed risk of bias and extracted data.Main resultsWe included three trials with a total of 128 participants in this review. The duration of zinc supplementation ranged between four and 12 weeks. Risk of bias was unclear for most studies regarding selection bias (random sequence generation, allocation concealment) and detection bias (blinding of outcome assessment). No study reported on our key outcome measures (incidence of type 2 diabetes mellitus, adverse events, health-related quality of life, all-cause mortality, diabetic complications, socioeconomic effects). Evaluation of insulin resistance as measured by the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) showed neutral effects when comparing zinc supplementation with control (two trials; 114 participants). There were neutral effects for trials comparing zinc supplementation with placebo for total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol and triglycerides (2 studies, 70 participants). The one trial comparing zinc supplementation with exercise also showed neutral effects for total cholesterol, HDL and LDL cholesterol, and a mean difference in triglycerides of -30 mg/dL (95% confidence interval (CI) -49 to -10) in favour of zinc supplementation (53 participants). Various surrogate laboratory parameters were also analysed in the included trials.Authors'conclusionsThere is currently no evidence on which to base the use of zinc supplementation for the prevention of type 2 diabetes mellitus. Future trials should investigate patient-important outcome measures such as incidence of type 2 diabetes mellitus, health-related quality of life, diabetic complications, all-cause mortality and socioeconomic effects.

Preoperative somatostatin analogues versus direct transsphenoidal surgery for newly-diagnosed acromegaly patients: a systematic review and meta-analysis using the GRADE system

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

Do anticoagulant and antiplatelet agents prevent acute graft thrombosis in renal transplantation? A meta-analysis of case series studies

Introduction & Objectives: Thrombosis of the renal allograft is expected to occur in 1–6% of kidney transplants, and graft loss is expected in almost all cases. Anticoagulant and anti-platelet agents could serve as an adjunctive preventive measure, but sound evidence of benefits are still lacking, in this setting. We therefore assessed the efficacy and safety of anticoagulant and anti-platelet agents, in reducing the rate of renal allograft thrombosis. Methods: A review of the literature was carried out in major databases (MEDLINE, EMBASE and LILACS), with a comprehensive search strategy, to locate all available case series studies of anticoagulant and/or anti-platelet prophylaxis of thrombosis in renal transplantation. The date of the last search was 11 August 2014. We pooled all case series in a proportional meta-analysis. Statistical significance was achieved if the 95% confidence intervals obtained for each intervention did not overlap. Results: Our search strategy retrieved 7160 titles, from which 21 case series were chosen for analysis. A total of 3246 patients were identified (1718 treated with antiplatelet and/or anticoagulant agents, and 1528 non-treated control subjects). Allograft thrombosis occurred in 7.24% (95% CI 3.45 to 12.27%) of the patients receiving no intervention, compared to 3.38% (95% CI 1.45 to 6.1%), 1.2% (95% CI 0.6 to 2.1%) and 0.47% (95% CI 0.001 to 1.79%), in the anticoagulant, aspirin, and aspirin + anticoagulant groups, respectively. Bleeding complication rates were 28.0% (95% CI 15.4 to 42.7%) for anticoagulants, compared to 12.13% (95% CI 0.8 to 33.93%) for aspirin + anticoagulant, 0.31% (95% CI 0.0001 to 1.32%) for aspirin, and 6.1% (95% CI 2.2 to 11.7%) for the control group. Conclusions: Aspirin is more effective in reducing allograft thrombosis, after kidney transplantation, whether alone or in association with an anticoagulant, when compared to no drug prophylaxis, and without higher haemorrhagic complication rates. Anticoagulants, when used alone, do not show a beneficial effect on thrombosis rates, additionally yielding higher bleeding rates.