Role of the clinical pharmacist in detection of drug therapy problemas in critically impatients: experience report

This is an experience report on clinical pharmacy in New York, United States of America, in a teaching hospital, describing the results of drug therapy monitoring in critically ill patients, as well as interventions to solve or prevent identified drug therapy problems. The cross-sectional study was conducted by the clinical staff at the Surgical Intensive Care Unit during August 20th to 24th, 2012. Blood counts, serum levels of certain antibiotics, microbiological cultures and their antibiotic susceptibility, possible drug interactions, dosage of each drug prescribed and the compatibility between the route of administration and pharmaceutical form were assessed daily through review of electronic medical records. Twenty seven patients were followed up and 16 drug therapy problems were identified: Unnecessary drug therapy (seven), adverse drug reaction (four), needs additional drug therapy (two), noncompliance (two) and dosage too low (one). After evaluation, the drug therapy problems and their pharmaceutical interventions were reported to clinical pharmaceutical responsible for the Surgical ICU, as well as the multidisciplinary team. Further, the clinical outcomes were monitored and interventions were classified as to its acceptance. Data demonstrate that clinical pharmacists can contribute to the security and proper use of medications, as the trigger tools for intensive monitoring helps in early detection of drug therapy problems and patient safety.

Os princípios pedagógicos de Freire e Steiner e suas relações com os meios eletrônicos do cotidiano discente

Pós-graduação em Educação - IBRC

Crianças desatentas ou práticas pedagógicas sem sentido? Relações entre motivo, sentido pessoal e atenção

The objective of this paper is to analyze the role of pedagogical activity in the formation of attention. first, we present critically the concept of adhd analyzing the criteria used for its diagnosis. analyze, then, the process of constitution of attention as higher psychological function by examining their relationship with the structure of pedagogical activity. finally, we focus on the relationships between the motives of activity and the formacion of attention, presenting the concept of actions that generate motives for learning as an important theoretical tool that can put the teacher in the active role of producer new motives to bring students to develop psychological functions superiors, including attention. as conclusion, we criticize the medicalization process, bringing the challenge of to develop attention for its real locus, school education.

Synergism of crude extracts and essential oils from medicinal plants with antimicrobial drugs

The emergence of resistant strains to conventional antimicrobial drugs has been constant as well as research aimed new alternatives of antibacterial agents. Therefore, considering that natural products have been an important potential source of new antimicrobial drugs, aim to verify the synergism by disk and time kill curve method between antimicrobials (extracts-Ext. and essential oils-EO) from four plant and eight antimicrobial drugs against Staphylococcus aureus and Escherichia coli strains from human specimens. The S. aures strains were highly susceptible with all plant antimicrobials (eg., 1.24 mg/ml with Vernonia polyanthes Ext. and 2.21 mg/ml with Eugenia uniflora EO for the Minimal Inhibitory Concentration-MIC). According disk method, the Bacharis dracunculifolia and V. polyanthes EO had synergism with all eight tested drugs while only Matricaria chamomilla Ext. showed synergism against S. aureus. The synergism was found with V. polyanthes and E. uniflora Ext. while M. chamomilla Ext. had antagonism against E. coli strains. By time kill curve, the bacterial growth inhibition was superior when drugs were tested alone and the synergism effect also was verified. The antagonism effect was detected only for E. coli strains and only with Ext. Results indicated the potential use of these products as coadjutants during treatment of infectious diseases.

Effect of natural antimicrobials on microbiological and sensorial quality of fresh-cut cantaloupe melon

The effect of different natural antimicrobials on the microbiological and sensorial quality of fresh-cut Cantaloupe melons stored up to 10 days at 5°C was examined. Pieces of melon were washed for 1 min at 5ºC in water (control), vanillin (1000 mg/L and 2000 mg/L) or cinnamic acid (148.16 mg/L and 296.32 mg/L). Other antimicrobial treatments consisted of packaging the pieces of melon with an antimicrobial pad which contained cinnamic acid (148.16 mg/L and 296.32 mg/L). After 10 days of storage, significant differences among antimicrobials treatments and water treatment were found. In water treatment, the psychrotroph load was 3.63 ± 0.09 log cfu g-1 meanwhile on all antimicrobial treatments the values ranged from 3.04 ±0.13 log cfu g-1 to 3.28±0.1 log cfu g-1. Mesophilic growth in the control treatment averaged 6.79±0.06 log cfu g-1 meanwhile on antimicrobial treatments the counts were from 5.15±0.01 log cfu g-1 to 5.30±0.03 log cfu g-1. Total coliform levels were 7.8±0.1 log cfu g-1 when melon was washed in water, followed by washing with cinnamon (296.32 mg/L) at 6.5 log cfu g-1 and for the rest of the treatments were around 5.5 log cfu g-1. The treatments did not display differences among mould and yeast growth after 10 days of storage. The sensorial quality decreased throughout storage. However, at the end of storage, the scores ranged between 6.5 and 7, above the minimum level for marketability (level 5). Sensorial panelist noted a ‘sweet’ taste when vanillin was used as sanitizer. In all antimicrobial treatments, no relation was found between a higher dose and a higher microbial reduction. So, vanillin at 1000 mg/L in water or cinnamic acid at 148.16 mg/L provided in water dip or as a pad inside the trays could be optimal natural sanitizers to substitute the use of chlorine in fresh-cut products as Cantaloupe melon.

Cutting Cursive: Is Handwriting Still Important to Today’s Preservice Teacher?

Handwriting is a tool for communication often untaught that has effects on learning and long-term development for students of the future. Handwriting used to be needed in order to function in society, however, today that skill is no longer needed. New technology, current teaching methods and societal needs have caused handwriting to be overlooked in many school districts. Classrooms are overwhelmed with information and many schools are simply running out of time to teach cursive, therefore no longer making it a priority. Handwriting is a perceptual motor skill requiring higher cognitive thinking, something that most primary school children find difficult, yet it is still needed in the school curriculum and provides a stable foundation for students of the future. The questions to be addressed by my research are to examine the factors that have led to the demise of cursive writing in elementary schools. I will research the complex issues that have contributed to the decline of cursive handwriting. This will include my investigation into the factors that technology has played, along with societal needs. I will interview preservice teachers, those students in college preparing to become teachers, and try to understand where the importance for teaching handwriting started and ended. By the end of my research I want to have constructed a timeline of events to explain the demise of this needed skill. My methodology for this research will be to gather information from various primary and secondary literature review sources. I want to understand when cursive started to disappear from the curriculum and why.

The western gray whale: a review of past exploitation, current status and potential threats

Gray whales (Eschrichtius robustus) occur along the eastern and western coastlines of the North Pacific as two geographically isolated populations and have traditionally been divided into the eastern (California-Chukchi) and western (Korean-Okhotsk) populations. Recent molecular comparisons confirm, based on differences in haplotypic frequencies, that these populations are genetically separated at the population-level. Both populations were commercially hunted, but only the eastern gray whale has returned to near pre-exploitation numbers. In contrast, the western population remains highly depleted, shows no apparent signs of recovery and its future survival remains uncertain. Research off Sakhalin Island, Russia between 1995 and 1999 has produced important new information on the present day conservation status of western gray whales and provided the basis for the World Conservation Union (IUCN) to list the population as 'Critically Endangered in 2000. The information presented here, in combination with potential impacts from anthropogenic threats throughout the range of this population, raises strong concerns about the recovery and continued survival of the western gray whale.

PUBLIC POLICY EDUCATION: AN IMPORTANT WILDLIFE MANAGEMENT OPPORTUNITY

Suburban wildlife management issues are generating heated debate between citizen organizations, elected public officials, and state wildlife management agencies. Decisions are being made by town and county officials which directly impact or supersede state authority for managing resident wildlife. As an example, I will focus this discussion on the white-tailed deer (Odocoileus virginianus), management controversy at Durand Eastman Park, in the greater Rochester metropolitan area, New York.

Two important but almost never related beliefs

Engelmann believes in two general strong beliefs. On one side, Engelmann believes in probabilistic skepticism. That the existence has its maximum probability or there is no existence at all is not possible. The other probabilities of existence are always possible. On the other hand, instead of elements that constitute a beginning arrived at by an unknown division, the Gestalt theory begins with wholes or Gestalten. These Gestalten can be divided in parts but each part can be only a part of his specific Gestalt. The majority of probabilistic skeptics and the majority of Gestalt theory followers do not believe they can be together accepted. On the contrary Engelmann is a member of a small group that both beliefs occur simultaneously. Bibace`s questions were each answered by Engelmann. In some questions Engelmann harmonize with Bibace, in others they disagree.

Cold Shock Genes cspA and cspB from Caulobacter crescentus Are Posttranscriptionally Regulated and Important for Cold Adaptation

Cold shock proteins (CSPs) are nucleic acid binding chaperones, first described as being induced to solve the problem of mRNA stabilization after temperature downshift. Caulobacter crescentus has four CSPs: CspA and CspB, which are cold induced, and CspC and CspD, which are induced only in stationary phase. In this work we have determined that the synthesis of both CspA and CspB reaches the maximum levels early in the acclimation phase. The deletion of cspA causes a decrease in growth at low temperature, whereas the strain with a deletion of cspB has a very subtle and transient cold-related growth phenotype. The cspA cspB double mutant has a slightly more severe phenotype than that of the cspA mutant, suggesting that although CspA may be more important to cold adaptation than CspB, both proteins have a role in this process. Gene expression analyses were carried out using cspA and cspB regulatory fusions to the lacZ reporter gene and showed that both genes are regulated at the transcriptional and posttranscriptional levels. Deletion mapping of the long 5'-untranslated region (5'-UTR) of each gene identified a common region important for cold induction, probably via translation enhancement. In contrast to what was reported for other bacteria, these cold shock genes have no regulatory regions downstream from ATG that are important for cold induction. This work shows that the importance of CspA and CspB to C. crescentus cold adaptation, mechanisms of regulation, and pattern of expression during the acclimation phase apparently differs in many aspects from what has been described so far for other bacteria.

Effluent volume and dialysis dose in CRRT: time for reappraisal

The results of several studies assessing dialysis dose have dampened the enthusiasm of clinicians for considering dialysis dose as a modifiable factor influencing outcomes in patients with acute kidney injury. Powerful evidence from two large, multicenter trials indicates that increasing the dialysis dose, measured as hourly effluent volume, has no benefit in continuous renal replacement therapy (CRRT). However, some important operational characteristics that affect delivered dose were not evaluated. Effluent volume does not correspond to the actual delivered dose, as a decline in filter efficacy reduces solute removal during therapy. We believe that providing accurate parameters of delivered dose could improve the delivery of a prescribed dose and refine the assessment of the effect of dose on outcomes in critically ill patients treated with CRRT.

Persistent luminescence mechanisms: human imagination at work

The present status and future progress of the mechanisms of persistent luminescence are critically treated with the present knowledge. The advantages to be achieved by a further need as well as the pitfalls of the excessive use of imagination are shown. As usual, in the beginning of the present era of persistent luminescence since the mid 1990s, the imagination played a more important role than the sparse solid experimental data and the chemical common sense and knowledge was largely ignored. Since some five years, the mechanistic studies seem to have reached the maturity and - perhaps deceivingly - it seems that there are only details to be solved. However, the development of red emitting nanocrystalline materials poses a challenge also to the more fundamental studies and interpretation. The questions still luring in the darkness include the problems how the increased surface area affects the defect structure and how the "persistent energy transfer" really works. There is still some light to be thrown onto these matters starting with agreeing on the terminology: the term phosphorescence should be abandoned altogether. The long lifetime of persistent luminescence is due to trapping of excitation energy, not to the forbidden nature of the luminescent transition. However, the technically well-suited term "afterglow" should be retained for harmful, short persistent luminescence. (C) 2012 Optical Society of America

Low pressure support changes the rapid shallow breathing index (RSBI) in critically ill patients on mechanical ventilation

Background: The rapid shallow breathing index (RSBI) is the most widely used index within intensive care units as a predictor of the outcome of weaning, but differences in measurement techniques have generated doubts about its predictive value. Objective: To investigate the influence of low levels of pressure support (PS) on the RSBI value of ill patients. Method: Prospective study including 30 patients on mechanical ventilation (MV) for 72 hours or more, ready for extubation. Prior to extubation, the RSBI was measured with the patient connected to the ventilator (Drager (TM) Evita XL) and receiving pressure support ventilation (PSV) and 5 cmH(2)O of positive end expiratory pressure or PEEP (RSBI_MIN) and then disconnected from the VM and connected to a Wright spirometer in which respiratory rate and exhaled tidal volume were recorded for 1 min (RSBI_ESP). Patients were divided into groups according to the outcome: successful extubation group (SG) and failed extubation group (FG). Results: Of the 30 patients, 11 (37%) failed the extubation process. In the within-group comparison (RSBI_MIN versus RSBI_ESP), the values for RSBI_MIN were lower in both groups: SG (34.79 +/- 4.67 and 60.95 +/- 24.64) and FG (38.64 +/- 12.31 and 80.09 +/- 20.71; p<0.05). In the between-group comparison, there was no difference in RSBI_MIN (34.79 +/- 14.67 and 38.64 +/- 12.31), however RSBI_ESP was higher in patients with extubation failure: SG (60.95 +/- 24.64) and FG (80.09 +/- 20.71; p<0.05). Conclusion: In critically ill patients on MV for more than 72h, low levels of PS overestimate the RSBI, and the index needs to be measured with the patient breathing spontaneously without the aid of pressure support.

Invasive aspergillosis: a severe infection in juvenile systemic lupus erythematosus patients

Infections are an important cause of morbidity and mortality in juvenile systemic lupus erythematosus (JSLE). Among them, invasive aspergillosis (IA), which is usually related to immunosuppressed patients, has been rarely reported in JSLE. From 1983 to 2011, 5604 patients were followed at our institution and 283 (5%) met the American College of Rheumatology (ACR) classification criteria for SLE. Six (2.1%) of our JSLE patients had IA. One of them was previously reported and five will be described herein. Four of them were female. The median age at JSLE diagnosis was 12 years (8-16) and the median interval between diagnosis of JSLE and IA was 6 months (1-38). All had pulmonary involvement and three of them had systemic involvement. The median Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) was 19 (7-22). Diagnosis of IA was performed by isolation of Aspergillus spp., two in bronchoalveolar lavage culture and by way of autopsy in the others. All of them were treated with corticosteroids and/or immunosuppressive drugs at IA diagnosis (azathioprine and/or intravenous cyclophosphamide). They all required treatment in the pediatric intensive care unit with mechanical ventilation and antifungal therapy (fluconazole, amphotericin B, itraconazole and/or voriconazole); nonetheless, none of them survived. In conclusion, this was the first report that evaluated the prevalence of IA in a large population of JSLE patients from a tertiary pediatric hospital, and clearly showed the severity of the outcome, especially in patients with active disease and treated with immunosuppressive agents. This study reinforces the importance of early diagnosis and treatment with certain antifungals, especially in critically ill patients. Lupus (2012) 21, 1011-1016.

Electroconvulsive Therapy in Brazil After the "Psychiatric Reform" A Public Health Problem-Example From a University Service

Objectives: The Brazilian public health system does not provide electroconvulsive therapy (ECT), which is limited to a few academic services. National mental health policies are against ECT. Our objectives were to analyze critically the public policies toward ECT and present the current situation using statistics from the Institute of Psychiatry of the University of Sao Paulo (IPq-HCFMUSP) and summary data from the other 13 ECT services identified in the country. Methods: Data regarding ECT treatment at the IPq-HCFMUSP were collected from January 2009 to June 2010 (demographical, number of sessions, and diagnoses). All the data were analyzed using SPSS 19, Epic Info 2000, and Excel. Results: During this period, 331 patients were treated at IPq-HCFMUSP: 221 (67%) were from Sao Paulo city, 50 (15.2%) from Sao Paulo's metropolitan area, 39 (11.8%) from Sao Paulo's countryside, and 20 (6.1%) from other states; 7352 ECT treatments were delivered-63.0% (4629) devoted entirely via the public health system (although not funded by the federal government); the main diagnoses were a mood disorder in 86.4% and schizophrenia in 7.3% of the cases. Conclusions: There is an important lack of public assistance for ECT, affecting mainly the poor and severely ill patients. The university services are overcrowded and cannot handle all the referrals. The authors press for changes in the mental health policies.