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OBJECTIVE The aim of the study was to evaluate the effectiveness of interventions designed to reduce problems with readability and comprehensibility in drug labels. METHODS A systematic review of observational and experimental studies was conducted using MEDLINE (via PubMed), Embase, and Scopus databases. Two independent reviewers selected articles and collected data about study design, interventions, and outcomes. RESULTS Of 1786 studies screened, 17 were included in this systematic review. The main findings were described according to the type of intervention in the drug package or label: color-coded labels (7 studies); changes in information layout (5 studies); changes in font size (3 studies); and interventions involving look-alike/sound-alike (LASA) drugs (3 studies). Color changes were important both for healthcare professionals to improve safety in hospital practice and for medication users to differentiate between the types of insulin. Layout changes were effective and included highlighting key information, such as medication name, dose, and instructions. Increased font size yielded good results in the recognition and identification of medications mainly for the population with impaired vision. This review was limited by the heterogeneity of interventions and populations studied, as well as the small number of high-quality studies, which prevented meta-analysis across any one intervention or outcome. CONCLUSIONS All studies reported positive results for the proposed interventions. In the case of LASA drug names, the use of resources beyond Tall Man lettering (such as color and highlighting) reduced recognition errors, which may contribute to the development of new strategies to improve safety in the use of LASA drugs.

Background Colorectal cancer (CRC) is the third most common cancer among men, and the second among women worldwide. In Brazil, the incidence andmortality of CRC continues to increase. In colonoscopies, adenoma detection rates (ADRs) higher than 25% are associated linearly with better outcomes and lower rates of interval cancer. Objective To assess the colonoscopy quality indexes. Methods This is a cross-sectional retrospective study in which anatomopathological data and data regarding the colonoscopies were collected from the patient records of Hospital Moinhos de Vento, in Southern Brazil. The exams were performed by doctors from the Colorectal Service from June to August 2015. Results A total of 430 exams were included. Most patients were women (60.9% [262]), with a mean age of 56.96 years. The cecal intubation rate was of 96.7% (416). The quality of the bowel preparation was excellent or good in 92.95% (396) of the cases. The average time of removal of the colonoscope in normal exams was of 6.15 minutes. Polyps were detected in 201 patients (46.7%), and adenomas, in 125 patients (29.1%); 12 patients (2.8%) had advanced adenomas, and 6 (2.3%) had malignant neoplasms. The proximal serrated lesion detection rate (PSLDR) was of 6.7% (29). The prevalence ratio (PR) of adenomas among men was 1.78 times greater than in women (95% confidence interval [95%CI]: 1.16-2.75). The PR of adenomas among people aged 50 years or older was 2.41 times that of those under 50 years of age (95%CI: 1.43-4.06). Conclusion The data obtained are in line with international quality criteria in colonoscopy. More studies are needed to assess the ADR in the Brazilian population. Resumo Introdução O câncer colorretal (CCR) é o terceiro mais comum em homens e o segundo mais comum em mulheres em todo o mundo. A incidência e mortalidade do CRC continuam a aumentar no Brasil. Taxas de detecção de adenoma superiores a 25% em colonoscopias estão associadas linearmente a melhores resultados emenores taxas de câncer de intervalo. Objetivo Avaliar a qualidade das colonoscopias analisadas. Métodos Este é um estudo transversal e retrospectivo no qual dados anatomopatológicos e relacionados às colonoscopias foram coletados de registros dos pacientes do Hospital Moinhos de Vento, no Sul do Brasil. Os exames foram realizados por médicos do Serviço de Coloproctologia de junho a agosto de 2015. Resultados Foram incluídos 430 exames. A maioria dos pacientes era do sexo feminino (60,9% [262]), com idade média de 56,96 anos. A taxa de intubação cecal foi de 96,7% (416). A qualidade do preparo intestinal foi excelente ou boaem92,95% (396) dos casos.O tempomédio de retirada do colonoscópio emexames normais foi de 6,15 minutos. Pólipos foram detectados em 201 pacientes (46,7%), e adenomas, em 125 (29.1%); 12 pacientes (2,8%) tinhamadenomas avançados, e 6 (2,3%), neoplasias malignas. A taxa de detecção de lesões serrilhadas foi de 6,7% (29). A razão prevalência (RP) de adenomas emhomens foi de 1,78 vezes emrelação amulheres (intervalo de confiança de 95% [IC95%]: 1,16-2,75). A RP de adenomas entre pacientes com 50 anos ou mais foi 2,41 vezes maior do que a daqueles com mais de 50 anos (IC95%: 1,43-4,06). Conclusão Os dados obtidos estão de acordo com os critérios internacionais de qualidade em colonoscopia. Mais estudos são necessários para avaliar as taxas de detecção de adenoma na população brasileira.

PurposeTo determine whether teleophthalmology can help physicians in assessing and managing eye conditions and to ascertain which clinical conditions can be addressed by teleophthalmology in primary care setting.MethodsWe evaluated the resolution capacity of TeleOftalmo, strategy implemented in the public health system of southern Brazil. Resolution capacity was defined as the ability to fully address patients' eye complaints in primary care with remote assistance from ophthalmologists. Data from tele-eye reports were collected over 14 months. Resolution capacity was compared across different age groups and different ocular conditions.ResultsOverall, 8,142 patients had a tele-eye report issued in the study period. Resolution capacity was achieved in 5,748 (70.6%) patients. When stratified into age groups, the lowest capacity was 43.1% among subjects aged ≥65 years, while the highest was 89.7% among subjects aged 13-17 years (pConclusionsWith telemedicine support, primary care physicians solved over two-thirds of patients' eye or vision complaints. Refractive errors had high case resolution rates, thus having a great impact on reducing the number of referrals to specialty care. Teleophthalmology adoption in primary-care settings as part of the workup of patients with eye or vision complaints promotes a more effective use of specialty centers and will hopefully reduce waiting times for specialty referral.

RESUMO Introdução: Há diversas terapias sendo utilizadas, consideradas ou propostas para o tratamento da COVID-19, muitas carecendo de apropriada avaliação de efetividade e segurança. O propósito deste documento é fornecer recomendações baseadas nas evidências científicas disponíveis e em sua interpretação transparente, para subsidiar decisões sobre o tratamento farmacológico da COVID-19 no Brasil. Métodos: Um grupo de 27 especialistas e metodologistas integraram a força-tarefa formada pela Associação de Medicina Intensiva Brasileira (AMIB), pela Sociedade Brasileira de Infectologia (SBI) e pela Sociedade Brasileira de Pneumologia e Tisiologia (SBPT). Foram realizadas revisões sistemáticas rápidas, atualizadas até 28 de abril de 2020. A qualidade das evidências e a elaboração das recomendações seguiram o sistema GRADE. As recomendações foram elaboradas nos dias 5, 8 e 13 de maio de 2020. Resultados: Foram geradas 11 recomendações, embasadas em evidência de nível baixo ou muito baixo. Não há indicação para uso de rotina de hidroxicloroquina, cloroquina, azitromicina, lopinavir/ritonavir, corticosteroides ou tocilizumabe no tratamento da COVID-19. Heparina deve ser utilizada em doses profiláticas no paciente hospitalizado, mas não deve ser realizada anticoagulação na ausência de indicação clínica específica. Antibacterianos e oseltamivir devem ser considerados somente nos pacientes em suspeita de coinfecção bacteriana ou por influenza, respectivamente. Conclusão: Até o momento, não há intervenções farmacológicas com efetividade e segurança comprovada que justifiquem seu uso de rotina no tratamento da COVID-19, devendo os pacientes serem tratados preferencialmente no contexto de pesquisa clínica. As recomendações serão revisadas continuamente, de forma a capturar a geração de novas evidências. ABSTRACT Introduction: Different therapies are currently used, considered, or proposed for the treatment of COVID-19; for many of those therapies, no appropriate assessment of effectiveness and safety was performed. This document aims to provide scientifically available evidence-based information in a transparent interpretation, to subsidize decisions related to the pharmacological therapy of COVID-19 in Brazil. Methods: A group of 27 experts and methodologists integrated a task-force formed by professionals from the Brazilian Association of Intensive Care Medicine (Associação de Medicina Intensiva Brasileira - AMIB), the Brazilian Society of Infectious Diseases (Sociedad Brasileira de Infectologia - SBI) and the Brazilian Society of Pulmonology and Tisiology (Sociedade Brasileira de Pneumologia e Tisiologia - SBPT). Rapid systematic reviews, updated on April 28, 2020, were conducted. The assessment of the quality of evidence and the development of recommendations followed the GRADE system. The recommendations were written on May 5, 8, and 13, 2020. Results: Eleven recommendations were issued based on low or very-low level evidence. We do not recommend the routine use of hydroxychloroquine, chloroquine, azithromycin, lopinavir/ritonavir, corticosteroids, or tocilizumab for the treatment of COVID-19. Prophylactic heparin should be used in hospitalized patients, however, no anticoagulation should be provided for patients without a specific clinical indication. Antibiotics and oseltamivir should only be considered for patients with suspected bacterial or influenza coinfection, respectively. Conclusion: So far no pharmacological intervention was proven effective and safe to warrant its use in the routine treatment of COVID-19 patients; therefore such patients should ideally be treated in the context of clinical trials. The recommendations herein provided will be revised continuously aiming to capture newly generated evidence.

Objective The objective of this randomized controlled trial was to evaluate the efficacy of presenting information on the risks of side effects from a medicine, presented in different formats. Methods A randomized, parallel-group, single-center controlled trial was conducted among adult users of a training pharmacy. The information was categorized into the following groups: verbal descriptors + percentage range, percentage range and absolute percentage. The main outcomes were gist understanding and verbatim understanding, classified either as adequate or inadequate. The analyses were performed using ANOVA and Pearson’s chi-square test. Results A total of 393 participants were recruited from June to October 2015. Adequate levels of gist understanding and verbatim understanding were respectively 65.6% and 53.9% for the verbal descriptors + percentage range (n = 128), 63.4% and 44.3% for percentage range (n = 131), and 62.3% and 48.5% for absolute percentage (n = 131), with no statistically significant difference between the groups (p = 0.852 and p = 0.299, respectively). Conclusion The understanding of the information was similar in all three formats, but the percentages of adequate understanding were low. Practical implications The percentage of inadequate understanding demonstrated in this study indicates that alternative formats for reporting adverse reactions need to be evaluated.

O objetivo deste artigo foi avaliar a conformidade entre as recomendações de uso de medicamentos antidepressivos durante a amamentação, presentes em bulas, e as recomendações de fontes bibliográficas baseadas em evidências científicas. Foram avaliadas as bulas padrão de 23 antidepressivos com registro ativo no Brasil. A presença de contraindicação do uso do antidepressivo durante a amamentação foi comparada com as informações presentes no manual técnico do Ministério da Saúde, no livro Medications and Mothers’ Milk e nas bases de dados LactMed, Micromedex e UpToDate. Na maioria das bulas (62,5%), o antidepressivo é contraindicado na amamentação. Entre as fontes bibliográficas, esse percentual variou de 0% a 25%. O estudo aponta para baixa conformidade entre bulas e fontes bibliográficas, alertando sobre a necessidade de revisão do conteúdo e forma de apresentação das informações presentes nas bulas dos antidepressivos no Brasil. This article sought to evaluate the conformity between recommendations regarding antidepressant use during breastfeeding found in drug package inserts with recommendations from science-based bibliographic sources. We evaluated the standard drug package inserts of 23 antidepressants with active registration in Brazil. The presence of contraindications of antidepressant use during breastfeeding was compared with information present in the Brazilian Ministry of Health technical manual, the book Medications and Mothers’ Milk and on the databases LactMed, Micromedex and UpToDate. In most drug package inserts (62.5%), antidepressants are contraindicated during breastfeeding. Among bibliographical sources, that percentage varied between 0% and 25%. The study shows a low conformity between drug package inserts and bibliographical sources, alerting to the need for revising the content and presentation of information present in antidepressant drug package inserts in Brazil. El objetivo de este artículo fue evaluar la conformidad entre las recomendaciones de uso de medicamentos antidepresivos durante la lactancia, presentes en prospectos, y las recomendaciones de fuentes bibliográficas, basadas en evidencias científicas. Se evaluaron los prospectos estándar de 23 antidepresivos con registro activo en Brasil. La presencia de contraindicaciones en el consumo de antidepresivos durante la lactancia se comparó con la información presente en el manual técnico del Ministerio de la Salud, en el libro Medications and Mothers’ Milk, y en las bases de datos LactMed, Micromedex y UpToDate. En la mayoría de los prospectos (62,5%), el antidepresivo está contraindicado durante la lactancia. Entre las fuentes bibliográficas el porcentaje varió de 0% a 25%. El estudio señala la escasa conformidad entre prospectos y fuentes bibliográficas, alertando sobre la necesidad de revisión del contenido, así como de la forma de presentación de la información que aparece en los prospectos de los antidepresivos en Brasil.

O objetivo do artigo é estimar a prevalência de utilização de medicamentos em crianças de zero a seis anos, analisando as características sociodemográficas associadas, e avaliar a adequação dos medicamentos quanto às indicações em pediatria e às restrições por faixa etária. Estudo transversal de amostra constituída por crianças de seis anos ou menos residentes em uma cidade no sul do Brasil, através de amostragem por conglomerados. Aplicou-se questionário padronizado sobre o uso de medicamentos nos 15 dias anteriores à entrevista. Foi realizada análise descritiva e avaliada a associação entre o uso de medicamentos e fatores sociodemográficos, além da análise da adequação dos medicamentos mais prevalentes. Das 687 crianças avaliadas, 52% utilizaram pelo menos um medicamento no período estudado. Não foram encontradas associações entre o uso de medicamentos e características sociodemográficas, à exceção da renda per capita mensal. O medicamento mais utilizado foi o paracetamol (17,1%), seguido da amoxicilina (9,5%) e da dipirona (8,4%). Entre os dez medicamentos mais utilizados, seis apresentaram restrições de faixa etária em pediatria. Os resultados indicam uso expressivo de medicamentos, incluindo os com restrições de faixa etária, particularmente em crianças menores de dois anos. The scope of this article was to estimate the prevalence of medication use in children between zero and six years old, analyzing the associated socio-demographic characteristics, and evaluating the adequacy of the medication with respect to pediatric recommendations and restrictions per age group. A cross-sectional study was conducted by means of cluster sampling on a sample comprised of children aged six or under, residents of a city in the south of Brazil. A standardized questionnaire about medication use 15 days prior to the interview was applied. A descriptive analysis was carried out, and the association between medication use and socio-demographic factors was evaluated, as well as the analysis of the pediatric adequacy of the most prevalent medication. Of the 687 children evaluated, 52% used at least one drug in the period. Associations between medication use and socio-demographic characteristics were not found, with the exception of per capita monthly income. The most prevalent medication was paracetamol (17.1%), followed by amoxicillin (9.5%) and dipyrone (8.4%). Among the ten drugs most used in children, six had pediatric restrictions for the age group. The results indicate significant use of medication, including medication with age restrictions, particularly for children under two years of age.

Objective: To assess the agreement between three recall periods for self-reported drug use using a 24-hour recall period as reference. Methods: Participants were allocated into three groups with different recall periods of 7, 14 and 30 days and were interviewed at two different times. A 24-hour recall questionnaire was answered during the first interview, and a questionnaire on drug use over the different recall periods tested was answered during the second interview. The agreement between the questionnaires was evaluated using percent agreement and kappa. Results: For continuous drugs, percent agreement varied between 92 and 99% and kappa varied between 0.71 and 0.97 for three periods tested. For drugs of occasional use, percent agreement varied between 63 and 81% and kappa varied between 0.27 and 0.52. The prevalence of drugs, particularly those of occasional use, increases with time. Conclusions: The high level of agreement between the three recall periods suggests that all of them are valid for the investigation of drugs of continuous use. RESUMO: Objetivo: Avaliar a concordância entre três períodos recordatórios para o auto-relato do uso de medicamentos, utilizando o período recordatório de 24 horas como referência. Métodos: Os participantes foram alocados em três grupos de acordo com os períodos recordatórios de 7, 14 e 30 dias e entrevistados em dois momentos. Um recordatório de 24 horas foi respondido na primeira entrevista e, um questionário sobre o uso de medicamentos com os diferentes períodos recordatórios avaliados foi respondido na segunda entrevista. A concordância entre os questionários foi avaliada pelo percentual de concordância e kappa. Resultados: O percentual de concordância variou entre 92 a 99% e o kappa de 0,71 a 0,97 para os medicamentos de uso contínuo nos três períodos recordatórios. Para os medicamentos de uso eventual, o percentual de concordância variou entre 63 a 81% e o kappa oscilou entre 0,27 a 0,52. A prevalência do uso de medicamentos, particularmente para os de uso eventual, aumentou com o tempo. Conclusão: A análise de concordância sugere que os três períodos recordatórios avaliados são válidos para a investigação da utilização de medicamentos de uso contínuo.