Search

Each patient admitted to the hospital is subject to one medication error per day, since the occurrence of this one with the potential to cause harm is three times more common in pediatric hospitalized patients than in adults. These harms can result from inaccurate or incomplete drug use histories when patients undergo a clinical evaluation, which jeopardizes patient safety and compromises hospitalization costs. Thus, medication reconciliation (MC) emerges as a possible solution to avoid the occurrence of these in pediatric patients and directly contributes to reducing costs in the hospital environment and increasing quality of life). Therefore, this study proposes to determine whether pharmacist-led medication reconciliation is a cost-effective strategy to improve health outcomes in pediatric patients.A randomized clinical trial will be carried out, over eight months, to carry out the cost analysis. Micro-costing pharmacoeconomic model through a questionnaire and clinical interview to collect the variables necessary for the study and comparison of the control and intervention groups. Participants in this study will be children aged 0 days to 12 years, admitted to the hospital. The perspective adopted will be that of the hospital. To assess the economic outcomes of MC, the cost-effect pairs will be categorized and visually represented in the cost-effectiveness plan to compare the intervention and control groups. Monte Carlo simulation and univariate sensitivity analysis will be performed to test the robustness of the findings.The clinical trial was approved by the Research Ethics Committee of the Federal University of Sergipe (CAAE: 19625319.6.0000.5546 and opinion number: 3,630,579). This protocol fully adhered to the recommendations of the 2010 CONSORT Declaration and was registered in the Brazilian Registry of Clinical Trials (ReBEC): RBR-25dnqsk.

BACKGROUND The clinical activities developed by pharmacists in a hospital environment can improve health outcomes and generate savings for hospitals. However, to determine whether pharmaceutical interventions are cost effective, it is essential to define a method according to which cost-effectiveness is intended to be measured. In addition, the quality of economic assessments and the amount of information present in systematic reviews in the literature make it difficult to analyze the effects of this intervention. OBJECTIVE This paper aims to provide an overview of systematic reviews on the pharmacoeconomic impact of the performance of pharmaceutical care in hospitals. METHODS A systematic search of the Cochrane Library databases, PubMed or MEDLINE, LILACS, Scopus, Web of Science, Google Scholar, and Open Thesis will be performed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. The search will involve the use of keywords determined using the Medical Subject Headings database to define the search terms and include the following terms: “pharmacoeconomics,” “pharmaceutical care,” and “hospital.” The study designs to be included will be systematic reviews of good quality. Studies will be included that address pharmacoeconomics; studies that evaluated pharmaceutical care in hospitals; and studies published in Portuguese, English, or Spanish. The primary outcome sought in the systematic reviews will be the cost ratio in monetary units and the outcomes in monetary or natural units. The secondary economic outcomes considered will be determined based on factors associated with the drugs and translated into benefit, efficacy, or utility. RESULTS It is intended to start this overview in January 2023. Thus far, only previous searches have been carried out to contextualize the theme and build the protocol. CONCLUSIONS This overview will determine the pharmacoeconomic impact of pharmaceutical care interventions in the hospital environment. In addition, this study will point out which clinical outcomes in natural units are impacted by the performance of pharmaceutical care and the strengths and limitations of each approach. It will also identify gaps in the literature and areas for future work. CLINICALTRIAL PROSPERO CRD42019140665; https://tinyurl.com/bddwnz43

BACKGROUND: Effective communication regarding the use of medications in hospital environments is a process that contributes to patient safety. Despite its importance, written communication about the medication use process in medical records remains insufficiently investigated. AIM: To describe the documentation in medical records regarding the medication use process by pharmacists, physicians and nurses on admission, during the hospital stay, and at hospital discharge. METHOD: A retrospective cross-sectional chart review study was carried out in medical records of patients admitted to a teaching hospital in Northeast Brazil. The study considered all patients admitted between December 2016 and February 2017, aged 18 or older and hospitalised for at least 48 hours. Clinical notes made by pharmacists, physicians and nurses were examined at three transition points of care. Data were collected using a questionnaire relating to the use of medications prior to hospital admission, changes in the prescribed medications during the hospital stay and discharge, as well as prescription non-conformities. Communication failures between the three healthcare professional groups were analysed and classified. The study was authorised by the Hospital's Board of Directors and approved by the Research Ethics Committee of the Federal University of Sergipe. RESULTS: This study included 202 medical records of patients with a mean age of 51.48 (SD 6.42, range: 19-97) years. There was no record of a patient or relative interview on allergies and adverse drug reactions in 54 (26.8%) physician notes, 44 (21.9%) nursing notes, and 9 (25.0%) pharmacist notes. Moreover, 1,588 changes in prescriptions were identified during data collection, and 1,198 (75.4%) of these were unjustified. CONCLUSION: Medication-related information in medical records was incomplete and inconsistent in the clinical notes of the three studied professions, especially in pharmacists' documentation. Future studies should focus on investigating the consequences of interprofessional communication in patient care.

Fundamento: O diagnóstico da hipertensão arterial resistente (HAR) requer a identificação e exclusão de casos de pseudorresistência, que por sua vez deve-se à (1) má técnica de medição da pressão arterial (PA), (2) efeito do jaleco branco, (3) baixa adesão terapêutica e/ou (4) esquema terapêutico inadequado. Objetivo: Este estudo teve como objetivo avaliar prevalência de hipertensão pseudorresistente (HAPR) causada pela presença de Inadequação do Regime Terapêutico (IRT). Métodos: Foi realizado um estudo transversal com pacientes atendidos na atenção primária em Maceió entre dezembro de 2013 a fevereiro de 2014. Foram incluídos pacientes com diagnóstico de hipertensão e em tratamento medicamentoso. Os pacientes foram avaliados quanto ao uso de medicamentos, análise do esquema terapêutico anti-hipertensivo, adesão terapêutica, valores de Pressão Arterial Sistólica (PAS) e Pressão Arterial Diastólica (PAD). Resultados: Foram incluídos no estudo 183 pacientes, destes 8 (4,3%) apresentaram HAR e 12 (6,6%) apresentaram HAPR. Todos os pacientes com HAPR apresentaram IRT entre os pacientes com HAS primária 74,8% foram expostos a IRT (p=0,000). O tipo de IRT mais frequente entre pacientes com HAPR foi a inércia terapêutica. Conclusão: Deste modo, concluímos que a IRT é recorrente entre pacientes com HAPR, sendo a inércia terapêutica o tipo de IRT mais frequente.

ObjectiveTo determine the incidence of medication discrepancies in transition points of care of hospitalised children.DesignA prospective observational multicentre study was carried out between February and August 2019. Data collection consisted of the following steps: sociodemographic data collection, clinical interview with the patient’s caregiver, review of patient prescriptions and evaluation of medical records. Medication discrepancies were classified as intentional (documented or undocumented) and unintentional. In addition, discrepancies identified were categorised according to the medication discrepancy taxonomy. Unintentional discrepancies were assessed for potential clinical harm to the patient.SettingPaediatric clinics of four teaching hospitals in Brazil.PatientsChildren aged 1 month–12 years.FindingsA total of 248 children were included, 77.0% (n=191) patients had at least one intentional discrepancy; 20.2% (n=50) patients had at least one unintended discrepancy and 15.3% (n=38) patients had at least one intentional discrepancy and an unintentional one. The reason for the intentional discrepancy was not documented in 49.6% (n=476) of the cases. The most frequent unintentional discrepancy was medication omission (54.1%; n=66). Low potential to cause discomfort was found in 53 (43.4%) unintentional discrepancies, while 55 (45.1%) had the potential to cause moderate discomfort and 14 (11.5%) could potentially cause severe discomfort.ConclusionsAlthough most medication discrepancies were intentional, the majority of these were not documented by the healthcare professionals. Unintentional discrepancies were often related to medication omission and had a potential risk of causing harm to hospitalised children.

Aims This review aims to determine the prevalence of clinically manifested drug-drug interactions (DDIs) in hospitalized patients. Methods PubMed, Scopus, Embase, Web of Science, and Lilacs databases were used to identify articles published before June 2019 that met specific inclusion criteria. The search strategy was developed using both controlled and uncontrolled vocabulary related to the following domains: “drug interactions,” “clinically relevant,” and “hospital.” In this review, we discuss original observational studies that detected DDIs in the hospital setting, studies that provided enough data to allow us to calculate the prevalence of clinically manifested DDIs, and studies that described the drugs prescribed or provided DDI adverse reaction reports, published in either English, Portuguese, or Spanish. Results From the initial 5,999 articles identified, 10 met the inclusion criteria. The pooled prevalence of clinically manifested DDIs was 9.2% (CI 95% 4.0–19.7). The mean number of medications per patient reported in six studies ranged from 4.0 to 9.0, with an overall average of 5.47 ± 1.77 drugs per patient. The quality of the included studies was moderate. The main methods used to identify clinically manifested DDIs were evaluating medical records and ward visits (n = 7). Micromedex® (27.7%) and Lexi-Comp® (27.7%) online reference databases were commonly used to detect DDIs and none of the studies evaluated used more than one database for this purpose. Conclusions This systematic review showed that, despite the significant prevalence of potential DDIs reported in the literature, less than one in ten patients were exposed to a clinically manifested drug interaction. The use of causality tools to identify clinically manifested DDIs as well as clinical adoption of DDI lists based on actual adverse outcomes that can be identified through the implementation of real DDI notification systems is recommended to reduce the incidence of alert fatigue, enhance decision-making for DDI prevention or resolution, and, consequently, contribute to patient safety.

O presente trabalho prospectou artigos científicos relacionadas à alimentos e produtos naturais com atividade anti-Covid com o intuito de apresentar, à comunidade científica, aos governos e à sociedade, dados sobre as principais estratégias nutracêuticas, biotecnológicas e plantas medicinais utilizadas em alguns países durante o enfrentamento da pandemia COVID-19. A revisão de artigos sobre alimentos, plantas medicinais e produtos biotecnológicos foi realizada nas bases de dados periódicos da CAPES, PubMed, Science Direct, Willey on line library, Springer-Nature, Taylor & Francis, BMC, Hindawi, Scielo, ACS – American Chemical Society, Google acadêmico, “The LENS” e Questel-Orbit. Alimentos de uso frequente como alho, gengibre, cúrcuma, laranja azeda, vegetais e lactobacilos demonstraram ação anti-coronavirus comprovada. Foram descritos usos de plantas medicinais da Medicina tradicional Chinesa, Coreana, Indiana bastante utilizadas durante a pandemia. Algumas plantas medicinais e nutracêuticos como: extrato de própolis verde e extrato de própolis vermelha brasileiras, geleia real, pólen e mel também foram citados como produtos anti-covid, antiinflamatórios naturais e imunomodulatórios.

This study aims to evaluate the effect of an intervention focused on medication adherence to improve blood at three basic health units in Maceio, Brazil. Patients were followed-up for three months. Primary outcomes were pressure control in patients with pseudoresistant hypertension. A randomized controlled clinical trial was conducted mean values of systolic blood pressure (SBP) and diastolic blood pressure (DBP). 185 patients were included, 145 of whom were randomly assigned to the experimental group, while 40 were allocated to the control group. After three months of follow-up, SBP did not change significantly in any of the groups; however, there was a significant reduction in DBP in the group submitted to intervention. Similar interventions given to patients with hypertension, without suspicion of resistant hypertension have focused exclusively on SBP. Key words: Resistant hypertension to conventional therapy, medication adherence, blood pressure.

Background Approximately 5–7 % of pregnant women have hypertension during pregnancy, requiring antihypertensive drug treatment. There have been a lack of studies evaluating how drug-related problems (DRPs) affect morbidity or mortality in the postpartum period among women with a history of preeclampsia. Objective To determine the influence of drug-related problems on length of hospital stay of postpartum women with a history of preeclampsia. Methods This cross-sectional study included postpartum women diagnosed with preeclampsia, from June to November 2016, in two teaching maternity hospitals in Brazil. The outcomes assessed were, length of hospital stay of postpartum women. The DRPs were classified through the Pharmaceutical Care Network Europe Foundation (PCNE) v 8.01. Results 600 women were included, and 354 (59%) were exposed to at least one DRP. The most frequent DRPs were no administration of the prescribed medication, lack of prescription of a medication, although the indication was clear, and ineffectiveness (unknown reason). In patients exposed to DRP, the average length of hospital stay after labour was 5.4 (S.D. 3.6) days versus 4.4 (S.D. 3.3) days in patients non-exposed to DRP (p = 0.0001). The period (in days) to achieve blood pressure control after labour was 4.5 (S.D. 3.5) 3.5 (S.D. 3.2), respectively (p = 0.0001). There were no deaths during the study. Conclusion and Relevance Drug-related problems significantly increased the length of hospital stay in postpartum women with a history of preeclampsia.

Objective The aim of the study was to determine the prevalence and main types of harm caused by high-alert medication after medication errors (MEs) in hospitals. Method A literature systematic review was conducted on PubMed, Scopus, Web of Science, and Lilacs. Eligible studies published until June 2017 were included. Result Of 6244 studies identified through searching four electronic databases, five studies meeting the selection criteria of this study were analyzed. There was wide variation in the overall prevalence of harm due to MEs involving HAM, from 3.8% to 100%, whereas the pooled prevalence was 16.3%. Overall, 0.01% of harm caused by MEs involving HAM resulted in death. The severity of errors ranged from 0.1% to 19.2% for moderate errors, 0.2% to 15.4% for serious errors, and 1.9% lethal to the patients. The highest prevalences of harm occurred after errors involving potassium chloride 15%, insulin, and epoprostenol. The lowest prevalence of harm was related to errors of anticoagulants administration. The methodological heterogeneity limited direct comparisons among the studies. Conclusions Of the 15 drugs on the list of Institute for Safe Medication Practices HAMs in the United States and Brazil, nine did not present scientific evidence of the potential for harm. In general, few studies, characterized by methodological and conceptual heterogeneity, were performed to determine the harm prevalence resulting from errors involving these drugs.

A Hipertensão Resistente (HAR) se manifesta quando os valores de pressão arterial (PA) permanecem acima da meta, apesar do uso regular de três classes de fármacos anti-hipertensivos, incluindo um diurético. Este estudo teve como objetivo identificar a HAR e a hipertensão pseudo-resistente em pacientes atendidos em uma Unidade de Saúde da Família. Foi realizado um estudo transversal com pacientes hipertensos em uso de medicamentos anti-hipertensivos atendidos em uma Unidade Básica de Saúde localizada no município de Maceió, por meio de entrevistas, com aplicação de questionário estruturado durante visitas domiciliares. Os valores de PA dos pacientes foram monitorados durante três semanas consecutivas. A adesão terapêutica foi determinada por meio da aplicação da Escala de Adesão Terapêutica de oito itens de Morisky (MMAS-8). Foram investigados 50 pacientes, com média de idade de 66,4 anos (DP = 13,5), sendo que a maioria dos pacientes era do sexo feminino (74%). Entre os pacientes estudados, 39 foram classificados com hipertensão pseudo-resistente (78%); destes, 28 utilizavam esquemas anti-hipertensivos considerados inapropriados e 11 eram não aderentes ao tratamento. No presente estudo, 8% dos hipertensos foram diagnosticados com HAR. Em relação à PA sistólica (PAS) e PA diastólica (PAD), não foi demonstrada a influência de sexo, fumo e atividade física. A prescrição apropriada apresentou relação com o controle da PAS, porém, não apresentou relação com o controle da PAD. O grau de aderência influenciou tanto a PAS como a PAD. Foi observada ainda a influência do subtipo de hipertensão sobre as médias de PAS e PAD.

Although the literature shows several studies on medication safety, there are few Latin American studies describing aspects in the practice of medication reconciliation carried out by pharmacists in the admission process. This study aimed to describe the acquisition of medication use history of patients during admission, and to characterize the unintentional discrepancies in their pharmacotherapy in a Brazilian teaching hospital. This cross-sectional study was conducted within the University Hospital of the Federal University of Sergipe. Pharmacist-researchers collected patient data in four steps through a structured questionnaire developed by the researchers and adapted from the literature. After collection, the pharmacist-researcher and pharmacy students analysed the data and assessed if there were any unintentional discrepancies. The present study defined unintentional discrepancies (UD) as the unjustified variations between the patient’s previous medication use history and the pharmacotherapy prescribed during hospitalization. In this study, 358 patients were included. Of all patients, 261 (72.90%) were adults with the mean age of 47.16 ± 18.80 years. In 117 cases of adult patients (44.82%), there was no record of previous pharmacotherapy, and 137 (52.49%) were not questioned about their allergies. A total of 327 UD were found in 150 patients (41.90%). Of these UD, omission was the most common type, followed by different doses, erroneous frequency, and unjustified start of treatment. This study revealed the prevalence of unintentional discrepancies in the studied hospital, and points out that the assessment of the history of medications used is a complex practice, in which the pharmacist can be an ally. Key words: Patient safety, medication errors, medication discrepancies, medication reconciliation.

Background: Hypertension is an important public health problem in Brazil, and has been affecting individuals of different ages and social strata. Objective: To determine the prevalence of hypertension and its associated factors in Brazilian adult population. Methods: Cross-sectional study involving Brazilian adults aged 18 years and older. Data were obtained from the National Health Survey conducted in 2013. A multistage sampling method was used to select a national representative sample of the Brazilian population. The selected sociodemographic variables studied were: sex, age, race, marital status and education level. Behavioral variables included physical activity, smoking status, self-perceived health status and reported salt intake self-perceived. Body Mass Index calculated from weight and height values obtained during household visits. Comorbidities diabetes type 2, high blood cholesterol, cardiovascular diseases, stroke and chronic renal failure were assessed by self-report. Results: Hypertension increased with age in both sexes, and the men were more likely than women to have that disease in all age categories analyzed. Male sex, older age, not living with partner, low educational level, physically inactive, smoking, overweight, diabetes type 2 and high blood cholesterol were associated with hypertension. Conclusion: These results reinforce the need for adoption and implementation of measures, based on strategies for prevention, treatment and control of hypertension, still present in expressive way in Brazil and different parts of the world.

Medications are perceived as health risk factors, because they might cause damage if used improperly. In this context, an adequate assessment of medication use history should be encouraged, especially in transitions of care to avoid unintended medication discrepancies (UMDs). In a case-controlled study, we investigated potential risk factors for UMDs at hospital admission and found that 150 (42%) of the 358 patients evaluated had one or more UMDs. We were surprised to find that there was no record of a patient and/or relative interview on previous use of medication in 117 medical charts of adult patients (44.8%). Similarly, in the medical charts of 52 (53.6%) paediatric patients, there was no record of parents and/or relatives interviews about prior use of medications. One hundred thirty-seven medical charts of adult patients (52.4%) and seventy-two medical charts of paediatric patients (74.2%) had no record about medication allergies and intolerances. In other words, there was a lack of basic documentation regarding the patient's medication use history. As patients move between settings in care, there is insufficient tracking of verbal and written information related to medication changes, which results in a progressive and cumulative loss of information, as evidenced by problems associated with clinical transfers and medication orders. Proper documentation of medication information during transfer is a key step in the procedure; hence, it should be rightly performed. It remains unclear whether interviews, and other investigations about medication use history have been performed but have not been recorded as health-care data. Therefore, it is crucial to the improvement of medication use safety that documentation of all drug-related information-even if not directly related to the actual event-become routine practice in health-care organizations, since 'what is not written does not exist'.

OBJETIVO: Avaliar a adesão terapêutica autorreferida durante a gestação em amostra de mulheres brasileiras. MÉTODOS: Foi realizado um estudo transversal com puérperas internadas no serviço de obstetrícia de um hospital universitário, entre agosto e novembro de 2010. Foram incluídas puérperas com 18 anos ou mais, idade gestacional superior a 22 semanas e peso do feto igual ou maior que 500 g. Foram excluídas puérperas em uso de sedativos e/ou outros medicamentos capazes de alterar o estado de consciência. Os dados foram coletados por meio de entrevista face a face, com uso de questionário estruturado contendo perguntas sobre características sociodemográficas, uso de medicamentos, número de gestações anteriores, métodos contraceptivos utilizados, atendimento pré-natal e adesão terapêutica. Para a determinação da adesão, foi utilizada a escala de adesão terapêutica de Morisky - MMAS-4 de quatro itens. Foram utilizados o Teste H de Kruskal-Wallis e o Teste de Χ2 de Pearson e exato de Fisher para análise estatística. RESULTADOS: A média de idade das gestantes foi de 22,5 anos (DP=6,5), das quais 53,8% iniciaram acompanhamento pré-natal no primeiro trimestre da gravidez. Das 130 pacientes entrevistadas, 96,9% fizeram uso de algum medicamento durante o período gestacional, com média de 2,8 medicamentos por paciente. As principais classes prescritas foram: antianêmicos (55,1%); analgésicos, anti-inflamatórios e antipiréticos (19,0%); e anti-infecciosos (7,2%). Fizeram uso de dois a quatro medicamentos 71,6% das pacientes. Apenas 19,2% das pacientes foram consideradas aderentes. As pacientes com menores taxas de adesão foram aquelas com maior escolaridade, renda própria, início do acompanhamento pré-natal no primeiro trimestre de gravidez e aborto prévio. CONCLUSÃO: Apesar de a maioria das gestantes fazer uso de medicamentos prescritos durante a gestação, a taxa de adesão ao tratamento foi baixa, indicando uma necessidade de investigações adicionais sobre o impacto da não adesão durante a gestação e suas causas.PURPOSE: To assess medication adherence therapeutic during pregnancy in a sample of Brazilian women during the post-partum period. METHODS: We conducted a cross-sectional study in the obstetric unit of a university hospital, Brazil, between August and November 2010. We recruited patients aged 18 years or more, with a gestational age of more than 22 weeks whose newborns weighed more than 500 g. Patients were excluded if they used sedatives or other mind-altering drugs. Data were collected after labor using a structured questionnaire containing questions about sociodemographic characteristics, medication use, number of previous pregnancies, contraceptive methods, prenatal care, and medication adherence. Medication adherence was assessed using the four-item Morisky medication adherence scale - MMAS-4, groups were compared by the Fisher exact Test and Kruskal-Wallis Test and Χ2 de Pearson Test. RESULTS: Mean age was 22.5 years (SD=6.5), and 53.8% of the pregnant women had initiated prenatal care during the first trimester of pregnancy. Of the 130 patients interviewed, 96.9% had used at least one prescribed drug during pregnancy, with an average of 2.8 drugs per patient. The major classes prescribed were antianemics (55.1%), analgesics, anti-inflammatories, and antipyretics (19.0%) and anti-infectives (7.2%). 71.6% took two to four drugs. Only 19.2% of patients were considered adherent. The variables that showed a negative influence on adherence were: higher level of education, having one's own income, earlier prenatal care and previous abortion. CONCLUSION: Our findings indicate that, although most of the patients used prescribed drugs during pregnancy, the rate of medication adherence was low, which indicates the need for further investigation about the impact of non-adherence during pregnancy and its causes.

Background Atrioventricular reentrant tachycardias account for approximately one third of cases referred for electrophysiological study (EPS). The anatomical substrate responsible for the reentry is an accessory pathway (AP) able to conduct the electrical stimulus in an anterograde, retrograde or bidirectional manner. Objective To evaluate the correlation of AP location with the male and female genders and AP clinical presentation, whether manifest or concealed. Methods Retrospective observational study including 942 consecutive patients, all diagnosed with EPS-confirmed AP from January 1994 to December 2008. APs were classified into eight anatomical groups: left lateral (LL), left posterior (LP), left posteroseptal (LPS), right posteroseptal (RPS), right midseptal (RMS), right anteroseptal (RAS), right lateral (RL), and right posterior (RP). Results Of the 942 patients, 52.6% were males. The mean age was 31.2±13.8years. As regards gender, APs were more prevalent among men. However, a statistically significant difference was observed only in the LPS (p=0.029) and RL (p=0.003) regions. In relation to the form of presentation of AP, the manifest form was more frequent than the concealed form in six of the eight regions studied, except for the LL and LPS regions. Conclusion AP predominated in males and the manifest form was more frequent than the concealed form in most of the regions studied.

© 2015, Specjalisci Dermatolodzy. All rights reserved. Background: Effective interventions to improve medication adherence are usually complex and expensive. Objective: To assess the impact of a low-cost intervention designed to improve medication adherence and clinical outcomes in post-discharge patients with CVD. Method: A pilot RCT was conducted at a teaching hospital. Intervention was based on the four-item Morisky Medication Adherence Scale (MMAS-4). The primary outcome measure was medication adherence assessed using the eight-item MMAS at baseline, at 1 month post hospital discharge and re-assessed 1 year after hospital discharge. Other outcomes included readmission and mortality rates. Results: 61 patients were randomized to intervention (n = 30) and control (n = 31) groups. The mean age of the patients was 61 years (SD 12.73), 52.5% were males, and 57.4% were married or living with a partner. Mean number of prescribed medications per patient was 4.5 (SD 3.3). Medication adherence was correlated to intervention (p = 0.04) and after 1 month, 48.4% of patients in the control group and 83.3% in the intervention group were considered adherent. However, this difference decreased after 1 year, when adherence was 34.8% and 60.9%, respectively. Readmission and mortality rates were related to low adherence in both groups. Conclusion: The intervention based on a validated patient self-report instrument for assessing adherence is a potentially effective method to improve adherent behavior and can be successfully used as a tool to guide adherence counseling in the clinical visit. However, a larger study is required to assess the real impact of intervention on these outcomes.

Resistanthypertension(RHTN)canbede finedasthefailuretoachievethegoalbloodpressure (lessthan140/90 mm Hg,fortheoverallpopula-tion, and less than 130/80 mm Hg for those with diabetes mellitus, orchronic kidney disease) when a patient adheres to a combination of atleast 3 optimally dosed antihypertensive drugs of different classes, oneof which should ideally be a diuretic [1]. This definition does not applyto patients who have been recently diagnosed with hypertension [2].Patients requiring four or more antihypertensive medications – even ifcontrolled – are also classified as having resistant hypertension [3].Initially, a large proportion of patients were considered to be resis-tant hypertensive patients. Based on clinical trials during which partic-ipants were aggressively titrated to reach a target BP, the prevalence ofRHTN wasestimated to be 20% to 30% [2]. However, many studies havedetermined RHTN based on the fact that medication adherence, drugprescription and blood pressure measures were optimal. Evaluationof patients with resistive hypertension should first confirm that theyhave true RHTN by ruling out or correcting factors associated withpseudo-resistancewhichistheappearanceofalackofBPcontrolcausedby inaccurate measurement of BP, inappropriate drug choices/doses,non-adherence to prescribed therapy or white-coat effect [3,4].Sinceasignificant part of patients with RHTN was actually considered patientswith “pseudo-resistant ”hypertension,prevalenceofRHTNhasbeenre-estimated at below 15% [5].The exclusion of patients with pseudo-resistance because of non-adherencewithprescribedantihypertensivemedicationsisrecognizedas a major methodological strength, and this determination hasbeen lacking in prior epidemiologic assessments of RHTN[5].Inan investigation to determine the association between adherenceto antihypertensive treatment and BP control in hypertensive outpa-tients we observed that 152 (43.9%) out of 359 patients did not adhereto antihypertensive therapy; 40 patients (11.1%) met criteriafor RHTN.Since “pseudoresistance” is commonly misdiagnosed as resistant hy-pertension, in our sample, 98 out of 157 (62.4%) patients with uncon-trolled BP and appropriate antihypertensive treatment were non-adherers and could be diagnosed as resistant hypertensive patients.These data indicate that non-adherence is an important, yet little-known, problem among patients with RHTN.AccordingtoDaughertyetal.[6],priorstudiesonresistanthyperten-sion are limited by failure to apply a uniform definition of resistanthypertension,alackoflongitudinalbloodpressuredataandaninabilityto identify “pseudo-resistant” hypertension due to poor medicationadherence. Thus, a standardized protocol was used to measure BP bytrained pairs of pharmacy students and health community agents,the values of systolic (SBP) and diastolic (DBP) blood pressure wereobtained by the mean of six blood pressure measurements, carried outby the research team during three visits over a two week period, usingmercury sphygmomanometers calibrated with a minimum interval of10 min between each double measurement. To reduce the influenceof the white-coat effect the measurements were taken at the patients'homes [7]. Adherence was assessed using a validated version inPortuguese of the 8-item Morisky Medication Adherence Scale (MMAS-8) [8]. In this study, the patients were considered adherent if they had ascore greater than or equal to 6 in the MMAS-8 [9]. Informed consentwasobtainedfromeachpatientandTheFederalUniversityofAlagoasin-stitutionalreviewboardapprovedthestudyprotocolandconsentform.It is important to consider that the proportion of non-adherentpatients could be even higher, as the self-reporting methods have asmajor limitation the underestimation of the number of non-adherentindividuals. However, self-reporting scales are usually simple, rapid,noninvasive and economical methods that can provide a real-timeopinionabouttheadherencebehaviorofpatientsandpotentialreasonsfornon-adherence.Webelievethatthediagnosisofresistanthyperten-sion should include a fundamental clinical step, which is the investiga-tionofnon-adherenceanditscauses,especiallyamongindividualswith

The Morisky Medication Adherence Scale (MMAS-8) remains one of the most widely used mechanisms to assess patient adherence. Its translation and testing on languages in addition to English would be very useful in research and in practice.To translate and examine the psychometric properties of the Portuguese version of the structured self-report eight-item Morisky Medication Adherence Scale among patients with hypertension.The study was designed as a cross-sectional survey conducted in six Family Health Units of the Brazilian Unified Health System, in Maceió, between March 2011 and April 2012. After a standard "forward-backward" procedure to translate MMAS-8 into Portuguese, the questionnaire was applied to 937 patients with hypertension. Reliability was tested using a measure of internal consistency (Cronbach's alpha), and test-retest reliability. Validity was confirmed using known groups validity. Three levels of adherence were considered based on the following scores: 0 to6 (low); 6 to8 (medium); 8 (high).The mean age of respondents was 57.1 years (SD = 12.7 years), and 71.5% were female. The mean number of prescribed antihypertensives per patient was 1.62 (SD = 0.67). The mean score for the medication adherence scale was 5.78 (SD = 1.88). Moderate internal consistency was found (Cronbach's alpha = 0.682), and test-retest reliability was satisfactory (Spearman's r = 0.928; P 0.001). A significant relationship between MMAS-8 levels of adherence and BP control (chi-square, 8.281; P = 0.016) was found. 46.0%, 33.6%, and 20.4% of patients had low, medium, and high adherence, respectively. The self-report measure sensitivity, specificity, positive and negative predictive values were 86.1%, 31.2%, 57.4% and 68.3% respectively.Psychometric evaluation of the Portuguese version of the MMAS-8 indicates that it is a reliable and valid measure to detect patients at risk of non-adherence. The MMAS-8 could still be used in routine care to support communication about the medication-taking behavior in hypertensive patients.

Introduction: Left ventricular hypertrophy (LVH) is an independent predictor of cardiovascular risk in patients with chronic renal disease (CRD) on hemodialysis (HD). Objective: To show the usefulness of chest radiography in the diagnosis of LVH in CRD patients on HD. Methods: Cross-sectional study including 100 patients (58 men and 42 women), mean age 46.2 ± 14.0 years, with CRD of all causes, for at least six months on HD. Were obtained echocardiogram and chest x-rays of patients, always up to one hour after the end of HD sessions. Results: LVH was detected in 83 patients (83%), of whom 56 (67.4%) had the concentric pattern and 27 (32.6%) with eccentric pattern of LVH. Cardiomegaly - defined by cardiothoracic index (CTI) > 0.5 - was present in 61 patients (61%). The following were the sensitivity, specificity and accuracy, respectively, for the variable ICT: 66.2%, 70.5% and 68.0%. The Pearson correlation between ICT and index of left ventricular mass (LVMI) was 0.552 (p < 0.05) and positive likelihood ratio of 2.2. Conclusion: Chest radiography is a safe and useful as a diagnostic tool of LVH in CKD patients on HD.

Inadequate prescriptions are one of the biggest causes of adverse events related to medications. The aim of this study was to evaluate rational drug prescribing for elderly inpatients. A cross-sectional study was conducted to monitor the quality of drug prescriptions of patients admitted from May to August 2009, in a cardiovascular ward in Brazil. The quality evaluation of drug prescribing for elderly inpatient medication appropriateness was assessed by detection of potentially inappropriate medications, therapeutic duplicity and drug interactions. A total of 62 elderly inpatients were included, 71% were female, median age was 77.5 years. Number of medications prescribed was 3818, ranging from 3 to 25 medications per prescription. Polypharmacy was highly common (86%) in analyzed prescriptions. 370 prescriptions were analyzed (6 prescriptions per patient). We reviewed 370 medication orders (3818 prescribed drugs), 34% of which had at least one potentially inappropriate medication for the elderly, 70% presented therapeutic duplicity. Drug interactions were detected in 77% of prescriptions. Positive associations were observed between therapeutic duplicity and potentially inappropriate medications and between therapeutic duplicity and severe drug interactions. Our study show high rate of inappropriate prescriptions, which can influence the effectiveness of pharmacotherapy as much as the elderly safety. Key words: Rational drug prescribing, elderly, inpatients.

To assess medication adherence therapeutic during pregnancy in a sample of Brazilian women during the post-partum period.We conducted a cross-sectional study in the obstetric unit of a university hospital, Brazil, between August and November 2010. We recruited patients aged 18 years or more, with a gestational age of more than 22 weeks whose newborns weighed more than 500 g. Patients were excluded if they used sedatives or other mind-altering drugs. Data were collected after labor using a structured questionnaire containing questions about sociodemographic characteristics, medication use, number of previous pregnancies, contraceptive methods, prenatal care, and medication adherence. Medication adherence was assessed using the four-item Morisky medication adherence scale - MMAS-4, groups were compared by the Fisher exact Test and Kruskal-Wallis Test and Χ2 de Pearson Test.Mean age was 22.5 years (SD=6.5), and 53.8% of the pregnant women had initiated prenatal care during the first trimester of pregnancy. Of the 130 patients interviewed, 96.9% had used at least one prescribed drug during pregnancy, with an average of 2.8 drugs per patient. The major classes prescribed were antianemics (55.1%), analgesics, anti-inflammatories, and antipyretics (19.0%) and anti-infectives (7.2%). 71.6% took two to four drugs. Only 19.2% of patients were considered adherent. The variables that showed a negative influence on adherence were: higher level of education, having one's own income, earlier prenatal care and previous abortion.Our findings indicate that, although most of the patients used prescribed drugs during pregnancy, the rate of medication adherence was low, which indicates the need for further investigation about the impact of non-adherence during pregnancy and its causes.