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ObjectivesCurrent evidence on fecal microbiota transplantation for inflammatory bowel disease is inconclusive. We conducted a systematic review to gather evidence on the efficacy and safety of fecal microbiota transplantation for inflammatory bowel disease.MethodsSystematic searches were conducted in PubMed, Scopus, and Web of Science. Clinical remission was considered as the primary endpoint. Pairwise meta-analyses were performed for the randomized controlled studies (Mantel Haenszel, random effects model). Proportion meta-analyses, accounting for weighted pooled rates reported in the interventional studies, were conducted using the mixed effects model. Subgroup analyses considering the type of stool, donor type, and disease subtype were also performed. Cumulative meta-analyses to assess further needs of evidence were conducted.ResultsSixty studies were included, from which 36 could be synthesized in the quantitative analyses. Pairwise meta-analyses of six controlled trials showed significant differences in favor of fecal microbiota transplantation compared with placebo (clinical remission: RR 1.70 [95% CI 1.12, 2.56]; clinical response: RR 1.68 [95% CI 1.04, 2.72]). An overall clinical remission of 37%, overall clinical response of 54%, and a prevalence of 29% of adverse events were found for the interventional studies. Frozen fecal material and universal donors were related to better efficacy outcomes. In addition, Crohn's disease patients seemed to benefit more from the procedure.ConclusionsThe comparative analyses demonstrated that frozen fecal material from universal donors may be related to a higher rate of clinical remission, especially for Crohn's disease.

Objective: To describe the profile of the dispensing errors identified through the drug strip conference by the hospital pharmacist and to quantify the discrepancies generated by the indicator in a high complexity hospital in the State of Paraná, in 2015. Method: Cross-sectional and retrospective study of dispensing errors that were avoided by the pharmacist. Once identified, the discrepancies were classified and counted, generating an indicator of the work process (number of avoided errors/number of dispensed strips x 100). Subsequently, a Pareto Analysis was performed in order to prioritize problem solving actions. Results: A total of 27,980 prescriptions were obtained, which originated 48,451 drug strips in the study period. The dispensing errors encountered during the conference of the strips by the pharmacist amounted to 1,453. The dispensing error rate was 3 errors per 100 strips. The most frequently occurring errors were lack of medication and change of medication schedule, representing 61% of all errors together. The same errors were identified in the analysis in the Pareto Diagram as the main intervention targets in the improvement of the processes. Conclusion: The occurrence of errors found through the indicator "Index of Dispensation Errors" was considered low, compared to what was read in the available literature. Through Pareto Analysis, it was possible to identify the most frequent errors, the ones that should be considered in the planning of improvement measures, aiming for the increase of patient safety.

Erros de prescrição e administração correspondem a mais de 75% dos erros de medicação em ambiente hospitalar e a reconciliação de medicamentos uma alternativa para diminuir tal ocorrência. No Brasil, estudos de reconciliação medica­mentosa são incipientes, assim o objetivo do trabalho foi apresentar o perfil dos pacientes e os resultados da reconciliação de medicamentos em unidade hospitalar. Trata-se de estudo transversal prospectivo realizado no Hospital Universitário do Oeste do Paraná, Brasil, em 2011. Foram entrevistados 58 pacientes, 27 (46,5%) possuíam pelo menos uma enfermidade crônica, 24 (41,3%) faziam uso de medicamentos em casa com 15 (62,5%) apresentando pelo menos um tipo de erro relacionado aos medicamentos, sendo o grupo dos anti-hipertensivos 24 (32%) o mais envolvido. Foram encontradas 61 discrepâncias, 49 (80%) não justificadas. As intervenções farmacêuticas foram aceitas em 13 (87%) dos casos. Os pacientes da reconciliação medicamentosa estavam acima dos 50 anos e usavam mais de 3 medicamentos. ABSTRACT Prescribing and administration errors account for more than 75% of medication errors in hospitals, and medica­tion reconciliation is one way of reducing their occurrence. Studies of medication reconciliation are incipient in Brazil and, accordingly, this study aimed to profile the patients and describe the results of medication reconciliation at a hospital. This prospective cross-sectional study was conducted at West Paraná University Hospital, Brazil, in 2011. Of the 58 patients in­terviewed, 27 (46.5%) had at least one chronic disease, and 24 (41.3%) used medication at home, with 15 (62.5%) showing at least one type of medication error, the anti-hypertensive pharmacological group being the most involved (24; 32%). Of the 61 discrepancies found, 49 (80%) were not justified. Medication reconciliation was accepted in 13 (87%) cases. The patients involved in medication reconciliation were over 50 years old and used more than 3 drugs. RESUMEN Errores de prescripción y administración son responsables por más de 75% de los errores de medicación en los hospitales y la reconciliación de medicamentos una alternativa para su reducción. En Brasil, los estudios de reconciliación de medicamentos son incipientes, por eso este trabajo tuvo el objetivo de presentar el perfil de los pacientes y los resultados de la reconciliación de medicamentos en unidad hospitalaria. Estudio transversal prospectivo en el Hospital Universitario del Oeste de Parana, Brasil, en 2011, donde se entrevistó a 58 pacientes. De estos 27 (46,5%) tenían una enfermedad crónica, 24 (41,3%) usaban medicamentos en casa, 15 (62.5%) han tenido al menos un tipo de error relacionado a la medicación y siendo el grupo de fármacos antihipertensivos 24 - (32%) - el más implicado. Se encontraron 61 discrepancias, 49 (80%) sin justificativa. Las intervenciones farmacéuticas fueron aceptadas en 13 (87%) casos. Los pacientes de la reconciliación de medicamentos eran mayores de 50 años y usaban más de 3 fármacos.

Os eventos adversos a medicamentos (EAMs) são causa importante de comprometimento da qualidade da atenção ao paciente hospitalizado e, por isso, devem ser identificados e caracterizados. Para tanto surgiram listas de rastreadores, entre elas a proposta pelo Institute for Healthcare Improvement. Aqui é apresentado o processo da aplicação dos rastreadores e o seu desempenho em um hospital de ensino. As informações sobre os rastreadores e os EAM foram coletadas por meio de revisão retrospectiva dos prontuários de pacientes com alta hospitalar de janeiro a junho de 2008. Foram identificados 497 rastreadores em 177 prontuários, onde cada prontuário apresentou, em média, 2,33 (DP = 2,7) rastreadores. Os encontrados com mais frequência foram: "antiemético" (72,1/100 prontuários), "interrupção abrupta da medicação" (70,0/100 prontuários) e "sedação excessiva, sonolência, torpor, letargia, queda e hipotensão" (34,6/100 prontuários). Os mais eficientes na captura de EAM (rendimento), isto é, aqueles que uma vez identificados sinalizaram possíveis eventos foram "antagonista de benzodiazepínico", "antidiarréicos" e "rash cutâneo". Os EAM mais encontrados foram relacionados aos rastreadores "interrupção abrupta da medicação" (8,3/100 prontuários), "antiemético" (4,6/100 prontuários) e "rash cutâneo" (2,1/100 prontuários). Essas considerações apontam para a utilidade do emprego da lista de rastreadores e podem contribuir para decidir sobre ajustes na sua aplicação.Adverse drug events (ADE) are important causes of impairment of the quality of care for inpatients and therefore should be identified and characterized. Thus, lists of triggers were developed, including the proposal by the Institute for Healthcare Improvement. We analyzed the application of these triggers in a university hospital, with the cooperation of pharmacy and medical students, field training, standardized forms and manuals. Here, we present the process of application and performance of these triggers in a teaching hospital. The information on the triggers and ADE were collected through a retrospective chart review of patients discharged from January to June 2008. Four hundred and ninety-seven triggers were identified in 177 charts, and each chart had 2.33 (SD = 2.7) triggers on average. The most frequent triggers were: "antiemetic" (72.1/100 charts), "abrupt cessation of medication" (70.0/100 charts) and "over-sedation, drowsiness, numbness, lethargy, hypotension and fall" (34.6/100 charts). The most effective triggers for capturing ADE were "benzodiazepine antagonist", "antidiarrheal" and "rash", which, when identified in charts, were related to an event. The ADE most commonly found were related to the triggers, "abrupt cessation of medication" (8.3/100 charts), "antiemetic" (4.6/100 charts), "rash" and "anti-allergy" (2.1/100 charts). These results may help to decide which triggers are more useful in each situation.

The objective of this study was to analyze the variation in antimicrobials' consumption and the costs related to their use at a University Hospital between 1999 and 2004. The annual consumption of nine antimicrobials, expressed in DDD/100 patients-day, and the direct costs with their acquisition were evaluated. Analysis of variance and regression techniques were used to compare data, considering a significance level of 5%. The most consumed antimicrobials were amikacin and ceftriaxone. In general, antimicrobials consumption, expressed in DDD/100 patients-day, increased from 9.21 in 1999 to 25.08 in 2004 (pO trabalho teve por objetivo analisar a variação do consumo e gastos financeiros com antimicrobianos em Hospital Universitário entre 1999 e 2004. Analisou-se 9 antimicrobianos, sendo o consumo expresso em DDDs/100 pacientes-dia e o preço médio de compra obtido do relatório da farmácia hospitalar. As variações anuais no consumo, o consumo por tipo de unidades de internação e gastos com cada antimicrobiano foram estudadas por análise de variância. Adotou-se 5% como limiar de significância. Os antimicrobianos mais consumidos no período foram amicacina e ceftriaxona. Observou-se aumento no consumo dos antimicrobianos selecionados de 9,21 DDDs/100 pacientes-dia em 1999 para 25,08 em 2004 (p