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da Silva Machado FL, Cañás M, Urtasun MA, Marín GH, Albuquerque FC, Pont L, Convertino I, Bonaso M, Tuccori M, Kirchmayer U, Lopes LC. A Cross-National Comparison of Biosimilars Pricing in Argentina, Australia, Brazil, and Italy. Ther Innov Regul Sci 2024; 58:549-556. [PMID: 38436905 DOI: 10.1007/s43441-024-00623-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 01/19/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Biosimilar medicines are defined as biological products highly similar to an already licensed biological product (RP). The market entry of biosimilars is expected to reduce the costs of biological treatments. OBJECTIVE This study aims to evaluate the range of differences between the prices of biosimilars and the corresponding RP for biologicals approved in four countries. METHOD This is a cross-national comparison of pricing of biosimilars in Argentina, Australia, Brazil, and Italy. The study examined online price databases provided by the national authorities of the investigated countries. Biosimilar price difference was calculated by subtracting the unit price of the biosimilar by the unit price of the RP, and then dividing it by the unit price of the RP. The results were presented as percentage. RESULTS Brazil had the highest median price reduction (- 36.3%) in biosimilars price, followed by Italy (- 20.0%) and Argentina (- 18.6%). All the biosimilars in Italy were priced below the RP presenting a minimum reduction of 6.3%, while in Australia, most of the prices of biosimilars were equal to the RP. In Argentina, one infliximab-biosimilar displayed price above the RP (40.7%) while the lower priced brand had a reduction of 14.4%. Brazil had four biosimilars with prices above the respective RP, including isophane insulin (1), insulin glargine (1) and somatropin (2). CONCLUSION The study revealed a marked dispersion in the price's differences between biosimilars and RP across the studied countries. Governments should evaluate whether their policies have been successful in improving affordability of biological therapies.
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Affiliation(s)
- Fernanda Lacerda da Silva Machado
- Instituto de Ciências Farmacêuticas, Universidade Federal Do Rio de Janeiro, Macaé, Rio de Janeiro, Brazil
- Sorocaba University, Sorocaba, São Paulo, Brazil
| | - Martín Cañás
- Universidad Nacional Arturo Jauretche-FEMEBA, La Plata, Argentina
| | - Martín A Urtasun
- Universidad Nacional Arturo Jauretche-FEMEBA, La Plata, Argentina
| | - Gustavo H Marín
- Universidad Nacional de La Plata-CONICET, La Plata, Argentina
| | | | - Lisa Pont
- University of Technology Sydney, Sydney, Australia
| | - Irma Convertino
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marco Bonaso
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marco Tuccori
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ursula Kirchmayer
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
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Lopes LPN, Itria A, Lopes LC. Budget Impact Analysis of Risperidone Use and Adverse Event Monitoring in Autism Spectrum Disorder in Brazil: Assessment of Theoretical Versus Real Data. Pharmacoecon Open 2023; 7:951-961. [PMID: 37707722 PMCID: PMC10721756 DOI: 10.1007/s41669-023-00436-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/20/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND AND AIMS Risperidone is used in autism spectrum disorder (ASD) to manage aggressive behavior. Budget impact analysis (BIA) assists managers in promoting more sustainable health systems; however, it is unclear whether BIAs underestimate or overestimate the estimates derived from real-world data. This study aimed to compare the estimated BIA values of risperidone use and the monitoring of adverse events in ASD using theoretical and real data. METHODS Analyses were conducted based on the clinical protocol and the Brazilian therapeutic guidelines for ASD. The perspective adopted was that of the Unified Health System (SUS), considering a time horizon of 5 years. Three possible scenarios were considered based on the maximum daily dose of risperidone. Expenses related to the acquisition of risperidone and the monitoring of adverse events were taken into account using health databases in Brazil. For the calculation based on theoretical data, the prevalence of ASD was estimated using information from the scientific literature and the Brazilian demographic census. The model calculated from real data was obtained by analyzing the linear trend of the number of users assisted in the SUS from 2017 to 2021. RESULTS The population estimated by the theoretical model compared with the model calculated from the real data was higher. Likewise, the 5-year budgetary impact of the theoretical model versus the model calculated from the real data was higher, with statistical significance in all scenarios (p < 0.001). In the real data model, the most economically advantageous scenarios were Scenario 1 for children (International dollars [I$] 7,630,040.73) and Scenario 3 for adults (I$60,329,288.17). Estimated expenditures for monitoring adverse events ranged from 17 to 74% in children and from 50% to 63% in adults. CONCLUSIONS The data revealed significant differences in population and cost estimation between theoretical data and real-world data. The expenses associated with monitoring adverse events represented a substantial expenditure estimate for the SUS.
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Affiliation(s)
- Luis Phillipe Nagem Lopes
- Graduate Course in Pharmaceutical Sciences, University of Sorocaba, UNISO, Rodovia Raposo Tavares, KM 92,5, Sorocaba, São Paulo, 18023-000, Brazil
| | - Alexander Itria
- Department of Gerontology, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Luciane Cruz Lopes
- Graduate Course in Pharmaceutical Sciences, University of Sorocaba, UNISO, Rodovia Raposo Tavares, KM 92,5, Sorocaba, São Paulo, 18023-000, Brazil.
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Machado FLDS, Cañás M, Doubova SV, Urtasun MA, Marín GH, Osorio-de-Castro CGS, Albuquerque FC, Ribeiro TB, Pont L, Crisóstomo Landeros J, Roldán Saelzer J, Sepúlveda Viveros D, Acosta A, Machado Beltrán MA, Gordillo Alas LI, Orellana Tablas LA, Benko R, Convertino I, Bonaso M, Tuccori M, Kirchmayer U, Contreras Sánchez SE, Rodríguez-Tanta LY, Gutierrez Aures Y, Lin B, Alipour-Haris G, Eworuke E, Lopes LC. Biosimilars approvals by thirteen regulatory authorities: A cross-national comparison. Regul Toxicol Pharmacol 2023; 144:105485. [PMID: 37659711 DOI: 10.1016/j.yrtph.2023.105485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/04/2023]
Abstract
Biosimilars are biological medicines highly similar to a previously licensed reference product and their licensing is expected to improve access to biological therapies. This study aims to present an overview of biosimilars approval by thirteen regulatory authorities (RA). The study is a cross-national comparison of regulatory decisions involving biosimilars in Argentina, Australia, Brazil, Chile, Canada, Colombia, Europe, Hungary, Guatemala, Italy, Mexico, Peru and United States. We examined publicly available documents containing information regarding the approval of biosimilars and investigated the publication of public assessment reports for registration applications, guidelines for biosimilars licensing, and products approved. Data extraction was conducted by a network of researchers and regulatory experts. All the RA had issued guidance documents establishing the requirements for the licensing of biosimilars. However, only three RA had published public assessment reports for registration applications. In total, the investigated jurisdictions had from 19 to 78 biosimilars approved, most of them licensed from 2018 to 2020. In spite of the advance in the number of products in recent years, some challenges still persist. Limited access to information regarding the assessment of biosimilars by RA can affect confidence, which may ultimately impact adoption of these products in practice.
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Affiliation(s)
- Fernanda Lacerda da Silva Machado
- Instituto de Ciências Farmacêuticas, Universidade Federal do Rio de Janeiro, Macaé, Rio de Janeiro, Brazil; Sorocaba University, Sorocaba, São Paulo, Brazil
| | - Martín Cañás
- Universidad Nacional Arturo Jauretche-FEMEBA, La Plata, Argentina
| | - Svetlana V Doubova
- Epidemiology and Health Services Research Unit, Mexican Institute of Social Security, Mexico City, Mexico
| | - Martín A Urtasun
- Universidad Nacional Arturo Jauretche-FEMEBA, La Plata, Argentina
| | - Gustavo H Marín
- Universidad Nacional de La Plata-CONICET, La Plata, Argentina
| | | | | | - Tatiane Bonfim Ribeiro
- Post Graduate Program in Epidemiology, Department of Epidemiology, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Lisa Pont
- University of Technology Sydney, Sydney, Australia
| | | | | | | | - Angela Acosta
- Facultad de Ciencias Naturales, Departamento de Ciencias Farmacéuticas, Universidad ICESI, Cali, Colombia
| | | | - Lily Iracema Gordillo Alas
- Department of Regulation and Control of Pharmaceutical and Related Products, Ministry of Public Health and Social Assistance, Guatemala City, Guatemala
| | - Lourdes Abigail Orellana Tablas
- Department of Regulation and Control of Pharmaceutical and Related Products, Ministry of Public Health and Social Assistance, Guatemala City, Guatemala
| | - Ria Benko
- Institute of Clinical Pharmacy, University of Szeged, Szeged, Hungary
| | | | | | | | - Ursula Kirchmayer
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Saúl E Contreras Sánchez
- Epidemiology and Health Services Research Unit, Mexican Institute of Social Security, Mexico City, Mexico
| | - L Yesenia Rodríguez-Tanta
- Carrera de Farmacia y Bioquímica, Facultad de Ciencias de la Salud, Universidad Científica del Sur, Lima, Perú
| | | | - Boya Lin
- University of Florida, United States
| | | | - Efe Eworuke
- Epidemiology and Drug Safety Team, Real World Solutions, IQVIA, United States
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Lopes LC, Moga DC, Da Silva Dal Pizzol T, Gisev N, Mesgarpour B, Bérard A. Editorial: Women in pharmacoepidemiology: 2021. Front Pharmacol 2023; 14:1278768. [PMID: 37771724 PMCID: PMC10523565 DOI: 10.3389/fphar.2023.1278768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 08/28/2023] [Indexed: 09/30/2023] Open
Affiliation(s)
- Luciane Cruz Lopes
- Pharmaceutical Science Graduate Course, University of Sorocaba, Sorocaba, Brazil
| | - Daniela C. Moga
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, KY, United States
| | - Tatiane Da Silva Dal Pizzol
- Graduate Program of Epidemiology, School of Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Department of Production and Control of Medicines, School of Pharmacy, UFRGS, Porto Alegre, Brazil
| | - Natasa Gisev
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Bita Mesgarpour
- National Institute for Medical Research and Development, Tehran, Iran
| | - Anick Bérard
- CHU Sainte Justine Research Center, Faculty of Pharmacy, University of Montreal, Montréal, QC, Canada
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Tavares Franquez R, Del Grossi Moura M, Cristina Ferreira McClung D, Barberato-Filho S, Cruz Lopes L, Silva MT, de Sá Del-Fiol F, de Cássia Bergamaschi C. E-Health technologies for treatment of depression, anxiety and emotional distress in person with diabetes mellitus: A systematic review and meta-analysis. Diabetes Res Clin Pract 2023; 203:110854. [PMID: 37499879 DOI: 10.1016/j.diabres.2023.110854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 07/03/2023] [Accepted: 07/25/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVE This systematic review of randomized clinical trials (RCT) summarized the available evidence regarding the use of e-Health technologies for the treatment of depression, anxiety, and emotional distress in person with diabetes mellitus. METHODS The Cochrane CENTRAL, MEDLINE, EMBASE, Web of Science and LILACS databases searched were up to January 11th, 2023. The primary outcomes were improvement of depression, anxiety, diabetes-related emotional distress and quality of life. Reviewers, in pairs and independently, selected the studies and extracted their data. RESULTS A total of 10 RCT involving 2,209 participants were analyzed. The methodological quality of the studies reviewed was high. Results showed improvements in depression with the use of Internet-Guided Self-Help (SMD = -0.74, 95%CI = -1.04 to -0.43) or Telephone-Delivered Cognitive Behavioral Therapy (CBT) (SMD = -0.42, 95%CI = -0.65 to -0.19); in anxiety with Internet-Guided Self-Help (SMD = -0.72, 95%CI = -1.02 to -0.42) or Diabetes-specific-CBT (SMD = -0.60, 95%CI = -1.18 to -0.02); and in emotional distress with Internet-Guided Self-Help (SMD = -0.72, 95%CI = -1.02 to -0.41) or Healthy Outcomes through Patient Empowerment (SMD = -0.26, 95%CI = -0.53 to 0.01) compared to usual care. CONCLUSION Due to heterogeneity in interventions, populations, follow-up time and outcomes, future RCT should be conducted to confirm these findings.
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Affiliation(s)
| | | | | | - Silvio Barberato-Filho
- Pharmaceutical Sciences Graduate Course, University of Sorocaba, Sorocaba, São Paulo, Brazil
| | - Luciane Cruz Lopes
- Pharmaceutical Sciences Graduate Course, University of Sorocaba, Sorocaba, São Paulo, Brazil
| | - Marcus Tolentino Silva
- Department of Public Health, Faculty of Health Sciences, University of Brasilia, Brasilia, Brazil
| | - Fernando de Sá Del-Fiol
- Pharmaceutical Sciences Graduate Course, University of Sorocaba, Sorocaba, São Paulo, Brazil
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Nagem Lopes LP, da Cunha LG, Silva ARO, Land MGP, Fonseca AR, Lopes LC, Lima EC. Multisystem inflammatory syndrome drug treatment in countries with different income profiles: a scoping review. Front Pharmacol 2023; 14:1228986. [PMID: 37680713 PMCID: PMC10481533 DOI: 10.3389/fphar.2023.1228986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/08/2023] [Indexed: 09/09/2023] Open
Abstract
Objective: The purpose of this study was to map and describe the studies that have investigated therapeutic alternatives for the management of paediatric multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19. Considering the origin of the studies performed (low-, middle- and high-income countries), a systematic scoping review was conducted with primary studies that reported the use of medications for the treatment of patients with MIS-C. Sources: The searches were performed in MEDLINE, Embase, Lilacs, Epistemonikos, CINAHL, and CENTRAL, in the grey literature (theses and dissertations from CAPES, ProQuest, and PROSPERO) and in clinical trial databases until May 2022. The selection and extraction of studies were performed independently by two reviewers. Summary of the findings: A total of 173 studies were included, most of which were published as case reports or series. No randomized controlled clinical trials (RCTs) were identified. The investigated drugs were immunoglobulins, glucocorticoids, monoclonal antibodies, anticoagulants, and antiplatelet agents. Conclusion: The dosages, when reported, were heterogeneous among the studies. The ethnicity and comorbidity of the participants were poorly reported. Monoclonal antibodies, drugs with higher costs, were mostly described in studies of high-income countries.
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Affiliation(s)
| | | | | | | | - Adriana Rodrigues Fonseca
- Post-Graduate Program in Saúde Materno Infantil, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luciane Cruz Lopes
- Post-Graduate Program in Pharmaceutical Sciences, University of Sorocaba, São Paulo, Brazil
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Del Fiol FDS, Bergamaschi CDC, De Andrade-Jr IP, Tolentino da Silva M, Barberato-Filho S, Bellini Silva BG, Higa Nakaghi AC, Cruz Lopes L. Increase in veterinary prescriptions of azithromycin during the COVID-19 pandemic in Brazil. J Infect Dev Ctries 2023; 17:930-936. [PMID: 37515794 DOI: 10.3855/jidc.17597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/28/2023] [Indexed: 07/31/2023] Open
Abstract
INTRODUCTION With the advent of the pandemic in 2020 and the lack of perspectives on the treatment of COVID-19, numerous therapeutic proposals have emerged, including hydroxychloroquine and azithromycin. Therefore, some studies have shown that in many countries, the demand for azithromycin has increased during the pandemic. In Brazil, antibiotics can only be purchased with a medical, dental, or veterinary prescription. This study aimed to determine whether the number of prescriptions made by veterinarians (which could be used by humans) has increased during the pandemic. METHODOLOGY Data on the purchase of antibiotics made under veterinary prescriptions in Brazilian pharmacies between 2014 and 2021 were collected. To assess the changes in monthly trends in the use of the selected antibiotics, we applied the Joinpoint regression. RESULTS The most prescribed antibiotic in all years was cephalexin (35%), followed by amoxicillin (24%). During the pandemic, sales of azithromycin substantially increased. Regression analysis showed that since 2014, azithromycin prescriptions grew by an average of 0.67% per month. At the beginning of the pandemic, the monthly growth rate became 12.64%. When comparing azithromycin sales during the pandemic with the historical average (2014-2019), the increase was 41%. CONCLUSIONS During the pandemic, there was no animal health situation in Brazil that required the use of this antibiotic. Veterinary prescriptions may have been an instrument for human access to azithromycin for the treatment of COVID-19. Stricter enforcement policies are needed to address this problem to avoid antimicrobial resistance.
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Affiliation(s)
| | | | | | | | - Silvio Barberato-Filho
- Doctoral Program in Pharmaceutical Sciences, University of Sorocaba, Sorocaba, SP, Brazil
| | | | | | - Luciane Cruz Lopes
- Doctoral Program in Pharmaceutical Sciences, University of Sorocaba, Sorocaba, SP, Brazil
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Caetano R, Lopes LC, Santos GML, Osorio-de-Castro CGS. [Authorization for off-label use may not be beneficial for the Brazilian Unified National Health System]. CAD SAUDE PUBLICA 2023; 39:e00085423. [PMID: 37377299 PMCID: PMC10494695 DOI: 10.1590/0102-311xpt085423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 05/11/2023] [Indexed: 06/29/2023] Open
Affiliation(s)
- Rosângela Caetano
- Instituto de Medicina Social Hesio Cordeiro, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Luciane Cruz Lopes
- Programa de Pós-graduação em Ciências Farmacêuticas, Universidade de Sorocaba, Sorocaba, Brasil
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Lopes LPN, de Oliveira JC, Bergamaschi CDC, Fulone I, Lima EDC, Abe FC, Mazzei LG, Figueiró MF, Lopes LC. Use of second-generation antipsychotics in autism spectrum disorder: a systematic review and meta-analysis protocol. BMJ Open 2023; 13:e069114. [PMID: 37339843 DOI: 10.1136/bmjopen-2022-069114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Abstract
INTRODUCTION Atypical antipsychotics have been studied to treat autism spectrum disorder (ASD). However, like little is known about whether these drugs are effective and safe when compared in controlled and non-controlled settings. This study aims to assess the efficacy and safety of second-generation antipsychotics in ASD in randomised controlled trials (RCT) and observational studies. METHODS AND ANALYSIS This systematic review will include RCT and prospective cohorts evaluating second-generation antipsychotics in people 5 years and older diagnosed with ASD. Searches will be conducted in Medline, Embase, Cochrane Library, Epistemonikos, Lilacs, CINAHL, PsycINFO, trial registries and grey literature databases without restriction on publication status, year of publication and language. The primary outcomes will be symptoms of aggressive behaviour, quality of life for the individual or their careers, and discontinuation or dropouts/withdrawals of antipsychotics due to adverse events. The secondary outcomes are other not serious adverse events and adherence to pharmacotherapy. Selection, data extraction, and quality assessment will be performed by pairs of reviewers, independently. The Risk of Bias 2 (RoB 2) and Risk of Bias in Non-Randomised Studies of Interventions (ROBINS-I) tools will be used to assess the risk of bias in the included studies. If appropriate, a meta-analysis and network meta-analysis will be conducted to synthesise the results. The overall quality of the evidence for each outcome will be determined by the Recommendation, Assessment, Development and Evaluation approach. ETHICS AND DISSEMINATION This study will systematically summarise the existing evidence evaluating the use of second-generation antipsychotics for treating ASD, in controlled and uncontrolled studies. The results of this review will be disseminated through peer-reviewed publications and conference presentations. PROSPERO REGISTRATION NUMBER CRD42022353795.
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Affiliation(s)
| | - Jardel Corrêa de Oliveira
- Pharmaceutical Science, University of Sorocaba, Sorocaba, Brazil
- Médico de Família e Comunidade, Especialista em Saúde da Família, Geriatria e Gerontologia, Secretaria Municipal de Saúde, Florianopolis, Brazil
| | | | - Izabela Fulone
- Pharmaceutical Science, University of Sorocaba, Sorocaba, Brazil
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Del Fiol FDS, Bergamaschi CDC, Lopes LC, Silva MT, Barberato-Filho S. Sales trends of psychotropic drugs in the COVID-19 pandemic: A national database study in Brazil. Front Pharmacol 2023; 14:1131357. [PMID: 37007033 PMCID: PMC10063839 DOI: 10.3389/fphar.2023.1131357] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 03/08/2023] [Indexed: 03/19/2023] Open
Abstract
Background: The social restrictions among coronavirus disease 2019 (COVID-19) pandemic have posed a thoughtful risk to mental health and have implications in the use of drugs, including antidepressants, anxiolytics and other psychotropics.Objective: This study analyzed the sales data of the psychotropics prescribed in Brazil, in order to verify the change in consumption trends of these drugs during the COVID-19 pandemic.Methods: This interrupted time-series analyzed psychotropic sales data, between January 2014 and July 2021, using the National System of Controlled Products Management from The Brazilian Health Regulatory Agency. The monthly mean DDDs per 1,000 inhabitants per day of psychotropic drugs was evaluated by analysis of variance (ANOVA) followed by Dunnett Multiple Comparisons Test. The changes in monthly trends in the use of the psychotropic studied were evaluated by Joinpoint regression.Results: During the period studied, clonazepam, alprazolam, zolpidem and escitalopram were the most sold psychotropic drugs in Brazil. According to Joinpoint regression, an upward trend was observed in sales during the pandemic of pregabalin, escitalopram, lithium, desvenlafaxine, citalopram, buproprion and amitriptyline. An increase in psychotropic consumption was noted throughout the pandemic period, with the maximum consumption (2.61 DDDs) occurring in April 2021, with a downward trend in consumption that accompanied the drop in the number of deaths.Conclusions: The increase in sales, mainly of antidepressants during the COVID-19 pandemic, draws attention to issues related to the mental health of the Brazilian population and on the need for greater monitoring in the dispensing of these drugs.
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de Oliveira AM, Galvão TF, Silva MT, Lopes LC. Analysis of relationship of psychosocial factors with patient safety culture in a Brazilian hospital: Study with structural equation modeling analysis. J Healthc Qual Res 2023; 38:112-119. [PMID: 35999167 DOI: 10.1016/j.jhqr.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/07/2022] [Accepted: 06/27/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION AND OBJECTIVES The scenario of the health system can develop physical and emotional impacts on health professionals, due to work overload and failure to manage the system. It is necessary to consolidate the theory that the safety of care provided by health services is affected by organizational conditions. The aim of this study is to assess whether safety culture is related to job satisfaction, depressive symptoms, and burnout syndrome among hospital professionals. MATERIALS AND METHODS This is an analysis with structural equation modeling, conducted in a teaching hospital in Brazil. Data collection was made via psychometric instruments, which sought to analyze job satisfaction (Job Satisfaction Survey), depressive symptoms (Patient Health Questionnaire), burnout syndrome (Maslach Burnout Inventory), as well as the relationship between this factors and patient safety culture (Safety Attitudes Questionnaire). The Pearson correlation coefficient (r) and the partial least squares structural equation modeling (PLS-SEM) were used for analysis. RESULTS A higher work satisfaction was associated with a higher perception of safety culture (r=0.69; P<0.001). Depressive symptoms and burnout dimensions showed an inverse relationship with the safety culture (P<0.05). PLS-SEM enabled us to understand the behavior of this association. Thus, satisfaction at work and the absence of burnout proved to be predictive factors for the implementation of an ideal patient safety culture (P<0.001). CONCLUSIONS Patient safety culture is related to job satisfaction and burnout among hospital professionals. These findings suggest that the psychosocial work environment influences the quality of care provided.
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Affiliation(s)
- A M de Oliveira
- School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - T F Galvão
- Faculty of Pharmaceutical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - M T Silva
- Pharmaceutical Sciences Graduate Course, University of Sorocaba, Sorocaba, São Paulo, Brazil
| | - L C Lopes
- Pharmaceutical Sciences Graduate Course, University of Sorocaba, Sorocaba, São Paulo, Brazil.
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Fulone I, Silva MT, Lopes LC. Use of atypical antipsychotics in the treatment of schizophrenia in the Brazilian National Health System: a cohort study, 2008-2017. Epidemiol Serv Saude 2023; 32:e2022556. [PMID: 36946832 PMCID: PMC10072313 DOI: 10.1590/s2237-96222023000300015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 01/11/2023] [Indexed: 03/23/2023] Open
Abstract
OBJECTIVE to investigate sociodemographic and clinical characteristics of users of atypical antipsychotics receiving care via the Specialized Component of Pharmaceutical Assistance (Componente Especializado da Assistência Farmacêutica - CEAF), for the treatment of schizophrenia in Brazil, between 2008 and 2017. METHODS this was a retrospective cohort study using records of the authorizations for high complexity procedures retrieved from the Outpatient Information System of the Brazilian National Health System, from all Brazilian states. RESULTS of the 759,654 users, 50.5% were female, from the Southeast region (60.2%), diagnosed with paranoid schizophrenia (77.6%); it could be seen a higher prevalence of the use of risperidone (63.3%) among children/adolescents; olanzapine (34.0%) in adults; and quetiapine (47.4%) in older adults; about 40% of children/adolescents were in off-label use of antipsychotics according to age; adherence to CEAF was high (82%), and abandonment within six months was 24%. CONCLUSION the findings expand knowledge about the sociodemographic and clinical profile of users and highlight the practice of off-label use.
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Affiliation(s)
- Izabela Fulone
- Universidade de Sorocaba, Departamento de Pós-Graduação em Ciências Farmacêuticas, Sorocaba, SP, Brazil
| | - Marcus Tolentino Silva
- Universidade de Sorocaba, Departamento de Pós-Graduação em Ciências Farmacêuticas, Sorocaba, SP, Brazil
| | - Luciane Cruz Lopes
- Universidade de Sorocaba, Departamento de Pós-Graduação em Ciências Farmacêuticas, Sorocaba, SP, Brazil
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Caetano R, Lopes LC, Santos GML, Osorio-de-Castro CGS. Incorporation and use of medicines in the Brazilian Unified National Health System: changes and risks of new Ministry of Health legislation. CAD SAUDE PUBLICA 2023; 39:e00148222. [PMID: 36820727 DOI: 10.1590/0102-311xpt148222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 12/19/2022] [Indexed: 02/19/2023] Open
Affiliation(s)
- Rosângela Caetano
- Centro Biomédico, Planejamento e Administração em Saúde, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Luciane Cruz Lopes
- Programa de Pós-graduação em Ciências Farmacêuticas, Universidade de Sorocaba, Sorocaba, Brasil
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14
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Ramos Alves M, Bergamaschi CDC, Barberato-Filho S, de Melo DO, Mayer RCF, de Oliveira JC, Gabriel FC, Sekercioglu N, Abdala CVM, Lopes LC. Critical appraisal and comparison of recommendations of clinical practice guidelines for the treatment of schizophrenia in children and adolescents: a methodological survey. BMJ Open 2023; 13:e070332. [PMID: 36746538 PMCID: PMC9906266 DOI: 10.1136/bmjopen-2022-070332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION The production of clinical practice guidelines (CPGs) has grown in the past years. Notwithstanding, the quality of these documents and their recommendations for the treatment of schizophrenia in children and adolescents is still unknown. OBJECTIVE To assess the quality of the guidelines and recommendations for the treatment of schizophrenia in this population. METHODS CPGs from 2004 to December 2020 were identified through a systematic search on EMBASE, MEDLINE, PsycINFO, PubMed, Epistemonikos, VHL, Global Index Medicus and specific CPG databases. The CPGs' quality was independently assessed by three reviewers using AGREE II and they were considered of high quality if they scored ≥60% in domains 3 and 6. The evidence classification systems were described, the quality of recommendations was assessed in pairs using AGREE-REX and the recommendations were compared. RESULTS The database search retrieved 3182 results; 2030 were screened and 29 were selected for full-text reading. Four guidelines were selected for extraction. Two CPGs were considered of high quality in the AGREE II assessment. We described the commonly agreed recommendations for each treatment phase. The pharmacological recommendations were described in all treatment phases. Scores of AGREE-REX were lower for psychosocial recommendations. CONCLUSION There are still few clinical studies and CPGs regarding schizophrenia in children and adolescents. The quality of the documents was overall low, and the quality of the recommendations report has much to improve. There is also a lack of transparency about the quality of the evidence and the strength of the recommendations. PROTOCOL REGISTRATION NUMBER CRD42020164899.
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Affiliation(s)
- Maíra Ramos Alves
- Graduate Course in Pharmaceutical Sciences, University of Sorocaba, Sorocaba, Brazil
| | | | | | | | | | - Jardel Corrêa de Oliveira
- Graduate Course in Pharmaceutical Sciences, University of Sorocaba, Sorocaba, Brazil
- Family Physician, Florianópolis Family Medicine Residency Program, Florianópolis, Brazil
| | | | - Nigar Sekercioglu
- Health Research Methodology, McMaster University, Mississauga, Ontario, Canada
| | | | - Luciane Cruz Lopes
- Graduate Course in Pharmaceutical Sciences, University of Sorocaba, Sorocaba, Brazil
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Rodríguez-Tanta LY, Garavito Farro H, Freitas Leal L, Salas M, Elseviers MM, Lopes LC. Drug utilization research in Peru: Is real-world data available? Front Pharmacol 2023; 13:1047946. [PMID: 36733379 PMCID: PMC9888663 DOI: 10.3389/fphar.2022.1047946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 12/28/2022] [Indexed: 01/18/2023] Open
Abstract
Background: Drug utilization research (DUR) is used to provide evidence-based data to inform policies and make decisions. The aim of this study was to map and describe available data sources for drug utilization research in Peru. Methods: We performed a search of data sources providing information on medication use on the website of governmental organizations. We also conducted a literature review using PubMed, LILACs, and BVS. Independently, researchers screened eligible data sources. Data characterization included accessibility, coverage data provider, type of data sources, and setting. We performed a descriptive analysis. Results: We identified seven data sources, CENAFyT, ICI, IDI (SISMED), and ENSUSALUD from MINSA, and CRI-ESSALUD, SGSS/ESSI, and ENSSA from ESSALUD. These presented information on adverse drug reactions (n = 2), drug consumption, and distribution (n = 2), prescription and drug dispensing (n = 1), and surveys addressed to medication users (n = 2). ENSUSALUD was the only data source publicly available. VIGIFLOW and ENSUSALUD have a national granularity from the public and private sectors. The setting of the data sources was both hospital and ambulatory care. Two data sources have individual-level data on adverse drug reactions and one on prescriptions. Four studies on drug utilization research in Peru were derived from ENSUSALUD. Conclusion: In Peru, few data sources are available for drug utilization research. There is an increased need to monitor medications for decision-making purposes. Local and international initiatives and partnerships of the government with academic institutions and the private sector might be a good strategy to increase the transparency of health data and for supporting decision-making using drug utilization research.
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Affiliation(s)
- L. Yesenia Rodríguez-Tanta
- Institute for the Evaluation of Health Technologies and Research, Social Security of Health, Lima, Peru,*Correspondence: L. Yesenia Rodríguez-Tanta, ; Luciane Cruz Lopes,
| | | | - Lisiane Freitas Leal
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Maribel Salas
- Daiichi Sankyo (United States), Parsippany, NJ, United States,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | | | - Luciane Cruz Lopes
- Pharmaceutical Science Graduate Course, University of Sorocaba, São Paulo, Brazil,*Correspondence: L. Yesenia Rodríguez-Tanta, ; Luciane Cruz Lopes,
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Caetano R, Lopes LC, Santos GML, Osorio-de-Castro CGS. Incorporation and use of medicines in the Brazilian Unified National Health System: changes and risks of new Ministry of Health legislation. CAD SAUDE PUBLICA 2023. [DOI: 10.1590/0102-311xen148222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
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17
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Abe FC, Kodaira K, Motta CDCB, Barberato-Filho S, Silva MT, Guimarães CC, Martins CC, Lopes LC. Antimicrobial resistance of microorganisms present in periodontal diseases: A systematic review and meta-analysis. Front Microbiol 2022; 13:961986. [PMID: 36262326 PMCID: PMC9574196 DOI: 10.3389/fmicb.2022.961986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 09/01/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThe aim of this study was to estimate the antimicrobial resistance in microorganisms present in periodontal diseases.MethodsA systematic review was conducted according to the PRISMA statement. The MEDLINE (PubMed/Ovid), EMBASE, BVS, CINAHL, and Web of Science databases were searched from January 2011 to December 2021 for observational studies which evaluated the antimicrobial resistance in periodontal diseases in permanent dentition. Studies that allowed the antimicrobial consumption until the time of sample collection, studies that used laboratory acquired strains, studies that only characterized the microbial strain present, assessment of cellular morphological changes, sequencing system validation, and time series were excluded. Six reviewers, working in pairs and independently, selected titles, abstracts, and full texts extracting data from all studies that met the eligibility criteria: characteristics of patients, diagnosis of infection, microbial species assessed, antimicrobial assessed, identification of resistance genes, and virulence factors. “The Joanna Briggs Institute” critical appraisal for case series was adapted to assess the risk of bias in the included studies.ResultsTwenty-four studies (N = 2.039 patients) were included. Prevotella and Porphyromonas species were the most cited microorganisms in the included studies, and the virulence factors were related to Staphylococcus aureus. The antimicrobial reported with the highest frequency of resistance in the included studies was ampicillin (39.5%) and ciprofloxacin showed the lowest frequency of resistance (3.4%). The most cited genes were related to macrolides. The quality of the included studies was considered critically low.ConclusionNo evidence was found regarding the profile of antimicrobial resistance in periodontal diseases, requiring further research that should focus on regional population studies to address this issue in the era of increasing antimicrobial resistance.Clinical relevanceThe knowledge about the present microorganism in periodontal diseases and their respective antimicrobial resistance profiles should guide dentists in prescribing complementary therapy for these infections.Systematic review registration[http://dx.doi.org/10.1097/MD.0000000000013158], identifier [CRD42018077810].
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Affiliation(s)
- Flávia Casale Abe
- Department of Pharmaceutical Sciences, University of Sorocaba, Sorocaba, Brazil
| | - Katia Kodaira
- Department of Pharmaceutical Sciences, University of Sorocaba, Sorocaba, Brazil
| | | | | | | | | | | | - Luciane Cruz Lopes
- Department of Pharmaceutical Sciences, University of Sorocaba, Sorocaba, Brazil
- *Correspondence: Luciane Cruz Lopes,
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Yamauti SM, Barreto JOM, Barberato-Filho S, Machado FLDS, Lopes LC. Public sector implementation strategies to approach the judicialization of health care: a systematic review protocol. Syst Rev 2022; 11:164. [PMID: 35948934 PMCID: PMC9364593 DOI: 10.1186/s13643-022-02043-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 07/28/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The judicialization of health care can be understood as a societal response to pressing healthcare needs, which probably are not being adequately addressed by the current healthcare system. This phenomenon increases the strain on service resources, both in the health sector and in the judiciary system as well, demanding an institutional reorganization to manage judicial actions. It is believed that each institution has developed strategies for coping with the problem in isolation and with little public disclosure. The purpose of this review will be to identify institutional strategies implemented and to investigate their effects in approaching the judicialization of health care. METHODS Electronic searches will be conducted up to December 2021 on 11 databases, supplemented with gray literature and references lists of secondary studies. The descriptor "judicialization of health" will be the basis for conducting the main research. Studies describing any strategy implemented by public institutions to approach the judicialization of health care will be included. Results related to the quality of services provided by the implemented strategy reported in the studies and those that report accessibility, usability, and potential adverse effects or harms caused by the implemented strategy will be investigated. In addition, it will be explored if there have been changes related to the value or characteristics of health litigation. Two reviewers will independently screen all citations, abstract data, and full-text papers. The risk of bias in each study will be appraised using a tool suggested by Cochrane Effective Practice and Care Organization Group (EPOC). Subsequently, the reviewers will also extract the data of interest and classify the findings of these studies according to their performance at the institutional level. The results obtained will be described as a narrative synthesis. DISCUSSION This review may provide evidence on the effects of the strategies implemented to approach the judicialization of health care. It will potentially benefit health care and legal professionals, decision-makers, and researchers by identifying the types and characteristics of strategies that have the potential to improve service delivery in the future. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020160608.
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Affiliation(s)
- Sueli Miyuki Yamauti
- Graduate Program in Pharmaceutical Science, University of Sorocaba, Rodovia Raposo Tavares, Km 92,5 -, Sorocaba, SP, Brazil
| | | | - Silvio Barberato-Filho
- Graduate Program in Pharmaceutical Science, University of Sorocaba, Rodovia Raposo Tavares, Km 92,5 -, Sorocaba, SP, Brazil
| | | | - Luciane Cruz Lopes
- Graduate Program in Pharmaceutical Science, University of Sorocaba, Rodovia Raposo Tavares, Km 92,5 -, Sorocaba, SP, Brazil.
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Fulone I, Barreto JOM, Barberato-Filho S, Bergamaschi CDC, Lopes LC. Improving the adherence to COVID-19 preventive measures in the community: Evidence brief for policy. Front Public Health 2022; 10:894958. [PMID: 35979464 PMCID: PMC9376604 DOI: 10.3389/fpubh.2022.894958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives To identify evidence-based strategies to improve adherence to the preventive measures against the coronavirus disease (COVID-19) at the community level. Method This is an evidence brief for policy, combining research evidence specific to contextual knowledge from stakeholders. A systematic search was performed in 18 electronic databases, gray literature, and a handle search, including only secondary and tertiary studies that focused on the adherence of the general population to COVID-19 preventive measures in the community. Two reviewers, independently, performed the study selection, data extraction, and assessment of the quality of the studies. Relevant evidence has been synthesized to draft evidence-based strategies to improve adherence. These strategies were circulated for external endorsement by stakeholders and final refinement. Endorsement rates >80%, 60-80% and <60% were considered high, moderate, and low respectively. Results Eleven studies, with varying methodological qualities were included: high (n = 3), moderate (n = 3), low (n = 1), and critically low (n = 4). Three evidence based strategies were identified: i. Risk communication; ii. Health education to the general public, and iii. Financial support and access to essential supplies and services. The rates of endorsement were: 83% for risk communication, 83% for health education, and 92% for financial support and access to essential supplies and services. The evidence showed that an increase in knowledge, transparent communication, and public awareness about the risks of COVID-19 and the benefits of adopting preventive measures results in changes in people's attitudes and behavior, which can increase adherence. In addition, the guarantee of support and assistance provides conditions for people to adopt and sustain such measures. Conclusions These strategies can guide future actions and the formulation of public policies to improve adherence to preventive measures in the community during the current COVID-19 pandemic and other epidemics.
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Affiliation(s)
- Izabela Fulone
- Graduate Course in Pharmaceutical Sciences, University of Sorocaba, Sorocaba, Brazil
| | | | | | | | - Luciane Cruz Lopes
- Graduate Course in Pharmaceutical Sciences, University of Sorocaba, Sorocaba, Brazil
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20
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Moraes FDS, Marengo LL, Moura MDG, Bergamaschi CDC, de Sá Del Fiol F, Lopes LC, Silva MT, Barberato-Filho S. ABCDE and ABCDEF care bundles: A systematic review of the implementation process in intensive care units. Medicine (Baltimore) 2022; 101:e29499. [PMID: 35758388 PMCID: PMC9276239 DOI: 10.1097/md.0000000000029499] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 05/05/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The ABCDE (Awakening and Breathing Coordination of daily sedation and ventilator removal trials, Delirium monitoring and management, and Early mobility and exercise) and ABCDEF (Assessment, prevent and manage pain, Both spontaneous awakening and spontaneous breathing trials, Choice of analgesia and sedation, assess, prevent and manage Delirium, Early mobility and exercise, Family engagement) care bundles consist of small sets of evidence-based interventions and are part of the science behind Intensive Care Unit (ICU) liberation. This review sought to analyse the process of implementation of ABCDE and ABCDEF care bundles in ICUs, identifying barriers, facilitators and changes in perception and attitudes of healthcare professionals; and to estimate care bundle effectiveness and safety. METHODS We selected qualitative and quantitative studies addressing the implementation of ABCDE and ABCDEF bundles in the ICU, identified on MEDLINE, Embase, CINAHL, The Cochrane Library, Web of Science, Epistemonikos, PsycINFO, Virtual Health Library and Open Grey, without restriction on language or date of publication, up to June 2018. The outcomes measured were ICU and hospital length of stay; mechanical ventilation time; incidence and prevalence of delirium or coma; level of agitation and sedation; early mobilization; mortality in ICU and hospital; change in perception, attitude or behaviour of the stakeholders; and change in knowledge of health professionals. Two reviewers independently selected the studies, performed data extraction, and assessed risk of bias and methodological quality. A meta-analysis of random effects was performed. RESULTS Twenty studies were included, 13 of which had a predominantly qualitative and 7 a quantitative design (31,604 participants). The implementation strategies were categorized according to the taxonomy developed by the Cochrane Effective Practice and Organization of Care Group and eighty strategies were identified. The meta-analysis results showed that implementation of the bundles may reduce length of ICU stay, mechanical ventilation time, delirium, ICU and hospital mortality, and promoted early mobilization in critically-ill patients. CONCLUSIONS : This study can contribute to the planning and execution of the implementation process of ABCDE and ABCDEF care bundles in ICUs. However, the effectiveness and safety of these bundles need to be corroborated by further studies with greater methodological rigor. PROTOCOL REGISTRATION PROSPERO CRD42019121307.
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Lopes LC, Benko R, Oliveira MG, Paniz VMV, Godman B, Motter FR. Editorial: Evidence for Assessing Drug Safety and Drug Use in Older People. Front Pharmacol 2022; 13:941813. [PMID: 35721158 PMCID: PMC9199432 DOI: 10.3389/fphar.2022.941813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 05/17/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Luciane Cruz Lopes
- Graduate Course in Pharmaceutical Sciences, University of Sorocaba (Uniso), São Paulo, Brazil
| | - Ria Benko
- Institution of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary.,Central Pharmacy, Albert Szent Györgyi Medical Center, University of Szeged, Szeged, Hungary.,Department of Emergency Medicine, Albert Szent Györgyi Medical Center, University of Szeged, Szeged, Hungary
| | - Marcio Galvão Oliveira
- Multidisciplinary Health Institute, Federal University of Bahia, Vitória da Conquista, Brazil
| | - Vera Maria Vieira Paniz
- Postgraduate Program in Collective Health, University of Vale do Rio dos Sinos (UNISINOS), São Leopoldo, Brazil
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Faculty of Science, University of Strathclyde, Glasgow, United Kingdom.,Centre of Medical and Bio Allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates.,Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Fabiane Raquel Motter
- Graduate Course in Pharmaceutical Sciences, University of Sorocaba (Uniso), São Paulo, Brazil
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Fadlallah R, Daher N, El-Harakeh A, Hammam R, Brax H, Bou Karroum L, Lopes LC, Arnous G, Kassamany I, Baltayan S, Harb A, Lotfi T, El-Jardali F, Akl EA. Approaches to prioritising primary health research: a scoping review. BMJ Glob Health 2022; 7:bmjgh-2021-007465. [PMID: 35501067 PMCID: PMC9062777 DOI: 10.1136/bmjgh-2021-007465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 02/28/2022] [Indexed: 11/25/2022] Open
Abstract
Objective To systematically identify and describe approaches to prioritise primary research topics in any health-related area. Methods We searched Medline and CINAHL databases and Google Scholar. Teams of two reviewers screened studies and extracted data in duplicate and independently. We synthesised the information across the included approaches by developing common categorisation of relevant concepts. Results Of 44 392 citations, 30 articles reporting on 25 approaches were included, addressing the following fields: health in general (n=9), clinical (n=10), health policy and systems (n=10), public health (n=6) and health service research (n=5) (10 addressed more than 1 field). The approaches proposed the following aspects to be addressed in the prioritisation process: situation analysis/ environmental scan, methods for generation of initial list of topics, use of prioritisation criteria, stakeholder engagement, ranking process/technique, dissemination and implementation, revision and appeal mechanism, and monitoring and evaluation. Twenty-two approaches proposed involving stakeholders in the priority setting process. The most commonly proposed stakeholder category was ‘researchers/academia’ (n=17, 77%) followed by ‘healthcare providers’ (n=16, 73%). Fifteen of the approaches proposed a list of criteria for determining research priorities. We developed a common framework of 28 prioritisation criteria clustered into nine domains. The criterion most frequently mentioned by the identified approaches was ‘health burden’ (n=12, 80%), followed by ‘availability of resources’ (n=11, 73%). Conclusion We identified and described 25 prioritisation approaches for primary research topics in any health-related area. Findings highlight the need for greater participation of potential users (eg, policy-makers and the general public) and incorporation of equity as part of the prioritisation process. Findings can guide the work of researchers, policy-makers and funders seeking to conduct or fund primary health research. More importantly, the findings should be used to enhance a more coordinated approach to prioritising health research to inform decision making at all levels.
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Affiliation(s)
- Racha Fadlallah
- Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon.,Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon.,Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon
| | - Najla Daher
- Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon
| | - Amena El-Harakeh
- Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon.,Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Rima Hammam
- Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
| | - Hneine Brax
- Faculty of Medicine, Université Saint-Joseph, Beirut, Lebanon
| | - Lama Bou Karroum
- Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon.,Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon.,Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon
| | | | - Ghida Arnous
- Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
| | - Inas Kassamany
- Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
| | - Stephanie Baltayan
- Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
| | - Aya Harb
- Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
| | - Tamara Lotfi
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Fadi El-Jardali
- Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon.,Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon.,Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon
| | - Elie A Akl
- Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon .,Clinical Research Institute, American University of Beirut, Beirut, Lebanon.,Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
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Moreira SS, Camargo MCD, Caetano R, Alves MR, Itria A, Pereira TV, Lopes LC. Efficacy and costs of nanocrystalline silver dressings versus 1% silver sulfadiazine dressings to treat burns in adults in the outpatient setting: A randomized clinical trial. Burns 2022; 48:568-576. [PMID: 34688520 DOI: 10.1016/j.burns.2021.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 05/01/2021] [Accepted: 05/24/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Nanocrystalline silver dressings can reduce the number of changes, facilitating burn wound management. However, the evidence regarding their efficacy and cost-consequences compared to well-established treatments, such as 1% silver sulfadiazine, is still scarce. OBJECTIVE To determine the efficacy, safety, and costs of nanocrystalline silver dressings compared to 1% silver sulfadiazine dressings to treat adult patients with burns. STUDY DESIGN AND SETTING Randomized, single-center, single-blind trial conducted at a referral hospital in São Paulo, Brazil. METHODS 100 adult patients were randomized 1:1 to nanocrystalline silver (n = 50) or 1% silver sulfadiazine (n = 50). The primary outcome was the proportion of participants with complete re-epithelization at day 15 after randomization. Secondary outcomes included the number of dressing changes, direct medical costs (in international dollars, I$), pain intensity, the incidence of infections, number of patients undergoing surgery, and adverse events. RESULTS On day 15, the proportion of patients who reached the primary outcome did not differ significantly between participants treated with nanocrystalline silver dressings (24 [48%]) and those treated with 1% silver sulfadiazine dressings (26 [52%]); risk difference of -4.0 percentage points (95% confidence interval [CI], -17 to 9; P = 0.56). The number of patients undergoing surgical intervention was similar between groups (6% vs. 6%), and no local or serious adverse events were reported. The mean (standard deviation, SD) number of dressing changes in the nanocrystalline silver group was 4.1 (2.3), and the corresponding estimate in the 1% silver sulfadiazine group was 9.6 (6.7); mean difference of -5.56 (95% CI), -7.57 to -3.55, P < 0.001). Treatment with nanocrystalline silver dressing incurred significant cost reductions in medical materials, human resources, and administrative labor. However, the mean total cost with nanocrystalline silver dressing was higher compared to 1% silver sulfadiazine dressings: I$496.37 (445.90) vs. I$274.73 (182.76); mean difference = 221.63 (95% CI, 89.04 to 354.23, P = 0.001). The main driver of higher mean total costs among nanocrystalline silver-treated participants was the purchase cost of the dressings, representing 79.3% of the total cost in the nanocrystalline silver group but only 15.2% in the 1% silver sulfadiazine group. CONCLUSION We found no evidence of a difference between nanocrystalline silver and 1% silver sulfadiazine dressings regarding efficacy and safety outcomes. Nanocrystalline silver dressings were associated with an increase in the total costs, but they could result in important savings for an institution (less changes of dressings, reducing human resources burden), especially if acquisition costs can be decreased. Additional cost-effectiveness studies are warranted. TRIAL REGISTRATION NUMBER NCT02108535.
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Affiliation(s)
| | | | - Rosângela Caetano
- Department of Planning and Public Policy, Institute of Social Medicine, UERJ, Brazil.
| | - Maíra Ramos Alves
- Pharmaceutical Sciences Graduate Course, University of Sorocaba, UNISO, Brazil.
| | - Alexander Itria
- Department of Economics, Federal University of São Carlos, UFSCAR, Brazil.
| | - Tiago Veiga Pereira
- Applied Health Research Centre, St. Michael's Hospital, University of Toronto, Canada; Department of Health Sciences, University of Leicester, Leicester, United Kingdom.
| | - Luciane Cruz Lopes
- Pharmaceutical Sciences Graduate Course, University of Sorocaba, UNISO, Brazil.
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Del Fiol FDS, Bergamaschi CDC, De Andrade IP, Lopes LC, Silva MT, Barberato-Filho S. Consumption Trends of Antibiotics in Brazil During the COVID-19 Pandemic. Front Pharmacol 2022; 13:844818. [PMID: 35387351 PMCID: PMC8978992 DOI: 10.3389/fphar.2022.844818] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/03/2022] [Indexed: 12/21/2022] Open
Abstract
Background: In 2019, a new type of coronavirus emerged and spread to the rest of the world. Numerous drugs were identified as possible treatments. Among the candidates for possible treatment was azithromycin alone or in combination with other drugs. As a result, many clinicians in Brazil have prescribed azithromycin in an attempt to combat or minimize the effects of COVID19. Aim: This study analyzed the sales data of the main antibiotics prescribed in Brazil to verify the change in consumption trends of these drugs during the COVID-19 pandemic. Methods: This is an interrupted time series that analyzed antimicrobial sales data between January 2014 and July 2021, publicly accessible information obtained from the Brazilian government's website. Monthly means of "defined daily doses of DDDs" (DDDs per 1,000 inhabitants per day) of antibiotics were compared by analysis of variance, followed by the Dunnett Multiple Comparisons Test. Monthly trend changes in antibiotic use were verified using Joinpoint regression. Results: Amoxicillin (31.97%), azithromycin (18.33%), and cefalexin (16.61%) were the most sold antibiotics in Brazil during the evaluation period. Azithromycin consumption rose from 1.40 DDDs in February 2020 to 3.53 DDDs in July 2020. Azithromycin sales showed a significant increase in the pandemic period [Monthly Percent Change (MPC) 5.83%, 95% 1.80; 10.00], whereas there was a fall in amoxicillin sales (MPC -9.00%, 95% CI -14.70; -2.90) and cefalexin [MPC-2.70%, 95% (CI -6.30; -1.10)] in this same period. Conclusion: The COVID-19 pandemic changed the pattern of antibiotic consumption in Brazil, with a decrease in the use of amoxicillin and cefalexin and an increase in the consumption of azithromycin.
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Ruano ASM, Motter FR, Lopes LC. Design and validity of an instrument to assess healthcare professionals' perceptions, behaviour, self-efficacy and attitudes towards evidence-based health practice: I-SABE. BMJ Open 2022; 12:e052767. [PMID: 35396280 PMCID: PMC8995964 DOI: 10.1136/bmjopen-2021-052767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To develop and validate an instrument to measure Brazilian healthcare professionals' perceptions, behaviour, self-efficacy and attitudes towards evidence-based health practice. DESIGN Validation of an instrument using the Delphi method to ensure content validity and data from a cross-sectional survey to evaluate psychometric characteristics (psychometric sensitivity, factorial validity and reliability). SETTING National Register of Health Establishments database. PARTICIPANTS We included clinical health professionals who were working in the Brazilian public health system. RESULTS The Instrument to assess Evidence-Based Health (I-SABE) was constructed with five domains: self-efficacy; behaviour; attitude; results/benefits and knowledge/skills. Content validity was done by 10-12 experts (three rounds). We applied I-SABE to 217 health professionals. Bartlett's sphericity test and the Kaiser-Meyer-Olkin (KMO) index were adequate (χ2=1455.810, p<0.001; KMO=0.847). Considering the factorial loads of the items and the convergence between the Scree Plot and the Kaiser criterion the four domains tested in this analysis, explaining 59.2% of the total variance. The internal consistency varied between the domains: self-efficacy (α=0.76), behaviour (α=0.30), attitudes (α=0.644), results/benefits to the patient (α=0.835). CONCLUSIONS The results of the psychometric analysis of the I-SABE confirm the good quality of this tool. The I-SABE can be used both in educational activities as well as an assessment tool among healthcare professionals in the Brazilian public health settings.
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Affiliation(s)
| | - Fabiane Raquel Motter
- Graduate Course in Pharmaceutical Sciences, University of Sorocaba (Uniso), Sorocaba, São Paulo, Brazil
| | - Luciane Cruz Lopes
- Graduate Course in Pharmaceutical Sciences, University of Sorocaba (Uniso), Sorocaba, São Paulo, Brazil
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de Oliveira JC, Alves MR, Lopes LPN, Iwami RS, Motter FR, Bergamaschi CDC, Silva MT, Itria A, Scalco DL, Lucio DDS, Mazzei LG, Derech RD, Pereira TV, Barreto JOM, Lopes LC. Sex differences and adverse events of antiretrovirals in people living with HIV/AIDS: a systematic review and meta-analysis protocol. BMJ Open 2022; 12:e057094. [PMID: 35210346 PMCID: PMC8883265 DOI: 10.1136/bmjopen-2021-057094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Antiretroviral therapy (ART) for HIV/AIDS is associated with adverse events (AEs). However, little is known about the differences in the risk of AEs between women and men living with HIV/AIDS. This study aims to determine (1) whether there are sex differences in the risk of AEs in people with HIV/AIDS treated with ART and (2) the prevalence of AEs to the reproductive system and bone mineral density in women. METHODS AND ANALYSIS This systematic review (SR) will include randomised trials evaluating ART in people living with HIV/AIDS with at least 12 weeks of duration follow-up. Searches will be conducted in Medline, Embase, Cochrane Library, Epistemonikos, Lilacs, trial registries and grey literature databases, without restriction on publication status, year of publication and language. The primary outcome will be the risk of ART discontinuation or drop-outs/withdrawals of ART due to AEs and the number of any treatment-emergent AE. The secondary outcomes are the incidence of serious clinic or laboratory (grade 3 and/or 4) treatment-emergent AEs, hospitalisation, death and AEs specific to the reproductive system and bone mineral density (osteoporosis, osteopenia and fractures) of women. Selection, data extraction and quality assessment will be performed by pairs of reviewers. Cochrane collaboration tools will be used to assess the risk of bias. If appropriate, a meta-analysis will be conducted to synthesise results. The overall quality of the evidence for each outcome will be determined by the Grades of Recommendation, Assessment, Development and Evaluation. ETHICS AND DISSEMINATION The results of this SR will assist the formulation of public policies aimed at the management and monitoring of AEs of ART in people living with HIV/AIDS. A deliberative dialogue will be scheduled with the Department of Chronic Conditions and Sexually Transmitted Infections of Brazil's Ministry of Health to align the project with policymakers' interests. PROSPERO REGISTRATION NUMBER CRD42021251051.
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Affiliation(s)
- Jardel Corrêa de Oliveira
- Graduate Course in Pharmaceutical Sciences, University of Sorocaba, Sorocaba, São Paulo, Brazil
- Family Physician, Florianópolis Family Medicine Residency Program, Florianópolis, Santa Catarina, Brazil
| | - Maíra Ramos Alves
- Graduate Course in Pharmaceutical Sciences, University of Sorocaba, Sorocaba, São Paulo, Brazil
| | - Luis Phillipe Nagem Lopes
- Pharmacy Undergraduate Course, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Fabiane Raquel Motter
- Graduate Course in Pharmaceutical Sciences, University of Sorocaba, Sorocaba, São Paulo, Brazil
| | | | - Marcus Tolentino Silva
- Graduate Course in Pharmaceutical Sciences, University of Sorocaba, Sorocaba, São Paulo, Brazil
| | - Alexander Itria
- Department of Economics, Federal University of São Carlos, Sorocaba, São Paulo, Brazil
| | - Diogo Luis Scalco
- Family Physician, Florianópolis Family Medicine Residency Program, Florianópolis, Santa Catarina, Brazil
| | - Donavan de Souza Lucio
- Family Physician, Florianópolis Family Medicine Residency Program, Florianópolis, Santa Catarina, Brazil
| | | | - Rodrigo D'Agostini Derech
- Geriatrician, Municipal Health Department of the Florianópolis City Hall, Florianópolis, Santa Catarina, Brazil
| | - Tiago Veiga Pereira
- Department of Health Sciences, University of Leicester, Leicester, Leicestershire, UK
| | | | - Luciane Cruz Lopes
- Graduate Course in Pharmaceutical Sciences, University of Sorocaba, Sorocaba, São Paulo, Brazil
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Leal LF, Osorio-de-Castro CGS, de Souza LJC, Ferre F, Mota DM, Ito M, Elseviers M, Lima EDC, Zimmernan IR, Fulone I, Carvalho-Soares MDL, Lopes LC. Data Sources for Drug Utilization Research in Brazil-DUR-BRA Study. Front Pharmacol 2022; 12:789872. [PMID: 35115935 PMCID: PMC8805708 DOI: 10.3389/fphar.2021.789872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/20/2021] [Indexed: 12/14/2022] Open
Abstract
Background: In Brazil, studies that map electronic healthcare databases in order to assess their suitability for use in pharmacoepidemiologic research are lacking. We aimed to identify, catalogue, and characterize Brazilian data sources for Drug Utilization Research (DUR). Methods: The present study is part of the project entitled, “Publicly Available Data Sources for Drug Utilization Research in Latin American (LatAm) Countries.” A network of Brazilian health experts was assembled to map secondary administrative data from healthcare organizations that might provide information related to medication use. A multi-phase approach including internet search of institutional government websites, traditional bibliographic databases, and experts’ input was used for mapping the data sources. The reviewers searched, screened and selected the data sources independently; disagreements were resolved by consensus. Data sources were grouped into the following categories: 1) automated databases; 2) Electronic Medical Records (EMR); 3) national surveys or datasets; 4) adverse event reporting systems; and 5) others. Each data source was characterized by accessibility, geographic granularity, setting, type of data (aggregate or individual-level), and years of coverage. We also searched for publications related to each data source. Results: A total of 62 data sources were identified and screened; 38 met the eligibility criteria for inclusion and were fully characterized. We grouped 23 (60%) as automated databases, four (11%) as adverse event reporting systems, four (11%) as EMRs, three (8%) as national surveys or datasets, and four (11%) as other types. Eighteen (47%) were classified as publicly and conveniently accessible online; providing information at national level. Most of them offered more than 5 years of comprehensive data coverage, and presented data at both the individual and aggregated levels. No information about population coverage was found. Drug coding is not uniform; each data source has its own coding system, depending on the purpose of the data. At least one scientific publication was found for each publicly available data source. Conclusions: There are several types of data sources for DUR in Brazil, but a uniform system for drug classification and data quality evaluation does not exist. The extent of population covered by year is unknown. Our comprehensive and structured inventory reveals a need for full characterization of these data sources.
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Affiliation(s)
- Lisiane Freitas Leal
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | | | | | - Felipe Ferre
- Faculdade de Medicina, Programa de Pós-Graduação em Saúde Pública, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Marcia Ito
- Professional Master's Program in Productive Systems, Centro Estadual de Educação Tecnológica Paula Souza, São Paulo, Brazil
| | | | | | - Ivan Ricardo Zimmernan
- Faculdade de Ciências da Saúde Campus Darcy Ribeiro, University of Brasília, Brasília, Brazil
| | - Izabela Fulone
- Graduate Pharmaceutical Science, University of Sorocaba, Sao Paulo, Brazil
| | | | - Luciane Cruz Lopes
- Graduate Pharmaceutical Science, University of Sorocaba, Sao Paulo, Brazil
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Barberato-Filho S, Bergamaschi CDC, Godman B, Silva MT, Del Fiol FDS, Baldoni AO, Barreto JOM, Lopes LC. Editorial: New Horizons in Health-Promoting: From Methods to Implementation Science. Front Pharmacol 2022; 12:830957. [PMID: 35095538 PMCID: PMC8795761 DOI: 10.3389/fphar.2021.830957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Silvio Barberato-Filho
- Pharmaceutical Science Graduate Course, University of Sorocaba (Uniso), Sorocaba, Brazil
| | | | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom.,Centre of Medical and Bio-allied Health Sciences Research, Ajman University, AlAin, United Arab Emirates.,School of Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, South Africa
| | - Marcus Tolentino Silva
- Pharmaceutical Science Graduate Course, University of Sorocaba (Uniso), Sorocaba, Brazil
| | | | | | | | - Luciane Cruz Lopes
- Pharmaceutical Science Graduate Course, University of Sorocaba (Uniso), Sorocaba, Brazil
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Abstract
BACKGROUND Deprescribing is the planned and supervised process of dose reduction or stopping of medication that might be causing harm, or no longer be of benefit. It is an activity that should be a normal part of care/the prescribing cycle. Although now broadly recognised, there are still challenges in its effective implementation. OBJECTIVES To develop and validate an instrument to measure Brazilian healthcare professionals' knowledge, attitudes and practices towards deprescribing. METHODS This study will include the following steps: (1) development of the preliminary instrument; (2) content validation; (3) pilot study; (4) evaluation of psychometric characteristics. After the elaboration of items of the instrument through the literature review, we will use a hybrid Delphi method to develop and establish the content validity of the instrument. Further, a pilot survey will be performed with 30 healthcare professionals. Finally, for the evaluation of psychometric characteristics, a cross-sectional study will be accomplished with a representative sample of different healthcare professionals from different Brazilian states using respondent-driven sampling. Exploratory factor analysis and confirmatory factor analysis will be performed. For assessing the model fit, we will use the ratio of χ2 and df (χ2/df), comparative fit index, the goodness of fit index and root mean square error of approximation. In addition, the reliability of the instrument will be estimated by test-retest reproducibility and Cronbach's alpha coefficient (α). ETHICS AND DISSEMINATION The Ethics Committee for Research at the University of Sorocaba (ethics approval number: 3.848.916) approved the study. Study findings will be circulated to healthcare professionals and scientists in the field through publication in peer-reviewed journals and conference presentations.
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Affiliation(s)
- Fabiane Raquel Motter
- Graduate Program in Pharmaceutical Sciences, University of Sorocaba, Sorocaba, Brazil
| | | | - Luciane Cruz Lopes
- Graduate Program in Pharmaceutical Sciences, University of Sorocaba, Sorocaba, Brazil
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Guimaraes CC, Lopes LC, Bergamaschi CDC, Ramacciato JC, Silva MT, Araújo JDO, de Andrade NK, Motta RHL. Local anaesthetics combined with vasoconstrictors in patients with cardiovascular disease undergoing dental procedures: systematic review and meta-analysis. BMJ Open 2021; 11:e044357. [PMID: 34266837 PMCID: PMC8286772 DOI: 10.1136/bmjopen-2020-044357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 06/15/2021] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES There is a lack of evidence about the use of local anaesthetics (LAs) in patients with cardiovascular diseases (CVD) in dental procedures. Thus, this study evaluated the safety of using LA with vasoconstrictor to determine the risk of cardiovascular events in patients with CVD. DESIGN Systematic review and meta-analysis. METHODS We have searched in Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (via Ovid), EMBASE (via Ovid), Healthstar (via Ovid), CINAHL, Web of Science and ClinicalTrials.gov for randomised controlled trials (RCTs) up to January 2020. We have included RCTs involving adults with CVD within two groups: intervention group with LA with vasoconstrictor and control group with LA without vasoconstrictor. The primary outcomes assessed were death, mortality by a specific cause, stroke, acute myocardial infarction, hospitalisation, pain, bleeding and arrhythmias. The secondary outcomes were ST segment depression, anxiety, adverse effects and changes in haemodynamic parameters. The data were pooled using random effects meta-analyses and the confidence in the estimates was verified using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS Ten RCTs (n=478 participants) were included. Most of them had a high risk of bias. There were more cases of pain and bleeding in groups without vasoconstrictor. Meta-analysis demonstrated a decrease in the systolic blood pressure with the use of LA with vasoconstrictor (standard mean difference -0.95, 95% CI -1.35 to -0.55) after procedure. Overall, for the other outcomes assessed there was no statistical difference. The quality of evidence was considered low according to the GRADE profile. CONCLUSIONS The results suggest that the use of LA with vasoconstrictors (epinephrine in low doses) is safe in patients with some types of CVD. However, the low quality of evidence demonstrated that literature needs further studies in order to confirm these results. PROTOCOL REGISTRATION PROSPERO (CRD42016045421).
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Affiliation(s)
- Caio Chaves Guimaraes
- Faculdade São Leopoldo Mandic, Instituto de Pesquisas São Leopoldo Mandic, Campinas, Brazil
| | - Luciane Cruz Lopes
- Department of Pharmaceutical Sciences, Universidade de Sorocaba, Sorocaba, Brazil
| | | | - Juliana Cama Ramacciato
- Division of Pharmacology, Anesthesiology and Therapeutics, Faculdade São Leopoldo Mandic, Instituto de Pesquisas São Leopoldo Mandic, Campinas, Brazil
| | | | | | | | - Rogério Heládio Lopes Motta
- Division of Pharmacology, Anesthesiology and Therapeutics, Faculdade São Leopoldo Mandic, Instituto de Pesquisas São Leopoldo Mandic, Campinas, Brazil
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Fulone I, Silva MT, Lopes LC. Gender differences in the use of atypical antipsychotics in early-onset schizophrenia: a nationwide population-based study in Brazil. BMC Psychiatry 2021; 21:320. [PMID: 34187418 PMCID: PMC8243572 DOI: 10.1186/s12888-021-03327-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 06/14/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The use of atypical antipsychotics for the treatment of schizophrenia and other mental disorders in populations under 18 years of age is increasing worldwide. Little is known about treatment patterns and the influence of gender differences, which may be a predictor of clinical outcomes. The aim of this study was to investigate gender differences in the use of atypical antipsychotics in patients with early-onset schizophrenia (EOS) assisted by the public health system in Brazil. METHODS We conducted a cross-sectional study of outpatients with EOS aged 10 to 17 years who received at least one provision of atypical antipsychotics (clozapine, olanzapine, risperidone, quetiapine or ziprasidone) from a large Brazilian pharmaceutical assistance programme. Data were retrieved from a nationwide administrative database from 2008 to 2017. RESULTS Of the 49,943 patients with EOS, 63.5% were males, and the mean age was 13.6 years old. The patients were using risperidone (62.5%), olanzapine (19.6%), quetiapine (12.4%), ziprasidone (3.3%) and clozapine (2.2%). We found gender differences, especially in the 13-17 year age group (65.1% for males vs. 34.9% for females, p < 0.001), in the use of risperidone (72.1% for males vs. 27.9% for females, p < 0.001) and olanzapine (66.5% for males vs. 33.5% for females, p < 0.001). Only in the 13 to 17 years age group were the prescribed doses of olanzapine (p = 0.012) and quetiapine (p = 0.041) slightly higher for males than for females. CONCLUSIONS Our findings showed gender differences among patients diagnosed with EOS and who received atypical antipsychotics. More attention should be devoted to gender differences in research and clinical practice.
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Affiliation(s)
- Izabela Fulone
- grid.442238.b0000 0001 1882 0259Pharmaceutical Sciences Graduate Course, University of Sorocaba, UNISO, Sorocaba/State of São Paulo, Brazil
| | - Marcus Tolentino Silva
- grid.442238.b0000 0001 1882 0259Pharmaceutical Sciences Graduate Course, University of Sorocaba, UNISO, Sorocaba/State of São Paulo, Brazil
| | - Luciane Cruz Lopes
- Pharmaceutical Sciences Graduate Course, University of Sorocaba, UNISO, Sorocaba/State of São Paulo, Brazil.
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Fulone I, Silva MT, Lopes LC. Switching Between Second-Generation Antipsychotics in Patients with Schizophrenia and Schizoaffective Disorder: 10-Year Cohort Study in Brazil. Front Pharmacol 2021; 12:638001. [PMID: 34135752 PMCID: PMC8201606 DOI: 10.3389/fphar.2021.638001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 04/29/2021] [Indexed: 11/17/2022] Open
Abstract
Objective: Switching between second-generation antipsychotics (SGAs) is a common clinical practice in the treatment of schizophrenia and schizoaffective disorders due to differences in the drugs’ tolerability and safety profiles as well as the challenge of obtaining an ideal response. However, the factors associated with SGA switching remain uncertain and related real-world data are scarce. The main objective was to identify the factors associated with the switching of SGAs in patients with schizophrenia or schizoaffective disorder. Methods: We conducted a retrospective cohort study of outpatients with schizophrenia or schizoaffective disorder, who were aged ≥18 years and received a SGA (clozapine, olanzapine, risperidone, quetiapine or ziprasidone) from a Brazilian pharmaceutical assistance program for at least 3 months. We identified SGA users from 2008 to 2017 by using a national administrative database (Ambulatory Information System-SIA/SUS). The factors associated with the switches were evaluated by Cox proportional hazards regression and adjusted for sex and age; the confidence interval was set at 95% (95% CI). Results: In total, 563,765 patients were included. Female sex, advanced age of ≥70 years, residence in the Brazilian northeast region, and the type of antipsychotic used were associated with an increased risk of switching (p < 0.001). The incidence of switching ranged from 37.6/100 person-years for clozapine users to 58.2/100 person-years for risperidone users. Compared to the adjusted hazard ratio, for clozapine users, the corresponding ratios for risperidone, ziprasidone, quetiapine and olanzapine were 1.59 (95% CI, 1.57–1.61), 1.41 (95% CI, 1.39–1.44), 1.25 (95% CI, 1.23–1.26) and 1.11 (95% CI, 1.10–1.12) respectively. Conclusion: The groups most susceptible to SGA switching in real-life setting were older individuals, women, and those living in the Brazilian northeast region. Risperidone was associated with the highest risk of switching and as expected, clozapine was associated with the lowest risk of switching than that associated with the other SGAs.
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Affiliation(s)
- Izabela Fulone
- Pharmaceutical Sciences Graduate Course, University of Sorocaba, Sorocaba, Brazil
| | | | - Luciane Cruz Lopes
- Pharmaceutical Sciences Graduate Course, University of Sorocaba, Sorocaba, Brazil
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Mayer RCF, Alves MR, Yamauti SM, Silva MT, Lopes LC. Quality of Life and Functioning of People With Mental Disorders Who Underwent Deinstitutionalization Using Assisted Living Facilities: A Cross-Sectional Study. Front Psychol 2021; 12:622973. [PMID: 34113278 PMCID: PMC8185360 DOI: 10.3389/fpsyg.2021.622973] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 04/19/2021] [Indexed: 11/13/2022] Open
Abstract
Context People with mental disorders can acquire long-term disabilities, which could impair their functioning and quality of life (QoL), requiring permanent care and social support. Systematic data on QoL and functioning, which could support a better management of these people, were not available. Objective To analyze the QoL, level of functioning and their association with sociodemographic and clinical factors of people with mental disorders who underwent deinstitutionalization using assisted living facilities. Methods A Cross-sectional study was conducted between July 2018 and July 2019, through interviews using the World Health Organization Quality of Life (WHOQOL-BREF) to determine the QoL scores, and the World Health Organization Disability Assessment Schedule (WHODAS 2.0) to determine the level of functioning. All adults (≥18 years old) with mental disorders, who underwent deinstitutionalization, users of assisted living facilities and assisted by the Psychosocial Assistance Centers III, in a city in the state of São Paulo, Brazil, were selected. For statistical analysis of the associated factors, Student’s t-test was used for dichotomous variables and ANOVA for polynomial variables. Pearson correlation coefficient was used to measure the association between QoL and functioning scores. Results Out of 359 people who underwent deinstitutionalization with mental disorders, 147 met the eligibility criteria. The mean total score for the WHOQOL-BREF was 66.5 ± 13.4 and the mean score for WHODAS 2.0 was 10.4 ± 7.6. An association was found between people who were studying (n = 65.8; 95%CI, 63.5–68.1 vs. n = 73.9; 95%CI, 67.5–80.3; p = 0.04) and better WHOQOL-BREF QoL scores or WHODAS 2.0 levels of functioning (n = 10.9; 95%CI, 9.6–12.2 vs. n = 5.1; 95%CI, 2.5–7.7; p = 0.01). A weak negative correlation (r = 0.41) emerged between higher QoL scores and functioning improvement. Conclusion This study indicates that the QoL of the sample is associated by their functioning levels, which, in turn, may reflect on their social interactions. Public policies that favor interventions increasing socialization of this population can result in better health outcomes. The QoL and functioning scores provide valuable insights to develop public policies more suited to this population profile.
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Affiliation(s)
| | - Maíra Ramos Alves
- Graduate Program in Pharmaceutical Sciences, University of Sorocaba, Sorocaba, Brazil
| | - Sueli Miyuki Yamauti
- Graduate Program in Pharmaceutical Sciences, University of Sorocaba, Sorocaba, Brazil
| | | | - Luciane Cruz Lopes
- Graduate Program in Pharmaceutical Sciences, University of Sorocaba, Sorocaba, Brazil
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Machado FLDS, Dos Santos DMDSS, Lopes LC. Strategies to Approach Medicines Litigation: An Action Research Study in Brazil. Front Pharmacol 2021; 12:612426. [PMID: 33967753 PMCID: PMC8100662 DOI: 10.3389/fphar.2021.612426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 02/16/2021] [Indexed: 11/15/2022] Open
Abstract
Background: In the last decades, litigation has been increasingly used to access medicines in Brazil. This phenomenon has led to the development of diverse strategies to reduce its negative impact on the organization of pharmaceutical services. In spite of that, managers still face difficulties dealing with lawsuits. Objective: This study aims to report the planning and implementation of strategies to approach medicines litigation in a municipality located in the southeast region of Brazil. Methods: Mixed methods were employed through an action research cycle. A network coordination team included researchers from university and municipal managers. The scenario analysis comprised the characterization of pharmaceutical services and the profile of medicines lawsuits. Afterward, strategies were planned to deal with the central problem identified. The action plan involved educational outreach visits and distribution of printed materials for health professionals, evaluated through opinion survey. Group conversations were conducted with the users of the public health system, followed by thematic analysis of reports. Results: The characterization of pharmaceutical services in the municipality revealed that treatments supplied were in accordance with the National Medicines Policy. In addition, a sector was implemented to attend demands for non-incorporated medicines. In spite of the services available, the characterization of lawsuits indicated that the main claimants were users of the public health system, requiring non-incorporated medicines, with therapeutic alternatives available. Thus, educational outreach visits were held in 14 health units (23 physicians in total). Everyone who answered the evaluation declared that they were very satisfied with the approach. Group conversations with the users of the health system reached 227 participants in total. In regard to users’ perception about pharmaceutical services, thematic analysis of reports identified three main categories including aspects related to medicines provided, users assisted, and quality of service. Conclusion: The study described the first cycle of an action research project to develop strategies to approach medicines litigation at the municipal level. The application of educational outreach visits for health professionals and group conversations with health system users is a promising approach to improve access to information about pharmaceutical services in Brazil.
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Affiliation(s)
| | | | - Luciane Cruz Lopes
- Pharmaceutical Sciences Graduate Course, University of Sorocaba, UNISO, Sorocaba, Brazil
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Honorato DJP, Fulone I, Silva MT, Lopes LC. Risks of Adverse Neonatal Outcomes in Early Adolescent Pregnancy Using Group Prenatal Care as a Strategy for Public Health Policies: A Retrospective Cohort Study in Brazil. Front Public Health 2021; 9:536342. [PMID: 33898367 PMCID: PMC8062755 DOI: 10.3389/fpubh.2021.536342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 03/15/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Adolescent pregnancy is a public health concern and many studies have evaluated neonatal outcomes, but few have compared younger adolescents with older using adequate prenatal care. Objective: To compare the risks of adverse neonatal outcomes in younger pregnant adolescents who are properly followed through group prenatal care (GPC) delivered by specialized public services. Methods: This retrospective cohort study followed pregnant adolescents (aged 10-17 years) who received GPC from specialized public services in Brazil from 2009 to 2014. Data were obtained from medical records and through interviews with a multidisciplinary team that treated the patients. The neonatal outcomes (low birth weight, prematurity, Apgar scores with 1 and 5 min, and neonatal death) of newborns of adolescents aged 10-13 years were compared to those of adolescents aged 14-15 years and 16-17 years. Incidence was calculated with 95% confidence intervals (CIs) and compared over time using a chi-squared test to observe trends. Poisson Multivariate logistic regression was used to adjust for confounding variables. The results are presented as adjusted relative risks or adjusted mean differences. Results: Of the 1,112 adolescents who were monitored, 758 were included in this study. The overall incidence of adverse neonatal outcomes (low birth weight and prematurity) was measured as 10.2% (95% CI: 9.7-11.5). Apgar scores collected at 1 and 5 min were found to be normal, and no instance of fetal death occurred. The incidence of low birth weight was 16.1% for the 10-13 age group, 8.7% for the 14-15 age group and 12.1% for the 16-17 age group. The incidence of preterm was measured at 12, 8.5, and 12.6% for adolescents who were 10-13, 14-15, and 16-17 years of age, respectively. Neither low birth weight nor prematurity levels significantly differed among the groups (p > 0.05). The infants born to mothers aged 10-13 years presented significantly (p < 0.05) lower Apgar scores than other age groups, but the scores were within the normal range. Conclusions: Our findings showed lower incidence of neonatal adverse outcomes and no risk difference of neonatal outcomes in younger pregnancy adolescents. It potentially suggests that GPC model to care pregnant adolescents is more important than the age of pregnant adolescent, however further research is needed.
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Affiliation(s)
| | - Izabela Fulone
- Pharmaceutical Sciences Graduate Course, University of Sorocaba (UNISO), Sorocaba, Brazil
| | - Marcus Tolentino Silva
- Pharmaceutical Sciences Graduate Course, University of Sorocaba (UNISO), Sorocaba, Brazil
| | - Luciane Cruz Lopes
- Pharmaceutical Sciences Graduate Course, University of Sorocaba (UNISO), Sorocaba, Brazil
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Ferreira TR, Lopes LC, Motter FR, de Cássia Bergamaschi C. Potentially inappropriate prescriptions to Brazilian older people with Alzheimer disease: A cross-sectional study. Medicine (Baltimore) 2021; 100:e25015. [PMID: 33761656 PMCID: PMC9282042 DOI: 10.1097/md.0000000000025015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 02/12/2021] [Indexed: 01/05/2023] Open
Abstract
Older adults are the leading users of medications, where this can be associated with a high number of potentially inappropriate medications (PIMs) and of potentially inappropriate prescribing (PIP) and consequent harm to health. No Brazilian study evaluating potentially inappropriate prescribing in older patients with Alzheimer's disease (AD) was found. This study determined and analyzed the prevalence of PIP and PIM prescribed for older people with AD.A cross-sectional study was carried out at the Specialty Drugs Pharmacy in the city of Sorocaba, São Paulo State, Brazil. The MEDEX system provided the register in older people with AD and data were collected during interviews with patients and/or caregivers between June and September 2017. The PIMs were identified according to the 2019 Beers Criteria. The association between PIMs and independent variables was analyzed by Poisson regression.This study included 234 older patients with AD. The prevalence of PIP prescribed was 66.7% (n = 156). Of the 1073 medications prescribed, 30.5% (n = 327) were inappropriate with most affecting the central nervous system or cardiovascular, particularly quetiapine (12.8%) and acetylsalicylic acid (11.6%), respectively. Around 45.2% of the PIMs should be avoided in older people, especially sertraline (14.2%) and clonazepam (7.4%). After adjusted analysis, the PIMs were associated with the diagnosis of depression (P = 0.010) and the number of comorbidities (P = 0.005).There was a high number of PIMs among older people, a substantial number of which should have been avoided in this population. Health care professionals can apply these findings to improve safety in the use of medications for treating patients with AD.
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Affiliation(s)
- Tânia Regina Ferreira
- Postgraduate Program in Pharmaceutical Sciences, University of Sorocaba, Sorocaba, State of São Paulo, Brazil
| | - Luciane Cruz Lopes
- Postgraduate Program in Pharmaceutical Sciences, University of Sorocaba, Sorocaba, State of São Paulo, Brazil
| | - Fabiane Raquel Motter
- Postgraduate Program in Pharmaceutical Sciences, University of Sorocaba, Sorocaba, State of São Paulo, Brazil
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Sorrilha FB, Mazzei LG, Lopes LC, Barberato-Filho S, Castro J, Castro A, Vélez CM, de Cássia Bergamaschi C. Treatment of urinary incontinence: a critical appraisal of clinical practice guidelines with the AGREE II instrument. Int Urogynecol J 2021; 32:2647-2656. [PMID: 33704538 DOI: 10.1007/s00192-021-04729-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 02/06/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS This systematic review evaluated the rigor of the development of clinical practice guidelines (CPG). METHODS The searched sources were MEDLINE, EMBASE, Web of Science, Scopus, and specific databases of CPG. Reviewers, organized in triplicate and independently, selected the studies and assessed the quality of the guidelines using the Appraisal of Guidelines Research and Evaluation (AGREE II) instrument, which contains six domains for classification. The classification of the CPGs prioritized the domain 3 (developmental rigor) considering: high (score > 60%), moderate (score 30-60%), or low quality (score < 30%). The results were checked for discrepancies and decided by consensus. The interventions were described. Descriptive statistics presented the results. RESULTS Of the ten CPGs evaluated, five were of high methodological quality, three were of moderate quality, and two of low quality. Three documents were not recommended for use. The domains with the highest scores were scope and purpose (mean = 90.1%) and clarity of presentation (mean = 88.9%). The domains of editorial independence (mean = 41.4%) and applicability (mean = 29.3%) were those with the lowest score. The most cited interventions in CPGs were the nonpharmacological, such as lifestyle interventions, bladder training, or re-education and pelvic floor muscle training. CONCLUSION Most guidelines showed rigor in development and were recommended for use; however, editorial independence and applicability were domains that need to be improved in these documents. Our findings can guide the choice of CPG for the treatment of urinary incontinence.
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Affiliation(s)
- Flávia Blaseck Sorrilha
- Graduate Program in Pharmaceutical Sciences, University of Sorocaba, Sorocaba, São Paulo, Brazil
| | - Lauren Giustti Mazzei
- Graduate Program in Pharmaceutical Sciences, University of Sorocaba, Sorocaba, São Paulo, Brazil
| | - Luciane Cruz Lopes
- Graduate Program in Pharmaceutical Sciences, University of Sorocaba, Sorocaba, São Paulo, Brazil
| | - Silvio Barberato-Filho
- Graduate Program in Pharmaceutical Sciences, University of Sorocaba, Sorocaba, São Paulo, Brazil
| | - Juliana Castro
- Graduate Program in Pharmaceutical Sciences, University of Sorocaba, Sorocaba, São Paulo, Brazil
| | - Analaura Castro
- Graduate Program in Pharmaceutical Sciences, University of Sorocaba, Sorocaba, São Paulo, Brazil
| | | | - Cristiane de Cássia Bergamaschi
- Graduate Program in Pharmaceutical Sciences, University of Sorocaba, Sorocaba, São Paulo, Brazil.
- Universidade de Sorocaba (UNISO), Rodovia Raposo Tavares, Km 92.5, Sorocaba, São Paulo, 18.023-000, Brazil.
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Pedroso JVDM, Motter FR, Koba ST, Camargo MC, de Toledo MI, Del Fiol FDS, Silva MT, Lopes LC. Feasibility of De-Escalation Implementation for Positive Blood Cultures in Patients With Sepsis: A Prospective Cohort Study. Front Pharmacol 2021; 11:576849. [PMID: 33643032 PMCID: PMC7907639 DOI: 10.3389/fphar.2020.576849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 12/16/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose: The aim of the present study was to determine whether de-escalation guided by blood cultures for patients with a diagnosis of sepsis, severe sepsis or septic shock reduces mortality, and antimicrobial drug resistance (ADR). Methods: A prospective, single-center, cohort study was conducted with adults admitted to the ICU with a diagnosis of sepsis, severe sepsis, or septic shock at a public hospital in Sorocaba, State of São Paulo, Brazil, from January 2013 to December 2013. We excluded patients who had negative blood cultures. Patients who had replaced the initial empirical broad-spectrum antibiotic therapy (EAT) by the antibiotic therapy guided by blood cultures were compared with those who continued receiving EAT. The outcome included mortality and antimicrobial drug resistance. We used the Cox regression (proportional hazards regression) and the Poisson regression to analyze the association between antibiotic therapy guided by blood cultures (ATGBC) and outcomes. The statistical adjustment in all models included the following variables: sex, age, APACHE II (Acute Physiology And Chronic Health Evaluation II) score and SOFA (Sequential Organ Failure Assessment) score. Results: Among the 686 patients who were admitted to the intensive care unit, 91 were included in this study. The mean age of the patients was 52.7 years (standard deviation = 18.5 years) and 70.3% were male. EAT was replaced by ATGBC in 33 patients (36.3%) while 58 patients (63.7%) continued receiving EAT. Overall hospital mortality decreased from 56.9% in patients who received EAT to 48.5% in patients who received ATGBC [Hazard ratio- HR 0.44 (95% CI 0.24–0.82), p = 0.009]. There was no association between ATGBC and ADR [HR 0.90 (95% CI 0.78 – 1.03) p = 0.15]. Conclusions: Although the early and appropriate empirical EAT is undoubtedly an important factor prognostic, ATGBC can reduce the mortality in these patients.
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Affiliation(s)
| | - Fabiane Raquel Motter
- Postgraduate Program in Pharmaceutical Sciences, University of Sorocaba, UNISO, São Paulo, Brazil
| | - Sonia Tiemi Koba
- Postgraduate Program in Pharmaceutical Sciences, University of Sorocaba, UNISO, São Paulo, Brazil
| | - Mayara Costa Camargo
- Postgraduate Program in Pharmaceutical Sciences, University of Sorocaba, UNISO, São Paulo, Brazil
| | - Maria Inês de Toledo
- Posgraduate Program in Tropical Medicine, University of Brasilia (UnB), Brasília, Brazil
| | - Fernando de Sá Del Fiol
- Postgraduate Program in Pharmaceutical Sciences, University of Sorocaba, UNISO, São Paulo, Brazil
| | - Marcus Tolentino Silva
- Postgraduate Program in Pharmaceutical Sciences, University of Sorocaba, UNISO, São Paulo, Brazil
| | - Luciane Cruz Lopes
- Postgraduate Program in Pharmaceutical Sciences, University of Sorocaba, UNISO, São Paulo, Brazil
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Ferreira TR, Lopes LC, Bergamaschi CDC. Frequency and Severity of Adverse Drug Reactions to Medications Prescribed for Alzheimer's Disease in a Brazilian City: Cross-Sectional Study. Front Pharmacol 2021; 11:538095. [PMID: 33519428 PMCID: PMC7845662 DOI: 10.3389/fphar.2020.538095] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 10/29/2020] [Indexed: 11/16/2022] Open
Abstract
Background: There is lack of national studies that assess the risks associated with the drugs provided under the Brazilian public health system for treating Alzheimer’s disease. Then, this study determined the prevalence and severity of self-reported adverse drug reactions (ADRs) prescribed to patients with Alzheimer’s disease in the Brazilian public health system. Methods: A cross-sectional study was carried out based on public data from the MEDEX system (information on dispensing data, known as exceptional dispensing medications) and interviews with patients and/or caregivers who get access to Alzheimer’s drugs at a public pharmacy in a large Brazilian city, between July and September 2017, inquiring about ADRs and serious adverse events (SAEs). Results: The subjects were asked about ADRs and SAEs related to the use of donepezil, galantamine, rivastigmine and memantine. Out of 285 patients enrolled on the database, 250 participated in the study (87.7%). Among the participants, approximately 63.0% were female, 70.3% aged ≥75 years and 70.3% had comorbidities. Overall, 209 patients (83.6%) reported at least one ADR (total 1,149 ADRs) and rivastigmine was associated with the largest number of ADRs per patient (7.9 ADRs/patient). The predominant adverse effects were psychiatric disorders with common frequency (57.1%) and mild severity (89.0%). Six patients (2.4%) had SAEs that required hospitalization. The use of antipsychotics was the variable associated with ADR (OR = 4.95; 95% CI: 1.45–16.93; p = 0.011). Conclusion: There was a large number of reported ADRs and most of them were of common frequency and mild severity, being mainly related to psychiatric disorders. Considering the fragility of these patients, it is important to improve safety-related care in the use of drugs for treating this disease.
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Affiliation(s)
- Tânia Regina Ferreira
- Graduate Program of Pharmaceutical Sciences, University of Sorocaba, Sorocaba, Brazil
| | - Luciane Cruz Lopes
- Graduate Program of Pharmaceutical Sciences, University of Sorocaba, Sorocaba, Brazil
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Araújo JDO, Bergamaschi CDC, Lopes LC, Guimarães CC, de Andrade NK, Ramacciato JC, Motta RHL. Effectiveness and safety of oral sedation in adult patients undergoing dental procedures: a systematic review. BMJ Open 2021; 11:e043363. [PMID: 33495257 PMCID: PMC7839856 DOI: 10.1136/bmjopen-2020-043363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES It can be challenging to manage patients who are anxious during dental procedures. There is a lack of evidence regarding the effectiveness and safety of oral sedation in adults. This study evaluated the effectiveness and safety of oral sedation in patients undergoing dental procedures. DESIGN Systematic review. METHODS Randomised clinical trials (RCTs) compared the oral use of benzodiazepines and other medications with a placebo or other oral agents in adult patients. A search of the Cochrane (CENTRAL), MEDLINE (via Ovid), EMBASE (via Ovid) and Cumulative Index to Nursing and Allied Health Literature (via Ovid) databases was conducted, without any restrictions on language or date of publication. The primary outcomes included the adverse effects and anxiety level. The secondary outcomes included sedation, satisfaction with the treatment, heart rate, respiratory rate, blood pressure and oxygen saturation. Reviewers, independently and in pairs, assessed each citation for eligibility, performed the data extraction and assessed the risk of bias. A narrative synthesis of the data was provided. RESULTS A number of RCTs (n=327 patients) assessed the use of benzodiazepines (n=9) and herbal medicines (n=3). We found good satisfaction with treatment after the use of midazolam 7.5 mg or clonidine 150 µg and reduced anxiety with alprazolam (0.5 and 0.75 mg). Midazolam 15 mg promoted greater anxiety reduction than Passiflora incarnata L. 260 mg, while Valeriana officinalis 100 mg and Erythrina mulungu 500 mg were more effective than a placebo. More patients reported adverse effects with midazolam 15 mg. Diazepam 15 mg and V. officinalis 100 mg promoted less change in the heart rate and blood pressure than a placebo. CONCLUSIONS Given the limitations of the findings due to the quality of the included studies and the different comparisons made between interventions, further RCTs are required to confirm the effectiveness and safety of oral sedation in dentistry. PROSPERO REGISTRATION NUMBER CRD42017057142.
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Affiliation(s)
- Jimmy de Oliveira Araújo
- Division of Pharmacology, Anesthesiology and Therapeutics, Faculdade São Leopoldo Mandic, Instituto de Pesquisas São Leopoldo Mandic, Campinas, Brazil
| | | | - Luciane Cruz Lopes
- Department of Pharmaceutical Sciences, Universidade da Sorocaba, Sorocaba, Brazil
| | - Caio Chaves Guimarães
- Division of Pharmacology, Anesthesiology and Therapeutics, Faculdade São Leopoldo Mandic, Instituto de Pesquisas São Leopoldo Mandic, Campinas, Brazil
| | - Natalia Karol de Andrade
- Division of Pharmacology, Anesthesiology and Therapeutics, Faculdade São Leopoldo Mandic, Instituto de Pesquisas São Leopoldo Mandic, Campinas, Brazil
| | - Juliana Cama Ramacciato
- Division of Pharmacology, Anesthesiology and Therapeutics, Faculdade São Leopoldo Mandic, Instituto de Pesquisas São Leopoldo Mandic, Campinas, Brazil
| | - Rogério Heládio Lopes Motta
- Division of Pharmacology, Anesthesiology and Therapeutics, Faculdade São Leopoldo Mandic, Instituto de Pesquisas São Leopoldo Mandic, Campinas, Brazil
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Fulone I, Barreto JOM, Barberato-Filho S, Bergamaschi CDC, Silva MT, Lopes LC. Improving Care for Deinstitutionalized People With Mental Disorders: Experiences of the Use of Knowledge Translation Tools. Front Psychiatry 2021; 12:575108. [PMID: 33981256 PMCID: PMC8109270 DOI: 10.3389/fpsyt.2021.575108] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 03/29/2021] [Indexed: 01/08/2023] Open
Abstract
Background: The deinstitutionalization process is complex, long-term and many countries fail to achieve progress and consolidation. Informing decision-makers about appropriate strategies and changes in mental health policies can be a key factor for it. This study aimed to develop an evidence brief to summarize the best available evidence to improve care for deinstitutionalized patients with severe mental disorders in the community. Methods: We used the SUPPORT (Supporting Policy Relevant Reviews and Trials) tools to elaborate the evidence brief and to organize a policy dialogue with 24 stakeholders. A systematic search was performed in 10 electronic databases and the methodological quality of systematic reviews (SRs) was assessed by AMSTAR 2. Results: Fifteen SRs were included (comprising 378 studies and 69,736 participants), of varying methodological quality (3 high-quality SRs, 2 moderate-quality SRs, 7 low-quality SRs, 3 critically low SRs). Six strategies were identified: (i). Psychoeducation; (ii). Anti-stigma programs, (iii). Intensive case management; (iv). Community mental health teams; (v). Assisted living; and (vi). Interventions for acute psychiatric episodes. They were associated with improvements on a global status, satisfaction with the service, reduction on relapse, and hospitalization. Challenges to implementation of any of them included: stigma, the shortage of specialized human resources, limited political and budgetary support. Conclusions: These strategies could guide future actions and policymaking to improve mental health outcomes.
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Affiliation(s)
- Izabela Fulone
- Pharmaceutical Sciences Graduate Course, University of Sorocaba, Sorocaba, Brazil
| | | | | | | | | | - Luciane Cruz Lopes
- Pharmaceutical Sciences Graduate Course, University of Sorocaba, Sorocaba, Brazil
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Lima EDC, Camarinha BD, Ferreira Bezerra NC, Panisset AG, Belmino de Souza R, Silva MT, Lopes LC. Severe Potential Drug-Drug Interactions and the Increased Length of Stay of Children in Intensive Care Unit. Front Pharmacol 2020; 11:555407. [PMID: 33343344 PMCID: PMC7744879 DOI: 10.3389/fphar.2020.555407] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 10/19/2020] [Indexed: 12/24/2022] Open
Abstract
Children are exposed to drug-drug interactions (DDI) risks due to their organism’s complexity and the need for several medicines prescriptions in pediatric intensive care units (PICU). This study aimed to assess the prevalence of potential DDIs in a Brazilian PICU. We carried out a cross-sectional study at a pediatric teaching hospital from Rio de Janeiro (Brazil) over one year. Potential DDIs (pDDIs) between prescribed medicines for hospitalized children in PICU (n = 143) were analyzed according to severity using Micromedex®. Sex, age group, number of drugs prescribed, vasoactive amines use (a proxy of clinical complexity), and the PICU length of stay were summarized using descriptive statistics. Association between the PICU length stay, and variables sex, age, clinical condition complexity, number of drugs prescribed, and severity of pDDI were examined by univariate and multiple linear regression. Seventy percent of patients aged three days to 14 years old were exposed at least one potential DDIs during PICU stay. Two hundred eighty-four different types of pDDIs were identified, occurring 1,123 times. Nervous system drugs were implicated in 55% of the interactions, and fentanyl (10%) was most involving in pDDIs. Most pDDIs were classified as higher severity (56.2%), with reasonable documentation (64.6%) and unspecified onset time (63.8%). Worse clinical condition, ten or more drugs prescribed, and most severe pDDIs were associated with a longer PICU length of stay. Multiple linear regression analysis showed an increase of 9.83 days (95% confidence interval: 3.61–16.05; p = 0.002) in the PICU length of stay in children with major or contraindicated pDDIs. The results of this research may support the monitoring and prevention of pDDIs related to adverse events in children in intensive care and the design and conduction of new studies.
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Affiliation(s)
| | - Barbara Dias Camarinha
- Instituto de Puericultura e Pediatria Martagão Gesteira, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | | | - Anderson Gonçalves Panisset
- Instituto de Puericultura e Pediatria Martagão Gesteira, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | - Raquel Belmino de Souza
- Instituto de Puericultura e Pediatria Martagão Gesteira, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | | | - Luciane Cruz Lopes
- Graduate Course of Pharmaceutical Science, Universidade de Sorocaba, Sorocaba, Brazil
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Hakoum MB, Noureldine H, Habib JR, Abou-Jaoude EA, Raslan R, Jouni N, Hasbani DJ, Lopes LC, Guyatt G, Akl EA. Authors of clinical trials seldom reported details when declaring their individual and institutional financial conflicts of interest: a cross-sectional survey. J Clin Epidemiol 2020; 127:49-58. [DOI: 10.1016/j.jclinepi.2020.05.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 04/25/2020] [Accepted: 05/25/2020] [Indexed: 11/29/2022]
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Abstract
OBJECTIVE Some patients with dengue fever tend to develop thrombocytopenia during the course of infection and are thus vulnerable to haemorrhagic manifestations and other complications. However, the factors associated with the development of thrombocytopenia are unknown. We aimed to identify factors associated with an increased risk of thrombocytopenia and haematological changes in patients with confirmed dengue fever. DESIGN Retrospective cohort study. SETTING Brazilian multicentre primary care databases. PARTICIPANTS 387 patients had positive laboratory serological confirmation of dengue infection during 2014. The data were identified from two databases: Notification of Injury Information System (SINAN) and Municipal Laboratory. MAIN OUTCOME MEASURE The presence of thrombocytopenia (platelet count <1 50×109/L). The associations of factors that predisposed patients to thrombocytopenia and haematological changes were analysed using logistic regression. ORs and 95% CIs were calculated. RESULTS Among 387 patients, 156 had both dengue and thrombocytopenia. The risk factors associated with thrombocytopenia included male sex (OR: 1.77, 95% CI: 1.16 to 2.71, p=0.007), age of 46-64 years (OR: 2.20, 95% CI: 1.15 to 4.21, p=0.009) or ≥65 years (OR: 3.02, 95% CI: 1.40 to 6.50, p=0.002), presence of leucopenia (OR: 6.85, 95% CI: 4.27 to 10.99, p<0.001) and high mean corpuscular haemoglobin (MCH) levels (OR: 2.00, 95% CI: 1.29 to 3.12, p=0.005). CONCLUSION Older age, male sex, presence of leucopenia and high MCH levels were identified as risk factors associated with the development of thrombocytopenia in this population.
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Affiliation(s)
- Bruna M Castilho
- School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, São Paulo, Brazil
| | - Marcus T Silva
- Pharmaceutical Sciences Graduate Course, University of Sorocaba (UNISO), Sorocaba, São Paulo, Brazil
| | | | - Izabela Fulone
- Pharmaceutical Sciences Graduate Course, University of Sorocaba (UNISO), Sorocaba, São Paulo, Brazil
| | - Luciane Cruz Lopes
- Pharmaceutical Sciences Graduate Course, University of Sorocaba (UNISO), Sorocaba, São Paulo, Brazil
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Lopes LC, Godman B, Bergamaschi CDC, Barberato-Filho S, Silva MT. Editorial: New Horizons in Health-Promoting Technologies: From Development to Rational Use. Front Pharmacol 2020; 11:1180. [PMID: 32848783 PMCID: PMC7424042 DOI: 10.3389/fphar.2020.01180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 07/20/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Luciane Cruz Lopes
- Pharmaceutical Science Graduate Course, University of Sorocaba, Sorocaba, Brazil
| | - Brian Godman
- Karolinska University Hospital Huddinge, Karolinska Institutet (KI), Stockholm, Sweden.,Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom.,School of Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, South Africa
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Kahale LA, Khamis AM, Diab B, Chang Y, Lopes LC, Agarwal A, Li L, Mustafa RA, Koujanian S, Waziry R, Busse JW, Dakik A, Schünemann HJ, Hooft L, Scholten RJ, Guyatt GH, Akl EA. Potential impact of missing outcome data on treatment effects in systematic reviews: imputation study. BMJ 2020; 370:m2898. [PMID: 32847800 PMCID: PMC7448113 DOI: 10.1136/bmj.m2898] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To assess the risk of bias associated with missing outcome data in systematic reviews. DESIGN Imputation study. SETTING Systematic reviews. POPULATION 100 systematic reviews that included a group level meta-analysis with a statistically significant effect on a patient important dichotomous efficacy outcome. MAIN OUTCOME MEASURES Median percentage change in the relative effect estimate when applying each of the following assumption (four commonly discussed but implausible assumptions (best case scenario, none had the event, all had the event, and worst case scenario) and four plausible assumptions for missing data based on the informative missingness odds ratio (IMOR) approach (IMOR 1.5 (least stringent), IMOR 2, IMOR 3, IMOR 5 (most stringent)); percentage of meta-analyses that crossed the threshold of the null effect for each method; and percentage of meta-analyses that qualitatively changed direction of effect for each method. Sensitivity analyses based on the eight different methods of handling missing data were conducted. RESULTS 100 systematic reviews with 653 randomised controlled trials were included. When applying the implausible but commonly discussed assumptions, the median change in the relative effect estimate varied from 0% to 30.4%. The percentage of meta-analyses crossing the threshold of the null effect varied from 1% (best case scenario) to 60% (worst case scenario), and 26% changed direction with the worst case scenario. When applying the plausible assumptions, the median percentage change in relative effect estimate varied from 1.4% to 7.0%. The percentage of meta-analyses crossing the threshold of the null effect varied from 6% (IMOR 1.5) to 22% (IMOR 5) of meta-analyses, and 2% changed direction with the most stringent (IMOR 5). CONCLUSION Even when applying plausible assumptions to the outcomes of participants with definite missing data, the average change in pooled relative effect estimate is substantive, and almost a quarter (22%) of meta-analyses crossed the threshold of the null effect. Systematic review authors should present the potential impact of missing outcome data on their effect estimates and use this to inform their overall GRADE (grading of recommendations assessment, development, and evaluation) ratings of risk of bias and their interpretation of the results.
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Affiliation(s)
- Lara A Kahale
- Department of Internal Medicine, American University of Beirut Medical Center, PO Box 11-0236, Riad-El-Solh Beirut 1107 2020, Beirut, Lebanon
- Cochrane Netherlands and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Assem M Khamis
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Batoul Diab
- Department of Internal Medicine, American University of Beirut Medical Center, PO Box 11-0236, Riad-El-Solh Beirut 1107 2020, Beirut, Lebanon
| | - Yaping Chang
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Luciane Cruz Lopes
- Pharmaceutical Sciences Post Graduate Course, University of Sorocaba, UNISO, Sorocaba, Sao Paulo, Brazil
| | - Arnav Agarwal
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ling Li
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Reem A Mustafa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Departments of Medicine and Biomedical and Health Informatics, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Serge Koujanian
- Department of Evaluative Clinical Sciences, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Reem Waziry
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Jason W Busse
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Anaesthesia, McMaster University, Hamilton, ON, Canada
- The Michael G DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON, Canada
- Canadian Veterans Chronic Pain Centre of Excellence, Hamilton, ON, Canada
| | - Abeer Dakik
- Department of Internal Medicine, American University of Beirut Medical Center, PO Box 11-0236, Riad-El-Solh Beirut 1107 2020, Beirut, Lebanon
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Lotty Hooft
- Cochrane Netherlands and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Rob Jpm Scholten
- Cochrane Netherlands and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Elie A Akl
- Department of Internal Medicine, American University of Beirut Medical Center, PO Box 11-0236, Riad-El-Solh Beirut 1107 2020, Beirut, Lebanon
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
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Yamauti SM, Barreto JOM, Barberato-Filho S, Lopes LC. Strategies Implemented by Public Institutions to Approach the Judicialization of Health Care in Brazil: A Systematic Scoping Review. Front Pharmacol 2020; 11:1128. [PMID: 32848747 PMCID: PMC7406659 DOI: 10.3389/fphar.2020.01128] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 07/10/2020] [Indexed: 11/13/2022] Open
Abstract
Background The judicialization of health care is a social claim concerning the right to the access to health care. It usually occurs due to gaps in public policy or failures in its application. In Brazil, several public institutions have implemented strategies to approach this phenomenon. However, these strategies have not yet been systematized into functional categories. Objective To categorize and analyze the strategies implemented by public institutions in Brazil to approach the judicialization of health care. Method A systematic scoping review was developed following the method proposed by the Joanna Briggs Institute. The descriptor ‘judicialization of health’ was used to conduct the searches for studies in 18 electronic databases and other types of documents in the gray literature until March 2019. Documents containing the reports of strategies implemented in public institutions to approach the judicialization of health care in Brazil were included. Two independent reviewers assessed the eligibility of the documents and extracted the data. The strategies identified were categorized using definitions from the World Health Organization and existing Brazilian legislation. Results Seventy eight implemented strategies were identified and organized into nine categories: i. Technical support to the judiciary; ii. State health committees; iii. Organization of assistance; iv. Compliance with court orders, v. Computerized information systems; vi. Administrative proceeding; vii. Defense of the public authority; viii. Pharmacy and therapeutics committee; ix. Alternative dispute resolution. These categories are not mutually exclusive and often act in concert or complement each other’s activities. They represent services either existing or provided for in legal provisions by the public administration to meet various types of demands. Conclusions The categories proposed to approach the judicialization of health care represent some of the recommendations for qualifying public administration or are provided for in Brazilian legislation, or both. The existence of recommendations and legislation facilitate, but do not guarantee, the implementation of strategies by public institutions.
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Affiliation(s)
- Sueli Miyuki Yamauti
- Graduate Program in Pharmaceutical Science, University of Sorocaba, Sorocaba, Brazil
| | | | | | - Luciane Cruz Lopes
- Graduate Program in Pharmaceutical Science, University of Sorocaba, Sorocaba, Brazil
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Kahale LA, Khamis AM, Diab B, Chang Y, Lopes LC, Agarwal A, Li L, Mustafa RA, Koujanian S, Waziry R, Busse JW, Dakik A, Hooft L, Guyatt GH, Scholten RJPM, Akl EA. Meta-Analyses Proved Inconsistent in How Missing Data Were Handled Across Their Included Primary Trials: A Methodological Survey. Clin Epidemiol 2020; 12:527-535. [PMID: 32547244 PMCID: PMC7266325 DOI: 10.2147/clep.s242080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background How systematic review authors address missing data among eligible primary studies remains uncertain. Objective To assess whether systematic review authors are consistent in the way they handle missing data, both across trials included in the same meta-analysis, and with their reported methods. Methods We first identified 100 eligible systematic reviews that included a statistically significant meta-analysis of a patient-important dichotomous efficacy outcome. Then, we successfully retrieved 638 of the 653 trials included in these systematic reviews’ meta-analyses. From each trial report, we extracted statistical data used in the analysis of the outcome of interest to compare with the data used in the meta-analysis. First, we used these comparisons to classify the “analytical method actually used” for handling missing data by the systematic review authors for each included trial. Second, we assessed whether systematic reviews explicitly reported their analytical method of handling missing data. Third, we calculated the proportion of systematic reviews that were consistent in their “analytical method actually used” across trials included in the same meta-analysis. Fourth, among systematic reviews that were consistent in the “analytical method actually used” across trials and explicitly reported on a method for handling missing data, we assessed whether the “analytical method actually used” and the reported methods were consistent. Results We were unable to determine the “analytical method reviews actually used” for handling missing outcome data among 397 trials. Among the remaining 241, systematic review authors most commonly conducted “complete case analysis” (n=128, 53%) or assumed “none of the participants with missing data had the event of interest” (n=58, 24%). Only eight of 100 systematic reviews were consistent in their approach to handling missing data across included trials, but none of these reported methods for handling missing data. Among seven reviews that did explicitly report their analytical method of handling missing data, only one was consistent in their approach across included trials (using complete case analysis), and their approach was inconsistent with their reported methods (assumed all participants with missing data had the event). Conclusion The majority of systematic review authors were inconsistent in their approach towards reporting and handling missing outcome data across eligible primary trials, and most did not explicitly report their methods to handle missing data. Systematic review authors should clearly identify missing outcome data among their eligible trials, specify an approach for handling missing data in their analyses, and apply their approach consistently across all primary trials.
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Affiliation(s)
- Lara A Kahale
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Assem M Khamis
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Batoul Diab
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Yaping Chang
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Luciane Cruz Lopes
- Pharmaceutical Sciences Post Graduate Course, University of Sorocaba, UNISO, Sorocaba, Sao Paulo, Brazil
| | - Arnav Agarwal
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ling Li
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Reem A Mustafa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,Departments of Medicine and Biomedical & Health Informatics, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Serge Koujanian
- Department of Evaluative Clinical Sciences, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Reem Waziry
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jason W Busse
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,Department of Anesthesia, McMaster University, Hamilton, Canada.,The Michael G. DeGroote National Pain Centre, McMaster University, Hamilton, Canada.,Chronic Pain Centre of Excellence for Canadian Veterans, Hamilton, Canada
| | - Abeer Dakik
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Lotty Hooft
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,Department of Medicine, McMaster University, Hamilton, Canada
| | - Rob J P M Scholten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Elie A Akl
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
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Mazzei LG, Bergamaschi CDC, Silva MT, Barberato Filho S, Fulone I, Moura MDG, Guimaraes C, Lopes LC. Use of IMMPACT domains in clinical trials of acupuncture for chronic pain: A methodological survey. PLoS One 2020; 15:e0231444. [PMID: 32298300 PMCID: PMC7162498 DOI: 10.1371/journal.pone.0231444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 03/24/2020] [Indexed: 12/15/2022] Open
Abstract
Acupuncture is one of the therapeutic resources used for the management of chronic pain. Variability in outcome measurements in randomized clinical trials of non-oncologic chronic pain (RCT-NOCP) generates inconsistencies in determining effects of treatments. The objective of this survey was to assess the adherence to the recommendations made by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) in the measurement of RCT-NOCP of acupuncture. This methodological research made a systematic search for eligible studies from different sources of information. Eligible studies included those with number of patients ≥100, who randomized and allocated patients with chronic non-oncologic pain to be treated with acupuncture or with "sham" acupuncture, or non-acupuncture. This research included the recommendations for IMMPACT in the measurement of RCT-NOCP: presence of outcomes pain, physical function, emotional state and improvement perception of patient, the source of the outcome information pain and the tools used to measure such domains. From a total of 1,386 studies, 24 were included in this survey. Eleven studies presented low risk of bias. Pain outcome was measured in 23 studies, physical function in 22 studies, emotional state in 14 studies and improvement perception of patient in one study. As for the pain outcome, the patient was the information source in 50% of the studies. The measurement tools recommended for IMMPACT were included in eight studies (35%) that evaluated pain, one study that evaluated the emotional state (7%), and one study that evaluated the improvement perception and satisfaction of patient. It was observed that studies which did not adhere to the recommendations had more favorable results for acupuncture in the outcome pain. This study concludes that randomized clinical trials that used acupuncture to manage chronic pain failed to adhere to IMMPACT recommendations. Clinical societies and IMMPACT do not share the same recommendations. This fact reflects in the diversity of outcomes and instruments adopted in the studies, making it difficult to compare the results.
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Affiliation(s)
- Lauren Giustti Mazzei
- Pharmaceutical Sciences Graduate Program, University of Sorocaba, Sorocaba, State of São Paulo, Brazil
| | | | - Marcus Tolentino Silva
- Pharmaceutical Sciences Graduate Program, University of Sorocaba, Sorocaba, State of São Paulo, Brazil
| | - Silvio Barberato Filho
- Pharmaceutical Sciences Graduate Program, University of Sorocaba, Sorocaba, State of São Paulo, Brazil
| | - Izabela Fulone
- Pharmaceutical Sciences Graduate Program, University of Sorocaba, Sorocaba, State of São Paulo, Brazil
| | - Mariana Del Grossi Moura
- Pharmaceutical Sciences Graduate Program, University of Sorocaba, Sorocaba, State of São Paulo, Brazil
| | - Caio Guimaraes
- Pharmaceutical Sciences Graduate Program, University of Sorocaba, Sorocaba, State of São Paulo, Brazil
| | - Luciane Cruz Lopes
- Pharmaceutical Sciences Graduate Program, University of Sorocaba, Sorocaba, State of São Paulo, Brazil
- * E-mail:
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50
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Fulone I, Barreto JOM, Barberato-Filho S, de Carvalho MH, Lopes LC. Knowledge Translation for Improving the Care of Deinstitutionalized People With Severe Mental Illness in Health Policy. Front Pharmacol 2020; 10:1470. [PMID: 32038229 PMCID: PMC6985550 DOI: 10.3389/fphar.2019.01470] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 11/13/2019] [Indexed: 11/18/2022] Open
Abstract
Background Knowledge translation (KT) is an effective strategy that uses the best available research evidence to bring stakeholders together to develop solutions and improve public health policy-making. Despite progress, the process of deinstitutionalization in Brazil is still undergoing consolidation, and the changes and challenges that are involved in this process are complex and necessitate evidence-informed decision-making. Accordingly, this study used KT tools to support efforts that aim to improve the care that is available to deinstitutionalized people with severe mental disorders in Brazil. Methods We used the Supporting Policy Relevant Reviews and Trials tools for evidence-informed health policymaking and followed eight steps: 1) capacity building; 2) identification of a priority policy issue within a Brazilian public health system; 3) meetings with policy-makers, researchers and stakeholders; 4) development of an evidence brief (EB) that addresses the problem of deinstitutionalization; 5) facilitating policy dialogue (PD); 6) the evaluation of the EB and PD; 7) post-dialogue mini-interviews; and 8) dissemination of the findings. Results Capacity building and meetings with key informants promoted awareness about the gap between research and practice. Local findings were used to define the problem and develop the EB. Twenty-four individuals (policy-makers, stakeholders, researchers, representatives of the civil society, and public defense) participated in the PD. They received the EB to subsidise their deliberations during the PD, which in turn were used to validate and improve the EB. The PD achieved the objective of promoting an exhaustive discussion about the problem and proposed options and improved communication and interaction among those who are involved in mental health care. The features of both the EB and PD were considered to be favorable and helpful. Conclusions The KT strategy helped participants understand different perspectives and values, the interpersonal tensions that exist among those who are involved in the field of mental health, and the strategies that can bridge the gap between research and policy-making. The present findings suggest that PDs can influence practice by promoting greater engagement among stakeholders who formulate or revise mental health policies.
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Affiliation(s)
- Izabela Fulone
- Pharmaceutical Sciences Graduate Course, University of Sorocaba, UNISO, Sorocaba, Brazil
| | | | - Silvio Barberato-Filho
- Pharmaceutical Sciences Graduate Course, University of Sorocaba, UNISO, Sorocaba, Brazil
| | | | - Luciane Cruz Lopes
- Pharmaceutical Sciences Graduate Course, University of Sorocaba, UNISO, Sorocaba, Brazil
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