The Pharmacoeconomic Impact of Pharmaceutical Care in the Hospital: Protocol for an Overview of Systematic Reviews

BACKGROUND

The clinical activities developed by pharmacists in a hospital environment can improve health outcomes and generate savings for hospitals. However, to determine whether pharmaceutical interventions are cost effective, it is essential to define a method according to which cost-effectiveness is intended to be measured. In addition, the quality of economic assessments and the amount of information present in systematic reviews in the literature make it difficult to analyze the effects of this intervention.

OBJECTIVE

This paper aims to provide an overview of systematic reviews on the pharmacoeconomic impact of the performance of pharmaceutical care in hospitals.

METHODS

A systematic search of the Cochrane Library databases, PubMed or MEDLINE, LILACS, Scopus, Web of Science, Google Scholar, and Open Thesis will be performed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. The search will involve the use of keywords determined using the Medical Subject Headings database to define the search terms and include the following terms: "pharmacoeconomics," "pharmaceutical care," and "hospital." The study designs to be included will be systematic reviews of good quality. Studies will be included that address pharmacoeconomics; studies that evaluated pharmaceutical care in hospitals; and studies published in Portuguese, English, or Spanish. The primary outcome sought in the systematic reviews will be the cost ratio in monetary units and the outcomes in monetary or natural units. The secondary economic outcomes considered will be determined based on factors associated with the drugs and translated into benefit, efficacy, or utility.

RESULTS

It is intended to start this overview in January 2023. Thus far, only previous searches have been carried out to contextualize the theme and build the protocol.

CONCLUSIONS

This overview will determine the pharmacoeconomic impact of pharmaceutical care interventions in the hospital environment. In addition, this study will point out which clinical outcomes in natural units are impacted by the performance of pharmaceutical care and the strengths and limitations of each approach. It will also identify gaps in the literature and areas for future work.

TRIAL REGISTRATION

PROSPERO CRD42019140665; https://tinyurl.com/bddwnz43.

Phallus eversion sexing in Phrynops geoffroanus (Testudines: Chelidae): a new non-invasive approach

The sexing of species is an important tool for population management. In tortoises and turtles, sexing is usually done according to secondary characteristics, such as plastron morphology or phallus eversion techniques. In this paper, we present the phallus eversion method and compare its efficiency to other existing techniques. This new method aims at shortening the management time and reducing the physical aftereffects on the animals, fostering the clinical and reproductive management of Geoffroy's side-necked turtle (Phrynops geoffroanus) and related species. A sample of fifty individuals was taken in the central region of Piauí state, Northeastern Brazil. The proposed method consisted of moving the head from its resting position. The methods achieving a success rate higher than 80% were compared to each other as for the stimulation time required for phallus eversion. The method as here proposed achieved 100% efficiency in the sex determination of specimens with a linear carapace length between 10 and 34 cm. Also, when compared to the second most efficient method, it substantially reduced the time needed for managing the specimens (91%), avoiding possible sequelae in the individuals handled.

Obesity and clinical severity in patients with COVID-19: a scoping review protocol

BACKGROUND

Coronavirus disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 strain, was first identified in late 2019 in China. The outcomes of patients affected by the virus can worsen, developing acute respiratory failure and other serious complications, especially in older individuals and people with obesity and comorbidities. Thus, obese patients tend to have a more severe course of COVID-19. Thus, this review aims to synthesize the evidence in the literature that associates COVID-19 and the severity of clinical outcomes in infected obese patients.

METHODS

This protocol was designed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols Statement. Scientific and gray literature will be systematically selected from PubMed/MEDLINE, Latin American Literature in Health Sciences, Online Scientific Electronic Library, Scopus, ScienceDirect, Web of Science, Embase, and Cochrane. The selection of articles will be limited to studies published in English, Portuguese, and Spanish from December 2019 onwards. The main clinical outcomes will be clinical severity in obese patients with COVID-19 as tachypnea (respiratory rate, ≥ 30 breaths per minute), hypoxemia (oxygen saturation, ≤ 93%), the ratio of the partial pressure of arterial oxygen to fraction of inspired oxygen (< 300), lung infiltrate (> 50% of the lung field involved within 24-48 h), diagnosis of the severe acute respiratory syndrome, need of invasive mechanical ventilation, and mortality. Two reviewers will independently screen all citations, full-text articles, and abstract data. Selection bias will be minimized by excluding studies published before December 2019. Conflicts will be resolved through a third reviewer and consensus-building. Moreover, findings will be reported using narrative synthesis and tabulation of the summaries.

DISCUSSION

Given the need for early detection of the possible implications and treatment for patients with obesity diagnosed with COVID-19, the scoping review will be useful to capture the state of the current literature, identify the gaps, and make recommendations for future research for directing the conduct and optimization of therapies in these patients by the multiprofessional teams.

SYSTEMATIC REVIEW REGISTRATION

Open Science Framework: https://osf.io/xrkec.

Algoritmos utilizados para o tratamento de feridas

Objetivos: Sintetizar criticamente os algoritmos encontrados na literatura para o tratamento de feridas. Método: revisão integrativa da literatura baseada na estratégia PICO. A busca na literatura foi realizada nas bases de dados eletrônicas LILACS, MedLine e CINAHL, baseada em cada um dos componentes da estratégia: algorithm and treatment and wounds and injuries. Resultados: Foram incluídos dezenove artigos, com um nível de confiabilidade de 0,99 na seleção dos estudos. Destaque de publicações para os Estados Unidos (64,3%). Observou-se diversidade significativa nos temas, com maior expressão da lesão por pressão (21,0%). A maioria dos estudos avaliados, 42,1% desenvolveu algoritmos e 36,8% desenvolveram e validaram o algoritmo. Em relação a confiabilidade dos instrumentos, todos os estudos que fizeram validação utilizaram o método “validação de conteúdo”. A maioria dos trabalhos (73,7%) foi classificada em Nível VII quanto à evidência. Conclusão: O tamanho da amostra selecionada foi razoavelmente suficiente para a coleta de informações a respeito do tema. No entanto, o elevado índice de publicações com baixa evidência cientifica, deixa claro que o assunto precisa ser melhor estudado.

Controle de qualidade físico-químico e caracterização fitoquímica das principais plantas medicinais comercializadas na feira-livre de Lagarto-SE

Segundo a Organização Mundial de Saúde (OMS), as plantas medicinais contribuem para a promoção da saúde, prevenção de doenças reabilitação e cura. Neste contexto, o presente estudo buscou realizar a caracterização físico – químico e fitoquímico das plantas medicinais mais comercializadas na feira – livre de Lagarto, munícipio do estado de Sergipe. As plantas medicinais mais comercializadas foram Plectranthus barbatus Andrews (boldo) 40%, Lippia alba (Mill.) N. E. Brown (erva cidreira) 25% e Pimpinella anisum L. (erva doce) 20%. Foi possível constatar os grupos dos compostos químicos provenientes do metabolismo secundário das plantas de cada espécie estudada com a ausência de alguns compostos descritos na literatura. Com relação a caracterização fitoquímica a espécie vegetal do boldo estava em sua maior parte dentro dos padrões estabelecidos pela farmacopeia, contudo as outras plantas medicinais ainda não estão incluídas na farmacopeia. Os testes realizados são vitais para o controle de qualidade, proporcionando segurança para os usuários, além de fornecer dados para futuros estudos para a padronização e desenvolvimento de novos fármacos.

Estimation of a closed population size of tadpoles in temporary pond

The practice of capture-recapture to estimate the diversity is well known to many animal groups, however this practice in the larval phase of anuran amphibians is incipient. We aimed at evaluating the Lincoln estimator, Venn diagram and Bayes theorem in the inference of population size of a larval phase anurocenose from lotic environment. The adherence of results was evaluated using the Kolmogorov-Smirnov test. The marking of tadpoles for later recapture and methods measurement was made with eosin methylene blue. When comparing the results of Lincoln-Petersen estimator corresponding to the Venn diagram and Bayes theorem, we detected percentage differences per sampling, i.e., the proportion of sampled anuran genera is kept among the three methods, although the values are numerically different. By submitting these results to the Kolmogorov-Smirnov test we have found no significant differences. Therefore, no matter the estimator, the measured value is adherent and estimates the total population. Together with the marking methodology, which did not change the behavior of tadpoles, the present study helps to fill the need of more studies on larval phase of amphibians in Brazil, especially in semi-arid northeast.

Risk factors for adverse drug reactions in pediatric inpatients: a systematic review

BACKGROUND

The main objective of the present systematic review is to identify potential risk factors for adverse drug reactions (ADRs) through prospective cohort studies in pediatric inpatients.

METHODS

The data search was done in the following electronic databases PubMed/MEDLINE; Scopus; LILACS and Web of Science from the earliest record until 31 May 2015. Two reviewers independently screened each study and one of them assessed the methodological quality according to the Newcastle-Ottawa scale for cohort studies. The data extraction was conducted according to Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) initiative for cohort studies.

RESULTS

The only risk factor observed in all studies was the increase in the number of prescription drugs. However, other factors were identified, such as the increase in the length of stay or the number of low- or high-risk drugs prescribed, use of general anesthesia and oncological diagnosis. The cumulative incidence of ADR was 16.4% (95% confidence interval: 15.6 to 17.2). The main professional responsible for ADR identification was the pharmacist and the dominant category among the ADRs were gastrointestinal disorders. In addition, analgesics, antibacterial agents and corticosteroids were the drug classes commonly associated with ADRs. The methodology used in this study was tried to homogenize the data extracted; however, this was not sufficient to correct the discrepancies so it was not possible to perform a meta-analysis.

CONCLUSIONS

The increase in the number of prescription drugs was the main risk factor in this population. However, additional studies are required to identify the risk factors for ADRs in pediatric inpatients.

Longevity and survival curves of Rhinella icterica (Anura, Bufonidae) under laboratory conditions

Life tables and survival curves of tadpoles from Rhinella icterica species were studied in the laboratory, under abiotic conditions controlled by a purification filter, a timer and a chiller. The survival curve for larval stage confirms a great mortality trend in the initial stages, which decreases when reaching the mature morphological condition (r = -0.94). Stages 37, 38, 39, 40 and 41 showed gradual values for their age structures, while stages 42, 43 and 44 presented high variations. Based on the results under laboratory conditions, it can be concluded that the maturity of R. icterica tadpoles development between 37 and 44 stages has a negative correlation and their predicted life expectancy is a logarithmic growth curve (y=-761.96Ln(x)+5298.5).

Use of herbal medicines by elderly patients: A systematic review

OBJECTIVES

We aimed to survey the published literature for articles that describe the use of herbal supplements by elderly patients and to summarize important aspects of selected studies, including most commonly used supplements, study type, study location, and potential hazards of herbal supplement use.

METHODS

Literature searches were conducted on three scientific/medical databases: Medline, Web of Science, and Scopus. Search results were examined for articles involving the use of herbal products in the elderly population that met selection criteria.

RESULTS

Initial searches yielded 1297 articles. Of these original results, only 16 met specific selection criteria. Twelve (75%) of studies identified were performed in North America. Nine studies (56.25%) were conducted in the United States. Seven of the studies were cross-sectional (43.8%). The most commonly reported were gingko biloba, garlic, ginseng, aloe vera, chamomile, spearmint, and ginger. Of these, gingko and garlic are the most commonly used among community-dwelling elderly. Both of these supplements have the potential to interact with anticoagulants and produce bruising or bleeding problems.

CONCLUSIONS

The use of herbal supplements is common among the elderly, a population that takes a disproportionate share of prescription medications compared to that taken by younger populations. Among the problems uncovered by these studies was a lack of dialog between medical professionals and patients about the use of herbal supplements. Prescribers need to consider the use of herbal supplements and discuss the matter with their elderly patients when making decisions about pharmacological treatments.

The choice of bromeliads as a microhabitat by Scinax argyreornatus (Anura, Hylidae)

The association of anurans to bromeliads presents different degrees of interaction such as: eventual, obligatory and bromeligen. The frog species Scinax argyreornatus shows a regular association with these plants. The goal of this study is to characterise the degree of association between the frog S. argyreornatus to different species of bromeliads. We identified which species of bromeliad is regularly associated with S. argyreornatus and recognised which factors interfere with this association preference. We analysed the Concentration of Relative Dominance of frogs per bromeliad species. As possible criteria for frog association preference to different bromeliads species we established the analysis of leaves number, length and width, number of leaf axils, stored water in the axils, pH and relative humidity, among other organographic components. Our observations were analyzed by ANOVA followed by the Tukey test. We also evaluated the preference for association by the constancy of Bodenheimer. The correlation matrix indicated that the relative humidity is the factor responsible for the frog-bromeliads association, except for Aechmea sp.. However Aechmea sp. was the species with greater constancy of occupation followed by Quesnelia arvensis and Neoregelia johannis. According to our statistical results, Aechmea sp. and Q. arvensis are not different regarding organographic parameters, but differ from N. johannis. Our observations suggest that the bromeliads organographic structure and the relative humidity are key conditions which influence the preferences of S. argyreornatus to bromeliad species, while the other features showed no correlation.