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Objective:To explore the effect of healthcare failure mode and effect analysis (HFMEA) in reducing the incidence of nursing interruption with negative outcome in operating room, so as to maximize the smooth progress of the surgical process.Methods:This was a quasi experimental study. The gastrointestinal surgery room of Shandong Provincial Hospital Affiliated to Shandong First Medical University was selected for the study. According to the surgical sequence, 38 surgeries performed in the gastrointestinal surgery suite from August 15-30, 2021 were set as the control group, and the conventional healthcare cooperation model process was implemented; 42 surgeries performed from September 15-30, 2021 were set as the intervention group, and the operating room under the HFMEA model was implemented negative outcome care disruption event management process.A video tracking method combined with a surgical care disruption event register was used to investigate the occurrence of negative outcome care disruption events in the operating room, comparing the number, duration, source of disruption events and the incidence of near miss events in the operating room between the control group and the intervention group.Results:In the control group, there were 38 observed surgeries, 190 negative outcome care interruptions, negative outcome interruptions of (5.26 ± 1.02) min duration, and no near misses; in the intervention group, there were 42 observed surgeries, 84 negative outcome care interruptions, negative outcome interruptions of (2.06 ± 0.08) min duration, and no near misses. There were statistically significant differences in the number, duration of negative outcome care interruptions between the intervention group and the control group ( χ2 = - 18.71, t = - 20.28; all P<0.01). There was statistically significant difference in the source of negative outcome care interruptions between the intervention group and the control group ( χ2 = - 12.71, P<0.01). Conclusions:HFMEA model can effectively reduce the number of negative nursing interruptions in the operating room, shorten the duration of interruptions, and minimize potential safety hazards caused by nursing interruptions, which is conducive to ensuring the safety of patients.

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BACKGROUND: Major depressive disorder (MDD) is a highly prevalent mood disorder affecting more than 300 million people worldwide. Biased processing of negative information and neural hyper-responses to negative events are hallmarks of depression. This study combined cross-sectional and longitudinal experiments to explore both persistent and resolved neural hyper-responses to negative outcomes from risky decision making in patients with current MDD (cMDD) and remitted MDD (rMDD). METHODS: A total of 264 subjects participated in the cross-sectional study, including 117 patients with medication-naïve, first-episode current depression; 45 patients with rMDD with only 1 episode of depression; and 102 healthy control subjects. Participants completed a modified balloon analog risk task during functional magnetic resonance imaging. In the longitudinal arm of the study, 42 patients with cMDD were followed and 26 patients with rMDD were studied again after 8 weeks of antidepressant treatment. RESULTS: Patients with cMDD showed hyper-responses to loss outcomes in multiple limbic regions including the amygdala and ventral anterior cingulate cortex (vACC). Amygdala but not vACC hyperactivity correlated with depression scores in patients with cMDD. Furthermore, amygdala hyperactivity resolved while vACC hyperactivity persisted in patients with rMDD in both cross-sectional and longitudinal studies. CONCLUSIONS: These findings provide consistent evidence supporting differential patterns of amygdala and vACC hyper-responses to negative outcomes during depression remission. Amygdala hyperactivity may be a symptomatic and state-dependent marker of depressive neural responses, while vACC hyperactivity may reflect a persistent and state-independent effect of depression on brain function. These findings offer new insights into the neural underpinnings of depression remission and prevention of depression recurrence.

Asunto(s)

Trastorno Depresivo Mayor , Giro del Cíngulo , Humanos , Trastorno Depresivo Mayor/diagnóstico por imagen , Trastorno Depresivo Mayor/tratamiento farmacológico , Trastorno Depresivo Mayor/patología , Estudios Transversales , Depresión , Estudios Longitudinales , Amígdala del Cerebelo , Imagen por Resonancia Magnética/métodos

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BACKGROUND: Few studies have assessed how children are affected by parental alcohol consumption without clinically diagnosed alcohol problems, especially in relation to more long-term and severe consequences. The aim is to investigate how fathers' alcohol use is related to the risk for substance-related disorders in offspring. METHOD: A prospective cohort study of 64 710 Swedish citizens whose fathers were conscripted for compulsory military training at ages 18-20 in 1969/70. Information on fathers' alcohol consumption, frequency of intoxication and apprehended for drunkenness, was collected during conscription. Offspring was followed for substance-related disorders from age 12 to end of follow up in 2009. RESULTS: All measures of fathers' alcohol use were significantly and positively associated with risk for substance-related disorders in offspring. The associations were to a large extent explained by other risk factors in childhood. In the fully adjusted model, those with fathers in the highest alcohol consumption quintile still had a 63% higher risk (HR=1.63 CI 1.26-2.12) of substance-related disorders compared to those whose fathers' reported abstinence. The highest risk was found among offspring to fathers with alcohol-related disorders or that had been apprehended for drunkenness, with a more than two-fold increased risk for substance-related disorders. CONCLUSIONS: Despite the lower risk found among offspring to fathers with sub-clinical drinking when compared to those with alcohol-related disorders, the former group accounts for a much larger proportion of all cases of substance-related disorders in the population, prompting universal prevention efforts targeting the level of total alcohol consumption in society.

Asunto(s)

Trastornos Relacionados con Alcohol , Intoxicación Alcohólica , Trastornos Relacionados con Sustancias , Adolescente , Adulto , Consumo de Bebidas Alcohólicas/epidemiología , Trastornos Relacionados con Alcohol/epidemiología , Niño , Padre , Humanos , Masculino , Estudios Prospectivos , Trastornos Relacionados con Sustancias/epidemiología , Adulto Joven

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The ability to make predictions based on stored information is a general coding strategy. A prediction error (PE) is a mismatch between expected and current events. Our memories, like ourselves, are subject to change. Thus, an acquired memory can become active and update its content or strength by a labilization-reconsolidation process. Within the reconsolidation framework, PE drives the updating of consolidated memories. In the past our lab has made key progresses showing that a blockade in the central cholinergic system during reconsolidation can cause memory impairment, while reinforcement of cholinergic activity enhances it. In the present work we determined that PE is a necessary condition for memory to reconsolidate in an inhibitory avoidance task using both male and female mice. Depending on the intensity of the unconditioned stimulus (US) used during training, a negative (higher US intensity) or positive (lower US intensity/no US) PE on a retrieval session modified the behavioral response on a subsequent testing session. Furthermore, we demonstrated that the cholinergic system modulates memory reconsolidation only when PE is detected. In this scenario administration of oxotremorine, scopolamine or nicotine after memory reactivation either enhanced or impaired memory reconsolidation in a sex-specific manner.

Asunto(s)

Neuronas Colinérgicas/fisiología , Consolidación de la Memoria , Animales , Reacción de Prevención/fisiología , Neuronas Colinérgicas/efectos de los fármacos , Condicionamiento Clásico/fisiología , Femenino , Masculino , Consolidación de la Memoria/efectos de los fármacos , Consolidación de la Memoria/fisiología , Ratones , Nicotina/farmacología , Oxotremorina/análogos & derivados , Oxotremorina/farmacología , Receptores Colinérgicos/efectos de los fármacos , Receptores Colinérgicos/fisiología , Escopolamina/farmacología

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OBJECTIVES: Dialysis patients report a low health-related quality of life (HRQOL) due to high disease burden and far-reaching consequences of dialysis treatment. This study examined several cognitive-behavioral and social factors, with a focus on negative outcome expectancies, that might be relevant for HRQOL in end-stage kidney disease (ESKD) patients treated with dialysis. METHODS: Patients treated with hemodialysis or peritoneal dialysis were recruited from Dutch hospitals and dialysis centers. Patients completed self-report questionnaires at baseline (n = 175) and six months follow-up (n = 130). Multiple regression analyses were performed. RESULTS: Higher scores on factors related to negative outcome expectancies at baseline, especially helplessness and worrying, and less perceived social support were significantly related to worse HRQOL six months later. When controlling for baseline HRQOL, besides sex and comorbidity, helplessness remained significantly predictive of worse HRQOL six months later, indicating that helplessness is associated with changes in HRQOL over time. CONCLUSIONS: Negative outcome expectancies and social support are relevant markers for HRQOL and/or changes in HRQOL over time. PRACTICE IMPLICATIONS: Negative outcome expectancies could be prevented or diminished by enhanced treatment information, an improved patient-clinician relationship, and interventions that promote adaptive and realistic expectations. Additionally, increasing supportive social relationships could be a relevant treatment focus.

Asunto(s)

Fallo Renal Crónico , Diálisis Peritoneal , Humanos , Fallo Renal Crónico/terapia , Calidad de Vida , Diálisis Renal , Apoyo Social

RESUMEN

BACKGROUND: Medical imaging is an important approach for the diagnosis of hepatocellular carcinoma (HCC), a common life threaten disease, however, the diagnostic efficiency is still not optimal. Developing a novel method to improve diagnosis is necessary. The aim of this project was to formulate a material that can combine with GPC3 of HCC for targeted enhanced ultrasound. METHODS: A material of sulfur hexafluoride (SF6) filled liposome microbubbles and conjugated with synthesized peptide (LSPMbs) was prepared and assessed in vitro and vivo. Liposome microbubbles were made of DPPC, DPPG, DSPE-PEG2000,and SF6, using thin film method to form shell, followed filling SF6, and conjugating peptide. A carbodiimide method was used for covalent conjugation of peptide to LSMbs. RESULTS: The prepared LSPMbs appeared round shaped, with size of 380.9 ±  176.5 nm, and Zeta potential of -51.4 ±  10.4mV. LSPMbs showed high affinity to Huh-7 cells in vitro, presented good enhanced ultrasound effects, did not show cytotoxicity, and did not exhibit targeted fluorescence and enhanced ultrasound in animal xenograft tumors. CONCLUSION: Extravascular contrast-enhanced ultrasound targeted GPC3 on HCC may not be realized, and the reason may be that targeted contrast agents of microbubbles are hard to access and accumulate in the tumor stroma and matrix.

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OBJECTIVE: To determine risk factors for negative global treatment outcomes as self-assessed by patients undergoing surgical treatment for lumbar spinal stenosis (LSS). METHODS: Patients from the Spine Tango registry undergoing first-time surgery for LSS were analyzed. The primary outcome was global treatment outcomes measured at the last available follow-up ≥3 months postoperatively using a single question rating how much the operation had helped the patient's back problem (negative = no change/operation made things worse). A 2-level logistic mixed effects model with the treating department as the random effect was used to assess factors associated with a negative outcome. RESULTS: A total of 4504 patients from 39 departments in 10 countries were included. Overall, 14.4% of patients reported a negative global treatment outcome after an average follow-up of 1.3 years. In patients with dominant leg pain, negative outcome was associated with higher baseline back pain; in those with dominant back pain, it was associated with higher baseline back pain, ASA (American Society of Anesthesiologists) ≥3, lower age, not having rigid stabilization, not having disc herniation, and the vertebral level of the most severely affected segment (L5/S1 vs. L3/4). Four departments had significantly higher odds of a negative outcome, whereas 1 department had significantly lower odds. Three out of the 4 negative effects were related to 2 departments from 1 country. CONCLUSIONS: LSS surgery fails to help at least 1 in 10 patients. High baseline back pain is the most important factor associated with a negative treatment outcome. Department-level and potentially country-level factors of unknown origin explained a nonnegligible variation in the treatment results.

Asunto(s)

Vértebras Lumbares/cirugía , Estenosis Espinal/cirugía , Resultado del Tratamiento , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Descompresión Quirúrgica/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Ortopédicos/métodos , Sistema de Registros , Factores de Riesgo , Adulto Joven

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PURPOSE: We investigated the characteristics, prognosis, and clinical outcome of the Charles Bonnet syndrome (CBS) in patients with neovascular age-related macular degeneration (AMD). METHODS: Five hundred psychiatrically healthy patients with neovascular AMD were screened for CBS. The individuals that fulfilled the inclusion criteria were systematically interviewed using a structured questionnaire that covered the impact, prognosis, risk factors, phenomenology, symptoms, and knowledge about the syndrome. A control group of 45 patients was used for comparison. Demographic data, current medication, and ocular risk factors were collected in all patients. RESULTS: Forty-five patients with CBS were identified. The majority of patients reported images that consisted of colored (62%) animals (44%) or faces (42%) that lasted for seconds (53%). Most patients reported a self-limited disease with a median duration of symptoms between 9 and 11.5 months, with only 7% knowing about CBS at symptom onset. The degree of visual deficit did not predict the characteristics, complexity, frequency, duration, or impact of visual hallucinations. One-third of patients reported negative outcome, which was associated with shorter duration of CBS (p = 0.023), fear-inducing images (p < 0.001), and impact on daily activities (p = 0.015). CONCLUSION: The prevalence of CBS in neovascular AMD patients is high and clinically relevant. Patients with recent onset of visual hallucinations and describing fear-inducing images are at greater risk for negative outcome. Periodic screening may minimize the negative consequences of this disease.

Asunto(s)

Síndrome de Charles Bonnet/diagnóstico , Diagnóstico Precoz , Agudeza Visual , Degeneración Macular Húmeda/diagnóstico , Anciano , Anciano de 80 o más Años , Síndrome de Charles Bonnet/complicaciones , Síndrome de Charles Bonnet/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Portugal/epidemiología , Prevalencia , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Encuestas y Cuestionarios , Degeneración Macular Húmeda/complicaciones , Degeneración Macular Húmeda/epidemiología

RESUMEN

OBJECTIVE: Microsurgical resection may be recommended for high grade brain arteriovenous malformations (BAVMs) (HBAVMs) in individualized patients. Careful case selection is necessary to minimize postoperative complications. The aim of this study was to determine the surgical outcomes in patients with HBAVMs and to identify their risk factors associated with postoperative negative outcomes. PATIENTS AND METHODS: We retrospectively studied 53 consecutive patients with HBAVMs. All patients had undergone preoperative diffusion tensor imaging (DTI), MRI, 3D time-of-flight MRA (3D TOF-MRA) and digital subtraction angiography (DSA) followed by resection. White matter (WM) eloquent fibre tracts, including the corticospinal tract (CST), optic radiation (OR) and arcuate fasciculus (AF), were tract. Both functional, angioarchitectural and operative factors were analyzed with respect to the surgical outcomes. RESULTS: Nineteen (35.8%) patients suffered from negative surgical outcomes (MRS > 2) one week after surgery. At the last clinic visit, 10 patients (18.9%) suffered from negative surgical outcomes. Diffuse nidus (P = 0.018), Perforating arteries (PA) supplying (P = 0.009) and CST involving (P = 0.001) were independent risk factors for negative short-term outcomes. PA supplying (P = 0.039), CST involving (P = 0.026) and postoperative intracranial haemorrhage (ICH) (P = 0.014) were independent risk factors for negative long-term neurological outcomes. Larger nidus size (P = 0.024) was predictor of postoperative ICH. The cut-off point was 6.8 cm. CONCLUSIONS: This study identified that diffuse nidus, PA supplying and CST involving are risk factors for negative short-term outcomes in patients with HBAVMs. PA supplying, CST involving and postoperative ICH are risk factors for negative long-term outcomes. Larger nidus size was risk factor for postoperative ICH.

Asunto(s)

Malformaciones Arteriovenosas Intracraneales/patología , Malformaciones Arteriovenosas Intracraneales/cirugía , Complicaciones Posoperatorias/etiología , Adulto , Anciano , Femenino , Humanos , Hemorragias Intracraneales/etiología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento , Adulto Joven

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BACKGROUND: The importance of experienced work stress and individual traits as well as their interplay is analyzed with regard to dysfunctional coping behavior in case of sickness. OBJECTIVE: The aim of this study was to examine the predictive capability of effort-reward imbalance (ERI) including overcommitment, meaning the intrinsic propensity in terms of excessive work-related expenditure (OC), in consideration of dispositional optimism/pessimism on presenteeism. METHODS: A total of 353 men and women aged 38 from the 25th panel wave of The Saxony Longitudinal Study in 2011 were included in the analysis. Effort-reward imbalance (ERI) including overcommitment was assessed with the Effort-Reward Imbalance Questionnaire. Dispositional optimism and pessimism were quantified using the German version of the Life-Orientation-Test (LOT-R). Presenteeism was measured by single item two years later. RESULTS: Multiple regression analysis showed that the amount of the effort-reward imbalance experienced in 2011 had no statistically significant predictive potential with regard to presenteeism in 2013. After splitting the sample according to a validated effort-reward imbalance threshold, remarkable prediction of presenteeism for participants experiencing an ERI was accomplished by the moderating effect of dispositional pessimism on overcommitment (ß= 0.32; p <  0.001). CONCLUSIONS: Although ERI did not have the expected predictive capability relating to the entire sample, the detailed analysis of the moderating effect of pessimism on overcommitment and the resulting amount of explained variance for those participants experiencing an ERI is a noteworthy finding.

Asunto(s)

Optimismo , Presentismo , Recompensa , Carga de Trabajo/psicología , Adulto , Femenino , Alemania , Humanos , Estudios Longitudinales , Masculino , Salud Laboral , Estrés Laboral , Pesimismo , Encuestas y Cuestionarios

RESUMEN

Few individuals with arthritis are sufficiently active. We surveyed a convenience sample of exercisers ( N = 134) to examine the utility of social cognitive theory variables, namely, self-regulatory efficacy, negative outcome expectations, and pain acceptance for predicting planned physical activity according to Weinstein's two prediction suggestions. Logistic regression revealed, after controlling for pain intensity, self-regulatory efficacy, negative outcome expectations, and pain acceptance distinguished groups achieving/not achieving planned physical activity, p < 0.001 (28% variance). A second model adding past physical activity also predicted the groups, p < 0.001 (57% variance). This is one of the first arthritis studies examining planned physical activity relative to Weinstein's recommendations.

RESUMEN

OBJECTIVES: In children and adolescents diagnosed with attention-deficit/hyperactivity disorder (ADHD), the comorbidity of the oppositional defiant disorder (ODD) negatively affects the course of ADHD. The purpose of this study was to compare ADHD-diagnosed children with and without ODD comorbidity in terms of smoking, psychoactive substance use, disciplinary punishments at school, criminal behaviors, and unintentional injuries. METHODS: This study included 109 children diagnosed with ADHD alone and 79 children with the ADHD-ODD comorbidity from a child psychiatry outpatient clinic. The children who participated in the study were aged between 6 and 15 years. Diagnoses of the children were determined by child psychiatrists according to DSM-IV criteria, and the Turgay DSM-IV-based Child and Adolescent Behavior Disorders Screening and Rating Scale-Parents Form was used to support the diagnosis in initial evaluations of children. Forty-six to fifty months after the first admission, parents were questioned regarding all negative outcomes from the time of first diagnosis to the time of the evaluation by phone. RESULTS: The groups were compared in terms of smoking, psychoactive substance use, disciplinary punishments at school, criminal behaviors, and unintentional injuries over a period of 4 years. The ODD-ADHD group was determined to have higher rates of disciplinary punishments at school, smoking, and unintentional injuries compared with the ADHD group. No statistically significant difference was found between the two groups in terms of criminal behaviors and psychoactive substance use. CONCLUSIONS: The ODD comorbidity increases the risk of negative outcomes in children diagnosed with ADHD.

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Obesity has been associated with impaired executive functions including working memory. Less explored is the influence of obesity on learning and memory. In the current study we assessed stimulus reward association learning, explicit learning and memory and working memory in healthy weight, overweight and obese individuals. Explicit learning and memory did not differ as a function of group. In contrast, working memory was significantly and similarly impaired in both overweight and obese individuals compared to the healthy weight group. In the first reward association learning task the obese, but not healthy weight or overweight participants consistently formed paradoxical preferences for a pattern associated with a negative outcome (fewer food rewards). To determine if the deficit was specific to food reward a second experiment was conducted using money. Consistent with Experiment 1, obese individuals selected the pattern associated with a negative outcome (fewer monetary rewards) more frequently than healthy weight individuals and thus failed to develop a significant preference for the most rewarded patterns as was observed in the healthy weight group. Finally, on a probabilistic learning task, obese compared to healthy weight individuals showed deficits in negative, but not positive outcome learning. Taken together, our results demonstrate deficits in working memory and stimulus reward learning in obesity and suggest that obese individuals are impaired in learning to avoid negative outcomes.

Asunto(s)

Aprendizaje por Asociación/fisiología , Trastornos del Conocimiento/fisiopatología , Memoria a Corto Plazo/fisiología , Obesidad/complicaciones , Sobrepeso/complicaciones , Recompensa , Adulto , Índice de Masa Corporal , Trastornos del Conocimiento/etiología , Femenino , Humanos , Masculino , Adulto Joven

RESUMEN

OBJECTIVES: This study sought to assess the usefulness of clopidogrel-pathway genotyping and on-treatment platelet reactivity (OTR) testing in predicting major adverse cardiac events (MACE) in stable coronary artery disease (CAD) patients receiving drug-eluting stents (DES) under dual antiplatelet (clopidogrel plus aspirin) therapy. BACKGROUND: The role of pharmacogenetics and OTR in predicting MACE-death, myocardial infarction, or stent thrombosis-in stable CAD patients scheduled for DES implantation is still debated. METHODS: Patients with stable CAD treated by DES implantation (n = 1,432) were genotyped with a TaqMan OpenArray (Applied Biosystems, Carlsbad, California) and assessed for OTR with the VerifyNow P2Y12 test (Accumetrics Inc., San Diego, California). Genes tested were ABCB1, CYP1A2, CYP2B6*9, CYP2C8*3, CYP2C9*2, CYP2C19, CYP3A4, CYP3A5*3, P2RY12, and PON1CYP2C19. High OTR was defined as P2Y12 reaction units ≥230. The endpoint at 12-month follow-up was MACE occurring during antiplatelet therapy. RESULTS: All groups that were stratified for loss-of-function variants of the cytochrome P450 gene CYP2C19 had significant hazard ratios (HR) for MACE (genotypic HR: 1.41, 95% confidence interval [CI]: 1.06 to 1.89, p = 0.01; allelic HR: 1.56, 95% CI: 2.26 to 1.2, p = 0.01). Variants of other clopidogrel-pathway genes were not significantly associated with MACE. When OTR was assessed, clinical significance was found only in high-risk diabetic (HR: 2.11, 95% CI: 1.29 to 3.45, p < 0.001) and chronic kidney disease (HR: 2.03, 95% CI: 1.03 to 4.02, p = 0.04) patients. CONCLUSIONS: CYP2C19 metabolizer status is an independent predictor of MACE after DES implantation and can be used for prognostication in all stable CAD patients. High OTR, as assessed by the VerifyNow P2Y12 test, is an independent predictor of MACE only for high-risk subsets, that is, patients with diabetes or chronic kidney disease.

Asunto(s)

Hidrocarburo de Aril Hidroxilasas/genética , Enfermedad de la Arteria Coronaria/terapia , Stents Liberadores de Fármacos , Intervención Coronaria Percutánea/instrumentación , Inhibidores de Agregación Plaquetaria/uso terapéutico , Agregación Plaquetaria/efectos de los fármacos , Polimorfismo Genético , Ticlopidina/análogos & derivados , Anciano , Hidrocarburo de Aril Hidroxilasas/metabolismo , Aspirina/uso terapéutico , Biotransformación/genética , Clopidogrel , Enfermedad de la Arteria Coronaria/diagnóstico , Enfermedad de la Arteria Coronaria/mortalidad , Trombosis Coronaria/etiología , Citocromo P-450 CYP2C19 , Técnicas de Apoyo para la Decisión , Quimioterapia Combinada , Femenino , Genotipo , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Infarto del Miocardio/etiología , Selección de Paciente , Intervención Coronaria Percutánea/efectos adversos , Intervención Coronaria Percutánea/mortalidad , Farmacogenética , Fenotipo , Inhibidores de Agregación Plaquetaria/efectos adversos , Inhibidores de Agregación Plaquetaria/farmacocinética , Pruebas de Función Plaquetaria , Valor Predictivo de las Pruebas , Modelos de Riesgos Proporcionales , Medición de Riesgo , Factores de Riesgo , Ticlopidina/efectos adversos , Ticlopidina/farmacocinética , Ticlopidina/uso terapéutico , Factores de Tiempo , Resultado del Tratamiento

RESUMEN

As interações medicamentosas (IM) são consideradas um problema de saúde pública, pois podem causar resultados negativos à saúde dos usuários de medicamentos. Portanto o referido trabalho teve como objetivos: estimar a prevalência de internações hospitalares relacionadas a Potenciais IM (PIM); identificar os sinais e sintomas, e os fatores de risco para a hospitalização relacionados à PIM. Metodologia: Realizou-se estudo transversal na clínica geral de um hospital privado do interior de São Paulo (Brasil), em maio de 2006, com pacientes acima de 18 anos, com tempo de hospitalização superior a 24horas, sendo os mesmos entrevistados sobre os sintomas/motivos de internação e os medicamentos que haviam utilizado previamente à hospitalização. Calculou-se Odds-ratio para identificar fatores de risco, sendo encontrado os seguintes resultados: 168 pacientes utilizando mais de um medicamento, dos quais 57 apresentaram PIM, sendo que em 17(10,1%), os sinais e sintomas da PIM possivelmente foram a causa da hospitalização. A maioria das manifestações clínicas das PIM foram sintomas cardiovasculares (44,3%), gastrintestinais (17,2%) e musculoesqueléticos (13,8%) e 10% das PIM foram consideradas potencialmente perigosas. Não foram detectados fatores de risco relacionados ao gênero, idade, uso de medicamentos de estreita faixa terapêutica para hospitalização por PIM. A polimedicação foi fator de risco para ocorrência de PIM (p<0,0001) opostamente ao aumento da idade que revelou ser um fator de proteção (p=0,02). Conclusão: Se faz necessário seguimento farmacoterapêutico de pacientes que utilizam fármacos de estreita faixa terapêutica, pois estas substâncias estão frequentemente envolvidas em IM perigosas.

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Drug-drug interactions (DDI) are considered a public health problem, since they may be the cause of negative outcomes for drug users. Research objectives: 1) estimate the prevalence of hospital admissions arising from potential DDI; 2) identify the signs and symptoms of, as well as risk factors for hospitalization related to, potential DDI. A cross-sectional study was performed in the general clinic of a private hospital in upstate São Paulo, in May 2006, focusing on patients over 18 years old, hospitalized for more than 24 hours, who were interviewed about their symptoms, reasons for hospitalization and the drugs taken prior to hospitalization. The odds ratio was calculated in order to identify risk factors. Results: 168 patients had taken more than one drug, of whom 57 showed potential DDI and, in 17 (10.1%), the signs and symptoms of DDI were probably the reason for hospitalization. The most frequent clinical manifestations of potential DDI were disorders in the cardiovascular (44.3%), digestive (17.2%) and musculoskeletal (13.8%) systems and 10% of the DDI identified were considered potentially hazardous. Risk factors for DDI-motivated hospitalization related to gender, age or the use of drugs with a narrow therapeutic range were not detected. Polypharmacy (p<0.0001) was a determining factor for DDI; conversely, old age was a protection factor (p=0.02). Conclusion: pharmacotherapeutic follow-up of patients who use drugs with a narrow therapeutic range is essential, since these drugs are often involved in hazardous DDI. Pharmacotherapeutic follow-up is also recommended for polymedicated patients, to prevent hospitalization arising from avoidable DDI.

Asunto(s)

Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Interacciones Farmacológicas , Errores de Medicación/estadística & datos numéricos , Hospitalización