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OBJECTIVE: To assess the effect of pharmacist interventions on glycemic control in type 2 diabetic patients and to examine factors that could explain the variation across studies. METHODS: A comprehensive literature search was performed in PubMed, Scopus, and LILACS databases for randomized controlled trials (RCTs) published up to July 2015. The search strategy included the use of MeSH terms or text words related to pharmacist interventions, type 2 diabetes, and randomized controlled trials. RCTs published in English, Portuguese, or Spanish that evaluated the effect of pharmacist intervention on glycemic control in type 2 diabetic outpatients were included. Two independent authors executed study selection, data extraction, and risk of bias assessment. Mean differences in glycosylated hemoglobin (HbA1c) were estimated using random-effect models, and heterogeneity was evaluated by subgroup and meta-regression analyses. RESULTS: The literature search yielded 963 records of potential interest, of which 30 were included in the systematic review and 22 in the meta-analysis. Most of these RCTs were conducted in the United States in patients in outpatient clinics using face-to-face contact only. All RCTs performed patient education, and most executed the medication review. The appraised sample showed uncertain or high risk of bias in most of the items evaluated, resulting in low-quality studies. In comparison with usual care, pharmacist interventions were associated with significant reductions in HbA1c levels (-8.5% [95% CI: -1.06, -0.65]; P < 0.0001; I2 = 67.3%). Subgroup analysis indicated differences of heterogeneity by country, baseline HbA1c levels, setting, intervention frequency, and random allocation. Age and HbA1c levels partly explained the variability across studies by meta-regression. CONCLUSIONS: Our findings confirmed that pharmacist interventions improve glycemic control in patients with type 2 diabetes compared with usual care and suggest that younger patients or with higher baseline HbA1c levels may be the main beneficiaries of pharmacist care. PROTOCOL PROSPERO REGISTRATION NUMBER: CRD42014007457.

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PURPOSE: This study was conducted to evaluate the heterogeneity of studies estimating the association between risk factors (age, gender, and polypharmacy) and the use of potentially inappropriate drug therapy for the elderly (PIDT). METHODOLOGY: This study is a systematic review with meta-analysis of observational studies. LILACS, PubMed, Scopus, and the Web of Science databases were reviewed. The following data were extracted from the included studies: country, type of study, characteristics of the sample, practice scenarios, instruments to evaluate potentially inappropriate drug therapy for the older adults, and patient-related variables. RESULTS: Twenty-nine articles (17 cross-sectional and 12 cohort) were included. The majority of the studies were conducted in Europe. Regarding the study durations, 3 to 18 months was necessary to perform the research. As for the sample characteristics, all the studies analyzed involved the older adults and included anywhere from 96 patients to 33,830,599 outpatient consultations. Of the variables analyzed, only polypharmacy presented a positive association with the use of PIDT. All meta-analysis studies showed high heterogeneity, indicating the lack of a methodological standardization of the studies included, among other factors.

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BACKGROUND: The number of medicines available without a prescription has increased in Brazil as elsewhere. The Brazilian National Health Surveillance Agency recently passed a resolution emphasizing the role of Brazilian pharmacists in promoting rational use of medicines. However, evidence that Brazilian pharmacists monitor the use of non-prescription medicines in the community promoting rational use of medicines is lacking. OBJECTIVE: To assess practice behavior of pharmacists in Brazil when providing nonprescription medicines in the community pharmacy setting. SETTING: The study was conducted in 25 community pharmacies from a city of Aracaju in Brazil. METHODS: Simulated patients visited a convenience sample of 25 pharmacies twice from March to July 2010. During the visits, simulated patients enacted two standardized scenarios: treatment for a persistent headache and childhood diarrhea accompanied by fever. The interactions with the pharmacists were audiovisually recorded using a hidden micro camera. Recordings were later used to fill out a questionnaire designed to evaluate practice behavior of community pharmacists. MAIN OUTCOME MEASURE: The communication and counseling skills of pharmacists in the recommendation of non-prescription medicines, aiming at the rational use of medicines. RESULTS: Pharmacists in the study spent on average 1.5 min counseling the simulated patient. At least one question was asked to assess signs and symptoms in 50.0 % of the simulated patient visits in the headache scenario and in 56.0 % of visits in the childhood diarrhea scenario. Non-pharmacological treatment was suggested in 25 % of visits in the childhood diarrhea scenario. During the counseling process, no pharmacist advised the simulated patient about possible drug interactions, adverse reactions and what to do if the patient forgot to take the medicine. The pharmacists had low scores in measures of non-verbal communication. The sample of this study presented poor communication skills, compromising the treatment of the patients. CONCLUSION: This study showed that the pharmacists' counseling in the simulated patient assessment was insufficient, indicating a need for substantial improvement in practice behavior.

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As doenças da tiróide são de grande significado, porquanto, a grande maioria é passível de tratamento clínico ou cirúrgico. Os nódulos frios da tiróide merecem especial atenção porque sempre levantam a suspeita de neoplasia. Um dos métodos empregados para diagnóstico de nódulos da tiróide é a cintilografia, dado que o aspecto funcional da lesão pode conduzir a investigação no sentido de benignidade e atualmente tal diagnóstico é feito através deste e da análise citológica e histológica da lesão. O estudo constituiu-se da análise do levantamento estatístico sobre a caracterização de nódulos tiroideanos hipocaptantes e o processo patológico subjacente. Os autores correlacionaram os achados cintigráficos obtidos no Laboratório de Medicina Nuclear da Universidade Federal da Paraíba com os achados histológicos e citológicos obtidos no arquivo geral do Hospital Lauro Wanderley. Foram analisados 354 cintilografias da tiróide com lesões nodulares frias isoladas, sendo 156 com diagnóstico citológico e(ou) histopatológico por biópsia aspirativa e(ou) cirúrgica, obtendo-se os resultados: bócio colóide 84/156 (53,84 por cento); adenoma 15/156 (9,61 por cento); carcinoma 14/156 (8,97 por cento); tiroidite 8/156 (5,12 por cento); blastoma 1/156 (0,64 por cento); insatisfatório 34/156(21,79 por cento). Os resultados mostraram incidência semelhante dos processos patológicos em nódulos hipocaptantes aos constatados na literatura.

The diseases of the thyroid gland are clinically important, then, the great majority of then are able of having clinical or surgical treatment. The thyroid cold nodules diserve special attention because they can be a site of cancer. The cintigraphy is one of the utilized methods in diagnosing thyroid cold nodules, and the functional aspect over benignity. Nowadays, this diagnosis is based on the cintigraphy and on the cytohistological analysis of the lesion. This study was based on the statistic data about cold thyroid nodules and the pathologic process found. The authors correlated cintigraphic findings obtained of the Nuclear Medicine Laboratory, with the cytological and histological ones obtained of the general file of Lauro Wanderley University Hospital of the Federal University of Paraíba. It was analysed 354 thyroid cintigraphy with cold thyroid nodules, in which 156 had cytological or histological diagnosis, through aspiration or surgical biopsy, obtaining the following results: colloied goiter 84/156 (53.84); adenoma 15/156 (9.61); carcinoma 14/156 (8.97); thyroiditis 8/156 (9.61); blastoma 1/156 (0.64); insatisfactory 34/156 (21.79). The results showed a similar incidente of the pathologic process in cold thyroid nodules to those foung in the literature.

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