scholarly journals Pilot-project of implantation of pharmaceutical care close to the program of bipolar mood disorder of the Hospital of Clinics of Porto Alegre

2009 ◽  
Vol 45 (2) ◽  
pp. 249-256 ◽  
Author(s):  
Keila Maria Mendes Ceresér ◽  
Marcello Ávila Mascarenhas ◽  
Aida Santin ◽  
Flávio Kapczinski
Keyword(s):  
Mood Disorder ◽  
Pharmaceutical Care ◽  
Pilot Project ◽  
Tertiary Hospital ◽  
Adherence To Treatment ◽  
Porto Alegre ◽  
Bipolar Mood Disorder ◽  
Number Of Patients ◽  
Bipolar Patients

The Bipolar Mood Disorder is characterized by the alternation of depressive crises with episodes of mania or euphoria, having these patients 15 to 35 times more chances of suicide, as compared with people without this disorder. The pharmacotherapy is fundamental for this disease, aiming to decrease the frequency of episodes and disease severity. In these patients, the polypharmacy has recently increased and one of the main difficulties is the adherence to treatment. The objective of this study was to contribute for the improvement of bipolar patients health conditions, developing their respective pharmacotherapeutic follow-up. Twenty eight adult bipolar patients who were participants of a specialized clinic within a tertiary hospital in Porto Alegre have been randomly selected, and the Dader Method of pharmacotherapeutic follow-up has been applied. The more common clinical comorbidities were: hypertension (50%), obesity (46.43%), and hypothyroidism (36.29%). The bipolar patients are more susceptible to clinical comorbidities, and many of them could be due to pharmacotherapy. Only 1.43% of patients presented Drug Related Problems, being all of them resolved along the study. It was also observed that 32.14% of evaluated patients presented low adherence to treatment, and between these patients, 55.56% passed to have good adherence after pharmacotherapeutic follow-up. The pharmacotherapeutic follow-up is fundamental for the improvement of patient's health. New studies, with higher number of patients and longer duration, are necessary to evaluate the percentage of patients that could be beneficiary of Pharmaceutical Care.

scholarly journals Impact of modification to DSM-5 criterion A for hypomania/mania in newly diagnosed bipolar patients: findings from the prospective BIO study

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Mette U. Fredskild ◽  
Sharleny Stanislaus ◽  
Klara Coello ◽  
Sigurd A. Melbye ◽  
Hanne Lie Kjærstad ◽  
...  
Keyword(s):  
Rating Scale ◽  
Newly Diagnosed ◽  
Young Mania ◽  
Dsm 5 ◽  
Criterion A ◽  
Number Of Patients ◽  
Bipolar Type ◽  
Dsm Iv ◽  
Bipolar Patients

Abstract Background DSM-IV states that criterion A for diagnosing hypomania/mania is mood change. The revised DSM-5 now states that increased energy or activity must be present alongside mood changes to diagnose hypomania/mania, thus raising energy/activity to criterion A. We set out to investigate how the change in criterion A affects the diagnosis of hypomanic/manic visits in patients with a newly diagnosed bipolar disorder. Results In this prospective cohort study, 373 patients were included (median age = 32; IQR, 27–40). Women constituted 66% (n = 245) of the cohort and 68% of the cohort (n = 253) met criteria for bipolar type II, the remaining patients were diagnosed bipolar type I. Median number of contributed visits was 2 per subject (IQR, 1–3) and median follow-up time was 3 years (IQR, 2–4). During follow-up, 127 patients had at least one visit with fulfilled DSM-IV criterion A. Applying DSM-5 criterion A reduced the number of patients experiencing a hypomanic/manic visit by 62% at baseline and by 50% during longitudinal follow-up, compared with DSM-IV criterion A. Fulfilling DSM-5 criterion A during follow-up was associated with higher modified young mania rating scale score (OR = 1.51, CL [1.34, 1.71], p < 0.0001) and increased number of visits contributed (OR = 1.86, CL [1.52, 2.29], p < 0.0001). Conclusion Applying the stricter DSM-5 criterion A in a cohort of newly diagnosed bipolar patients reduced the number of patients experiencing a hypomanic/manic visit substantially, and was associated with higher overall young mania rating scale scores, compared with DSM-IV criterion A. Consequently, fewer hypomanic/manic visits may be detected in newly diagnosed bipolar patients with applied DSM-5 criterion A, and the upcoming ICD-11, which may possibly result in longer diagnostic delay of BD as compared with the DSM-IV.

scholarly journals Development of pharmaceutical care tools for people living with HIV treated at a medium- and high-complexity hospital

2022 ◽  
Vol 11 (1) ◽  
pp. e28511124965
Author(s):  
Almir de Aguiar Picanço ◽  
Ranieri Carvalho Camuzi ◽  
Graziela de Medeiros Silva Loureiro
Keyword(s):  
Pharmaceutical Care ◽  
Practical Experience ◽  
Development Project ◽  
People Living With Hiv ◽  
Adherence To Treatment ◽  
High Complexity ◽  
Experimental Development ◽  
Living With Hiv ◽  
The City

The exposure of people living with HIV (PLHIV) to antiretrovirals (ARV) can cause significant adverse effects, contributing to their low adherence to treatment. The pharmacist can contribute to the optimization of PLHIV drug therapy through pharmacotherapeutic monitoring, favoring adherence to ARV therapy and, consequently, suppression of the viral load. The objective of the present study was to develop a pharmacotherapeutic monitoring routine for PLHIV in outpatient follow-up at a medium- and high-complexity hospital in the city of Rio de Janeiro. This is an experimental development project that consists of using knowledge from practical experience and research from the specialized literature to subsidize the structuring of a new service to support PLHIV. The work was divided into three parts: development of the necessary instruments for pharmaceutical care, elaboration of standard operating procedures (SOPs) for patient care, and testing of routines and work tools. The educational leaflets for patients and information boards were developed through a literature search, whereas the pharmaceutical documentation instruments and SOP were developed through adaptations of the Dáder Method. All work instruments were subjected to a test to evaluate the need for changes to improve the service.

scholarly journals Experience of Using a Mobile App to Improve Adherence to Treatment in Patients with TB/HIV Coinfection

2021 ◽  
Vol 99 (11) ◽  
pp. 17-24
Author(s):  
S. N. Zhdаnovа ◽  
O. B. Ogаrkov ◽  
O. G. Koshkinа ◽  
E. Yu. Zorkаltsevа ◽  
E. Ya. Moiseevа ◽  
...  
Keyword(s):  
Viral Suppression ◽  
Mobile App ◽  
Adherence To Treatment ◽  
Hiv Coinfection ◽  
Number Of Patients ◽  
Therapy Interruption ◽  
Group 2 ◽  
Outpatient Appointments ◽  
Group 1

The objective of the study: to summarize experience of using a mobile technology to improve adherence in patients with tuberculosis and HIV infection (TB/HIV) who are psychoactive substance users.Subjects and Methods. A smartphone app was used, it included daily patient inquiries about mood, stress levels, and medication intake; periodic reminders about outpatient appointments; and anonymous chats with the coordinating physician and other patients. Treatment results were evaluated in Group 1 (n = 54) and Group 2 (n = 50), where this technology was used and not used, respectively.Results. The number of patients cured of tuberculosis was not significantly different between Groups 1 and 2 (32/51 vs. 27/48; χ2 = 0.61, p = 0.48). Patients from Group 2 died significantly more often during the follow-up period (14/48 vs. 3/51; χ2 = 7.86, p = 0.006) associated with antiretroviral therapy interruption or withdrawal. Increased CD4 count by 6 months of follow-up was found in both groups, most pronounced among those who started ART (W = 6.0, p = 0.004 – in Group 1 and W = 15.0, p = 0.004 – in Group 2). The total number of patients with viral suppression was greater in Group 1 than in Group 2 (34/47 vs. 20/39; χ2 = 4.05, p = 0.04).Conclusion. The mobile app used is suitable for supporting the outpatient management of patients with TB/HIV coinfection but its direct impact was reflected only in the formation of ART adherence and lower number of deaths.

scholarly journals Using patient–centered approach for improving adherence to treatment in DS/DR–TB patients in Ukraine

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
E Geliukh ◽  
V Tabunshchyk ◽  
N Kamenska ◽  
Z Islam
Keyword(s):  
Treatment Outcomes ◽  
Successful Treatment ◽  
Cohort Analysis ◽  
Scale Up ◽  
Adherence To Treatment ◽  
Patient Centered ◽  
Number Of Patients ◽  
Mdr Tb ◽  
Lost To Follow Up

Abstract Issue/problem Ukraine is among 30 high MDR-TB burden countries with about 6500 laboratory confirmed MDR-TB cases annually. Ukraine provides full coverage for first- and second-line TB drugs from the state budget. Nevertheless, successful treatment outcomes are one of the lowest in EECA region - 49% in MDR/RR-TB cases and 37% in XDR-TB. High rates of lost to follow-up (15.8%), treatment failed (18%) and died (15.9%) among MDR-TB cases contribute to unsuccessful treatment outcomes. Description of the problem A new intervention was introduced aimed at improving patients' adherence to treatment. Medical-psycho-social services (MPSS) provision based on patient-centered approach is provided to all patients. In 2018, project funded by GFATM was launched in 8 oblasts of Ukraine. All patients are assessed on treatment adherence before discharge from hospitals. Those with low adherence are referred to NGOs. MPSS starts from the patient's needs assessment followed by development of individual plan of support. MPSS is provided during the whole period of outpatient treatment and may include DOT/VOT, social workers' permanent support, food kits, psychologist counselling, transport and/or cell reimbursement, housing, documents restore, legal services and other services as per patients' needs. Electronic depersonalized database SyrEx is used for the project related notes. Results Total amount of TB/DR-TB patients treated in 2018-2019 is 8640 and 4246 accordingly. Cohort analysis is used for treatment outcomes assessment. Intervention allowed reducing the number of patients lost to follow up in DS/DR-TB (to 1.2% and 2.5% accordingly), treatment failed (to 5.4% and 10.9%) and number of died (to 2.1% and 3.2%) Lessons MPSS based on patient-centered approach improved successful treatment outcomes: to 91% in DS-TB patients and 82.3% in DR-TB. Further initiative scale-up is required as well as transition of MPSS services from donor funding to domestic.

scholarly journals Idiopathic versus Provoked Renal Infarction: Characteristics and Long-Term Follow-Up of a Cohort of Patients in a Tertiary Hospital

2019 ◽  
Vol 44 (6) ◽  
pp. 1432-1440
Author(s):  
Alejandra García-García ◽  
Pablo Demelo-Rodríguez ◽  
Lucia Ordieres-Ortega ◽  
Eva Cervilla-Muñoz ◽  
Irene García-Fernández-Bravo ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Mortality Rates ◽  
Tertiary Hospital ◽  
Renal Infarction ◽  
Limited Evidence ◽  
Number Of Patients ◽  
Long Term Follow Up ◽  
Baseline Characteristics

Background: There is limited evidence on the etiology and outcomes of renal infarction. A provoking factor is identified only in one- to two-thirds of patients. Methods: This is a retrospective observational study. The clinical characteristics and outcomes of patients with acute renal infarction were studied; the sample was divided into two groups according to the presence of at least one provoking factor at the time of diagnosis (atrial fibrillation, flutter, major thrombophilia, or renal artery malformations). Results: The study comprised 59 patients with a mean age of 63 (±16.7) years and a follow-up period of 3.1 (±2.8) years. An identifiable provoking factor was found for 59.3% of the renal infarctions at the time of diagnosis, and atrial fibrillation was the most frequent one (in 49.2% of all patients). Renal impairment was found in 49.2% of the patients at diagnosis and in 50.8% of the patients 6 months after the event (p = 0.525). When compared with the idiopathic group, the patients with provoked infarction were older (69.8 vs. 57.9 years, p = 0.014) and had a higher rate of recurrence of arterial thrombosis during follow-up (18.8 vs. 0%, p = 0.028), but there were no differences in the rest of the baseline characteristics or in mortality rates. Six patients (10.2%) in the idiopathic group were diagnosed with atrial fibrillation during follow-up. Conclusions: Atrial fibrillation, both at diagnosis and at follow-up, is the most common identifiable cause of renal infarction; however, a significant number of patients are idiopathic, and these are younger, but they have a similar burden of cardiovascular disease and a lower risk of arterial recurrence.

scholarly journals Pattern and management of bear maul injuries in tertiary hospital in Kashmir

2019 ◽  
Vol 6 (5) ◽  
pp. 1729
Author(s):  
Tariq Ahmed Mala ◽  
Syeed Rayees Ahmad ◽  
Shahid Amin Malla
Keyword(s):  
Skin Grafting ◽  
Soft Tissue Injuries ◽  
Tertiary Hospital ◽  
Black Bears ◽  
Medical College ◽  
Number Of Patients ◽  
Split Skin Grafting ◽  
Split Skin ◽  
Serious Injuries

Background: Bears are very powerful and strong animals that defend themselves and their young ones if they feel insecure once disturbed by humans. Encroachment of forest land and haphazard construction has led to increase in the conflicts between humans and animals. Our valley is surrounded by forests all around and lush green forest area is habitant of black bears (Ursus thiabetanus). The aim of this study was to report and manage these complicated injuries.Methods: This study was conducted for a period of two years and all the patients were received in the surgical casuality in Government Medical College Srinagar. A total of 32 patients were registered in the two years period.Results: A total of 32 patients were studied, majority of patients were males. Maximum number of patients was in the age group of 31 to 40 years. All patients had soft tissue injuries; bone involvement was seen in 13 patients. Deep lacerations were seen in 22 (68.75%). Primary suturing was done in 12 (37.5%) of patients, split skin grafting in 7 (21.87%). All 32 patients had ugly scar in follow up with loss of vision in one eye in 3 (9.37%) patients. Four patients were advised psychiatric consultation and further treatment.Conclusions: Conflicts between humans and bears are common in bear-prevalent areas of the world. Bear maul injuries should be evaluated in detail as some patients may have serious injuries which need multispecialty treatment to maintain cosmetic and identity of a person.

scholarly journals Impact of Modification to DSM-5 Criterion A for Hypomania/Mania in Newly Diagnosed/First Episode Bipolar Patients – Findings From the Prospective BIO Study

2020 ◽  
Author(s):  
Mette Ungermann Fredskild ◽  
Sharleny Stanislaus ◽  
Klara Coello ◽  
Sigurd Melbye ◽  
Hanne Lie Kjærstad ◽  
...  
Keyword(s):  
Rating Scale ◽  
First Episode ◽  
Newly Diagnosed ◽  
Young Mania ◽  
Dsm 5 ◽  
Criterion A ◽  
Number Of Patients ◽  
Dsm Iv ◽  
Bipolar Patients

Abstract Background: DSM-IV states that criterion A for diagnosing hypomania/mania is mood change. The revised DSM-5 now states that increased energy or activity must be present alongside mood changes to diagnose hypomania/mania, thus raising energy/activity to criterion A. We set out to investigate how the change in criterion A affects the diagnosis of hypomanic/manic visits in patients with a newly diagnosed / first episode bipolar disorder. Results: In this prospective cohort study, 373 patients were included (median age=32; IQR, 27-40). Women constituted 66% (n=245) of the cohort and 68% of the cohort (n=253) met criteria for bipolar type II, the remaining patients were diagnosed bipolar type I. Median number of contributed visits was 2 per subject (IQR, 1-3) and median follow-up time was 3 years (IQR, 2-4). During follow-up, 127 patients had at least one visit with fulfilled DSM-IV criterion A. Applying DSM-5 criterion A reduced the number of patients experiencing a hypomanic/manic visit by 62% at baseline and by 50% during longitudinal follow-up, compared with DSM-IV criterion A. Fulfilling DSM-5 criterion A during follow-up was associated with higher modified young mania rating scale score (OR=1.51, CL [1.34, 1.71], p <.0001) and increased number of visits contributed (OR=1.86, CL [1.52, 2.29], p <.0001). Conclusion: Applying the stricter DSM-5 criterion A in a cohort of newly diagnosed bipolar patients reduced the number of patients experiencing hypomanic/manic visit substantially, and was associated with higher overall young mania rating scale scores, compared with DSM-IV criterion A. Overall, fewer hypomanic/manic visits may be detected in newly diagnosed /first episode bipolar patients with applied DSM-5 criterion A. Consequently, with the DSM-5 criteria applied less severe bipolar disorders may be overlooked, especially early during the course of illness, and result in a diagnostic delay. Further studies are warranted on this issue.

Effect of a Structured Pharmaceutical Care Intervention Versus Usual Care on Cardiovascular Risk in HIV Patients on Antiretroviral Therapy: INFAMERICA Study

2018 ◽  
Vol 52 (11) ◽  
pp. 1098-1108 ◽  
Author(s):  
Ramón Morillo-Verdugo ◽  
María de las Aguas Robustillo-Cortés ◽  
María Teresa Martín-Conde ◽  
Gador Callejón-Callejón ◽  
Purificación Cid-Silva ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Usual Care ◽  
Pharmaceutical Care ◽  
Intervention Group ◽  
Text Messages ◽  
Control Group ◽  
Framingham Score ◽  
Hiv Patients ◽  
Number Of Patients

Background: HIV+ patients have increased their life expectancy with a parallel increase in age-associated comorbidities. Objective: To determine the effectiveness of an intensive pharmaceutical care follow-up program in comparison to a traditional model among HIV-infected patients with moderate/high cardiovascular risk. Method: This was a multicenter, prospective, randomized study of a structured health intervention conducted between January-2014 and June-2015 with 12 months of follow-up at outpatient pharmacy services. The selected patients were randomized to a control group (usual care) or intervention group (intensive pharmaceutical care). The interventional program included follow-up of all medication taken by the patient to detect and work toward the achievement of pharmacotherapeutic objectives related to cardiovascular risk and making recommendations for improving diet, exercising, and smoking cessation. Individual motivational interview and periodic contact by text messages about health promotion were used. The primary end point was the percentage of patients who had reduced the cardiovascular risk index, according to the Framingham-score. Results: A total of 53 patients were included. As regards the main variable, 20.7% of patients reduced their Framingham-score from high/very high to moderate/low cardiovascular risk versus 12.5% in the control group ( P=0.016). In the intervention group, the number of patients with controlled blood pressure increased by 32.1% ( P=0.012); 37.9% of patients overall stopped smoking ( P=0.001), and concomitant medication adherence increased by 39.4% at the 48-week follow-up ( P=0.002). Conclusion and Relevance: Tailored pharmaceutical care based on risk stratification, motivational interviewing, and new technologies might lead to improved health outcomes in HIV+ patients at greater cardiovascular risk.

STRUCTURAL AND DYNAMIC FEATURES OF EAR-LY DISABILITY DUE TO MENTAL DISEASES

2020 ◽  
pp. 62-67
Author(s):  
Shmakova O.P.
Keyword(s):  
People With Disabilities ◽  
Child And Adolescent Psychiatry ◽  
Child Psychiatrist ◽  
Childhood And Adolescence ◽  
Disabled Children ◽  
Dynamic Features ◽  
Factors Affecting ◽  
Number Of Children ◽  
Number Of Patients

Prevention of disability is one of the most significant tasks of child and adolescent psychiatry. Obtaining data on the dynamics of the number of people with disabilities and the factors affecting this indicator seems to be one of the relevant aspects. Aim: to trace the dynamics of the number of children with disabili-ties and to assess the change in the structure of early disability over the past decades. Materials and Meth-ods. A comparative analysis of two cohorts of patients was carried out: 1st - patients born in 1990-1992. (1203 patients (men - 914, 76%; women - 289, 24%)) who applied to the district neuropsychiatric dispensa-ry for outpatient care in childhood and adolescence; II - children and adolescents born in 2005 - 2018 (602 patients (male - 410, 68%; female - 192, 32%), ob-served at the time of the study by a child psychiatrist in the neuropsychiatric dispensary. Research methods: clinical and psychopathological; follow-up; statisti-cal. Results. Comparison of the number and nosologi-cal distribution of disabled children in two cohorts showed that over the 15th year there has been a shift towards an increase in the proportion of disabled children among patients observed by child and ado-lescent psychiatrists. The increase in the number of children with disabilities was due to those suffering from childhood autism and other disorders of general development. There were no statistically significant differences in the number of people with disabilities who received benefits before the age of 7, as well as differences in gender ratios among disabled people in the two cohorts. Conclusion. Early disability is a mul-tifactorial phenomenon, prevalence, dynamics, the structure of which depends not only on clinical, but also on socio-administrative realities. Children with autism require increased attention, since there has been a multiple increase in the number of patients with this diagnosis.

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