scholarly journals Identification of anticholinergic activity of drugs of the Brazilian National List of Essential Drugs

2020 ◽  
Vol 11 (2) ◽  
pp. 0350
Author(s):  
Mariana S. LIMA ◽  
Adriano M. REIS
Keyword(s):  
Clinical Practice ◽  
Cumulative Effect ◽  
Essential Medicines ◽  
Activity Measurement ◽  
Measurement Scales ◽  
Anticholinergic Activity ◽  
Essential Drugs ◽  
Central Nervous System Activity ◽  
Level 3 ◽  
Practice Methods

Objectives: Identify drugs from the National List of Essential Medicines-Rename 2018 that have anticholinergic activity and scales of anticholinergic activity available for use in clinical practice. Methods: Drug utilization study, emphasizing the analysis of supply. The drugs included in Brazilian National List of Essential Drugs (BNLED) 2018 were classified according to level 3 of the chemical therapeutic anatomical classification. A literature review was performed to identify anticholinergic activity measurement scales. Anticholinergic activity of BNLED 2018 drugs was determined using the Composite anticholinergic scale. Results: It was identified two systematic reviews, among the 13 identified scales, Duran's Scale and Composite Anticholinergic Scale. Composite Anticholinergic Scale is the most comprehensive with 197 drugs. It was found that 14.6% of the drugs have anticholinergic activity and 69.1% are included in the basic component of the national list. Drugs with central nervous system activity constitute about 50% of the substances with anticholinergic activity, mainly comprised of antipsychotics, followed by cardiovascular system drugs, mostly represented by betablockers. The cumulative effect of anticholinergic activities, from several drugs prescribed concomitantly, reflects the importance of verifying prescriptions and aware health professionals of strategies to reduce this impact. Conclusions: To measure anticholinergic load in clinical practice, 13 scales are available. The most comprehensive scale is the Composite Anticholinergic Scale. Although medicines with anticholinergic activity are uncommon among medicines included in BNLED 2018, it is needed to provide information to prescribers due to the negative clinical outcomes attributed to cumulative anticholinergic burden.

Development of Harmonized Outcome Measures for Use in Patient Registries and Clinical Practice: Methods and Lessons Learned

2019 ◽  
Author(s):  
Michelle B. Leavy ◽  
Claudia Schur ◽  
Ferhat Q. Kassamali ◽  
Margaret Edder Johnson ◽  
Raj Sabharwal ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Outcome Measures ◽  
Lessons Learned ◽  
Patient Registries ◽  
Practice Methods

scholarly journals The Role of Research in Guiding Treatment for Women’s Health: A Qualitative Study of Traditional Chinese Medicine Acupuncturists

2021 ◽  
Vol 18 (2) ◽  
pp. 834
Author(s):  
Mike Armour ◽  
Debra Betts ◽  
Kate Roberts ◽  
Susanne Armour ◽  
Caroline A. Smith
Keyword(s):  
Clinical Practice ◽  
Women’S Health ◽  
Women's Health ◽  
Clinical Decision ◽  
Health Conditions ◽  
Case Histories ◽  
Research Literacy ◽  
The Right ◽  
Practice Methods

Background: Surveys of acupuncture practitioners worldwide have shown an increase in the use of acupuncture to treat women’s health conditions over the last ten years. Published studies have explored the effectiveness of acupuncture for various conditions such as period pain, fertility, and labor induction. However, it is unclear what role, if any, peer-reviewed research plays in guiding practice. Methods: Acupuncturists with a significant women’s health caseload were interviewed online in three small groups to explore factors that contribute to acupuncturists’ clinical decision made around treatment approaches and research. Results: Eleven practitioners participated in the focus groups. The overarching theme that emerged was one of ‘Not mainstream but a stream.’ This captured two themes relating to acupuncture as a distinct practice: ‘working with what you’ve got’ as well as ‘finding the right lens’, illustrating practitioners’ perception of research needing to be more relevant to clinical practice. Conclusions: Acupuncture practitioners treating women’s health conditions reported a disconnect between their clinical practice and the design of clinical trials, predominantly due to what they perceived as a lack of individualization of treatment. Case histories were popular as a learning tool and could be used to support increasing research literacy.

scholarly journals The Relation between Stress of Clinical Practice and Burnout among Nursing Students: The Mediation Effect of Spiritual Well-being

2017 ◽  
Vol 23 (3) ◽  
pp. 300-308
Author(s):  
Do Young Lee ◽  
Jin Kyoung Park ◽  
Mi Young Choi
Keyword(s):  
Clinical Practice ◽  
Nursing Students ◽  
Negative Correlation ◽  
Well Being ◽  
Self Report ◽  
Mediation Effect ◽  
Mediating Effects ◽  
Significant Difference ◽  
Spiritual Well Being ◽  
Practice Methods

Purpose: The purpose of this study is to examine the factors that influence the clinical practice of nursing students and to identify the mediating effects of spiritual well-being in the relation between stress of clinical practice and burnout caused by clinical practice. Methods: Data were collected by self-report questionnaires targeting 420 nursing students in three nursing colleges located in Gyeonggi and Chungnam province. Results: Burnout of clinical practice according to general characteristics of the study subjects showed significant difference in religion (t=1.895, p=.049). Stress of clinical practice and burnout of clinical practice showed positive correlation (r=.42, p<.001), existential spiritual well-being showed negative correlation between stress of clinical practice (r=-.17, p<.001) and burnout of clinical practice (r=-.47, p<.001). In addition, religious spiritual well-being in spiritual well-being showed no mediating effects and existential spiritual well-being showed mediating effects between burnout in clinical practice stress. Conclusion: In order to alleviate the stress of clinical practice for burnout of clinical practice prevention of nursing students, solutions to improve the existential spiritual well-being will be required in the future.

scholarly journals Clinical Practice of Adjuvant Chemotherapy in Patients with Early-Stage Epithelial Ovarian Cancer

Chemotherapy ◽  
2016 ◽  
Vol 61 (6) ◽  
pp. 287-294
Author(s):  
Lindy M.J. Frielink ◽  
Brenda M. Pijlman ◽  
Nicole P.M. Ezendam ◽  
Johanna M.A. Pijnenborg
Keyword(s):  
Ovarian Cancer ◽  
Clinical Practice ◽  
Adjuvant Chemotherapy ◽  
Epithelial Ovarian Cancer ◽  
Early Stage ◽  
Figo Stage ◽  
Selective Treatment ◽  
Platinum Based Chemotherapy ◽  
Grade 3 ◽  
Practice Methods

Background: Adjuvant platinum-based chemotherapy improves survival in women with early-stage epithelial ovarian cancer (EOC). Yet, there is a wide variety in clinical practice. Methods: All patients diagnosed with FIGO I and IIa EOC (2006-2010) in the south of the Netherlands were analyzed. The percentage of patients that received adjuvant chemotherapy was determined as well as the comprehensiveness of staging and outcome. Results: Forty percent (54/135) of the patients with early-stage EOC received adjuvant chemotherapy. Treatment with adjuvant chemotherapy was associated with FIGO stage, clear-cell histology and nonoptimal staging. Optimal staging was achieved in 50%, and nonoptimal staging was associated with advanced age, comorbidity and treatment in a non-referral hospital. Overall, there was no difference in outcome between patients with and without adjuvant chemotherapy. Yet, in grade 3 tumors, adjuvant chemotherapy seems beneficial. Conclusions: Selective treatment of patients with early-stage EOC might reduce adjuvant chemotherapy without compromising outcome.

Dissosiativ identitetsforstyrrelse i utredning av barn og ungdom: Teori og kliniske utfordringer

2021 ◽  
Vol 58 (8) ◽  
pp. 672-680
Keyword(s):  
Clinical Practice ◽  
Relevant Literature ◽  
Dissociative Disorders ◽  
Cognitive Difficulties ◽  
Dissociative Symptoms ◽  
Literature Searches ◽  
Adequate Understanding ◽  
Assessment And Treatment ◽  
Trauma Model ◽  
Practice Methods

Background: Clinical practice and recent research indicate that dissociative symptoms and disorders are left unidentified and undiagnosed by health professionals. Based on a clinical case from our work setting, this article describes relevant literature regarding dissociation and dissociative disorders to add to the knowledge of the theoretical and phenomenological features of complex dissociative disorders. Further, we describe differential diagnostic challenges that may arise in clinical practice. Methods: Both systematic and non-systematic literature searches were performed. Findings: Recent research shows the Trauma model to be central to understanding dissociative disorders. Symptoms can be mistaken for cognitive difficulties, oppositional issues or other somatic symptoms. Quantitative measures, systematic observations and clinical evaluations are fundamental for identifying dissociative symptoms and disorders. Implications: There is potential for identifying and evaluating dissociative symptoms at an earlier stage. Interdisciplinary and differential diagnostic evaluations are crucial to provide adequate understanding, assessment, and treatment of these patients. Keywords: Dissociative identity disorder, dissociation, somnambulism, biopsychosocial framework, clinical practice

scholarly journals Cognitive assessment: A challenge for occupational therapists in Brazil

2017 ◽  
Vol 11 (2) ◽  
pp. 121-128 ◽  
Author(s):  
Juliana Conti
Keyword(s):  
Clinical Practice ◽  
Cognitive Assessment ◽  
Occupational Therapists ◽  
Brazilian Portuguese ◽  
Assessment Tools ◽  
Neurological Injury ◽  
Cognitive Tools ◽  
Practice Methods ◽  
Brazilian Culture

ABSTRACT Cognitive impairment is a common dysfunction after neurological injury. Cognitive assessment tools can help the therapist understand how impairments are affecting functional status and quality of life. Objective: The aim of the study was to identify instruments for cognitive assessment that Occupational Therapists (OT) can use in clinical practice. Methods: The instruments published in English and Portuguese between 1999 and 2016 were systematically reviewed. Results: The search identified 17 specific instruments for OT not validated in Brazilian Portuguese, 10 non-specific instruments for OT not validated in Brazilian Portuguese, and 25 instruments validated for Portuguese, only one of which was specific for OT (Lowenstein Occupational Therapy Cognitive Assessment). Conclusion: There are few assessment cognitive tools validated for use in the Brazilian culture and language. The majority of the instruments appear not to be validated for use by OT in clinical practice.

scholarly journals Effects of clinical practice focusing on level-3 OSCE items

2015 ◽  
Vol 27 (5) ◽  
pp. 1533-1537 ◽  
Author(s):  
Hiroaki Sakurai ◽  
Yoshikiyo Kanada ◽  
Yoshito Sugiura ◽  
Ikuo Motoya ◽  
Yosuke Wada ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Level 3

Pazopanib in metastatic renal carcinoma (mRC): Experience of 31 centers in Spain in first, second, third, or subsequent lines in daily clinical practice.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e15609-e15609 ◽  
Author(s):  
Angel Rodriguez Sanchez ◽  
Rocio García Domínguez ◽  
Guillermo De Velasco ◽  
Alvaro Pinto ◽  
Javier Puente ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Renal Carcinoma ◽  
Soft Tissues ◽  
Clear Cell ◽  
Daily Clinical Practice ◽  
Limited Information ◽  
Time To Treatment Failure ◽  
Metastatic Sites ◽  
Practice Methods

e15609 Background: In clinical trials pazopanib (P) was superior to placebo, noninferior to sunitinib, and very well tolerated as 1st-line for mRC, but there is limited information in daily clinical practice. Methods: We retrospectively reviewed 159 patients (p) who received P in in 31 centers in Spain during the first 18 month after P approval, to evaluate the timing of use and its efficacy. Results: Mean age was 66 y, 64.8% were males, 81.1% clear-cell, 12% non-clear cell, and 6.9% unspecified. At diagnosis of mRC 73.6% had nephrectomy, 78.6% and 71.7% of p were of good-intermediate risk (MSKCC and Heng criteria respectively). Metastatic sites were lung (59.7%), lymph nodes (26.4%), bone (22.6%), skin/soft-tissues (17.6%), liver (11.9%), CNS (2.5%), and 31.4% others (adrenal, pancreas, etc.). Median follow-up since diagnosis of mRC was 16 months (m). P was given as 1st systemic treatment in 81 p, (50.9%), as 2nd line in 32 p (20.1%, most after sunitinib, 17 due to intolerance), or as ≥3r line (46 p, 29%). Median follow-up after P was 7 m in 1st line, and 10 m in 2nd or ≥ 3rd line. Toxicity was as expected. No toxic deaths were registered. At the time of analysis, 85 p have discontinued P (progression: 73 p, toxicity: 10 p, other causes: 2 p), and 35 p have died. The table shows time to treatment failure due to progression or toxicity (TTF), and overall survival (OS) since the 1st dose of P. There were statistically significant differences in 1st line TTF and OS between MSKCC subgroups. Conclusions: In p with mRC and good-intermediate prognosis, P appears to be as effective in daily clinical practice as it was in 1st line trials. P also showed efficacy in p with poor risk, in 2nd-line (particularly progression or intolerance to sunitinib), and after 2 or more TKIs. Updated analysis will be available in June 2013. [Table: see text]

Investigation of the tolerability of FOLFIRINOX in patients with unresectable advanced pancreatic cancer: Single-institution experience in Japan.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 487-487 ◽  
Author(s):  
Kouichirou Miyashita ◽  
Takashi Sekikawa ◽  
Ken Shimada ◽  
Taikan Yamamoto ◽  
Yasuhiro Kaga ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Clinical Practice ◽  
Clinical Stage ◽  
Performance Status ◽  
Objective Response ◽  
Advanced Pancreatic Cancer ◽  
Dose Intensity ◽  
Eligibility Criteria ◽  
Grade 3 ◽  
Practice Methods

487 Background: FOLFIRINOX therapy has contributed to the overall survival extension of unresectable advanced pancreatic cancer. This regimen is however associated with significant toxicity. And doing the treatment, while careful to toxicity at our institution. We investigated the tolerability of FOLFIRINOX for the treatment of unresectable advanced pancreatic cancer in clinical practice. Methods: We conducted a retrospective analysis of patients with unresectable advanced pancreatic cancer who received FOLFIRINOX between November 2012 and August 2014. FOLFIRINOX is as follows: irinotecan at 150 mg/m2; oxaliplatin at 85 mg/m2; 5-fluorouracil (5FU) at 400mg/m2 bolus, 2,400mg/m2 continuous infusion. Patients' characteristics, objective response, survival and toxicities were collected. Response were evaluated with RECIST version 1.1 and toxicities with NCI-CTCAE version 4.0. Results: 13 patients were includes (8 males and 5 females). Treatment eligibility criteria in our institution were Performance Status 0 or 1, and UGT1A1 polymorphisms were excluded. Median age was 58.6 years (41-74). Clinical stage IVa/IVb was 3/10. The mean number therapy was 7.7 (3-15) cycles. The toxicity of all grade was 100% and grade 3 was 80%. The non-hematological toxicities included nausea in 8 patients (61.5%) and anorexia in 9 (69.2%). The hematological toxicities included neutropenia in 12 patients (92.3%), of which 11 (84.6%) presented a grade 3/4 neutropenia. In patients who developed grade 3 neutropenia, the treatment of FOLFIRINOX could be continued once every three weeks (triweekly) without reducing the dose. Response rate was 38.5% (CR: 0, PR: 5, SD: 6, PD: 2) and disease control rate was 84.6%. Time to treatment failure was 175 days. Relative dose intensity was 95.0% for oxaliplatin, 88.9% for irinotecan, 81.9% for 5FU (bolus), and 95.6% for 5FU (continuous). Conclusions: In clinical practice, it is expected that FOLFIRINOX is an effective, well-tolerated regimen by reducing the dose or determining the appropriate dosing interval.

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