RESUMO
BACKGROUND AND OBJECTIVE: The Modified Rankin Scale (mRS) is a widely adopted scale for assessing stroke recovery. Despite limitations, the mRS has been adopted as primary outcome in most recent clinical acute stroke trials. Designed to be used by multidisciplinary clinical staff, the congruency of this scale is not consistent, which may lead to mistakes in clinical or research application. We aimed to develop and validate an interactive and automated digital tool for assessing the mRS-the iRankin. METHODS: A panel of five board-certified and mRS-trained vascular neurologists developed an automated flowchart based on current mRS literature. Two international experts were consulted on content and provided feedback on the prototype platform. The platform contained five vignettes and five real video cases, representing mRS grades 0-5. For validation, we invited neurological staff from six comprehensive stroke centers to complete an online assessment. Participants were randomized into two equal groups usual practice versus iRankin. The participants were randomly allocated in pairs for the congruency analysis. Weighted kappa (kw) and proportions were used to describe agreement. RESULTS: A total of 59 professionals completed the assessment. The kw was dramatically improved among nurses, 0.76 (95% confidence interval (CI) = 0.55-0.97) × 0.30 (0.07-0.67), and among vascular neurologists, 0.87 (0.72-1) × 0.82 (0.66-0.98). In the accuracy analysis, after the standard mRS values for the vignettes and videos were determined by a panel of experts, and considering each correct answer as equivalent to 1 point on a scale of 0-15, it revealed a higher mean of 10.6 (±2.2) in the iRankin group and 8.2 (±2.3) points in the control group (p = 0.02). In an adjusted analysis, the iRankin adoption was independently associated with the score of congruencies between reported and standard scores (beta coefficient = 2.22, 95% CI = 0.64-3.81, p = 0.007). CONCLUSION: The iRankin adoption led to a substantial or near-perfect agreement in all analyzed professional categories. More trials are needed to generalize our findings. Our user-friendly and free platform is available at https://www.irankinscale.com/.
Assuntos
Acidente Vascular Cerebral , Humanos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Feminino , Variações Dependentes do Observador , Masculino , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , NeurologistasRESUMO
Bromelain, the main protease enzyme found in the pineapple plant (Ananas comosus), has had its antinociceptive effect previously demonstrated. This investigation aimed to appraise the role of TRP (Transient Receptor Potential) channels in the nociception-relieving effects of bromelain in the orofacial region of adult zebrafish. The animals were pretreated with bromelain (3.0, 10.0 or 30.0 mg/mL; gavage) and submitted to open field and acute orofacial (capsaicin - TRPV1 agonist, cinnamaldehyde - TRPA1 agonist or menthol - TRPM8 agonist) nociception tests. The investigation also explored the contribution of central afferent C-fibers. Naive groups were included for comparison. Bromelain did not independently affect the zebrafish movement patterns. However, bromelain decreased the nociceptive responses elicited by all three TRP channel activators. Capsazepine (TRPV1 inhibitor) and AMTB (TRPM8 inhibitor), but not HC-030031 (TRPA1 inhibitor), prevented the antinociceptive effect of bromelain. Moreover, capsaicin-induced desensitization effectively nullified the antinociceptive effect of bromelain. Collectively, these findings corroborate the therapeutic relevance of bromelain as a suppressor of orofacial nociception, which seems to be intricately connected to the modulation of TRP channels.
RESUMO
O objetivo do estudo foi descrever a implantação, estruturação e desenvolvimento da prática de auditoria farmacêutica em uma operadora de planos de saúde de Fortaleza (OPS). Trata-se de um estudo descritivo do tipo estudo de caso, em que a unidade de análise foi uma OPS localizada em Fortaleza, capital do estado do Ceará (Brasil). Foram coletados e analisados dados qualitativos e quantitativos que corresponderam ao período de 2007 a 2010. Para a implantação da área de auditoria farmacêutica foi utilizada como primeira estratégia sua formalização na Diretoria de Recursos Médicos Hospitalares e na estrutura organizacional da OPS em janeiro de 2007. Com o reconhecimento do trabalho desenvolvido pela área, a equipe chegou em 2010 com dois farmacêuticos, dois assistentes de farmácia e cinco estagiários. O desenvolvimento da prática de auditoria farmacêutica resultou na exigência de pareceres técnicos para inclusão de medicamentos em tabela definida pela OPS e de solicitação para medicamentos de alto custo e de reserva terapêutica. A intervenção do farmacêutico, em seis meses de experiência, junto a pacientes em uso de antimicrobianos mostrou uma economia de R$ 279.153,80. A gestão de quimioterápicos resultou em uma economia total de R$ 2.502.278,31 para a OPS em 2009. Embora a auditoria farmacêutica envolva uma discussão recente, é preciso desde já, que aspectos relacionados à sua implantação, estruturação e desenvolvimento sejam apoiados, uma vez que essa prática ajuda na descrição e análise de elementos assistenciais e de gestão que envolve pacientes em tratamento farmacológico.
The purpose of this study was to describe the implantation, organization and development of pharmaceutical audit in a health insurance provider (HIP) in northeast Brazil. This is a descriptive case study in which the unit of analysis was an HIP located n Fortaleza, capital of Ceará State. Qualitative and quantitative data covering the period from 2007 and 2010 were collected and analyzed. In order to create the pharmaceutical auditing team, the first strategy used was to set up a section in the Hospital Medical Resources Directorate and in the managerial structure of the HIP, in January 2007. With the recognition of the work developed by the section, the team was amplified in 2010 with the arrival of two pharmacists, two pharmacy assistants and five trainees. The development of the practical aspects of pharmaceutical auditing revealed a need for technical opinions on the inclusion of medicines in the table defined by the HIP and requests for authorization in the case of high-cost medicines and those used in reserved therapy. The pharmacists intervention, over a six-month period, in the treatment of patients with antibiotics, yielded savings of R$ 279,153.80. The management of chemotherapy resulted in total savings of R$ 2,502,278.31 for the HIP in 2009. Although pharmaceutical auditing has only come out in recent discussions, there is an immediate need to support actions related to its implantation, organization and development, since this practice helps in describing and analyzing the healthcare and management features that involve patients under pharmacological treatment.
Assuntos
Auditoria Médica/métodos , Administração Hospitalar , Controle de CustosRESUMO
The gastroprotective effect of DDF (3,6-dimethoxy-6'', 6''-dimethyl-[2'', 3'' : 7,8]-chromeneflavone) from Lonchocarpus araripensis Benth. (Leguminosae) on gastric damage induced by absolute ethanol (96%, 0.2 mL/mouse) and indometacin (30 mg kg(-1), p.o.) in mice was investigated. Intraperitoneally administered DDF at dose levels of 50, 100 and 200 mg kg(-1) markedly reduced the gastric lesions in the ethanol model by 62, 72 and 96%, and in the indometacin model by 34, 70 and 75%, respectively, as compared with misoprostol (50 microg kg(-1), p.o.), the reference compound that caused lesion suppression by 67% in ethanol model and by 72% against indometacin-induced ulceration. The ED50 of DDF in reducing gastric lesions induced by ethanol and indometacin (dose of the DDF that reduced the gastric lesion area by 50% in relation to the control value) was 50.87 and 61.56 mg kg(-1), respectively. Mechanistic studies were carried out at 100 mg kg(-1) DDF using the ethanol model. Compared with N-acetylcysteine (750 mg kg(-1), p.o.), a donor of sulfhydryls, DDF only partially replenished the ethanol-induced depletion of gastric mucosal NP-SH. Pretreatment with TRPV1 antagonist capsazepine (5 mg kg(-1), i.p.) or the non-selective cyclooxygenase inhibitor indometacin (10 mg kg(-1), p.o.) effectively blocked the gastroprotective effect of DDF (100 mg kg(-1)) against ethanol damage. Furthermore, the effect of DDF was significantly reduced in mice pretreated with L-NAME, or glibenclamide, the respective inhibitors of nitric oxide synthase and K+ ATP channel activation. These data provide evidence to show that DDF affords gastroprotection against gastric damage induced by ethanol and indometacin by different and complementary mechanisms, which include involvement of endogenous prostaglandins, nitric oxide release, the activation of TRPV1 receptor or K+ ATP channels, besides a sparing effect on NP-SH reserve.