Papers by Vânia Andrzejevski
Revista Brasileira de Cancerologia, Sep 29, 2020
Este é um artigo publicado em acesso aberto (Open Access) sob a licença Creative Commons Attribut... more Este é um artigo publicado em acesso aberto (Open Access) sob a licença Creative Commons Attribution, que permite uso, distribuição e reprodução em qualquer meio, sem restrições, desde que o trabalho original seja corretamente citado.
Pharmacy Practice (internet), Dec 31, 2016
Background: Potentially inappropriate medication (PIM) use in the elderly is associated with incr... more Background: Potentially inappropriate medication (PIM) use in the elderly is associated with increased risk of adverse drug reactions (ADRs), but there is limited information regarding PIM use in the intensive care unit (ICU) setting. Objective: The aim of the study is to describe the prevalence and factors associated with the use of PIM and the occurrence of PIM-related adverse reactions in the critically ill elderly. Methods: This study enrolled all critically ill older adults (60 years or more) admitted to medical or cardiovascular ICUs between January and December 2013, in a large tertiary teaching hospital. For all patients, clinical pharmacists listed the medications given during the ICU stay and data on drugs were analyzed using 2012 Beers Criteria, to identify the prevalence of PIM. For each identified PIM the medical records were analyzed to evaluate factors associated with its use. The frequency of ADRs and, the causal relationship between PIM and the ADRs identified were also evaluated through review of medical records. Results: According to 2012 Beers Criteria, 98.2% of elderly patients used at least one PIM (n=599), of which 24.8% were newly started in the ICUs. In 29.6% of PIMs, there was a clinical circumstance that justified their prescription. The number of PIMs was associated with ICU length of stay and total number of medications. There was at least one ADR identified in 17.8% of patients; more than 40% were attributed to PIM, but there was no statistical association. Conclusions: There is a high prevalence of PIM used in acutely ill older people, but they do not seem to be the major cause of adverse drug reactions in this population. Although many PIMs had a clinical circumstance that led to their prescription during the course of ICU hospitalization, many were still present upon hospital discharge. Therefore, prescription of PIMs should be minimized to improve the safety of elderly patients.
Revista Brasileira de Farmácia Hospitalar e Serviços de Saúde, 2016
Conhecer as fragilidades envolvidas na prescrição, dispensação e administração de medicamentos vi... more Conhecer as fragilidades envolvidas na prescrição, dispensação e administração de medicamentos via sonda, bem como propor e desenvolver estratégias para minimizar os riscos relacionados a esta atividade. Estudo observacional descritivo, realizado em diferentes etapas: 1) análise dos medicamentos sólidos orais padronizados no hospital; 2) avaliação das prescrições com medicamentos via sonda e, 3) realização de entrevista com profissionais da farmácia e da equipe de enfermagem para identificar o perfil da prática de dispensação e administração de medicamentos por esta via. Foram identificados 207 medicamentos sólidos orais padronizados, dos quais, 71 não podem ser via sonda. De 590 prescrições médicas avaliadas, 117 continham pelo menos um medicamento a ser administrado por esta via, para 42 pacientes distintos. Um total de 483 doses foram prescritas de 68 medicamentos diferentes, sendo que 78,16% eram medicamentos na forma sólida. A entrevista realizada com as equipes de farmácia e de enfermagem demonstrou a falta de treinamento, as constantes dúvidas e, a falta de materiais de consulta para a execução segura e eficaz da farmacoterapia via sonda. A partir disso, foram desenvolvidas e sugeridas estratégias para melhorar esta prática. O estudo evidenciou que existem muitas dúvidas e fragilidades em relação à administração de medicamentos via sonda. Baseado nisso, medidas como a inserção da análise de prescrições por farmacêuticos, a interação multidisciplinar e a elaboração de materiais para padronizar condutas se fazem necessárias para promover o uso racional de medicamentos por essa via, garantindo a segurança e a eficácia da farmacoterapia dos pacientes.
The role of the clinical pharmacist in guiding adjuvant hormonal therapy in patients with breast cancer
Journal of Oncology Pharmacy Practice, Jul 5, 2021
Breast cancer is the most prevalent type of cancer among women, affecting about 2.1 million world... more Breast cancer is the most prevalent type of cancer among women, affecting about 2.1 million worldwide and is responsible for the highest number of cancer-related deaths among women. Approximately 80% of breast cancers express on the surface of hormone receptor cells, such as progesterone and estrogen. In these cases, Adjuvant Hormonal Therapy (AHT) is indicated for a period of five to ten years and consists of taking a daily oral pill. The two most used drugs in AHT are tamoxifen and Aromatase Inhibitors. One of the issues most faced by individuals who are subjected to long periods of treatment is the lack of medication adherence and, consequently, therapeutic inefficiency. It is believed that the monitoring by the pharmacist can contribute to the reduction of errors inherent to the medication, making the treatment more effective and improving the patient's quality of life. The present study aimed to know the perception of patients who live with breast cancer and who do AHT in relation to the educational performance of the clinical pharmacist. This is a qualitative, descriptive and exploratory study, carried out from March to October 2020, with 15 women undergoing treatment at the oncology unit of a tertiary-care hospital in south of Brazil. The data were obtained through a semi-structured interview using an instrument composed of two parts, one referring to the characterization of the participants and the other with the guiding question of the research: "How do you perceive the role of the pharmacist in relation to the guidelines for the use of adjuvant hormonal therapy?". The method of theoretical saturation was used to perform the sample closure and the thematic analysis was used to analyze the data. The participants were between 32 and 74 years old, seven were on tamoxifen therapy and eight on anastrozole, ten were on the first year of treatment, two on the second and three on the third year. The themes that emerged were: pharmacist-patient interaction as a safety factor in hormone therapy; role of the pharmacist in the development of strategies for self-management of the patients during hormone therapy; and, challenges for the pharmacist in relation to hormone therapy through continued guidance. It was evident that the pharmacist's educational action encouraged the participants to carry out the treatment in a more confident and assertive manner according to their particularities and beliefs.
Interrelação entre Qualidade de Vida, Resiliência e Síndrome de Burnout: estudo longitudinal com residentes multiprofissionais
Tempus Actas de Saúde Coletiva, Dec 4, 2018
Resumo: O programa de residencia foi ampliado para demais areas da saude, o que levou a melhor qu... more Resumo: O programa de residencia foi ampliado para demais areas da saude, o que levou a melhor qualidade assistencial aos pacientes, bem como a capacitacao dos profissionais. A carga horaria intensa somada as exigencias e responsabilidades da rotina acaba sobrecarregando o residente. Assim, objetivou-se a avaliacao da interrelacao da Qualidade de Vida (QV), Resiliencia e indicios de Sindrome de Burnout, por meio da Escala SF-36, Escala dos Pilares da Resiliencia e Maslach Burnout Inventory, respectivamente. A amostra foi composta por 49 residentes multiprofissionais, entrevistados em quatro momentos. Trata-se de um estudo longitudinal, quantitativo, exploratorio e comparativo, cuja analise dos resultados se deu por estatistica descritiva, analises multivariadas e univariadas e pos-teste de Tukey. Considerou-se nivel de significância de 5% e intervalo de confianca de 95%. Constatou-se um aumento significativo da Exaustao Emocional ao longo dos dois anos, aumento da satisfacao pessoal no trabalho no final da residencia. Prejuizo na QV em aspecto emocional e vitalidade. Desenvolvimento favoravel nas subescalas dos pilares de resiliencia, principalmente na Independencia e Valores Positivos. Correlacoes negativas para as relacoes: vitalidade e exaustao emocional; aceitacao positiva de mudanca e dominio da dor; e autoconfianca com exaustao emocional e despersonalizacao. Esses resultados auxiliam na identificacao dos fatores preditivos favoraveis e desfavoraveis do perfil dos residentes e denotam a importância de atentar ao bem-estar destes.
Einstein (São Paulo), Jun 1, 2013
Objective: To analyze the clinical pharmacist interventions performed during the review of prescr... more Objective: To analyze the clinical pharmacist interventions performed during the review of prescription orders of the Adult Intensive Care, Cardiologic Intensive Care, and Clinical Cardiology Units of a large tertiary teaching hospital in Brazil. Methods: The analysis took place daily with the following parameters: dose, rate of administration, presentation and/or dosage form, presence of inappropriate/unnecessary drugs, necessity of additional medication, more proper alternative therapies, presence of relevant drug interactions, inconsistencies in prescription orders, physicalchemical incompatibilities/solution stability. From this evaluation, the drug therapy problems were classified, as well as the resulting clinical interventions. Results: During the study, a total of 6,438 drug orders were assessed and 933 interventions were performed. The most prevalent drug therapy problems involved ranitidine (28.44%), enoxaparin (13.76%), and meropenem (8.26%). The acceptability of the interventions was 76.32%. The most common problem found was related to dose, representing 46.73% of the total. Conclusion: Our study showed that up to 14.6% of the prescriptions reviewed had some drug therapy problem and the pharmacist interventions have promoted positive changes in seven to ten of these prescriptions.
To assess the role of social risk factors on adherence to tyrosine kinase inhibitors (TKI) therap... more To assess the role of social risk factors on adherence to tyrosine kinase inhibitors (TKI) therapy in chronic myeloid leukemia (CML) patients. Methods: This is a retrospective study and eligible patients were adults with CML on TKI treatment. Cases of no adherence to treatment were confirmed during pharmacists' consultation (patient-reported adherence). Baseline characteristics between groups were compared between cases and controls groups. Risk factors identified in bivariate analysis (p<0.2) were included in multivariate model. A qualitative investigation assessed whether such predictors of non-adherence had causal relationship. Results: Of 151 patients with CML consulted by pharmacists, 21% had adherence problems. Despite patients with secondary school (p=0.03), most of investigated social risk factors did not differ between groups. However, by using a qualitative approach, patients' level of education could not explain low adherence rates behavior. Conclusions: Social determinants of health, herein investigated, were unlikely to predict adherence to treatment. Regression techniques may lead to untrue statements, so future researches should consider investigating the causes, not only the statistical estimates.
To assess the role of social risk factors on adherence to tyrosine kinase inhibitors (TKI) therap... more To assess the role of social risk factors on adherence to tyrosine kinase inhibitors (TKI) therapy in chronic myeloid leukemia (CML) patients. Methods: This is a retrospective study and eligible patients were adults with CML on TKI treatment. Cases of no adherence to treatment were confirmed during pharmacists' consultation (patient-reported adherence). Baseline characteristics between groups were compared between cases and controls groups. Risk factors identified in bivariate analysis (p<0.2) were included in multivariate model. A qualitative investigation assessed whether such predictors of non-adherence had causal relationship. Results: Of 151 patients with CML consulted by pharmacists, 21% had adherence problems. Despite patients with secondary school (p=0.03), most of investigated social risk factors did not differ between groups. However, by using a qualitative approach, patients' level of education could not explain low adherence rates behavior. Conclusions: Social determinants of health, herein investigated, were unlikely to predict adherence to treatment. Regression techniques may lead to untrue statements, so future researches should consider investigating the causes, not only the statistical estimates.
Medicamentos via sonda: perfil prático em um hospital terciário de ensino
To know the weaknesses involved the prescribing, dispensing and administration of drugs... more To know the weaknesses involved the prescribing, dispensing and administration of drugs through feeding tube and propose and develop strategies to minimize the risks related to this activity. The was an observational and descriptive study conducted in different stages: 1) analysis of oral solid drugs used within the hospital; 2) evaluation of the prescription of drugs via tube and 3) interviews with pharmacy professionals and nursing staff to identify the profile of the practice of dispensing and administration of drugs by tube feeding. Were identified 207 oral solid drugs, of which 71 cannot be by this route. Among 590 evaluated medical prescriptions, 117 containing at least one medicament to be administered in this way to 42 different patients. A total of 483 doses were required of 68 different drugs, and 78.16% were medicines in solid form. The interview with the pharmacy and nursing teams, demonstraded the lack of...
Interrelação entre Qualidade de Vida, Resiliência e Síndrome de Burnout: estudo longitudinal com residentes multiprofissionais
Tempus Actas de Saúde Coletiva, 2018
Resumo: O programa de residencia foi ampliado para demais areas da saude, o que levou a melhor qu... more Resumo: O programa de residencia foi ampliado para demais areas da saude, o que levou a melhor qualidade assistencial aos pacientes, bem como a capacitacao dos profissionais. A carga horaria intensa somada as exigencias e responsabilidades da rotina acaba sobrecarregando o residente. Assim, objetivou-se a avaliacao da interrelacao da Qualidade de Vida (QV), Resiliencia e indicios de Sindrome de Burnout, por meio da Escala SF-36, Escala dos Pilares da Resiliencia e Maslach Burnout Inventory, respectivamente. A amostra foi composta por 49 residentes multiprofissionais, entrevistados em quatro momentos. Trata-se de um estudo longitudinal, quantitativo, exploratorio e comparativo, cuja analise dos resultados se deu por estatistica descritiva, analises multivariadas e univariadas e pos-teste de Tukey. Considerou-se nivel de significância de 5% e intervalo de confianca de 95%. Constatou-se um aumento significativo da Exaustao Emocional ao longo dos dois anos, aumento da satisfacao pessoal...
Orientador : Prof. Dr. José Zanis NetoCoorientador : Prof. Dr. Sérgio Lunardon PadilhaColaborador... more Orientador : Prof. Dr. José Zanis NetoCoorientador : Prof. Dr. Sérgio Lunardon PadilhaColaborador : Thais Teles de SouzaColaborador : Antônio Eduardo Matoso MendesDissertação (mestrado) - Universidade Federal do Paraná, Setor de Ciências da Saúde, Programa de Pós-Graduação em Medicina Interna. Defesa : Curitiba, 20/09/2016Inclui referências : f. 120-128Resum
Objetivo: relatar a experiência dos dez anos de implementação do Programa de Residência Multiprof... more Objetivo: relatar a experiência dos dez anos de implementação do Programa de Residência Multiprofissional em Atenção Hospitalar no Complexo Hospital de Clínicas da Universidade Federal do Paraná. Desenvolvimento: relato de experiência, sobre os dez anos de implementação do programa de residência. Os dados foram coletados de documentos internos e dos relatos dos coordenadores e preceptores. Trezentos e setenta e dois profissionais foram formados. Dentre os avanços do programa, destaca-se o aumento no número de vagas e especialidades, consolidação do Regimentos Interno, gerenciamento informatizado das informações Acadêmicas, incentivo à pesquisa e melhoria da assistência no âmbito hospitalar. Considerações finais: Os dez anos de programa foram marcados pelo desafio da desconstrução do olhar uniprofissional para um projeto que contemplasse a diversidade das múltiplas profissões, proporcionando a construção de novos paradigmas, a transformação das práticas profissionais, o desenvolvimen...
Pharmacy Practice, Jun 15, 2015
To assess the role of social risk factors on adherence to tyrosine kinase inhibitors (TKI) therap... more To assess the role of social risk factors on adherence to tyrosine kinase inhibitors (TKI) therapy in chronic myeloid leukemia (CML) patients. This is a retrospective study and eligible patients were adults with CML on TKI treatment. Cases of no adherence to treatment were confirmed during pharmacists' consultation (patient-reported adherence). Baseline characteristics between groups were compared between cases and controls groups. Risk factors identified in bivariate analysis (p<0.2) were included in multivariate model. A qualitative investigation assessed whether such predictors of non-adherence had causal relationship. Of 151 patients with CML consulted by pharmacists, 21% had adherence problems. Despite patients with secondary school (p=0.03), most of investigated social risk factors did not differ between groups. However, by using a qualitative approach, patients' level of education could not explain low adherence rates behavior. Social determinants of health, herein...
Inhibidores de la tirosin-kinasa en pacientes con leucemia mielógena crónica: definir el papel de los factores de riesgo sociales y la no adherencia al tratamiento
Pharmacy Practice (granada), 2015
Pharmacy Practice, 2015
To assess the role of social risk factors on adherence to tyrosine kinase inhibitors (TKI) therap... more To assess the role of social risk factors on adherence to tyrosine kinase inhibitors (TKI) therapy in chronic myeloid leukemia (CML) patients. Methods: This is a retrospective study and eligible patients were adults with CML on TKI treatment. Cases of no adherence to treatment were confirmed during pharmacists' consultation (patient-reported adherence). Baseline characteristics between groups were compared between cases and controls groups. Risk factors identified in bivariate analysis (p<0.2) were included in multivariate model. A qualitative investigation assessed whether such predictors of non-adherence had causal relationship. Results: Of 151 patients with CML consulted by pharmacists, 21% had adherence problems. Despite patients with secondary school (p=0.03), most of investigated social risk factors did not differ between groups. However, by using a qualitative approach, patients' level of education could not explain low adherence rates behavior. Conclusions: Social determinants of health, herein investigated, were unlikely to predict adherence to treatment. Regression techniques may lead to untrue statements, so future researches should consider investigating the causes, not only the statistical estimates.
Summary This study evaluated the in vitro alteration in the resistance/susceptibility profiles of... more Summary This study evaluated the in vitro alteration in the resistance/susceptibility profiles of Staphylococcus aureus, Enterococcus faecalis, Pseudomonas aeruginosa, Escherichia coli and Klebsiella pneumoniae induced by 5fluorouracil, bleomycin, and cis-diamminedichloroplatinum. Results showed that antineoplastic drugs might induce discrete fluctuations in resistance/susceptibility profiles that are important during the course of a infection in patients undergoing antiproliferative chemotherapy.
Introduction: The low adherence to treatment with oral antineoplastic agents reflects the need fo... more Introduction: The low adherence to treatment with oral antineoplastic agents reflects the need for measures to facilitate compliance with therapy, such as providing educational materials. Objective: Develop and validate leaflets guiding the use of tamoxifen, anastrozole and capecitabine for breast cancer treatment. Method: To define the leaflet ́s content, the MEDLINE and UpToDate databases and national and international guidelines were consulted, adopting language accessible to the public. The validation was performed by oncology specialists through the Delphi method, considering the attributes of language, content and appearance. A satisfactory consensus was reached when the interquartile range (IR) was ≤ 1, obtained through a Likert scale ranging from 1 to 5. Results: The group of specialists was formed by 29 professionals. In the first round an IR of 1.43 was obtained; 1.14 and 1.43, and, in the second round, 0.71; 1.04 and 0.79 for language, content and appearance, respectively...
Revista Brasileira de Cancerologia
Introdução: A adesão aos antineoplásicos orais (AO) e um importante indicador de resposta terapêu... more Introdução: A adesão aos antineoplásicos orais (AO) e um importante indicador de resposta terapêutica relacionada a fatores pessoais, sociais e estruturais. Objetivo: Determinar as taxas de adesão aos AO, investigando possíveis fatores de risco para a não adesão, e avaliar as crenças dos pacientes sobre medicamentos, identificando oportunidades de intervenção farmacêutica. Método: Estudo analítico realizado com pacientes com câncer em uso de AO em 2015. Escala de Adesão e Recarga dos Medicamentos (ARMS) e Questionário de Crenças sobre Medicamentos (BMQ) foram aplicados para avaliar a adesão e crenças sobre medicamentos e tratamento. Os testes de Mann-Whitney, qui-quadrado e exato de Fisher foram usados para análise de dados. Resultados: Foram entrevistados 222 pacientes, com taxa de adesão de 92,8%, segundo o ARMS e 84,7%, segundo o BMQ, no qual as crenças de necessidade excederam as preocupações com o tratamento e o uso de AO. Renda familiar, interrupção do tratamento, número e cau...
Introduction: Adherence to oral antineoplastics (OA) is an important indicator of therapeutic res... more Introduction: Adherence to oral antineoplastics (OA) is an important indicator of therapeutic response related to personal, social, and structural factors. Objective: To determine rates of adherence to OA, investigating possible risk factors for nonadherence and to assess patient beliefs about medication, identifying opportunities for pharmaceutical intervention. Method: An analytical study was conducted with cancer patients using OA in 2015. Adherence to Refills and Medication Scale (ARMS) and Beliefs about Medicines Questionnaire (BMQ) were applied to assess adherence and beliefs about medication and treatment. Mann-Whitney, Chi-square, and Fisher’s Exact tests were used for data analysis. Results: A total of 222 patients were interviewed, with a 92.8% adherence rate according to ARMS and 84.7% according to BMQ, in which the necessity-beliefs exceeded the concerns with the treatment and use of OA. Family income, treatment interruption, number and causes of interruptions, depressio...
Cogitare Enfermagem
Objetivo: relatar a experiência dos dez anos de implementação do Programa de Residência Multiprof... more Objetivo: relatar a experiência dos dez anos de implementação do Programa de Residência Multiprofissional em Atenção Hospitalar no Complexo Hospital de Clínicas da Universidade Federal do Paraná. Desenvolvimento: relato de experiência, sobre os dez anos de implementação do programa de residência. Os dados foram coletados de documentos internos e dos relatos dos coordenadores e preceptores. Trezentos e setenta e dois profissionais foram formados. Dentre os avanços do programa, destaca-se o aumento no número de vagas e especialidades, consolidação do Regimentos Interno, gerenciamento informatizado das informações Acadêmicas, incentivo à pesquisa e melhoria da assistência no âmbito hospitalar. Considerações finais: Os dez anos de programa foram marcados pelo desafio da desconstrução do olhar uniprofissional para um projeto que contemplasse a diversidade das múltiplas profissões, proporcionando a construção de novos paradigmas, a transformação das práticas profissionais, o desenvolvimen...
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Papers by Vânia Andrzejevski