Browsing by Author "Guerreiro, Mara Pereira"
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- Alcohol-antibacterial drug interactions: comparison of three drug compendiaPublication . Lança, Teresa; Auxtero, Deolinda; Costa, Isabel Margarida; Guerreiro, Mara Pereira
- Consensual improvement actions for the Tuberculosis Control Programme in Pernambuco state, Brazil: an e-Delphi studyPublication . Bezerra, Simone Santos; Guerreiro, Mara Pereira; Sobrinho, José Lamartine SoaresObjectives: Tuberculosis (TB) remains a major public health problem, particularly in low and middle-income countries. The aim of this study is to consensualise improvement actions for the Tuberculosis Control Programme of the Pernambuco state (SPTC), Brazil. Methods: Firstly, a preliminary workshop was conducted with experts (n = 8), including key stakeholders and health professionals, to select structure and process indicators pertaining to the tuberculosis control programme. Then, an e-Delphi was carried out with a purposive sample of 11 local TB experts. The first-round questionnaire was comprised of 19 open-ended questions on possible improvement actions, based on programme indicators obtained in the previous stage. In the second-round experts rated each action for relevance and feasibility, using a four-point scale. In the last round the participants rated the actions again, in the light of group's answers. We used published criteria to define consensus at the outset of the study. Key findings: Eighty-nine improvement actions achieved a high degree of consensus in both feasibility and relevance in round three. Eighty-six actions were grouped under 19 structure and process indicators, while three were consideredcross-sectional in scope (i.e. related to more than one indicator). Ten out of the 86 actions obtained at least 70% of ratings on the highest score of the scale both for relevance and feasibility. These included: "Request and availability of sputum pots can be made by any health professional in the health unit". Conclusions: The wide array of actions obtained in this Delphi represent a resource from which local SPTC services can select the actions most suitable for each context. The ten most relevant and feasible actions represent a particularly useful starting point to streamline change and potentially improve programme indicators.
- Cross-cultural validation and psychometric evaluation of the Self-Medication Assessment Tool (SMAT) for assessing and optimizing medication therapy management of older peoplePublication . Advinha, Ana Margarida; Barros, Carla Teixeira de; Guerreiro, Mara Pereira; Nunes, Carla; Lopes, Manuel José; Oliveira-Martins, Sofia deBackground, rationale and objectives: The assessment of medication management ability in the elderly can be performed using specific tools, such as the Self-Medication Assessment Tool, which considers real and simulated regimens. The objective of this study was to perform the linguistic and cultural adaptation of the Self-Medication Assessment Tool to European Portuguese and determine its psychometric properties. Methods: The adaptation commenced with the translation/back translation cycle completed by 4 independent bilingual experts. The cultural component was accomplished through an external expert meeting and a longitudinal screening of concepts and construct. The pilot study was carried out in a sample of 150 Portuguese community-dwelling elders. Descriptive data, correlations, internal reliability, response consistency and exploratory factor analysis was conducted using SPSS Statistics (v22). Results: The pilot study was carried out in a sample of 150 community-dwelling elders: 112 (74.7%) participants were women; mean age was 74.73 ± 6.43 years. The Self-Medication Assessment Tool (Portuguese version) standard regimen (simulated medication regimen) mean scores were 20.92 ± 6.83 in functional ability and 38.75 ± 5.92 in cognitive ability; the real regimen (medication taken by the elderly) mean scores were 83.74 ± 15.86 in medication recall, 96.96 ± 11.39 in adherence self-report and 4.82 ± 10.1 in intentional non-adherence. Cronbach's α were 0.87 (functional ability), 0.84 (cognitive ability), 0.57 (medication recall), 0.94 (adherence self-report) and 0.79 (intentional non-adherence). The response consistency between test and re-test was verified. Conclusions: We have developed the European Portuguese version of the Self-Medication Assessment Tool with acceptable psychometric properties which can now be employed in the study of the elderly in clinical and research contexts.
- ‘Everyone plays defence’: a qualitative exploration of issues that influence the prescribing of antibiotics by Portuguese dentistsPublication . Oliveira, Ana Sofia; Guerreiro, Mara PereiraObjective: The aim of this study was to explore issues influencing antibiotic prescribing by Portuguese dentists. Methods: Semi-structured qualitative interviews were conducted with 14 purposively selected dentists. Interviews were audio-recorded with consent, anonymised during verbatim transcription and analysed using the five-stage ‘Framework Approach’, with the aid of the software WebQDA. Ethical approval was granted. Results: ‘Defensive’ practice emerged as a significant influence on antibiotic prescribing by Portuguese dentists, based on concerns related to avoiding clinical complications and fears of losing patients. Analysis indicated a divide regarding the influence of guidelines on antibiotic prescribing; their influence seemed subtle, even among those who claimed to use them for decision-making. The influence of peers appeared minimal, although less experienced dentists considered it an issue. Dentists recognised the existence of patient pressure; patient demand for antibiotics was mentioned, as well as expectations of not being prescribed such drugs. Pressure from pharmaceutical sales representatives was not unanimously acknowledged; even those mentioning it attempted to demonstrate reluctance in changing prescribing habits. Clinical experience recurred in the dataset as an overarching influence on antibiotic prescribing. Conclusions: The main factors that influence antibiotic prescribing appear to be issues intrinsic to dentists, such as a defensive practice and clinical experience; issues related to the environment seem less prominent. Multimodal interventions targeting both knowledge gaps and these intrinsic issues, such as audit and feedback combined with behaviour change messages, may be useful in optimising antibiotic prescribing in Portuguese dentistry.
- Influences on antibiotic prescribing by dentists: insights from a pilot studyPublication . Oliveira, Ana Sofia; Guerreiro, Mara Pereira
- Intravenous versus subcutaneous Trastuzumab in the treatment of breast cancerPublication . Maximiano, Sofia; Magalhães, Paulo; Guerreiro, Mara Pereira; Morgado, Manuel
- A national e-Delphi towards the measurement of safe medication practices in Portuguese hospitalsPublication . Guerreiro, Mara Pereira; Plácido, Madalena; Barros, Carla Teixeira; Coelho, Anabela; Graça, Anabela; Gaspar, Maria João; Martins, Sofia de OliveiraObjectives: To determine the face and content validity of items for measuring safe medication practices in Portuguese hospitals. Methods: 128 items were drafted from content analysis of existing questionnaires and the literature, employing preferred terms of the WHO International Classification for Patient Safety (Portuguese version). A two-round e-Delphi was convened, using a purposive multidisciplinary panel. Hospital-based experts were asked to rate the relevance of items on a 7-point Likert scale and to comment on their clarity and completeness. Results: The response rate was similar in both rounds (70.3% and 73.4%, respectively). In the first round 91/128 (71.1%) items reached the predefined level of positive consensus. In the second round 23 additional items reached positive consensus, as well as seven items newly derived by the panel. Conclusions: Most items have face and content validity, indicating relevance and clarity, and can be included in a future questionnaire for measuring safe medication practices in Portuguese hospitals.
- A national e-Delphi towards the measurement of safe medication practices in Portuguese hospitalsPublication . Guerreiro, Mara Pereira; Plácido, Madalena; Barros, Carla Teixeira; Coelho, Anabela; Graça, Anabela; Gaspar, Maria João; Martins, Sofia de OliveiraObjectives To determine the face and content validity of items for measuring safe medication practices in Portuguese hospitals. Methods 128 items were drafted from content analysis of existing questionnaires and the literature, employing preferred terms of the WHO International Classification for Patient Safety (Portuguese version). A two-round e-Delphi was convened, using a purposive multidisciplinary panel. Hospital-based experts were asked to rate the relevance of items on a 7-point Likert scale and to comment on their clarity and completeness. Results The response rate was similar in both rounds (70.3% and 73.4%, respectively). In the first round 91/128 (71.1%) items reached the predefined level of positive consensus. In the second round 23 additional items reached positive consensus, as well as seven items newly derived by the panel. Conclusions Most items have face and content validity, indicating relevance and clarity, and can be included in a future questionnaire for measuring safe medication practices in Portuguese hospitals.
- The perspectives of patients and health professionals regarding the tuberculosis control programme in Recife, Brazil: a contribution to evaluationPublication . Bezerra, Simone Santos; Guerreiro, Mara Pereira; Pessoa, Nathany França; Silva, Maria Gabriela Pereira da; Barros, Mirela Galvão de; Gomes, João José Ferreira; Athayde, Maria Paula; Auad, Rodrigo Zeymer; Sobrinho, José Lamartine SoaresThe study objective is to describe patients and professionals’ perspectives on the Tuberculosis Control Program (PCT) in Recife, Brazil, contributing to the program evaluation. A cross-sectional study was conducted in three purposively selected sites, representing the three levels of care in the public health system. All eligible PCT patients in sites A, B and C were invited to participate (n = 123). Physicians, nurses, pharmacists and community health agents providing care to PCT patients in these sites, plus their managers, were purposively selected. Data were collected by means of interviews with 44 patients and a questionnaire to 24 professionals. Instruments encompassed previously published items to capture stakeholders’ perspectives (16 and 12 closed-questions, respectively), grouped into categories. The overall evaluation by patients was unsatisfactory (median score 35%; third quartile below 50%; interquartile range 21.9%). Analysis of scores by categories showed that opinions about organizational accessibility were significantly worse than about economic and geographical accessibility, taken together. Overall the median score attributed by professionals was 52% (third quartile below 65%). Professionals had significantly worse opinions about diagnosis, clinical and laboratory assistance. Patients and professionals’ perspectives highlight potential opportunities for improvement. Our findings can be used by managers as a starting point for shared decision-making, potentially contributing to a better performance of the PCT in Recife and, consequently, reducing the risk posed by tuberculosis.
- Prescrição de Antibióticos em Medicina Dentária: estudo pilotoPublication . Oliveira, Ana Sofia; Guerreiro, Mara Pereira