Publications by authors named "Mayara Sousa Vianna"

6 Publications

  • Page 1 of 1

Self-report instruments for assessing adherence to warfarin therapy: a systematic review.

Eur J Clin Pharmacol 2021 Jul 22. Epub 2021 Jul 22.

Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627, Pampulha, Belo Horizonte, MG, 31270-901, Brazil.

Background: The assessment of adherence to warfarin therapy is useful in clinical practice due to its wide variability in dose-response and risks of complications. The aim of this study was to investigate validated instruments used to assess adherence to warfarin therapy.

Methods: Information was collected from the MEDLINE (PubMed), LILACS, EMBASE, and Cochrane Library databases. Search strategies were applied for each database, with no time limit or language restriction. Inclusion criteria consisted of study participants of ≥ 18 years of age, from both sexes, on chronic anticoagulation with warfarin for any indication and the use of validated instruments to assess adherence to warfarin therapy. Exclusion criteria consisted of duplicate articles, narrative or systematic reviews, and meta-analyses, as well as case reports/series and experimental studies involving animals. Two independent reviewers performed the following steps: evaluation of titles/abstracts, selection of studies after full reading, data extraction, and evaluation of potential bias. Discrepancies were resolved by a third reviewer.

Results: Overall, 19 articles were selected for this systematic review, including 17 cross-sectional studies, one cohort study, and one quasi-experimental study, published from 2009 to 2019. The validated instruments identified in this review were Morisky Medication Adherence Scale (MMAS), the eight-item Morisky Medication Adherence Scale (MMAS-8), Measurement of Treatment Adherence (MTA), and Brief Medication Questionnaire (BMQ). Only MMAS-8 was tested for reliability, using the internal consistency assessment, with Cronbach's α range 0.56-0.71.

Conclusions: This review highlighted a gap in knowledge regarding the scarcity of validated instruments to assess adherence to warfarin therapy. Limitations were found in instruments that comprised the assessment of the isolated use of medication and the lack of analysis of other relevant therapeutic aspects. Future studies are needed to develop and validate more comprehensive instruments in an attempt to assess adherence to warfarin therapy.

Prospero: Registration number CRD42019128324.
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http://dx.doi.org/10.1007/s00228-021-03168-zDOI Listing
July 2021

Sex-influence on the time in therapeutic range (TTR) during oral anticoagulation with coumarin derivatives: Systematic review and meta-analysis.

Br J Clin Pharmacol 2021 May 11. Epub 2021 May 11.

Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil.

Aims: We sought to investigate the association between sex and oral anticoagulation control employing coumarin derivatives.

Methods: Electronic sources were MEDLINE, Biblioteca Virtual em Saúde (BVS), The Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Cochrane Central and Web of Science. Inclusion criteria were: observational and experimental studies; age ≥18 years; both sexes; treatment with any coumarin derivative for ≥3 months; any indication of long-term use; quality of oral anticoagulation measured by time in therapeutic range (TTR). The meta-analysis was developed with odds ratios (OR) for binary variables and mean differences (MD) for continuous variables, using random-effects models (DerSimonian and Laird) with 95% confidence intervals (CI).

Results: Overall, 22 articles were selected, comprising 16 cohort studies, four cross-sectional studies and two clinical trials. The number of participants ranged from 110 to 104 505 (183 612; women: 45%). The main indication of oral anticoagulation was atrial fibrillation. Most studies reported the use of warfarin. In the meta-analysis, 15 studies were analysed using TTR as a binary variable (OR = 0.87; 95% CI = 0.78, 0.96; z = -2.75; P = .006.; I  = 67%) and seven studies as a continuous variable (MD = -2.97; 95% CI = -4.80, -1.14; z = -3.19; P = .0014; I  = 75%). The pooled estimates indicated that women were associated with lower TTR than men.

Conclusions: Our findings revealed an association between female sex and worse oral anticoagulation control. Further studies are needed with primary design to investigate sex-related factors influencing oral anticoagulation control with coumarin derivatives. Innovative strategies focused on women's health may be useful to improve patient-centred care.
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http://dx.doi.org/10.1111/bcp.14892DOI Listing
May 2021

Relationship of health literacy and adherence to oral anticoagulation therapy in patients with atrial fibrillation: a cross-sectional study.

J Thromb Thrombolysis 2021 Apr 15. Epub 2021 Apr 15.

Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, CEP 30130-100, Brazil.

Oral anticoagulant therapy (OAT) has increased substantially due to the aging population and prevalence rise of atrial fibrillation (AF). Medication adherence is important to achieve effectiveness and safety of OAT. The study aim was to investigate the relationship between health literary (HL) and the adherence to OAT in patients with atrial fibrillation (AF). This is a cross-sectional study conducted in a public cardiology clinic in Brazil, 2019. Sociodemographic and clinical data were collected by the review of medical records and interviews with patients. The relation between health literacy (HL) and adherence to OAT was investigated by a multiple logistic regression model. Overall, 100 AF patients were included in this study, with average age of 68.8 ± 13.8 years and predominance of women (54 %). Inadequate HL was found in 79 % of the patients and non-adherence was identified in 66 % of the participants. Sex was the only variable with a statistically significant association with non-adherence to OAT. Men presented a 2.54-fold greater chance of non-adherence to OAT, when compared to the women (Odds ratio (OR) = 2.54; 95 % confidence interval (CI): 1.03-6.62; p = 0.047). No statistically significant relationship was found between inadequate HL and non-adherence to OAT (OR 1.48; 95 % CI, 0.47-4.61; p = 0.49). High rates of inadequate HL and non-adherence to OAT were identified in this study; however, this relationship did not prove to be statistically significant. Further studies are needed to investigate factors associated with non-adherence to OAT in large samples of vulnerable populations and strategies for its improvement in public health.
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http://dx.doi.org/10.1007/s11239-021-02432-4DOI Listing
April 2021

Influence of sex-based differences on oral anticoagulation control in patients taking coumarin derivatives: a systematic review protocol.

JBI Evid Synth 2021 02;19(2):477-483

Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.

Objective: This review will aim to assess the influence of sex-based differences on oral anticoagulation control in patients taking coumarin derivatives.

Introduction: Coumarin derivatives, such as warfarin, have a narrow therapeutic index, requiring frequent monitoring to achieve adequate anticoagulation control, which can be assessed by the time in therapeutic range. Differences in the quality of oral anticoagulation control between men and women have been reported, although the current evidence is controversial. A systematic review on this topic would provide results that could be incorporated into clinical practice to enhance oral anticoagulation control and treatment outcomes.

Inclusion Criteria: Observational and experimental studies were assessed for eligibility, with participants aged ≥18 years of either sex taking oral anticoagulation or other coumarin derivatives for ≥3 months, for any indication of chronic use, who had oral anticoagulation control evaluated by time in therapeutic range.

Methods: Electronic databases to be searched include MEDLINE, BVS, CINAHL, Embase, Cochrane CENTRAL, and Web of Science. Two reviewers will independently perform title/abstract selection and screening, and then full text retrieval and screening of articles that meet the inclusion criteria. The evaluation of methodological quality and data extraction will also be performed by two independent reviewers. Data will be synthesized in tables and then the compiled results will be meta-analyzed. In the presence of subgroup differences, meta-regression methods will be used to investigate the effects of categorical or continuous covariates. If statistical pooling is not possible, a narrative synthesis will be presented.

Systematic Review Registration Number: PROSPERO (CRD42019128329).
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http://dx.doi.org/10.11124/JBIES-20-00168DOI Listing
February 2021

Instruments for the assessment of patient adherence to oral anticoagulation with warfarin protocol for a systematic review.

Medicine (Baltimore) 2019 Oct;98(42):e17323

Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte.

Background: Non-adherence can be highlighted as one of the main contributors to the occurrence of adverse events in patients treated with warfarin. The usefulness of self-reporting measures of drug adherence could be improved by following psychometric properties in the development of the measurement scales. Thus, we aimed to describe the protocol of a systematic literature review designed to investigate and describe validated instruments used to assess adherence to warfarin therapy.

Methods: We will perform a systematic review will include observational and experimental studies involving the use of validated instruments to assess adherence to warfarin therapy. Dimensions of adherence raised by the selected studies will be extracted to be compared. We will systematically search electronic databases including MEDLINE, LILACS, EMBASE, and Cochrane Library using a comprehensive strategy from inception to June 31, 2019. Two reviewers will revise the literature independently using a standardized form and assess the potential bias. After the comparison of results, discrepancies will be solved after the analysis of a third reviewer.

Result: The development of the present systematic will help to summarize and evaluate the validated instruments that have been previously published to assess adherence to warfarin therapy.

Conclusion: This review will substantiate the discussion of relevant topics that should be assessed while providing care to patients taking warfarin. This knowledge will enable a comprehensive approach for healthcare professionals to improve treatment outcomes and the design of future investigations.

Registration: The systematic review is registered in the PROSPERO international prospective register of systematic review (PROSPERO# CRD42019128324).
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http://dx.doi.org/10.1097/MD.0000000000017323DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6824815PMC
October 2019

Self-care competence in the administration of insulin in older people aged 70 or over1.

Rev Lat Am Enfermagem 2017 Oct 30;25:e2943. Epub 2017 Oct 30.

PhD, Associate Professor, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.

Objective: to analyze the self-care competence in the administration of insulin performed by older people aged 70 or over.

Method: cross-sectional study carried out with 148 older people aged 70 or over, who performed self-administration of insulin. Data collection was carried out using a structured questionnaire and an adapted guide for the application of the Scale to Identify Self-Care Competence of Patients with Diabetes, at the participants' home. Data analysis included descriptive and inferential statistical tests, with forward logistic regression.

Results: the prevalence of self-care competence in the administration of insulin was 35.1%. Handwashing error was the most frequent in self-administration of insulin. Self-care competence was negatively associated with retirees and positively associated with senior patients who performed capillary blood glucose monitoring and skin pinching during insulin application.

Conclusion: there was low self-care competence and it was associated with both the sociodemographic and the clinical characteristics with regard to self-application of insulin by the older people.
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http://dx.doi.org/10.1590/1518-8345.2080.2943DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5706607PMC
October 2017
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