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Browsing by Author "Sousa, Catarina"

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  • Diminuir devoluções de medicamentos: análise de métodos de distribuição em ambiente hospitalar
    Publication . Costa, Bárbara; Sousa, Catarina; Vintena, Diogo; Silva, Gonçalo; Cruz, José Pedro; Jesus, Ângelo
    Atualmente, existem vários sistemas de distribuição de medicamentos em contexto de Farmácia Hospitalar, tais como: Clássica/Tradicional, Individual Diária, Individual Diária em Dose Unitária (SDIDDU), Reposição de Stocks Nivelados e Circuitos Especiais, cujos objetivos são aumentar a segurança do doente, diminuir erros de distribuição e administração, envolver ativamente os profissionais de farmácia na prestação de cuidados, facilitar o processo de distribuição e uniformizar a carga de trabalho de todas as equipas associadas ao circuito do medicamento. Comparar a eficácia e segurança dos sistemas de distribuição e propor estratégias para diminuir a taxa de devolução de medicação, nos Serviços de Ortopedia e Cirurgia. Trata-se de um Estudo Descritivo Observacional, referente aos Serviços Farmacêuticos (SF) de um Hospital Distrital. Solicitaram-se os dados dos últimos 5 anos ao Conselho Administrativo do Hospital, que os forneceu em formato Excel, plataforma onde se procedeu ao tratamento dos dados. Estes dizem respeito aos stocks, número de camas e de técnicos em cada Serviço, taxas de consumo e devolução de medicação, horários de preparação e saída das malas e horários de admissões e altas. No Serviço de Cirurgia, as malas são preparadas às 14h e saem às 15h30 e as altas são feitas às 13h30. Observa-se que 4 dos 10 medicamentos mais consumidos são também os mais devolvidos. No Serviço de Ortopedia, as malas são preparadas às 13h30 e saem às 15h30 e as altas são feitas às 14h. Observa-se que 7 dos 10 medicamentos mais consumidos são também os mais devolvidos. Na Ortopedia, sugere-se adotar o Sistema de Distribuição de Reposição de Stocks por Dupla Caixa e alterar o horário de preparação para as 14h30 e saída das malaspara as 16h. Na Cirurgia, sugere-se adotar o Sistema de Distribuição por Reposição de Stocks Nivelados por Reposição Direta. Os internamentos mantêm o SDIDDU e a medicação em SOS é enviada nas 4 gavetas destinadas a esse fim. Sugere-se que a medicação menos consumida nos dois Serviços seja armazenada nos SF. Após comparação dos diferentes Sistemas, conclui-se que a sua adoção depende das particularidades, finalidade e objetivos que se pretendem alcançar em cada Serviço Hospitalar. Pensa-se que as sugestões apresentadas consigam diminuir a taxa de devolução, mas poderá ser realizado outro estudo observacional para avaliar a sua eficácia, caso o Hospital adote estas medidas.
    2023-09Conference object Open access Show more
  • Resistance profile of osimertinib in pre-treated patients with EGFR T790M-mutated non-small cell lung cancer
    Publication . Fernandes, Maria Gabriela O.; Sousa, Catarina; Jacob, Maria; Almeida, Leonor; Santos, Vanessa; Araújo, David; Bastos, Hélder Novais; Magalhães, Adriana; Cirnes, Luís; Moura, Conceição Souto; Queiroga, Henrique; Cruz-Martins, Natália; Hespanhol, Venceslau
     Osimertinib efficacy in pre-treated patients with epidermal growth factor receptor (EGFR) T790M-mutated non-small cell lung cancer (NSCLC) has been demonstrated in clinical trials, but real-world data, particularly regarding resistance profile, remains limited. This study aims to analyze the resistance mechanisms acquired after treatment with Osimertinib. Clinical outcomes and molecular results from re-biopsies at the time of osimertinib progression of EGFR T790M-mutated NSCLC patient were analyzed. Twenty-one patients with stage IV adenocarcinoma were included [median 69 years; 57.1% female; 85.7% never-smokers; 23.8% ECOG performance status (PS) ≥2]. Median PFS and OS were 13.4 (95% CI: 8.0–18.9) and 26.4 (95% IC: 8.9–43.8) months, respectively. At the time of analysis, 10 patients had tumor progression (47.6%). T790M loss occurred in 50%, being associated with earlier progression (median PFS 8.1 vs. 21.4 months, p = 0.011). Diverse molecular alterations were identified, including C797S mutation (n = 1), PIK3CA mutation (n = 2), MET amplification (n = 1), CTNNB1 mutation (n = 1), and DCTN1-ALK fusion (n = 1). Histological transformation into small cell carcinoma occurred in one patient. This real-world life study highlights the relevance of re-biopsy at the time of disease progression, contributing to understand resistance mechanisms and to guide treatment strategies.
    2021-05-06Journal article Open access Show more
  • Targeted Gene Next-Generation Sequencing Panel in Patients with Advanced Lung Adenocarcinoma: Paving the Way for Clinical Implementation
    Publication . Fernandes, Maria Gabriela O.; Jacob, Maria; Martins, Natália; Moura, Conceição Souto; Guimarães, Susana; Pereira Reis, Joana; Justino, Ana; Pina, Maria João; Cirnes, Luís; Sousa, Catarina; Pinto, Josué; Marques, José Agostinho; Machado, José Carlos; Hespanhol, Venceslau; Costa, José Luis
    Identification of targetable molecular changes is essential for selecting appropriate treatment in patients with advanced lung adenocarcinoma. Methods: In this study, a Sanger sequencing plus Fluorescence In Situ Hybridization (FISH) sequential approach was compared with a Next-Generation Sequencing (NGS)-based approach for the detection of actionable genomic mutations in an experimental cohort (EC) of 117 patients with advanced lung adenocarcinoma. Its applicability was assessed in small biopsies and cytology specimens previously tested for epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) mutational status, comparing the molecular changes identified and the impact on clinical outcomes. Subsequently, an NGS-based approach was applied and tested in an implementation cohort (IC) in clinical practice. Using Sanger and FISH, patients were classified as EGFR-mutated (n = 22, 18.8%), ALK-mutated (n = 9, 7.7%), and unclassifiable (UC) (n = 86, 73.5%). Retesting the EC with NGS led to the identification of at least one gene variant in 56 (47.9%) patients, totaling 68 variants among all samples. Still, in the EC, combining NGS plus FISH for ALK, patients were classified as 23 (19.7%) EGFR; 20 (17.1%) KRAS; five (4.3%) B-Raf proto-oncogene (BRAF); one (0.9%) Erb-B2 Receptor Tyrosine Kinase 2 (ERBB2); one (0.9%) STK11; one (0.9%) TP53, and nine (7.7%) ALK mutated. Only 57 (48.7%) remained genomically UC, reducing the UC rate by 24.8%. Fourteen (12.0%) patients presented synchronous alterations. Concordance between NGS and Sanger for EGFR status was very high (κ = 0.972; 99.1%). In the IC, a combined DNA and RNA NGS panel was used in 123 patients. Genomic variants were found in 79 (64.2%). In addition, eight (6.3%) EML4-ALK, four (3.1%), KIF5B-RET, four (3.1%) CD74-ROS1, one (0.8%) TPM3-NTRK translocations and three (2.4%) exon 14 skipping MET Proto-Oncogene (MET) mutations were detected, and 36% were treatable alterations. Conclusions: This study supports the use of NGS as the first-line test for genomic profiling of patients with advanced lung adenocarcinoma.
    2019Journal article Open access Show more