Browsing by Author "Almeida, A"
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- O efeito de um programa de exercício físico na qualidade de vida em doentes cardíacosPublication . Tavares, N; Madeira, R; Henriques, A; Almeida, A; Nuno, LAs políticas públicas de saúde e os programas de reabilitac¸ão cardíaca, com exercício físico, são reconhecidos como uma componente essencial nos cuidados fornecidos aos cidadãos, permitindo preservar ou readquirir o seu lugar na comunidade, bem como aumentar a sua qualidade de vida. Objetivo: Aplicar o exercício físico supervisionado (grupo ES), em fase de ambulatório precoce, realizado na comunidade, com vista a analisar e comparar os resultados desta aplicac¸ão com os dados obtidos pelos doentes sujeitos apenas ao tratamento convencional (grupo TC). Método: O estudo teve uma durac¸ão superior a 3 meses, dividindo os doentes cardíacos em 2 grupos (grupo ES vs. grupo TC), tendo sido esclarecidos, através de consentimento informado, do propósito e procedimentos do estudo. Após a divisão, os doentes sujeitos ao exercício físico supervisionado (grupo ES) foram submetidos a um plano de intervenc¸ão estruturado em 3 fases, segundo a frequência, intensidade, tempo e tipo de exercício físico, conforme a devida estratificac¸ão do risco e recomendac¸ões da American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR). Os doentes realizaram 2 avaliac¸ões no Hospital de Vila Franca de Xira, recorrendo ao questionário MacNew para avaliar a qualidade de vida relacionada com a saúde na doenc¸a cardíaca. Avaliou-se a média e o desvio padrão para todas as variáveis em estudo, recorrendo-se aos testes não paramétricos e paramétricos para um nível de significância de alfa = 0,05. Resultados: Foram observadas diferenc¸as estatisticamente significativas ao nível da qualidade de vida geral (p < 0,01), bem como uma variac¸ão percentual crescente (+ 53,86%) no grupo ES. Conclusão: O exercício físico supervisionado, realizado na comunidade logo após alta hospitalar, com uma intensidade pelo menos moderada, potencia a qualidade de vida em doentes cardíacos.
- Effectiveness of the association between carbamazepine and peripheral analgesic block with ropivacaine for the treatment of trigeminal neuralgiaPublication . Lemos, L; Fontes, R; Flores, S; Oliveira, P; Almeida, ATreatment of trigeminal neuralgia (TN) is achieved by using adjuvant analgesics like antiepileptics, with carbamazepine (CBZ) being the first-line approach for TN patients, although side effects may be present. Other approaches using gabapentin, namely when associated with peripheral analgesic block of TN trigger points with the local anesthetic ropivacaine (ROP), resulted in decreased pain and daily drug intake (reduced side effects). This study evaluates if the association between CBZ and the peripheral block with ROP reinforces the clinical value of CBZ. In this parallel, double-blinded study, idiopathic TN patients were randomized to receive during 4 weeks either CBZ (CBZ; n = 21) or CBZ associated with the peripheral analgesic block using ROP (CBZ + ROP; n = 24). The primary outcome measures were the following: i) pain intensity, evaluated by the numerical rating scale; ii) number of pain crises; and iii) number needed to treat. Evaluation points were at the beginning (day 1) and end (day 29) of treatment and after a follow-up of 5 months (month 6). Both protocols resulted in a decrease of pain intensity and number of pain crises, but only the association CBZ + ROP showed i) a significant stronger reduction in pain intensity at month 6 and ii) a significant decrease in the daily dose of CBZ given to patients (both at day 29 and month 6). In contrast, the daily dose in CBZ-only patients remained constant or even increased. The number needed to treat for the association CBZ + ROP over the CBZ protocol reduced from 5 at the end of the 4-week treatment to 3 after the 5-month follow-up. Data reinforce the use of CBZ as a primary tool to control pain in TN patients, as the association CBZ + ROP i) improves the clinical qualities of CBZ, ii) strongly reduces the daily dose of CBZ, and iii) reduces the potential side effects attributed to high doses of CBZ.
- Multidisciplinary Development and Initial Validation of a Clinical Knowledge Base on Chronic Respiratory Diseases for mHealth Decision Support SystemsPublication . Pereira, AM; Jácome, C; Jacinto, T; Amaral, R; Pereira, M; Sá-Sousa, A; Couto, M; Vieira-Marques, P; Martinho, D; Vieira, A; Almeida, A; Martins, C; Marreiros, G; Freitas, A; Almeida, R; Fonseca, JAMost mobile health (mHealth) decision support systems currently available for chronic obstructive respiratory diseases (CORDs) are not supported by clinical evidence or lack clinical validation. The development of the knowledge base that will feed the clinical decision support system is a crucial step that involves the collection and systematization of clinical knowledge from relevant scientific sources and its representation in a human-understandable and computer-interpretable way. This work describes the development and initial validation of a clinical knowledge base that can be integrated into mHealth decision support systems developed for patients with CORDs. A multidisciplinary team of health care professionals with clinical experience in respiratory diseases, together with data science and IT professionals, defined a new framework that can be used in other evidence-based systems. The knowledge base development began with a thorough review of the relevant scientific sources (eg, disease guidelines) to identify the recommendations to be implemented in the decision support system based on a consensus process. Recommendations were selected according to predefined inclusion criteria: (1) applicable to individuals with CORDs or to prevent CORDs, (2) directed toward patient self-management, (3) targeting adults, and (4) within the scope of the knowledge domains and subdomains defined. Then, the selected recommendations were prioritized according to (1) a harmonized level of evidence (reconciled from different sources); (2) the scope of the source document (international was preferred); (3) the entity that issued the source document; (4) the operability of the recommendation; and (5) health care professionals' perceptions of the relevance, potential impact, and reach of the recommendation. A total of 358 recommendations were selected. Next, the variables required to trigger those recommendations were defined (n=116) and operationalized into logical rules using Boolean logical operators (n=405). Finally, the knowledge base was implemented in an intelligent individualized coaching component and pretested with an asthma use case. Initial validation of the knowledge base was conducted internally using data from a population-based observational study of individuals with or without asthma or rhinitis. External validation of the appropriateness of the recommendations with the highest priority level was conducted independently by 4 physicians. In addition, a strategy for knowledge base updates, including an easy-to-use rules editor, was defined. Using this process, based on consensus and iterative improvement, we developed and conducted preliminary validation of a clinical knowledge base for CORDs that translates disease guidelines into personalized patient recommendations. The knowledge base can be used as part of mHealth decision support systems. This process could be replicated in other clinical areas.
- Pharmacological versus microvascular decompression approaches for the treatment of trigeminal neuralgia: clinical outcomes and direct costsPublication . Lemos, L; Alegria, C; Oliveira, J; Machado, A; Oliveira, P; Almeida, AIn idiopathic trigeminal neuralgia (TN) the neuroimaging evaluation is usually normal, but in some cases a vascular compression of trigeminal nerve root is present. Although the latter condition may be referred to surgery, drug therapy is usually the first approach to control pain. This study compared the clinical outcome and direct costs of (1) a traditional treatment (carbamazepine [CBZ] in monotherapy [CBZ protocol]), (2) the association of gabapentin (GBP) and analgesic block of trigger-points with ropivacaine (ROP) (GBP+ROP protocol), and (3) a common TN surgery, microvascular decompression of the trigeminal nerve (MVD protocol). Sixty-two TN patients were randomly treated during 4 weeks (CBZ [n = 23] and GBP+ROP [n = 17] protocols) from cases of idiopathic TN, or selected for MVD surgery (n = 22) due to intractable pain. Direct medical cost estimates were determined by the price of drugs in 2008 and the hospital costs. Pain was evaluated using the Numerical Rating Scale (NRS) and number of pain crises; the Hospital Anxiety and Depression Scale, Sickness Impact Profile, and satisfaction with treatment and hospital team were evaluated. Assessments were performed at day 0 and 6 months after the beginning of treatment. All protocols showed a clinical improvement of pain control at month 6. The GBP+ROP protocol was the least expensive treatment, whereas surgery was the most expensive. With time, however, GBP+ROP tended to be the most and MVD the least expensive. No sequelae resulted in any patient after drug therapies, while after MDV surgery several patients showed important side effects. Data reinforce that, (1) TN patients should be carefully evaluated before choosing therapy for pain control, (2) different pharmacological approaches are available to initiate pain control at low costs, and (3) criteria for surgical interventions should be clearly defined due to important side effects, with the initial higher costs being strongly reduced with time.
- Qualitative serology in patients recovered from SARS CoV 2 infectionPublication . Bettencourt, P; Fernandes, C; Gil, A; Almeida, A; Alveolos, M
- Recomendações para o diagnóstico, tratamento e monitorização da leucemia mielóide crónicaPublication . Almeida, A; Castro, I; Coutinho, J; Guerra, L; Marques, H; Pereira, AMChronic Myeloid Leukemia (CML) is a clonal stem cell disease characterized by the expression of the fusion protein bcr-abl1, which has deregulated tirosine-kinase activity. Tyrosine kinase inhibitors (TKIs), and in particular imatinib, introduced fundamental changes in the treatment of CML, becoming, in most cases, the first-line treatment of choice in the chronic phase of this disease. Compared to other available therapies imatinib results in a marked increase in overall survival, tolerability and quality of life. The introduction of second generation TKI, with increased potency against bcr-abl1, expanded the number of therapeutic options for this disease and offers an alternative for patients resistant or intolerant to imatinib or who have progressed to the accelerated phase under this therapy. In order to achieve optimal outcomes, TKI therapy must be managed rigorously, requiring a careful monitoring of treatment response in pre-established time periods, thus permitting disease evaluation and safe decision of the most adequate option. Despite the definition of the criteria for imatinib treatment response, the therapeutic strategies to adopt according to the responses obtained are less clear. The objective of this paper is to review the criteria for CML diagnosis, treatment and monitoring, with recommendations as to the most adequate therapeutic choice according to the response to TKI therapy. The paper also focuses the current lines of investigation and debate areas that in the short term can significantly change the therapeutic scenario in this disease. These recommendations, supported by published scientific evidence and by the clinical practice of the expert panel involved in their elaboration, may constitute an important instrument for a better understanding and standardisation of the treatment and monitoring of CML in Portugal.
- Risk Factors for Persistent Postsurgical Pain in Women Undergoing Hysterectomy Due to Benign Causes: A Prospective Predictive StudyPublication . Pinto, PR; McIntyre, T; Nogueira-Silva, C; Almeida, A; Araújo-Soares, VPersistent postsurgical pain (PPSP) is a major clinical problem with significant individual, social, and healthcare costs. The aim of this study was to examine the role of demographic, clinical, and psychological risk factors in the development of PPSP after hysterectomy due to benign disorders. In a prospective study, a consecutive sample of 186 women was assessed 24 hours before surgery (T1), 48 hours after surgery (T2), and 4 months after surgery (T3). Regression analyses were performed to identify predictors of PPSP. Four months after hysterectomy, 93 (50%) participants reported experiencing pain (numerical rating scale >0). Age, pain due to other causes, and type of hysterectomy emerged as significant predictive factors. Baseline presurgical psychological predictors identified were anxiety, emotional illness representation of the condition leading to surgery, and pain catastrophizing. Among the identified psychological predictors, emotional illness representation emerged as the strongest. Acute postsurgical pain frequency and postsurgical anxiety also revealed a predictive role in PPSP development. These results increase the knowledge on PPSP predictors and point healthcare professionals toward specific intervention targets such as anxiety (presurgical and postsurgical), pain catastrophizing, emotional illness representations, and acute pain control after surgery. PERSPECTIVE: This study found that presurgical anxiety, emotional illness representations, and pain catastrophizing are risk factors for PPSP 4 months after hysterectomy, over and above age and clinical variables. These findings improve knowledge on PPSP and highlight potential intervention targets for healthcare professionals.
- Síndrome de Brugada Complicado de Morte SúbitaPublication . Rabaçal, C; Mendonça, C; Nuno, L; Almeida, A; Afonso, SBrugada syndrome is an electrocardiographic diagnosis that is increasingly recognized as a cause of sudden cardiac death. The authors present a clinical case of a patient with a family history of sudden death, in whom a diagnosis of Brugada syndrome had been established, and who died suddenly. They also present a brief review of the main findings of this entity, particularly the diagnostic criteria and treatment of choice, since it is recognized that its prevalence will rise in the coming years.
- The Manchester Triage System in acute coronary syndromesPublication . Matias, C; Oliveira, R; Duarte, R; Bico, P; Mendonça, C; Nuno, L; Almeida, A; Rabaçal, C; Afonso, SINTRODUCTION: A growing number of hospitals have implemented the Manchester Triage System (MTS) in their Emergency Department (ED), so as to better prioritize the evaluation of those attending these departments. OBJECTIVES: To assess whether the MTS was used effectively in patients admitted to the hospital with a diagnosis of acute coronary syndrome (ACS). METHODS: We evaluated 114 consecutive patients admitted to the Cardiology Department with a diagnosis of ACS. We recorded the color assigned in the MTS, mean time from arrival in the ED to MTS, mean time from MTS to first medical assessment (1-MA) and mean time from 1-MA to admission. We also analyzed the correlation between the type of ACS and clinical presentation and its relation with MTS. RESULTS: Of the 114 patients, one was coded red (0.9%), 71 orange (62.3%), 12 green (11%), and two were not assigned a color code according to MTS because they were admitted via a Medical Emergency and Resuscitation Vehicle. Mean time from arrival in the ED to MTS was 5.2 +/- 0.6 min and from MTS to MA was 20 +/- 2.5 min. In patients triaged as orange the time from MTS to MA was 15.1 +/- 1.5 min, as yellow 36.2 +/- 7 min, and as green 35.2 +/- 20.6 min (p = 0.003). Mean time from 1-MA to admission was 144.4 +/- 17 min, with no differences according to triage code or ACS type. Clinical presentation influenced triage and the speed of 1-MA and admission, patients with typical presentation being evaluated and admitted more quickly. CONCLUSIONS: Most patients admitted for ACS are initially triaged as orange or yellow, an indication for prompt assessment in the ED; this has a positive effect on time to first medical assessment, but has no effect on time to hospital admission.