Browsing by Author "Azevedo, Ana"
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- COVID-19 em doentes hemodialisados – qual o impacto do status vacinal?Publication . Ferreira da Silva, Bárbara; Oliveira, Ana Isabel; Stock da Cunha, Teresa; Ferreira, Joel; Azevedo, Ana
- Emergency surgeons’ perceptions and attitudes towards antibiotic prescribing and resistance: a worldwide cross-sectional surveyPublication . M. Labricciosa, Francesco; Sartelli, Massimo; Correia, Sofia; M. Abbo, Lilian; Severo, Milton; Ansaloni, Luca; Coccolini, Federico; Alves, Carlos; Bessa Melo, Renato; Baiocchi, Gian Luca; Paiva, José-Artur; Catena, Fausto; Azevedo, AnaBackground: Antibiotic resistance (AMR) is a growing public health problem worldwide, in part related to inadequate antibiotic use. A better knowledge of physicians' motivations, attitudes and practice about AMR and prescribing should enable the design and implementation of effective antibiotic stewardship programs (ASPs). The objective of the study was to assess attitudes and perceptions concerning AMR and use of antibiotics among surgeons who regularly perform emergency or trauma surgery. Methods: A cross-sectional web-based survey was conducted contacting 4904 individuals belonging to a mailing list provided by the World Society of Emergency Surgery. Participation was voluntary and anonymous. The survey was open for 5 weeks (from May 3, 2017, to June 6, 2017), within which two reminders were sent. The self-administered questionnaire was developed by a multidisciplinary team; reliability and validity were assessed. Results: The overall response rate was 12.5%. Almost all participants considered AMR an important worldwide problem, but 45.6% of them underrated the problem in their own hospitals. Surgeons provided with periodic reports on local AMR demonstrated a lower underrating in their hospital. Only 66.3% of the surgeons stated to receive periodic reports on local AMR data, and among them, 56.2% had consulted them to select an antibiotic in the previous month. Availability of systematic reports about AMR, availability of guidelines for therapy of infections, and advice from an infectious diseases specialist were considered very helpful measures to improve antibiotic prescribing by 68.0, 65.7, and 64.9%, respectively. Persuasive and restrictive ASPs were both considered helpful measures by 64.5%. Moreover, 86.3% considered locally developed guidelines more useful than national ones. Only 21.9% received formal training in antibiotic prescribing in the previous year; among them, 86.6% declared to be interested in receiving more training. Conclusions: Availability of periodic reports on local AMR data was considered an important tool to guide surgeons in choosing the correct antibioticand to increase awareness of the problem of AMR. Local guidelines for therapy of infections should be implemented in every emergency surgery setting, and developed by a multidisciplinary team directly involving surgeons, infectious diseases specialists, and microbiologists, and formally established in an ASP
- Inequalities in access to cardiac rehabilitation after an acute coronary syndrome: the EPiHeart cohortPublication . Viana, Marta; Borges, Andreia; Araújo, Carla; Rocha, Afonso; Ribeiro, Ana; Laszcznska, Olga; Dias, Paula; Maciel, Maria J.; Moreira, Ilidio; Lunet, Nuno; Azevedo, AnaOBJECTIVES: To estimate cardiac rehabilitation (CR) referral and participation rates among patients with acute coronary syndrome (ACS) and to identify their determinants, in two Portuguese regions. DESIGN: Prospective cohort study. SETTING: Patients consecutively admitted to the cardiology department of two hospitals, one in the district of Porto and one in the north-east region (NER) of Portugal, were enrolled in the EPIHeart cohort and then followed up for 6 months. PARTICIPANTS: Between August 2013 and December 2014, 939 patients were included in the cohort, and 853 were re-evaluated at 6-month follow-up. OUTCOME MEASURES: Referral rate was defined as the proportion of eligible patients who were referred to a CR programme, whereas participation rate was defined as the proportion of eligible patients who completed a CR programme, as was recommended by their physicians. RESULTS: Patients referred were 32.3% and 10.7% of those eligible in Porto and NER, respectively. In both regions, referral to CR decreased with age and with longer travel times to CR centres and increased with education or social class. At follow-up, 128 patients from Porto (26.2% of those eligible and 81.0% of those referred) and 26 from NER (7.1% of those eligible and 66.7% of those referred) reported actually participating in a CR programme. In Porto, the main barriers to participation were the long time until a programme was available and lack of perceived benefit. Patients in NER identified distance to CR and costs as the main barriers. CONCLUSIONS: CR remains clearly underused in Portugal, with major inequalities in access between regions. Achieving equitable and greater use of CR requires a multilevel approach addressing barriers related to healthcare system, providers and patients in order to improve provision, referral and participation.
- Nefropatia membranosa como manifestação de doença IgG4Publication . Stock da Cunha, Teresa; Ferreira, Joel; Macau, Ricardo; Góis, Mário; Azevedo, Ana
- Prevalence and Determinants of Bullying Among Health Care Workers in PortugalPublication . Norton, Pedro; Costa, Viviana; Teixeira, Joel; Azevedo, Ana; Roma-Torres, António; Amaro, Joana; Cunha, LilianaBullying is defined as systematic exposure to humiliation as well as hostile and violent behaviors against one or more individuals. These behaviors are a serious, growing problem, which affects a significant proportion of health care professionals. To support the hospital's risk management policy, a cross-sectional study was undertaken to determine the prevalence of bullying in this institution and identify the determinants of bullying. Bullying was measured using the Negative Acts Questionnaire-Revised, Portuguese version (NAQ-R), a self-administered tool. The questionnaire was made available in digital format on the hospital's internal network (Intranet) and in hard copy; questionnaires were returned via nonidentified internal mail addressed to the occupational health unit or deposited in suggestion boxes located throughout the hospital. Multiple questionnaire delivery methods guaranteed data anonymity and confidentiality. The prevalence of bullying in this hospital was 8% (95% confidence interval [CI] = [6.2, 10.2]). Reported bullying was predominantly vertical and more frequently occurring among nurses, clerical staff, and health care assistants (12.5%, 7.6%, 6.4%, respectively; p = .005). After adjusting for gender, age, occupation, type of contract, and work schedule, only type of contract was significantly associated with bullying in the workplace; the risk of bullying was twice as high among government employees compared to workers with indefinite duration employment contracts ( p = .038). This study identified a high prevalence of bullying among health professionals; hence a program to prevent and control this phenomenon was implemented in this institution.
- A projeção/retração de uma Força Nacional Destacada – Estudo de caso da República Centro- Africana e KosovoPublication . Sousa, Nelson; Azevedo, Ana; Carqueijo, Aires; Dias, OrlandoEste trabalho de investigação pretende apresentar contributos para um modelo de projeção e retração de Forças Nacionais Destacadas, com possível utilização pelo Exército Português, que permita agilizar o processo respeitante ao transporte estratégico. O ponto de partida consubstanciou-se em estudos prévios sobre a temática, complementado com a leitura de documentos doutrinários, legislação e bibliografia diversa, utilizando-se a pesquisa qualitativa e o modelo dedutivo, através da análise de dois estudos de caso (projeção para a República Centro-Africana e retração do Kosovo) e de entrevistas semiestruturadas, efetuadas a militares diretamente envolvidos nestes mesmo casos ou, com experiência/responsabilidades na área. Determinou-se a importância de pré-definir, para as diversas tipologias de forças, as estruturas de pessoal e de material, tal-qualmente as dotações de munições inerentes aos Teatros de Operações, de modo a efetuar uma mais apurada estimativa da real necessidade da capacidade de transporte estratégico, e facilitar a elaboração da documentação intrínseca. Identicamente relevante, é adotar a consulta às iniciativas multinacionais de transporte estratégico, de modo a rentabilizar as suas possibilidades/potencialidades, permitindo a sua utilização quando tal for vantajoso. A continuação/incrementação do processo de lições aprendidas, também se configura uma mais-valia, de modo a retirar ensinamentos para futuras projeções/retrações. Abstract: This research work intends to present contributions to a model of deployment and redeployment of National Detached Forces, with possible use by the Portuguese Army, which allows to streamline the process regarding strategic movement. The point of departure consisted in previous studies on the subject, complemented by the reading of doctrinal documents, legislation and diverse bibliography, using qualitative research and the deductive model, through the analysis of two case studies (deployment for the Central African Republic and redeployment from Kosovo) and semi-structured interviews with military personnel directly involved in these cases or with experience/responsibilities in the area. It was determined the importance of pre-defining, for the various typologies of forces, the personnel and material structures, as well as the ammunition requirements inherent to the Theatres of Operations, in order to make a more accurate estimate of the real need of the strategic movement capacity, and facilitate the preparation of the intrinsic documentation. Equally relevant is the consultation of multinational strategic movement initiatives, in order to exploit their possibilities / potentialities, allowing their use when advantageous. The continuity/enhancement of the lessons learned process also creates an added value in order to acquire lessons for future deployments/redeployments.
- Saúde materna: Intervenção do enfermeiro especialista nas alterações psicológicas manifestadas por casais com problemas de fertilidadePublication . Gomes, Dorita; Azevedo, Ana; Mar, Maria; Bastos, Vera; Torres, AnaA infertilidade é considerada um problema de saúde pública, estimando-se que em Portugal existam cerca de 500.000 casais inférteis. Neste contexto, o envolvimento dos enfermeiros de saúde materna é de extrema importância, porque além de contribuírem para diminuir os efeitos negativos da infertilidade, ajudam o casal a ultrapassar as dificuldades que possam estar a sentir. Este artigo foi elaborado com o objetivo de identificar as principais alterações psicológicas associadas aos casais com problemas de fertilidade, bem como abordar a intervenção do enfermeiro especialista em saúde materna neste contexto. Usando a pesquisa bibliográfica de artigos publicados entre 2010 e 2015 e disponíveis em texto integral, as autoras recorreram às bases de dados: Scielo, PsycArticles, B-on, Lilacs e Google Académico e foram utilizados os descritores: Saúde materna, Enfermagem, Infertilidade e Alterações psicológicas, em português e inglês. Os resultados obtidos parecem indicar que apesar das adversidades inerentes à sua patologia, os casais inférteis conseguem lidar melhor com a situação quando acompanhados por profissionais especializados. A infertilidade é um tema complexo que afeta toda as áreas da vida do casal, pelo que merece uma atenção cuidada por parte dos técnicos que trabalham com estes casos, no sentido de minimizar/ultrapassar a sintomatologia patológica associada às suas vivências.
- The postoperative venous thromboembolism (TREVO) study - risk and case mortality by surgical specialtyPublication . Amaral, Cristina; Pereira, Luís Guimarães; Moreto, Ana; Sa, Ana Carolina; Azevedo, AnaINTRODUCTION AND OBJECTIVES: Venous thromboembolism, risk of which is increased in surgical patients, is a preventable cause of morbidity and death. The primary objective of this study was to estimate the incidence of symptomatic postoperative venous thromboembolism in adults at a tertiary university hospital, overall and by surgical specialty. The secondary objective was to analyze severity of and mortality from thromboembolic events. METHODS: We performed a retrospective study to identify cases of in-hospital postoperative venous thromboembolism, encoded by the International Classification of Diseases, Ninth Revision, according to the Joint Commission International criteria. Adult patients admitted for surgery in 2008-2012 were included. RESULTS: Among 67 635 hospitalizations, 90 cases of postoperative symptomatic venous thromboembolism were identified, corresponding to an incidence of 1.33/1000 admissions (95% confidence interval [CI] 1.1-1.6/1000). Neurosurgery had the highest risk (4.07/1000), followed by urological surgery and general surgery (p<0.001). There were 50 cases of pulmonary embolism, 11 of which were fatal. Of the 90 cases, 12.2% occurred under neuraxial anesthesia and 55.1% in patients with American Society of Anesthesiology III physical status. At least 37.7% of patients with events received a prophylactic dose of injectable anticoagulant postoperatively. The overall risk decreased from 2008 to 2012. Venous thromboembolism-associated mortality during hospitalization was 21.1% (95% CI 13.6-30.4). CONCLUSIONS: The incidence of postoperative symptomatic venous thromboembolism was 1.33/1000. Neurosurgery showed the greatest risk. Mortality was 21.1%.
- Von Willebrand Disease: be or not to be, that is the questionPublication . Azevedo, Ana; Freire, Isabel; Fidalgo, Teresa; Gago, Teresa