Percorrer por autor "Fonseca, J"
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- [ARIA 2019: An Integrated Care Pathway for Allergic Rhinitis in Portugal]Publication . Fonseca, J; Taveira-Gomes, T; Pereira, AM; Branco-Ferreira, M; Carreiro-Martins, P; Alves-Correia, M; Correia de Sousa, J; Costa, E; Lourenço, O; Morais-Almeida, M; Morête, A; Regateiro, F; Todo Bom, A; Bachert, C; Pfaar, O; Wallace, D; Bedbrook, A; Czarlewski, W; Bousquet, JThe Allergic Rhinitis and Its Impact on Asthma (ARIA) initiative started more than 20 years ago and has developed and disseminated evidence-based guidelines and projects in the field of allergic rhinitis. This initiative is currently focused on providing patient-centred guidelines that contribute to an integrated care pathway between the various levels of care and take advantage of digital solutions, and the introduction of integrated care pathways in clinical practice has been recommended. In this article we describe the adaptation for Portugal of the ARIA Integrated Care Pathways document. After a brief review of the epidemiology and impact of allergic rhinitis in Portugal and the activities carried out in Portugal within the ARIA initiative, we describe the broad knowledge base used for the development of recommendations for the pharmacological treatment of allergic rhinitis, and these recommendations are based on the GRADE methodology, real world evidence acquired by mobile technology (mHealth) and resulting from allergenic exposure chamber studies. What follows is a summary of integrated care pathways for allergen immunotherapy produced in 2019. Allergen immunotherapy is considered an example of precision medicine where the use of mHealth technologies will improve stratification for patient selection and response monitoring. These recommendations were considered as best practices of integrated patient-centred care supported by digital systems from Directorate General for Health and Food Safety of the European Union (DG Santé) and represent the ARIA Phase 4 Change Management strategy.
- Chronic Intestinal Failure and Short Bowel Syndrome in Adults: The State of the ArtPublication . Vara-Luiz, F; Glória, L; Mendes, I; Carlos, S; Guerra, P; Nunes, G; Oliveira, CS; Ferreira, A; Santos, AP; Fonseca, JBackground: Short bowel syndrome (SBS) is a devastating malabsorptive condition and the most common cause of chronic intestinal failure (CIF). During the intestinal rehabilitation process, patients may need parenteral support for months or years, parenteral nutrition (PN), or hydration/electrolyte supplementation, as a bridge for the desired enteral autonomy. Summary: Several classification criteria have been highlighted to reflect different perspectives in CIF. The management of CIF-SBS in adults is a multidisciplinary process that aims to reduce gastrointestinal secretions, slow transit, correct/prevent malnutrition, dehydration, and specific nutrient deficiencies, and prevent refeeding syndrome. The nutritional support team should have the expertise to take care of these complex patients: fluid support; oral, enteral, and PN; disease/PN-related complications; pharmacologic treatment; and surgical prevention/treatment. Key messages: CIF-SBS is a complex disease with undesired consequences, if not adequately identified and managed. A comprehensive approach performed by a multidisciplinary team is essential to reduce PN dependence, promote enteral independence, and improve quality of life.
- Collecting system percutaneous access using real-time tracking sensors: first pig model in vivo experiencePublication . Rodrigues, PL; Vilaça, JL; Oliveira, C; Cicione, A; Rassweiler, J; Fonseca, J; Rodrigues, NF; Correia-Pinto, J; Lima, EPURPOSE: Precise needle puncture of the renal collecting system is a challenging and essential step for successful percutaneous nephrolithotomy (PCNL). This works aims to evaluate the efficiency of a new real-time electromagnetic tracking (EMT) system for in vivo kidney puncture. MATERIALS AND METHODS: Six anesthetized female pigs underwent ureterorenoscopies in order to place a catheter with an EMT sensor into the desired puncture site and to ascertain the success of puncture. Subsequently, a tracked needle with a similar EMT sensor was navigated into the sensor inside the catheter. Four punctures were performed by two surgeons in each pig: one in the kidney and one in the middle ureter, on both right and left pig sides. Number of attempts and time needed to evaluate the virtual trajectory and to perform the percutaneous puncture were outcomes measurements. RESULTS: Overall 24 punctures were easily performed without any complications. Surgeons required more time to evaluate the trajectory during ureteral puncture than kidney (median 15 versus 13 seconds, range 14 to 18 and 11 to 16 seconds, respectively; p= 0.1). The median renal and ureteral puncture time were 19 and 51 seconds respectively (range 14 to 45 and 45 to 67; p=0.003). Two attempts were needed to achieve a successful ureteral puncture. The presented technique demands presence of renal stone for testing. CONCLUSIONS: The proposed EMT solution for renal collecting system puncture proved to be highly accurate, simple and quicker. This method might represent a paradigm shift in percutaneous kidney access techniques.
- Effects of allergen immunotherapy in the MASK-air study: a proof-of-concept analysisPublication . Pfaar, O; Sousa-Pinto, B; Devillier, P; Canonica, GW; Klimek, L; Zuberbier, T; Fonseca, J; Bousquet, J
- Polidocanol Foam Injected at High Doses with Intravenous Needle: The (Almost) Perfect Treatment of Symptomatic Internal HemorrhoidsPublication . Fernandes, V; Fonseca, JBACKGROUND AND AIMS: Hemorrhoid disorders are common. This study aimed to assess the efficacy and safety of polidocanol foam injected at high doses with intravenous needle for the treatment of symptomatic internal hemorrhoids that prolapse or bleed. METHODS: We evaluated 2,000 consecutive patients with prolapsed hemorrhoids (grades II/III/IV) recruited over 6 years. Foam injection was performed in one to four sessions with polidocanol 2%: 10 mL of the mixture (2 mL liquid plus air) or 20 mL (4 mL liquid plus air). The number of sessions and amount of foam injected depended on initial hemorrhoid size, compliance to receive foam, and clinical response. The mixture, prepared using a three-way tap connected to two 10/20-mL syringes, was injected immediately after preparation using an intravenous needle. The primary endpoint was self-reported satisfaction without major complications at 4 weeks. RESULTS: Efficacy was very high, with 1,957 patients (98%) reporting satisfaction regarding blood loss control and prolapse reduction. The procedure was well tolerated: 1,838 patients (92%) presented mild/no pain. Objective reduction of prolapse volume was documented in 86% of reobserved cases. Complications were rare and usually minor: only 3 cases of clinically significant bleeding (0.15%), 2 of whom were on dual antiplatelet therapy plus oral anticoagulation, 2 cases of rectal abscess, 8 hemorrhoid thromboses, and 1 urinary retention requiring catheter (0.7% severe complications). CONCLUSIONS: Treatment of internal hemorrhoids with polidocanol foam injected in high doses is very effective and safe for the control of blood loss and prolapse, even for patients on anticoagulation/antiplatelet treatment.
- Portugal at the cross road of international chronic respiratory programmesPublication . Bousquet, J; Rosado Pinto, J; Barbara, Cristina; Sousa, J Correira da; Fonseca, J; Pereira Miguel, J; et alJuly 1-4, 2015 two meetings will be held with the Directorate General of Health in Lisbon, Portugal to discuss chronic respiratory programmes of the WHO Global Alliance against Chronic Respiratory Diseases (GARD)1,2 and European Innovation Partnership on Active and Healthy Ageing (EIP on AHA)3 (AIRWAYS ICPs: Integrated Care Pathways for airway diseases).4 The goals of these meetings will be to make an update of these two international actions and to strengthen the WHO noncommunicable disease (NCD) action plan (2013---2020).