Percorrer por autor "Pereira, C"
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- Análise económica do rituximab, em associação com ciclofosfamida, vincristina e prednisolona no tratamento de doentes com linfoma folicular avançado em PortugalPublication . Braga, P; Carvalho, S; Gomes, M; Guerra, L; Lúcio, P; Marques, H; Negreiro, F; Pereira, C; Silva, C; Teixeira, AOBJECTIVE: Evaluate costs and benefits of rituximab in combination with cyclophosphamide/vincristine/prednisolone chemotherapy regimen (R-CVP), in previously untreated patients with indolent non-Hodgkin lymphoma (NHL), compared to CVP alone from a Portuguese National Health System (NHS) perspective. METHODS: Cost-effectiveness (Life Years Gained--LYG) and cost-utility analysis (Quality Adjusted Life Years--QALYs) were performed for a time horizon of 10 years, according to a Markov economic model with three health states (progression free survival, progression and death) and monthly cycles for a population of previously untreated patients with indolent NHL. Data from a phase III clinical trial was used and expanded to include unpublished 53-month median follow-up data. Survival after first-line therapy was estimated from the Scotland and Newcastle Lymphoma Group registry data and utilities were derived from a study in the UK performed in patients with follicular lymphoma. Resource consumption was estimated by a Portuguese expert panel (Delbecq Panel). Costs were calculated from the Portuguese NHS perspective through official data with prices updated to 2008. Only direct medical costs were considered. Costs and clinical outcomes were discounted at 5% per annum. Deterministic and probabilistic sensitivity analysis were performed around assumptions on the time horizon, costs, utilities and excess mortality rate due to progression applied in the base-case analysis. RESULTS: The 10-year base-case analysis showed a lower total cost per patient with CVP alone (€ 85,838) in comparison with R-CVP (€ 87,774). Life expectancy and Quality adjusted life expectancy per patient were higher with R-CVP (6.361 and 4.166, respectively) than with CVP alone (5.557 and 3.438, respectively), representing increases of 0.804 in LYG and 0.728 (8.7 months) in QALYs gained. The incremental cost per LYG was € 2,407 and the incremental cost per QALY gained was € 2,661. The probabilistic sensitivity analysis confirmed the robustness of the base-case analysis results. CONCLUSIONS: This study demonstrates that the combination R-CVP in previously untreated indolent NHL patients improves life expectancy and is a cost-effective alternative to CVP in Portugal.
- Atividades funcionais limitadas pela disfunção respiratóriaPublication . Pereira, C; Alves Lopes, AntónioO índice de mortalidade e esperança média de vida é reconhecido como um indicador da saúde da população, mas com aumento da longevidade e das doenças crónicas da população mundial o índice de funcionalidade e consequentemente a qualidade de vida poderá tornar-se um indicador mais realista de saúde. Em muitos dos modelos de avaliação e intervenção do Fisioterapeuta, o utente é reconhecido como elemento activo de ambos, mas não como elemento dominante uma vez que os objectivos definidos pelo Fisioterapeuta nem sempre vão ao encontro dos objectivos do utente, talvez por não haver um levantamento prévio das necessidades sentidas e expressas, não valorizando a avaliação que o utente faz do seu estado funcional. Reconhecendo a dificuldade de avaliar a funcionalidade do indivíduo, quando este não está inserido no seu meio, físico, sócio, cultural, considera-se relevante que o Fisioterapeuta valorize o enquadramento sociocultural na avaliação da funcionalidade, para se estabelecer objectivos realistas para cada utente. A disfunção respiratória é uma das áreas de intervenção da Fisioterapia que por vezes não realça a avaliação das funcionalidade, não inserindo o utente no processo de avaliação, como elemento primordial para a definição de objectivos de tratamento. Para minorar esta realidade identificada na bibliografia, Este estudo teve por objectivo: identificar as actividades funcionais mais limitadas pela disfunção respiratória. O estudo realizou-se segundo os moldes de um estudo de opinião descritivo como uma técnica de consenso. A amostra foi composta por Fisioterapeutas, que tinham por actividade diária o tratamento de disfunções respiratórias à mais de 5 anos, e que estavam ligados á formação e educação, garantindo-lhe o titulo de experts, e utentes com disfunção respiratória que soubessem ler e escrever. Os resultados obtidos mostram uma listagem de 51 actividades funcionais limitadas pela disfunção respiratória da qual se apurou a lista de 11 actividades com representatividade superior a 40%, nas quais as actividades da vida diária e actividades instrumentais tiveram uma representação muito significativa. Pressupõem-se que qualquer avaliação de funcionalidade realizada em meio controlado será pouco representativa, porque não contempla a avaliação das limitações funcionais no seu meio sociocultural. De forma dar utilidade a lista de actividades funcionais limitadas pela disfunção respiratória sugere-se o cruzamento da lista com a escala de Borg na tentativa de quantificar a incapacidade de realizar as actividades funcionais mais limitadas pela disfunção respiratória.
- Contributions to the Portuguese National Plan for Patient Safety 2021–2026: A Robust Methodology Based on the Mixed-Method ApproachPublication . Sousa, P; Paiva, SG; Lobão, MJ; Van-Innis, AL; Pereira, C; Fonseca, VIntroduction: Several countries prioritize patient safety in their health policies. In Portugal, following the implementation of the National Plan for Patient Safety (NPPS) 2015– 2020, the research team of the National School of Public Health (NSPH) carried out extensive work to continue improving aspects of the previous Plan. This work was focused on identifying the strengths and weaknesses of NPPS 2015– 2020 and aspects related to its applicability and main challenges and opportunities for the implementation of the NPPS 2021–2026. Methods: Methodological dynamic process was based on the most relevant international and national guidelines and the feedback from key patient safety stakeholders. We developed a cross-sectional mixed-methods study from January to August 2021. We used documentation and periodical reports from National Health Service (NHS) healthcare institutions as secondary sources of information. For primary data collection, we used an online survey (applied to elements in the different quality and safety structures of hospitals and primary care units), interviews, and focus groups to collect information from patient safety experts. Results and Discussion: Strengthening safety culture, patient safety training, communication, leadership involvement, patient and family engagement, and monitorization process is considered essential. We also identified local limitations such as the lack of resources and protected time for the healthcare professionals and lack of leadership involvement on patient safety strategies for dedicating to patient safety actions. Most of the patient safety stakeholders agreed that the safety and health of clinical teams and new modalities of healthcare (such as telemedicine, home hospitalization, home care) should be a priority for patient safety strategies. Conclusions: In our study, we used a robust methodology with a participatory process involving different stakeholders. An alignment between local, regional, and national levels in terms of measuring indicators, the definition of priorities, and actions and activities to improve patient safety is recommended. Reinforced partnerships and alignment between the institution’s mission, and safety priorities will be crucial to enhance patient safety. Additionally, this work highlights the added value for health systems achieved through strong partnerships between public administration and academic institutions to improve healthcare quality and patient safety
- Contributions to the Portuguese National Plan for Patient Safety 2021–2026: A Robust Methodology Based on the Mixed-Method ApproachPublication . Sousa, P; Paiva, SG; Lobão, MJ; Van-Innis, AL; Pereira, C; Fonseca, VIntroduction: Several countries prioritize patient safety in their health policies. In Portugal, following the implementation of the National Plan for Patient Safety (NPPS) 2015– 2020, the research team of the National School of Public Health (NSPH) carried out extensive work to continue improving aspects of the previous Plan. This work was focused on identifying the strengths and weaknesses of NPPS 2015– 2020 and aspects related to its applicability and main challenges and opportunities for the implementation of the NPPS 2021–2026. Methods: Methodological dynamic process was based on the most relevant international and national guidelines and the feedback from key patient safety stakeholders. We developed a cross-sectional mixed-methods study from January to August 2021. We used documentation and periodical reports from National Health Service (NHS) healthcare institutions as secondary sources of information. For primary data collection, we used an online survey (applied to elements in the different quality and safety structures of hospitals and primary care units), interviews, and focus groups to collect information from patient safety experts. Results and Discussion: Strengthening safety culture, patient safety training, communication, leadership involvement, patient and family engagement, and monitorization process is considered essential. We also identified local limitations such as the lack of resources and protected time for the healthcare professionals and lack of leadership involvement on patient safety strategies for dedicating to patient safety actions. Most of the patient safety stakeholders agreed that the safety and health of clinical teams and new modalities of healthcare (such as telemedicine, home hospitalization, home care) should be a priority for patient safety strategies. Conclusions: In our study, we used a robust methodology with a participatory process involving different stakeholders. An alignment between local, regional, and national levels in terms of measuring indicators, the definition of priorities, and actions and activities to improve patient safety is recommended. Reinforced partnerships and alignment between the institution’s mission, and safety priorities will be crucial to enhance patient safety. Additionally, this work highlights the added value for health systems achieved through strong partnerships between public administration and academic institutions to improve healthcare quality and patient safety
- Serviço Social: Importância das visitas domiciliárias no Centro Multidisciplinar de Medicina de DorPublication . Roberts, Mónica; Pereira, C; França, C; Vieira, F; Brazão, I; Romeira, J; Vieira, M; Nascimento, M; Correia, R; Silva, S; Ferreira, T