Browsing by Author "Teles, Paulo"
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- Arteriovenous access banding revisitedPublication . Teixeira, Gabriela; Almeida, Paulo; Sousa, Clemente Neves; Teles, Paulo; De Sousa, Paulo; Loureiro, Luís; Teixeira, Sérgio; Rego, Duarte; Almeida, Rui; Norton de Matos, AntónioThe aim of this study is to validate the current applicability of arteriovenous access banding in high flow access (HFA) and/or haemodialysis access-induced distal ischaemia (HAIDI). This retrospective study was conducted at the GEV (Grupo de Estudos Vasculares) vascular access centre. The clinical records of consecutive patients undergoing banding for HAIDI and HFA symptoms, between June 2011 and January 2015, were reviewed until April 2015. All vascular access patients’ consultation records and surgical notes were reviewed. We analysed and compared patients’ age, gender, comorbidities, symptoms and intraoperative ultrasound control. We defined technical failure as recurrence of symptoms, requiring new banding. Excessive banding, access thrombosis, rupture and false aneurysm development were registered as complications. Primary clinical success was defined as improvement of symptoms or effective flow reduction after banding, with no need for reintervention. If one reintervention was necessary, we have defined it as secondary clinical success. Overall, 119 patients underwent banding: 64 (54%) with HAIDI and 55 (46%) with HFA. The HAIDI group was significantly older (65 ± 13 years compared with 56 ± 22 years, p = 0.001) and had significantly greater number of patients with diabetes (56% vs 24%, p = 0.004). Primary success was achieved in 85 patients (71.4%) and the secondary success rate was 84.9%. Older age (p = 0.016) and intraoperative ultrasound control (p = 0.012) were significantly associated with primary success. Our results do not corroborate the high incidence of thrombosis previously reported as associated with AV access banding and suggest that ultrasound control is crucial for preventing technical failure. The procedure was effective on both compared groups.
- Construção e validação de instrumento de percepção do trabalho do gestorPublication . Martins, MM; Gonçalves, Maria Narcisa; Teles, Paulo; Bernardino, Elizabeth; Guerra, Nelson; Ribeiro, OlgaObjective: to describe the process of building and validating a scale for measuring the perception of the work done by nurse managers. Method: it is a quantitative, descriptive, methodological study, with literature review and manager’s experience expressed in a previous study, developed through an instrument containing eight dimensions and 42 items, applied to 372 nurses who develop their activity in the area of management in public and private hospitals, with non-probabilistic sampling. For the instrument validation, exploratory factor analysis and internal consistency assessment of each factor/dimension were employed. Results: it is noted that the factorial analysis indicated readjustments in the original composition of the scale from five to eight dimensions, maintaining the 42 items and presenting a high global internal consistency (Cronbach alpha of Conclusion: it is evaluated that the scale has adequate psychometric properties, revealing the potential for use in future studies in the area of management in Nursing.
- Construction and validation of a scale of assessment of self-care behaviors with arteriovenous fistula in hemodialysisPublication . Sousa, Clemente Neves; Apóstolo, João Luís Alves; Figueiredo, Maria; Dias, Vanessa Filipa Ferreira; Teles, Paulo; Martins, MMSeveral guidelines recommend the importance of educating the patient about the care of vascular access. Nurses have a key role in promoting the development of self-care behaviors by providing the necessary knowledge to patients, so that they develop the necessary skills to take care of the arteriovenous fistula (AVF). This article describes the process of building a scale of assessment of self-care behaviors with arteriovenous fistula in hemodialysis (ASBHD-AVF). This is a cross-sectional study in which the development, construction, and validation process followed the directions of the authors Streiner and Norman. This is a convenience sample, sequential, and nonprobabilistic constituted by 218 patients. The study was conducted in two stages during 2012-2014. The first phase corresponds to the scale construction process, 64 patients participated, while the second corresponds to the evaluation of metric properties and 154 patients participated. The principal component analysis revealed a two-factor structure, with factorial weights between 0.805 and 0.511 and between 0.700 and 0.369, respectively, explaining 39.12% of the total variance of the responses. The Cronbach's alpha of the subscale management of signs and symptoms is 0.797 and from the subscale prevention of complications is 0.722. The ASBHD-AVF revealed properties that allow its use to assess the self-care behaviors in the maintenance and conservation of the AVF.
- Construction and validation of a scale of assessment of self-care behaviours anticipatory to creation of arteriovenous fistulaPublication . Sousa, Clemente Neves; Figueiredo, Maria; Dias, Vanessa Filipa; Teles, Paulo; Apóstolo, João LuísAims and objectives. We developed a scale to assess the self-care behaviours developed by patients with end-stage renal disease to preserve the vascular network prior to construction of arteriovenous fistula. Background. The possibility of creation of an arteriovenous fistula depends on the existence of an arterial and venous network in good condition, namely the size and elasticity of the vessels. It is essential to teach the person to develop self-care behaviours for the preservation of the vascular network, regardless of the modality of dialysis selected.Design. Methodological study. Methods. The scale was developed based on clinical experience and research conducted by the researcher in the area of the vascular access for haemodialysis. The content of the scale was judged by two panels of experts for content validity. The revised version of the scale was administered to a convenience sample of 90 patients with end-stage renal disease. In the statistical analysis, we used the Cronbach’s alpha, the Kaiser–Meyer–Olkin and scree plot and the principal component analysis with varimax rotation. Results. A principal component analysis confirmed the univariate structure of the scale (KMO = 0 759, Bartlett’s sphericity test-approximate v2 142 201, p < 0 000). Cronbach’s a is 0 831, varying between 0 711–0 879. Conclusion. This scale revealed properties that allow its use to assess the patients self-care behaviours regarding the preservation of the vascular network. Relevance to clinical practice. This scale can be used to evaluate educational programmes for the development of self-care behaviours in the preservation of vascular network. This scale can identify not only the patients that are able to take care of their vascular network but also the proportion of patients who are not able to do it, that need to be educated.
- Effect of Dialysis Day on Intradialytic Hypotension RiskPublication . Rocha, Ana; Sousa, Clemente Neves; Teles, Paulo; Coelho, Augusto; Xavier, EvaBackground/Aims: Intradialytic hypotension (IDH) is a serious and frequent complication of hemodialysis (HD). Thus far, data are scarcely available to assess the impact of first versus subsequent HD sessions of the week in IDH. Therefore, the purpose of this work was to evaluate IDH risk in patients on thrice-weekly HD. Methods: We conducted an analysis of all blood pressure (BP) measurements obtained during 492 HD treatments given to 41 prevalent adult patients over a one month period. A logistic regression model for repeated binary observations was used to determine the association between hypotension and patient and dialysis factors. Results: The incidence of IDH was 32.5%. First dialysis session of the week was associated with a 9% higher risk of hypotension relatively to the second one. The risk was even higher from the first to the third session of the week (60%) and from the second to the third (50%). A higher hypotension odds ratio was also associated with age (1.03, 90%CI: 1.01-1.06), higher predialysis BP (1.04, 90%CI: 1.03-1.05) and higher phosphorus level (1.38, 90%CI: 1.07-1.76). The risk decreased 24.4% for each additional antihypertensive drug taken by the patient. Conclusions: The odds of hypotension occurrence decrease throughout dialysis sessions of the week. Minimizing modifiable risk factors may decrease IDH episodes.
- The effect of exergame rehabilitation on the quality of life of cancer patients undergoing abdominal surgery: a randomized controlled trialPublication . Alves, Isabel; Moreira, Ana Paula; Sousa, Teresa; Teles, Paulo; Magalhães, Bruno Miguel; Gonçalves, Filipe; Fernandes, Carla SílviaPurpose Exergames, which combine digital games and physical exercise, have become increasingly popular for rehabilitation in the health domain. This study aimed to assess the effectiveness of exergame rehabilitation on the quality of life of cancer patients undergoing abdominal surgery. Methods This randomized controlled trial evaluated the effectiveness of exergame rehabilitation on the quality of life of cancer patients who had undergone abdominal surgery. Seventy postoperative patients were included, and data collection took place between January 2023 and May 2023. The patients were randomly assigned to either an exergame rehabilitation program (n = 35) or a traditional rehabilitation program (n = 35). The assessed outcome was the quality of life, and data collection occurred at three different time points: upon admission, 48 h postoperatively, and on the 7th day after surgery. Results Quality of life was evaluated using the WHOQOL-BREF Scale. At the third assessment, a statistically significant difference was observed between the two groups (p = 0.016), indicating that the intervention group had a higher quality of life than the control group. Conclusions The study showed a positive effect of exergames on the population under investigation. By the 7th day after surgery, the intervention group demonstrated an improvement in their quality of life compared to the control group. Clinical trial registration Center of Open Science OSF https:// osf. io/ 286zb/, registered in July, 2023
- Effects of demographic and clinical character on differences in self‐care behavior levels with arteriovenous fistula by hemodialysis patients: An ordinal logistic regression approachPublication . Sousa, Clemente Neves; Teles, Paulo; Paquete, Ana Rita Cabral; Dias, Vanessa Filipa Ferreira; Manzini, Carlene Souza Silva; Nicole, Andressa Garcia; Sousa, Rui André Saldanha Santos; de Souza, Lara Helk; Ribeiro, Olga; Lira, Marta Nunes; de Queiroz Frazão, Cecília Maria Farias; Ramos, Vânia Pinheiro; Leal, Luciana; Ribeiro, Rita Cássia Helú Mendonça; Magalhães, Anna Luiza Pereira; de Sá Basílio Lins, Sílvia Maria; Mendonça, Ana Elza Oliveira; Delgado, Millena Freire; Pressi, Maira Maria Trevisan; Pressi, Nicole Trevisan; Campos, Luís; Campos, Tiago; Gonçalves, Diana; Ribeiro, Edgar; Ozen, NurtenIntroduction: Hemodialysis (HD) patients should be trained to develop selfcare behaviors in order to prevent and preserve their arteriovenous fistula (AVF). The aim of this study was identifying the factors that affect the levels of self-care behavior with AVF by HD patients. Methods: A cross-sectional study was conducted involving 89 patients. Results: Self-care levels were negatively affected by patients' location (Azores) and positively affected by marital status, education, employment, AVF duration, and absence of complications with the AVF. Concerning the management of signs and symptoms, self-care levels were negatively affected by patients' location. Regarding prevention of complications, self-care levels were negatively affected by age and marital status and positively affected by marital status, employment, chronic kidney disease etiology, AVF duration, and previous AVF. Conclusion: Further studies are required in order to confirm whether the considered factors affect levels of self-care behaviors with AVF, or whether other factors are needed as well.
- Evaluation and cross-cultural adaptation of the Hendrich II Fall Risk Model to PortuguesePublication . Nilza Caldevilla, Maria; Costa, M. Arminda M.; Teles, Paulo; Ferreira, Pedro M.Background: Several tools for the assessment of the risk of falling are used commonly by clinical nurses, but none have been validated in Portuguese. Aims: To adapt and evaluate the Hendrich II Fall Risk Model (HIIFRM) for use with elderly Portuguese inpatients. Method: We conducted a prospective study of 586 older inpatients in acute care hospitals, from November 2007 to May 2010. Results: The study involved 270 men and 316 women. The most frequent risk factor on admission and at discharge was a score ‡3 on the ‘Get Up and Go’ test. The adapted HIIFRM showed a sensitivity of 93.2% and 75.7%, and a specificity of 35% and 46.7%, on admission and at discharge, respectively. A positive predictive value of 17.2% on admission and 17% at discharge and a negative predictive value of 97.3% and 93%, respectively, were estimated. Conclusions: The HIIFRM was shown to be a useful tool in predicting falls by patients. Nevertheless, the research model suggested that only four risk factors affected the occurrence of falls significantly on admission and two risk factors at discharge. Further research is required in Portuguese hospital settings.
- Exergame-based rehabilitation for cancer patients undergoing abdominal surgery: Effects on pain, anxiety, depression, and fatigue - A pilot studyPublication . Alves, Isabel; Moreira, Ana Paula; Sousa, Teresa; Teles, Paulo; Fernandes, Carla Sílvia; Goncalves. Filipe; Magalhães, BrunoPurpose: This study aimed to determine the efficacy of an exergame rehabilitation program on pain, anxiety or depression, and fatigue in oncology patients undergoing abdominal surgery. Methods: The randomized controlled trial evaluated the efficacy of exergame rehabilitation on Pain, Anxiety, Depression, and Fatigue in oncology patients undergoing abdominal surgery. Patients were recruited from October 2022–March 2023 and were randomly assigned to the intervention group (postoperative traditional rehabilitation plus an exergame rehabilitation program) or control group (postoperative traditional rehabilitation). Data were collected at three different times: on admission, in the first 48 h, and on the 7th day after surgery. Primary outcomes were evaluated and monitored with different validated instruments: numeric rating scale (NRS) for pain, Hospital Anxiety and Depression Scale (HADS) to assess the level of anxiety and depression, and the Fatigue Assessment Scale (FAS) to assess physical and psychological fatigue. The length of stay and program completion were secondary outcomes. Results: A total of 128 postoperative patients were recruited. Of these, 58 patients were excluded from the study due to clinical complications related to the surgical procedure (n = 53) or healthcare staff-related reasons (n = 5). Both the control and intervention groups were the same size (n = 35). Lower pain scores were observed on the 7th postoperative day in the group subject to the “exergame rehabilitation program” (p = 0.006). No statistically significant differences were observed for anxiety and depression between the 2 groups. Regarding fatigue, statistically significant differences were observed on admission (p = 0.03), which disappeared 48 h after surgery (p = 0.143). Differences between the groups were observed again on the 7th day after surgery (p = 0.005). Conclusions: The intervention using exergames was effective in reducing the postoperative pain of the patient undergoing major abdominal surgery and in restoring the levels of fatigue before surgical intervention. However, no differences were observed for anxiety or depression. Future studies with larger samples should be carried out.
- Frequency of intradialytic hypotensive episodes: old problem, new insightsPublication . Rocha, Ana; Sousa, Clemente Neves; Teles, Paulo; Coelho, Augusto; Xavier, EvaSymptomatic intradialytic hypotension (IDH) continues to be an important complication of hemodialysis treatment. There is some evidence that besides an IDH episode, repeated episodes could represent an even more important independent risk factor for mortality in hemodialysis patients. A retrospective cross-sectional study was performed to study 18 dialysis treatments in 43 patients during 6 weeks. Relationships of IDH episodes with baseline variables were examined using a Poisson regression model (generalized linear model). IDH was frequent (93% of patients) and highly variable by patient (0%-100%). Multivariate analysis showed that patients who experienced frequent hypotensive episodes had a lower dry weight (90% confidence interval [CI]: 0.95-0.99), higher phosphorus levels (90% CI: 1.07-1.47), greater prevalence of diabetes mellitus (90% CI: 1.11-2.71), and hypertension (90% CI: 1.04-2.45). Dry weight, hypertension, and phosphorus levels are modifiable risk factors to possibly reduce the rate of IDH episodes. The potential protective role of phosphorus warrants further investigation.
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