CI - CHUSJ - Centro Hospitalar Universitário de São João, EPE
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O Centro Hospitalar de São João (CHSJ) é uma pessoa coletiva de direito público com a natureza de entidade pública empresarial dotada de autonomia administrativa, financeira e patrimonial, nos termos do regime jurídico do sector empresarial do Estado e das empresas públicas e do artigo 18º do anexo da Lei n.º 27/2002 de 8 de Novembro tendo sido criado pelo Decreto-Lei n.º 30/2011, de 2 de março.
É constituído por duas unidades hospitalares: o pólo do Porto (Hospital de São João) e pólo de Valongo (Hospital Nossa Senhora da Conceição de Valongo).
Tem como missão prestar os melhores cuidados de saúde, com elevados níveis de competência, excelência e rigor, fomentando a formação pré e pós-graduada e a investigação, respeitando sempre o princípio da humanização e promovendo o orgulho e sentido de pertença de todos os profissionais.
O Repositório Científico do Centro Hospitalar de São João é criado com o propósito de reunir, armazenar, organizar e difundir toda a produção científica da comunidade hospitalar, de forma a promover o seu reconhecimento e impacto, maximizando a visibilidade e o prestígio Institucional.
www.portal-chsj.min-saude.pt/Browse
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- Decision on conducting HCV Immunoblot and HCV Viral Load Tests Dependent upon the Result of the Screening TestsPublication . Bischoff, Francisco; Koch, Maria; Araújo, FernandoTesting for the presence of antibody to hepatitis C virus (anti-HCV) is recommended for initially identifying persons with HCV infection. According to the CDC guidelines it is appropriate to use a signal-to-cut-off value (S/CO) to limit the number of samples that needs supplemental testing. Moreover, the use of quantitative PCR assays for HCV RNA testing is fundamental for the assessment of chronic hepatitis C. The purpose of this study is to determine a specific value for a serological test for anti-HCV with a Positive Predictive Value (PPV) of 95% on positive HCV Immunoblot, and also determine a cut-off value for performing a clinically relevant HCV PCR. Were observed 415 individuals identified de novo as anti-HCV reactive, between 2009 and 2011. We estimate that a S/CO of 6.0 has a PPV of 99.83% being positive Immunoblot assay and that 99.49% of the samples with a S/CO ≤6.0 will have no detectable virus on PCR. Based on these results we propose a new algorithm for evaluation persons identified de novo as anti-HCV reactive: Immunoblot assay needs to be performed only for samples with a S/CO ≤6.0 and HCV PCR will be performed for persons with a S/CO >6.0. Using these criteria it would be possible to save € 9,000/year with acceptable clinical accuracy. This algorithm does not apply to rare cases of suspected acute HCV infection or suspicion of HCV infection in immunocompromised patients; for these cases we maintain the current approach of NAT testing for laboratory diagnosis of HCV infection.
- Educating healthcare professionals in antimicrobial stewardship: can online-learning solutions help?Publication . Rocha-Pereira, Nuno; Lafferty, Natalie; Nathwani, DilipEducation is widely recognized as one of the cornerstones of successful antimicrobial stewardship programmes. There is evidence of important knowledge flaws around antimicrobial prescribing among both medical students and clinicians. Educational interventions improve antimicrobial prescribing, but traditional tools may be insufficient to deliver training to meet the complex demands of global healthcare professionals working across a diverse range of healthcare and resource settings. The educational solutions increasingly need to be timely, efficient, pragmatic, high quality, aligned to the needs of the professional in a specific context, sustainable and cost-effective. Online learning has been playing a growing role in education about antimicrobial stewardship and the recent phenomenon of massive open online courses (MOOCs) offers novel and additional opportunities to deliver relevant information to a wide range of people. Additional research on MOOCs as an educational approach is needed in order to define their effectiveness, sustainability and the best ways to achieve the intended results. Although the precise value of new online strategies such as MOOCs is ill defined, they certainly will have an important place in increasing awareness and improving antimicrobial prescribing.
- [Comparing the Application of Hema-Obs RSS to 250 Pregnancies from Obstetrics/Hematology Consultation in Centro Hospitalar São João, Portugal with the Application of Galit Sarig RSS to 90 Pregnancies from Rambam Health Care Campus, Israel]Publication . Salselas, Ana; Pestana, Inês; Bischoff, Francisco; Guimarães, Mariana; Andrade, Joaquim AguiarPregnant women with thromboembolic diseases, previous thrombotic episodes or thrombophilia family history were supervised in a multidisciplinary Obstetrics/ Hematology consultation in Centro Hospitalar São João EPE, Porto, Portugal. For the evaluation and medication of these women, a risk stratification scale was used.
- 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.
- 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%.
- Nurses knowledge in Transfusion Medicine in a Portuguese university hospital: the impact of an educationPublication . Freixo, Ana; Matos, Isabel; Leite, Ana; Silva, Albina; Bischoff, Francisco; Carvalho, Milene; Monteiro, Carla; Ferreira, Alcídio; Fernandes, Susana; Lemos, Nuno; Delgado, Beatriz; Gomes, Helena; Regalado, Maria; Sabio, Federico; Cardoso, Filomena; Do Carmo Koch, Maria; Ramos, Lurdes; Araújo, Fernando
- Autogestão do doente diabético: papel do enfermeiro na promoção da autonomiaPublication . Regufe, Virginia MariaA diabetes mellitus tipo 2 é uma doença crónica em larga expansão em todo o mundo. A rápida evolução epidemiológica global registada nos últimos anos (aumento da prevalência e da incidência) leva a que ela seja considerada uma das pandemias do século XXI, acarretando consigo elevados custos sociais e económicos. É desejável que as pessoas com diabetes mellitus tipo 2 possam ter uma vida saudável e sem grandes limitações, mas para que isso aconteça, é necessário fazer o tratamento adequado, facto que implica a existência de uma parceria de cuidados entre a pessoa com diabetes e o enfermeiro que se apresente como facilitador da autogestão da doença. Este estudo tem como principais objetivos contribuir para a compreensão do processo da autogestão na pessoa com diabetes mellitus tipo 2 e o papel do enfermeiro na promoção da sua autonomia. Trata-se de um estudo quantitativo, exploratório, descritivo e transversal, sustentado concetualmente na teoria da autodeterminação. A amostra do estudo foi constituída por pessoas com diabetes mellitus tipo 2 há mais de um ano, com idade superior a 18 anos e que eram seguidas na consulta da diabetes há, pelo menos, 6 meses. Participaram no estudo 144 pessoas de ambos os sexos, com idades entre os 21 e os 84 anos. Para a recolha de dados foi utilizado um questionário intitulado “Autogestão na pessoa com diabetes mellitus tipo 2”, composto por seis instrumentos: questionário sociodemográfico, clínico e de tratamento; questionário de autorregulação; questionário de perceção sobre o ambiente terapêutico; escala de competência percebida; escala de adesão aos medicamentos; e, escala de suporte social. Os resultados evidenciam que as pessoas portadoras de diabetes mellitus tipo 2 conseguem fazer a autogestão da sua doença, demonstrando adesão ao regime medicamentoso proposto pelo médico e sentindo-se autónomos e competentes para adotar os comportamentos de saúde esperados. Sentem-se, no entanto, um pouco controladas pelos outros (familiares e profissionais de saúde) para aderirem ao regime terapêutico e moderadamente motivadas para realizar as alterações necessárias à sua vivência com a doença. Os resultados mostram, ainda, que as pessoas com diabetes que incluíram a amostra tinham uma boa perceção sobre o ambiente terapêutico (relação com o enfermeiro) e sobre o suporte social que detinham. Verificou-se, ainda, que as variáveis sexo, idade e escolaridade influenciaram a perceção de autonomia no autocuidado da pessoa face à gestão do regime terapêutico. Com base nos resultados, consideramos que este estudo contribui para a compreensão dos processos associados à mudança de comportamentos e à promoção desses comportamentos no que concerne à autogestão da diabetes mellitus tipo 2. Este estudo vem, também, corroborar a necessidade de adotar novas abordagens à pessoa portadora de diabetes mellitus tipo 2, sendo que os cuidados centrados na pessoa permitem que esta mobilize competências para gerir, com maior eficácia, a sua saúde e obter ganhos em saúde.
- Psoriasis and comorbidities: general practitioners’ awarenessPublication . Costa-Silva, Miguel; Vide, Julia; Lopes, Sofia; Azevedo, Filomena; Magina, SofiaINTRODUCTION: Systemic inflammatory diseases such as psoriasis, systemic lupus erythematosus (SLE), and rheumatoid arthritis (RA) are associated with an increased prevalence of cardiovascular diseases (CVD) and other comorbidities. The primary aim of this study was to assess the screening practices of general practitioners (GPs) with regard to the most frequent comorbidities in patients with psoriasis. METHODS: We adapted, with permission, a questionnaire that was used by Parsi et al. in 2012, which was then distributed to GP residents and consultants. RESULTS: Overall, 372 questionnaires were collected. Significantly more physicians screen for CV risk factors in patients with RA and SLE than in patients with psoriasis. There was no statistically significant difference between GP residents in the initial and final phase of residency, or between GP residents and consultants regarding awareness of increased prevalence of CVD in psoriasis or comorbidity screening practices in psoriasis patients. CONCLUSIONS: Most GP residents and consultants that participated in this study are not aware of an increased CV risk in patients with psoriasis and assign greater importance regarding this risk to other inflammatory diseases such as RA and SLE.
- How Does Minimally Invasive Transforaminal Lumbar Interbody Fusion Influence Lumbar Radiologic Parameters?Publication . Pereira, Cláudia; Santos Silva, Pedro; Cunha, Marisa; Vaz, Rui; Pereira, PauloAbstract BACKGROUND: Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) has become a popular method of interbody fusion. Clinical outcomes after single-level MIS-TLIF have been reported, but few studies have focused on the radiologic changes in the segmental parameters of the operated and adjacent segments and in lumbar lordosis. METHODS: From March 2009 to September 2016, 117 patients who underwent a single-level MIS-TLIF surgery for lumbar degenerative disease were enrolled in this retrospective study. The anterior disc height (ADH), posterior disc height (PDH), and segmental angle (SA) of the operated and adjacent levels and lumbar lordosis (LL) were evaluated on radiographs obtained pre- and postoperatively at 6- to 12-month follow-up visits. Cage-related parameters including fusion and subsidence rates were analyzed on postoperative computed tomography scans. Clinical assessment used validated outcome scores such as the Oswestry Disability Index questionnaire and the Odom criteria. RESULTS: ADH and PDH of the operated segment increased significantly after surgery, but no significant changes were seen in the SA of that level. Statistically significant decreases were observed in the PDH of both adjacent segments and increases in the adjacent superior SA. LL showed a slight but statistically significant improvement after surgery that was mostly correlated with a postoperative increase in the adjacent superior SA (r = 0.58; P < 0.001). No significant correlations were found between clinical and radiologic results. CONCLUSIONS: Single-level MIS-TLIF increased disc height but not the SA at the operated level. LL improvement after surgery was mainly associated with the increase of the cranial segmental angle
- Spectrum of CFTR gene sequence variants in a northern Portugal populationPublication . Grangeia, A.; Alves, S.; Gonçalves, L; Gregório, I; Santos, AC; Barros, H; Barros, A; Carvalho, F; Moura, CIn Portugal, the spectrum of Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) gene variants is not known. The main objective of this work was to determine the type and frequency of CFTR variants in a sample from northern Portugal by the complete analysis of the CFTR coding sequencing performed in 512 Portuguese children. A total of 30 different CFTR sequence variants, already reported as cystic fibrosis (CF) or CFTR related disorders variants, were detected. Ninety-two children (18.0%; 95%CI: 14.7-21.6) were found to be carriers of one sequence variant and 8 (1.6%; 95%CI: 0.7-3.1) had two sequence variants. Taking into consideration only variants that may cause CF when combined with a pathogenic CF variant, the CF pathogenic variant carrier frequency was 3.3% (95%CI: 1.9-5.3). One (0.2%; 95%CI: 0.01-0.7) child presented two CF pathogenic variants. CONCLUSIONS: The majority of CFTR variants detected have been associated with a less severe CF phenotype. A wide spectrum of CFTR variants was identified, confirming the highest CFTR allelic heterogeneity previously reported in Mediterranean country. Additionally, better knowledge about the CFTR sequence variation spectrum may contribute to more efficient genetic testing in the Portuguese population.