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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- Anterior fixation of odontoid fractures: results.Publication . Ferraz Montenegro Lobo, João Pedro; Veludo Moutinho, Veludo Moutinho; Martingo Serdoura, António Francisco; Fernandes Oliveira, Carolina; Rodrigues Pinho, AndréOBJECTIVE: To evaluate the clinical and radiological outcomes of the surgical treatment in patients diagnosed with odontoid fracture who underwent open reduction and internal fixation (ORIF) with screws. METHODS: This was a retrospective study with nine patients. Pain (visual analog scale [VAS]) and neurological status (Frankel scale) were assessed. The neck disability index (NDI) and the post-operative cervical range of motion were calculated. The cervical spine was radiologically evaluated (X-ray and CT) pre- and postoperatively. RESULTS: The mean age of patients was 70 years. All patients presented type IIb (Grauer classification) fractures, with a mean deviation of 2.95 mm. Two patients had subaxial lesions. The mean follow-up was 30 months. The mean time from trauma to surgery was seven days. The pre-operative Frankel score was E in all except one patient (B), in whom a post-operative improvement from B to D was observed. Post-operative pain was 2/10 (VAS). A total of 77% of patients presented a mild or moderate disability (NDI). Six patients regained full range of cervical movement, and bone union required approximately 14 weeks. Pseudarthrosis complications were observed in two patients (77% union rate), one patient presented screw repositioning and one case, dysphonia. CONCLUSION: Delayed diagnosis is still an issue in the treatment of odontoid fractures, especially in elderly patients. Concomitant lesions, especially in younger patients, are not uncommon. The literature presents high fusion rates with ORIF (≥80%), which was also observed in the present study. However, surgical success depends on proper patient selection and strict knowledge of the technique. This pathology presents a reserved functional prognosis in the medium-term, especially in the elderly.
- Anuário Científico do Centro Hospitalar Universitário São João 2016Publication . Santos, ManuelaAnuário da produção científica do Centro Hospitalar Universitário de São João do ano 2016.
- 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.
- Azathioprine-induced interstitial nephritis in an anti-neutrophil cytoplasmic antibody (ANCA) myeloperoxidase (MPO) vasculitis patientPublication . Pires da Rosa, Gilberto; Marques, Sofia; Coelho, Fátima; Pereira, Edite; Ferreira, Ester; Rodrigues-Pereira, Pedro; Dias, Dias; Bettencourt, PauloAzathioprine (AZA) is used in a wide array of autoimmune diseases, still corresponding to the mainstay maintenance therapy in anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides. Although generally well-tolerated, several side effects are recognized. We report the case of a 50-year-old Caucasian man with kidney-limited ANCA myeloperoxidase (MPO) vasculitis who presented with general malaise, fever, worsening renal function, and elevated inflammatory markers 2 weeks after the initiation of therapy with oral AZA. Although a disease relapse was suspected, renal biopsy revealed an eosinophilic infiltrate, suggestive of acute interstitial nephritis. After suspension of AZA, a sustained improvement of renal function and normalization of inflammatory markers was observed. A diagnosis of allergic interstitial nephritis secondary to AZA was established, corresponding to the first biopsy-proven case described in an ANCA MPO vasculitis patient. Although rare, renal toxicity of AZA must be present in the clinician's mind, avoiding the straightforward assumption of disease relapse in the case of worsening renal function.
- Can We Assess the Success of Surgery for Degenerative Spinal Diseases Using Patients' Recall of Their Preoperative Status?Publication . Rodrigues, Ricardo; Silva, Pedro Santos; Cunha, Marisa; Vaz, Rui; Pereira, PauloBackground: Patients' recall of their preoperative status is seldom used to assess surgical outcomes because of concerns of inaccuracy and bias. Objective: The present study aims to measure the significance of this recall bias and its repercussion on patients' recollection of their preoperative status. Methods: Patients submitted to surgery due to degenerative spine diseases during the period of one year (n=198) were included in this study. EQ-5D (including EQ VAS), COMI Neck (including Neck Pain and Shoulder/Arm Pain NRS), COMI Back (including Back Pain and Buttock/Leg Pain NRS), NDI and ODI were completed preoperatively. One year after surgery, patients were asked to complete 2 sets of the same questionnaires, one regarding their postoperative status and the other one regarding their recall of the preoperative status. Results: There was poor to moderate agreement between recalled and collected preoperative scores for all PROMs. Patients' recollection of their preoperative status was accurate for patients who underwent cervical spine surgery, but not after lumbar spine surgery. Patients satisfied with the outcome after lumbar spine surgery recalled significantly worse scores compared to the preoperatively collected. Conclusions: Using patients' recall of their preoperative status may lead to an overestimation of the surgery effectiveness, particularly for lumbar spine surgery. The self-assessed surgery effectiveness interferes with the recollection of the baseline status.
- [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.
- Congenital anomalies of the coronary arteriesPublication . Silva, Andreia; Baptista, Maria João; Araújo, EmanuelCongenital coronary artery anomalies are modifications of their origin, course or structure and its incidence varies between 0,2 and 5,6% of the general population. Although the majority is asymptomatic, they are the second leading cause of sudden cardiac death in young athletes. The aim of this study is to highlight the main anomalies with hemodynamic significance, including the anomalous origin of a coronary artery from the opposite sinus and anomalous origin of the left coronary artery from pulmonary artery. The anomalous aortic origin of a coronary artery from the opposite sinus accounts for 14-16% of all cardiac deaths, that unexpectedly occur in healthy children or young athletes during or immediately after exercise. The mechanism responsible for the compression/occlusion of the coronary artery originating from the opposite sinus is still unclear and there are several proposed mechanisms. The clinical presentation of these patients is variable and physical examination is normal in most individuals. Transthoracic echocardiogram is the diagnostic test most commonly used. Treatment and management are controversial topic. The anomalous origin of the left coronary artery from pulmonary artery is a very rare condition and without surgery, most infants die within the first 12 months of life. The echocardiogram is also the method of choice for diagnostic confirmation. The diagnosis of this congenital anomaly in an infant, usually seriously ill, is an indication for urgent surgery. Because these anomalies produce hemodynamic changes, it is important an early diagnosis and treatment.
- 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.
- 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