A importância da espirometria na deteção precoce de alterações ventilatórias obstrutivas em adultos

Mestrado em Gestão e Avaliação de Tecnologias em Saúde

Relatório de estágio em reabilitação da dor lombar crónica

Mestrado em Fisioterapia

Tissue composition and density impact on the clinical parameters for 125I prostate implants dosimetry

The MCNPX code was used to calculate the TG-43U1 recommended parameters in water and prostate tissue in order to quantify the dosimetric impact in 30 patients treated with (125)I prostate implants when replacing the TG-43U1 formalism parameters calculated in water by a prostate-like medium in the planning system (PS) and to evaluate the uncertainties associated with Monte Carlo (MC) calculations. The prostate density was obtained from the CT of 100 patients with prostate cancer. The deviations between our results for water and the TG-43U1 consensus dataset values were -2.6% for prostate V100, -13.0% for V150, and -5.8% for D90; -2.0% for rectum V100, and -5.1% for D0.1; -5.0% for urethra D10, and -5.1% for D30. The same differences between our water and prostate results were all under 0.3%. Uncertainties estimations were up to 2.9% for the gL(r) function, 13.4% for the F(r,θ) function and 7.0% for Λ, mainly due to seed geometry uncertainties. Uncertainties in extracting the TG-43U1 parameters in the MC simulations as well as in the literature comparison are of the same order of magnitude as the differences between dose distributions computed for water and prostate-like medium. The selection of the parameters for the PS should be done carefully, as it may considerably affect the dose distributions. The seeds internal geometry uncertainties are a major limiting factor in the MC parameters deduction.

Intérêts du travail isolé du pouce dans le jeu de la harpe: rapport de stage

Résumé I (Pratiques Pédagogiques)- Ce compte-rendu du stage réalisé pour ma deuxième année de master rapporte le résultat de l’observation des cours donnés à trois élèves de niveaux différents par le professeur de harpe de l’Ecole de Musique « Nossa Senhora do Cabo » à Linda-a-Velha, commune de Oeiras, située près de Lisbonne. Grâce à l’activité du professeur, et par le suivi de l’évolution de ses élèves tout au long de l’année scolaire 2012-2013, tant sur le plan technique que sur le plan musical, j’ai pu participer à toutes les étapes de leur apprentissage et retrouver quelques principes pédagogiques fondamentaux. Ainsi, j’ai constaté la nécessité d’une organisation didactique solide dans la définition d’objectifs, la planification du travail, le choix des méthodes d’étude, mais souple par la régulation des rythmes d’apprentissage et des techniques d’acquisition. La métacognition est aussi une notion composante essentielle de la pratique du professeur, dont un des grands objectifs est de développer chez ses élèves la capacité de se prendre en charge seul. J’ai également apprécié l’importance de l’aspect relationnel intrinsèque à toute situation d’apprentissage, ainsi que celle de la connaissance des théories de la motivation, atout important permettant d’agir au niveau psychologique sur les élèves et d’obtenir à plus ou moins long terme des changements comportementaux influents sur la qualité de ces apprentissages. J’ai enfin essayé de dégager différents types d’approches pédagogiques possibles, parmi les stratégies observées chez le professeur, ainsi que d’après quelques éléments de réflexion personnelle.

Failure on clinical image quality criteria in digital mammography: how can radiographers do better?

Purpose: To assess image quality using PGMI (perfect, good, moderate, inadequate) scale in digital mammography examinations acquired in DR systems. Identify the main failures and propose corrective actions. Evaluate the most typical breast density. Methods and Materials: Clinical image quality criteria were evaluated considering mammograms acquired in 13 DR systems and classified according to PGMI scale using the criteria described in European Commission guidelines for radiographers. The breast density was assessed according to ACR recommendations. The data were collected on the acquisition system monitor to reproduce the daily practice of the radiographer. Results: The image quality criteria were evaluated in 3044 images. The criteria were fully achieved in 41% of the images that were classified as P (perfect), 31 % of the images were classified as M (moderate), 20% G (good) and 9% I (inadequate). The main cause of inadequate image quality was absence of all breast tissue in the image, skin folders in the pectoral muscle and in the infra-mammary angle. The higher number of failures occurred in MLO projections (809 out of 1022). The most represented (36%) breast type was type 2 (25-50% glandular tissue). Conclusion: Incorrect radiographic technique was frequently detected suggesting potential training needs and poor communication between the team members (radiographer and radiologists). Further correlations are necessary to identify the main causes for the failures, namely specific education and training in digital mammography and workload.

Relatório de estágio em reabilitação neurológica: intervenção da fisioterapia em crianças com necessidades especiais

Mestrado em Fisioterapia

The effects of clinical support surfaces on pressure as a risk factor in the development of pressure ulcers, from a radiographical perspective: a narrative literature review

Purpose: Pressure ulcers are a high cost, high volume issue for health and medical care providers, having a detrimental effect on patients and relatives. Pressure ulcer prevention is widely covered in the literature, but little has been published regarding the risk to patients in the radiographical setting. This review of the current literature is to identify findings relevant to radiographical context. Methods: Literature searching was performed using Science Direct and Medline databases. The search was limited to articles published in the last ten years to remain current and excluded studies containing participants less than 17 years of age. In total 14 studies were acquired; three were excluded as they were not relevant. The remaining 11 studies were compared and reviewed. Discussion: Eight of the studies used ‘healthy’ participants and three used symptomatic participants. Nine studies explored interface pressure with a range of pressure mat technologies, two studies measured shear (MRI finite element modelling, and a non-invasive instrument), and one looked at blood flow and haemoglobin oxygenation. A range of surfaces were considered from trauma, nursing and surgical backgrounds for their ability to reduce pressure including standard mattresses, high specification mattresses, rigid and soft layer spine boards, various overlays (gel, air filled, foam). Conclusion: The current literature is not appropriate for the radiographic patient and cannot be extrapolated to a radiologic context. Sufficient evidence is presented in this review to support the need for further work specific to radiography in order to minimise the development of PU in at risk patients.

Clinical classification versus semiquantification with adapted reference values for 123I-FP-CIT SPECT in a nuclear medicine department

Semi quantification (SQ) in DaTScan® studies is broadly used in clinic daily basis, however there is a suspicious about its discriminative capability, and concordance with the diagnostic classification performed by the physician. Aim: Evaluate the discriminate capability of an adapted database and reference's values of healthy controls for the Dopamine Transporters (DAT) with 123I–FP-IT named DBRV adapted to Nuclear Medicine Department's protocol and population of Infanta Cristina's Hospital, and its concordance with the physician classification.