Comunicação médico-doente e consentimento informado em Portugal

Introdução – O consentimento informado (CI) para a realização de procedimentos médicos é influenciado pela comunicação entre o médico e o doente, ainda que se desconheça o impacto de alguns dos determinantes da comunicação entre estes dois intervenientes. Objetivo – Identificar e analisar os determinantes da comunicação entre o médico e o doente que influenciam o dever ético de informar para obter um CI. Métodos – Pesquisaram-se artigos de investigação originais, escritos em Portugal entre janeiro de 2005 e março de 2015, nas bases de dados eletrónicas Google Académico, PubMed, B-ON e no Repositório Científico de Acesso Aberto de Portugal, utilizando as palavras-chave ‘consentimento informado’, ‘médico’ e ‘doente‘ ou ‘informed consent’, ‘doctor’ e ‘patient’. Resultados – Identificaram-se cinco artigos que obedeciam aos critérios de inclusão e verificou-se a existência de determinantes da comunicação na relação médico-doente que influenciam o CI livre e esclarecido. Conclusão – O conhecimento da importância dos determinantes da comunicação que influenciem o CI pode ajudar na interação médico-doente e no desenvolvimento de medidas para melhorar a qualidade da prestação de cuidados de saúde.

Quantificação da difusão na ressonância magnética da mama: ADC e Kurtosis

Mestrado em Radiações Aplicadas às Tecnologias da Saúde. Área de especialização: Ressonância Magnética

Image quality of myocardial perfusion-gated studies: effect of ingestion of different fat content in the reduction of extra-myocardial abdominal signal

Myocardial perfusion-gated-SPECT (MP-gated-SPECT) imaging often shows radiotracer uptake in abdominal organs. This accumulation interferes frequently with qualitative and quantitative assessment of the infero-septal region of myocardium. The objective of this study is to evaluate the effect of ingestion of different fat content on the reduction of extra-myocardial uptake and to improve MP-gated-SPECT image quality. In this study, 150 patients (65 ^ 18 years) who were referred for MP-gated-SPECT underwent a 1-day-protocol including imaging after stress (physical or pharmacological) and resting conditions. All patients gave written informed consent. Patients were subdivided into five groups: GI, GII, GIII, GIV and GV. In the first four groups, patients ate two chocolate bars with different fat content. Patients in GV – control group (CG) – had just water. Uptake indices (UI) of myocardium (M)/liver(L) and M/stomach–proximal bowel(S) revealed lower UI of M/S at rest in all groups. Both stress and rest studies using different food intake indicate that patients who ate chocolate with different fat content showed better UI of M/L than the CG. The UI of M/L and M/S of groups obtained under physical stress are clearly superior to that of groups obtained under pharmacological stress. These differences are only significant in patients who ate high-fat chocolate or drank water. The analysis of all stress studies together (GI, GII, GIII and GIV) in comparison with CG shows higher mean ranks of UI of M/L for those who ate high-fat chocolate. After pharmacological stress, the mean ranks of UI of M/L were higher for patients who ate high- and low-fat chocolate. In conclusion, eating food with fat content after radiotracer injection increases, respectively, the UI of M/L after stress and rest in MP-gated-SPECT studies. It is, therefore, recommended that patients eat a chocolate bar after radiotracer injection and before image acquisition.

Caracterização da prática do fisioterapeuta na sua intervenção em crianças até um ano de idade com torcicolo muscular congénito

Mestrado em Fisioterapia.

Exposição profissional a nanopartículas na indústria farmacêutica: estudo exploratório

Mestrado em Segurança e Higiene no Trabalho

Psoríase: o impacto da doença no dia-a-dia dos portadores

Mestrado em Fisioterapia

Consumo de benzodiazepinas por idosos institucionalizados: inapropriação, qualidade de sono e contributo para a segurança na medicação

A racionalização do uso de medicamentos constitui-se como um fator contribuinte para a melhoria da segurança do doente, particularmente no que respeita à segurança na medicação, tendo-se tornado prioritária para as organizações e instituições de saúde. A avaliação do uso de medicamentos inapropriados no idoso constitui-se como uma medida que concorre para evitar, prevenir ou corrigir eventos adversos associados ao seu uso. As benzodiazepinas são uma das classes de medicamentos mais prescritas em idosos. No entanto, e apesar de sua utilidade clínica, algumas benzodiazepinas são consideradas inapropriadas nesta faixa etária por potenciarem o efeito sedativo e aumentar a incidência de quedas e fraturas. A longo prazo, na promoção da qualidade do sono, a sua efetividade é discutível já que a toma de uma benzodiazepina para a resolução de um problema como o sono, muitas vezes pontual, passa a ser um problema crónico de exigência de toma contínua, sem que a qualidade deste seja restabelecida, pondo em risco a segurança do doente. Este estudo tem como objetivo caracterizar o consumo de benzodiazepinas por idosos institucionalizados, numa instituição de longa permanência do concelho de Sesimbra, sua inapropriação e a relação com a qualidade de sono. Foi desenvolvido um estudo descritivo e transversal, assente no paradigma qualitativo, com a recolha de dados a decorrer em três momentos: registo de informação em grelha própria da caracterização sociodemográfica e da caracterização do consumo de benzodiazepinas; aplicação do índice de Katz para determinar a funcionalidade dos participantes; aplicação do questionário adaptado do Pittsburgh Sleep Quality Index para avaliação da qualidade do sono. A inapropriação foi avaliada pela aplicação dos critérios de Beers. Após aplicação dos critérios de inclusão (idade superior a 65 anos e capacidade funcional) aos 97 utentes da instituição, a amostra foi constituída por 51 utentes. Foi recolhido consentimento informado de todos os participantes. Os resultados obtidos mostram que 46% das benzodiazepinas consumidas são de duração intermédia de ação, observando-se ainda um valor considerável de consumo de benzodiazepinas de longa duração de ação (36%). Estes valores correspondem a um grau elevado de inapropriação, potenciando os riscos para a segurança do doente nesta faixa etária. O lorazepam 2,5mg é a benzodiazepina mais utilizada como hipnótico. Mas, apesar do consumo deste grupo de medicamentos 81,6% dos idosos que consumem benzodiazepinas não apresentam boa qualidade de sono (PSQI>5), enquanto 77% dos idosos que não consomem benzodiazepinas apresentam boa qualidade de sono (PSQI≤5). Nos idosos que consomem benzodiazepinas, a média de tempo despendido na cama até adormecer foi de cerca de 55 minutos, valor superior ao grupo que não consome benzodiazepinas, onde a média é de 27 minutos. Neste grupo de idosos, o consumo de benzodiazepinas não só é inapropriado como não contribuiu para uma melhoria na qualidade de sono nem para a segurança do doente, como são os consumidores de benzodiazepinas que apresentam uma pior qualidade de sono, nas suas várias dimensões.

Mediterranean diet: the impact on cardiovascular risk and metabolic syndrome in HIV patients, in Lisbon, Portugal

Introduction - Metabolic syndrome (MS) is common in HIV-infected individuals and it is associated with higher cardiovascular risk (CVR). Mediterranean diet has been associated with a better metabolic control and lower CVR. Materials and methods - From December 2013 to May 2014, individuals between 18 and 65 years of age, who attended the outpatient HIV Clinic at the University Hospital Santa Maria, Lisbon, were selected. Adherence to Mediterranean diet was evaluated with MedDietScore, a scale from 0 to 55 that punctuates 11 food items according to the frequency of intake. Higher scores represent higher adherence. CVR was assessed using D.A.D tool (classified as low, moderate or high risk). We excluded individuals with opportunistic disease, hospitalized in the past three months or with renal disease diagnosis. All participants gave written informed consent. Results - In the 571 HIV patients included, 67.1% (n=383) were male, 91.6% (n=523) Caucasian, with a mean age of 46.5±8.9 years. Patients were divided in two groups: naïve (7.5%; n=43) or on antiretroviral treatment (ART) (92.5%; n=528). Mean length of HIV diagnosis was 6.7±6.5 years (naïve) and 13.3±6.1 years (ART); TCD4+ counts were above 500 cel/mm3 in 55.8% (n=24) and 67.6% (n=357) of the patients, respectively. MS was present in 33.9% (n=179) of patients in ART group and 16.3% (n=7) in naïve group. Presence of MS was associated with ART group (OR=2.7; p=0.018). MS was also associated with older age in this group (p=0.000). Overall, mean MedDietScore was 27.3±5.5. Higher score was associated with older age (r=0.319; p=0.000). Naïve patients presented a trend to higher adherence to Mediterranean diet (65.1% vs 51.7% in naïve group; p=0.090). No relation between MS and Mediterranean diet was found. Higher CVR was associated with the presence of MS in the ART group (p=0.001). In this group, individuals with moderate CVR presented higher rates of adherence to Mediterranean diet (p=0.036) when compared to low and high CVR score. Conclusions - In this cross-sectional study, naïve individuals presented a trend to higher adherence to Mediterranean diet. On the ART group, higher adherence to Mediterranean diet was found in individuals with moderate CVR score. We think that this might suggest that this group of patients adopt this diet only in the presence of metabolic alterations or perceived CVR. Prospective studies in HIV patients are required to determine the impact of adherence to Mediterranean diet on the reduction of CVR.

Formaldehyde's genotoxicity effects in pathology anatomy technologists and medical pathologists

Formaldehyde (FA) had been considered to be carcinogenic by the International Agency for Research on Cancer (group1), on the basis of sufficient evidence both in humans and in experimental animals, making it a subject of major environmental concern, especially in the occupational context. Manifold in vitro studies clearly indicated that FA is genotoxic, inducing various genotoxic effects in proliferating cultured mammalian cells. Cytokinesis-blocked micronucleus (CBMN) assay is used extensively in molecular epidemiology, and the chromosomal alterations most reported and studied by the CBMN are: micronucleus (MN), nucleoplasmic bridges (NPB) and nuclear buds (NBUDs). The pathology anatomy laboratories are work places that manipulate routinely FA and pathology anatomy technologists and pathologists contact daily with this chemical compound particularly in the macroscopic exam and grossing procedures. The aim of this study was to identify genotoxicity biomarkers in the set workers groups, such as micronucleus (MN), nucleoplasmic bridges (NPB) and nuclear buds (NBUD) in peripheral blood lymphocytes.

The (well) informed piano : internalization and growth process

The subject matter of this book is about piano methodology, including technical, musical, artistic, ethical and philosophical issues and reflections. The purpose of this work is to share a personal professional experience insight in the field of piano performance. This text assumes a certain continuity to the major contributions of artists like Ludwig Deppe, Tobias Matthay, Grigory Kogan, Heinrich Neuhaus and George Kochevitsky. At the same time, it tries to integrate and complement this selected literature, bringing new ideas and hints to specific professional issues.

Caracterização da formação em primeiros socorros: realidade em pequenas e médias empresas da região de Lisboa

Mestrado em Higiene e Segurança no Trabalho

Relatório de estágio de natureza profissional em PET/CT: Clinical Imaging Sciences Centre, Sussex

Mestrado em Medicina Nuclear - Ramo de especialização: Tomografia por Emissão de Positrões

Níveis de referência em diagnóstico em tomografia computorizada para planeamento em radioterapia

Mestrado em Radiações Aplicadas às Tecnologias da Saúde- Ramo de especialização: Terapia com Radiações

A survey in Portuguese X-ray fluoroscopy equipment: dose rates and image quality

X-ray fluoroscopy is essential in both diagnosis and medical intervention, although it may contribute to significant radiation doses to patients that have to be optimised and justified. Therefore, it is crucial to the patient to be exposed to the lowest achievable dose without compromising the image quality. The purpose of this study was to perform an analysis of the quality control measurements, particularly dose rates, contrast and spatial resolution of Portuguese fluoroscopy equipment and also to provide a contribution to the establishment of reference levels for the equipment performance parameters. Measurements carried out between 2007 and 2013 on 143 fluoroscopy equipment distributed by 34 nationwide health units were analysed. The measurements suggest that image quality and dose rates of Portuguese equipment are congruent with other studies, and in general, they are as per the Portuguese law. However, there is still a possibility of improvements intending optimisation at a national level.

OPTIMAX 2014 - Radiation dose and image quality optimisation in medical imaging

Medical imaging is a powerful diagnostic tool. Consequently, the number of medical images taken has increased vastly over the past few decades. The most common medical imaging techniques use X-radiation as the primary investigative tool. The main limitation of using X-radiation is associated with the risk of developing cancers. Alongside this, technology has advanced and more centres now use CT scanners; these can incur significant radiation burdens compared with traditional X-ray imaging systems. The net effect is that the population radiation burden is rising steadily. Risk arising from X-radiation for diagnostic medical purposes needs minimising and one way to achieve this is through reducing radiation dose whilst optimising image quality. All ages are affected by risk from X-radiation however the increasing population age highlights the elderly as a new group that may require consideration. Of greatest concern are paediatric patients: firstly they are more sensitive to radiation; secondly their younger age means that the potential detriment to this group is greater. Containment of radiation exposure falls to a number of professionals within medical fields, from those who request imaging to those who produce the image. These staff are supported in their radiation protection role by engineers, physicists and technicians. It is important to realise that radiation protection is currently a major European focus of interest and minimum competence levels in radiation protection for radiographers have been defined through the integrated activities of the EU consortium called MEDRAPET. The outcomes of this project have been used by the European Federation of Radiographer Societies to describe the European Qualifications Framework levels for radiographers in radiation protection. Though variations exist between European countries radiographers and nuclear medicine technologists are normally the professional groups who are responsible for exposing screening populations and patients to X-radiation. As part of their training they learn fundamental principles of radiation protection and theoretical and practical approaches to dose minimisation. However dose minimisation is complex – it is not simply about reducing X-radiation without taking into account major contextual factors. These factors relate to the real world of clinical imaging and include the need to measure clinical image quality and lesion visibility when applying X-radiation dose reduction strategies. This requires the use of validated psychological and physics techniques to measure clinical image quality and lesion perceptibility.