The patient safety journey in Portugal : challenges and opportunities from a public health perspective

ABSTRACT - Despite improvements in healthcare interventions, the incidence of adverse events and other patient safety problems constitutes a major contributor to the global burden of diseases and a concern for Public Health. In the last years there have been some successful individual and institutional efforts to approach patient safety issues in Portugal, unless such effort has been fragmented or focused on specific small areas. Long-term and global improvement has remained elusive, and most of all the improvement of patient safety in Portugal, must evaluate not only the efficacy of a change but also what was effective for implementing the change. Clearly, patient safety issues result from various combinations of individual, team, organization, system and patient factors. A systemic and integrated approach to promote patient safety must acknowledge and strive to understand the complexity of work systems and processes in health care, including the interactions between people, technology, and the environment. Safety errors cannot be productively attributed to a single human error. Our objective with this paper is to provide a brief overview of the status quo in patient safety in Portugal, highlighting key aspects that should be taken into account in the design of a strategy for improving patient safety. With these key aspects in mind, policy makers and implementers can move forward and make better decisions about which changes should be made and about the way the needed changes to improve patient safety should be implemented. The contribution of colleagues that are international leaders on healthcare quality and patient safety may also contribute to more innovative research methods needed to create the knowledge that promotes less costly successful changes.---- ---------------------- RESUMO – As questões relacionadas com a Segurança do Doente, e em particular, com a ocorrência de eventos adversos tem constituído, de há uns tempos a esta parte, uma crescente preocupação para as organizações de saúde, para os decisores políticos, para os profissionais de saúde e para os doentes/utentes e suas famílias, sendo por isso considerado um problema de Saúde Pública a que urge dar resposta. Em Portugal, nos últimos anos, têm sido desenvolvidos esforços baseados, maioritariamente, em iniciativas isoladas, para abordar os aspectos da Segurança do Doente. O facto de essas iniciativas não serem integradas numa estratégia explícita e de dimensão regional ou nacional, faz com que os resultados sejam parcelares e tenham visibilidade reduzida. Paralelamente, a melhoria da qualidade dos cuidados de saúde (a longo prazo) resultante dessas iniciativas tem sido esparsa e nem sempre a avaliação tem sido feita tendo em conta critérios de efectividade e de eficiência. A Segurança do Doente resulta da interacção de diversos factores relacionados, por um lado, com o doente e, por outro, com a prestação de cuidados que envolvem elementos de natureza individual (falhas activas) e organizacional/estrutural (falhas latentes). Devido à multifactorialidade que está na base de «problemas/falhas» na Segurança do Doente, qualquer abordagem a considerar deve ser sistémica e integrada. Simultaneamente, tais abordagens devem contemplar a compreensão da complexidade dos sistemas e dos processos de prestação de cuidados de saúde e as suas interdependências (envolvendo aspectos individuais, tecnológicos e ambientais). O presente trabalho tem por objectivo reflectir sobre o «estado da arte» da Segurança do Doente em Portugal, destacando os elementos-chave que se consideram decisivos para uma estratégia de acção nesse domínio. Com esses elementos os responsáveis pela governação da saúde poderão valorizar os aspectos que consideram decisivos para uma política de Segurança do Doente mais eficaz. A contribuição de quatro colegas internacionalmente reconhecidos como líderes na área da Qualidade em Saúde e da Segurança do Doente, constitui, por certo, uma oportunidade ímpar para a identificação e discussão de alguns dos principais desafios, ameaças e oportunidades que s

Surface Imprinting Approach on Screen Printed Electrodes Coated with Carboxylated PVC for Myoglobin detection with Electrochemical Transduction

A novel surface molecularly-imprinted (MI) material to detect myoglobin (Myo) using gold screen printed electrodes (SPE) was developed. The sensitive detection was carry out by introducing a carboxylic polyvinyl chloride (PVC-COOH) layer on gold SPE surface. Myo was attached to the surface of gold SPE/PVC-COOH and the vacant spaces around it were filled by polymerizing acrylamide and N,N-methylenebisacrylamide (cross-linker). This polymerization was initiated by ammonium persulphate. After removing the template, the obtained material was able to rebind Myo and discriminate it among other interfering species. Various characterization techniques including electrochemical impedance spectroscopy (EIS) and cyclic voltammetry (CV) confirmed the surface modification. This sensor seemed a promising tool for screening Myo in point-of-care.

Chromatin dynamics in Arbidopsis development: a live cell imaging approach

Dissertation presented to obtain the Ph.D degree in Biology

Condition-Based Diagnosis of Mechatronic Systems Using a Fractional Calculus Approach

While fractional calculus (FC) is as old as integer calculus, its application has been mainly restricted to mathematics. However, many real systems are better described using FC equations than with integer models. FC is a suitable tool for describing systems characterised by their fractal nature, long-term memory and chaotic behaviour. It is a promising methodology for failure analysis and modelling, since the behaviour of a failing system depends on factors that increase the model’s complexity. This paper explores the proficiency of FC in modelling complex behaviour by tuning only a few parameters. This work proposes a novel two-step strategy for diagnosis, first modelling common failure conditions and, second, by comparing these models with real machine signals and using the difference to feed a computational classifier. Our proposal is validated using an electrical motor coupled with a mechanical gear reducer.

A Modular Programming Approach for IoTBased Wireless Sensor Networks

Poster presented in 12th European Conference on Wireless Sensor Network (EWSN 2015). 9 to 11, Feb, 2015. Porto, Portugal.

A competing values framework approach on growth and performance in micro firms

This study aims to analyze and compare four micro-firms' organizational culture, evaluated through the Competing Values Framework (Quinn & Rohbaugh, 1983). Data was collected in 2011 and 2013 in firms selling the same type of software and providing the same kind of services, focusing on the years between 2008-2011. Findings point to somewhat different results of micro-firms, when comparing to other samples in the literature. Suggestions for future research are given.

Short-Circuit Impedance of Power Transformers: the Fractional Order Calculus Approach

First IFAC Workshop on Fractional Differentiation and Its Application - 19-21 July 2004, Enseirb, Bordeaux, France - FDA'04

Ensemble: an innovative approach to practice computer programming

Currently, the teaching-learning process in domains, such as computer programming, is characterized by an extensive curricula and a high enrolment of students. This poses a great workload for faculty and teaching assistants responsible for the creation, delivery, and assessment of student exercises. The main goal of this chapter is to foster practice-based learning in complex domains. This objective is attained with an e-learning framework—called Ensemble—as a conceptual tool to organize and facilitate technical interoperability among services. The Ensemble framework is used on a specific domain: computer programming. Content issues are tacked with a standard format to describe programming exercises as learning objects. Communication is achieved with the extension of existing specifications for the interoperation with several systems typically found in an e-learning environment. In order to evaluate the acceptability of the proposed solution, an Ensemble instance was validated on a classroom experiment with encouraging results.

Social entrepreneurship

The purpose of this chapter is to contribute to a better understanding of the link between social entrepreneurship and institutional environment in Portugal. A quantitative approach is used in the study, with primary data collected through an online survey. A questionnaire was emailed to both Portuguese Non-Governmental Organizations and projects available on the Portuguese Social Stock Exchange. In the analysis of the data, we used descriptive statistics, factorial analysis and t-student tests in an attempt to validate the research hypotheses. The results show that a favorable institutional environment has low importance in the decision to develop social entrepreneurial initiatives. This conclusion supports the idea that many social entrepreneurs can emerge even in developing regions where the institutional environment is weak. Therefore,social entrepreneurship could be an instrument of regional development and contribute to attenuating the social and economic differences among Portuguese regions.

The Arterial Switch Operation in Europe for Transposition of the Great Arteries: a Multi-Institutional Study from the European Congenital Heart Surgeons Association

OBJECTIVES: This study analyzes the results of the arterial switch operation for transposition of the great arteries in member institutions of the European Congenital Heart Surgeons Association. METHODS: The records of 613 patients who underwent primary arterial switch operations in each of 19 participating institutions in the period from January 1998 through December 2000 were reviewed retrospectively. RESULTS: A ventricular septal defect was present in 186 (30%) patients. Coronary anatomy was type A in 69% of the patients, and aortic arch pathology was present in 20% of patients with ventricular septal defect. Rashkind septostomy was performed in 75% of the patients, and 69% received prostaglandin. There were 37 hospital deaths (operative mortality, 6%), 13 (3%) for patients with an intact ventricular septum and 24 (13%) for those with a ventricular septal defect (P < .001). In 36% delayed sternal closure was performed, 8% required peritoneal dialysis, and 2% required mechanical circulatory support. Median ventilation time was 58 hours, and intensive care and hospital stay were 6 and 14 days, respectively. Although of various preoperative risk factors the presence of a ventricular septal defect, arch pathology, and coronary anomalies were univariate predictors of operative mortality, only the presence of a ventricular septal defect approached statistical significance (P = .06) on multivariable analysis. Of various operative parameters, aortic crossclamp time and delayed sternal closure were also univariate predictors; however, only the latter was an independent statistically significant predictor of death. CONCLUSIONS: Results of the procedure in European centers are compatible with those in the literature. The presence of a ventricular septal defect is the clinically most important preoperative risk factor for operative death, approaching statistical significance on multivariable analysis.

Dilated Cardiomyopathy. New Therapeutic Approach

Inflammatory reaction has been associated with dilated cardiomyopathy. In this context, cardiac autoantibodies and inflammatory cell infiltration have been studied during the last two decades towards the understanding of their origin and the underlying pathogenic mechanisms. Recent research has increasingly focused on the development of an etiological therapeutic approach. Immunoadsorption has shown to improve clinical, echocardiographic, haemodynamic and laboratory parameters in patients with inflammatory dilated cardiomyopathy. In this article we review recent literature concerning this subject, including classification, pathophysiological mechanisms and therapy.

A New Electronic Approach for the Surgical Safety Checklist

To improve surgical safety, and to reduce the mortality and surgical complications incidence, the World Health Organization (WHO) developed the Surgical Safety Checklist (SSC). The SSC is a support of information that aids health professionals to reduce the number of complications, induction of anaesthesia, period before skin incision and period before leaving the operating room (OR). The SSC was tested in several countries of the world and their results shown that after introduction of the SSC the incidence of patient complication lowered from 11.0% to 7.0% (P<0.001), the rate of death declined from 1.5% to 0.8% (P = 0.003) and the nurses recognized that patients identity was more often con rmed (81.6% to 94.2%, P<0.01) in many institutions. Recently the SSC was also implemented in Portuguese hospitals, which led us to its study in the real clinical environment. An observational study was performed: several health professionals were observed and interviewed, to understand the functioning of the SSC in an OR, during the clinical routine. The objective of this study was to understand the current use of the SSC, and how it may be improved in terms of usability, taking advantage of the technological advancements such as mobile applications. During two days were observed 14 surgeries, only 2 surgeries met the requirements for the three phases of the SSC, as de ned by the WHO. Of the remaining 12 observed surgeries, 9 surgeries completed the last phase at the correct time. It was also observed that only in 2 surgeries all the phases of the SSC were read aloud to the team and that, in 7 surgeries, several items were read aloud and answered but no one was checking the SSC, only after the end of the phase. The observational study results disclose that several health professionals do not meet with rules of the WHO manual. This study demonstrates that it is urgent to change the mindset of health professionals, and that di erent features in the SSC may be useful to make it more easy to use. With the results of the observational study, a SSC application proposal was developed with new functionalities to improve and aid the health professional in its use. In this application the user can chose between a SSC already created to a speci c surgery or to create a new SSC, adding and adapting some questions from the WHO standard. To create a new SSC, the application is connected to an online questionnaire builder (JotForm). The choice for this online questionnaire builder went through three essential characteristics: number of types of questions, mainly checkbox, radio button and text; the possibility of to create sections inside sections and the API. In addition, in this proposal the improvements are focused in forcing the user to focus in the work ow of the SSC and to save the input timestamps and any actions made by them. Therefore, the following features was implemented to achieve that goal: display one item of the SSC at a time; display the stage where the SSC is; do not allow going back to the previous step; do not allow going forward to the next item if the current is not lled; do not allow going forward to the next item if the time it took to ll the item was too short and log any action made by the user.

Are coffee silverskin extracts safe for topical use? An in vitro and in vivo approach

Recent changes in regulatory requirements and social views on animal testing have incremented the development of reliable alternative tests for predicting skin and ocular irritation potential of products based on new raw materials. In this regard, botanical ingredients used in cosmetic products are among those materials, and should be carefully reviewed concerning the potential presence of irritant constituents. In particular, cosmetic products used on the face, in vicinity of the eyes or that may come in contact with mucous membranes, should avoid botanical ingredients that contain, or are suspected to contain, such ingredients. In this study, we aimed to evaluate the effect of a new cosmetic ingredient, namely, coffee silverskin (CS), with an in vitro skin and ocular irritation assay using reconstructed human epidermis, EpiSkin™, and human corneal epithelial model, SkinEthics™ HCE, and an in vivo assay. Three different extracts of CS were evaluated. The histology of the models after extracts applications was analysed. The in vitro results demonstrated that extracts were not classified as irritant and the histological analyses proved that extracts did not affect both models structure. The content of caffeine, 5-hydroxymethyl furfural and chlorogenic acid was quantified after the epidermal assay. The in vivo test carried out with the most promising extract (hydroalcoholic) showed that, with respect to irritant effects, these extracts can be regarded as safe for topical application.

Assessment of groundwater contamination in an agricultural peri-urban area (NW Portugal): an integrated approach

The excessive use of pesticides and fertilisers in agriculture has generated a decrease in groundwater and surface water quality in many regions of the EU, constituting a hazard for human health and the environment. Besides, on-site sewage disposal is an important source of groundwater contamination in urban and peri-urban areas. The assessment of groundwater vulnerability to contamination is an important tool to fulfil the demands of EU Directives. The purpose of this study is to assess the groundwater vulnerability to contamination related mainly to agricultural activities in a peri-urban area (Vila do Conde, NW Portugal). The hydrogeological framework is characterised mainly by fissured granitic basement and sedimentary cover. Water samples were collected and analysed for temperature, pH, electrical conductivity, chloride, phosphate, nitrate and nitrite. An evaluation of groundwater vulnerability to contamination was applied (GOD-S, Pesticide DRASTIC-Fm, SINTACS and SI) and the potential nitrate contamination risk was assessed, both on a hydrogeological GIS-based mapping. A principal component analysis was performed to characterised patterns of relationship among groundwater contamination, vulnerability, and the hydrogeological setting assessed. Levels of nitrate above legislation limits were detected in 75 % of the samples analysed. Alluvia units showed the highest nitrate concentrations and also the highest vulnerability and risk. Nitrate contamination is a serious problem affecting groundwater, particularly shallow aquifers, especially due to agriculture activities, livestock and cesspools. GIS-based cartography provided an accurate way to improve knowledge on water circulation models and global functioning of local aquifer systems. Finally, this study highlights the adequacy of an integrated approach, combining hydrogeochemical data, vulnerability assessments and multivariate analysis, to understand groundwater processes in peri-urban areas.

Revalorization of spent coffee residues by a direct agronomic approach

Spent coffee grounds (SCG) represent a high-volume food waste worldwide, and several reuse approaches have been attempted. Herein, a greenhouse field experiment was carried out by cultivating Batavia lettuce with 5%, 10%, 15%, 20% and 30% (v/v) espresso SCG directly composted in the soil. Healthy vegetables were obtained for all treatments, without yield loss for up to 10% SCG. A progressive increment of green color intensity with increasing SCG content was observed, corroborated by the increase of their photosynthetic pigments (chlorophylls and carotenoids). Furthermore, total ascorbic acid and tocopherols showed statistical significant increases (p < 0.001) between control and all tested groups. Marked variations of nutritionally relevant minerals, particularly potassium, phosphorous and sodium were also revealed at higher percentage treatments (20% and 30%). This approach constitutes a clean, direct, simple and cost-effective measure to produce value-added vegetables, while reducing food waste disposal.