When Does Quality of Life Improve After Liver Transplantation? A Longitudinal Prospective Study

OBJECTIVES: We sought to investigate the improvement in quality of life (mental and physical components) at 1 and 6 months after liver transplantation. METHODS: A sample of liver transplant candidates (n = 60), comprising consecutive patients attending outpatient clinics of a liver transplantation central unit (25% of the patients had familial amyloid polyneuropathy [FAP] and the remaining patents had chronic liver diseases), was assessed by means of the Short Form (SF)-36, Portuguese-validated version, a self-rating questionnaire developed by the Medical Outcome Trust, to investigate certain primary aspects of quality of life, at 3 times: before, and at 1 and 6 months after transplantation. RESULTS: We observed a significant improvement in quality of life (both mental and physical components) by 1 month after transplantation. Between the first month and the sixth month after transplantation, there also was an improvement in the quality of life (both mental and physical components), although only the physical components of quality of life was significantly improved. CONCLUSIONS: Our findings suggested that quality of life improved early after liver transplantation (1 month). Between the first and the sixth months, there only was a significant improvement in the physical quality of life.

Psychosocial Determinants of Quality of Life 6 Months After Transplantation: Longitudinal Prospective Study

OBJECTIVES: We sought to investigate the psychosocial determinants of quality of life at 6 months after transplantation. METHODS: A sample of liver transplant candidates (n = 60), composed of consecutive patients (25% with familial amyloid polyneuropathy [FAP]) attending outpatient clinics was assessed in the pretransplant period using the Neo Five Factor Inventory, Hospital Anxiety and depression Scale (HADS), Brief COPE, and SF-36, a quality-of-life, self-rating questionnaire. Six months after transplantation, these patients were assessed by means of the SF-36. RESULTS: Psychosocial predictors where found by means of multiple regression analysis. The physical component of quality of life at 6 months after transplantation was determined based upon coping strategies and physical quality of life in the pretransplant period (this model explained 32% of variance). The mental component at 6 months after transplantation was determined by depression in the pretransplant period and by clinical diagnoses of patients. Because FAP patients show a lower mental component of quality of life, this diagnosis explained 25% of the variance. CONCLUSIONS: Our findings suggested that coping strategies and depression measured in the pretransplant period are important determinants of quality of life at 6 months after liver transplantation.

Impact of Syncope on Quality of Life: Validation of a Measure in Patients Undergoing Tilt Testing

INTRODUCTION AND OBJECTIVES: Recurrent syncope has a significant impact on quality of life. The development of measurement scales to assess this impact that are easy to use in clinical settings is crucial. The objective of the present study is a preliminary validation of the Impact of Syncope on Quality of Life questionnaire for the Portuguese population. METHODS: The instrument underwent a process of translation, validation, analysis of cultural appropriateness and cognitive debriefing. A population of 39 patients with a history of recurrent syncope (>1 year) who underwent tilt testing, aged 52.1 ± 16.4 years (21-83), 43.5% male, most in active employment (n=18) or retired (n=13), constituted a convenience sample. The resulting Portuguese version is similar to the original, with 12 items in a single aggregate score, and underwent statistical validation, with assessment of reliability, validity and stability over time. RESULTS: With regard to reliability, the internal consistency of the scale is 0.9. Assessment of convergent and discriminant validity showed statistically significant results (p<0.01). Regarding stability over time, a test-retest of this instrument at six months after tilt testing with 22 patients of the sample who had not undergone any clinical intervention found no statistically significant changes in quality of life. CONCLUSIONS: The results indicate that this instrument is of value for assessing quality of life in patients with recurrent syncope in Portugal.

Organizational culture influence on information quality - use of business intelligence systems relationship: portuguese context

Dissertação apresentada como requisito parcial para obtenção do grau de Mestre em Estatística e Gestão de Informação

Health-Related Quality of Life Impact of a Triple Combination of Olmesartan Medoxomil, Amlodipine Besylate and Hydrochlorotiazide in Subjects with Hypertension

BACKGROUND: A post-hoc analysis was performed on the data from a 54 weeks phase III study (ClinicalTrials.gov identifier: NCT00923091) to measure changes in the health-related quality of life (HRQoL) of 2,690 patients aged ≥18 with moderate-to-severe hypertension who received one of six doses of olmesartan/amlodipine/hydrochlorothiazide (OLM/AML/HCTZ), using the MINICHAL and EQ-5D instruments. METHODS: Descriptive statistics were used to assess blood pressure and HRQoL scores over the study period. Analysis of covariance (ANCOVA) was used to identify those factors that could possibly have influenced HRQoL. Linear regression was used to assess the relationship between changes in blood pressure and HRQoL scores. RESULTS: Patients' baseline MINICHAL mood and somatic domains scores were 5.5 and 2.6. Over the study period HRQoL improved as both MINICHAL scores decreased by 31-33%. Patients' baseline EQ-5D index and VAS scores were 0.9 and 73.4 respectively, increasing by 6% and 12% over the study period. Patients' QALY gain over the 54 weeks study period was estimated to be 0.029 QALYs. The ANCOVA showed that changes in patients' HRQoL was likely to have been influenced by patients' achievement of blood pressure control, the amount of concomitant medication and patients' last used dosage strength of antihypertensive. Linear regression showed that blood pressure improvement may have been associated with improved HRQoL. CONCLUSIONS: This study showed that OLM/AML/HCTZ reduced blood pressure and significantly increased blood pressure control whilst improving patients' HRQoL. Achieving blood pressure control, amount of concomitant medication and dosage strength of antihypertensive impacted on patients' HRQoL.

Strategic Noise Mapping with GIS for the Universitat Jaume I Smart Campus: best methodology practices

Dissertation submitted in partial fulfillment of the requirements for the Degree of Master of Science in Geospatial Technologies.

Reclamações : a sua importância nas unidades de saúde privadas : um estudo de caso

RESUMO - O sector privado da saúde tem registado um forte crescimento em Portugal. Como principais factores apontam-se a crescente preocupação dos indivíduos com a sua saúde, o aumento do poder de compra, a possibilidade de exercer a escolha do seu prestador de cuidados, o maior conforto proporcionado no consumo de cuidados de saúde e o acesso mais rápido a esses cuidados (por comparação com o serviço público). Em consequência desses factores, existe por parte da instituição privada de saúde a necessidade de apostar num sistema de gestão de reclamações capaz de dar uma resposta rápida às necessidades, expectativas e preferências do indivíduo enquanto doente e cliente. Nesse âmbito, desenvolveu-se um estudo de investigação qualitativo. Recorreu-se à realização de entrevistas semi-estruturadas cujo tratamento foi submetido à técnica de análise de conteúdo. Procurou-se perceber o que pensam os responsáveis pela gestão e tratamento das reclamações acerca da importância do circuito de reclamação, da utilização das reclamações como uma ferramenta de gestão e qual o seu impacto na estratégia da instituição privada de saúde. Dos resultados obtidos, verifica-se que, à data, dá-se ainda pouca relevância a este tema, observando-se falhas a nível do circuito de reclamação. Hoje, a reclamação é ainda pouco utilizada e perspectivada como uma ferramenta de gestão. O seu impacto na estratégia da instituição, apesar de ser relevante, tem potencial para ser melhorado, na perspectiva da learning organization. Seria importante articular as estratégias de qualidade, com a formação dos profissionais na área da reclamação, implementação ou melhoria dos instrumentos utilizados nas respostas ao cliente e à entidade reguladora do sector, bem como com o redesenho do circuito do sistema de informação nesta área.

Neuropsychiatric Questionnaires in Systemic Lupus Erythematosus

Patients with systemic lupus erythematosus (SLE) can be affected by a multitude of neurologic and psychiatric symptoms with a wide range of prevalence and severity. Irrespectively from attribution to SLE or other causes, neuropsychiatric (NP) symptoms strongly impact short-term and long-term outcomes,thus NP evaluation during routine clinical practice in SLE should be undertaken regularly. The assessment of NP involvement in SLE patients is challenging and the available diagnostic tools fail to guarantee optimal diagnostic accuracy, sensitivity to changes as well as feasibility in routine clinical care. Standardised questionnaires (both physician-administered and self-reported) can offer valuable help to the treating physician to capture all possible NP syndromes; few SLE-specific NP questionnaire have been developed but validation in large cohort or cross-cultural adaptations are still pending. On the other hand, general instruments have been largely applied to SLE patients. Both kinds of questionnaires can address all possible NP manifestations either globally or, more frequently, focus on specific NP symptoms. These latter have been mainly used in SLE to detect and classify mild and subtle symptoms, more likely to be overlooked during routine clinical assessment such as headache, cognitive impairment and psychiatric manifestations. In conclusion, this literature review highlights a clear case for validation studies in this area and the wider implementation of questionnaires to assess NP involvement is still warranted. The broader use of such instruments could have important consequences; first of all, by standardising symptom assessment, a better definition of the prevalence of NP manifestation across different centres could be achieved. Secondly, prospective studies could allow for the evaluation of clinical significance of mild symptoms and their impact on the patient’s function and quality of life.

Time diversity solutions to cope with lost packets

A dissertation submitted to Departamento de Engenharia Electrotécnica of Faculdade de Ciências e Tecnologia of Universidade Nova de Lisboa in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Engenharia Electrotécnica e de Computadores

Marketing plan for Gazela

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA – School of Business and Economics

Development and Characterization of bioactive, edible whey protein films and coatings to improve quality and safety of Food products

Dissertação para a obtenção de grau de doutor em Ciências da Engenharia e Tecnologia

Effectiveness of online marketing tools

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA – School of Business and Economics

Gas emissions on rice culture and its importance on air quality

Dissertação para obtenção do Grau de Mestre em Engenharia do Ambiente Perfil Gestão de Sistemas Ambientais

Implementing quality management systems in small and medium construction companies: a contribution to a road map for success

Leadership and Management in Engineering, January 2009

Fatores explicativos dos resultados obtidos na medida de independência funcional aplicada a doentes com lesão neurológica

RESUMO - A medicina baseada na evidência e as iniciativas para melhorar a qualidade dos cuidados de saúde, têm aumentado bem como o reconhecimento da necessidade de medir os resultados funcionais em todos os cuidados de saúde. A reabilitação tem dado grande importância à necessidade de existência de instrumentos clínicos sensíveis aos resultados funcionais e, tem procurado instrumentos que possam ser usados em ambientes clínicos. A doença cérebro-vascular não é uma entidade patológica ou clínica única, podendo apresentar-se segundo quadros clínicos distintos. É uma ameaça à qualidade de vida não só pela sua elevada incidência e mortalidade, mas também pela alta morbilidade. Considerando estas premissas, pretendeu-se estudar a influência das características individuais, demográficas e de prognóstico neurológico dos doentes em reabilitação nas avaliações de funcionalidade. Utilizou-se a base de dados do Centro de Medicina de Reabilitação de Alcoitão, com todos os episódios de internamento de adultos (2647) que ocorreram entre 2006 e 2011, avaliados com a Medida de Independência Funcional (MIF). Este estudo revela que as variáveis com maior impacto na MIF, quer ao nível do score motor quer no score cognitivo são: a idade, o tempo de evolução e o tempo de internamento. A MIF não apresenta grandes variações entre grupos de diagnóstico no score motor mas releva valores estatisticamente significativos, no que diz respeito a esta variável, ao nível do score cognitivo. Os resultados deste estudo suportam ainda a validade da escala de avaliação e sugerem que esta fornece informações fundamentais para um bom programa de reabilitação.