Accidents and errors in the operating theatre : incidence and mechanisms

RESUMO - Os blocos operatórios têm uma prevalência alta de erros e acidentes. Estes vão desde as interrupções do fluxo cirúrgico, a acidentes minor e eventos catastróficos. O autor revê as áreas de actividade do bloco operatório em que os erros acontecem com mais frequência e identifica os mecanismos e a origem mais comuns — factores humanos e de equipa, factores organizacionais, a complexidade das tarefas, as influências do ambiente e o puro acaso. Os erros típicos e os padrões de erros são revisitados tal como os mecanismos de ocorrência: cirurgia errada, no doente errado, no órgão errado e no lado errado, corpos estranhos deixados, infecção cirúrgica e trombose venosa — embolia pulmonar. As relações mal estabelecidas entre o volume cirúrgico e a performance são discutidas, bem como, as suas complicações. A segurança dos doentes no bloco operatório é um tema actual que recebeu recentemente grande atenção da OMS que o tomou mesmo como prioridade.ABSTRACT - Operation theatres are the health care spots where error and accident prevalence is higher. Those adverse events span from surgical flow interruptions to minor accidents to catastrophic events. The author reviews the activity areas where errors most likely occur and identifies their major determinants and mechanisms — human factors, system factors, team factors, task complexity, ambiance and pure chance. Typical errors and error patterns are revisited, as well as their occurring mechanisms — wrong patient, wrong surgery, wrong organ, wrong side surgeries, unwanted foreign bodies left, surgical infection and deep venous thrombosis plus pulmonary embolism. The unsettled relations between surgical performance and volume load is discussed also. Patient safety in the operating theatre is a most actual topic that recently deserved WHO attention and even became that organization’s priority.info:eu-repo/semantics/publishedVersio

Ordenamento do território e gestão da qualidade

Mestrado em Planeamento Regional e UrbanoO presente trabalho teve como objetivo propor, no quadro de um sistema de gestão da qualidade, uma metodologia para construção de uma estrutura de indicadores relativos a objetivos municipais de ordenamento territorial. Para tal percorreram-se as seguintes etapas, reveladoras da metodologia adotada: Identificação de objetivos do Ordenamento Municipal do Território, com base em legislação e bibliografia de âmbito nacional e europeu, tendo-se chegado a uma lista sistematizada de 27 objetivos gerais, enquadrados em 8 temas. Reunião e confronto, com base em conhecimento erudito, de princípios de Gestão da Qualidade e de conceitos de Monitorização e de Avaliação, estes inerentes às teorias de planeamento do território. Reportaram-se ambos à gestão por processos, incidindo especialmente na matéria relativa a indicadores. Conceção, com base nos conhecimentos adquiridos, de uma estrutura de indicadores para monitorização e avaliação do ordenamento municipal do território. Combinação de indicadores respeitantes ao território com indicadores relativos à ação municipal que visa a transformação desse mesmo território. Início de ensaio, na Câmara Municipal de Coimbra, de aplicação desta estrutura de indicadores a um dos objetivos gerais de ordenamento do território. Foi possível concluir que a proposta encerra forte potencial e grande desafio, podendo contribuir para induzir maior rigor no planeamento de toda a atividade municipal, mas exigindo alterações muito significativas na prática dominante.The present work aims to propose, in the framework of a quality management system, a methodology to construct a structure of indicators related with the municipal goals for the land use planning. With that aim, the following stages, which by themselves reveal the methodology adopted, were pursued: Identification of the goals of the Municipal Land Use Planning based on the National and European legislations and bibliography: 27 general goals were found integrated in 8 different themes. The principles of quality management (included in the NP EN ISO norm 9001) and the concepts of monitoring and assessment (inherent to the theories of land planning) were put together and collated. Both related to a process approach, with special emphasis on the indicators. Based on acknowledge acquired in the previous stage, a structure of indicators for monitoring and assessing the municipal land use planning was built up. Indicators related to the land use were combined with indicators associated to the municipal actions related with the transformation of the land use. Starting of an essay for applying that structure of indicators to one of the general goals of the land use planning of the City Hall of Coimbra. It was possible to conclude that the proposal developed in the present work contains both a strong potential and a great challenge, being able to contribute for introducing a larger degree of accuracy in the municipal activity but requiring very significant changes in the present municipal practices

A Systematic Review and Discussion of the Clinical Potential

Funding Information: Funding by Portuguese Foundation for Science and Technology (FCT-MCTES) under the following projects: PTDC/EMD-EMD/1230/2021—Fluid-structure interaction for functional assessment of ascending aortic aneurysms: a biomechanical-based approach toward clinical practice ; UNIDEMI UIDB/00667/2020; A. Mourato PhD grant UI/BD/151212/2021; R. Valente PhD grant 2022.12223.BD. Publisher Copyright: © 2022 by the authors.Aortic aneurysm is a cardiovascular disease related to the alteration of the aortic tissue. It is an important cause of death in developed countries, especially for older patients. The diagnosis and treatment of such pathology is performed according to guidelines, which suggest surgical or interventional (stenting) procedures for aneurysms with a maximum diameter above a critical threshold. Although conservative, this clinical approach is also not able to predict the risk of acute complications for every patient. In the last decade, there has been growing interest towards the development of advanced in silico aortic models, which may assist in clinical diagnosis, surgical procedure planning or the design and validation of medical devices. This paper details a comprehensive review of computational modelling and simulations of blood vessel interaction in aortic aneurysms and dissection, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). In particular, the following questions are addressed: “What mathematical models were applied to simulate the biomechanical behaviour of healthy and diseased aortas?” and “Why are these models not clinically implemented?”. Contemporary evidence proves that computational models are able to provide clinicians with additional, otherwise unavailable in vivo data and potentially identify patients who may benefit from earlier treatment. Notwithstanding the above, these tools are still not widely implemented, primarily due to low accuracy, an extensive reporting time and lack of numerical validation.publishersversionpublishe

Psychometric properties of the Portuguese version of the Kansas City Cardiomyopathy Questionnaire in dilated cardiomyopathy with congestive heart failure

Vários estudos demonstraram que os doentes com insuficiência cardíaca congestiva (ICC) têm um compromisso da qualidade de vida relacionada com a saúde (QVRS), tendo esta, nos últimos anos, vindo a tornar-se um endpoint primário quando se analisa o impacto do tratamento de situações crónicas como a ICC. Objectivos: Avaliar as propriedades psicométricas da versão portuguesa de um novo instrumento específico para medir a QVRS na ICC em doentes hospitalizados: o Kansas City Cardiomyopathy Questionnaire (KCCQ). População e Métodos: O KCCQ foi aplicado a uma amostra consecutiva de 193 doentes internados por ICC. Destes, 105 repetiram esta avaliação 3 meses após admissão hospitalar, não havendo eventos ocorridos durante este período de tempo. A idade era 64,4± 12,4 anos (entre 21 e 88), com 72,5% a pertencer ao sexo masculino, sendo a ICC de etiologia isquémica em 42%. Resultados: Esta versão do KCCQ foi sujeita a validação estatística semelhante à americana com a avaliação da fidelidade e validade. A fidelidade foi avaliada pela consistência interna dos domínios e dos somatórios, apresentando valores Alpha de Cronbach idênticos nos vários domínios e somatórios ( =0,50 a =0,94). A validade foi analisada pela convergência, pela sensibilidade às diferenças entre grupos e pela sensibilidade à alteração da condição clínica. Avaliou-se a validade convergente de todos os domínios relacionados com funcionalidade, pela relação verificada entre estes e uma medida de funcionalidade, a classificação da New York Heart Association (NYHA), tendo-se verificado correlações significativas (p<0,01), como medida para avaliar a funcionalidade em doentes com ICC. Efectuou-se uma análise de variância entre o domínio limitação física, os somatórios e as classes da NYHA, tendo-se encontrado diferenças estatisticamente significativas (F=23,4; F=36,4; F=37,4; p=0,0001), na capacidade de descriminação da gravidade da condição clínica. Foi realizada uma segunda avaliação em 105 doentes na consulta do 3º mês após a intervenção clínica, tendo-se observado alterações significativas nas médias dos domínios avaliados entre o internamento e a consulta (diferenças de 14,9 a 30,6 numa escala de 0-100), indicando que os domínios avaliados são sensíveis à mudança da condição clínica. A correlação interdimensões da qualidade de vida que compõe este instrumento é moderada, sugerindo dimensões independentes, apoiando a sua estrutura multifactorial e a adequabilidade desta medida para a sua avaliação. Conclusão: O KCCQ é um instrumento válido, sensível à mudança e específico para medir a QVRS numa população portuguesa com miocardiopatia dilatada e ICC. ABSTRACT - Several studies have shown that patients with congestive heart failure (CHF) have a compromised health-related quality of life (HRQL), and this, in recent years, has become a primary endpoint when considering the impact of treatment of chronic conditions such as CHF. Objectives: To evaluate the psychometric properties of the Portuguese version of a new specific instrument to measure HRQL in patients hospitalized for CHF: the Kansas City Cardiomyopathy Questionnaire (KCCQ). Methods: The KCCQ was applied to a sample of 193 consecutive patients hospitalized for CHF. Of these, 105 repeated the assessment 3 months after admission, with no events during this period. Mean age was 64.4±12.4 years (21-88), and 72.5% were 72.5% male. CHF was of ischemic etiology in 42% of cases. Results: This version of the KCCQ was subjected to statistical validation, with assessment of reliability and validity, similar to the American version. Reliability was assessed by the internal consistency of the domains and summary scores, which showed similar values of Cronbach alpha (0.50-0.94). Validity was assessed by convergence, sensitivity to differences between groups and sensitivity to changes in clinical condition. We evaluated the convergent validity of all domains related to functionality, through the relationship between them and a measure of functionality, the New York Heart Association (NYHA) classification. Significant correlations were found (p<0.01) for this measure of functionality in patients with CHF. Analysis of variance between the physical limitation domain, the summary scores and NYHA class was performed and statistically significant differences were found (F=23.4; F=36.4; F=37.4, p=0.0001) in the ability to discriminate severity of clinical condition. A second evaluation was performed on 105 patients at the 3-month follow-up outpatient appointment, and significant changes were observed in the mean scores of the domains assessed between hospital admission and the clinic appointment (differences from 14.9 to 30.6 on a scale of 0-100), indicating that the domains assessed are sensitive to changes in clinical condition. The correlation between dimensions of quality of life in the KCCQ is moderate, suggesting that the dimensions are independent, supporting the multifactorial nature of HRQL and the suitability of this measure for its evaluation. Conclusion: The KCCQ is a valid instrument, sensitive to change and a specific measure of HRQL in a population with dilated cardiomyopathy and CHF

Image Analysis System for Early Detection of Cardiothoracic Surgery Wound Alterations Based on Artificial Intelligence Models

Funding Information: This work is part of a research project funded by Fundação para a Ciência e Tecnologia, which aims to design and implement a post-surgical digital telemonitoring service for cardiothoracic surgery patients. The main goals of the research project are: to study the impact of daily telemonitoring on early diagnosis, to reduce hospital readmissions, and to improve patient safety, during the 30-day period after hospital discharge. This remote follow-up involves a digital remote patient monitoring kit which includes a sphygmomanometer, a scale, a smartwatch, and a smartphone, allowing daily patient data collection. One of the daily outcomes was the daily photographs taken by patients regarding surgical wounds. Every day, the clinical team had to analyze the image of each patient, which could take a long time. The automatic analysis of these images would allow implementing an alert related to the detection of wound modifications that could represent a risk of infection. Such an alert would spare time for the clinical team in follow-up care. Funding Information: This research has been supported by Fundação para a Ciência e Tecnologia (FCT) under CardioFollow.AI project (DSAIPA/AI/0094/2020), Lisboa-05-3559-FSE-000003 and UIDB/04559/2020. Publisher Copyright: © 2023 by the authors.Cardiothoracic surgery patients have the risk of developing surgical site infections which cause hospital readmissions, increase healthcare costs, and may lead to mortality. This work aims to tackle the problem of surgical site infections by predicting the existence of worrying alterations in wound images with a wound image analysis system based on artificial intelligence. The developed system comprises a deep learning segmentation model (MobileNet-Unet), which detects the wound region area and categorizes the wound type (chest, drain, and leg), and a machine learning classification model, which predicts the occurrence of wound alterations (random forest, support vector machine and k-nearest neighbors for chest, drain, and leg, respectively). The deep learning model segments the image and assigns the wound type. Then, the machine learning models classify the images from a group of color and textural features extracted from the output region of interest to feed one of the three wound-type classifiers that reach the final binary decision of wound alteration. The segmentation model achieved a mean Intersection over Union of 89.9% and a mean average precision of 90.1%. Separating the final classification into different classifiers was more effective than a single classifier for all the wound types. The leg wound classifier exhibited the best results with an 87.6% recall and 52.6% precision.publishersversionpublishe

A Systematic Review

Funding Information: Portuguese Foundation for Science and Technology (FCT-MCTES): Fluid-structure interaction for functional assessment of ascending aortic aneurysms: a biomechanical-based approach toward clinical practice (AneurysmTool)\u2014https://doi.org/10.54499/PTDC/EMD-EMD/1230/2021 accessed on 17 July 2024; UNIDEMI.UIDB/00667/2020 and UNIDEMI.UIDP/00667/2020; R. Valente Ph.D. grant 2022.12223.BD; A. Mourato Ph.D. grant UI/BD/151212/2021. Publisher Copyright: © 2024 by the authors.Experimental protocols are fundamental for quantifying the mechanical behaviour of soft tissue. These data are crucial for advancing the understanding of soft tissue mechanics, developing and calibrating constitutive models, and informing the development of more accurate and predictive computational simulations and artificial intelligence tools. This paper offers a comprehensive review of experimental tests conducted on soft aortic tissues, employing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology, based on the Scopus, Web of Science, IEEE, Google Scholar and PubMed databases. This study includes a detailed overview of the test method protocols, providing insights into practical methodologies, specimen preparation and full-field measurements. The review also briefly discusses the post-processing methods applied to extract material parameters from experimental data. In particular, the results are analysed and discussed providing representative domains of stress–strain curves for both uniaxial and biaxial tests on human aortic tissue.publishersversionpublishe

Chemical Composition and Optimization of Liquefaction Parameters of Cytisus scoparius (Broom)

Invasive plants spread in such a way that they are threats to native species and to biodiversity. In this context, this work aims to determine possible valorizations of Scotch Broom Cytisus scoparius (L.) Link. This species harvested in the Viseu region was used in the present study. The eco-valorization of these renewable resources was made by conversion into liquid mixtures that can later be used in the manufacture of valuable products. For a better understanding of the results obtained, a chemical characterization of the Cytisus scoparius branches (CsB) was made. The ash content, extractives in dichloromethane, ethanol and water, lignin, cellulose and hemicellulose of the initial material were determined. Liquefaction was made in a reactor with different granulometry, temperatures and time. Results show that Broom is mainly composed of cellulose (36.1%), hemicelluloses (18.6%) and lignin (14.6%) with extractives mainly soluble in ethanol, followed by water and a small amount in dichloromethane. Ashes were around 0.69%, mainly composed of potassium and calcium. Generally, smaller size, higher solvent ratio, higher temperature and higher time of liquefaction lead to higher liquefaction. The highest percentage of liquefaction was 95% which is better than most of the lignocellulosic materials tested before.info:eu-repo/semantics/publishedVersio

Chapala (Jalisco) (Lago). Hidrología. Planos. 1815

En la misma colección se conserva otro original de mayor tamaño (Manso Porto, Cartografía histórica de América, nº 55. Sign. C-I a 1 p) y una copia de éstos (Ibid., nº 57. Sign. C-I a 6 p)En el ángulo superior izquierdo inserta: [Vista de las islas de Mexcala y Chica]. Escala indeterminada. Nota: "Así aparese la Ysla de Mescala vista al O.S.O. en toda su longitud, teniendo de altura perpendicular en la línea A B. Sobre la superficie del agua 65 varas castellanas"Al verso anotado a lápiz: "Nº 40"Escala gráfica [ca. 1:116.100] también expresada en 500 (sic) varas castellanas igual a una legua de las usuales en el Reino [= 3,6 cm]Copia Digital. Real Academia de la Historia : 2010Forma de ingreso: Donado a la RAH por su correspondiente Fernando de Gabriel y Ruiz de Apodaca (Memorias de la RAH, t. X, 1886, nº 40, p. 845)Nota en el campamento de Tlachichilco: "Su latitud p.r alturas meridianas del O. 20º 20' 21''N ". Orientado con media lis en cuadrante. Relieve por sombreado. Sondas batimétricas. Toponimia de puertos, bocas, islas, etc. Se indica la profundidad de todas las aguas del lago. En el ángulo inferior izquierdo, cartela rectangular con título, menciones de responsabilidad, escala y nota: "Los números de sonda son brazas de 2 v[ara]s castell[ana]s cada una, reducidas a la menor agua que tubo el lago en los meses de Maio y Junio del presente año"Manuscrito firmado por el alférez de fragata José Narváez en 1815 por orden del general José de la CruzManuscrito dibujado a plumilla en tinta de bugalla, iluminado a la aguada en verde y gris. Leves roturas en los bordes. Realizado en dos papeles unidos con col

Influence of Pre-Hydrolysis on the Chemical Composition of Prunus avium Cherry Seeds

During the industrial processing of sweet cherry fruits, the seeds are considered agricultural waste and must be disposed of, typically through burning. In this context, it is intended to contribute to the scientific development of the ecovalorization of by-products and to provide new strategies for their transformation into value-added products obtained from sweet cherry seeds (SCS). This work aimed to establish the chemical characterization of SCS before and after several pre-hydrolysis steps in order to allow the solubilization of hemicelluloses that can later be used for the recovery of sugars. The higher percentage of cellulose and lignin remaining in the solid phase will allow its further processing for an integral valorization of the raw material. The temperature (160 and 170 °C) and time (0 and 180 min) of pre-hydrolysis were optimized to obtain the best liquefaction. The percentage of liquefied material was determined from the solid waste obtained at the time of filtration. The best liquefaction by the hydrolysis of SCS was obtained at 170 °C and 180 min, with a yield of 26.7%. The chemical analyses of SCS throughout hydrolysis showed the solubilization of hemicelluloses with increases in the time and temperature of the reactor. α-cellulose and lignin showed an increase both with temperature and time, increasing the material’s potential for further processing in adhesives. FTIR analysis showed that there were significant changes in the spectra between the initial SCS, the solid residue, and the liquefied material. Pre-hydrolysis was proven to be an efficient process to improve the chemical composition of the material for further processing into adhesives or higher-mechanical-strength polyurethane foamsinfo:eu-repo/semantics/publishedVersio