IMPACTOS DA CIRURGIA ROBÓTICA NA PRÁTICA CLÍNICA

  Robotic surgery has emerged as a significant innovation in modern clinical practice. This article aims to conduct a systematic review of the current medical literature on the impacts of robotic surgery in clinical practice, following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The research was conducted in the databases PubMed, Cochrane, SciELO, and BVS, covering the last five years (2018-2023). The search strategy included terms such as "simulation," "medical education," and "robotic surgical procedures." The results indicate that robotic surgery has shown significant benefits in various aspects. Firstly, surgical precision is notably increased, which contributes to the reduction of intraoperative and postoperative complications. Additionally, patients undergoing robotic procedures tend to have a shorter recovery time, allowing for a quicker return to daily activities. Another relevant point is the improvement in the learning curve of surgeons. The simulation and medical education associated with robotic surgery provide a safer and more controlled training environment, allowing surgeons to develop complex skills more efficiently. It is concluded that robotic surgery represents a significant advancement in surgical practice, offering benefits for both patients and healthcare professionals. Increased precision, reduced complications, and shorter recovery times are some of the main positive points highlighted in recent literature. Furthermore, the improvement in the learning curve of surgeons contributes to the growing adoption of this technology in various surgical procedures.A cirurgia robótica tem se destacado como uma inovação significativa na prática clínica moderna. Este artigo tem por objetivo realizar uma revisão sistemática da literatura médica vigente sobre os impactos da cirurgia robótica na prática clínica, seguindo as diretrizes PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). A pesquisa foi conduzida nas bases de dados PubMed, Cochrane, SciELO e BVS, abrangendo os últimos cinco anos (2018-2023). A estratégia de busca incluiu termos como "simulação", "educação médica" e "procedimentos cirúrgicos robóticos". Os resultados indicam que a cirurgia robótica tem mostrado benefícios significativos em diversos aspectos. Primeiramente, a precisão cirúrgica é notavelmente aumentada, o que contribui para a redução de complicações intraoperatórias e pós-operatórias. Além disso, os pacientes submetidos a procedimentos robóticos tendem a apresentar um tempo de recuperação mais curto, permitindo um retorno mais rápido às atividades diárias. Outro ponto relevante é a melhoria na curva de aprendizado dos cirurgiões. A simulação e a educação médica associadas à cirurgia robótica proporcionam um ambiente de treinamento mais seguro e controlado, permitindo que os cirurgiões desenvolvam habilidades complexas de maneira mais eficiente. Conclui-se que a cirurgia robótica representa um avanço significativo na prática cirúrgica, oferecendo benefícios tanto para os pacientes quanto para os profissionais de saúde. A precisão aumentada, a redução de complicações e o tempo de recuperação mais curto são alguns dos principais pontos positivos destacados na literatura recente. Além disso, a melhoria na curva de aprendizado dos cirurgiões contribui para a adoção crescente dessa tecnologia em diversos procedimentos cirúrgicos

Identification of clusters of asthma control: A preliminary analysis of the inspirers studies

This work was funded by ERDF (European Regional Development Fund) through the operations: POCI- -01-0145-FEDER-029130 (“mINSPIRERS—mHealth to measure and improve adherence to medication in chronic obstructive respiratory diseases - generalisation and evaluation of gamification, peer support and advanced image processing technologies”) co-funded by the COMPETE2020 (Programa Operacional Competitividade e Internacionalização), Portugal 2020 and by Portuguese Funds through FCT (Fundação para a Ciência e a Tecnologia).© 2020, Sociedade Portuguesa de Alergologia e Imunologia Clinica. All rights reserved. Aims: To identify distinct asthma control clusters based on Control of Allergic Rhinitis and Asthma Test (CARAT) and to compare patients’ characteristics among these clusters. Methods: Adults and adolescents (≥13 years) with persistent asthma were recruited at 29 Portuguese hospital outpatient clinics, in the context of two observational studies of the INSPIRERS project. Demographic and clinical characteristics, adherence to inhaled medication, beliefs about inhaled medication, anxiety and depression, quality of life, and asthma control (CARAT, >24 good control) were collected. Hierarchical cluster analysis was performed using CARAT total score (CARAT-T). Results: 410 patients (68% adults), with a median (percentile 25–percentile 75) age of 28 (16-46) years, were analysed. Three clusters were identified [mean CARAT-T (min-max)]: cluster 1 [27(24-30)], cluster 2 [19(14-23)] and cluster 3 [10(2-13)]. Patients in cluster 1 (34%) were characterised by better asthma control, better quality of life, higher inhaler adherence and use of a single inhaler. Patients in clusters 2 (50%) and 3 (16%) had uncontrolled asthma, lower inhaler adherence, more symptoms of anxiety and depression and more than half had at least one exacerbation in the previous year. Further-more, patients in cluster 3 were predominantly female, had more unscheduled medical visits and more anxiety symp-toms, perceived a higher necessity of their prescribed inhalers but also higher levels of concern about taking these inhalers. There were no differences in age, body mass index, lung function, smoking status, hospital admissions or specialist physician follow-up time among the three clusters. Conclusion: An unsupervised method based on CARAT--T, identified 3 clusters of patients with distinct, clinically meaningful characteristics. The cluster with better asthma control had a cut-off similar to the established in the validation study of CARAT and an additional cut-off seems to distinguish more severe disease. Further research is necessary to validate the asthma control clusters identified.publishersversionpublishe

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Melanoma maligno da próstata primário / Primary malignant melanoma of the prostate

Introdução: Descreve-se um caso de melanoma maligno da próstata primário. Será possível compreender que a próstata é um local raro de se encontrar um melanoma maligno primário e que devido a sua infrequência, possui um prognóstico ruim e um difícil diagnóstico. Apresentação do caso: Homem de 66 anos, com quadro típico de neoplasia prostática com alterações tanto na ressonância magnética quanto nos exames laboratoriais. Após a realização da prostatectomia radical videolaparoscópica e estudo histopatológico foi verificado que se tratava de um melanoma primário da próstata. A prostatectomia radical pode ser uma opção de tratamento, apesar dos efeitos colaterais prejudiciais e das poucas chances de cura. O melanoma de origem prostática é um tumor muito agressivo e possui poucos casos relatados.