Relatório de estágio

A unidade curricular Estágio em Enfermagem Médico-Cirúrgica, inserida no Curso de Mestrado em Enfermagem, é composta por três módulos, designadamente, o de cuidados intensivos/intermédios, o opcional e o de serviço de urgência. Relativamente ao módulo cuidados intensivos/intermédios, estagiei na unidade de cuidados intensivos do Hospital Curry Cabral. Desenvolvi competências técnicas, científicas e relacionais na prestação de cuidados especializados ao doente submetido a cirurgia hepatobilio- pancreática, com ventilação mecânica invasiva; divulguei aos enfermeiros escalas de monitorização de dor, enfatizando as estratégias de promoção da avaliação e controlo da dor aguda adoptadas no seio da equipa de enfermagem e, por último, colaborei na formação em serviço através da realização de uma sessão sobre a comunicação de más notícias em saúde. No que concerne ao módulo opcional, estagiei no bloco operatório do Hospital da Luz. No seguimento, prestei cuidados de enfermagem especializados ao doente e sua família, no intra e pós-operatório imediato; e contribui para a melhoria e segurança dos cuidados ao doente através da realização de um plano de integração do enfermeiro de anestesia. A respeito do módulo serviço de urgência, realizei o estágio no Hospital de Santa Maria. Prestei cuidados de enfermagem especializados ao doente e sua família em situação de urgência; contribui para a melhoria e segurança dos cuidados através da elaboração de fichas de procedimentos de enfermagem no serviço de urgência, nomeadamente no que toca a enema de limpeza e drenagem torácica; contribui para a melhoria dos cuidados ao doente através da sensibilização dos enfermeiros para a importância de uma adequada monitorização da dor, destacando a aplicação da escala comportamental da dor no que reporta a doentes em estado crítico. Este relatório faz referência ao processo evolutivo das competências diferenciadas alcançadas ao nível da prestação de cuidados de enfermagem à pessoa adulta, idosa e em situação crítica. Paralelamente, traduz o desenvolvimento de competências não só na concepção e gestão de cuidados, planeamento estratégico, supervisão e formação, como também na capacidade de liderança, com vista a motivar e a orientar a equipa de saúde para a mudança e, consequentemente, para a melhoria contínua da qualidade dos cuidados de enfermagemThe training course on Medical-Nursing, part of the the Master's degree in Nursing, is comprised by three modules, namely, intensive/intermediate care, emergency service and an optional module. Considering the module on intensive/intermediate care, I opted for an internship at the intensive care unit of the Curry Cabral Hospital and set the following objectives: develop technical, scientific and relational competences in the instalment of specialized care to the patients submitted to hepatic-bilious-pancreatic surgery, with invasive ventilation mechanics; publish nurse scales on pain monitorization , with emphasis on strategies for the promotion of the evaluation and control of acute pain taken within a nursing team and, finally, collaborate on in-service training by setting-up a training session on communicating bad news in health. Regarding the optional module, I selected an internship at the operating theatre of the Luz Hospital with the aim to develop the following: provide specialized nursing care to both patient and family, intra and immediate post operation stages; and contribute to the improvement and safety of patient care by elaborating a plan integrating the anaesthesia nurses. Finally, for the emergency room module, I did my internship at the Santa Maria's Hospital, in order to grow on the following internship objectives: provide specialized care to patients and family in an emergency; contribute to the improvement and safety of medical care through the planning of nursing procedures in the emergency service, specific to enema of cleaning and thoracic drainage; improve patient care increasing nurses' awareness towards appropriate monitorization of the pain, in particular the application of the behavioural pain scale for a patient in a critical condition. This report makes reference to the evolutionary process of distinct competences achieved in the delivery of nursing care to an adult, an elderly or a patient in a critical condition. This translates the development of competences not only in the conception and administration of cares, strategic planning, supervision and education, but also the building of leadership skills in order to motivate and guide the health care team to change and therefore seek a continuous improvement of the quality of the nursing practice

Efficacy and Safety of Intravitreal Aflibercept Treat and Extend for Polypoidal Choroidal Vasculopathy in the ATLANTIC Study: A Randomized Clinical Trial

Aflibercept; Efficacy; Polypoidal choroidal vasculopathyAflibercept; Eficacia; Vasculopatía coroidea polipoideaAflibercept; Eficàcia; Vasculopatia coroidal polipoidalImportance: Polypoidal choroidal vasculopathy (PCV) is far less common and studied in a Caucasian population than in an Asian population, and the optimal treatment approach remains to be confirmed. Methods: A 52-week, double-masked, sham-controlled, phase 4, investigator-initiated randomized clinical trial (RCT) in naive symptomatic Caucasian patients with PCV treated with aflibercept in a treat-and-extend regimen (T&E) (intravitreal aflibercept injection [IVAI] T&E). Patients were randomized at week 16 to receive IVAI T&E plus either sham photodynamic therapy (PDT) or standard fluence PDT with verteporfin. The main outcome measures were changes in best-corrected visual acuity (BCVA) from baseline to 52 weeks and polyp occlusion at week 52. Data are presented as median (interquartile range [IQR]) for BCVA, number of IVAI, and change in central retinal thickness (CRT). Results: Of the 50 patients included in the study, 48 patients completed the 52 weeks of follow-up. During this period, a significant median (IQR) BCVA gain of 6 [2–12] Early Treatment Diabetic Retinopathy Study letters was observed for all patients (p < 0.001), after 8 (7–9) injections, with a significant reduction of −93.0 [−154.0, −44.0] µm in central macular thickness (p < 0.001). Using indocyanine green angiography, a complete occlusion of polypoidal lesions was documented in 72% of the cases. Still, no significant difference was detected between the sham PDT and the aflibercept PDT arms, at week 52, for BCVA change (6.5 [2–11] vs. 5 [2–13] letters (p = 0.98)), number of IVAIs (8.5 [7–9] vs. 8 [7–9] (p = 0.21)), change in CRT (−143 [−184; −47] vs. −89 [−123; −41.5] µm [p = 0.23]), and rates of complete polyp occlusion: 77 versus 68% (p = 0.53) or presence of fluid: 68 versus 57% (p = 0.56). No serious ocular adverse events were registered in the 2 arms. Conclusions and Relevance: To our knowledge, this is the first RCT to compare aflibercept T&E monotherapy with aflibercept T&E plus verteporfin PDT in a Caucasian population with PCV. Aflibercept monotherapy in a T&E showed to be effective and safe with a significant median BCVA improvement of 6 letters and a complete occlusion of polypoidal lesions in near 3 quarters of the eyes, at 1 year. As only 22% of the eyes underwent PDT treatment, the benefit of combined treatment for PCV in Caucasian patients could not be definitively elucidated from this study. Trial Registration: The clinical trial was registered in ClinicalTrials.gov Identifier NCT02495181 and the European Union Drug Regulating Authorities Clinical Trials Database EudraCT No. 2015-001368-20.Funding/support: This investigator-initiated study was financially supported by Bayer. Role of the funder/sponsor: Bayer had no role in the design and conduct of the study, collection, management, analysis, and interpretation of the data

Progression of Myopic Maculopathy after Treatment of Choroidal Neovascularization

Purpose: To evaluate the long-term progression of myopic maculopathy and functional outcome after treatment of myopic choroidal neovascularization (CNV) with photodynamic therapy (PDT) and/or intravitreal ranibizumab (IVR). Methods: Retrospective study with a cross-sectional evaluation. Eyes were assigned to 4 groups (PDT, IVR, PDT + IVR, dry myopic maculopathy) and evaluated with best-corrected visual acuity, color fundus photography and spectral-domain optical coherence tomography. Chorioretinal atrophy progression was quantified. Results: Fifty-four eyes were included with a mean follow-up of 80.6 ± 28.0 months. The prevalence of diffuse, patchy and macular atrophy increased during the follow-up, in contrast with tessellated fundus, lacquer cracks and active CNV. Progression of macular atrophy was significant in the 3 treatment groups (p < 0.05) and predictive of visual acuity. It depended on age, degree of myopia and presence of staphyloma, but not on the type of treatment. Conclusions: The long-term functional outcome of eyes with myopic CNV is more dependent on the progression of macular atrophy, and not on the type of treatment

EAIR 41st Annual Forum in Leiden, The Netherlands 25 till 28 August 2019

Trabalho apresentado em EAIR 41st Annual Forum, 25-28 agosto 2019, Leiden, Países Baixos.Polytechnic Institutes in Portugal: research on the impact of twelve institutes on the local economy Higher Education Institutions are recognized as important actors in regional development. The Portuguese higher education system comprises both Universities and Polytechnic Institutes, which face an increasing pressure to demonstrate that their presence has an impact on the surrounding communities contributing to their economic development. This paper presents the estimation of the economic impact of twelve Polytechnic Institutes, located in quite diverse regions, based on a shared model so that comparisons have a collective framework of analysis. The main results obtained show that the economic impact ranged from 1.8% to 10.6% of the local GDP and that these Institutes are major local employers.info:eu-repo/semantics/publishedVersio

Prevalence of Age-Related Macular Degeneration in Europe: The Past and the Future

Purpose Age-related macular degeneration (AMD) is a frequent, complex disorder in elderly of European ancestry. Risk profiles and treatment options have changed considerably over the years, which may have affected disease prevalence and outcome. We determined the prevalence of early and late AMD in Europe from 1990 to 2013 using the European Eye Epidemiology (E3) consortium, and made projections for the future. Design Meta-analysis of prevalence data. Participants A total of 42 080 individuals 40 years of age and older participating in 14 population-based cohorts from 10 countries in Europe. Methods AMD was diagnosed based on fundus photographs using the Rotterdam Classification. Prevalence of early and late AMD was calculated using random-effects meta-analysis stratified for age, birth cohort, gender, geographic region, and time period of the study. Best-corrected visual acuity (BCVA) was compared between late AMD subtypes; geographic atrophy (GA) and choroidal neovascularization (CNV). Main Outcome Measures Prevalence of early and late AMD, BCVA, and number of AMD cases. Results Prevalence of early AMD increased from 3.5% (95% confidence interval [CI] 2.1%–5.0%) in those aged 55–59 years to 17.6% (95%

Investigator-Driven Clinical Research. Imaging biomarkers of progression in Diabetic Retinopathy and Age-Related Macular Degeneration. Contribution for evidence-based clinical eye research.

Tese de doutoramento em Ciências da Saúde (Pré-Bolonha), ramo de Ciências Biomédicas, apresentada à Faculdade de Medicina da Universidade de CoimbraA Investigação Clínica da Iniciativa do Investigador (ICII) desempenha um papel importante na promoção do conhecimento científico tanto na área do diagnóstico como na área das abordagens terapêuticas, contribuindo como tal para a medicina baseada em evidências bem como para a investigação orientada para o doente. A ICII tem como objectivo a identificação de novos biomarcadores e/ou de novas metodologias que permitam a identificação precoce de doentes com maior risco, a melhoria das atuais abordagens diagnósticas e/ou terapêuticas, a melhoria das estratégias de tratamento e/ou acompanhamento dos doentes, bem como a melhoraria da qualidade, acessibilidade e relação custo-eficácia do sistema de saúde. A investigação clínica em ciências da visão representa menos de 5% da investigação clínica realizada em todo o mundo. A Retinopatia Diabética (RD) e a Degenerescência Macular Relacionada com a Idade (DMI) representam cerca de 20% dessa investigação. Estas duas doenças da retina são a principal causa de perda da visão em todo o mundo tendo, como tal, um elevado impacto socioeconômico na população ativa. A detecção precoce da RD e da DMI, bem como a identificação precoce dos doentes que estão em risco de progredir, são portanto grandes desafios da investigação clínica na área das ciências da visão. A identificação e validação de biomarcadores baseados em imagem, capazes de identificar/prever os doentes com maior risco, são assim de grande importância. Nesta tese são apresentados três estudos de ICII que permitiram a caracterização e/ou validação de biomarcadores baseados em imagem como estimadores de risco de progressão da RD e da DMI. O estudo em RD demonstra a existência de três fenótipos diferentes de progressão da RD (fenótipos A, B e C), caracterizados por dois biomarcadores retinianos de progressão da RD, quantificáveis usando técnicas não-invasivas de imagiologia: a presença de edema macular, com base em tomografia de coerência ótica (fenótipo B), e a atividade dos microaneurismas (MA), com base na fotografia do fundo ocular (fenótipo C). Os doentes classificados nos fenótipos B e C apresentam um maior risco de desenvolver Edema Macular Clinicamente Significativo (EMCS). O primeiro estudo de ICII em DMI mostra que, através de imagiologia multimodal, a presença de: áreas hiperfluorescentes em Angiografia de Indocianina Verde (Indocyanine Green Angiography – ICG) nas fases precoces e tardias; áreas hipofluorescentes em ICG nas fases precoces; áreas de derrame identificadas com Retinal Leakage Analyser (RLA); são fatores preditivos para a neovascularização da coróide. No segundo estudo de ICII a prevalência da DMI na região Centro de Portugal foi estimada com base em biomarcadores retinianos obtidos em fotografias do fundo ocular. Este segundo estudo decorreu em duas unidades de cuidados de saúde, o centro de saúde de Mira e a unidade de saúde familiar da Lousã. Os resultados preliminares mostram uma prevalência da DMI tardia inferior ao que esta publicado, ou seja, cerca de 80% da população não tem, ou tem poucas alterações morfológicas (sem drusens ou com drusens < 63 μm de diâmetro), cerca de 19% tem DMI precoce e cerca de 1% tem DMI tardia. Os estudos de ICII apresentados nesta tese demonstram a relevância da ICII para a investigação clínica orientada para o doente bem como a importância dos biomarcadores baseados em imagem para a investigação clínica na área das ciências da visão. Ao classificar os doentes com RD num dos três fenótipos de progressão da RD, podemos identificar precocemente os doentes com maior risco de desenvolver EMCS, bem como, otimizar o acompanhamento clínico desses doentes. A identificação de biomarcadores para a DMI é também um grande desafio. A identificação de lesões da retina e/ou da coróide associadas com um maior risco de conversão é de grande relevância para retardar a perda de visão nos doentes com DMI. Com base nos estudos apresentados, novos estudos de ICII foram desenhados, e com o apoio de uma nova infraestrutura de apoio à ICII, o Centro de Coimbra de Coordenação de Investigação Clínica (4C), foram implementados estudos clínicos multicêntricos a nível europeu, para caracterizar as alterações que ocorrem na retina e/ou coróide nas fases precoces das doenças, e/ou para confirmar os resultados obtidos anteriormente em diferentes populações. A ICII é uma atividade complexa e demorada como tal, para poder promover a ICII foi criada em 2009 com o apoio do Centro Coordenador da rede europeia de centros de investigação clínica em ciências da visão (European Vision Institute Clinical Research network – EVICR. net), a infraestrutura de apoio aos investigadores 4C. A identificação e/ou validação de biomarcadores baseados em imagem na RD e na DMI irá contribuir para a identificação dos doentes em risco, a monitorização da progressão da doença, bem como a avaliação da eficácia de novas abordagens terapêuticas.Investigator-Driven Clinical Research (IDCR) plays a major role, for the promotion of scientific knowledge on diagnostic and/or therapeutic approaches, and for the contribution to evidence-based medicine and to patient-oriented research. IDCR aims to identify new biomarkers, and/or new methodologies, that can allow for an early identification of patients at risk; improve the existing diagnostic and/or therapeutic approaches; improve therapies and patient-care strategies; and improve the quality, accessibility and cost-effectiveness of the health-care system. Clinical eye research represents less than 5% of the clinical research performed worldwide. Diabetic Retinopathy (DR) and Age-Related Macular Degeneration (AMD) represent approximately 20% of the clinical eye research. These two retinal diseases are the major causes of visual impairment and have a high socioeconomic impact in the working population. The early detection of DR and AMD, and the early identification of the patients that are at risk of progression and sight threatening, are therefore major challenges in clinical eye research. The identification and validation of imaging biomarkers, able to predict patients at risk for vision impairment, are therefore of major importance in clinical eye research. In this thesis three IDCR that characterized and/or validated imaging biomarkers as risk estimators of DR and AMD progression are presented. The IDCR on DR demonstrates the existence of 3 different phenotypes of DR progression (phenotypes A, B and C), characterized by two retinal biomarkers of DR progression/worsening, quantifiable using non-invasive imaging techniques (Optical Coherence Tomography – OCT, and Colour Fundus Photography – CFP): the presence of macular edema based on OCT (phenotype B); and the microaneurysms (MA) turnover based on CFP (phenotype C). Patients from phenotypes B and C show a higher risk for the development of Clinically Significant Macular Edema (CSME). The first IDCR on AMD shows, using multimodal imaging, that the presence of early and late Indocyanine Green Angiography (ICG) hyperfluorescent spots, early ICG hypofluorescent spots and leakage detected with Retinal Leakage Analyser (RLA), are predictive factors for the conversion to wet AMD (Choroidal Neovascularization – CNV). In the second IDCR the prevalence of AMD in the Central region of Portugal was estimated using retinal biomarkers assessed on CFP. This second IDCR was conducted in two healthcare units, Mira and Lousã. The preliminary results showed a lower prevalence for the late stage AMD, when compared to other studies, i.e., approximately 80% of the population had no or minimal morphological changes (no drusens or small drusens < 63 µm in diameter), approximately 19% had early AMD and approximately 1% had late AMD. The IDCR presented in this thesis show the relevance of IDCR for patient-oriented research and the importance of imaging biomarkers for evidence-based clinical eye research. By classifying DR patients according to the different phenotypes of DR progression, patients showing a higher risk for CSME development can be identified earlier and followed more closely. The identification of biomarkers for AMD is also a challenging task, with a high impact for the management of AMD patients. The identification of specific retinal and/or choroidal lesions, that are associated with a higher risk of conversion, is of major importance to delay vision loss in these patients. Based on these studies new IDCR were designed, and with the support of the newly created infrastructure for IDCR support, the Coimbra Coordinating Centre for Clinical Research (4C), multicentre IDCR were setup at the European level to characterize more precisely changes occurring in the retina and/or choroid in the early stages of the diseases, and/or to confirm the results obtained previously in different populations. IDCR is a complex and time-consuming activity, and therefore to promote IDCR a new infrastructure was created in 2009 with the collaboration of the Coordinating Centre of the European Vision Institute Clinical Research network (EVICR.net), to support investigators for the different activities involved in clinical research, the 4C. The identification and/or validation of DR and AMD imaging biomarkers will contribute for the identification of the patients at risk, the monitoring of the disease progression, and the assessment of the efficacy of new therapeutic approaches

Relatório final de estágio : escola secundária Infanta D. Maria

Relatório de estágio do mestrado em Ensino da Educação Física nos Ensinos Básico e Secundário, apresentado à Fac. de Ciências do Desporto e Educação Fisica da Univ. de Coimbra.Este documento expõe uma descrição e reflexão, do Estágio Pedagógico, no âmbito do Mestrado em Ensino da Educação Física dos Ensinos Básico e Secundário, da Faculdade de Ciências do Desporto e Educação Física, da Universidade de Coimbra, realizado 3º e 4º semestre, do ano lectivo 2010/2011, na Escola Secundária Infanta D. Maria. A elaboração deste documento tem por objectivo reflectir detalhadamente sobre todo o processo realizado ao longo do ano lectivo e analisar, de forma aprofundada e criteriosa, todos os pormenores deste percurso que consubstancia o Estágio Pedagógico

Teoria, práticas e investigação em intervenção precoce II

O mestrado de Intervenção Precoce da Escola Superior de Educação (ESELx) do Instituto Politécnico de Lisboa apresenta o seu terceiro ebook. Este livro pretende ser uma janela aberta para as dissertações de mestrado e para a investigação desenvolvida pelos seus estudantes no seio dessas teses. Estes trabalhos empíricos são enquadrados por dois artigos de revisão redigidos por convidados que ajudam a traçar o mapa conceptual da prática na intervenção precoce.info:eu-repo/semantics/publishedVersio

Enhanced extraction of ergosterol from Pleurotus ostreatus using response surface methodology (RSM)

Pleurotus ostreatus (Jacq. ex Fr.) P. Kumm., is one of the most widely consumed mushrooms in the world with interesting health-promoting benefits, mainly due to its richness in several bioactive compounds [1]. Mushrooms produce ergosterol as one of their main sterols, which has been considered a contributor to their anti-inflammatory, antioxidant, and antitumor properties [2]. Obtaining an ergosterol enriched extract depends on different variables, such as the extraction method, solvent type, temperature, extraction time, and the solid-liquid ratio [3]. Therefore, it is essential to define the main variables and relevant response criteria to maximize the extraction yield and purity, combining the economic competitivity. In the present work, response surface methodology (RSM) was applied to optimize a heat assisted extraction system (HAE), combining time (t) and temperature (T) effects, and using a circumscribed central composite design (CCCD) for the recovery of ergosterol from the fruiting bodies of P. ostreatus produced with lignocellulose substract. The obtained responses were the quantification of ergosterol by HPLC-UV (Y1: mg of ergosterol per g of extract residue and Y2: mg of ergosterol per 100 g of dry weight mushroom), and the extraction yield (Y3: %). The CCCD consist of 16 response combinations and 4 centre points. Response surface models were fitted by using the following second order polynomial equation. The results obtained showed a significant interaction between the variables. For all the three responses (Y1, Y2, and Y3), the model successfully explained more than 80% variation in the experimental data (i.e. R2˃8). The individual optimum conditions and responses were as follows; Y1 (10 min, 30°C, 57.6 mg/g), Y2 (150 min, 61°C, 246.3 mg/100 g dw), and Y3 (10 min, 80.9°C, 9.3%). The global optimum conditions predicted by the model were: 150 min and 54.3 °C, capable of yielding 7.3 %, 33.3 mg/g and 244.3 mg/100 g dw. The values predicted by the model are in close agreement with the experimental observations with very low residual distribution, proving the validity of the applied model. The results also showed the usefulness of the predictions for future scale up based on the desired responses. The obtained ergosterol enriched extract can be considered as a bioactive ingredient for pharmaceutical, cosmeceutical and nutraceutical purposes.FCT for financial support to CIMO (UID/AGR/00690/2013), M. Carocho (SFRH/BPD/114650/2016) and S. Heleno’s (SFRH/BPD/101413/2014) grants, and L. Barros’ contract; European Agricultural Fund for Rural Development (EAFRD), through the Rural Development Program (PDR2020), within the scope of Project MicoCoating (PDR2020-101-031472); Xunta de Galicia for financial support to M.A. Prieto. This work was also funded by the European Structural and Investment Funds (FEEI) through the Regional Operational Program North 2020, within the scope of ProjectMobilizadorValorNatural®info:eu-repo/semantics/publishedVersio

Age-Related Macular Degeneration Staging by Color Fundus Photography vs. Multimodal Imaging-Epidemiological Implications (The Coimbra Eye Study-Report 6)

Epidemiology of age-related macular degeneration (AMD) is based on staging systems relying on color fundus photography (CFP). We aim to compare AMD staging using CFP to multimodal imaging with optical coherence tomography (OCT), infra-red (IR), and fundus autofluorescence (FAF), in a large cohort from the Epidemiologic AMD Coimbra Eye Study. All imaging exams from the participants of this population-based study were classified by a central reading center. CFP images were graded according to the International Classification and Grading System for AMD and staged with Rotterdam classification. Afterward, CFP images were reviewed with OCT, IR, and FAF and stage update was performed if necessary. Early and late AMD prevalence was compared in a total of 1616 included subjects. In CFP-based grading, the prevalence was 14.11% for early AMD (n = 228) and 1.05% (n = 17) for late AMD, nine cases (0.56%) had neovascular AMD (nAMD) and eight (0.50%) geographic atrophy (GA). Using multimodal grading, the prevalence increased to 14.60% for early AMD (n = 236) and 1.61% (n = 26) for late AMD, with 14 cases (0.87%) of nAMD and 12 (0.74%) of GA. AMD staging was more accurate with the multimodal approach and this was especially relevant for late AMD. We propose that multimodal imaging should be adopted in the future to better estimate and compare epidemiological data in different populations