Gugging Swallowing Screen na avaliação clínica da deglutição

Mestrado em Gestão e Avaliação de Tecnologias em SaúdeA disfagia é um problema comum, que afeta uma percentagem significativa de doentes e pode resultar numa alta incidência de complicações por aspiração. O estudo da deglutição e da eventual disfagia é importante do ponto de vista clínico. O rastreio precoce dos distúrbios da deglutição pode evitar grandes riscos ao doente, como o desenvolvimento de pneumonia, diminuir o tempo de internamento hospitalar e os custos associados. A escala Gugging Swallowing Screen (GUSS) é considerada uma ferramenta promissora para avaliação clínica precoce da deglutição, que avalia o potencial risco de aspiração pulmonar. Objetivo: Esta tese tem como finalidade obter um corpo de evidência científica que reúna um conjunto de informações acerca da utilização da Gugging Swallowing Screen (GUSS) em meio hospitalar e, através desta ferramenta avaliar a prevalência da disfagia assim como os fatores de risco que influenciam a deglutição nos doentes internados no serviço de Medicina de Lagos. Metodologia: O tema abordado baseia-se em dois artigos, sendo um deles uma revisão sistemática da literatura e outro um estudo quantitativo, do tipo prospetivo correlacional, realizado num serviço de medicina. Resultados: Quatro estudos primários evidenciam dados relevantes acerca da utilidade da escala GUSS no âmbito hospitalar. A mesma foi testada numa amostra de 174 indivíduos, dos quais 52,87% não apresentaram disfagia, 14,37% apresentaram disfagia ligeira, 17,24% disfagia moderada e 15,52% disfagia grave. Fatores como sexo, doença oncológica, quadro respiratório, uso de medicamentos, tipo de medicamentos e frequência da medicação não apresentam correlação estatisticamente significativa. Idade, história prévia de disfagia, doença neurológica, doença neuromuscular e comprometimento motor apresentam uma correlação estatisticamente significativa negativa fraca. O nível de consciência apresenta uma correlação estatisticamente negativa e moderada. E a cooperação apresenta uma correlação estatisticamente positiva e moderada. Conclusão: A introdução de novas ferramentas na avaliação clínica da deglutição para despiste de disfagia proporciona uma oportunidade substancial para definir estratégias de melhoria contínua, de forma a reduzir o risco de danos aos doentes internados. Para tal, são necessários mais estudos com a aplicação da mesma ferramenta noutros serviços e hospitais.ABSTRACT - The dysphagia is a common problem which affects a large percentage of patients and may result in high incidents of complications by aspiration. The study of deglutition and of the eventual dysphagia is important from the clinical point of view. The early detection of deglutition disorders can avoid great risks to patients, such as the development of pneumonia, the reduction of hospitalization and its associated costs. The Gugging Swallowing Screen scale (GUSS) is considered a promising tool for early clinical evaluation of deglutition, which assesses the potential risk of pulmonary aspiration. Objective: The aim of this thesis is to obtain a body of scientific evidence, bringing together a range of information about the use of the GUSS methodology in hospitals, and through this tool assess the predominance of dysphagia as well as the factors of risk that influence the deglutition in hospitalized patients in Lagos medical service. Methodology: The analysis of the subject of this thesis is based on two articles. One of them is a systematic literature review, and the other is a quantitative, prospective and correlational study, carried out in a medical service. Results: Four primary studies have shown relevant data on the usefulness of GUSS methodology in hospitals. The GUSS scale was tested in a total of 174 individuals, of whom 52,87% did not present dysphagia, 14,37% presented light dysphagia, 17,24% moderated dysphagia and 15,52% serious dysphagia. Factors such as gender, oncological and respiratory diseases, the use of medicines, the type and frequency of medication do not show statistically significant correlation. Age, previous history of dysphagia, neurological disease, neuromuscular disease and motor impairment, show a weak negative statistically significant correlation. The level of awareness shows a statistically negative and moderate correlation. And the cooperation shows a statistically positive and moderate correlation. Conclusion: The introduction of new tools in the clinical assessment of deglutition for detection of dysphagia provides a substantial opportunity to define strategies for further improvement in order to reduce the risk of damages to hospitalized patients. To do this, more studies are needed using this tool in other services and hospitals.info:eu-repo/semantics/publishedVersio

Trigger Tool na segurança do doente: uma revisão sistemática de literatura

Introdução: A elevada incidência de eventos adversos (EA) é uma das situações preocupantes descritas na literatura sendo relacionada diretamente com o aumento dos custos com a prestação de cuidados de saúde e com o aumento do número de dias de internamento. A metodologia Global Trigger Tool (GTT) é relativamente nova mas tem-se mostrado promissora, em contextos internacionais, em ações de rastreio dos EA. Objetivo: Obter um corpo de evidência, reunindo um conjunto de informações acerca da utilização desta metodologia em contexto hospitalar. Metodologia: Trata-se de uma revisão sistemática da literatura, baseada em estudos primários relacionados com esta temática, publicados entre o ano 2009 e 2014. Resultados: O estudo incluiu 8 estudos primários e os resultados evidenciam dados relevantes acerca da utilidade da ferramenta GTT no âmbito hospitalar. Conclusão: A evidência científica mostra que a aplicação do método GTT, como estratégia de monitorização dos EA, é uma ferramenta viável, uma vez que permite acompanhar a implementação de mudanças orientadas para a redução da ocorrência dos EA.ABSTRACT - Introduction: The high incidence of adverse events (AE) is one of the troubling situations described in the literature that is directly related to the rise of healthcare costs and the days of hospitalization. The Global Trigger Tool (GTT) methodology is relatively new but has shown promising results, in international contexts, by tracking AE actions. Objective: To obtain a body of proof, sets of information relating to the use of this methodology in a hospital setting were gathered. Methodology: This is a systematic review of the literature, based on primary studies of this subject, published between 2009 and 2014. Results: The study includes 8 primary studies and their results show relevant data on the utility of GTT in a hospital setting. Conclusion: The scientific evidence shows that the implementation of the GTT method as an AE monitoring strategy is a viable tool since it allows to follow up the implementation of AE occurrence reduction changes.info:eu-repo/semantics/publishedVersio

An experience with the Global Trigger Tool for the study of adverse events in a medical ward

Background: Health care provision is associated with adverse events (AEs) which harm hospitalized patients. Objectives: To study AEs in a medical ward. Methodology: A quantitative, descriptive, observational and retrospective study was conducted from 1 September 2014 to 31 December 2014 in a medical ward of the Algarve Hospital Center. The instrument used to identify the AEs was the Global Trigger Tool (GTT). All the patients who were discharged between 1 January 2014 and 30 September 2014 were listed. Results: The interrater agreement concerning the AE classification, using the Kappa value, proved to be perfect. A total of 278 triggers were identified, of which 124 resulted in AEs: 44.6% of AEs occurred during the hospitalization, and 9.4% of the patients presented AEs at the moment of admission. We found a total of 62.63 AEs per 1,000 patient days, 137.8 AE per 100 admissions, and one AE in 31.1% of the cases during hospitalization. Conclusion: The GGT proved to be a useful tool to analyze AEs in hospital settings.info:eu-repo/semantics/publishedVersionhttp://creativecommons.org/licenses/by/4.0

Are cyanobacteria a nearly immortal source of high market value compounds?

BACKGROUND: When the human population increases, so does the need to explore a wider range of feedstocks and biomasses, such as cyanobacteria. However, a deeper understanding of the growth patterns and pigment production is required to support the selection of the most beneficial species and conditions for industrial production. The growth and pigment production (i.e., chlorophyll a and C-phycocyanin) of three cyanobacterium species were evaluated following a three-fold aim. The first goal was to compare among a species commonly selected for exploitation (Arthrospira platensis) and two alternative species (Anabaena cylindrica and Nostoc muscorum). The second goal was analyzing pigment production in the long-term. The last goal involved comparing different methods (spectrophotometry and fluorimetry) to understand whether there is an appropriate proxy of biomass increase and pigment production that can be used for monitoring purposes. RESULTS: All species showed high longevity and proved capable of growing for more than 100 days without any additional supplementation. However, the maximum quantum yield of PS II (Fv /Fm) revealed that their photosynthetic efficiency varied over time with a clear decrease after 2 months. Pigment analysis showed a heterogeneous pattern during the growth periods of all three species that could only be captured by the parameter Fv /Fm, but the pattern was only present for A. cylindrica and N. muscorum in some stages of the culture period. CONCLUSION: N. muscorum was found to be the best chlorophyll a and C-phycocyanin producer, with the production peaking for all species at defined time periods within the growth profile. © 2022 The Authors. Journal of Chemical Technology and Biotechnology published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry (SCI).publishe

Bio-based solar energy harvesting for onsite mobile optical temperature sensing in Smart Cities

The Internet of Things (IoT) fosters the development of smart city systems for sustainable living and increases comfort for people. One of the current challenges for sustainable buildings is the optimization of energy management. Temperature monitoring in buildings is of prime importance, as heating account for a great part of the total energy consumption. Here, a solar optical temperature sensor is presented with a thermal sensitivity of up to 1.23% °C-1 based on sustainable aqueous solutions of enhanced green fluorescent protein and C-phycocyanin from biological feedstocks. These photonic sensors are presented under the configuration of luminescent solar concentrators widely proposed as a solution to integrate energy-generating devices in buildings, as windows or façades. The developed mobile sensor is inserted in IoT context through the development of a self-powered system able to measure, record, and send data to a user-friendly website.publishe

SARS-CoV-2 introductions and early dynamics of the epidemic in Portugal

Genomic surveillance of SARS-CoV-2 in Portugal was rapidly implemented by the National Institute of Health in the early stages of the COVID-19 epidemic, in collaboration with more than 50 laboratories distributed nationwide. Methods By applying recent phylodynamic models that allow integration of individual-based travel history, we reconstructed and characterized the spatio-temporal dynamics of SARSCoV-2 introductions and early dissemination in Portugal. Results We detected at least 277 independent SARS-CoV-2 introductions, mostly from European countries (namely the United Kingdom, Spain, France, Italy, and Switzerland), which were consistent with the countries with the highest connectivity with Portugal. Although most introductions were estimated to have occurred during early March 2020, it is likely that SARS-CoV-2 was silently circulating in Portugal throughout February, before the first cases were confirmed. Conclusions Here we conclude that the earlier implementation of measures could have minimized the number of introductions and subsequent virus expansion in Portugal. This study lays the foundation for genomic epidemiology of SARS-CoV-2 in Portugal, and highlights the need for systematic and geographically-representative genomic surveillance.We gratefully acknowledge to Sara Hill and Nuno Faria (University of Oxford) and Joshua Quick and Nick Loman (University of Birmingham) for kindly providing us with the initial sets of Artic Network primers for NGS; Rafael Mamede (MRamirez team, IMM, Lisbon) for developing and sharing a bioinformatics script for sequence curation (https://github.com/rfm-targa/BioinfUtils); Philippe Lemey (KU Leuven) for providing guidance on the implementation of the phylodynamic models; Joshua L. Cherry (National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health) for providing guidance with the subsampling strategies; and all authors, originating and submitting laboratories who have contributed genome data on GISAID (https://www.gisaid.org/) on which part of this research is based. The opinions expressed in this article are those of the authors and do not reflect the view of the National Institutes of Health, the Department of Health and Human Services, or the United States government. This study is co-funded by Fundação para a Ciência e Tecnologia and Agência de Investigação Clínica e Inovação Biomédica (234_596874175) on behalf of the Research 4 COVID-19 call. Some infrastructural resources used in this study come from the GenomePT project (POCI-01-0145-FEDER-022184), supported by COMPETE 2020 - Operational Programme for Competitiveness and Internationalisation (POCI), Lisboa Portugal Regional Operational Programme (Lisboa2020), Algarve Portugal Regional Operational Programme (CRESC Algarve2020), under the PORTUGAL 2020 Partnership Agreement, through the European Regional Development Fund (ERDF), and by Fundação para a Ciência e a Tecnologia (FCT).info:eu-repo/semantics/publishedVersio

Representações dos modelos clássicos militares no rei medieval português

Perante o tema geral que nos foi proposto - «representações do masculino» - o assunto do nosso trabalho constitui um refúgio, uma espécie de santuário. Assim, entrincheiramo-nos na rei militaris, exclusiva do gênero masculino e na representação do rei como paradigma. Rei e reino formam a mesma matéria, construída pela força das armas e garantida na suprema representação dos poderes régios. A imagem do rei medieval português, plena de futuras potencialidades, contém em si o modelo e a substância afirmada na longa evolução das monarquias da Antiguidade

Risk Factor Prevalence in Handball Athletes with and without Overuse Injury History

Handball is a demanding sport with risk of overuse injuries. We aimed to compare scapular motion, the external/internal rotator strength ratio, and shoulder rotator range of motion of handball athletes with and without a history of overuse injury. Cross-sectional data were collected from male handball athletes. The results showed no differences between groups, except for dyskinesia in final assessment position and external rotation range of motion. Scapular dyskinesis prevalence was high in both groups. These findings emphasize the importance of identifying and addressing these risk factors in injury prevention and rehabilitation programs for handball athletes

Experiences with remote communication in adult intensive care units during the COVID-19 pandemic: a systematic review protocol

Objective: The objective of this review is to explore the lived experiences of critically ill adults, their families, or health care professionals with remote communication in intensive care units (ICUs) during the COVID-19 pandemic. Introduction: Family visiting restrictions in ICUs during the COVID-19 pandemic imposed significant challenges to communication between critically ill adults, their families, and the health care team. Evidence shows that several communication strategies were developed and implemented in ICUs during the COVID-19 pandemic to promote family engagement; however, the experiences of critically ill adults, their families, and health care professionals with these strategies are scattered across primary qualitative studies. Inclusion criteria: This review will consider qualitative studies that include critically ill adults, their families, or health care professionals, focusing on their experiences with remote communication strategies in ICUs during the COVID-19 pandemic. Methods: This review will be conducted in accordance with JBI methodology. The search strategy will aim to locate both published and unpublished qualitative studies in English, Spanish, and Portuguese. Studies published after January 2020 will be included. Study selection, critical appraisal, and data extraction will be performed independently by 2 reviewers. Data will be presented in narrative format and synthesized using the JBI meta-aggregation process. A ConQual Summary of Findings will be presentedinfo:eu-repo/semantics/publishedVersio