Conflito femoro-acetabular

Trabalho de projecto de mestrado em Medicina (Ortopedia), apresentado à Faculdade de Medicina da Universidade de CoimbraO conflito femoro-acetabular é um problema dinâmico. Trata-se de uma condição patológica da anca, em adultos jovens e activos, provocada pelo contacto repetitivo do fémur proximal com o limite do acetábulo, que poderá conduzir ao estabelecimento precoce de artrite degenerativa e, consequentemente, a uma coxartrose. São descritos dois tipos de mecanismos diferentes subjacentes à sua patogenia: o mecanismo cam e o mecanismo pinça (tenaz), que poderão encontrar-se associados (tipo misto). O mecanismo tipo cam é provocado pela colisão de uma cabeça femoral anormal, com um raio de curvatura aumentado, com o acetábulo, mais frequentemente, no seu limite anterosuperior, durante um movimento forçado, nomeadamente, a flexão da anca e a rotação interna. Como consequência do movimento repetido desta, pode desenvolver-se um desgaste excessivo do labrum e da cartilagem acetabular adjacente. O mecanismo tipo pinça (tenaz), ocorre pelo contacto repetido entre uma junção cabeça-colo femoral normal e um acetábulo que recobre excessivamente a cabeça do fémur. Em resultado disto, pode desenvolver-se uma degeneração do labrum acetabular, formação de quistos sinoviais do colo femoral, ossificação heterotópica do rebordo acetabular e aprofundamento do acetábulo. A dor localizada na região inguinal representa a principal queixa clínica. Atinge, na maioria dos casos, o adulto jovem e activo, tem um início insidioso e é do tipo mecânico. Com os progressos alcançados no exame clínico e nos exames imagiológicos (radiografia, ressonância magnética, TC) o diagnóstico de conflito femoro-acetabular é estabelecido cada vez mais cedo. A abordagem terapêutica de eleição é a intervenção cirúrgica efectuada por via aberta ou artroscópica, incluindo a exploração artroscópica modificada (Heuter). Com a intervenção cirúrgica pretende-se o alívio sintomático, bem como o aumento da amplitude dos movimentos da anca, através do alívio da zona de contacto entre o fémur e o limite acetabular. Ao longo deste trabalho, procede-se a uma revisão bibliográfica sobre o conflito femoro-acetabular no que diz respeito à anatomia, etiopatogenia, clínica, meios complementares de diagnóstico, diagnóstico, tratamento, e bem assim como as suas indicações e prognóstico, tendo por base de estudo as mais recentes revistas da EspecialidadeFemoro-acetabular conflict is a dynamic problem. It is a pathological condition of the hip, in young and active adults, caused by the repetitive contact between the proximal femur and the acetabular rim, which can lead to an early establishment of degenerative arthritis and, consequently, to an hip osteoarthritis. There are two different types of pathological mechanisms described: type cam and type pincer, which can coexist. Cam mechanism is caused by the collision between an abnormal femoral head (with an increased radius) and the acetabulum, more frequently in its anterior superior limit, during a forceful movement, which is the case of the hip flexion and internal rotation. As a consequence of this repeated movement, an excessive abrasion of the labrum and adjacent acetabular cartilage will be developed. The pincer mechanism, develops through a repeated contact between a normal head-neck femoral junction and an acetabulum that covers excessively the femoral head. As a result, it may develop a degeneration of the labrum, intrasubstance ganglion formation, heterotopic ossification of the acetabular rim and deepening of the acetabulum. A groin pain represents the main clinical complaint. It happens, most frequently, in young and active adults, with an insidious onset, and it has mechanical characteristics. With the improvement of clinical examination of the hip and of the radiological imaging (X-ray, magnetic resonance, computed tomograms scans), femoro-acetabular impingement’s diagnosis is achieved earlier. The gold standard approach is the surgical intervention, with open or arthroscopic management, including the modified arthroscopic exploration (Heuter). With surgical’s intervention the goal is pain relief, as well as the improvement of the hip’s movements amplitude, through the reduction of contact between the femur and the limit of the acetabulum. A bibliographic review of the hip’s anatomy, etiopathogenesis, clinical aspects, complementary exams, diagnosis, treatment, as so their guidelines, and the prognosis of this entity, will be made in this article, according to the most recent and up to date specialty’s magazines

Robotic process automation framework - The implementation of Robotic Process Automation in Business Processing Outsourcing Organizations

Dissertation presented as the partial requirement for obtaining a Master's degree in Statistics and Information Management, specialization in Marketing Research and CRMDigital transformation is the digitalization of earlier analogue machine and material processes, service operations, and organizational tasks to aggregate new value for clients and employees. There is an increasing number of organizations that are taking advantage of digital transformation, competing in the market of the digital economy. The advances of the global market in competitiveness trigger organizations whose ambition is to distinguish themselves to develop more efficient and effective processes, delivering distinctive services or products to their consumers. When the Business Process Outsourcing (BPO) processes are automated with Robot Process Automated (RPA), the organization can raise cost efficiency, acquire efficiency advantages, and increase their rank in the market. Additionally, when repetitive and tedious activities are automated, human employees have time and opportunity to enhance their cognitive judgment, creative thinking, and social skills. This research approaches the steps that lead to the elaboration of a framework that can be adopted in BPO processes, aiming to help in the knowledge of which processes are typical in BPO, and which of those processes can be fully automated, semi-automated or cannot be automated with Robotic Processing Outsourcing. Afterwards, are revealed the assumptions that were the base of the artifact elaboration, following the description of each component and stage that constitute the framework. Lastly, it is referred the validation of the framework by experts and the discussion of the obtained results, conclude the utility of the artifact as support to the automation of BPO with RPA

Protective equipment applicable to a centralized cytostatic preparation unit

Occupational exposure to cytotoxic agents has been recognized as a potential danger to the health of handlers. However, collective and individual protection equipment has been developed for use by professionals. This article aims to identify and describe the protection equipment applicable to a centralized unit of cytostatics preparation, using a qualitative and quantitative descriptive analysis. A questionnaire survey yielded 83 responses, covering 18 centralized cytostatic preparation units. The results show some weaknesses detected in some institutions such as the absence of a shower and eyewash fountain, the lack of knowledge about the procedures manual, and the use of a surgical mask. However, the results point to awareness by the general manipulators regarding the use of some personal protective equipment. This study contributes to the investigation of the use of equipment for the protection of cytostatic manipulators at work in centralized cytostatic preparation units.The authors are grateful to the Foundation for Science and Technology (FCT, Portugal) for financial support by national funds FCT/MCTES to UNIAG, under Project no. UIDB/04752/2020.info:eu-repo/semantics/publishedVersio

Qualidade de vida no trabalho nos serviços de maior turnover do Hospital Nossa Senhora do Rosário, E.P.E.

O desempenho de uma atividade laboral prende-se, de um modo geral, com a necessidade de realização pessoal e profissional e a necessidade de subsistência. A qualidade de vida no trabalho envolve fatores fundamentais, desde as condições físicas do local de trabalho à progressão na carreira que, por sua vez vão influenciar a produtividade, a motivação e os custos associados à falta de qualidade dos cuidados. Cabe a cada Organização ser responsável pela manutenção e melhoria qualidade de vida dos seus colaboradores e, deste modo, com o desenvolvimento de pessoal especializado e motivado, a Organização consegue diminuir os custos e aumentar a produtividade. Esta investigação pretende identificar quais os fatores que influenciam a qualidade de vida no trabalho dos enfermeiros que desenvolvem os seus cuidados nos Serviços com maior turnover do Hospital Nossa Senhora do Rosário, E.P.E. (HNSR, E.P.E.), que são: o Serviço de Cirurgia, Medicina e a Urgência Geral. Foi elaborado um questionário dirigido aos enfermeiros prestadores de cuidados com o intuito de recolher dados relativos aos fatores que influenciam a qualidade de vida e as suas consequências (turnover, acidentes de trabalho e stress ocupacional). Os enfermeiros destacaram como principais fatores influenciadores da qualidade de vida no trabalho a sobrecarga de trabalho e a motivação para a realização do trabalho e como consequências da falta de qualidade de vida no trabalho a desmotivação e o desgaste físico e psicológico. ABSTRACT: The requirement of an employment is closely related to personal and professional fulfilments, and also to subsistence matters. The quality of life of the employee depends upon factors like physical labor conditions to range from career development. These factors will affect the performance and motivation of the employee. Each institution should be responsible for the maintenance and improvement of the quality of life of their employees. This will allow for the development of specialized staff which in turn may lead to a reduction on costs and to higher productivity. The aim of this research project is to identify the factors that have a great influence on the quality of life of nurses working on HNSR, E.P.E. departments with higher turnover. The departments with higher turnover are: surgery, medicine and emergency. ln order to collect information about the different factors influencing quality of life and their ultimate consequences, such as turnover, labor accidents and occupational stress, a questionnaire was set up. Afterwards, this questionnaire was sent to nursing care staff of HNSR, E.P.E. The nurses mention as major indicators influencing their quality of life at their job: the overload of work and motivation to care. The main stated consequences of the lack of quality life at work were: demotivation and burnout

The occupational risks and health effects resulting from exposition to cytotoxic drugs preparation

Health professionals dealing with cytotoxic drugs are exposed to occupational hazards, which need to be controlled and reduced to the lowest possible level. The research intends to analyse the effect on the health of the manipulators and the main risks exposition in the preparation of cytotoxic drugs. To achieve this aim, a quantitative analysis was carried out based on data collected through the application of a survey developed for cytotoxic drugs manipulators in Portuguese Oncology institutions. The main results show some symptoms for general manipulators, the occurrence of accidents in the past and more training is required as important. The number of accidents is not connected with more training needs and proceedings lack of knowledge by manipulators. The research intends to contribute to the manipulation of cytotoxic drugs by health professionals, proposing the necessity of better and good practices implemented and organised throughout the CTX manipulation process that must be transversal between different oncology institutions.The authors are grateful to the Foundation for Science and Technology (FCT, Portugal) for financial support by national funds FCT/MCTES to UNIAG, under Project no. UIDB/04752/2020.info:eu-repo/semantics/publishedVersio

β-lactam dosing in critical patients: a narrative review of optimal efficacy and the prevention of resistance and toxicity

© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).Antimicrobial prescription in critically ill patients represents a complex challenge due to the difficult balance between infection treatment and toxicity prevention. Underexposure to antibiotics and therapeutic failure or, conversely, drug overexposure and toxicity may both contribute to a worse prognosis. Moreover, changes in organ perfusion and dysfunction often lead to unpredictable pharmacokinetics. In critically ill patients, interindividual and intraindividual real-time β-lactam antibiotic dose adjustments according to the patient's condition are critical. The continuous infusion of β-lactams and the therapeutic monitoring of their concentration have both been proposed to improve their efficacy, but strong data to support their use are still lacking. The knowledge of the pharmacokinetic/pharmacodynamic targets is poor and is mostly based on observational data. In patients with renal or hepatic failure, selecting the right dose is even more tricky due to changes in drug clearance, distribution, and the use of extracorporeal circuits. Intermittent usage may further increase the dosing conundrum. Recent data have emerged linking overexposure to β-lactams to central nervous system toxicity, mitochondrial recovery delay, and microbiome changes. In addition, it is well recognized that β-lactam exposure facilitates resistance selection and that correct dosing can help to overcome it. In this review, we discuss recent data regarding real-time β-lactam antibiotic dose adjustment, options in special populations, and the impacts on mitochondria and the microbiome.info:eu-repo/semantics/publishedVersio

Análise da estrutura salarial na banca portuguesa no período 2002-2009

Dissertação de mestrado em Economia Monetária, Bancária e FinanceiraA presente tese analisa a evolução salarial e as diferenças salariais no sector bancário em Portugal no período 2002-2009 e pretende dar seguimento à análise de Monteiro (2009) que se debruçou sobre o tema no período de 1985-2000. Os resultados evidenciam um aumento dos salários ao longo dos anos, no entanto com várias oscilações. Relativamente às diferenças salariais estas têm aumentado, tanto no que diz respeito aos dois sectores (bancário e não bancário) bem como em relação ao género. No que respeita à propriedade das empresas os salários também têm sofrido oscilações, sendo atualmente no sector bancário e nas empresas privadas onde o salário é maior.This thesis analyzes the evolution of wages and wage differentials in the banking sector in Portugal in the period 2002-2009, following the work by Monteiro (2009) which focused on the same subject for the period of 1985-2000. The results obtained suggest an increase in wages over the years but with several oscillations. In terms of wage differentials, these have also increased when compared to non-banking sector and among both males and females. In addition, banking wages have been changing considerably across firm ownership and are the highest in the private sector

Influência do fumo dos incêndios florestais na saúde respiratória da população na Região de Viseu

Os incêndios florestais são fenómenos frequentes em Portugal e a sua grande incidência a partir de 2003 tem levado a uma maior consciencialização pública devido, principalmente, aos impactos que causam, entre os quais as consequências que podem ter na saúde da população, através dos poluentes presentes nas plumas de fumo. Viseu é um distrito fortemente fustigado pelos incêndios, destacando-se os anos de 2005 e 2013 pelo elevado número de incêndios registados, e consequentemente, de plumas de fumo, estando as freguesias mais afetadas localizadas a Oeste do distrito. A partir da análise de imagens de satélite MODIS foram identificadas 55 plumas de fumos que afetaram o distrito de Viseu, no período de 2005 e 2015, assim como as massas de ar que influenciam a dispersão do fumo através de trajetórias HySplit. Foi analisada a qualidade do ar em dias quando ocorreram plumas tendo em conta os limiares definidos na diretiva 120/2010, comparando com dias sem incêndios. Para além disso, foi avaliado o nível de risco de inalação de fumo nas freguesias de Viseu, através da análise da população exposta, da frequência de plumas e da análise da vulnerabilidade social. Os poluentes libertados no fumo dos incêndios possuem prazos de vida curtos a médios e podem espalhar-se por muitos quilómetros, afetando não só os locais de origem dos incêndios, mas também as áreas circundantes. Através da comparação dos limiares de poluentes, nomeadamente material particulado (PM), Ozono(O3) e Óxidos de Azoto (NOx), verifica-se que na região de Viseu Dão Lafões, entre os anos de 2005 até 2015, os limites de qualidade do ar pré-estabelecidos pela Comissão Europeia foram ultrapassados, na maioria das situações, devido a incêndios. A libertação destes poluentes com tanta regularidade, devido à ocorrência de incêndios com emissão de plumas, provocam efeitos nocivos na saúde respiratória da população. Viseu não é exceção, levando ao aumento dos internamentos e afetando a população mais vulnerável, como os idosos (com idades superior a 65 anos) e as crianças (idade inferior a 4 anos), nomeadamente nos homens, provocando patologias como bronquites, doenças do aparelho respiratório e com maior frequência pneumonias. A partir da frequência de plumas observadas através de imagens de satélite, e tendo em consideração o número de residentes por freguesia, constata-se que em Viseu a exposição da população à inalação de fumo é elevada, uma vez que todas as freguesias foram afetadas várias vezes entre os anos 2005 e 2015, no mínimo 8 vezes ao longo destes 10 anos em estudo.Wildfires are a quite frequent phenomenon in Portugal and the increased incidence since 2003 is leading to a greater public awareness, partly because of the impacts they can have on public health due to the pollutants that are present in the smoke plumes. Viseu district has been heavily affected by wildfires, especially in the years of 2005 and 2013 that stand out as the ones with the highest number of wildfires and, consequently, of smoke plumes. The parishes located west of the district were the most affected. Upon examining MODIS satellite images, 55 smoke plumes were identified in the district of Viseu between the years of 2005 and 2015, and the air masses that influence smoke dispersion were defined through HySplit trajectories. The air quality was analyzed for the days with smoke plumes, according to the thresholds established on directive 120/2010, and compared to days without the occurrence of plumes. In addition, the level of risk of smoke inhalation in the parishes of Viseu was assessed, through the analysis of the exposed population, the frequency of smoke plumes and the analysis of the population’s vulnerability. The pollutants in wildfire smoke have a short to medium life span and can spread across many kilometers, affecting not only the area where the fire originated but also its surroundings. Taking into account the pollutant thresholds, namely particulate matter (PM), Ozone (O3) and Nitrogen Oxides (NOx), from 2005 to 2015 the region of Viseu Dão Lafões exceeded the air quality limits pre-established by the European Commission in several occasions, mostly due to wildfires. The regular release of these pollutants, due to wildfires with smoke plumes, can have harmful effects on the population’s respiratory health. The district of Viseu is no exception, leading to an increase in hospitalizations and affecting the most vulnerable population, such as the elderly (aged over 65) and children (aged under 4), affecting more the male population, causing pathologies such as bronchitis and more frequently pneumonia. Having in consideration the frequency with which smoke plumes are detected and the number of residents per parish, it is concluded that the population’s exposure to smoke inhalation is high, since every parish was affected at least 8 times between the years of 2005 and 2015