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

Perturbações do comportamento em adolescentes: intervenções terapêuticas de enfermagem

Este relatório expressa a preocupação com a problemática das alterações do comportamento em adolescentes, e descreve o trabalho desenvolvido ao longo do Ensino Clínico. Através da avaliação das necessidades e dificuldades apresentadas pelos adolescentes, desenvolveu-se um conjunto de intervenções de enfermagem com a finalidade de atenuar os factores de risco e potenciar capacidades e competências nos adolescentes com esta problemática. A intencionalidade terapêutica incidiu sobre a reorganização do seu processo de crescimento, sem marcas de sofrimento e com uma melhor adaptação a este processo de desenvolvimento. Após a implementação de diversas intervenções de enfermagem dirigidas ao adolescente e à sua família observaram-se diversos ganhos em saúde, nomeadamente a potenciação para a mudança de comportamentos, assim como a reabilitação do adolescente e a recuperação do controlo sobre o seu projecto de vida; ABSTRACT:This report expresses the concern about the problem of abnormal behavior in adolescents and describes the work developed over the Clinical Teaching. By assessing the needs and difficulties presented by adolescents, a set of nursing interventions was developed in order to mitigate the risk factors and enhance capabilities and skills in adolescents with this problem. The therapeutic intent focused on the reorganization of its growth process, without marks of suffering and a better adaptation to this development process. After the implementation of several nursing interventions aimed at teenagers and their family, there were many gains in health, including the empowerment to change behaviors, as well as adolescent rehabilitation and recovery of control over their life project

Expectativas dos doentes face ao internamento numa Unidade de Cuidados Paliativos Expectativas de la persona ingresada en una Unidad de Cuidados Paliativos Expectations of patients during a hospitalization in a Palliative Care Unit

As equipas das Unidades de Cuidados Paliativos (UCP) propõem-se atender à totalidade bio-psico-social-espiritual do doente e seus familiares, minimizando a dor e dando suporte emocional e espiritual a todos os envolvidos no processo de morte. Para desenvolver práticas de cuidados que facilitem a vivência do fim de vida é imperativo compreender as expectativas destes doentes face ao internamento numa UCP e face aos profissionais de saúde que nestas trabalham. Este estudo, de caráter qualitativo, utilizou como referencial metodológico a Teoria Fundamentada nos Dados - Grounded Theory. Os dados foram colhidos através de entrevista semiestruturada realizada a 14 doentes internados em duas instituições. A análise dos dados teve como base uma codificação teórica, levando à identificação do tema central «Processo de Negação da Morte», representativa da interação entre os dois temas principais: Perceção da Doença e Expectativas da Pessoa internada numa UCP. O processo de transição em que estes doentes se encontram, envolve reorganização interior e tomar consciência da realidade. Contudo, assume um caráter de sobrevivência psicológica, mantendo a esperança perante a morte, negando-a. Face ao internamento numa UCP estes procuram a cura, a recuperação ou pelo menos alguma qualidade de vida.<br>Los equipos de Unidades de Cuidados Paliativos (UCP) procuran atender a la “totalidad bio-psico-social-espiritual” del paciente y de sus familiares, reduciendo el dolor, dando apoyo emocional y espiritual a todos los involucrados en el proceso de una muerte. Al desarrollar pautas de cuidados que faciliten la experiencia de la enfermedad terminal, es prioritario entender las expectativas de dichos pacientes ante al ingreso en una UCP y ante a los profesionales que allí trabajan. Este estudio, de carácter cualitativo, usó por referencia metodológica la Teoría Basada en los Datos - Teoría Fundamentada. Los datos fueron recogidos mediante entrevistas semiestructuradas realizadas con 14 pacientes ingresados en dos instituciones. El análisis de los datos estuvo basado en una codificación teórica, que condujo a la identificación del tema central: “El Proceso de Negación de la Muerte”, representativo de la interacción entre los dos temas principales: Percepción de la Enfermedad y Expectativas de la Persona ingresada en una UCP. El proceso de transición en el que estos pacientes se encuentran que implica una reorganización interior y una toma de consciencia de la realidad. Sin embargo, asume un carácter de supervivencia psicológica manteniendo la esperanza de vivir negando la muerte. Ante el ingreso en una UCP estos buscan la cura, la recuperación o por lo menos alguna calidad de vida.<br>The goal of Palliative Care Units is to focus on the “bio-psycho-social-spiritual” whole of patients and their families, minimizing pain and providing emotional and spiritual support to all involved in the process of dying. To develop care practices that facilitate living at the end of life, it is imperative to understand the expectations of these patients while in a Palliative Care Unit and of healthcare professionals who work in these units. This study, qualitative in nature, used Grounded Theory as its methodological base. Data were collected through semi-structured interviews with 14 patients admitted to two institutions. Data analysis was based on theoretical coding, allowing identification of the “The Process of Denial of Death” as the central theme, representative of the interaction between the main themes Perceptions of Illness and Expectations of the person admitted to a Palliative Care Unit. The transition process in which these patients find themselves involves psychological reorganization and becoming aware of a distinct reality. However, it is a matter of psychological survival, maintaining hope in the face of death while denying it. As inpatients in a Palliative Care Unit, they look for cure or recovery, or at least some quality of life

Feasibility and Acceptability of an Asthma App to Monitor Medication Adherence : Mixed Methods Study

Background: Poor medication adherence is a major challenge in asthma, and objective assessment of inhaler adherence is needed. The InspirerMundi app aims to monitor adherence while providing a positive experience through gamification and social support. Objective: This study aimed to evaluate the feasibility and acceptability of the InspirerMundi app to monitor medication adherence in adolescents and adults with persistent asthma (treated with daily inhaled medication). Methods: A 1-month mixed method multicenter observational study was conducted in 26 secondary care centers from Portugal and Spain. During an initial face-to-face visit, physicians reported patients' asthma therapeutic plan in a structured questionnaire. During the visits, patients were invited to use the app daily to register their asthma medication intakes. A scheduled intake was considered taken when patients registered the intake (inhaler, blister, or other drug formulation) by using the image-based medication detection tool. At 1 month, patients were interviewed by phone, and app satisfaction was assessed on a 1 (low) to 5 (high) scale. Patients were also asked to point out the most and least preferred app features and make suggestions for future app improvements. Results: A total of 107 patients (median 27 [P25-P75 14-40] years) were invited, 92.5% (99/107) installed the app, and 73.8% (79/107) completed the 1-month interview. Patients interacted with the app a median of 9 (P25-P75 1-24) days. At least one medication was registered in the app by 78% (77/99) of patients. A total of 53% (52/99) of participants registered all prescribed inhalers, and 34% (34/99) registered the complete asthma therapeutic plan. Median medication adherence was 75% (P25-P75 25%-90%) for inhalers and 82% (P25-P75 50%-94%) for other drug formulations. Patients were globally satisfied with the app, with 75% (59/79) scoring &gt;= 4,; adherence monitoring, symptom monitoring, and gamification features being the most highly scored components; and the medication detection tool among the lowest scored. A total of 53% (42/79) of the patients stated that the app had motivated them to improve adherence to inhaled medication and 77% (61/79) would recommend the app to other patients. Patient feedback was reflected in 4 major themes: medication-related features (67/79, 85%), gamification and social network (33/79, 42%), symptom monitoring and physician communication (21/79, 27%), and other aspects (16/79, 20%). Conclusions: The InspirerMundi app was feasible and acceptable to monitor medication adherence in patients with asthma. Based on patient feedback and to increase the registering of medications, the therapeutic plan registration and medication detection tool were redesigned. Our results highlight the importance of patient participation to produce a patient-centered and engaging mHealth asthma app

Feasibility of a mobile app to improve inhaler adherence in real‐world patients with asthma: A multicentre observational study in Portugal and Spain

InspirerMundi app aims to transform adherence into a positive experience through gamification and social support, while allowing objective monitoring of inhaler adherence. This study assessed the feasibility of the app in adolescents and adults with persistent asthma.info:eu-repo/semantics/publishedVersio

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved

ISARIC-COVID-19 dataset: A Prospective, Standardized, Global Dataset of Patients Hospitalized with COVID-19

The International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) COVID-19 dataset is one of the largest international databases of prospectively collected clinical data on people hospitalized with COVID-19. This dataset was compiled during the COVID-19 pandemic by a network of hospitals that collect data using the ISARIC-World Health Organization Clinical Characterization Protocol and data tools. The database includes data from more than 705,000 patients, collected in more than 60 countries and 1,500 centres worldwide. Patient data are available from acute hospital admissions with COVID-19 and outpatient follow-ups. The data include signs and symptoms, pre-existing comorbidities, vital signs, chronic and acute treatments, complications, dates of hospitalization and discharge, mortality, viral strains, vaccination status, and other data. Here, we present the dataset characteristics, explain its architecture and how to gain access, and provide tools to facilitate its use

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research