Arquitectura de resposta a situações de emergência : intervenção em Bohol.

Dissertação para obtenção do grau de Mestre em Arquitetura, apresentada na Universidade de Lisboa - Faculdade de Arquitetura

Surgical multicenter collaborative studies: ¿What happen in Latin America?

Antecedentes: GlobalSurg es un grupo internacional de investigadores que tiene como propósito la conducción y la diseminación de robustos estudios colaborativos, internacionales y multicéntricos. Objetivo: Exponer las estrategias necesarias y las barreras encontradas en la conducción de estudios multicéntricos masivos en cirugía. Método: Durante el segundo semestre del año 2020 se llevó a cabo el estudio Surg-Week Prospective International Cohort Study, hasta la fecha el estudio internacional más grande en el campo de la cirugía, con 141,582 pacientes incluidos. Un total de 4975 miniequipos, de uno a cinco integrantes, recopilaron datos de 116 países de todos los continentes. Resultados: La creación de un sitio web oficial del estudio, reportes con información relevante vía e-mail o grupos vía WhatsApp, conformación de un comité de diseminación del protocolo, dictado de webinars sobre publicaciones recientes del equipo, designación de líderes nacionales e internacionales, y la divulgación por medio de sociedades, fueron las estrategias utilizadas para el desarrollo de la investigación. Sin embargo, las barreras detectadas para llevar a cabo el estudio multicéntrico fueron variadas. Conclusiones: Los trabajos colaborativos permiten establecer redes entre diferentes profesionales con el fin de mejorar la calidad de la gestión, las políticas sanitarias y la atención a los pacientes en tiempos de constante cambio.Background: GlobalSurg is an international group of researchers whose purpose is to conduct and disseminate robust collaborative, international and multicenter studies. Objective: To expose the necessary strategies and the barriers crossed in conducting massive multicenter studies in surgery. Method: During the second semester of 2020, the study Surg-Week Prospective International Cohort Study was carried out. Surg-Week has been the largest international study in the field of surgery to date, with 141,582 patients included. A total of 4975 mini-teams, of between 1 and 5 members, collected data from 116 countries on all continents. Results: The creation of an official website for the study, reports with relevant information via email or groups via WhatsApp, formation of a Dissemination Committee of the protocol, delivery of webinars on recent team publications, appointment of leaders at the national and international level, and outreach through partnerships, were the strategies used for the development of the research. However, the barriers turned out to involve different aspects. Conclusions: Collaborative work allows establishing networks between different professionals with the goal of improving the quality of management, health policies and care of our patients in a timely manner of constant change

Global wealth disparities drive adherence to COVID-safe pathways in head and neck cancer surgery

Peer reviewe

Timing of surgery following SARS-CoV-2 infection: an international prospective cohort study.

Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4-1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0-2 weeks, 3-4 weeks and 5-6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3-4.8), 3.9 (2.6-5.1) and 3.6 (2.0-5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9-2.1)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2-8.7) vs. 2.4% (95%CI 1.4-3.4) vs. 1.3% (95%CI 0.6-2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Relatório estágio profissional

Relatório final do estágio profissionalizante do 6.º ano