Evaluation of patients' discomfort regarding regional anesthesia: 8AP6‐7

Background and Goal of Study: Regional anesthesia may cause physical and psychological discomfort. 50% of patients scheduled for urologic procedures undergo regional anesthesia, and their comfort represents a concern to the anesthesiologist. This study aims to: 1. identify factors related to patients’ discomfort regarding regional anesthesia(position for anesthesia and surgery procedures, puncture site pain, room temperature, audio-visual perception, sensitive/motor blockade); 2. Evaluate patients’ satisfaction with anesthesia. Materials and Methods: Af ter approval from the Hospital Ethics Committee all patients over 18years old, scheduled for urologic surgery, understanding Portuguese and anesthetized with spinal anesthesia were included. Patients in day case surgery or with incomplete medical records were excluded. We performed a questionnaire(with closed ended questions) in the first 24 hours af ter surgery and consulted anesthesia records. We asked yes or no questions, used a 1-10 scale to evaluate pain and a 1-4 scale to evaluate satisfaction. Because there isn’t a valid questionnaire in the literature to evaluate what we aimed to, we created one based on multiple articles1,2. Results and Discussion: 50patients were included; mean age 65 years old (min.32, max.89); 78% males and 70% ASAII. 75%denied discomfort during positioning for back puncture and 58% referred cold during anesthesia or surgery. One person was uncomfortable in the surgical position and no one considered being awake uncomfortable; sensitive/motor blockade was uncomfortable for 22%. Spinal was more painful than the venous puncture for32%; for 50%venous puncture was more painful and for 18%pain was similar. Patients were satisfied or very satisfied with the anesthetic technique and would choose the same technique in the future in 98% of cases. Conclusion: Although this questionnaire is not validated, it allowed us to understand that cold during anesthesia/surgery is a problem for most patients but this is easily solved. It also showed us that most patients are not uncomfortable with positioning during procedures, being awake and not feeling the legs.Interestingly only about one third of the patients thought that the back puncture was more painful than the venous puncture. In general we consider spinal anesthesia a good choice for these patients and we are satisfied that patients don’t find it uncomfortable and are also satisfie

Compliance to radiation therapy of head and neck cancer patients and impact on treatment outcome

The aims of the study were to evaluate head and neck cancer (HNC) patient's compliance to the planned radiation therapy (RT) using the department policy established in 2005 at IPOCFG and to estimate the impact on treatment outcome due to failure in receiving RT as prescribed.info:eu-repo/semantics/publishedVersio

Biological dose-escalated definitive radiation therapy in head and neck cancer

To compare treatment outcome of patients with head and neck (HN) tumours treated with definitive radiation therapy that, mainly owing to differences in the fractionation scheme used with simultaneous integrated boost techniques, resulted in a different biological dose. Methods: 181 patients with HN cancer, prescribed to about 70.2Gy in the primary tumour, were included in this study. Population cohort was divided into Group ,70 and Group $70 when the mean dose converted to a 2 Gy fractionation in the primary tumour was less or higher than 70.2Gy, respectively. The probability of local control (LC), locoregional control (LRC), disease-free survival (DFS) and overall survival (OS) was determined for both groups. The incidence of acute and late complications was compared between the two groups. Results: At 24 months for Groups ,70 and$70, LC was 83.2% and 87.5%, LRC was 79.5% and 81.6%, DFS was 56.3% and 66.8% and OS was 63.9% and 71.5% p5ns, respectively. The incidence of acute dysphagia, odynophagia and pain, and late mucositis was significantly higher in Group $70 than in Group ,70. The rate of xerostomia, dysphonia, radiodermatitis, alopecia, dental complications, hypoacusia and weight loss was comparable between the two groups. Conclusion: The biological dose escalation was safe, but an increase in the incidence of the acute side effects: dysphagia, odynophagia and pain and late mucositis, was obtained. Advances in knowledge: Despite the significant biological dose escalation, within the range of doses delivered to this cohort, no clear dose–response effect was observe

Higher pain intensity, depression, and being 75 Years or Older are associated with lower Levels of self-reported physical activity in older adults with pain attending primary care

Objective: This study investigated whether pain characteristics (intensity, frequency, duration and number of pain sites), depression, age, sex and comorbidities are associated with lower levels of selfreported physical activity in older adults with pain at the primary healthcare setting.Methods: A total of 504 participants aged 60 years of age and over were assessed for: socio-demographics, comorbidities, pain, depression, and physical activity. Associations between these variables were investigated using ordinal logistic regression.Results: Reporting severe pain or worst imaginable pain, being older (≥ 75 years), and feeling depressed were significantly associated with lower physical activity in the univariate (OR = 2.33, 2.93, 2.31, and 2.23, respectively) and multivariate models (Adj OR = 2.21, 2.47, 2.49, and 1.97, respectively).Conclusions: Interventions aiming to increase physical activity for older adults in primary care should consider the needs of those reporting higher pain intensity, feeling depressed and who are 75 years or older

Multidisciplinary Development and Initial Validation of a Clinical Knowledge Base on Chronic Respiratory Diseases for mHealth Decision Support Systems

Most mobile health (mHealth) decision support systems currently available for chronic obstructive respiratory diseases (CORDs) are not supported by clinical evidence or lack clinical validation. The development of the knowledge base that will feed the clinical decision support system is a crucial step that involves the collection and systematization of clinical knowledge from relevant scientific sources and its representation in a human-understandable and computer-interpretable way. This work describes the development and initial validation of a clinical knowledge base that can be integrated into mHealth decision support systems developed for patients with CORDs. A multidisciplinary team of health care professionals with clinical experience in respiratory diseases, together with data science and IT professionals, defined a new framework that can be used in other evidence-based systems. The knowledge base development began with a thorough review of the relevant scientific sources (eg, disease guidelines) to identify the recommendations to be implemented in the decision support system based on a consensus process. Recommendations were selected according to predefined inclusion criteria: (1) applicable to individuals with CORDs or to prevent CORDs, (2) directed toward patient self-management, (3) targeting adults, and (4) within the scope of the knowledge domains and subdomains defined. Then, the selected recommendations were prioritized according to (1) a harmonized level of evidence (reconciled from different sources); (2) the scope of the source document (international was preferred); (3) the entity that issued the source document; (4) the operability of the recommendation; and (5) health care professionals' perceptions of the relevance, potential impact, and reach of the recommendation. A total of 358 recommendations were selected. Next, the variables required to trigger those recommendations were defined (n=116) and operationalized into logical rules using Boolean logical operators (n=405). Finally, the knowledge base was implemented in an intelligent individualized coaching component and pretested with an asthma use case. Initial validation of the knowledge base was conducted internally using data from a population-based observational study of individuals with or without asthma or rhinitis. External validation of the appropriateness of the recommendations with the highest priority level was conducted independently by 4 physicians. In addition, a strategy for knowledge base updates, including an easy-to-use rules editor, was defined. Using this process, based on consensus and iterative improvement, we developed and conducted preliminary validation of a clinical knowledge base for CORDs that translates disease guidelines into personalized patient recommendations. The knowledge base can be used as part of mHealth decision support systems. This process could be replicated in other clinical areas.info:eu-repo/semantics/publishedVersio

The national inventory of geological heritage: methodological approach and results

A existência de um inventário nacional de património geológico é fundamental para se poderem implementar estratégias de geoconservação. Este trabalho apresenta a metodologia usada no desenvolvimento do mais completo inventário de geossítios, realizado até ao momento em Portugal, assim como os principais resultados obtidos. O inventário vai integrar o Sistema de Informação do Património Natural e o Cadastro Nacional dos Valores Naturais Classificados, ambos geridos pelo Instituto de Conservação da Natureza e da Biodiversidade.The existence of a national inventory of the geological heritage is of paramount importance for the implementation of a geoconservation strategy. This paper presents the methodological approach used to produce the most complete geosites inventory in Portugal, so far, and the obtained results. This inventory will be uploaded into the National Database of Natural Heritage managed by the Portuguese authority for nature conservation.Este trabalho é apoiado pela Fundação para a Ciência e a Tecnologia, através do financiamento plurianual do CGUP e do projecto de investigação “Identificação, caracterização e conservação do património geológico: uma estratégia de geoconservação para Portugal” (PTDC/CTE-GEX/64966/2006).info:eu-repo/semantics/publishedVersio

Sugarcane (Saccharum X officinarum): A Reference Study for the Regulation of Genetically Modified Cultivars in Brazil

Global interest in sugarcane has increased significantly in recent years due to its economic impact on sustainable energy production. Sugarcane breeding and better agronomic practices have contributed to a huge increase in sugarcane yield in the last 30 years. Additional increases in sugarcane yield are expected to result from the use of biotechnology tools in the near future. Genetically modified (GM) sugarcane that incorporates genes to increase resistance to biotic and abiotic stresses could play a major role in achieving this goal. However, to bring GM sugarcane to the market, it is necessary to follow a regulatory process that will evaluate the environmental and health impacts of this crop. The regulatory review process is usually accomplished through a comparison of the biology and composition of the GM cultivar and a non-GM counterpart. This review intends to provide information on non-GM sugarcane biology, genetics, breeding, agronomic management, processing, products and byproducts, as well as the current technologies used to develop GM sugarcane, with the aim of assisting regulators in the decision-making process regarding the commercial release of GM sugarcane cultivars