Search

Optimizing patients��� condition before surgery, bringing patients to their best fitness status, has always been tried by surgeons, even if it was in stochastic models. Setting up a prehabilitation program should take into account patients and their circumstances. To ensure success, programs should be personalized (patient balanced) and aim to ensure patients��� regular support as well as easy and effective contact with the healthcare team. A two-platform clinic was planned based on hospital and community facilities and health care specialists. A wide range of languages and communications systems needed to be merged and operationalized. The governance of this project is a demanding and forever ongoing process. The aim of this paper is to provide a narrative of the why and the how we are setting a community and home-based personalized prehabilitation clinic, and to give a reflective analysis of the process of gathering the right associates to implement this innovation of changing the ways and the places for prehabilitation to happen., Revista Portuguesa de Cirurgia, 2021: N��mero 51 - Outubro 2021

Introduction: Prehabilitation is a multimodal strategy implemented in the preoperative period, aiming to increase preoperative functional reserve, leading to better postoperative functional recovery and reduced incidence of complications. The majority of the prehabiliation programs are developed under supervision in an outpatient clinic, which might be an obstacle for those patients with geographical and/or travelling constrains. Home-based programs, with the support of telehealth resources, could be a convenient way to surpass these barriers. Methods: Patients with locally advanced, potentially resectable gastric or GEJ adenocarcinoma, undergoing perioperative chemotherapy with FLOT regimen will be recruited at IPO-Porto and Hospital Garcia de Orta. Patient will be invited to undergo a prehabilitation program (PREHAB) in addition to their usual (medical optimization, nutritional and psychological care). Exercise intervention will comprise aerobic and resistance training. An internet-based platform (iTerapy) via computer or mobile devices, will be used to deliver and monitor the intervention. The primary outcome of this study is to test the acceptability, feasibility and safety of the intervention. As secondary outcomes, we intend to assess the impact of home- based prehabilitation on functional capacity, frailty status, quality of life, disability, postoperative complications and mortality, length of hospital stay, need of ICU, hospital readmission and place of discharge. Conclusion: This study will inform for a future randomized clinical trial to assess the role of prehabilitation to reduce postoperative morbidity and mortality in this population., Revista Portuguesa de Cirurgia, 2021: N��mero 51 - Outubro 2021

Copyright © 2021, The Author(s) Open Access. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data., Background: Core outcome sets (COS) should be relevant to key stakeholders and widely applicable and usable. Ideally, they are developed for international use to allow optimal data synthesis from trials. Electronic Delphi surveys are commonly used to facilitate global participation; however, this has limitations. It is common for these surveys to be conducted in a single language potentially excluding those not fluent in that tongue. The aim of this study is to summarise current approaches for optimising international participation in Delphi studies and make recommendations for future practice. Methods: A comprehensive literature review of current approaches to translating Delphi surveys for COS development was undertaken. A standardised methodology adapted from international guidance derived from 12 major sets of translation guidelines in the field of outcome reporting was developed. As a case study, this was applied to a COS project for surgical trials in gastric cancer to translate a Delphi survey into 7 target languages from regions active in gastric cancer research. Results: Three hundred thirty-two abstracts were screened and four studies addressing COS development in rheumatoid and osteoarthritis, vascular malformations and polypharmacy were eligible for inclusion. There was wide variation in methodological approaches to translation, including the number of forward translations, the inclusion of back translation, the employment of cognitive debriefing and how discrepancies and disagreements were handled. Important considerations were identified during the development of the gastric cancer survey including establishing translation groups, timelines, understanding financial implications, strategies to maximise recruitment and regulatory approvals. The methodological approach to translating the Delphi surveys was easily reproducible by local collaborators and resulted in an additional 637 participants to the 315 recruited to complete the source language survey. Ninety-nine per cent of patients and 97% of healthcare professionals from non-English-speaking regions used translated surveys. Conclusion: Consideration of the issues described will improve planning by other COS developers and can be used to widen international participation from both patients and healthcare professionals., This study is funded by the National Institute for Health Research (NIHR) Doctoral Research Fellowship Grant (DRF-2015-08-023). JMB is partially funded by the NIHR Bristol Biomedical Research Centre and the MRC ConDUCT-II Hub for Trials Methodology Research. PRW was funded by the MRC North West Hub for Trials Methodology Research (Grant ref: MR/K025635/01).

77 p. : il Submitted by Jéssica Lais Kriese Duffeck (biblio.auxiliar@est.edu.br) on 2017-11-22T01:01:38Z No. of bitstreams: 1 lages_ps_tmp510.pdf: 791409 bytes, checksum: 5bc01b825ab8c8eb92581f82fc70915b (MD5) Approved for entry into archive by Allan Krahn (allan@est.edu.br) on 2017-12-03T05:24:19Z (GMT) No. of bitstreams: 1 lages_ps_tmp510.pdf: 791409 bytes, checksum: 5bc01b825ab8c8eb92581f82fc70915b (MD5) Approved for entry into archive by Allan Krahn (allan@est.edu.br) on 2017-12-03T05:29:58Z (GMT) No. of bitstreams: 1 lages_ps_tmp510.pdf: 791409 bytes, checksum: 5bc01b825ab8c8eb92581f82fc70915b (MD5) Made available in DSpace on 2017-12-03T05:31:12Z (GMT). No. of bitstreams: 1 lages_ps_tmp510.pdf: 791409 bytes, checksum: 5bc01b825ab8c8eb92581f82fc70915b (MD5) Previous issue date: 2017-06-29 O presente estudo aborda as implicações éticas do Cadastro Único para Programas Sociais do Governo Federal. O Cadastro Único é uma ferramenta de identificação e caracterização socioeconômica das famílias de baixa renda do Brasil. Os dados e informações obtidos através dessa ferramenta servem de base para a implementação das políticas sociais nas três esferas de governo, objetivando minimizar as carências da população mais vulnerável economicamente. A pergunta que orientou a pesquisa diz respeito à conduta ética dos atores envolvidos no processo de identificação, inclusão e atualização de pessoas e famílias no sistema de Cadastro Único, pois pode impactar positivamente ou negativamente na lisura e na fidedignidade da base. Quando não manuseada dentro dos padrões éticos necessários pode-se obter falsos resultados nos índices gerados pelo sistema. Isso ocorre, por exemplo, quando há omissão de informação ou inserção de informações não verídicas no sistema. Tais práticas podem ter consequências danosas para a população, uma vez que a base de dados abre portas para concessão de aproximadamente 27 benefícios sociais que devem atender exclusivamente as famílias no perfil de Cadastro Único. A partir de uma pesquisa bibliográfica, pretende-se analisar a importância do caráter ético em todo o processo de coleta e inserção de dados no sistema. O estudo também analisa questões referentes à pobreza, e a desigualdade social e aponta a importância da política pública de assistência social no auxílio da superação das mais diversas vulnerabilidades sociais, através de projetos, serviços, benefícios e programas. This study deals with the ethical implications of the Single Registry for Social Programs of the Federal Government. The Single Registry is a tool for the identification and socioeconomic characterization of the low-income families of Brazil. The data and information obtained through this tool serve as the base for the implementation of the social policies in the three spheres of government, aiming at attending to the needs of the economically most vulnerable population. The question which guides this research is about the ethical conduct of the agents involved in the process of identification, inclusion and updating of people and families in the Single Registry system, since this can impact positively or negatively on the integrity and the trustworthiness of the database. When (the process) is not handled within the necessary ethical patterns one can obtain false results in the indexes generated by the system. This occurs, for example, when there is omission of information or the insertion of untruthful information into the system. Such practices can have harmful consequences for the population, since the data base opens doors to the concession of approximately 27 social benefits which should tend exclusively to the families in the profile of the Single Registry. Based on a bibliographic research, we intend to analyze the importance of the ethical character in the whole process of collection and insertion of data into the system. The study also analyzes issues referring to poverty and to social inequality and points to the importance of the public policy of social assistance in helping overcome the various social vulnerabilities through projects, services, benefits and programs.

Introdução: A anastomose esofagogástrica cervical está associada a taxa elevada de deiscências (0-18%) e estenoses ( até 43%). O objectivo deste trabalho é analisar uma série consecutiva de doentes submetidos a esofagectomia, em que o tubo gástrico foi sistematicamente elaborado para minimizar estas complicações. Material e Métodos: Estudo retrospectivo, incluindo os últimos 50 doentes consecutivos, com Carcinoma do esófago, 7 F e 43 M, idade média 63 [46-85] anos. Foram excluídos deste estudo os doentes sem cancro esofágico e as esofagocoloplastias. Na construção do tubo gástrico (n=50) e na sua mobilização para o tórax (n=3) ou para o pescoço (n=47) foi tido em atenção: manipulação mínima do estômago, preservação cuidada da vascularização, manobra de Kocher para que o piloro seja mobilizável até ao hiato, piloromiotomia, anastomose esofagogástrica término-lateral. A estabilidade hemodinâmica e ventilatória, intrae pós-operatórias, foram cuidadosamente asseguradas por monitorização contínua. Avaliação clínica e radiológica da continência e permeabilidade das anastomoses. Dilatação endoscópica das estenoses. Resultados: 2 fístulas cervicais (clínicas) e 1 radiológica. Não se verificou nenhuma necrose da plastia. Os 11 doentes com estenose foram submetidos a dilatações endoscópicas. O tubo gástrico com operação de drenagem pilórica comportou-se como um bom método de assegurar a alimentação dos doentes esofagectomizados sem ter sido necessário nenhuma substituição do conduto. Conclusão: Os detalhes técnicos da construção da plastia gástrica e a estabilidade peri-operatória são factores determinantes dos resultados conseguidos com esta técnica. Introduction: Anastomotic complications are responsible for significant morbidity after oesophagectomy for cancer. Cervical oesophagogastrostomy is associated with high incidence of anastomotic leaks (0 - 18%) and stenosis (143%). The aim of this study was to address the reliability of our method of preparation of the gastric tube, the pull-up of the gastric conduit and the esophagogastrostomy, based on a consecutive series of esophagetomies for cancer. Material and Methods: Retrospective analysis of the last 50 consecutive patients, with oesophageal carcinoma, 7 female and 43 males, median of age 63 [46-85] years. Oesophagocoloplasties were excluded from the group. A gastric tube was pulled-up to the thorax (n=3) or the neck (n=47). Gentle manipulation of the stomach in all the steps of its mobilization, preservation of the gastric vascularization of the tube (details for preserving the right and left gastric vascular arcades and networks were focused), the technique to carry out the gastric pull-up and the hand-sewn end-to-lateral anastomosis to the posterior face of the tube were key technique details presented. Homeostatic monitoring was guaranteed. Clinical, endoscopic and radiologic control of the anastomosis was done. Endoscopic control of bleeding and stenosis was achieved on demanding cases. Results: 2 anastomotic leaks and 1 detected only on radiologic study. No gastric tube necrosis. 1 haemorrhage endoscopic controlled. 11 cases of post-operative stenosis required one ore more dilatation sessions through the first year. Hospital stays, median - 19 [9-64] days. Mortality: 8 weeks - 8%; in hospital - 14%. Survival median - 17 [3 - 75] months. Conclusions: A reliable preparation of the gastric tube for pulling up is founded on key technique points. Strict adherence to a meticulous preservation of the gastric tube vascularization is mandatory for minimizing complications. Control of the homeostasis during the operative procedure and in the post-operative period was a significant issue in our experience. Early diagnosis and fixing of complication is crucial for getting good results.

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2018 Submitted by Sofia Amador (sofiamador@fm.ul.pt) on 2020-03-12T11:38:54Z No. of bitstreams: 1 ManuelBCotovio.pdf: 1222812 bytes, checksum: 2565c93096afd5c14603c370e5dfccb6 (MD5) Made available in DSpace on 2020-03-12T14:18:18Z (GMT). No. of bitstreams: 1 ManuelBCotovio.pdf: 1222812 bytes, checksum: 2565c93096afd5c14603c370e5dfccb6 (MD5) Previous issue date: 2018

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2018 Submitted by Sofia Amador (sofiamador@fm.ul.pt) on 2020-03-16T14:56:41Z No. of bitstreams: 1 MartaMHerculano.pdf: 463842 bytes, checksum: 303f7ab2212876805589aa45a73a46eb (MD5) Made available in DSpace on 2020-03-16T17:22:41Z (GMT). No. of bitstreams: 1 MartaMHerculano.pdf: 463842 bytes, checksum: 303f7ab2212876805589aa45a73a46eb (MD5) Previous issue date: 2018

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2016 Submitted by Biblioteca da Faculdade de Medicina da Universidade de Lisboa (repositorio@medicina.ulisboa.pt) on 2017-07-19T14:02:38Z No. of bitstreams: 1 TiagoJGaspar.pdf: 1113949 bytes, checksum: 036751ae4f94fbbeb01d7b281afb31f2 (MD5) Made available in DSpace on 2017-11-03T11:17:45Z (GMT). No. of bitstreams: 1 TiagoJGaspar.pdf: 1113949 bytes, checksum: 036751ae4f94fbbeb01d7b281afb31f2 (MD5) Previous issue date: 2016