Acta medica portuguesa最新文献

{"title":"The Red Reflex Test and Leukocoria in Childhood.","authors":"Joana Santos Oliveira, Sara Catarino, Augusto Magalhães, Gustavo Rocha, Renato Santos Silva","doi":"10.20344/amp.21367","DOIUrl":"10.20344/amp.21367","url":null,"abstract":"<p><p>The red reflex test, performed using a direct ophthalmoscope, serves as a critical diagnostic tool in identifying various ocular conditions. These conditions encompass retinal anomalies (such as retinoblastoma, Coats disease, retinopathy of prematurity, familial exudative vitreoretinopathy, myelinated nerve fibers, ocular toxocariasis, ocular toxoplasmosis, retinochoroidal coloboma, astrocytic, and combined hamartoma), vitreous abnormalities (including persistent fetal vasculature), lens issues (like cataract), anterior chamber and corneal conditions (comprising dysgenesis of the anterior segment, congenital glaucoma, birth trauma), and tear film disturbances. During this examination, the presence of leukocoria, characterized by a white pupillary reflex, can suggest the presence of underlying conditions. Any suspicion of an abnormal red reflex test warrants immediate evaluation by a qualified ophthalmologist. This article primarily underscores the paramount importance of the red reflex examination, not only to identify potential sight-threateningbut also life-threatening conditions. It delves into the most common causes of leukocoria in childhood and offers insights into a comprehensive diagnostic approach. The target audience for this article includes pediatricians, primary care clinicians, and ophthalmologists, all of whom play a pivotal role in the early detection and intervention of these critical eye disorders.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141791639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality of Informed Consent in Phase III Clinical Trials in Portugal: The Participants' Perspective.","authors":"Pedro L Ferreira, Ana Barradas, Inês Ribeiro","doi":"10.20344/amp.20570","DOIUrl":"10.20344/amp.20570","url":null,"abstract":"<p><strong>Introduction: </strong>Some studies show that participants do not always fully understand the informed consent form (ICF), which is one of the reasons for dropouts. This study aimed to adapt the Quality of Informed Consent (QuIC) questionnaire into a valid instrument to be applied to the Portuguese population and to measure its reliability and validity in the Portuguese population, by applying it to a sample of participants in controlled trials.</p><p><strong>Methods: </strong>The QuIC questionnaire was developed to assess the quality of informed consent in clinical trials and consists of two parts, addressing both the objective (part A) and the subjective (part B) understanding. After being translated and validated into Portuguese, it was implemented in 100 cardiac participants of phase III clinical trials in a University Hospital Center.</p><p><strong>Results: </strong>The QuIC-PT questionnaire showed excellent stability over time and good validity. All patients evaluated their participation and their health positively and recognized the main purpose of the clinical trial. Almost all participants understood their role in helping future patients and the purpose of the trial and realized that, by signing the ICF, they were participating in a clinical trial. However, none of them knew that their experimental treatment was not proven to be the best alternative for their condition.</p><p><strong>Conclusion: </strong>The QuIC-PT questionnaire seems to be a valid and useful instrument to evaluate the participants' understanding of the ICF. In this study, we found that some concepts, like 'study protocol' or 'randomization', were not well understood by participants when signing the ICF, especially by participants with lower education levels. They also believed that the experimental intervention would solve their health condition. Greater awareness about the importance of the informed consent process and ICF is necessary so that participants can fully understand the protocol, especially the risks involved, and their rights as participants.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141722846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Limits of Viability: Perspectives of Portuguese Neonatologists and Obstetricians.","authors":"Inês Pais-Cunha, Sara Peixoto, Henrique Soares, Sandra Costa","doi":"10.20344/amp.21473","DOIUrl":"10.20344/amp.21473","url":null,"abstract":"<p><strong>Introduction: </strong>Advances in neonatal care have improved the prognosis in extremely preterm infants. The gestational age considered for active treatment has decreased globally. Despite implemented guidelines, several studies show variability in practice. The aim of this study was to understand theperspectives of Portuguese neonatologists and obstetricians regarding the management of extremely preterm infants.</p><p><strong>Methods: </strong>An online survey was sent through the Portuguese Neonatology Society and the Portuguese Society of Obstetrics and Maternal-Fetal Medicine from August to September 2023.</p><p><strong>Results: </strong>We obtained 117 responses: 53% neonatologists, 18% pediatricians, and 29% obstetricians, with 62% having more than 10 years of experience. The majority (80%) were familiar with the Portuguese Neonatology Society consensus on the limits of viability and 46% used it in practice; 62% were unaware of Portuguese morbidity-mortality statistics associated with extremely preterm infants. Most (91%) informed parents about morbiditymortality concerning the gestational age more frequently upon admission (64%) and considered their opinion in the limit of viability situations (95%). At 22 weeks gestational age, 71% proposed only comfort care, while at 25 and 26 weeks, the majority suggested active care (80% and 96%, respectively). Less consensus was observed at 23 and 24 weeks. At 24 weeks, most obstetricians offered active care with the option of comfort care by parental choice (59%), while the neonatology group provided active care (65%), p < 0.001. Regarding the lower limit of gestational age for in utero transfer, corticosteroid administration, cesarean section for fetal indication, neonatologist presence during delivery, and endotracheal intubation; neonatologists considered a lower gestational age than obstetricians (23 vs 24 weeks; p = 0.036; p < 0.001; p < 0.001; p = 0.021; p < 0.001, respectively).</p><p><strong>Conclusion: </strong>Differences in perspectives between obstetricians and neonatologists in limits of viability situations were identified. Neonatologists considered a lower gestational age in various scenarios and proposed active care earlier. Standardized counseling for extremely preterm infants is crucial to avoid ambiguity, parental confusion, and conflicts in perinatal care.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141786959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endobronchial Obstruction by an Inflammatory Myofibroblastic Tumor.","authors":"Bruno Silva, Maria Luísa Sacramento, Hélder Novais E Bastos","doi":"10.20344/amp.21664","DOIUrl":"10.20344/amp.21664","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141756522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Ethical Responsibility in the Management of Environmentally Sustainable Health Care.","authors":"Jose Chen-Xu","doi":"10.20344/amp.20883","DOIUrl":"10.20344/amp.20883","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141247313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anesthetic Management of Labor in a Woman with Hereditary Angioedema.","authors":"Inês P Rodrigues, Maria M Armindo, Luísa Marinho","doi":"10.20344/amp.21580","DOIUrl":"https://doi.org/10.20344/amp.21580","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142124420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gender Disparities in the Academic Performance of Neurology Residents in Portugal.","authors":"Filipa Ladeira, Patrícia Faustino, Mafalda Soares, Vanessa Carvalho","doi":"10.20344/amp.21637","DOIUrl":"10.20344/amp.21637","url":null,"abstract":"<p><p>Implicit bias has been linked to gender disparities in medical careers, impacting not only access to leadership positions but also early career opportunities. We aimed to evaluate if there were differences in the assessment of Neurology residents according to gender. We collected publicly available grades and rankings of two major evaluations that residents are submitted to, one at the beginning and another at the end of the neurology residency program, the National Board Exam and neurology examination, respectively. The National Board Examination is a multiple-choice gender-blinded evaluation, while the neurology examination is an oral gender-unblinded evaluation. We found that 36.5% of women and 21.6% of men were in the first quartile of the National Board Examination ranking, which reflects a similar representation among top classifications when assessed through a gender-blinded examination. On the other hand, the percentage of men who were in the top classification of NE, a gender-unblinded evaluation, was more than twice as high compared to women (37.8% vs 18.3%, p < 0.05). The findings of the present study may imply that there could be a disparity in women's career progression among neurology residents in Portugal, although the recruitment seems balanced between genders.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141589411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What is Needed for Parents to Work Together with Primary Care Physicians in Dealing with Childhood Obesity and Overweight?","authors":"Beatriz Nicolau Soares, Luís António Sousa Queirós, Álvaro Mendes, Alcina Bastos","doi":"10.20344/amp.21656","DOIUrl":"https://doi.org/10.20344/amp.21656","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142124493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Usability of APIMedOlder: A Web Application to Manage Potentially Inappropriate Medication in Older Adults.","authors":"Daniela A Rodrigues, Ana I Plácido, Ramona Mateos-Campos, Adolfo Figueiras, Maria Teresa Herdeiro, Fátima Roque","doi":"10.20344/amp.21537","DOIUrl":"https://doi.org/10.20344/amp.21537","url":null,"abstract":"<p><strong>Introduction: </strong>Considering the increase in the proportion of the older population worldwide, the demand for health system resources also arises. These tools optimize clinical decision-making, thus avoiding iatrogenesis and thus contributing to a better quality of life for the older population. In response, we created an online web application, the APIMedOlder, that provides access to healthcare professionals to allow healthcare professionals to access potentially inappropriate medication identification criteria through a useful tool with a simplified profile, allowing its applicability in clinical practice. This study aims to assess the usability of the APIMedOlder online web application by healthcare professionals.</p><p><strong>Methods: </strong>A questionnaire, based on the System Usability Scale, was distributed among 15 healthcare professionals (five pharmacists, four physicians, three pharmacy technicians, and three nurses), to fully explore the website.</p><p><strong>Results: </strong>Overall, healthcare professionals' evaluation of the usability of the APIMedOlder online web application was rated as \"Best imaginable\" (mean score of 87.17 points), with individual scores ranging from 75 to 100 points. Internal consistency of α = 0.881 (CI 95%: 0.766 - 0.953) was achieved. Specific questionnaire items contributing to this high score included ease of use, learning efficiency, and integration of functions.</p><p><strong>Conclusion: </strong>The overall evaluation of the developed tool was positive, with this online application being recognized as being easy to use and having well-integrated functions.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142124492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impacts of Climate Change on the Emergence and Reemergence of Mosquito-Borne Diseases in Temperate Zones: An Umbrella Review Protocol.","authors":"Raquel Rosado E Silva, Christopher Millett, Sabine Dittrich, Helena Donato","doi":"10.20344/amp.21355","DOIUrl":"10.20344/amp.21355","url":null,"abstract":"<p><strong>Introduction: </strong>Mosquito-borne diseases represent a global public health concern and are responsible for over 700 000 deaths globally every year. Additionally, many mosquito species have undergone a dramatic global expansion due to various factors, including climate change, and forecasts indicate that mosquito populations will persist in dispersing beyond their present geographic range, namely in temperate climates. The research literature on this topic has grown in recent years, including some systematic evidence synthesis. However, to provide a comprehensive overview of this growing literature needed for policy action, a summary of this evidence, including existing systematic reviews, is required. This study aims to undertake an umbrella review that explores the impacts of climate change on the emergence and reemergence of diseases transmitted by mosquitoes in temperate zones and the publication of the protocol is a fundamental step to ensure the credibility, transparency and reproducibility of this research.</p><p><strong>Methods and analysis: </strong>Studies published in scientific journals indexed by PubMed, EMBASE, Cochrane Library, Epistemonikos, and Web of Science Core Collection to be included in this umbrella review will meet the following criteria: the topic of study (climate change and mosquito-borne diseases), regions (temperate zones), study designs (systematic reviews and meta-analysis), language (any) and date (since inception until December 31st, 2023). Titles and abstracts from selected articles will be evaluated by two authors independently and any discrepancy will be resolved through consensus or, if not possible, through a third author. The data will be extracted, and the risk of bias will be evaluated. The quality of the methodology of the included reviews will be assessed using AMSTAR 2. A narrative synthesis will examine the included systematic reviews. The quality of evidence for all outcomes will be judged using the Grading of Recommendations Assessment, Development and Evaluation working group methodology.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141900586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}