OBJECTIVES: To externally and prospectively validate the International Ovarian Tumor Analysis (IOTA) Simple Rules (SRs), Logistic Regression model 2 (LR2) and Assessment of Different NEoplasias in the adneXa (ADNEX) model in a Portuguese population, comparing these approaches with subjective assessment and the risk-of-malignancy index (RMI), as well as with each other. This study also aimed to retrospectively validate the IOTA two-step strategy, using modified benign simple descriptors (MBDs) followed by the ADNEX model in cases in which MBDs were not applicable. METHODS: This was a prospective multicenter diagnostic accuracy study conducted between January 2016 and December 2021 of consecutive patients with an ultrasound diagnosis of at least one adnexal tumor, who underwent surgery at one of three tertiary referral centers in Lisbon, Portugal. All ultrasound assessments were performed by Level-II or -III sonologists with IOTA certification. Patient clinical data and serum CA 125 levels were collected from hospital databases. Each adnexal mass was classified as benign or malignant using subjective assessment, RMI, IOTA SRs, LR2 and the ADNEX model (with and without CA 125). The reference standard was histopathological diagnosis. In the second phase, all adnexal tumors were classified retrospectively using the two-step strategy (MBDs + ADNEX). Sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios and overall accuracy were determined for all methods. Receiver-operating-characteristics curves were constructed and corresponding areas under the curve (AUC) were determined for RMI, LR2, the ADNEX model and the two-step strategy. The ADNEX model calibration plots were constructed using locally estimated scatterplot smoothing (LOESS). RESULTS: Of the 571 patients included in the study, 428 had benign disease and 143 had malignant disease (prevalence of malignancy, 25.0%), of which 42 had borderline ovarian tumor, 93 had primary invasive adnexal cancer and eight had metastatic tumors in the adnexa. Subjective assessment had an overall sensitivity of 97.9% and a specificity of 83.6% for distinguishing between benign and malignant lesions. RMI showed high specificity (95.6%) but very low sensitivity (58.7%), with an AUC of 0.913. The IOTA SRs were applicable in 80.0% of patients, with a sensitivity of 94.8% and specificity of 98.6%. The IOTA LR2 had a sensitivity of 84.6%, specificity of 86.9% and an AUC of 0.939, at a malignancy risk cut-off of 10%. At the same cut-off, the sensitivity, specificity and AUC for the ADNEX model with vs without CA 125 were 95.8% vs 98.6%, 82.5% vs 79.7% and 0.962 vs 0.960, respectively. The ADNEX model gave heterogeneous results for distinguishing between benign masses and different subtypes of malignancy, with the highest AUC (0.991) for discriminating benign masses from primary invasive adnexal cancer Stages II-IV, and the lowest AUC (0.696) for discriminating primary invasive adnexal cancer Stage I from metastatic lesion in the adnexa. The calibration plot suggested underestimation of the risk by the ADNEX model compared with the observed proportion of malignancy. The MBDs were applicable in 26.3% (150/571) of cases, of which none was malignant. The two-step strategy using the ADNEX model in the second step only, with and without CA 125, had AUCs of 0.964 and 0.961, respectively, which was similar to applying the ADNEX model in all patients. CONCLUSIONS: The IOTA methods showed good-to-excellent performance in the Portuguese population, outperforming RMI. The ADNEX model was superior to other methods in terms of accuracy, but interpretation of its ability to distinguish between malignant subtypes was limited by sample size and large differences in the prevalence of tumor subtypes. The IOTA MBDs are reliable in identifying benign disease. The two-step strategy comprising application of MBDs followed by the ADNEX model if MBDs are not applicable, is suitable for daily clinical practice, circumventing the need to calculate the risk of malignancy in all patients. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.

• MeSH
• antigen CA-125 krev   MeSH
• diferenciální diagnóza MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• logistické modely MeSH
• nádory vaječníků * diagnostické zobrazování   patologie   klasifikace   krev   MeSH
• nemoci děložních adnex * diagnostické zobrazování   MeSH
• prediktivní hodnota testů MeSH
• prospektivní studie MeSH
• reprodukovatelnost výsledků MeSH
• retrospektivní studie MeSH
• ROC křivka MeSH
• senioři MeSH
• senzitivita a specificita MeSH
• ultrasonografie * metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• validační studie MeSH
• Geografické názvy
• Portugalsko MeSH

Thanks to technical progress and the availability of virtual data, sex estimation methods as part of a biological profile are undergoing an inevitable evolution. Further reductions in subjectivity, but potentially also in measurement errors, can be brought by approaches that automate the extraction of variables. Such automatization also significantly accelerates and facilitates the specialist's work. The aim of this study is (1) to apply a previously proposed algorithm (Kuchař et al. 2021) to automatically extract 10 variables used for the DSP2 sex estimation method, and (2) to test the robustness of the new automatic approach in a current heterogeneous population. For the first aim, we used a sample of 240 3D scans of pelvic bones from the same individuals, which were measured manually for the DSP database. For the second aim a sample of 108 pelvic bones from the New Mexico Decedent Image Database was used. The results showed high agreement between automatic and manual measurements with rTEM below 5% for all dimensions except two. The accuracy of final sex estimates based on all 10 variables was excellent (error rate 0.3%). However, we observed a higher number of undetermined individuals in the Portuguese sample (25% of males) and the New Mexican sample (36.5% of females). In conclusion, the procedure for automatic dimension extraction was successfully applied both to a different type of data and to a heterogeneous population.

• MeSH
• algoritmy * MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• pánevní kosti * diagnostické zobrazování   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• soudní antropologie * metody   MeSH
• určení pohlaví podle kostry * metody   MeSH
• zobrazování trojrozměrné * MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Portugalsko MeSH

Aim: To analyze the influence of sociodemographic, obstetric, childbirth, and breastfeeding variables on maternal self-efficacy in newborn care. Design: Descriptive cross-sectional study. Methods: The study was conducted in three hospital units in the Northern region of Portugal, with a non-probabilistic sample composed of 340 women recruited at postnatal wards on the day of hospital discharge. A questionnaire including the mother's sociodemographic, obstetric, childbirth, and breastfeeding data was used. For the analysis of maternal self-efficacy in newborn care, the Scale of Perceived Parental Self-Efficacy in Child Care was used. The scale is a 20-item self-report instrument developed to identify women with low levels of self-efficacy in newborn care. Descriptive and inferential statistics were used for data analysis. Results: Significant differences concerning maternal self-efficacy in newborn care were found with regard to level of education and parity, with multiparous women and women with lower levels of education presenting higher levels of self-efficacy in newborn care. Conclusion: The analysis of these variables could be valuable in building new knowledge to support the development of an action model that would allow at-risk women to be highly confident in their parenting role.

• MeSH
• dospělí MeSH
• lidé MeSH
• matky * psychologie   MeSH
• mladý dospělý MeSH
• postnatální péče * statistika a číselné údaje   MeSH
• průzkumy a dotazníky MeSH
• sebeuplatnění MeSH
• statistika jako téma MeSH
• zpráva o sobě MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladý dospělý MeSH
• ženské pohlaví MeSH
• Geografické názvy
• Portugalsko MeSH

Aim: To identify attitudes and barriers to evidence-based practice from the perspective of Portuguese nurses specialized in medical-surgical nursing. Design: Descriptive cross-sectional study. Methods: Data collection in 2022, via a digital form comprising a questionnaire on socio-professional characterization and the Portuguese version of the "Barriers to Evidence-Based Practice in Primary Care". Non-probability convenience sampling. Data analysis performed using the Statistical Package for the Social Sciences, version 24. The checklist used was "Strengthening the Reporting of Observational Studies in Epidemiology". Results: The final sample consisted of 218 specialist medical-surgical nurses working in clinical practice settings in Portugal, who showed a generally positive attitude towards evidence-based practice. The barriers to evidence-based practice highlighted were lack of incentives, support from expert colleagues, training, financing, and time. Conclusion: Specialist medical-surgical nurses value evidence-based practice and recognized its benefits, but also identified barriers that make its practical implementation a challenge. The identification of the attitudes and barriers allows for the identification of shortcomings and the making of tailored training plans, thereby increasing the integration of evidence into the practice of these renowned professionals.

• MeSH
• chirurgické ošetřovatelství * statistika a číselné údaje   MeSH
• kvalitativní výzkum MeSH
• ošetřovatelství založené na důkazech statistika a číselné údaje   MeSH
• postoj zdravotnického personálu * MeSH
• průzkumy a dotazníky MeSH
• sestry specialistky statistika a číselné údaje   MeSH
• Geografické názvy
• Portugalsko MeSH

Aim: To describe nurses' perspectives on promoting tracheostomy self-care. There is little information on the nurses' perspective as care providers with knowledge of clinical contexts. Design: A qualitative descriptive study was conducted. Methods: A purposeful sample of nurses was selected from eight Portuguese hospitals. Recruitment ended once data saturation was reached (n = 12). Data were collected using semi-structured interviews and analysed through content analysis. Results: The nurses described the most important aspects to promote tracheostomy self-care, namely the objectives, the contents to be addressed, the methods and resources to be used, the appropriate moment to intervene, the necessary conditions to promote self-care, the way to ensure the standardisation of interventions among nurses, and the level of tailored planned interventions. Conclusion: From the nurses' perspective, promoting tracheostomy self-care is critical for regaining autonomy. Therefore, it is crucial to establish an intervention plan sensitive to individual needs and preferences. These results can help elucidate the aspects considered by nurses when promoting tracheostomy self-care so that more meaningful and feasible care models can be designed.

• MeSH
• kvalitativní výzkum MeSH
• lidé MeSH
• nemocnice MeSH
• péče o sebe metody   MeSH
• rozhovory jako téma MeSH
• tracheostomie * ošetřování   MeSH
• vzdělávání pacientů jako téma metody   MeSH
• zdravotní sestry MeSH
• Check Tag
• lidé MeSH
• Geografické názvy
• Portugalsko MeSH

Kontext: S akutními koronárními syndromy (AKS) a s fibrilací síní (FS) se lze v portugalské populaci setkat často. V některých případech může první epizoda FS proběhnout v rámci AKS. Zdá se přitom, že nově vzniklá FS (nFS) v přítomnosti AKS je spojena s nepříznivou prognózou. Cíle: Popsat různé charakteristiky pacientů s nFS při AKS a posoudit prediktory nFS. Metody: Multicentrická prospektivní studie používající údaje portugalského Národního registru akutních koronárních syndromů získané od 29 851 pacientů přijatých pro AKS v období od 1. října 2010 do 4. září 2019 a klasifikovaných podle přítomnosti nebo nepřítomnosti nFS během hospitalizace. Pacienti s dřívějšími epizodami FS nebyli do studie zařazeni. Výsledky: K nFS došlo u 1 067 pacientů (4,1 %), většinou starších osob, s několika komorbiditami jiné než kardiovaskulární etiologie, se sníženou ejekční frakcí levé komory (EF LK) a s komplexnějším postižením koronárních tepen. U pacientů s nFS se častěji prováděla antiarytmická terapie, avšak pouze 21,5 % jich užívalo trojkombinaci antitrombotik a 30,3 % duální antitrombotickou léčbu. Tato skupina vykazovala i vysoký výskyt komplikací a úmrtí během hospitalizace. Podle vícečetné logistické regrese byly prediktory nFS v přítomnosti AKS věk nad 75 let, prodělaná cévní mozková příhoda, vysoká třída klasifikace podle Killipa a Kimballa, hemoglobin < 12 g/dl a EF LK < 50 %. Při kontrolním vyšetření po jednom roce predikovalo skóre CHA2DS2-VASc nový vznik FS v rámci AKS (poměr šancí 2,07; p < 0,001), opětovný příjem do nemocnice z kardiovaskulárních příčin (p < 0,001) a opětovnou hospitalizaci z jakýchkoli příčin (p < 0,001). Závěr: Prognóza pacientů s nFS v přítomnosti AKS je nepříznivější než prognóza pacientů se sinusovým rytmem. Ukázalo se, že skóre CHA2DS2-VASc použité pro hodnocení rizika vzniku tromboembolie představuje středně spolehlivý prediktor nFS.

Background: Acute coronary syndrome (ACS) and atrial fibrillation (AF) are common in the Portuguese population. In some cases, AF first episode can occur in ACS context. Nevertheless, the impact of new-onset AF (nAF) in the setting of ACS seems to be associated with a poor prognosis. Objectives: To understand different characteristic in nAF patients with ACS and to evaluate the predictors of nAF. Methods: Multicenter retrospective study based on the Acute Coronary Syndrome Portuguese National Registry, including 29 851 patients admitted for ACS between 1/10/2010-4/09/2019, classified according to the presence or absence of nAF during the hospitalization. Patients with previous AF were excluded. Results: nAF was identified in 1067 patients (4.1%), mostly older, presenting more non-cardiovascular comorbidities, decreased left ventricular ejection fraction (LVEF) and a more complex coronary disease. nAF patients received more anti-arrhythmic therapy, but just 21.5% had triple anti-thrombotic therapy and 30.3% had dual anti-thrombotic therapy. This group also presented high rates of in-hospital complications and death. Multiple logistic regression revealed that age >75 years old, previous stroke, higher Killip-Kimball class, haemoglobin <12g/dL and LVEF <50% were predictors of nAF in the setting of ACS. CHA2DS2-VASc score was a predictor of nAF in the setting of ACS (odds ratio 2.07, p <0.001), of cardiovascular re-admission (p<0.001) and all-cause of re-admission (p <0.001) at one year follow-up. Conclusions: Patients with nAF in the setting of ACS have a worse prognosis when compared to sinus rhythm patients. CHA2DS2-VASc score used for thromboembolic risk assessment was noted to be a moderate predictor of nAF.

• MeSH
• akutní koronární syndrom * komplikace   patologie   terapie   MeSH
• fibrilace síní * epidemiologie   etiologie   MeSH
• Kaplanův-Meierův odhad MeSH
• lidé MeSH
• prognóza MeSH
• prospektivní studie MeSH
• riziko MeSH
• rutinně sbírané zdravotní údaje MeSH
• statistika jako téma MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• multicentrická studie MeSH
• Geografické názvy
• Portugalsko MeSH

• MeSH
• hlášení nemocí MeSH
• lidé MeSH
• opičí neštovice * epidemiologie   MeSH
• Check Tag
• lidé MeSH
• Geografické názvy
• Portugalsko MeSH
• Spojené království MeSH

OBJECTIVES: To implement evidence-based practice related to care and flushing of nasogastric tubes inserted for feeding, in a general medicine ward. INTRODUCTION: Nasogastric tube feeding is a widely used nutritional support form. Although performed by qualified professionals, it is not a harm-free intervention. Progression to the trachea during initial insertion, aspiration of gastric contents, improper position for patient feeding, and/or a blocked tube are examples of problems that can occur. METHODS: The project used JBI's methodological approach of the Clinical Evidence System and Getting Research into Practice audit and feedback tool. A baseline audit focused on nursing procedures related to the maintenance of nasogastric tube feeding, based on 14 criteria informed by the JBI evidence summaries, was performed for a month. Education sessions and other engagement strategies and resources were used to increase nasogastric tube maintenance. This best-practice implementation was conducted in Portugal, between January 2020 and April 2021, in a 33-bed general medicine ward with a staff of 30 registered nurses. RESULTS: Different samples, for each audited procedure, were obtained from a universe of 25 nurses and 14 episodes of patients with nasogastric tube in baseline and 10 in follow-up audit. At baseline, compliance with the criteria ranged from 0 to 88%. Ten of the 14 criteria were below 50%. The follow-up audit showed significant improvement in all compliance criteria (ranging from 44.4 to 100%). Criteria 1 and 2, which were aimed at preventing adverse consequences related to wrong placement or displacement of the nasogastric tube, showed a high postimplementation compliance level (89.3 and 90%). CONCLUSION: With an integrated plan incorporating interventions, strategies, and resources, tailored for this context, we improved nurses' knowledge of nasogastric tube maintenance and achieved significantly increased compliance with nasogastric tube care best-practice. We suggest maintaining current strategies, and reinforcing clinical supervision and regular assessment.

• MeSH
• gastrointestinální intubace * MeSH
• klinické kompetence * MeSH
• lékařská praxe založená na důkazech MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Portugalsko MeSH

BACKGROUND: Parasitic conjunctivitis caused by Philophthalmus spp. is a common ophthalmic disease in birds, with localized outbreaks occurring worldwide. There is no consensus on treating this disease; mechanical removal is considered a standard recommendation, but is associated with disease relapses within days or weeks. METHODS: From 2015 to 2020, we examined 4295 Larus michahellis and Larus fuscus gulls in southern Portugal for the presence of Philophthalmus spp. Due to the need to treat dozens of infected gulls in the rescue station, we tested three treatment regimens aimed at targeting Philophthalmus lucipetus in the infected gulls: (I) the ophthalmic application of levamisole; (II) the oral application of milbemycin in combination with praziquantel; and (III) the subcutaneous application of ivermectin. RESULTS: The outbreak of philophthalmosis in gulls in southern Portugal has been ongoing since the first cases were reported in 2015-2016. The prevalence of philophthalmosis has fluctuated annually, peaking a maximum of 10.3% in L. fuscus in 2017 and at 2.1% in L. michahellis in 2016. The infection intensity peaked at a median of 11.5 eye-flukes per host bird in L. fuscus in 2016 and a median of six eye-flukes per host bird in L. michahellis in 2017. Nine gulls were infected with >50 eye-flukes. None of the treatment options were effective at treating P. lucipetus infections: the numbers of eye-flukes in the infected birds did not decrease, and the clinical signs of the disease did not change. CONCLUSIONS: An outbreak of philophthalmosis in southern Portugal has massively affected two species of gulls in the region. Two previously suggested philophthalmosis treatments (ocular levamisole and praziquantel given orally), as well as a third mode of treatment with a previously failed compound (ivermectin administered subcutaneously) were used. However, the treatments did not affect the numbers of P. lucipetus in the eyes of the treated gulls. Further research should address ophthalmic gel formulations or sub-conjunctival delivery mode for antihelminthic drugs that are effective against Philophthalmus spp. in vitro.

• MeSH
• anthelmintika * terapeutické užití   MeSH
• Charadriiformes * parazitologie   MeSH
• epidemický výskyt choroby MeSH
• infekce červy třídy Trematoda * parazitologie   MeSH
• ivermektin MeSH
• levamisol MeSH
• praziquantel terapeutické užití   MeSH
• ptáci MeSH
• Trematoda * MeSH
• zvířata MeSH
• Check Tag
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Portugalsko MeSH

• Klíčová slova
• tipiracil,
• MeSH
• analýza přežití MeSH
• doba přežití bez progrese choroby MeSH
• kolorektální nádory * farmakoterapie   MeSH
• kombinovaná farmakoterapie * MeSH
• lidé středního věku MeSH
• lidé MeSH
• metastázy nádorů MeSH
• prognóza MeSH
• retrospektivní studie MeSH
• senioři MeSH
• trifluridin aplikace a dávkování   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• pozorovací studie MeSH
• Geografické názvy
• Portugalsko MeSH