Adjustments of iodinated contrast media using lean body weight for abdominopelvic computed tomography: A systematic review and meta-analysis.

PURPOSE: This systematic review aimed to compare the effect of contrast media (CM) dose adjustment based on lean body weight (LBW) method versus other calculation protocols for abdominopelvic CT examinations. METHOD: Studies published from 2002 onwards were systematically searched in June 2024 across Medline, Embase, CINAHL, Cochrane CENTRAL, Web of Science, Google Scholar and four other grey literature sources, with no language limit. Randomised controlled trials (RCT) and quasi-RCT of abdominopelvic or abdominal CT examinations in adults with contrast media injection for oncological and acute diseases were included. The comparators were other contrast dose calculation methods such as total body weight (TBW), fixed volume (FV), body surface area (BSA), and blood volume. The main outcomes considered were liver and aortic enhancement. Titles, abstracts and full texts were independently screened by two reviewers. RESULTS: Eight studies were included from a total of 2029 articles identified. Liver parenchyma and aorta contrast enhancement did not significantly differ between LBW and TBW protocols (p = 0.07, p = 0.06, respectively). However, the meta-analysis revealed significantly lower contrast volume injected with LBW protocol when compared to TBW protocol (p = 0.003). No statistical differences were found for contrast enhancement and contrast volume between LBW and the other strategies. CONCLUSION: Calculation of the CM dosage based on LBW allows a reduction in the injected volume for abdominopelvic CT examination, ensuring the same image quality in terms of contrast enhancement.

Acute Lymphoblastic Leukemia in a Pediatric Patient With Turnpenny-Fry Syndrome.

Turnpenny-Fry Syndrome (TPFS) is a rare genetic disorder characterized by a severe developmental delay and a distinctive facial gestalt. It is caused by mutations in the Polycomb Group Ring Finger Protein 2 (PCGF2) gene, which is also known to play a role in numerous tumor types. Up to date, there have been no published case reports of patients with TPFS and concomitant malignancies. The present case describes the clinical evaluation and follow-up of a male infant with severe global developmental delay (GDD) and a distinctive phenotype. At 4 years of age, clinical exome sequencing confirmed the diagnosis of TPFS. Posteriorly, at 5 years of age, the patient was also diagnosed with T-cell acute lymphoblastic leukemia (ALL). Given the scarce literature regarding this syndrome, the authors expect that this case report will provide valuable information that could improve the follow-up of patients with TPFS. Furthermore, this case highlights the necessity for the appropriate diagnosis of developmental disorders, to ensure adequate care, surveillance of comorbidities and proper genetic counselling.

A scoping review of interpretability and explainability concerning artificial intelligence methods in medical imaging.

PURPOSE: To review eXplainable Artificial Intelligence/(XAI) methods available for medical imaging/(MI). METHOD: A scoping review was conducted following the Joanna Briggs Institute's methodology. The search was performed on Pubmed, Embase, Cinhal, Web of Science, BioRxiv, MedRxiv, and Google Scholar. Studies published in French and English after 2017 were included. Keyword combinations and descriptors related to explainability, and MI modalities were employed. Two independent reviewers screened abstracts, titles and full text, resolving differences through discussion. RESULTS: 228 studies met the criteria. XAI publications are increasing, targeting MRI (n = 73), radiography (n = 47), CT (n = 46). Lung (n = 82) and brain (n = 74) pathologies, Covid-19 (n = 48), Alzheimer's disease (n = 25), brain tumors (n = 15) are the main pathologies explained. Explanations are presented visually (n = 186), numerically (n = 67), rule-based (n = 11), textually (n = 11), and example-based (n = 6). Commonly explained tasks include classification (n = 89), prediction (n = 47), diagnosis (n = 39), detection (n = 29), segmentation (n = 13), and image quality improvement (n = 6). The most frequently provided explanations were local (78.1 %), 5.7 % were global, and 16.2 % combined both local and global approaches. Post-hoc approaches were predominantly employed. The used terminology varied, sometimes indistinctively using explainable (n = 207), interpretable (n = 187), understandable (n = 112), transparent (n = 61), reliable (n = 31), and intelligible (n = 3). CONCLUSION: The number of XAI publications in medical imaging is increasing, primarily focusing on applying XAI techniques to MRI, CT, and radiography for classifying and predicting lung and brain pathologies. Visual and numerical output formats are predominantly used. Terminology standardisation remains a challenge, as terms like "explainable" and "interpretable" are sometimes being used indistinctively. Future XAI development should consider user needs and perspectives.

Artificial intelligence to support person-centred care in breast imaging - A scoping review.

AIM: To overview Artificial Intelligence (AI) developments and applications in breast imaging (BI) focused on providing person-centred care in diagnosis and treatment for breast pathologies. METHODS: The scoping review was conducted in accordance with the Joanna Briggs Institute methodology. The search was conducted on MEDLINE, Embase, CINAHL, Web of science, IEEE explore and arxiv during July 2022 and included only studies published after 2016, in French and English. Combination of keywords and Medical Subject Headings terms (MeSH) related to breast imaging and AI were used. No keywords or MeSH terms related to patients, or the person-centred care (PCC) concept were included. Three independent reviewers screened all abstracts and titles, and all eligible full-text publications during a second stage. RESULTS: 3417 results were identified by the search and 106 studies were included for meeting all criteria. Six themes relating to the AI-enabled PCC in BI were identified: individualised risk prediction/growth and prediction/false negative reduction (44.3%), treatment assessment (32.1%), tumour type prediction (11.3%), unnecessary biopsies reduction (5.7%), patients' preferences (2.8%) and other issues (3.8%). The main BI modalities explored in the included studies were magnetic resonance imaging (MRI) (31.1%), mammography (27.4%) and ultrasound (23.6%). The studies were predominantly retrospective, and some variations (age range, data source, race, medical imaging) were present in the datasets used. CONCLUSIONS: The AI tools for person-centred care are mainly designed for risk and cancer prediction and disease management to identify the most suitable treatment. However, further studies are needed for image acquisition optimisation for different patient groups, improvement and customisation of patient experience and for communicating to patients the options and pathways of disease management.

Genetic counseling and carrier screening in candidates for gamete donation at a Portuguese center.

OBJECTIVE: Genetic counseling and carrier screening are part of the gamete donation process by healthy individuals. We aim to review the findings of genetic counseling and carrier screening of a cohort of candidates at our public gametes bank. METHODS: Thirty-four male and 64 female candidates had genetic counseling with a medical geneticist before donation. Of these, one female candidate voluntarily dropped-out. Thirty-four males and 63 females performed karyotype and screening for the more common pathogenic variants for CFTR-related cystic fibrosis and spinal muscular atrophy (SMN1) in the Portuguese population. In addition, all females also performed Fragile X expansion screening (FMR1). Thirty candidates with known or assumed African ancestry performed hemoglobinopathies screening. RESULTS: Six candidates were definitely or temporarily withheld from the donation process given their family or personal history that required further investigation. Of 97 candidates tested, 16.5% presented anomalous laboratory results (16/97): ten candidates were carriers for an autosomal recessive disorder - cystic fibrosis (5/97), sickle cell anemia (3/30), and spinal muscular atrophy (2/97). One female was an FMR1 pre-mutation carrier (1/63). One female candidate presented with triple X mosaicism: 47,XXX[2]/46,XX[50]. Two candidates presented with chromosomal instability of unknown origin. In one candidate, a mosaic for the Philadelphia chromosome was detected, revealing the diagnosis of chronic myeloid leukemia. CONCLUSIONS: From a cohort of 97 candidates, 21.7% had a family/personal history or an anomalous laboratory result that required additional genetic counseling, stressing the importance of performing pre-donation genetic counseling in this population.

Interventions to improve patient experience in mammography: a scoping review protocol.

OBJECTIVE: The objective of this review is to map the global evidence on interventions aiming to enhance the patient experience during mammography examination. INTRODUCTION: Mammography is the examination of choice to detect breast cancer, which is the most common malignant condition among women globally. However, this examination can cause psychological distress, discomfort, and pain for patients. To limit these negative experiences, and to promote patient engagement in diagnostic and screening examinations, some interventions have been tested in clinical practice. Each intervention has key differing features that need to be explored in a scoping review. This mapping will help inform mammography professionals and researchers. INCLUSION CRITERIA: This review will consider studies that focus on women, men, transgender, nonbinary, or intersexual persons undergoing diagnostic or screening mammography. It will consider studies evaluating interventions and reporting data on the patient experience. These interventions may, for instance, be related to the information provided, breast compression, relaxation, medication, or physical environment. The review will also describe the outcomes related to patient experience (eg, anxiety, pain, discomfort). METHODS: The search strategy will aim to find published and unpublished studies and will be conducted in MEDLINE, Embase, CINAHL, PsycINFO, Cochrane Central Register of Controlled Trials, Web of Science, and ProQuest Dissertation and Theses. Furthermore, three registries will be searched for ongoing studies. This review will be conducted following JBI methodology, utilizing the three-step search strategy with two independent reviewers performing study selection and data extraction. The results, frequencies, and conceptual categories will be presented in a tabular and narrative summary. SCOPING REVIEW REGISTRATION: Open Science Framework ( https://osf.io/fn865/ ).

Sugammadex administration in pregnant patients undergoing non-obstetric surgery: a case series.

The use of sugammadex for reversal of rocuronium-induced neuromuscular blockade after caesarean section is nowadays common practice, but concerns exist about its use in pregnant women undergoing non-obstetric surgery. We report six cases of pregnant women submitted to general anesthesia for non-obstetric surgery in which neuromuscular blockade was reversed with sugammadex. We followed the outcome of both mother and baby during and after delivery. Sugammadex seemed to be a safe option for both mother and baby but more reports are necessary to fill the evidence gap and increase the global knowledge about its safety in this special group of patients.

Autoeficácia e procrastinação acadêmica em estudantes do ensino superior: um estudo correlacional / Self-efficacy and academic procrastination in higher education students: a correlational study / Autoeficacia y procrastinación académica en estudiantes de enseñanza superior: un estudio correlacional

Os objetivos do estudo são analisar as diferenças da autoeficácia na formação superior (AEFS) e da procrastinação acadêmica em função do sexo, idade e momento do curso e estabelecer relações entre os construtos. Participaram da investigação 1.635 estudantes do ensino superior, 66,5% mulheres, 48,6% ingressantes e 67,5% menores de 22 anos. Os instrumentos utilizados foram a Escala de Autoeficácia na Formação Superior e a Escala de Procrastinação Acadêmica. As mulheres relataram níveis superiores na AEFS e nas dimensões regulação da formação, ações proativas e gestão acadêmica. Os estudantes mais velhos descreveram autoeficácia mais elevada na totalidade da escala e em todas as dimensões e os ingressantes indicaram menor nível de autoeficácia acadêmica. Os homens e os estudantes mais jovens relataram resultados mais elevados na procrastinação. As correlações entre a autoeficácia e a procrastinação são negativas e, na maioria, moderadas. Os achados reforçam a relação conceitual entre os construtos e potenciais implicações para o sucesso acadêmico são discutidas.

The purposes of this study are to examine gender, age and graderelated differences in Higher Education Self-efficacy (HESE) and Academic Procrastination, also to investigate the relationship between the constructs. This study was conducted using 1.635 undergraduates, 66.5% of them were women, 48.6% were freshman, and 65.7% were students under the age of 22 years old. The data was collected using the Higher Education Self-efficacy Scale and the Academic Procrastination Scale. The women had a higher level of HESE and of education regulation, proactive actions, and academic management factors. Students above the age of 22 reported high values of self-efficacy in all of its factors and the freshman showed a lower level of academic self-efficacy. The male and the younger students reported higher values of procrastination. There were negative correlations between the levels of Self-efficacy and Procrastination in an almost moderate relationship. These findings were strengthening the conceptual relationship between the constructs and the potential implications to undergraduates' academic success are discussed.

Los objetivos del estudio son analizar las diferencias de la Autoeficacia para la Formación Superior (AEFS) y la Procrastinación Académica en función del sexo, edad y año cursado; y establecer relaciones entre los constructos.Participaron de la investigación 1.635 estudiantes, siendo: 66.5% mujeres, 48.6% ingresantes y 67.5% menores de 22 años. Los instrumentos utilizados fueron las Escala de Autoeficacia en la Formación Superior y Escala de Procrastinación Académica. Las mujeres relataron valores más altos en la AEFS total y en lasdimensiones regulación de la formación, acciones proactivas, gestión académica. Los estudiantes con más edad describieron Autoeficacia total más elevada y en sus dimensiones y los ingresantes indicaron valores menores en la Autoeficacia académica. Los hombres y los estudiantes más jóvenes relataron una mayor frecuencia de Procrastinación. Las correlacións entre la AEFS y la procrastinación son negativas y moderadas en la mayor parte de las relaciones estudiadas. Los esultados refuerzan la relación conceptual entre los constructos y se presentan las implicaciones para el éxito académico.

Consensus about image quality assessment criteria of breast implants mammography using Delphi method with radiographers and radiologists.

AIMS: To identify image quality criteria that can be applied to assess breast implant (BI) mammograms according to radiologists and radiographers' perspectives and to explore the level of agreement about criteria priority. METHODS: A two-round Delphi method using a questionnaire was applied to identify the level of agreement between experts, asking them to rank each image criteria available for mammography according to 4 possible answers (1 = need to have, 2 = nice to have, 3 = not pertinent/appropriate, 4 = do not know). Criteria for craniocaudal (CC), mediolateral-oblique (MLO) and lateral (ML), with and without Eklund manoeuvre, were included. This process was repeated after removing the less relevant criteria. RESULTS: Between first and second rounds, different results were obtained regarding the criteria to assess CC and MLO images. Details for anatomic areas were considered the most relevant by radiographers during the first round, while general criteria were prioritised during the second round. Radiologists focused more on analysis of the spread of the breast tissue, if the breast was aligned with detector's centre and level of contrast. The analysis of implant flow, the BI anterior edge and the maximum retropulsion of BI when Eklund manoeuvre is performed were the specific aspects of BI imaging considered as relevant for assessment. CONCLUSIONS: The importance of each criterion used to assess BI mammograms was not the same between radiographers and radiologists, suggesting the two groups of experts are looking for different requirements from the image. Further education and training is necessary to align strategies for assessing BI mammograms, and some criteria need to be adapted to reduce subjectivity.

Study of breast implants mammography examinations for identification of suitable image quality criteria.

PURPOSE: To characterise the mammography technique used in breast cancer screening programmes for breast implants (BI) and to identify if the image quality (IQ) criteria available in literature are applicable to BI imaging. METHODS: The study was conducted in two phases: literature review to find IQ criteria used in mammography combining keywords in several sources; and assessment of 1207 BI mammograms using the criteria that was identified previously to see if they were achieved or not. An observation grid was used to collect information about positioning, beam energy, compression force, and exposure mode. Descriptive statistics and Student's t test and χ2 test were performed according to the nature of the variables. RESULTS: Forty-seven out of 2188 documents were included in the analysis, with 13 items identified to assess the quality of positioning, 4 for sharpness, 3 for artefacts, and 2 for exposure parameters. After applying the criteria to BI mammograms, retroglandular fat was not included in 37.3% of the images. The "Pectoral-Nipple-Line" criterion was achieved in 35% of MLO/ML images. The placement of the implant (subpectoral/subglandular) or performing the Eklund had significant influence on the visible anatomy (p = < 0.005), alongside whether the breast was aligned to the detector's centre. CONCLUSIONS: Some of the criteria used to assess standard mammograms were not applicable to BI due to implant overlap. The alignment of the image with the detector's centre seems to have an impact on the amount of visible tissue. Further studies are necessary to define the appropriate protocol, technique, and suitable quality criteria to assess BI mammograms.

Segurança do paciente no cuidado odontológico: revisão integrativa / Seguridad del paciente en el cuidado odontológico: revisión integradora / Patient safety in dental care: an integrative review

Resumo: Eventos adversos constituem grave problema relacionado à qualidade do cuidado de saúde. A prática odontológica, por ser eminentemente invasiva e implicar contato íntimo e rotineiro com secreções, é potencialmente propícia à ocorrência desses eventos. Diversos estudos em segurança do paciente foram desenvolvidos nas duas últimas décadas, entretanto, em maior número no ambiente hospitalar, em função de sua complexidade organizacional, gravidade de casos, diversidade e especificidade de procedimentos. O objetivo foi identificar e explorar os estudos voltados à segurança do paciente odontológico. Foi realizada revisão integrativa da literatura com consulta ao MEDLINE via PubMed, Scopus via Portal Capes e ao Portal Regional da Biblioteca Virtual de Saúde, utilizando-se os termos segurança do paciente e odontologia nos idiomas inglês, espanhol e português a partir de 2000. Utilizou-se o ciclo de pesquisa em segurança do paciente, proposto pela Organização Mundial da Saúde para classificar os estudos incluídos. Foram analisados 91 artigos. Os eventos adversos mais comuns foram relacionados às alergias, às infecções, ao atraso ou falha de diagnóstico e ao erro da técnica. Medidas para mitigar o problema apontaram para a necessidade de melhoria da comunicação, incentivo à notificação e procura por instrumentos para auxiliar a gestão do cuidado. Constatou-se carência de estudos de implementação e avaliação de impacto das propostas de melhoria. A Odontologia evoluiu no campo da segurança do paciente, mas ainda está aquém de transpor resultados para a prática, sendo importante envidar esforços para prevenir os eventos adversos nesta área.

Resumen: Los eventos adversos constituyen un grave problema relacionado con la calidad del cuidado en la salud. La práctica odontológica, por ser eminentemente invasiva e implicar contacto íntimo y rutinario con secreciones, es potencialmente propicia para la ocurrencia de esos eventos. Diversos estudios en seguridad del paciente se desarrollaron en las dos últimas décadas, sin embargo, en mayor número en el ambiente hospitalario, en función de su complejidad organizativa, gravedad de casos, diversidad y especificidad de procedimientos. El objetivo fue identificar e investigar los estudios dirigidos a la seguridad del paciente odontológico. Se realizó una revisión integradora de la literatura con consulta al MEDLINE vía PubMed, Scopus vía Portal Capes y al Portal Regional de la Biblioteca Virtual de Salud, utilizándose los términos seguridad del paciente y odontología en los idiomas inglés, español y portugués a partir de 2000. Se utilizó el ciclo de investigación en seguridad del paciente, propuesto por la Organización Mundial de la Salud para clasificar los estudios incluidos. Se analizaron 91 artículos. Los eventos adversos más comunes estuvieron relacionados con las alergias, infecciones, retraso o fallo de diagnóstico y con el error de la técnica. Las medidas para mitigar el problema apuntaron la necesidad de una mejora de la comunicación, incentivos a la notificación y búsqueda de instrumentos para apoyar la gestión del cuidado. Se constató la carencia de estudios de implementación y evaluación de impacto de las propuestas de mejora. La Odontología evolucionó en el campo de la seguridad del paciente, pero todavía está lejos de trasladar resultados a la práctica, siendo importante aunar esfuerzos para prevenir eventos adversos en esta área.

Abstract: Adverse events pose a serious problem for quality of healthcare. Dental practice is eminently invasive and involves close and routine contact with secretions; as such, it is potentially prone to the occurrence of adverse events. Various patient safety studies have been developed in the last two decades, but mostly in the hospital setting due to the organizational complexity, severity of the cases, and diversity and specificity of the procedures. The objective was to identify and explore studies on patient safety in Dentistry. An integrative literature review was performed in MEDLINE via PubMed, Scopus via Portal Capes, and the Regional Portal of the Virtual Health Library, using the terms patient safety and dentistry in English, Spanish, and Portuguese, starting in 2000. The research cycle in patient safety was used, as proposed by the World Health Organization to classify studies. We analyzed 91 articles. The most common adverse events were allergies, infections, diagnostic delay or failure, and technical error. Measures to mitigate the problem highlight the need to improve communications, encourage reporting, and search for tools to assist the management of care. The authors found a lack of studies on implementation and assessment of the impact of proposals for improvement. Dentistry has made progress in patient safety but still needs to transpose the results into practice, where efforts are crucial to prevent adverse events.

Quantitative Measurements of Breast Density Using Magnetic Resonance Imaging: A Systematic Review and Meta-Analysis.

Breast density, a measure of dense fibroglandular tissue relative to non-dense fatty tissue, is confirmed as an independent risk factor of breast cancer. Although there has been an increasing interest in the quantitative assessment of breast density, no research has investigated the optimal technical approach of breast MRI in this aspect. Therefore, we performed a systematic review and meta-analysis to analyze the current studies on quantitative assessment of breast density using MRI and to determine the most appropriate technical/operational protocol. Databases (PubMed, EMBASE, ScienceDirect, and Web of Science) were searched systematically for eligible studies. Single arm meta-analysis was conducted to determine quantitative values of MRI in breast density assessments. Combined means with their 95% confidence interval (CI) were calculated using a fixed-effect model. In addition, subgroup meta-analyses were performed with stratification by breast density segmentation/measurement method. Furthermore, alternative groupings based on statistical similarities were identified via a cluster analysis employing study means and standard deviations in a Nearest Neighbor/Single Linkage. A total of 38 studies matched the inclusion criteria for this systematic review. Twenty-one of these studies were judged to be eligible for meta-analysis. The results indicated, generally, high levels of heterogeneity between study means within groups and high levels of heterogeneity between study variances within groups. The studies in two main clusters identified by the cluster analysis were also subjected to meta-analyses. The review confirmed high levels of heterogeneity within the breast density studies, considered to be due mainly to the applications of MR breast-imaging protocols and the use of breast density segmentation/measurement methods. Further research should be performed to determine the most appropriate protocol and method for quantifying breast density using MRI.

Characterization of radiographers' mammography practice in five European countries: a pilot study.

OBJECTIVES: This pilot study aimed to characterize and compare radiographers' mammography practice, including quality control and continuous professional development in five European countries. METHODS: Online survey was performed to collect data regarding participants' profile, institution's profile, mammography practice, quality control and continuous professional development. The questionnaire was sent to clinical radiographers working in Estonia, Finland, Norway, Portugal and Switzerland. Descriptive statistical and subgroup analyzes were performed. RESULTS: The amount of returned questionnaires was 140. Most respondents were female (92%), having radiography bachelor. The majority (89%) of radiographers was working with full-field digital mammography. The majority (97%) of mammography images were acquired using AEC, and half of the radiographers were using dose saving programmes suggested by the manufacturers. The most typical (50%) compression force ranged from 8 to 11 kg. Part of the radiographers (44%) did not know if their practice followed specific guidelines. The most challenging tasks in mammography identified by radiographers were patient positioning (86%), coping with pain (88%), managing anxiety (83%) and imaging breast implants (71%). The majority (88%) of the respondents undertook continuous professional development activities. CONCLUSIONS: The mammography practice varies across the five countries. We found country-specific traits related to mammography image acquisition, patient-centered care and quality management procedures. The lack of evidence-based knowledge suggests the importance of well-designed studies on these topics. The variability found in this pilot study encourages radiographers to question their own practice and teachers to review and revise the training programmes. Validation in larger studies including more countries is needed.

Reliability and validity of the Brazilian version of the HSOPSC: a reassessment study / Confiabilidade e validade da versão brasileira do HSOPSC: um estudo de reavaliação / Fiabilidad y validez de la versión brasileña del HSOPSC: un estudio de revisión

Abstract: This study aimed to reassess the psychometric properties of the Hospital Survey on Patient Safety Culture (HSOPSC) adapted to Portuguese for use in the Brazilian context. An observational, cross-sectional study was performed in a large, private, non-profit, acute care hospital, reference in patient safety, in a major Brazilian metropolis. Participants were selected from a non-probability sample of all eligible personnel in the various hospital departments invited to participate in the study. Reliability of the HSOPSC was assessed by estimating Cronbach's alpha for each dimension. confirmatory factor analysis (CFA), a matrix of correlations between the dimensions, and exploratory structural equation modelling (ESEM) were used in exploratory and confirmatory analyses of the structural validity of the construct. The overall response rate was 18.7% (n = 1,439). Four dimensions ("overall perceptions of patient safety"; "staffing"; "teamwork across units"; and "non-punitive response to error") returned problems of internal consistency. CFA returned acceptable fit with the original 12-dimension model. Correlations between the dimensions of the original 12-dimension model indicated discriminant validity problems, while residual variance was greater than 0.70 in 13 items. The ESEM of the original 12-dimension model returned good fit, with the following indices: CFI = 0.985; TLI = 0.968, and RMSEA = 0.026 (90%CI: 0.024-0.029). Although better than those of the first evaluation, the results obtained in this validity and reliability reassessment of the Brazilian version of the HSOPSC require further research.

Resumo: O estudo teve como objetivo reavaliar as propriedades psicométricas da versão do Hospital Survey on Patient Safety Culture (HSOPSC) adaptada para o português, para uso no contexto brasileiro. Foi realizado um estudo observacional, transversal, em um hospital particular sem fins lucrativos, referência em segurança do paciente, localizado em uma metrópole brasileira. Os participantes foram selecionados a partir de uma amostra não-probabilística de todos os funcionários elegíveis de diversos departamentos hospitalares, convidados a participar no estudo. A confiabilidade do HSOPSC foi avaliada pela estimativa do alfa de Cronbach para cada dimensão. Foram usadas análise fatorial confirmatória (AFC), uma matriz de correlações entre as dimensões e modelagem de equações estruturais (MEE) na análise exploratória e confirmatória da validade estrutural do construto. Houve uma taxa global de resposta de 18,7% (n = 1.439). Quatro dimensões ("percepção geral de segurança do paciente"; "recursos humanos"; "trabalho de equipe entre unidades" e "resposta não-punitiva aos erros") apresentaram problemas de consistência interna. A AFC mostrou um ajuste aceitável em relação ao modelo original de 12 dimensões. As correlações entre as dimensões do modelo original de 12 dimensões indicaram problemas de validade discriminante, enquanto a variância residual foi maior de 0,70 em 13 itens. A MEE do modelo original de 12 dimensões mostrou bom ajuste, com os seguintes índices: CFI = 0,985; TLI = 0,968 e RMSEA = 0,026 (IC90%: 0,024-0,029). Embora tenham superado a primeira avaliação, os resultados obtidos nesta reavaliação da validade e confiabilidade da versão do questionário traduzida e adaptada para o contexto brasileiro indicam a necessidade de mais estudos.

Resumen: El estudio tuvo como objetivo revisar las propiedades psicométricas de la versión del Hospital Survey on Patient Safety Culture (HSOPSC) adaptado al portugués, para su uso en el contexto brasileño. Se realizó un estudio transversal observacional, en un hospital grande con cuidados intensivos, privado, sin ánimo de lucro, punto de referencia en seguridad del paciente, situado en una de las mayores metrópolis brasileñas. Los participantes se seleccionaron de un muestreo no probabilístico entre todo el personal elegible de los diversos departamentos hospitalarios invitados a participar en el estudio. La fiabilidad del HSOPSC se evaluó estimando el alfa de Cronbach para cada dimensión. Se utilizaron tanto el análisis factorial confirmatorio (AFC), como la matriz de correlaciones entre las dimensiones y los modelos de ecuaciones estructurales exploratorios (ESEM) en el análisis exploratorio y confirmatorio para la validez estructural del constructo. El porcentaje general de respuesta fue de un 18,7% (n = 1,439). Hubo cuatro dimensiones ("percepciones generales de seguridad del paciente"; "dotación de personal"; "trabajo en equipo en las unidades"; y "respuesta al error no-punitiva"), problemas recurrentes de consistencia interna. El AFC mostró un ajuste aceptable con el modelo original de 12-dimensiones. Las correlaciones entre las dimensiones del modelo original de 12-dimensiones indicaron problemas de validez discriminante, mientras que varianza residual era mayor a 0,70 en 13 ítems. Los ESEM del modelo original de 12-dimensiones tuvieron un buen ajuste con los siguientes índices: CFI = 0,985; TLI = 0,968 y RMSEA = 0,026 (90%CI: 0,024-0,029). A pesar de que eran mejores que los de la primera evaluación, los resultados obtenidos en esta revisión de la validez y fiabilidad de la versión del cuestionario, traducido y adaptado al contexto brasileño, es necesario que haya más investigaciones al respecto sobre este asunto.

Synchrotron radiation computed tomography versus conventional computed tomography for assessment of four types of stent grafts used for endovascular treatment of thoracic and abdominal aortic aneurysms.

BACKGROUND: To determine the accuracy of synchrotron radiation computed tomography (CT) for measurement of stent wire diameters for in vitro simulation of endovascular aneurysm repair by four different types of stent grafts when compared to conventional CT images. METHODS: This study was performed using an aorta model with implantation of four aortic stent grafts for endovascular treatment of thoracoabdominal and abdominal aortic aneurysms. The aorta model was scanned using synchrotron radiation CT with beam energies ranging from 60 to 90 keV with 10 keV increment at each scan and spatial resolution of 41.6 µm per pixel. Stent wire diameters were measured at the top and body regions of each stent graft based on 2-dimensional (2D) axial and 3-dimensional (3D) reconstruction images, with measurements compared to those obtained from 128-slice CT images which were acquired with slice thickness of 0.5 mm. RESULTS: Synchrotron radiation CT images clearly demonstrated stent graft details with accurate assessment of stent wire diameters, with measurements at the top of stent grafts (between 0.32±0.02 and 0.47±0.02 mm) similar to the actual diameters (between 0.32±0.01 and 0.48±0.01 mm) when the beam energies of 70 and 80 keV were used, regardless of the types of stent grafts assessed. A beam energy of 60 keV resulted in stent wires thicker than the actual sizes, although this did not reach statistical significance (P=0.07-0.29), while the beam energy of 90 keV led to stent wires smaller than the actual sizes at the top (P=0.16) and body region (P=0.02) of stent grafts on 2D axial images. The stent wire sizes measured at the body region of stent grafts on 3D synchrotron radiation images (between 0.19±0.02 and 0.43±0.02 mm) were significantly smaller than the actual diameters (P=0.02-0.04). Stent wires were overestimated on conventional CT images with diameters more than 2-fold larger than the actual sizes (P=0.007-0.03) at both top and body regions of all four stent grafts. CONCLUSIONS: This study further confirms the accuracy of high-resolution synchrotron radiation CT in image visualization and size measurement of different aortic stent grafts with measured wire diameters similar to the actual ones, thus allowing for more accurate assessment of stent wire details for endovascular repair of aortic aneurysms.

Mucoadhesive assessment of different antifungal nanoformulations.

Oral candidiasis is an important opportunistic fungal infection and polyenes and azoles are still the most used antifungal agents. However, the oral absorption resulting from most available treatments is generally poor and, consequently, a very high frequency of administrations of antifungal agents is strongly required. Therefore, the major challenge is to improve the retention of the antifungal agents in buccal mucosa, and the encapsulation into mucoadhesive systems may be considered as a possible strategy to achieve this objective. Three types of mucoadhesive polymeric nanoparticles (polylactic acid (PLA), polylactic-co-glycolic acid (PLGA) and alginate) were prepared using nystatin as model drug. The drug-loaded nanoparticles were then included in toothpaste, oral gel and oral films, respectively. The results demonstrated that the loaded nanoparticles were successfully produced, presenting a mean size between 300-900 nm and with a negative surface charge. Also, the determination of the encapsulation efficiency of all nanoparticles showed values above 70%. In terms of the in vitro mucoadhesion, the best formulation was the oral film loaded with the PLGA nanoparticles followed by the oral gel with PLA nanoparticles and thirdly the toothpaste with alginate nanoparticles. This was confirmed in an in vitro rinsing model with mucus producing HT29-MTX cells, where the percentage of nystatin retained to the cells after 40 min of simulated saliva flow was between 10-27% when formulations were used and only 4% for free nystatin. Further studies will include in vivo testing using animal models.

Correction to: European radiographers' challenges from mammography education and clinical practice-an integrative review.

Affiliation number 2 was rendered incorrectly.

PORTUGUESE STUDY OF MEAN GLANDULAR DOSE IN MAMMOGRAPHY AND COMPARISON WITH EUROPEAN REFERENCES.

To characterise the mean glandular dose (MGD) in a sample of healthcare providers for digital mammography in Portugal. To compare the achieved values with European references. The MGD was measured on a poly-methyl-methacrylate phantom (45 mm) for each system using dosimeters. In addition, MGD was estimated using exposure settings collected from mammography exams in clinical context. Data were collected from 25 computed-radiography systems (CR) and 13 integrated digital (DR). For both measurements (phantom and clinical exposures), the average MGD for CR was higher compared to the DR. For CR the mean MGD was 1.85 mGy (CC projection) and 2.10 mGy (MLO projection). For DR systems the corresponding values were 1.54 mGy (CC) and 1.68 mGy (MLO). The average MGD obtained using both methods and for both technologies is within the acceptable reference range proposed by European guidelines (<2.5 mGy). Dose Reference Levels implementation should be the next step to optimise mammography practice in Portugal.