IROCA-TES: Improving Quality in Radiation Oncology through Clinical Audits - Training and Education for Standardization.

Background: Clinical audits are an important tool to objectively assess clinical protocols, procedures, and processes and to detect deviations from good clinical practice. The main aim of this project is to determine adherence to a core set of consensus- based quality indicators and then to compare the institutions in order to identify best practices. Materials and methods: We conduct a multicentre, international clinical audit of six comprehensive cancer centres in Poland, Spain, Italy, Portugal, France, and Romania as a part of the project, known as IROCATES (Improving Quality in Radiation Oncology through Clinical Audits - Training and Education for Standardization). Results: Radiotherapy practice varies from country to country, in part due to historical, economic, linguistic, and cultural differences. The institutions developed their own processes to suit their existing clinical practice. Conclusions: We believe that this study will contribute to establishing the value of routinely performing multi-institutional clinical audits and will lead to improvement of radiotherapy practice at the participating centres.

Results of the IROCA international clinical audit in prostate cancer radiotherapy at six comprehensive cancer centres.

To assess adherence to standard clinical practice for the diagnosis and treatment of patients undergoing prostate cancer (PCa) radiotherapy in four European countries using clinical audits as part of the international IROCA project. Multi-institutional, retrospective cohort study of 240 randomly-selected patients treated for PCa (n = 40/centre) in the year 2015 at six European hospitals. Clinical indicators applicable to general and PCa-specific radiotherapy processes were evaluated. All data were obtained directly from medical records. The audits were performed in the year 2017. Adherence to clinical protocols and practices was satisfactory, but with substantial inter-centre variability in numerous variables, as follows: staging MRI (range 27.5-87.5% of cases); presentation to multidisciplinary tumour board (2.5-100%); time elapsed between initial visit to the radiation oncology department and treatment initiation (42-102.5 days); number of treatment interruptions ≥ 1 day (7.5-97.5%). The most common deviation from standard clinical practice was inconsistent data registration, mainly failure to report data related to diagnosis, treatment, and/or adverse events. This clinical audit detected substantial inter-centre variability in adherence to standard clinical practice, most notably inconsistent record keeping. These findings confirm the value of performing clinical audits to detect deviations from standard clinical practices and procedures.

Indole based cyclooxygenase inhibitors: synthesis, biological evaluation, docking and NMR screening.

The close structural similarity between the two cyclooxygenase (COXs) isoforms and the absence of selective inhibitors without side effects continues to stimulate the development of novel approaches towards selective anti-inflammatory drugs. In the present study a small library of new indolic compounds involving two different substitutions patterns at the indole scaffold was synthesized. In order to establish a relation between the spatial distribution of known functional groups related with inhibitory activity, two substitution patterns were explored: one with substituents at N-1, C-3, C-5 positions and another at C-2, C-3 and C5 positions. Accordingly, indole positions C-5, C-3 and N-1 were substituted with: sulfonamide or methylsulfone at C-5, p-halo-benzyl group at C-3, and an alkyl chain with a trifluoromethyl group at N-1. Alternatively, a p-halo-benzyl group was introduced at C-2, leaving the indolic nitrogen free. Inhibitory studies were performed and the activity results obtained against both COXs isoforms were rationalized based on docking and NMR studies. Docking studies show that dialkyation at C-2 and C-3 favors a binding with an orientation similar to that of the known selective inhibitor SC-558. From the tested compounds, this substitution pattern is correlated with the highest inhibitory activity and selectivity: 70% COX-2 inhibition at 50 µM, and low COX-1 inhibition (18 ± 9%). Additionally, Saturation Transfer Difference NMR experiments reveal different interaction patterns with both COXs isoforms that may be related with different orientations of the sulfonamide group in the binding pocket. Despite the moderated inhibitory activities found, this study represents an innovative approach towards COXs inhibitory activity rationalization and to the design of anti-inflammatory drugs.

De obeso a magro: As vivências das pessoas submetidas a cirurgia bariátrica / From obese to thin: The experiences of people who have undergone bariatric surgery

Actualmente, a obesidade é um problema de saúde pública nos países desenvolvidos e Portugal não é excepção. A cirurgia bariátrica faz parte das estratégias de intervenção preconizadas pela Direcção Geral da Saúde no Plano Nacional de Combate à Obesidade. A bibliografia sobre os impactos da cirurgia bariátrica na vida da pessoa é parca, e pertence essencialmente ao âmbito da psicologia. Face ao crescente número de pessoas que se submetem a cirurgia bariátrica e visando um cuidar holístico e de qualidade, constituiu objectivo de estudo conhecer não só os ganhos em saúde decorrentes da perda de peso, mas também conhecer as experiências, os sentimentos e as alterações que a cirurgia e a consequente perda de peso trouxeram para a vida de cada pessoa que foi submetida a cirurgia bariátrica. Realizou-se uma investigação de natureza qualitativa, com recurso a uma abordagem fenomenológica, com o objectivo de conhecer as vivências das pessoas que se submeteram a cirurgia bariátrica e o que mudou nas suas vidas. A incursão pelas vivências dos participantes fez-se através da aproximação ao seu contexto, que permitiu a concretização da colheita de informação, através de entrevistas semi-estruturadas a seis pessoas submetidas a cirurgia bariátrica, em Outubro e Novembro de 2010. A análise interpretativa e de reflexão fenomenológica seguiu o proposto por van Manen e permitiu identificar sete temas centrais: O meu corpo; Eu e o meu corpo; Eu, o meu corpo e os outros; e Como cheguei à consulta de Cirurgia de Obesidade para compreender como foi viver com obesidade e O que mudou em mim; O que sinto e como me vejo; e A relação com os outros, para compreender como foi a sua vida após a realização de cirurgia bariátrica.