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1.
Acta Med Port ; 36(1): 42-48, 2023 Jan 02.
Article in English | MEDLINE | ID: mdl-35906853

ABSTRACT

INTRODUCTION: The dissemination of the COVID-19 pandemic in Europe, namely in Portugal, demanded an organizational and clinical reaction from the Portuguese National Health Service. With the unpredictable impact of COVID-19 infected patients redefining hospital logistics, reducing non-priority elective care and extending the hospital capacity for critical care patients made mobilizing a significant part of human resources a priority. We conducted a national survey to monitor the contribution and the role of anaesthesiologists belonging to the 53 Portuguese National Health Service hospitals in the first wave fight against the pandemic. MATERIAL AND METHODS: This prospective cross-sectional observational study used a weekly survey sent to the Directors of the Anaesthesiology Departments of all Portuguese National Health Service hospitals, between the period of 13th April and 21st June 2020. Directors were asked about human resources, hospital logistics, anaesthetic activity and residency programs in their departments as well as contingency plans facing the impact of the pandemic growth in the PNHS. RESULTS: Contingency strategy for all Portuguese National Health Service hospitals planned for a total of 1524 level III critical care beds during the initial phases of the pandemic, an increase of 151% from the existing 607 level III critical care beds in Portugal in January 2020. This re-configuration effort of the Portuguese National Health Service was only possible due to the partial or total suspension of non-urgent elective activity that reached over 90% of these institutions in the first pandemic months (March and April) and the deployment of anaesthesiologists from their normal activities to the treatment of critical care patients. During the peak of the first pandemic wave, 209 anaesthesiology specialists and 170 trainees (22.9% of the total anaesthesiologist's staff in the Portuguese National Health Service) were deployed in critical care. There was an almost complete interruption of the residency program rotation in 70.4% of hospitals with anaesthesiology residents, between March and April 2020. CONCLUSION: During the first pandemic wave there was an effective and fast reorganisation of the Portuguese National Health Service in order to increase level III critical care beds, which might have contributed to the low mortality rates in Portugal. We believe that this could have also been a result of the contribution given by all public anaesthesiology departments.


Introdução: A disseminação da pandemia por COVID-19 na Europa, designadamente em Portugal, exigiu uma resposta clínica e organizativa por parte do Serviço Nacional de Saúde português. Com o imprevisível impacto da COVID-19 nos doentes infectados, foi prioritário redefinir a logística hospitalar, reduzir a prestação de cuidados electivos não prioritários, e estender a capacidade hospitalar ao tratamento do doente crítico, mobilizando uma parte significativa dos recursos humanos. Utilizou-se um inquérito nacional que permitisse monitorizar a contribuição que os anestesiologistas pertencentes aos 53 hospitais do Serviço Nacional de Saúde tiveram no combate à COVID-19 durante a primeira vaga da pandemia. Material e Métodos: Estudo observacional transversal de tipo prospectivo, baseado num inquérito semanal enviado aos directores dos Serviços de Anestesiologia de todos os hospitais do Serviço Nacional de Saúde, entre 13 de abril e 21 de junho de 2020. Foi solicitada informação relativa aos recursos humanos, logística hospitalar, atividade assistencial, programa de formação pós-graduado, assim como plano de contingência face ao crescimento da pandemia. Resultados: O plano de contingência hospitalar nos hospitais do Serviço Nacional de Saúde previu um total de 1524 camas de cuidados intensivos de nível III, o que corresponde a um crescimento de 151% das 607 camas existentes em janeiro de 2020. Esta reconfiguração dos hospitais do Serviço Nacional de Saúde só foi possível devido à suspensão parcial ou total da atividade eletiva não prioritária que afectou mais de 90% das instituições hospitalares nos primeiros meses da pandemia (março e abril), e à mobilização dos anestesiologistas das suas atividades eletivas para o tratamento do doente crítico. Nos piores momentos, esta mobilização envolveu 209 especialistas e 170 internos de especialidade (22,9% do total destes profissionais nos hospitais do Serviço Nacional de Saúde). Por outro lado, registou-se uma interrupção quase total do programa de formação pós-graduada em mais de 70,4% dos hospitais com esta idoneidade formativa, de março a abril de 2020. Conclusão: Durante a primeira vaga da pandemia houve uma rápida reorganização do Serviço Nacional de Saúde que poderá ter contribuído para a baixa taxa de mortalidade em Portugal. Os autores acreditam que para esse resultado poderá ainda ter contribuído a ajuda dada pelos serviços de Anestesiologia do Serviço Nacional de Saúde.


Subject(s)
Anesthesiology , COVID-19 , Humans , COVID-19/epidemiology , Pandemics , Portugal/epidemiology , State Medicine , Cross-Sectional Studies , Prospective Studies
2.
Arch Gynecol Obstet ; 282(3): 255-60, 2010 Sep.
Article in English | MEDLINE | ID: mdl-19756676

ABSTRACT

PURPOSE: Parturients with lumbar tattoos are often proposed to neuroaxial blocks (NB). There are no guidelines for this situation, and no reports of major complications derived from NB through tattoos. We conducted a survey of a sample of anaesthetists, to find out about their approach when facing NB on parturients with lumbar tattoos. METHODS: We surveyed 537 anaesthetists through a multiple choice questionnaire. The obtained data were subjected to a descriptive analysis. RESULTS: A total of 162 replies were received. Ninety-two anaesthetists had already been asked to carry out a NB through a tattoo. Fifty-five of them executed the NB on all occasions, always on pigment free skin, 6 always refused to do so, and 31 didn't always performed the NB. Most of these approaches were based on literature. This is according to the fact that literature is not unanimous, which explains opposite actions having similar backgrounds. Of the 70 anaesthetists never confronted with this situation, 74.3% would carry it out when faced with that situation, being that 67.2% would do it over an ink free area, while 7.1% would choose the pigmented one. Personal opinion is the major grounding for this group. CONCLUSIONS: A tendency towards performing NB on pigment free skin, seems to exist. Literature has been the backup for anaesthetists confronted with the above scenario, while personal opinion seems to have been the basis for the remainders. The nonexistence of guidelines as well as the controversy regarding the risks involved in performing NB over tattoo, probably explain the diverse actions taken by the anaesthetists.


Subject(s)
Analgesia, Obstetrical/methods , Nerve Block , Practice Patterns, Physicians' , Tattooing/adverse effects , Data Collection , Female , Humans , Portugal , Pregnancy
3.
Rev Port Pneumol ; 9(4): 293-310, 2003.
Article in Portuguese | MEDLINE | ID: mdl-19771688

ABSTRACT

The Viriato Study is a nationwide, prospective, multicenter surveillance study of the antimicrobial susceptibility of bacterial pathogens commonly associated with community-acquired respiratory tract infections in Portugal. In years 2001 and 2002, 31 laboratories participated in the study with a total of 2,600 strains, with testing undertaken in a central laboratory. Of the 486 Streptococcus pyogenes strains isolated from patients with acute tonsillitis all were susceptible to penicillin and other beta-lactams but 21.6% were resistant to erythromycin, clarithromycin and azithromycin. From patients with lower respiratory tract infection 1,071 strains of Streptococcus pneumoniae, 811 of Haemophilus influenzae, and 232 of Moraxella catarrhalis were studied. Among S. pneumoniae isolates 23% were resistant to penicillin (6.7% showing high-level resistance), 9.1% to cefuroxime, 1.0% to amoxycillin, 12.5% to erythromycin, clarithromycin and azithromycin, 10.9% to tetracycline, 29.8% to co-trimoxazol, and 3.0% to ofloxacin. Beta-lactamase was produced by 13.1% of H. influenzae and 94.4% of M. catarrhalis. In H. influenzae resistance to clarithromycin was 12.5% and to co-trimoxazole 15%. Most strains were susceptible to amoxycillin/clavulanate, cefuroxime, azithromycin, tetracycline and ciprofloxacin. In M. catarrhalis resistance to co-trimoxazole was 25%. All strains were susceptible to amoxycillin/clavulanate, cefuroxime, clarithromycin, azithromycin, tetracycline and ciprofloxacin. As verified in previous years of the Viriato Study, penicillin was the most active antimicrobial against S. pyogenes and amoxycillin/clavulanate the most active in vitro simultaneously against H. influenzae, S. pneumoniae and M. catarrhalis isolated from patients with community-acquired lower respiratory tract infection in Portugal.


Subject(s)
Respiratory Tract Infections/drug therapy , Community-Acquired Infections/drug therapy , Community-Acquired Infections/microbiology , Drug Resistance, Bacterial , Humans , Microbial Sensitivity Tests , Portugal , Prospective Studies , Respiratory Tract Infections/microbiology
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