The Portuguese Model of Home Respiratory Care: Healthcare Professionals' Perspective.

Patients' and carers' views regarding the Portuguese model of home respiratory care were recently described, yet the complementary perspective of healthcare professionals (HCPs) is still to be investigated. Thus, this study explored HCPs experience in the management of patients needing home respiratory therapies (HRT), and their perspective about the Portuguese model. A phenomenological descriptive study, using focus groups, was carried out with 28 HCPs (median 42 y, 68% female) with distinct backgrounds (57% pulmonologists, 29% clinical physiologists, 7% physiotherapists, 7% nurses). Three focus groups were conducted in three regions of Portugal. Thematic analysis was performed by two independent researchers. HCPs have in general a positive view about the organization of the Portuguese model of home respiratory care, which was revealed in four major topics: Prescription (number of references, n = 171), Implementation and maintenance (n = 162), Carer involvement (n = 65) and Quality of healthcare (n = 247). Improvements needed were related to patients' late referral, HRT prescription (usability of the medical electronic prescription system and renewals burden), patients' education, access to hospital care team, lack of multidisciplinary work and articulation between hospital, primary and home care teams. This study describes the perspective of HCPs about the Portuguese model of home respiratory care and identifies specific points where improvements and reflections are needed. This knowledge may be useful to decision makers improve the current healthcare model.

Patient Experience in Home Respiratory Therapies: Where We Are and Where to Go.

The increasing number of patients receiving home respiratory therapy (HRT) is imposing a major impact on routine clinical care and healthcare system sustainability. The current challenge is to continue to guarantee access to HRT while maintaining the quality of care. The patient experience is a cornerstone of high-quality healthcare and an emergent area of clinical research. This review approaches the assessment of the patient experience in the context of HRT while highlighting the European contribution to this body of knowledge. This review demonstrates that research in this area is still limited, with no example of a prescription model that incorporates the patient experience as an outcome and no specific patient-reported experience measures (PREMs) available. This work also shows that Europe is leading the research on HRT provision. The development of a specific PREM and the integration of PREMs into the assessment of prescription models should be clinical research priorities in the next several years.

[Analysis of the Cochrane Review: Pedicle Screw Fixation for Traumatic Fractures of the Thoracic and Lumbar Spine. Cochrane Database Syst Rev. 2013;05:CD009073]. / Análise da Revisão Cochrane: Fixação com Parafusos Pediculares de Fraturas Traumáticas da Coluna Vertebral Torácica e Lombar. Cochrane Database Syst Rev. 2013;05:CD009073.

Traumatic fractures of the thoracic and lumbar spine are common causes of spine surgery. Pedicle screw fixation is usually chosen, using monosegmentar, short or long segment instrumentations, with or without bone graft. This review aims to evaluate the effect of transpedicular fixation in traumatic fractures of the thoracic and lumbar spine. A systematic search on controlled, randomized or quasi-randomized trials comparing different methods of surgical treatment of this fractures was performed, followed by a process of article selection, data extraction and bias assessment by 3 independent authors. Eight articles were included in a total of 5 comparisons, between different transpedicular fixation techniques. No significant differences on function or quality of life, neurologic status or limitation of motion were found. Only instrumentation with fracture level screw incorporation showed significant decrease of pain when compared with instrumentation alone. Several techniques resulted in significant improvements of different radiological parameters. Significantly, surgeries with smaller duration were associated with lesser blood loss. Bone graft use caused a significant raise in post-operative complications, namely donor site pain. So, this paper showed that significative improvements in radiological parameters do not associate with correspondent clinical benefits, and only instrumentation with level screw incorporation is associated with a clear benefit on pain. Moreover, the need for bone graft is questioned, since it leads to no clinic-radiological improvement with a raise of complications. However, a small number of controlled studies is available on this topic.

As fraturas da coluna vertebral torácica e lombar são causa comum de cirurgia da coluna vertebral. A fixação com parafusos pediculares é geralmente escolhida para a sua estabilização, com recurso a instrumentações curtas, longas ou monosegmentares com ou sem enxerto ósseo. O objetivo desta revisão é avaliar o efeito da fixação transpedicular nas fraturas vertebrais torácicas e lombares traumáticas. Foi realizada uma pesquisa sistemática de estudos controlados aleatorizados ou quasi-aleatorizados que comparassem diferentes técnicas de tratamento cirúrgico destas fraturas, seguida de um processo de seleção, extração de dados e avaliação de viéses por três autores independentes. Oito estudos foram incluídos, num total de cinco comparações entre diferentes fixações com parafusos pediculares. Não se encontraram diferenças significativas quanto à melhoria da função e qualidade de vida, dos défices neurológicos ou da mobilidade. Apenas a instrumentação com parafusos pediculares no nível da fratura mostrou melhoria significativa da dor quando comparada com instrumentação posterior sem parafuso no nível. Várias técnicas resultaram em melhoria significativa dos parâmetros imagiológicos, sem melhoria clínica correspondente. De modo significativo tempos cirúrgicos mais curtos associaram-se a menores perdas sanguíneas. O uso de enxerto ósseo causou um aumento significativo das complicações pós-operatórias, nomeadamente dor no local dador. Assim, os resultados mostram que melhorias imagiológicas significativas não se associam a impactos clínicos correspondentes, e que apenas o uso de fixação transpedicular no nível da fratura se associa a melhoria clínica evidente da dor. Adicionalmente, a necessidade de enxerto ósseo é posta em causa, pela ausência de melhoria clínico-imagiológica, com aumento das complicações. Contudo, o número de estudos controlados disponíveis acerca deste tópico é reduzido.