Browsing by Author "Capelas, Manuel"
Now showing 1 - 6 of 6
Results Per Page
Sort Options
- Body composition analysis in metastatic non-small-cell lung cancer: depicting sarcopenia in Portuguese tertiary carePublication . Mendes, José Leão; Ferreira, Rita Quaresma; Mata, Inês; Barreira, João Vasco; Rodrigues, Ysel Chiara; Dias, David Silva; Capelas, Manuel; Mäkitie, Antti; Guerreiro, Inês; Pimenta, Nuno; Ravasco, PaulaBackground/Objectives: Sarcopenia is an emergent prognostic biomarker in clinical oncology. Albeit increasingly defined through skeletal muscle index (SMI) thresholding, literature cut-offs fail to discern heterogeneous baseline muscularity across populations. This study assesses the prognostic impact of using cohort-specific SMI thresholds in a Portuguese metastatic non-small-cell lung cancer (mNSCLC) cohort. Methods: Retrospective study including mNSCLC patients treated between January 2017 and December 2022. ImageJ v1.54g was used to assess cross-sectional CT imaging at the third lumbar vertebra (L3) and calculate L3SMI. Sarcopenia was defined both according to Prado et al. and L3SMI thresholds derived from receiver operating characteristic analysis. Overall survival (OS) was the primary endpoint. Secondary endpoints included first-line (1L) progression-free survival (PFS) and sarcopenia subgroup analysis regarding body mass index impact on OS. Results: The initial cohort included 197 patients. Mean age was 65 years (± 11.31). Most tumors were adenocarcinomas (n = 165) and presented with metastasis (n = 154). SMI was evaluable in 184 patients: cohort-specific thresholds (< 49.96 cm2/m2 for men; < 34.02 cm2/m2 for women) yielded 46.74% sarcopenic patients (n = 86) versus 66.30% (n = 122) per the literature definition. Cohort-specific thresholds predicted both OS (12.75 versus 21.13 months, hazard ratio [HR] 1.654, p = 0.002) and PFS (7.92 versus 9.56 months, HR 1.503, p = 0.01). Conversely, Prado et al. definition lacked prognostic value. Among sarcopenic patients, overweight (HR 0.417, p = 0.01) and obesity (HR 2.723, p = 0.039) had contrasting impacts on OS. Conclusions: Amid reclassification of nearly one-fifth of the cohort, cohort-specific thresholds improved sarcopenia prognostication in mNSCLC. Homogeneity regarding both cancer treatment setting and ethnicity could be key to defining sarcopenia based on SMI.
- Difficulties and opportunities in providing care to patients in the last hours or days of life: focus groupPublication . Carneiro, Rui; Simões, Catarina; Capelas, Manuel; Carneiro, AntónioBackground: In Portugal, two thirds of deaths occur in the hospital and it is estimated that these numbers will increase considerably in the coming decades. The proper organization of care at this stage promotes peaceful deaths and catalyzes healthy bereavements. The Project MiMI (Morte Iminente em Medicina Interna; Imminent Death in Internal Medicine) is a collaboration between the Portuguese Society of Internal Medicine, the International Collaborative for the Best Care for the Dying Person and the Institute of Health Sciences of the Portuguese Catholic University, whose ultimate goal is to create a training model adjusted to the needs identified by the health professionals involved in the care of these patients and their families Aim(s): (1) Identification of the main difficulties and opportunities for improving the quality of care for patients with imminent death and their families hospitalized for Internal Medicine care, from the perspective of the professional care provider (doctors and nurses working in the Internal Medicine environment); (2) Identification of training needs in the various moments of monitoring patients in a situation of imminent death (diagnosis; adjustment of individual and integrated care plan; death and post-mortem care). Methods: Qualitative methodology of response to a semi-structured script, by a group of professionals considered relevant in the contributions they can provide to the construction of a training curriculum in the area in question. Thus, a convergent discussion will be promoted with a convenience panel consisting of: two doctors with the Specialty of Internal Medicine and with responsibility for the service management, two doctors of the Specialty of Internal Medicine with at least 5 (five) years of experience and who has taken on the role of training supervisor, two Internal Medicine residents, two nurses working in the Internal Medicine environment and two members of the behavioral sciences area (Psychiatrist and/or Psychologist) with experience in supporting to Internal Medicine war. Results: The meeting is schedule to early September and results will be available in October Conclusions: In the construction of the curriculum, it is essential to incorporate the elements that respond to the main difficulties regarding the diagnosis, elaboration of the care plan, communicational management and care after death.
- Risk behaviors to psychoactive substances use in children and young people in LisbonPublication . Deodato, Sérgio; Nunes, Elisabete; Capelas, Manuel; Seabra, Paulo; Sarreira-Santos, Alexandra; Medeiros-Garcia, LurdesObjective: To characterize the risk behavior of the psychoactive substances use in a youth population of Lisbon. Method: An observational, descriptive, cross-sectional study. Participants were 113 children and young people who responded to the Portuguese version of the Risk and Health Behavior questionnaire - Youth Risk Behavior Survey. Results: Participants with regard to age were between 9-13, most attending the 5th grade, living with parents, had good school performance, good relationship with colleagues while 1/4 refer problems. When concerned, recourse to the mother, but it is significant the attention of peers. As for the trial of psychoactive substances was found: 9.7% tobacco, 19.5% alcohol, other substances 5.3%. Conclusion: With regard to risk behavior stands primarily to early alcohol testing. Emerged as protective factors: family relationship and relationship with the school space. This age group may constitute the ideal time for prevention.
- The factorial analysis of a quality of life scale for people addicted to drugs in methadone programsPublication . Seabra, Paulo; Amendoeira, José; Sá, Luís; Capelas, Manuel
- Validation of an assessment and monitoring instrument for the care of patients in imminent death situation admitted in internal medicine wardsPublication . Carneiro, Rui; Simões, Catarina; Freire, Elga; Capelas, Manuel; Carneiro, AntónioBackground: In Portugal, two thirds of deaths occur in the hospital and it is estimated that these numbers will increase considerably in the coming decades. The proper organization of care at this stage promotes peaceful deaths and catalyzes healthy bereavements. There is no validated instrument that supports health teams in the organization of care in the situation of imminent death syndrome. Aim(s): We propose the validation of an instrument for organizing care for patients in the last hours or days of life in Internal Medicine wards. Methods: We recruited an incidental sample of Internal Medicine doctors with Competence in Palliative Medicine. We will evaluate the response to a semi-structured questionnaire of the Delphi rounds type, evaluating the degree of agreement with the principles proposed by the instrument, which was already validated in accordance with the best international practices and derived from the best scientific evidence by the International Collaborative for the Best for the Dying Person Results: The Delphi rounds are underway Conclusions: The validation of this instrument will be the basis for the subsequent development of a national audit on the subject and the mainstay for the construction of a training model for national Internal Medicine based on the proposed principles of action, that constitutes the main goals of the MiMI Project (Morte iminente em Medicina Interna) of the Portuguese Society of Internal Medicine.
- “You died on me”: internist narratives about the caring patients in the final hours or days of lifePublication . Carneiro, Rui; Simões, Catarina; Magalhães, Susana; Capelas, Manuel; Carneiro, AntónioBackground: In Portugal, two thirds of deaths occur in the hospital and it is estimated that these numbers will increase considerably in the coming decades. The Internist is, therefore, called upon to take care of patients for whom cure is not expected and whose confrontation with the limits of existence is palpable. This is a great opportunity to assume the Suffering of the Other as a therapeutic target, but also to invite reflection on the limits of science, opening space for the relationship. Narrative medicine aims not only to validate the patient's experience, but also to stimulate the physician's creativity and self-reflection and to reinforce the clinical bond. Aim(s): The goal of this project is to characterize the experience of Portuguese internists in the follow-up of their patient(s) in the final phase of their life(s). Methods: A semi-structured questionnaire will be used using a narrative medicine work methodology - parallel chart, focusing on a convenience panel of doctors with the specialty of Internal Medicine. The data will be analyzed in four cycles: In the first cycle, the NVivo software will be used, which allows the analytical process of the data, not replacing the researcher's responsibility in the interpretation of the results. In the second cycle, the analysis of parallel clinical records will be guided by the following narrative categories (and the questions that emerge from them): Voice, Characters, Time, Space and Plot. A third cycle of analysis will follow, in which the autobiographical/personal elements will be identified in the texts; dialogic/interpersonal; socio-cultural and institutional. The fourth and final cycle of analysis will allow the evaluation of previous cycles and the identification of contents that stand out for their novelty and/or relevance. Results: The collection of records is underway. Conclusions: The appreciation of the results of the reflection will lead to relevant contributions for the construction of a training model for the integral care of patients in the last hours or days of life by the national Internal Medicine, the main purpose of the MiMI Project (Morte Iminente em Medicina Interna) of the Portuguese Society of Internal Medicine.