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- White spot lesions: diagnosis and treatment – a systematic reviewPublication . Lopes, Pedro C.; Carvalho, Teresa; Gomes, Ana T. P. C.; Veiga, Nélio; Blanco, Leticia; Correia, Maria; Mello-Moura, Anna Carolina VolpiBackground: Dental caries is one of the most prevalent pathologies in the world and its first stage appears as a white spot lesion. It is important to know its activity and the differential diagnoses. There are several ways to diagnose an injury and several clinical approaches to its treatment. The aim of this study is related to a previously established PICO(S) question: “Do new diagnostic tools have the potential to change the conventional treatment of white spots?”. Methods: A systematic search of available studies in the literature was carried out in Pubmed and Scopus electronic databases and manually to identify relevant articles. This systematic review included trials complying the following inclusion criteria: (1) being in humans, (2) being in English, (3) being about white spot lesions, (4) have been published between 2012 and 2023, (5) having both diagnosis and treatment and (6) having full text available. In this review we excluded other systematic reviews of clinical trials and studies in vitro. The RoB tool was used to assess the risk of bias. Results: The systematic literature search identified 143 potentially relevant references, which after applying the exclusion criteria, resulted in only 22 articles. Regarding diagnostic methods, most articles found were based on visual examination (10) or fluorescence (7). The least referenced diagnostic techniques were based on the use of clinical photographs (2), cross-sectional microrafiography (1) and computed microtomography (1). The use of DIAGNOdent was reported by 3 studies. With regard to therapies, most studies reported the use of infiltrating resin (7) and fluoride-based products (5). Other studies have reported the use of SAPP11-4 (1), home care (1), CPP-ACP (2) and HCL (1). Combination therapies were also considered: 2 studies reported the use of fluoride varnish, 2 studies used infiltrating resin and fluoride varnish, and one study reported the use of a combination of fluoride varnish and chlorhexidine.
- Nursing process related to nursing focus "Airway clearance": a scoping review “Nursing process related to nursing focus "Airway clearance": a scoping review”Publication . Gaspar, Luís Jorge Rodrigues; Reis, Neuza Cristina Moura; Sousa, Paula Cristina Moreira Mesquita; Silva, Abel Avelino Paiva e; Brito, Maria Alice Correia; Morais, Ernesto Jorge de Almeida; Oliveira, Manuel Fernando dos Santos; Sousa, Inês Maria da Cruz; Campos, Maria Joana Alves; Gonçalves, Paulo José Parente; Pereira, Filipe Miguel Soares; Machado, Natália de Jesus BarbosaBackground: Each year, more than a billion people suffer from respiratory diseases leading to about 4 million deaths worldwide. Airway Clearance impairment is deeply related to these diseases causing a significant impact on self-care and quality of life. Therefore, it is essential to identify clinical data, nursing diagnoses and nursing interventions, providing a solid basis for clinical reasoning and integrating the best scientific evidence to enhance nursing care. This scoping review aims to map the existing evidence on clinical data, nursing diagnoses and nursing interventions addressing nursing focus “Airway Clearance”. Methods: A scoping review was performed according to Joanna Briggs Institute framework. We searched MEDLINE, CINAHL Complete, Scopus, Web of Science, and PEDro databases for published English, Portuguese, and Spanish literature between 1975 and 2021. It included all studies on airway clearance in adult patients in all contexts of nursing care. Quantitative, qualitative, and mixed-methods studies, as well as systematic reviews, were included. The PRISMA-ScR checklist was used. Results: In total 1355 studies were identified. After removing duplicates, 104 matched the inclusion criteria and were included in the review. The findings of this review showed two areas of nursing attention: one related to signs and symptoms management and the other related to health/illness transition. The data that lead to nursing diagnoses can be divided into cognitive and clinical data. The nursing diagnoses were mostly related to secretions retention, excessive mucus production and airway obstruction. The most commonly identified nursing interventions were the educational interventions assembled into predesign education programs rather than patient-tailored programs. Conclusions: The findings of this review can add substantial value for systematising the nursing process related to nursing focus “Airway Clearance”. Reaching a consensus seems highly relevant, as it could improve nursing decision-making, nursing care quality and produce more reliable nursing outcomes.
- Neurophysiological correlates of tactile width discrimination in humansPublication . Pais-Vieira, Miguel; Pais-Vieira, Carla; Allahdad, Mehrab; Perrotta, André; Peres, André; Kunicki, Carolina; Oliveira, ManuelTactile information processing requires the integration of sensory, motor, and cognitive information. Width discrimination has been extensively studied in rodents, but not in humans. Here, we describe Electroencephalography (EEG) signals in humans performing a tactile width discrimination task. Comparison of changes in Spectral Power Density during two different periods of the task corresponding to the discrimination of the tactile stimulus and the motor response, revealed the engagement of a complex network associated with the electrodes recording from fronto-temporo-parieto-occipital areas and across multiple frequency bands. Analysis of ratios of higher [Ratio1:(0.5-20Hz)/(0.5-45Hz)] or lower frequencies [Ratio2: (0.5-4.5Hz)/(0.5-9Hz)], also revealed that the periods of tactile discrimination and motor response, were accompanied by changes in these ratios. Further analysis of the tactile discrimination period demonstrated that ratios of frequencies recorded from electrodes located in frontoparietal regions were correlated to tactile width discrimination performance between subjects, while the dynamics in parietal and occipital electrodes were correlated to the changes in performance within subjects. These results support the notion that a bilateral asymmetrical widespread network is associated with tactile width discrimination.
- 360 Health Analysis (H360) – a comparison of key performance indicators in breast cancer management across health institution settingsPublication . Rego, Inês Brandão; Coelho, Sara; Semedo, Patrícia Miguel; Cavaco-Silva, Joana; Teixeira, Laetitia; Sousa, Susana; Reis, Joana; Dinis, Rui; Schmitt, Fernando; Afonso, Noémia; Fougo, José Luís; Pavão, Francisco; Costa, LuísBackground: The increased focus on quality indicators (QIs) and the use of clinical registries in real-world cancer studies have led to higher compliance with therapeutic standards and increased patient survival. The European Society of Breast Cancer Specialists (EUSOMA) defined QIs to assess compliance with current standards in breast cancer care. Methods: This population-based retrospective study is part of the H360 Health Analysis (H360) project - Phase 2 and represents the first comprehensive assessment of the quality of breast cancer care in different hospital settings in Portugal. Its aim is to describe compliance with EUSOMA-defined QIs in breast cancer management in different hospital settings (public vs. private; general hospitals vs. Oncology centers) and thereby assess equity in the provision of care across health institutions. To do so, a set of key performance indicators (KPIs) was selected based on EUSOMA and previously identified QIs. Secondary data were retrieved from patients’ clinical records. Compliance with target KPIs in different stages of disease across the considered hospital settings was compared with minimum and target EUSOMA standards. Results: A total of 259 patient clinical records were assessed. In stage I, II, and III disease, eighteen KPIs met target EUSOMA standards, five met minimum standards, and eight failed to meet minimum standards. Compliance with KPIs varied according to the type of hospital (particularly concerning diagnosis) and stage of the disease. Conclusions: Study results show that, although most QIs meet EUSOMA standards, there is room for improvement regarding diagnostic and therapeutic procedures. There are differences in the clinical practice across health institutions, particularly between Oncology centers and general hospitals regarding diagnosis and KPI compliance among disease stages. These findings should be addressed in future studies in a coordinated effort to improve the quality of breast cancer care nationally.
- Embodiment comfort levels during motor imagery training combined with immersive virtual reality in spinal cord injury: a case reportPublication . Pais-Vieira, Carla; Gaspar, Pedro; Matos, Demétrio; Alves, Leonor Palminha; Cruz, Bárbara Moreira da; Azevedo, Maria João; Gago, Miguel; Poléri, Tânia; Perrotta, André; Pais-Vieira, MiguelBrain-machine interfaces combining visual, auditory, and tactile feedback have been previously used to generate embodiment experiences during spinal cord injury (SCI) rehabilitation. It is not known if adding temperature to these modalities can result in discomfort with embodiment experiences. In this case study, the levels of comfort with the embodiment experiences were investigated in an intervention that required a chronic pain SCI patient to generate lower limb motor imagery commands in an immersive environment combining visual (virtual reality -VR), auditory, tactile, and thermal feedback. Assessments were made pre/post and throughout the intervention (Weeks 0–5), and at seven weeks follow up. Overall, high levels of embodiment in the adapted three-domain scale of embodiment were found throughout the sessions. No significant adverse effects of VR were reported. Sessions induced only a modest reduction in the levels of pain. Overall reductions occurred in all pain scales (Faces, Intensity, Verbal) at follow up. A high degree of comfort in the comfort scale for the thermal-tactile sleeve, in both the thermal and tactile feedback components of the sleeve was reported. This study supports the feasibility of combining multimodal stimulation involving visual (VR), auditory, tactile, and thermal feedback to generate embodiment experiences in neurorehabilitation programs.
- Adaptation of the quality-caring model to hospitalized school aged children and their parentsPublication . Loureiro, Fernanda; Antunes, Vanessa; Charepe, ZaidaBackground: the development of nursing theory improves nursing practice and consequently the health of those who receive nursing care. The aim of this article is to describe the adaptation of the quality-caring model to hospitalized school aged children and their parent. Methods: a mixed methods study in 4 phases was outlined. Study integrated a literature review (phase 1); application of surveys to hospitalized children and their parents (phase 2); delphi panel with nurses as experts (phase 3); and the the adaptation of quality-caring model (phase 4). Participants included hospitalized children (n=252), their parents (n=251) and nurses (round 1 n=47; round 2 n=42). National Data Protection Commission provided authorization for the study as well as the ethics committee from 6 health institutions where the study was applied. Results: Findings highlight the identifications of key aspects valued by children, parents, and nurses, such as: information, family involvement, play, distraction, and communication. Conclusions: The adapted model includes fundamental aspects of children hospitalization and is focused on satisfaction with care as an outcome of nursing care. Its integration in daily clinical practice if fundamental to improve quality of care and accomplish parents and children satisfaction with nursing care.
- Unlocking the potential of probiotic administration in caries management: a systematic reviewPublication . Lopes, Pedro C.; Gomes, Ana T. P. C.; Mendes, Karina; Blanco, Leticia; Correia, Maria J.Background: The use of prebiotics and/or probiotic bacteria with the potential to modulate the oral ecosystem may play an important role in the prevention and management of dental caries. To assess the evidence of the potential of pre/probiotics both in the prevention and treatment of dental caries, and therefore as adjuvant approaches in caries management, we focused on the PICO question “In individuals with caries, after probiotic administration, is there an improvement in outcomes directly related to caries risk and development?". Methods: An extensive systematic search was conducted in electronic databases PubMed, Web of Science, Scopus and Cochrane, to identify articles with relevant data. This systematic review included trials complying the following inclusion criteria: studies performed in Humans; published in English; including the observation of patients with caries, with clear indication of the probiotic used and measurement of outcomes directly involved with the cariogenic process, including quantification of bacteria with cariogenic potential. To evaluate methodological quality of the studies, the critical assessment tool Joanna Briggs Institute was used. Results: Eight hundred and fifty articles, potentially relevant, were identified. Following PRISMA guidelines 14 articles were included in this systematic review. Outcomes related to improvement of caries risk and development parameters were salivary counts of S. mutans and Lactobacillus, salivary pH and buffer capacity, new caries and caries activity, reduction of the cariogenic organisms content, assessed through sequencing approaches and salivary concentration of antimicrobial peptides. The probiotic most often referred with beneficial results in dental caries outcomes is Lacticaseibacillus rhamnosus being the most recommended to be included in clinical studies related to oral health. Regarding the most used administration vehicle, in studies with positive effects on the caries management, probiotic supplemented milk is considered the best administration vehicle. Conclusions: Evidence suggests a beneficial effect of probiotic supplemented milk (Lacticaseibacillus rhamnosus) as an adjuvant for caries prevention and management. However, comparable evidence is scarce and better designed and comparable studies are needed.
- Virtual reality and behaviour management in paediatric dentistry: a systematic reviewPublication . Padilha, Diana; Veiga, Nélio Jorge; Moura, Anna Carolina; Correia, PatríciaBackground: Virtual reality (VR) has emerged as an innovative tool in medicine and dentistry, improving anxiety and pain management in children. The immersive and interactive environments of VR technology helps distract and engage young patients during dental procedures, potentially reducing anxiety levels and improving treatment experience. The aim of this review was to provide current evidence-based guidance on the usage of VR in the clinical practice of paediatric dentistry. Methods: A systematic review was conducted according to the PRISMA guidelines with the following research question using the PICO format: Does VR (I) effectively manage anxiety and pain (O) during a paediatric dental consultation (P) compared to alternative behavioural control techniques (C)? PubMed/Medline®, SCOPUS, and Web of Science databases were searched and analysed. Results: Search queries identified a total of 525 abstracts from three different databases. Duplicate articles were removed (n=79), leaving a total of 446 abstracts. After reading the title and abstract, 392 records were excluded. In the end, 22 articles were considered suitable for this systematic review. Conclusions: VR is a highly effective method of behaviour management, successfully alleviating pain and anxiety in children during dental treatment, surpassing traditional tools. By offering an engaging and immersive experience, VR effectively diverts patients' attention away from the clinical environment, fostering a positive and enjoyable treatment experience. However, it is crucial to acknowledge the limitations of existing studies and the need for further research to enhance the understanding of VR's full potential in paediatric.
- "Ser criança" – an oral health literacy program for vulnerable children and familiesPublication . Veiga, Nélio Jorge; Mello-Moura, Anna Carolina Volpi; Dias, Beatriz; Oliveira, Mário; Correia, Patrícia; Couto, Patrícia; Correia, Maria; Duarte, AnaBackground: Over the years, there has been an increasing and effective integration and participation of oral health in the concept of general health. The absence of educational interventions, and behavioral strategies for children´s oral health are still considered gaps in today's society. The main objective of this work was to define strategies of educational interventions in children's oral health. Methods: The intervention for the “Ser Criança” Program involved the development of a website - “Ser Criança – Aprender a Sorrir” (A Child - Learn to Smile) for three target groups: children, parents and educators / teachers. With this proposition, it is expected that children, families, and school communities improve behavioral habits related to oral health. Also, the “Ser Criança” Program involves a specific protocol defining oral health literacy strategies and dental appointments among the children and families. Results: The “Ser Criança” Program involves a specific protocol defining oral health literacy strategies and dental appointments for children and families. It is crucial to emphasize that most recreational activities are beneficial in the transmission of motivational values. The use of educational games, exploration of macro dental models, theatre and music are valid examples of these activities. Interventions based on digital media (applications or "apps" and the Internet) also prove to be a constant demonstration of success for children's personal and cognitive growth. Aiming on a digital tool for pre-school and elementary school children, through a web-based platform allows, especially amongst the hard-to-reach communities, an immeasurable access to multiple possibilities. Conclusions: Educating future generations using attractive educational, didactic and, above all pedagogical interventions can greatly improve health interventions, especially in the field of dental medicine.
- Learning from the pandemic, building international increased cooperation for the futurePublication . Lopes, Henrique; Middleton, JoshObjective: The COVID-19 pandemic highlighted a fragile preparation by countries and regions for epidemic events, exposing exacerbated nationalisms in pandemic mitigation and control actions. Both conditions decisively compromise the effectiveness and efficiency of pandemic control capacity. It is important to develop frameworks that help overcome frailties in response to epidemics. Methods: Thematic literature review and discussions with multiple national and international entities. The discussions were not specific to the article, hence were not considered as formal information collection. Based on this information, an attempt was made to build a tool for responding to the identified problems. Results: Proposal of the 2PF tool. Conclusion: The proposed 2PF tool is aligned with the Sendai Framework and proposals from international bodies, such as HERA, among others. It aims to be a framework for operationalizing these agreements, at least in part of its dimensions. The general idea is that pandemic preparedness cannot fail or to all other disaster risks and similar recognized by the UN. The response to pandemics must be based essentially on international action and closer collaboration between countries and regions.