Browsing by Author "Ferreira-dos-Santos, G"
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- Análise da Revisão Cochrane: Pregabalina no Tratamento da Dor Crónica Moderada a Grave em Adultos com Fibromialgia. Cochrane Database Syst Rev. 2016;9:CD011790 e 2016;4:CD009002Publication . Ferreira-dos-Santos, G; Cordeiro Sousa, D; Costa, J; Vaz-Carneiro, AFibromyalgia can be clinically defined by widespread pain lasting for longer than 3 months with tenderness on palpation in 11 or more of 18 specified tender points. Many people with fibromyalgia are significantly disabled, and experience moderate to severe pain for many years, for which conventional analgesics are usually not effective. For these patients treatment options generally include antidepressants like tricyclic agents, serotonin and noradrenaline reuptake inhibitors, or anticonvulsants like pregabalin or gabapentin. Pregabalin is a drug licensed for the treatment of fibromyalgia in the United States of America, with a mechanism of action similar to gabapentin. This mode of action confers antiepileptic, analgesic, and anxiolytic effects. This Cochrane systematic review included 8 randomized, placebo-controlled trials with low risk of bias, which studied the effect of a daily dose of pregabalin for the treatment of moderate to severe pain in adult patients suffering from fibromyalgia. Of the main results of this systematic review we highlight the major effect that a daily dose of 300 to 600 mg of pregabalin had in the reduction of pain intensity over a follow-up period of 12 to 26 weeks, with tolerable adverse effects, for a minority of people with moderate to severe pain due to fibromyalgia. This paper aims to summarize and discuss the main results and conclusions of this systematic review, as well as its implications for the daily clinical practice.
- Análise da Revisão Cochrane: Reabilitação Cardíaca Baseada no Exercício na Doença Arterial Coronária. Cochrane Database Syst Rev. 2016;1:CD001800Publication . Carvalheira-dos-Santos, R; Delgado, RM; Ferreira-dos-Santos, G; Vaz-Carneiro, AA doença coronária, responsável por um terço de todas as mortes, é a causa de morte mais comum em todo o mundo. Todavia, com o decréscimo das taxas de mortalidade associadas a esta patologia, observa-se um número crescente de doentes com a doença, com aumento da necessidade de gestão dos seus sintomas e prognóstico. A reabilitação cardíaca, componente essencial do tratamento contemporâneo da doença arterial coronária, é uma intervenção complexa que envolve variadas técnicas, incluindo exercício físico, correção dos fatores de risco cardiovasculares tradicionais, terapia comportamental e apoio psicológico, sendo considerada uma prioridade em países em que a prevalência da doença é elevada. Esta revisão sistemática Cochrane constitui uma atualização de uma revisão Cochrane publicada em 2011, tendo identificado 16 novos ensaios clínicos (3872 doentes), predominantemente em status pós-enfarte agudo do miocárdio e pós-cirurgia de revascularização miocárdica. Incluiu, assim, 63 ensaios clínicos aleatorizados que estudaram a eficácia e o custo-efetividade da reabilitação cardíaca baseada no exercício físico, em pacientes com doença arterial coronária. A confiança na evidência científica variou de baixa a moderada. Dos principais resultados destaca-se o efeito da reabilitação cardíaca, em comparação com a ausência de exercício físico, na redução na mortalidade cardiovascular, todavia sem redução da mortalidade total. Apesar da reabilitação cardíaca ter diminuído o risco global de internamento hospitalar, o mesmo não se verificou para o risco de enfarte, cirurgia de revascularização miocárdica ou intervenção coronária percutânea. Neste artigo sumarizam-se e discutem-se os principais resultados, conclusões e implicações desta revisão sistemática para a prática clínica.
- Choosing Wisely Portugal: a Visão dos Médicos PortuguesesPublication . Morgado, M; Alves, M; Reis Carvalho, C; Viegas Dias, C; Cordeiro Sousa, D; Ferreira-dos-Santos, G; Leal, I; Valente Jorge, J; Bigotte Vieira, M; Fortunato, P; Baeta Baptista, R; Vaz-Carneiro, A
- Circuito de Prevenção de Quedas do Centro Hospitalar Universitário de Lisboa Central, E.P.E.Publication . Correia, A; Pereira, AP; Mendes, B; Caldeira, C; Ferreira-dos-Santos, G; Rodrigues, I; Domingos, I; Horta, L; Soares Branco, PObjetivos do projeto: O circuito de prevenção de quedas do Centro Hospitalar Universitário de Lisboa Central (CHULC) pretende, a longo prazo, identificar, tratar e reavaliar todos os indivíduos da área de influência do CHULC, com idade ≥ a 65 anos, com risco moderado a elevado de queda e fratura (considerando uma área de influência com cerca de trezentos mil habitantes, com uma taxa de 20,85% da população alvo com idade igual ou superior a 65 anos, de acordo com os dados demográficos nacionais mais recentes, de 2016).
- Pain Medicine Fellowship Program Websites in the United States of America - A Nonparametric Statistic Analysis of 14 Different CriteriaPublication . Gupta, S; Palmer, S; Ferreira-dos-Santos, GObjective: To evaluate the content of Pain Medicine Fellowship Program websites in the United States of America. Methods: We obtained a list of accredited 104 Pain Medicine Fellowship Program websites from the Accreditation Council for Graduate Medical Education and the Electronic Residency Application Service. Individual Pain Medicine Fellowship Program websites were then evaluated on 14 different criteria. We grouped fellowship programs based on census region and Electronic Residency Application Service participation status, and analyzed the differences using nonparametric statistics. Results: A total of 104 accredited Pain Medicine Fellowship Program websites were evaluated for a total of 14 different criteria. Of the 14 different criteria, an average of 3.94 were described in each website. Number of Fellowship positions per year (71.8%), clinical rotations during the program (65.1%), and faculty background (62.2%) were the most frequently described features on the websites. Night call responsibilities (3.9%), meal allowance (7.8%) and parking availability (10.7%) were the least described features in the websites. There were no significant differences between program websites when grouped by census regions or the participation status in the Electronic Residency Applications Service. Conclusion: The content of Pain Medicine Fellowship Program websites is extremely variable across the United States of America. This study indicates that there is room for improvement and enhancement of the comprehensiveness of website content for the majority of the programs analyzed. Additionally, this study also emphasizes the importance of having accurate and easily available online information in a post-pandemic era, when prospective fellows evaluate programs online through their websites.
- Revisiting the Genicular Nerve Block: An Up-to-Date Guide Utilizing Ultrasound Guidance and Peripheral Nerve Stimulation - Anatomy Description and Technique StandardizationPublication . Ferreira-dos-Santos, G; Hurdle, MF; Gupta, S; Tran, J; Agur, A; Clendenen, SBackground: Over the last decade, several authors have reported that percutaneous peripheral nerve stimulation (PNS) can be used to assist in verifying the position of the procedure needle tip in relation to nerve structures, and that the combined technique using both ultrasound (US) guidance and PNS may serve as a reliable method for confirmation of the correct position of the procedure needle tip. It has also been reported that, when combined with US guidance, PNS may increase the success rate of pain management interventions. Objectives: The aim of this technical report was to standardize an effective and easy to learn illustrated step-by-step technical approach to nerve identification during US-guided genicular nerve blocks, using percutaneous PNS as a verification instrument for procedure needle tip location. Study design: This technical protocol was developed based on the results of the authors' most recent cadaveric study on the innervation of the knee joint capsule. The technique was developed and tested by 4 different interventionists with different levels of expertise in US-guided procedures. Setting: The cadaveric study of the knee joint capsule innervation was performed at the laboratory of the Division of Anatomy of one institution. The technical protocol using US and PNS was later developed at the medical simulation center of a different institution. Methods: A team of anatomists from a division of anatomy of one institution performed the cadaveric study on the innervation of the knee joint capsule. A team of physicians then developed the step-by-step approach to this technical protocol at the medical simulation center of a different institution. Finally, the illustrated step-by-step approach was tested by 4 different interventionists with different levels of expertise in US-guided procedures (1 beginner-level user; 1 intermediate-level user; 2 expert-level users), using a portable percutaneous PNS and 2 different US transducers at 2 different institutions. Results: This technical protocol was successfully developed based on the results of the cadaveric study on the innervation of the knee joint capsule. Additionally, it was later successfully tested by interventionists with various levels of expertise utilizing different US equipment at separate institutions. Limitations: By combining US and nerve stimulation, this protocol requires the availability of both US equipment and necessary equipment for nerve stimulation that must all be made available in the sterile field. Another potential disadvantage is that nerve stimulation controls and the US image screen are generally located on 2 separate display panels, which could cause difficulty with visualization and simultaneous calibration for 2 individual devices. Conclusions: Our illustrated step-by-step technical protocol can be effectively and safely utilized as a reliable method of training, by which physicians with little to moderate US experience can improve their skills in accurately identifying the genicular nerves while performing US-guided examinations with the intent of executing a peripheral nerve block.
- Ultrasound-Guided Percutaneous Peripheral Nerve Stimulation for the Treatment of Chronic Intractable Pain Originating From a Lipofibromatous Hamartoma of the Median NervePublication . Ferreira-dos-Santos, G; Hurdle, M; Gupta, S; Ghazi, S; Trigg, S; Clendenen, SThis case report presents an application of peripheral nerve stimulation to the median nerve to treat a patient with intractable pain due to a lipofibromatous hamartoma of the left upper extremity. Ultra high-frequency ultrasound was used to determine the boundaries of the hamartoma. The patient then underwent an ultrasound-guided implantation of 2 stimulator electrodes distal to the elbow along the median nerve with stimulation coverage achieved at 1.2 and 1.4 mA, respectively. After an uneventful procedure, the pain score immediately decreased from 9 out of 10 to less than 6 on a numeric rating scale. Two weeks after the procedure, the patient reported substantial pain relief, with an average pain level of 5 to 6 out of 10. Twelve months after implantation, the patient maintained significant pain relief, rating her average pain level as a 4 to 6 out of 10. Placement of a percutaneous peripheral nerve stimulator was safe and effective with no adverse events being reported at the 12-month follow-up.