According to World Health Organization (WHO), about 1 out of 10 hospitalized patients suffers an adverse event, in developed countries, being an adverse event an injury related to medical management, in contrast to complications of disease. These events cause both unnecessary suffering and huge cost to health systems. This issue is so important that WHO has defined it as a global health problem and in 2004 launched the World Alliance for Patient Safety, with the aim to coordinate, disseminate and accelerate improvements in Patient Safety. Office Hysteroscopy (OH), as an independent technique of the hospital circuit, has the ideal conditions to be qualified as the gold standard technique for the surgical treatment of intracavitary uterine pathology. It does not require the use of an operating room, hospital admission and general or locoregional anaesthesia. The appropriate surgical techniques, allied to pain control, allow OH to resolve much more than 90 % of the surgical needs of the intracavitary uterine pathology, thus being an important contribution for Patient Safety.
Anemia and iron deficiency (ID) can impair quality of life and socioeconomic development. We evaluated the prevalence of anemia and ID in the adult Portuguese population in real-life contexts by gender, age, and pregnancy status. We performed a cross-sectional screening in adult individuals in mainland Portugal from 2013 to 2017. Participants completed a survey about demographics and signs or symptoms compatible with anemia, and ID and hemoglobin and ferritin concentrations were determined by point-of-care tests. We estimated and compared prevalence ratios (PR) of anemia and ID using Poisson regression with robust variance and the Wald chi-square test. We collected data from 11,030 individuals (26% men, 64% nonpregnant women, and 10% pregnant women). We found anemia in 51.8% (95% CI 50.1–53.4%) of nonpregnant women in fertile age, 46.6% (95% CI 44.7–48.6%) of nonpregnant women >51 years, 38.2% (95% CI 35.4–41.1%) of pregnant women, and 33.3% (95% CI 31.6–35.1%) of men. The prevalence of ID was 72.9% (95% CI 71.4–74.4%) in nonpregnant women in fertile age, 50.5% (95% CI 48.5–52.4%) in nonpregnant women >51 years, 94.8% (95% CI 93.3–96.0%) in pregnant women, and 28.9% (95% CI 27.3–30.6%) in men. We found significant associations between the prevalence of anemia or ID and nonpregnant women (PR: 1.50, 95% CI 1.42–1.59 or PR: 2.21, 95% CI 2.09–2.35, respectively), manifestation of signs or symptoms (PR: 1.19, 95% CI 1.53–1.23 or PR: 1.22, 95% CI 1.18–1.26), pregnant women (PR: 0.74, 95% CI 0.68–0.80 or PR: 1.30, 95% CI 1.27–1.33), and nonpregnant women ≤51 years (PR: 1.11, 95% CI 1.06–1.17 or PR: 1.42, 95% CI 1.36–1.48). In conclusion, anemia and ID represent moderate to severe public health problems, particularly among women in fertile age and in 3rd trimester, of pregnancy emphasizing the need to raise the public and health professionals’ awareness of these problems and their prevention, diagnosis, and treatment.
Introduction: Anaemia and iron deficiency are associated with increased mortality and poor surgical outcomes. Consensus in their definitions is expected to optimize their management, which is encompassed by patient blood management, providing patient-centred care while improving patient safety and clinical outcomes. Patient blood management implementation is even more relevant in contingency times and faces barriers due to lack of standardization, among others. The aim is to establish a consensus on these diagnoses and implement patient blood management principles in clinical practice in Portugal.Material and Methods: Eight experts in Transfusion Medicine, Haematology, Anaesthesiology, Internal Medicine, and Obstetrics/Gynaecology were assembled; a focus group was conducted, defining 33 statements. A Delphi panel was conducted, with experts from the clinical specialities named above as well as from General Surgery, Urology, and Orthopaedics.Results: The Delphi panel’s rounds had 70 (Round 1) and 46 (Round 2) respondents. Specialists were consensual in only two statements, on the existence of a preoperative patient blood management consultation for candidates to elective surgeries in which the use of blood derivatives is anticipated and, on the importance of the correction of postoperative anaemia and iron deficiency. Of the remaining 31 statements, 27 reached high agreement or disagreement by the respondents.Conclusion: Consensus was reached in only two (6%) of the 33 statements. There was a consensual agreement on the relevance of establishing patient blood management as the standard of care and of valuing preoperative and postoperative patient blood management interventions. Nevertheless, our results point to the lack of awareness regarding patient blood management principles – which could result in better postoperative outcomes, shorter hospitalizations, reduced costs and increased availability of beds. Training and literacy initiatives could help further implement patient blood management standards in Portuguese hospitals.
The aging of the population has led to an increased prevalence of chronic diseases such as chronic kidney disease. Anemia is one of the most frequent complications of chronic kidney disease, with an impact not only on the quality of life but also on the patient’s prognosis and associated costs. Knowledge in this therapeutic area has increased significantly: from the appearance of recombinant erythropoietin in 1989, through the use of increasing doses of parenteral iron and, more recently, to new molecules such as hypoxia-inducible factor inhibitors. The aim of this article is to present a pragmatic review of the state of the art in the epidemiology, pathophysiology, diagnosis and treatment of anemia associated with chronic kidney disease.
Background: Office hysteroscopy is an affordable and popular approach in gynecology, offering high quality and inexpensive care. It has been made possible by miniaturization of instruments along with a range of technical variations and innovations which have made the procedure tolerable in outpatient care units. Pain is still a problem and has not to date been adequately managed.Objectives: Our main objective is to compare two centers where hysteroscopy is performed without general anesthesia or sedation in an office setting. In Lisbon a novel local anesthetic technique has been introduced when patients complained of pain. These centres have slightly different protocols namely in assessing pain and evaluating score results. Materials and methods:This was a prospective observation multicenter study, comparing pain in office hysteroscopy with three groups: mini-hysteroscopy (3 mm scope), conventional (5 mm) hysteroscopy without anesthesia and (5 mm) hysteroscopy with "hysteroscopic anesthesia". Data collection and analysis:We analyzed data from two centers involving one hundred and eighty one participants who completed the intervention. Pain was evaluated using a 10 cm visual analogue scale and a numeric rating scale. Analysis included the Kruskal-Wallis and Mann-Whitney Tests for the three groups and the Wilcoxon Signed Ranks Test for comparing repeated measurements. Results were discussed at 5% significance level.Main results: Analysis revealed a significant reduction pain score (p value <0.001) in the group where "hysteroscopic anesthesia" was used.Conclusions: Pain scores in office hysteroscopy can be lowered with "hysteroscopic anesthesia".
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