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- Early Mobilization Decision after an Acute Ischemic Stroke: Protocol for an Umbrella ReviewPublication . Fernandes, C; Sousa, JA; Bernardo-Castro, S; Silva, F; Donato, H; Sargento-Freitas, JIntroduction: Stroke is considered one of the greatest public health challenges worldwide, with the ischemic subtype being the most prevalent. Various acute stroke clinical guidelines recommend early rehabilitation interventions, including very early mobilization. However, despite the studies conducted in recent years regarding when to initiate mobilization after an acute stroke, there are few systematic and personalized protocols based on the factors for which patient mobilization should ideally be performed. We aim to conduct an umbrella review of systematic reviews and meta-analyses to study the early mobilization decision after an acute ischemic stroke in comparison with conventional care and correlate the different approaches with patient clinical outcomes. Methods and analysis: We will perform a systematic search on PubMed/MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Epistemonikos and Web of Science Core Collection databases. Retrieved studies will be independently reviewed by two authors and any discrepancies will be resolved by consensus or with a third reviewer. Reviewers will extract the data and assess the risk of bias in the selected studies. We will use the 16-item Assessment of Multiple Systematic Reviews 2 (AMSTAR2) checklist as the critical appraisal tool to assess cumulative evidence and risk of bias of the different studies. This will be the first umbrella review that compares early mobilization approaches in post-acute ischemic stroke. This study may help to define the optimal early mobilization strategy in stroke patients. PROSPERO registration number: CRD42023430494.
- Avaliação da Produção Científica na Área da Medicina Geral e Familiar em PortugalPublication . Fonseca Marques, JP; Santiago, LM; Donato, HIntroduction: The Portuguese publications in the field of General Practice and Family Medicine have not yet been assessed in bibliometric studies. The aim of this study was to analyze that production between 2012 and 2022. Methods: The Web of Science Core Collection was used to gather the number of articles, journals and citations obtained; the Journal Citation Reports to obtain the Impact Factor and quartile of journals; and Scimago Journal & Country Rank, for the comparison of data with other European countries. The search was based on the following query: "usf OR unidade de Saude Familiar OR centro de Saude OR ACeS OR medicina geral familiar OR Gen Practice Family SAME Portugal", and a time window between 2012 and 2022 was defined. The study considered the following quantitative indicators: total number of publications, typology, language, affiliation, co-authors, geographical distribution, thematic areas, and the number of publications/inhabitant and publications/physician from European countries; the qualitative indicators selected were the Impact Factor (IF), the quartile and the number of citations. Results: Between 2012 and 2022, the national scientific production had an average annual growth rate of 36.6%. Of 389 publications, 73.8% were 'Articles' and 11.8% were 'Review Articles', predominantly in English (88.4%). The fields of 'General Internal Medicine' (24.7%) and 'Public Environmental Health' (14.9%) had the highest publication rates among the journals. The 389 publications received 5354 citations, for an average of 13.76 citations per article, and the average yearly citation growth was 115%. According to IF, 22.5% of the 222 journals belonged to Q4, 27.5% to Q3, 29.7% to Q2 and 20.3% to Q1, and therefore no significant bias regarding the journals where Portuguese doctors publish was observed. Conclusion: The bibliometric analysis allowed us to examine the evolution of the scientific production in the field of Portuguese General Practice and Family Medicine by observing an increasing publication trend and with a high potential for publication growth.
- Early Mobilization Decision after an Acute Ischemic Stroke: Protocol for an Umbrella ReviewPublication . Fernandes, C; Sousa, JA; Bernardo-Castro, S; Silva, F; Donato, H; Sargento-Freitas, JIntroduction: Stroke is considered one of the greatest public health challenges worldwide, with the ischemic subtype being the most prevalent. Various acute stroke clinical guidelines recommend early rehabilitation interventions, including very early mobilization. However, despite the studies conducted in recent years regarding when to initiate mobilization after an acute stroke, there are few systematic and personalized protocols based on the factors for which patient mobilization should ideally be performed. We aim to conduct an umbrella review of systematic reviews and meta-analyses to study the early mobilization decision after an acute ischemic stroke in comparison with conventional care and correlate the different approaches with patient clinical outcomes.Methods and analysis: We will perform a systematic search on PubMed/MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Episte-monikos and Web of Science Core Collection databases. Retrieved studies will be independently reviewed by two authors and any discrepancies will be resolved by consensus or with a third reviewer. Reviewers will extract the data and assess the risk of bias in the selected studies. We will use the 16-item Assessment of Multiple Systematic Reviews 2 (AMSTAR2) checklist as the critical appraisal tool to assess cumulative evidence and risk of bias of the different studies. This will be the first umbrella review that compares early mobilization approaches in post-acute ischemic stroke. This study may help to define the optimal early mobilization strategy in stroke patients. PROSPERO registration number: CRD42023430494
- Total neoadjuvant therapy: A new standard of care for locally advanced rectal cancer?Publication . Leite, J; Martins, SDelivering chemotherapy before surgery is a newer treatment approach called total neoadjuvant therapy (TNT), and the National Comprehensive Cancer Network guidelines recommend it for locally advanced rectal cancer (LARC) with cT3 / cN+ / cT4, in contrast with the European Society for Medical Oncology guidelines, in which most rectal cancers can be treated with surgery alone if good quality mesorectal resection is assured. Neoadjuvant or adjuvant treatments are reserved for patients with high-risk tumours, including cT3c/d or cT4, or that threaten the mesorectal fascia. The favourable outcomes in the RAPIDO trial for high-risk rectal cancers with a lower incidence of distant metastasis in the TNT group were observed but with an unexpected increase in the local recurrence with more extended follow-up. This suggests early surgery for nonresponding tumours. The TNT approach was also evaluated in the OPRA trial with long-course chemoradiotherapy and induction versus consolidation chemotherapy. Half the patients presented complete clinical responses and were enrolled in the watch-and-wait (WW) approach. Given the high number of trials and guidelines in this subject, the multidisciplinary team's decision-making process in rectal cancer management is complex. Looking at the actual data, it was concluded that TNT is not for all patients with LARC and is an option if organ preservation is a priority, although with a high regrowth rate in a WW strategy and increasing risk of distant metastasis, questioning the deleterious effect of deferral of surgery.
- CTA and CTP for Detecting Distal Medium Vessel Occlusions: A Systematic Review and Meta-analysisPublication . Sousa, JA; Sondermann, A; Bernardo-Castro, S; Varela, R; Donato, H; Sargento-Freitas, JBackground: The optimal imaging method for detecting distal medium vessel occlusions (DMVOs) remains undefined. Purpose: The objective of this study is to compare the diagnostic performance of CTA with CTP in detecting DMVOs. Data sources: We searched PubMed, EMBASE, Web of Science Core Collection, and Cochrane Central Register of Controlled Trials up to March 31, 2023 (PROSPERO: CRD42022344006). Study selection: A total of 12 studies reporting accuracy values of CTA and/or CTP were included, comprising 2607 patients with 479 cases (18.3%) of DMVOs. Data analysis: Pooled sensitivity and specificity of both imaging methods were compared using a random-effects model. Subgroup analyses were performed based on the technique used in CTA (multi or single-phase) and the subtype of DMVOs (M2-only vs. M2 and other DMVOs). We applied Quality Assessment of Diagnostic Accuracy (QUADAS-2) tool and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) quality assessment criteria. Data synthesis: CTA demonstrated significantly lower sensitivity compared to CTP in detecting DMVOs [0.74, 95%CI (0.63-0.82) vs. 0.89, 95% CI (0.82-0.93), P < 0.01]. When subgrouped into single-phase and multi-phase CTA, multi-phase CTA exhibited higher sensitivity for DMVO detection than single-phase CTA [0.91, 95%CI (0.85-0.94) vs. 0.64, 95%CI (0.56-0.71), P < .01], while reaching similar levels to CTP. The sensitivity of single-phase CTA substantially decreased when extending from M2 to other non-M2 DMVOs [0.74, 95%CI (0.63-0.83) vs. 0.61, 0.95%CI (0.53-0.68), P = .02]. Limitations: We identified an overall high risk of bias and low quality of evidence, attributable to the design and reference standards of most studies. Conclusions: Our findings highlight a significantly lower sensitivity of single-phase CTA compared to multi-phase CTA and CTP in diagnosing DMVOs.
- Artificial Intelligence Revolutionizing Scientific PublishingPublication . Donato, H
- Revisão das Revisões (Revisões Umbrella): Guia Passo a PassoPublication . Donato, H; Donato, MIn recent years, as a result of the dramatic increase in the number of systematic reviews, a new type of systematic review, the ‘systematic reviews of systematic reviews’, also known as umbrella reviews, reviews of reviews, meta-reviews or synthesis of review, was developed. The aim of this article is to provide recommendations on how this type of systematic review should be conducted and reported to ensure its quality and usefulness. These reviews are designed to compile evidence from multiple systematic reviews of interventions into an accessible and usable document and are one of the highest levels of evidence synthesis
- Próteses totais primárias da anca com um recuo superior a 15 anos a propósito de 12 casos clínicosPublication . Corte-Real, C; Ferreira, I; Mendes, J; Dias, P; Mendonça, A; Cura-Mariano, J; Lucas, F; Judas, FO Ortopedista dispõe, atualmente, de um leque alargado de endopróteses articulares primárias da anca para o tratamento da artropatia degenerativa ou inflamatória e, bem assim para a cirurgia reconstrutiva da anca traumática, que incluem implantes cimentados, não cimentados, híbridos, revestidos ou não com biocerâmicos, com diversas cúpulas de fricção articular. A implantação de uma prótese total da anca representa uma das intervenções de maior sucesso clínico em Ortopedia, quiçá em Medicina, proporcionando o alívio/supressão da dor e o restabelecimento precoce da função articular a milhões de doentes em todo o mundo. Apesar de ser assim, a artroplastia total da anca não é uma solução definitiva, a médio ou a longo prazo assiste-se a uma falência mecânica originada, na maioria das situações, pela osteólise periprotética provocada pelas partículas de degaste dos biomateriais que constituem a cúpula de fricção articular, processo biológico que o melhor cirurgião não consegue evitar. Pode-se aceitar que o tempo médio de duração de uma prótese total da anca situa-se, nas melhores casuístas, acima dos 15 anos. O objetivo central deste trabalho é mostrar os resultados clínicos e radiológicos do tratamento de uma série de 12 diferentes situações clínicas em que foram implantadas próteses totais primárias da anca, com um recuo clínico superior a 15 anos.