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Objective: To analyze changes in performance indicators five years after Portugal joined the Stent for Life (SFL) initiative. Methods: National surveys were carried out annually over one-month periods designated as study Time Points between 2011 (Time Zero) and 2016 (Time Five). In this study, 1340 consecutive patients with suspected ST-elevation myocardial infarction (STEMI) who underwent coronary angiography, admitted to 18 24/7 primary percutaneous coronary intervention (PCI) centers, were enrolled. Results: There was a significant reduction in the proportion of patients who attended primary healthcare centers (20.3% vs. 4.8%, p

Objetivo: Identificar as evidências científicas disponíveis acerca dos diagnósticos de enfermagem para pacientes em cuidados paliativos (CP), bem como elencar os mais utilizados nessa prática. Método: Revisão integrativa, na qual foram analisados artigos publicados nos últimos dez anos, nas bases de dados: Literatura Latino-Americana e do Caribe de Informação em Ciências da Saúde (Lilacs); Pubmed; Web of Science; Scopus; CINAHL Resultados: A amostra foi composta por 14 estudos, averiguando-se um maior quantitativo de produções no ano de 2016, sendo a NANDA-I o sistema de classificação mais empregado para a formulação do diagnóstico de enfermagem (DE). Dentre os DE mais prevalentes, destacaram-se: ‘Dor’, ‘Ansiedade relacionada à morte’ e ‘Mobilidade física prejudicada’. Conclusão: Embora seja incipiente a produção de estudos acerca da temática, espera-se que este estudo possa contribuir para a tomada de decisão pelo enfermeiro, baseada em evidências, que possa assegurar ao paciente sob CP uma assistência digna, humanizada, sistematizada e de qualidade.

Objetivo: Identificar as evidências científicas disponíveis acerca dos diagnósticos de enfermagem para pacientes em cuidados paliativos (CP), bem como elencar os mais utilizados nessa prática. Método: Revisão integrativa, na qual foram analisados artigos publicados nos últimos dez anos, nas bases de dados: Literatura Latino-Americana e do Caribe de Informação em Ciências da Saúde (Lilacs); Pubmed; Web of Science; Scopus; CINAHL Resultados: A amostra foi composta por 14 estudos, averiguando-se um maior quantitativo de produções no ano de 2016, sendo a NANDA-I o sistema de classificação mais empregado para a formulação do diagnóstico de enfermagem (DE). Dentre os DE mais prevalentes, destacaram-se: ‘Dor’, ‘Ansiedade relacionada à morte’ e ‘Mobilidade física prejudicada’. Conclusão: Embora seja incipiente a produção de estudos acerca da temática, espera-se que este estudo possa contribuir para a tomada de decisão pelo enfermeiro, baseada em evidências, que possa assegurar ao paciente sob CP uma assistência digna, humanizada, sistematizada e de qualidade.

Introduction and Aims: System delay (time between first medical contact and reperfusion therapy) is an indicator of quality of primary percutaneous coronary intervention (pPCI) in ST-segment elevation myocardial infarction (STEMI) patients. This study aimed to assess changes in system delay between 2011 and 2015, and to identify its predictors. Methods: The study included 838 patients admitted to 18 Portuguese interventional cardiology centers suspected of having STEMI with less than 12 hours’ duration who were referred for primary percutaneous coronary intervention. Data were collected for a one-month period every year from 2011 to 2015. Univariate and multivariate logistic regression models were used to determine predictors of system delay. Results: No significant changes in system delay were observed during the study. Only 27% of patients had a system delay of ≤90 min. Multivariate analysis identified four predictors of system delay: age ≥75 years (OR 2.57; 95% CI 1.50-4.59; p=0.001), attending a center without pPCI (OR 4.08; 95% CI 2.75-6.10; p75 anos», «entrada num centro sem P-PCI», não «ligar para o 112-SEM» e «Região Centro» foram identificados como fatores preditores para maior atraso no sistema. O conhecimento destes fatores permitirá programar intervenções que visem reduzir o atraso do sistema e melhorar os resultados dos doentes com STEMI. Keywords: Predictive factors, System delay, ST-segment elevation myocardial infarction, Stent for Life, Palavras-chave: Fatores preditivos, Atraso do sistema, Enfarte do miocárdio com supradesnivelamento do segmento ST, Stent for Life

Introduction and Aims: Shorter patient delays are associated with a better prognosis for patients diagnosed with ST-segment elevation myocardial infarction (STEMI). This study aimed to identify predictors of patient delay in the Portuguese population. Methods: Data on 994 patients with suspected STEMI of less than 12 hours’ duration and referred for primary percutaneous coronary intervention (pPCI) and admitted to 18 Portuguese interventional cardiology centers were collected for a one-month period every year from 2011 to 2015. Univariate and multivariate linear regression models were used to identify predictors of patient delay. Results: No significant differences were observed in patient delay over the course of the survey. The multivariate analysis identified five predictors of patient delay: age ≥75 years (exp[beta] 1.28; 95% CI 1.10-1.50; p=0.001), symptom onset between 0:00 and 8:00 a.m. (exp[beta] 1.26; 95% CI 1.10-1.45; p=0.001), and attending a primary care unit before first medical contact (exp[beta] 1.75; 95% CI 1.41-2.16; p

Background and Objectives High-dose melphalan and autologous stem cell transplantation is currently the treatment of choice for selected patients with AL amyloidosis; however, new treatments are needed for patients who are ineligible for or relapse after this procedure. Bortezomib is a proteasome inhibitor with proven activity in multiple myeloma, and the addition of dexamethasone results in superior outcome. We evaluated the activity and feasibility of the combination of bortezomib and dexamethasone (BD) in patients with AL amyloidosis.Design and Methods Consecutive patients with histologically proven, symptomatic AL amyloidosis were treated with BD.Results Eighteen patients, including seven who had relapsed or progressed after previous therapies were treated with BD. Eleven (61%) patients had two or more organs involved; kidneys and heart were affected in 14 and 15 patients, respectively. The majority of patients had impaired performance status and high brain natriuretic peptide values; serum creatinine was elevated in six patients. Among evaluable patients, 94% had a hematologic response and 44% a hematologic complete response, including all five patients who had not responded to prior high dose dexamethasone-based treatment and one patient under dialysis. Five patients (28%) had a response in at least one affected organ. Hematologic responses were rapid (median 0.9 months) and median time to organ response was 4 months. Neurotoxicity, fatigue, peripheral edema, constipation and exacerbation of postural hypotension were manageable although necessitated dose adjustment or treatment discontinuation in 11 patients.Interpretation and Conclusions The combination of BD is feasible in patients with AL amyloidosis. Patients achieve a rapid hematologic response and toxicity can be managed with close follow-up and appropriate dose adjustment. This treatment may be a valid option for patients with severe heart or kidney impairment.