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  1. Article ; Online: Practical Management Methodology of the Program Choosing Wisely Portugal

    António Vaz Carneiro

    Acta Médica Portuguesa, Vol 35, Iss 5, Pp 403-

    Wise Health Decisions

    2022  Volume 403

    Abstract: N/a. ...

    Abstract N/a.
    Keywords adesão a directrizes ; medicina baseada em evidências ; melhoria de qualidade ; padrões de prática de médica ; portugal ; sobrediagnóstico ; sobremedicalização ; sobretratamento ; tomada de decisões ; Medicine ; R ; Medicine (General) ; R5-920
    Language English
    Publishing date 2022-05-01T00:00:00Z
    Publisher Ordem dos Médicos
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: O problema da sobreutilização de recursos e o projeto Choosing Wisely Portugal - Escolhas Criteriosas em Saúde

    Miguel Bigotte Vieira / António Vaz-Carneiro

    Ciência & Saúde Coletiva, Vol 26, Iss 11, Pp 5653-

    2021  Volume 5660

    Abstract: Resumo A variação da prática clínica é um fenómeno que se encontra bem descrito e que se caracteriza por uma prática clínica utilizando testes diagnósticos e esquemas terapêuticos diversos, em doentes semelhantes na patologia que apresentam e no seu ... ...

    Abstract Resumo A variação da prática clínica é um fenómeno que se encontra bem descrito e que se caracteriza por uma prática clínica utilizando testes diagnósticos e esquemas terapêuticos diversos, em doentes semelhantes na patologia que apresentam e no seu risco basal. A sobreutilização de recursos em saúde caracteriza-se por apresentar um benefício-risco negativo. Infelizmente ambos os fenómenos se verificam em diversos países, em particular países desenvolvidos. Neste contexto, o American Board of Internal Medicine lançou a campanha Choosing Wisely, a qual foi, entretanto, implementada em diversos países incluindo Portugal.
    Keywords Variação da prática clínica ; Choosing Wisely ; Escolhas Criteriosas em Saúde ; Decisão Informada ; Decisão Partilhada ; Public aspects of medicine ; RA1-1270
    Language English
    Publishing date 2021-11-01T00:00:00Z
    Publisher Associação Brasileira de Pós-Graduação em Saúde Coletiva
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: Vitamin D in the Prevention of Chronic Diseases

    António Vaz-Carneiro

    Acta Médica Portuguesa, Vol 30, Iss 5, Pp 351-

    An Evidence Based Analysis

    2017  Volume 353

    Abstract: N/A. ...

    Abstract N/A.
    Keywords Doença Crónica/prevenção e controlo ; Suplementos Nutricionais ; Vitamina D ; Medicine ; R ; Medicine (General) ; R5-920
    Language English
    Publishing date 2017-05-01T00:00:00Z
    Publisher Ordem dos Médicos
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. Article ; Online: Bacteriuria. Cochrane Database Syst Rev. 2015;4:CD009534.

    Miguel Bigotte Vieira / Mariana Alves / João Costa / António Vaz-Carneiro

    Acta Médica Portuguesa, Vol 31, Iss 2, Pp 76-

    2018  Volume 79

    Abstract: Asymptomatic bacteriuria is frequently detected in women aged up to 60 years, patients with diabetes and elderly patients. The benefit of antibiotic treatment for this condition is controversial. The objective of this Cochrane systematic review was to ... ...

    Abstract Asymptomatic bacteriuria is frequently detected in women aged up to 60 years, patients with diabetes and elderly patients. The benefit of antibiotic treatment for this condition is controversial. The objective of this Cochrane systematic review was to assess the effectiveness and safety of antibiotic treatment for asymptomatic bacteriuria in adults. A systematic review of the literature up to 24 February 2015 was performed using the Cochrane Renal Group’s Specialised Register. Randomised controlled trials (RCTs) and quasirandomised controlled trials comparing antibiotics to placebo or no treatment for asymptomatic bacteriuria in adults were included. The outcomes of interest were the development of symptomatic urinary tract infection, complications, death, adverse events, development of antibiotic resistance, bacteriological cure, and decline in kidney function. Nine studies (1614 participants) were included in this review. The incidence of symptomatic urinary tract infection, complications or death was similar between groups. Antibiotic use was significantly associated with bacteriological cure and an increase in minor adverse events. No decline in kidney function was observed with any one of the treatments. According to the results of the studies included in this revision, authors have concluded that there is no clinical benefit in treating asymptomatic bacteriuria in adults.
    Keywords Adulto ; Antibióticos ; Bacteriúria ; Infecções Assintomáticas ; Revisão sistemática ; Medicine ; R ; Medicine (General) ; R5-920
    Subject code 610
    Language English
    Publishing date 2018-02-01T00:00:00Z
    Publisher Ordem dos Médicos
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  5. Article ; Online: Analysis of the Cochrane Review

    Inês Leal / David Cordeiro Sousa / João Costa / António Vaz-Carneiro

    Acta Médica Portuguesa, Vol 31, Iss 5, Pp 243-

    Cortisteroid Implants for Chronic Non-Infectious Uveitis. Cochrane Database Syst Rev. 2016;2:CD010469

    2018  Volume 246

    Abstract: Non-infectious uveitis is a heterogeneous collection of inflammatory eye diseases and is one of the most important causes of blindness among active adults in developed countries. Inflammation control is crucial in the prevention of ocular structural and ... ...

    Abstract Non-infectious uveitis is a heterogeneous collection of inflammatory eye diseases and is one of the most important causes of blindness among active adults in developed countries. Inflammation control is crucial in the prevention of ocular structural and functional damage. Regarding acute inflammatory control, corticosteroids are the mainstay of treatment. Several types of intra-ocular corticosteroids have been used with the aim of enhanced efficacy compared to their topical or peri-ocular administration, while minimizing its adverse effects associated with the systemic administration. The purpose of this Cochrane review was to synthetize the available evidence regarding the efficacy and safety of corticosteroid implants in comparison with standard treatment. Due to the heterogeneity in the design of the studies and outcome measures assessed, authors could not conclude that implants are superior to traditional systemic therapy in Non-infectious uveitis. The safety analysis suggested increased risks of post-implant surgery for cataract and high intraocular pressure compared with standard-of-care therapy.
    Keywords Adrenal Cortex Hormones/administration & dosage ; Drug Implants ; Randomized Controlled Trials as Topic ; Uveitis/drug therapy ; Medicine ; R ; Medicine (General) ; R5-920
    Subject code 610
    Language English
    Publishing date 2018-05-01T00:00:00Z
    Publisher Ordem dos Médicos
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  6. Article ; Online: Analysis of the Cochrane Review

    Rita Carvalheira-dos-Santos / Ricardo-Manuel Delgado / Guilherme Ferreira-dos-Santos / António Vaz-Carneiro

    Acta Médica Portuguesa, Vol 32, Iss 7-8, Pp 483-

    Exercise-Based Cardiac Rehabilitation for Coronary Heart Disease. Cochrane Database Syst Rev. 2016;1:CD001800

    2019  Volume 487

    Abstract: Coronary heart disease is the single most common cause of death globally, accounting for one-third of all deaths. However, with falling coronary heart disease mortality rates, an increasing number of people live with the disease and may need support to ... ...

    Abstract Coronary heart disease is the single most common cause of death globally, accounting for one-third of all deaths. However, with falling coronary heart disease mortality rates, an increasing number of people live with the disease and may need support to manage their symptoms and prognosis. A complex intervention that may involve a variety of therapies, cardiac rehabilitation includes exercise, risk factor education, behavioral change, psychological support, and strategies that are aimed at targeting traditional risk factors for cardiovascular disease. Cardiac rehabilitation is an essential part of contemporary heart disease care and is considered a priority in countries with a high prevalence of coronary heart disease. This Cochrane systematic review constitutes an update of a Cochrane review published in 2011, having identified 16 new trials (3872 participants), predominantly post-myocardial infarction and post-revascularization patients. Therefore, it included 63 randomized trials looking at the effectiveness and cost-effectiveness of exercise-based cardiac rehabilitation in patients with coronary heart disease. The quality of the evidence ranged from low to moderate. The main results highlight the effect of cardiac rehabilitation, in comparison with absence of physical exercise, in the reduction in cardiovascular mortality, with no reduction, however, in total mortality. The overall risk of hospital admissions was reduced with cardiac rehabilitation but there was no significant impact on the risk of myocardial infarction, coronary artery bypass graft or percutaneous coronary intervention. 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.
    Keywords Doença Coronária/reabilitação ; Ensaios Clínicos Aleatorizados ; Exercício ; Qualidade de Vida ; Reabilitação Cardíaca ; Revisão Sistemática ; Medicine ; R ; Medicine (General) ; R5-920
    Subject code 610
    Language English
    Publishing date 2019-08-01T00:00:00Z
    Publisher Ordem dos Médicos
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  7. Article ; Online: Analysis of the Cochrane Review

    David Cordeiro Sousa / Inês Leal / João Costa / António Vaz-Carneiro

    Acta Médica Portuguesa, Vol 30, Iss 7-8, Pp 513-

    Anti-vascular Endothelial Growth Factor for Prevention of Postoperative Vitreous Cavity Hemorrhage after Vitrectomy for Proliferative Diabetic Retinopathy. Cochrane Database Syst Rev. 2015;8:CD008214.

    2017  Volume 516

    Abstract: Postoperative vitreous hemorrhage is a complication following vitrectomy for proliferative diabetic retinopathy, delaying visual recovery and making fundus examination and disease follow-up more difficult. Anti-vascular endothelial growth factor drugs ... ...

    Abstract Postoperative vitreous hemorrhage is a complication following vitrectomy for proliferative diabetic retinopathy, delaying visual recovery and making fundus examination and disease follow-up more difficult. Anti-vascular endothelial growth factor drugs such as bevacizumab, when injected in the vitreous cavity, reduce vascular proliferation and their use has been proposed to reduce the incidence of postoperative vitreous hemorrhage. The authors of this Cochrane systematic review evaluated all randomized controlled trials on the pre- or intraoperative use of anti-vascular endothelial growth factor to reduce postoperative vitreous hemorrhage occurrence after vitrectomy in patients with proliferative diabetic retinopathy. The results suggested that the use of intravitreal bevacizumab was effective in reducing early postoperative vitreous hemorrhage (i.e. at four weeks) occurrence, with a good safety profile. This work aims to summarize and discuss the findings and clinical implications of this Cochrane systematic review.
    Keywords Bevacizumab ; Factores de Crescimento do Endotélio Vascular/ antagonistas & inibidores ; Hemorragia Pós-Operatória/prevenção e controlo ; Hemorragia Vítrea/prevenção e controlo ; Revisão Sistemática ; Retinopatia Diabética ; Vitrectomia/efeitos adversos ; Medicine ; R ; Medicine (General) ; R5-920
    Subject code 610
    Language English
    Publishing date 2017-08-01T00:00:00Z
    Publisher Ordem dos Médicos
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  8. Article ; Online: Analysis of the Cochrane Review

    Mariana Alves / Miguel Bigotte Vieira / João Costa / António Vaz Carneiro

    Acta Médica Portuguesa, Vol 30, Iss 12, Pp 835-

    Early Discharge Hospital at Home. Cochrane Database Syst Rev. 2017;6:CD000356.

    2017  Volume 839

    Abstract: Hospital at home is a service that provides active treatment by healthcare professionals in the patient’s home for a condition that otherwise would require acute hospital in-patient care. However, the clinical benefit of this intervention and its effect ... ...

    Abstract Hospital at home is a service that provides active treatment by healthcare professionals in the patient’s home for a condition that otherwise would require acute hospital in-patient care. However, the clinical benefit of this intervention and its effect on health costs are not established. This Cochrane systematic review aimed to assess the effectiveness and costs of managing patients with hospital at home compared with inpatient hospital care. A systematic review of the literature was carried out by searching the following databases to 9 January 2017: Cochrane Effective Practice and Organization of Care Group (EPOC) register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, EconLit and clinical trials registries. Thirty-two randomized trials (2 of which unpublished), including 4746 patients, were included. The present review provides insufficient objective evidence of economic benefit (through a reduction in hospital length of stay) or improved health outcomes.
    Keywords Alta Hospitalar ; Custos de Cuidados de Saúde ; Mortalidade ; Reinternamento ; Revisão Sistemática ; Serviços Hospitalares de Assistência Domiciliar ; Medicine ; R ; Medicine (General) ; R5-920
    Subject code 360
    Language English
    Publishing date 2017-12-01T00:00:00Z
    Publisher Ordem dos Médicos
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  9. Article ; Online: Como avaliar a investigação clínica. O exemplo da avaliação crítica de um ensaio clínico

    António Vaz Carneiro

    Jornal Português de Gastrenterologia , Vol 15, Iss 1, Pp 30-

    2008  Volume 36

    Abstract: O papel da ciência na prática clínica é, hoje em dia, absolutamente insubstituível. A publicação permanente de estudos e ensaios clínicos produz evidência (prova científica) de boa qualidade, sobre a qual é possível o médico tomar decisões sólidas, mesmo ...

    Abstract O papel da ciência na prática clínica é, hoje em dia, absolutamente insubstituível. A publicação permanente de estudos e ensaios clínicos produz evidência (prova científica) de boa qualidade, sobre a qual é possível o médico tomar decisões sólidas, mesmo que num contexto de incerteza e risco. Para além disso, a combinação entre a gestão de recursos cada vez mais escassos e dispendiosos por um lado, com responsabilização dos médicos por parte da sociedade na prestação de cuidados eficazes mas custo-efectivos, por outro, cria novas exigências de rigor e racionalização da prática médica. Hoje em dia, a evidência científica proveniente de estudos clínicos pode caracterizar-se - em relação à existente digamos há 30 anos atrás - em três pontos: 1) existe muito maior quantidade de estudos; 2) a qualidade destes é muito melhor; e 3) estes podem pode ser rápida e eficazmente localizados (através de meios informáticos que pesquisam as grandes bases de dados biomédicas). Portanto a questão não deverá ser “Existe uma resposta para a minha questão?” (a resposta será na maior parte dos casos afirmativa), mas sim “Estes dados que encontrei são fiáveis?”. Por estas (e outras) razões, torna-se absolutamente fundamental que o médico saiba analisar a qualidade metodológica dos artigos que seleccionou para ler. Neste artigo apresentamos, como exemplo de avaliação da investigação clínica, um esquema de análise crítica de ensaios clínicos. The role of science in medical practice is nowadays absolutely irreplaceable. The continuous publication of studies and clinical trials produces evidence of good quality, based on which physicians can base their decisions, even in a uncertain and risky environment. Moreover, the combination of rare and expensive resource management with professional accountability of doctors in efficacious and cost-effective care creates new rational needs and demands. Nowadays, scientific research from clinical studies can be looked upon from three standpoints of view (as opposed from 30 years ago): 1) there is a much bigger number of studies; 2) their quality is higher and 3) they can be located easily (through search of electronic databases). So the question is not “Is there an answer to my questions?” (most of the time the answer will be yes), but “Are these data I locate reliable?”. For these (and other) reasons, is absolutely mandatory that doctors know how to critically appraisal the clinical evidence from studies.In this paper we present a scheme of critical appraisal of clinical trials, as an example of evaluation of clinical research.
    Keywords Diseases of the digestive system. Gastroenterology ; RC799-869 ; Specialties of internal medicine ; RC581-951 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Gastroenterology ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
    Language Portuguese
    Publishing date 2008-02-01T00:00:00Z
    Publisher Sociedade Portuguesa de Gastrenterologia
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  10. Article ; Online: Excess Mortality Estimation During the COVID-19 Pandemic

    Paulo Jorge Nogueira / Miguel de Araújo Nobre / Paulo Jorge Nicola / Cristina Furtado / António Vaz Carneiro

    Acta Médica Portuguesa, Vol 33, Iss 6, Pp 376-

    Preliminary Data from Portugal

    2020  Volume 383

    Abstract: Introduction: Portugal is experiencing the effects of the COVID-19 pandemic since March 2020. All-causes mortality in Portugal increased during March and April 2020 compared to previous years, but this increase is not explained by COVID-19 reported ... ...

    Abstract Introduction: Portugal is experiencing the effects of the COVID-19 pandemic since March 2020. All-causes mortality in Portugal increased during March and April 2020 compared to previous years, but this increase is not explained by COVID-19 reported deaths. The aim of this study was to analyze and consider other criteria for estimating excessive all-causes mortality during the early COVID-19pandemic period. Material and Methods: Public data was used to estimate excess mortality by age and region between March 1 and April 22, proposing baselines adjusted for the lockdown period. Results: Despite the inherent uncertainty, it is safe to assume an observed excess mortality of 2400 to 4000 deaths. Excess mortality was associated with older age groups (over age 65). Discussion: The data suggests a ternary explanation for early excess mortality: COVID-19, non-identified COVID-19 and decrease in access to healthcare. The estimates have implications in terms of communication of non-pharmaceutical actions, for research, and to healthcare professionals. Conclusion: The excess mortality occurred between March 1 and April 22 was 3.5- to 5-fold higher than what can be explained by the official COVID-19 deaths.
    Keywords coronavirus ; coronavirus infections ; disease outbreaks ; mortality ; pandemics ; portugal ; Medicine ; R ; Medicine (General) ; R5-920 ; covid19
    Subject code 310
    Language English
    Publishing date 2020-06-01T00:00:00Z
    Publisher Ordem dos Médicos
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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