Percorrer por autor "Sousa, Luís"
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- Avaliar para gerir a doença aguda: propriedades clinicométricas dos instrumentos e avaliação económica em enfermagemPublication . Sousa, Luís; Novo, André; Ferreira, Rogério Ferrinho; Marques-Vieira, CristinaO enfermeiro na sua prática clínica deve utilizar instrumentos que permitam realizar a avaliação do caso e a verificação da efetividade das intervenções, conduzindo à resolução do diagnóstico de enfermagem. Os instrumentos necessitam ser válidos, fiáveis e responsivos, pois só assim, no âmbito da investigação, se traduz a efetividade dos cuidados de enfermagem. Na seleção do instrumento de avaliação, para medir ou avaliar uma determinada função, o enfermeiro tem de garantir qualidades. É desejável que o instrumento seja uma medida válida para a função, além da adequada fiabilidade, devendo os resultados ser suficientemente sensíveis, traduzindo alterações clínicas, quando na realidade tal se verifica. Neste sentido, a verificação das propriedades clinicométricas dos instrumentos utilizados na prática clínica, é fundamental. Minimizar-se-á o viés na avaliação diagnóstica e na verificação dos resultados em enfermagem. Concorre-se ainda que de forma algo oculta ou remota, para maior rigor dos estudos de avaliação da efetividade das intervenções dos enfermeiros. Em contexto clínico é fundamental que o enfermeiro selecione os instrumentos válidos, fiáveis, responsivos ou sensíveis às mudanças, estimando-se que sejam considerados úteis e eficientes.
- Effectiveness and reproducibility of an exercise training program: the ERIC-HF - multicenter randomized controlled trialPublication . Delgado, Bruno; Novo, André; Lopes, Ivo; Sousa, Luís; Klompstra, LeonieDecompensated Heart Failure patients are characterized by functional dependence and low exercise tolerance. Aerobic exercise can improve symptoms, promoting functional capacity and increasing exercise tolerance. Little is known about the effectiveness and feasibility of it. The ERIC-HF program is an aerobic exercise training program developed for HF inpatients and includes cycloergometer training, walking and climbing stairs in order to promote patient’s functional capacity during the in-hospital stay period. Objective: To analyze the effect of an aerobic exercise training program (ERIC-HF)on exercise capacity of patients with decompensated heart failure. Secondary objectives were to assess the effects of an aerobic exercise training on functional independence and experience of dyspnea during activities of daily living. Design and setting: A randomised controlled clinical trial with follow-up at discharge. Eight different hospitals were included where patients with decompensated heart failure, admitted to the hospital, were randomly assigned to training (aerobic exercise program) or control (usual rehabilitation care guideline recommended). Patients were randomized (at a ratio of 1:1) to training group or control group using the software available online. After randomization, patients were clarified about the study and asked to provide informed consent. Patients were not informed about the group they were part of and no one declined participation. Only the investigators knew in which group patients were. The main outcome was exercise capacity, measured by 6-minute walking test at discharge. Other outcomes were the independence for the activitiers of daily living and the dyspnea associated to the activities of daily living. Results: 257 patients were included. The mean age of the patients was 67±11 years, 84% (n = 205) presented reduced ejection fraction and the in hospital stay average was 16±10 days. At discharge, patients in the ERIC-HF group walked further compared to the control group (278±117m vs 219±115m) and this difference stayed significant after correcting for confounders (p-value<0.001). A statistically significant difference was found favoring the ERIC-HF exercise group in functional independence (96±7 vs 93±12) and dyspnea associated to ADL (13±5 vs 17±7) and these differences stayed in correcting for baseline values and confounders (functional independence p-value=0.002; dyspnea associated to ADL p = 0.018). Conclusion: The ERIC-HF program is safe, feasible and an effective exercise program to increase exercise capacity and functional independence and to decrease dyspnea during ADL in in-hospital patients admitted due to decompensated HF.
- El proceso de transición y capacitación de la persona trasplantada al corazón y familia: ensayo teóricoPublication . Loureiro, Maria; Sousa, Luís; Duarte, João; Coutinho, Gonçalo; Martins, Maria Manuela; Novo, AndréLa persona trasplantada de corazón y la familia experimentan diferentes tipos de transición, y un acompañante facilitador de su formación para una transición saludable es fundamental. La Enfermería de Rehabilitación (ER), debido a sus habilidades, puede ayudar a las personas a recuperar la estabilidad y el bienestar, sin embargo, existe poca difusión de su fundamento en las teorías de enfermería. Objetivo: Analizar el aporte de la Teoría de las Transiciones en la práctica de la enfermería rehabilitadora orientada al empoderamiento de la persona trasplantada al corazón y a la familia. Metodología: Estudio crítico-reflexivo guiado por la Teoría de las Transiciones de Afaf Meleis y por la legislación reguladora para la práctica del enfermero rehabilitador. Resultado: Se percibe que la teoría de las Transiciones sustenta la intervención de Enfermería de Rehabilitación en las áreas de conocimiento y aprendizaje de habilidades de la persona trasplantada cardíaca y su familia, conduciendo a su empoderamiento, toma de decisiones y acción, haciendo que la persona se sienta empoderada para superar los retos diarios derivados de su proceso de transición. Conclusión: Es fundamental demostrar la conceptualización en la práctica de enfermería, siendo la transición un foco significativo para la Enfermería de Rehabilitación.
- Enfermagem de reabilitação à pessoa em programa regular de hemodiálisePublication . Novo, André; Gaspar, Luís; Sousa, Luís; Mendes, Eugénia; Martins, PedroJá desde finais da década de 70 do século XX que se investiga em concreto a necessidade e os efeitos de programas de reabilitação em pessoas submetidas a programa regular de hemodiálise Com efeito, pensa-se que a primeira publicação que demonstrou que estas pessoas tinham um baixo nível de capacidade física data de 1977 (Jetté, Posen, & Cardarelli, 1977). A partir dessa data está bem documentado que as pessoas com doença renal crónica (DRC') em programa regular de hemodiálise, estão limitadas na sua capacidade física global entre 60-70 % do esperado para a sua idade, quando comparados com indivíduos saudáveis com as mesmas características ( Johansen, & Painter, 2012).
- A enfermagem de reabilitação no empoderamento e capacitação da pessoa em processos de transição saúde-doençaPublication . Sousa, Luís; Martins, Maria Manuela; Novo, AndréDiscutir a contribuição da Enfermagem de Reabilitação para o Empoderamento e a Capacitação da pessoa em processos de transição saúde-doença. Método: Prática reflexiva com discussão norteada pela Teoria das Transições de Afaf Ibrahim Meleis, os diagnósticos de enfermagem segundo a linguagem da Classificação Internacional para a Prática de Enfermagem e as competências prescritas para o enfermeiro de reabilitação. Resultados: Os enfermeiros de reabilitação desenvolvem um processo de capacitação privilegiando o foco de atenção o conhecimento e aprendizagem de capacidades desenvolvendo intervenções de modo a contribuir para indicadores específicos dos processos de transição saúde doença. Estes resultados assentam em conceitos subsidiários de boas práticas preconizadas com o objetivo último de uniformizar linguagem e terminologia dos enfermeiros de reabilitação. Conclusão: A intervenção do enfermeiro de reabilitação nos focos conhecimento e aprendizagem de capacidades da pessoa permite o empoderamento, a tomada de decisão e a passagem à ação, de modo a desenvolver habilidades e assim fazer a pessoa sentir-se capacitada para lidar com os desafios que surgem no dia a dia, decorrentes de processos de transição.
- Exercício intervalado de alta intensidade em reabilitação cardíacaPublication . Novo, André; Delgado, Bruno; Mendes, Eugénia; Preto, Leonel; Sousa, Luís; Loureiro, Maria“Reabilitação cardíaca: evidência e fundamentos para a prática” é um livro organizado e maioritariamente escrito por 6 pessoas geograficamente afastadas, mas que o destino quis juntar. O que nos une? A paixão pela reabilitação e, mais em concreto, pela reabilitação cardíaca. Para além dos 6 principais autores, este livro contou com a preciosa colaboração de mais de 30 autores distribuídos ao longo dos diferentes capítulos.Existia em Portugal um défice de literatura aglutinadora sobre reabilitação cardíaca. Assim, procurámos organizar neste livro as melhores e mais recentes evidências e fundamentos científicos que servem de alicerces para uma prática segura e eficiente. Esperamos que este livro não se encerre em si mesmo e estimule quem nos lê a procurar ainda mais evidências e fundamentos sobre reabilitação cardíaca.Este livro é direcionado para profissionais. Se não é um profissional de saúde, ler o conteúdo deste livro não habilita para a implementação de programas de reabilitação cardíaca. Os programas de reabilitação cardíaca devem ser geridos por profissionais de saúde especializados e experientes. Se é um paciente e não tem orientação, procure um profissional de saúde que o possa ajudar.
- Heart failure inpatient"s self-care behaviour: multicenter approach focousing on gender differencesPublication . Delgado, Bruno; Lopes, Ivo; Mendes, Eugénia; Loureiro, Maria; Preto, Leonel; Sousa, Luís; Novo, AndréHeart failure is often characterized by low exercise capacity and great impairment on performance in activities of daily living. The correct management of the disease can prevent the worsening of symptoms and promote a better quality of life. Self-care behaviour plays an important role on patient"s quality of life. Aim: The aims of this study are to evaluate the self-care behaviour in a sample of heart failure inpatients, using the Self-Care Heart Failure Index (SCHFI) and to understand whether gender and patophisiologic characteristics does interfere on it. Methods: Cross-sectional multicenter study enrolling 225 heart failure inpatients from eight hospitals. At admission, patient’s functional capacity was evaluated as well as their self-care behaviour, using the SCHFI Portuguese v6.2. Comparison between self-care behaviour with gender was performed. Also some correaltions were perfomed with the total sample of patients, aiming to understand which were the variables that may interfere with the socre of each sub-scale of the self-care HF index. Results: Patients’ mean age was 68.4 ± 10.7 years old, 68% were male and 82.3% have reduced ejection fraction. A mean value of 47.9, 35.6 and 38.8 points was found in the SCHFI score of the sections self-care maintenance (SCMt), self-care management (SCMg) and self-care confidence (SCC), respectively. Heart failure inpatients present inadequate levels of self-care behaviour. No difference was found between genders on any section of the SCHFI. Among all variables, only the number of CVRFs and the left ventricular ejection fraction had significant differences. Males had better results, but not with a statistically significant difference. Association tests (ANOVA) between different variables and the score of each section of the SCHFI were perfomred. Only in the NYHA there are variables associated with a better self-care, namely in the SCMg (p = 0.011) and in SCC (p = 0.010). Correlations were made using the numeric variables age, CVRF, BI, LCADL, SCMt, SCMg and SCC, in order to understand the influence of the variables with each other. All the three dimesnions present a positive correlation, at 99% confidence interval between them (SCMt with SCMg: r = 0.365, p < 0.000; SCMt with SCC: r = 0.272, p < 0.000 and SCMg with SCC: r = 0.670, p < 0.000). In addition, SCMt presents a positive correlation with age at a 95% confidence interval (r = 0.158, p = 0.018). Negative correlations were found between 1) BI and age (r=-0.151, p = 0.023), at a 95% confidence interval and 2) BI with LCALD (r=-0.407, p < 0.000), at a 99% confidence interval. Regarding NYHA functional class and left ventricular systolic function, only NYHA class II patients present a statistically significant difference in SCMg and SCC comparing to Class III and IV patients (who do not present differences between them). Conclusion: The results do not suggest a relationship between gender and pathophysiological characteristics with self-care behaviour.
- Heart failure inpatient's self care behavior: mulricentre approach focusing on gender differencesPublication . Delgado, Bruno; Lopes, Ivo; Mendes, Eugénia; Loureiro, Maria; Preto, Leonel; Sousa, Luís; Novo, AndréHeart failure is often characterized by low exercise capacity and great impairment on performance in activities of daily living. The correct management of the disease can prevent the worsening of symptoms and promote a better quality of life. Self-care behaviour plays an important role on patient"s quality of life. Aim: The aims of this study are to evaluate the self-care behaviour in a sample of heart failure inpatients, using the Self-Care Heart Failure Index (SCHFI) and to understand whether gender and patophisiologic characteristics does interfere on it. Methods: Cross-sectional multicenter study enrolling 225 heart failure inpatients from eight hospitals. At admission, patient’s functional capacity was evaluated as well as their self-care behaviour, using the SCHFI Portuguese v6.2. Comparison between self-care behaviour with gender was performed. Also some correaltions were perfomed with the total sample of patients, aiming to understand which were the variables that may interfere with the socre of each sub-scale of the self-care HF index. Results: Patients’ mean age was 68.4 ± 10.7 years old, 68% were male and 82.3% have reduced ejection fraction. A mean value of 47.9, 35.6 and 38.8 points was found in the SCHFI score of the sections self-care maintenance (SCMt), self-care management (SCMg) and selfcare confidence (SCC), respectively. Heart failure inpatients present inadequate levels of self-care behaviour. No difference was found between genders on any section of the SCHFI. Among all variables, only the number of CVRFs and the left ventricular ejection fraction had significant differences. Males had better results, but not with a statistically significant difference. Association tests (ANOVA) between different variables and the score of each section of the SCHFI were perfomred. Only in the NYHA there are variables associated with a better selfcare, namely in the SCMg (p = 0.011) and in SCC (p = 0.010). Correlations were made using the numeric variables age, CVRF, BI, LCADL, SCMt, SCMg and SCC, in order to understand the influence of the variables with each other. All the three dimesnions present a positive correlation, at 99% confidence interval between them (SCMt with SCMg: r = 0.365, p < 0.000; SCMt with SCC: r = 0.272, p < 0.000 and SCMg with SCC: r = 0.670, p < 0.000). In addition, SCMt presents a positive correlation with age at a 95% confidence interval (r = 0.158, p = 0.018). Negative correlations were found between 1) BI and age (r=-0.151, p = 0.023), at a 95% confidence interval and 2) BI with LCALD (r=-0.407, p < 0.000), at a 99% confidence interval. Regarding NYHA functional class and left ventricular systolic function, only NYHA class II patients present a statistically significant difference in SCMg and SCC comparing to Class III and IV patients (who do not present differences between them). Conclusion: The results do not suggest a relationship between gender and pathophysiological characteristics with self-care behaviour.
- Investigação em enfermagem: das prioridades aos reptosPublication . Sousa, Luís; José, Helena; Novo, AndréEsta obra, de fácil leitura, incide sobre os assuntos básicos da investigação, numa lógica de teoria versus prática, e é dirigida a estudantes de Enfermagem (licenciatura, mestrado e doutoramento), enfermeiros, investigadores, profissionais de saúde e outros interessados.Visa aumentar o conhecimento existente, agregando um conjunto de temáticas e experiências adaptadas à realidade portuguesa, com o objetivo de apoiar os profissionais que se interessem pela investigação. Esperamos que a compilação desta informação possa potenciar a investigação em enfermagem, ajudando os investigadores a construírem um percurso com mais e melhor investigação. · Investigação em Enfermagem: Das Prioridades aos Reptos · Metodologia da Investigação Quantitativa · Validação e Adaptação de Instrumentos de Medida · Metodologia Qualitativa Aplicada à Investigação em Cuidados de Saúde · Ética da Investigação em Saúde · Otimização da Pesquisa de Informação · Leitura Crítica de Artigos Científicos · Comunicação de Resultados Científicos · Escrita de Artigos Científicos · Visibilidade da Produção Científica · Prática Baseada na Evidência · Revisão Narrativa, Integrativa e Sistemática da Literatura · Relatos de Experiências na Realização de uma Tese de Doutoramento
- Pathophysiologic and gender differences regarding exercise responses in decompensated Heart Failure patientsPublication . Delgado, Bruno; Froelicher, Erika; Lopes, Ivo; Sousa, Luís; Novo, AndréIntroduction: Heart Failure patients often present impairment on their functional capacity. Exercise training is the key component of cardiac rehabilitation and must be early implemented. Knowing the characteristics that lead a patient to be a good responder to an exercise intervention would be useful to identify the ones that could benefit from this same intervention. Purpose: Identify the characteristics of good responses to an aerobic exercise training in decompensated heart failure (HF) patients and understand if there are gender differences. Methods: Cross sectional study with 76 inpatients who performed an aerobic exercise training program (AET). Functional capacity was evaluated at admission and discharge using three different tools: the London Chest of Activity of Daily Living (LCADL) scale, the Barthel Index (BI) and the 6-minute walking test (6MWT). Multivariate linear regression was performed by gender to understand which variables lead a patient to have better performance. Since it is known that men and women have different responses to exercise training, the results and analysis of the data collected were performed by gender. Results: Seventy-six patients (52 men) were included. The mean age was 67 ± 10 years, 15.8% were New York Heart Association (NYHA) class IV and 76.3% had reduced ejection fraction. The major etiology of HF was ischemic disease (35.5%). Six predictive equations were obtained, one for each functional capacity (FC) tool divided by gender. NYHA class III patients do not differ from class IV in terms of FC at discharge. However, HFreduced ejection fraction patients presented higher 6MWT distance (309,6m vs 231m) and lower LCADL score (11 vs 15) compared to non-reduced. Gender analysis showed that women had an average of 4 days longer in-hospital stay and a considerable difference in the 6MWT. At admission women walked 15 meters less than man and at discharge 69 meters less, presenting also lower score at BI and higher at LCADL. However, only the discharge 6MWT distance presents a statistical significant difference (69 meters; p = 0.01). Traditionally women are more sedentary and present less fitness level than men. The linear regression model shows that gender is a independent variable that contributes to the change in the 6MWT - favouring men. Conclusions: The AET program appears to be more effective in younger patients, with low FC at admission and who are less impaired. Those with left systolic ventricular function apparently interfered with progression during the program. Gender influences the performance of patients undergoing exercise training. Men present higher FC at discharge but the predictive models are stronger for women. These results are consistent with the idea that gender plays an important role in determine the performance of patients in exercise training programs.