Introduction: Atrial fibrillation and flutter are prevalent conditions. Direct oral anticoagulants require dose adjustment to glomerular filtration rate. The objective of this study was to assess the quality of prescription of direct oral anticoagulants in adults with these pathologies. Methods: We conducted an observational study in 5 Portuguese health care centers. We included adults with atrial fibrillation or flutter, a glomerular filtration rate under 50 mL/min, treated with direct oral anticoagulants and with updated weight and creatinine between june 2020 and may 2021. Glomerular filtration rate was calculated using Cockcroft-Gault formula and direct oral anticoagulants’ prescription adequacy was confirmed according to the summary of product characteristics. A descriptive analysis of the population was made. A correlation between prescription adequacy and patient characteristics, as well as the prescribed direct oral anticoagulant was assessed. Results: From 95 adults, 43 (45,3%) were male, with an average age of 83 years. 46 (48,4%) presented with inadequate anticoagulant prescription, from whom, 43 (45,3%) had an incorrect dosage and 3 (3,2%) had a formal contraindication to the treatment. We found no association between prescription adequacy, sociodemographic characteristics or the prescribed direct oral anticoagulant. Discussion: This study suggests that there is an important prevalence of inappropriate prescription of direct oral anticoagulant in patients with reduced glomerular filtration rate in primary health care, compromising the efficacy and safety of this medication. The glomerular filtration rate vigilance is necessary for a correct prescription of direct oral anticoagulants in patients with atrial fibrillation and flutter.

No presente artigo apresentamos o projeto ”Implementation of Dedicated Education Units in Europe” (IDEUs_EU), projeto Erasmus+ na área da educação em enfermagem, financiado pela Comissão Europeia. O IDEUs_EU visa implementar e avaliar o modelo DEU (Unidades Dedicadas à Educação) em cinco países europeus, estando desenhado para decorrer de 2015 a 2018. Na fase de design foi conceptualizado um curso de mentores clínicos, sendo posteriormente realizado com um grupo internacional integrando membros dos diferentes parceiros no projeto. A formação de mentores clínicos, realizada em Portugal, resultou numa experiência particularmente positiva, sendo reconhecida como fundamental no processo de capacitação dos enfermeiros a desenvolverem a sua atitude como mentores de estudantes do Curso de Licenciatura em Enfermagem na aprendizagem clínica.

Com o envelhecimento populacional, o aumento das doenças crónicas e o consequente crescimento das situações de dependência, torna-se imperativo rever os paradigmas existentes, de modo a abordar eficazmente as problemáticas associadas. Até 2006, foram realizadas diversas tentativas de implementação de políticas para responder ao aumento da procura de cuidados médicos e sociais. Neste contexto, foi criada, em 2006, a Rede Nacional de Cuidados Continuados Integrados (RNCCI), que tem sido objeto de alterações significativas desde então. Atualmente, a RNCCI organiza-se em quatro tipologias: Convalescença, Média Duração e Reabilitação, Longa Duração e Manutenção, e Equipas de Cuidados Continuados Integrados. Este estudo centra-se nas Unidades de Convalescença, analisando a adequabilidade dos tempos de internamento. Utilizou-se uma metodologia quantitativa, com um questionário dirigido às Unidades de Convalescença de Portugal Continental e análise documental dos relatórios de monitorização da RNCCI.Os resultados evidenciam que os protelamentos de altas são um problema significativo, resultante de fatores clínicos e sociofamiliares, causando constrangimentos às unidades e prolongando desnecessariamente a permanência de utentes em hospitais de agudos.

Background: The role of cardiovascular risk factors in amyotrophic lateral sclerosis (ALS) is controversial. A favourable profile has been found in ALS patients, but previous studies have not specifically considered the profile in different disease phenotypes. Methods: Demographic data, smoking habits, lifetime exercise, and medical history including diabetes mellitus, arterial hypertension, hypercholesterolemia, hypertriglyceridemia, stroke, and cardiac events, were analysed in ALS patients and in controls with other neurological disorders, utilising a standardized questionnaire applied by the same neurologist. In ALS patients the results were analysed according to their different phenotypes. Univariate analyses and multinomial logistic models were applied to estimate the odds ratios (ORs) and confidence intervals (CIs) for covariates, to test potential modifiers and their effects. Results: 500 consecutively assessed adult ALS patients (mean age 65.6, 47% women, and 136 bulbar-onset) and 327 age and gender-matched controls were studied. Patients with spinal-onset ALS took more exercise (p = 0.012), reported less hypertension (p = 0.002) and had fewer cardiac events (p = 0.012). Multinomial regression analysis showed that men without hypertension have a higher risk of having spinal-onset ALS (p < 0.001) while female with hypertension have a higher risk of having bulbar-onset ALS (p = 0.033). Conclusions: Risk-factors in ALS can be influenced by gender and phenotype. This study suggests that men with spinal ALS are healthier, exercise more and have lower rate of hypertension, but females with bulbar-onset ALS are more prone to hypertension. The complex interplay between exercise, diet and comorbidities with ALS phenotype requires further investigation.