Introduction: Interventional cardiovascular procedures are increasingly complex, raising concerns about heightened radiation exposure for both patients and healthcare professionals. This exposure can lead to serious complications, including skin injuries, cataracts, and cancer. A range of protective tools—such as lead aprons, thyroid collars and glasses, ceiling-mounted shields, and table skirts—are available to minimize occupational exposure. Effective radiation protection relies not only on equipment but also on procedural strategies such as improved beam collimation, reduced fluoroscopic pulse rates, fluoroscopy intensity and the number of cine acquisitions, and maintaining distance from the X-ray source. Staff education, ongoing training, and routine audits are essential to ensure adherence to radiation safety protocols. While interventional cardiology teams show general awareness and use of protective measures, significant gaps remain—particularly in the consistent use of eye protection, personal dosimeters, and standardized practices across cath labs. Strengthening these areas is critical to promoting a unified national approach to radiation safety and safeguarding the long-term health of Cath lab personnel.Objectives: This position paper aims to raise operator awareness and propose novel strategies for minimizing ionizing radiation doses, thus mitigating associated risks.Methods and results: This working group conducted a review of the scientific literature and the most recent international guidelines on radiation protection in cardiac cath labs. Based on this analysis, effective protective measures and best practices were identified and systematized, adapted to the Portuguese context.Conclusion: Minimizing radiation exposure in the cath lab requires a comprehensive, multidisciplinary approach that combines protective equipment, procedural adjustments, and collaborative safety protocols to safeguard both patients and healthcare providers without compromising clinical outcomes.
Introduction and objectives To present the report on the trends in percutaneous coronary activity data in Portugal from the last decade (from 2014 to 2023). Methods Data were extracted from the Portuguese National Registry of Interventional Cardiology (RNCI) and the numbers in recent years were compared and complemented by information from the 2023 European Society of Cardiology Atlas in Interventional Cardiology (IC) survey, which was administered to the director of every IC department. Linear regression analysis was used to assess trends in activity over time. Results From 2014 to 2023, there were 160101 percutaneous coronary interventions reported in the RNCI. The number of annual PCI in the last decade remained constant (1360/million inhabitants in 2014 to 1322/million in 2023; R2=0.039, p=0.276). Importantly, there was a 22% increase in primary PCI (306/million inhabitants in 2014 to 374/million inhabitants in 2023; R2=0.759, p<0.001) and there was a decrease in the geographical disparities in primary PCI across Portugal. The following PCI trends were noted: a 43% increase in PCI performed by radial access (57.4% in 2014 to 82.1% in 2023; R2=0.908, p<0.001), a 27% increase in drug-eluting stents (78.4% in 2014 to 99.2% of all PCI with stents in 2023; R2=0.638, p=0.003), and a 47% decrease of thrombectomy in primary PCI (35.0% in 2014 to 18.6% in 2023; R2=0.649, p=0.003). There was a slight increase in the use of intracoronary diagnostic devices during PCI, with intravascular imaging and physiological assessments reaching 7.6% and 4.2%, respectively, in 2023. Conclusion The RNCI was able to depict changes in our practice along the study period. The annual PCI volume per million inhabitants remained stable, driven by an increase in primary PCI offset by a decrease in chronic coronary syndrome indications. The geographical asymmetries were markedly reduced due to the expansion on PCI capable centers, enabling a progress towards a more universal access to percutaneous coronary techniques.
The positive impact of cardiac rehabilitation in terms of improvement in functional capacity, quality of life, and prognosis is well established. However, not all patients respond adequately to the programs. The objective of this work is to determine the rate and predictors of non-response to a cardiac rehabilitation program in terms of functional capacity. Additionally, it aims to evaluate the impact of non-response on prognosis. Prospective observational single-center study including patients enrolled in a phase II CR program between 2016 and 2024. Clinical, imaging, laboratory and CPET data were collected.The population was divided into two groups: responders and non-responders to the CR program. A responder was defined as someone who showed an improvement in peak VO2 of at least 1 ml/kg/min in the CPET after completing the program. A total of 236 patients completed a phase II CR program, of these 105 were non-responders to the CR program. The peak VO2 increased by 2,9 ml/kg/min (1,9-4,6) in the responders group compared to a decrease of 0,3 ml/kg/min (-2,15-0,2) in the non-responders group. The baseline walking test results were similar between the groups, but the responders group showed improvement at the end of the program (539m vs. 575m, p=0.03). Both groups were similar regarding baseline characteristics, except for the presence of diabetes, hypertension, age and BMI. In the non-responder group, the percentage of diabetics was higher (37% vs. 22%, p=0,02), as well hypertension (79.5% vs 56.5%, p=0.04). Non-responders were older (61.2±0.9 years vs. 57.8±1.2 years, p=0.024) and more obese (28.3±1.4 kg/m2 vs 27.0±0.7 kg/m2, p=0.023). There was a significant correlation between non-response to CR and diabetes (p=0.02), with a 52% probability of no improvement in peak VO2 among diabetics. Patients aged 62 or older demonstrated a statistically significant association with no improvement in peak VO2 (p = 0.024). The mean follow-up time was 2.97 ± 1.69 years. Seven deaths were recorded and 12 hospitalizations. Non-responders reported a higher incidence of events and mortality compared to the responder group (1.4% vs. 1% for reinfarction, and 4% vs. 2% for deaths, respectively). A statistically significant correlation was observed between composite outcomes and a peak VO2 ≤ 15 ml/kg/min (p = 0.02) Our findings highlight the importance of peak VO2 improvement in monitoring functional improvement during cardiac rehabilitation and its role in reducing events during follow-up. Diabetes and age were identified as predictors of non-improvement, emphasizing the need to enhance adherence and tailored interventions in these high-risk groups.
This case demonstrates a comorbid Borderline Personality Disorder and Factitious Disorder situation, uncommon and sparsely described in the literature. Our purpose in sharing it resides as means to augment scientific data and possibly help manage similar situations. This case represents a patient with Borderline Personality Disorder, from an outpatient setting, who was hospitalized due to a mixed state suspicion. She then developed consciousness and behavior changes. Firstly, it resembled a delirium, although there was no obvious explanation for it and besides benzodiazepines in her system, all lab exams were clear. When her consciousness was recovered she was confronted with family information we gathered, and admitted self-injuring (excessive medication) as a means to pretend a stroke, as well forged cancer and chemotherapy symptoms (she cut off all her hair), in order to receive her children's attention. She was later discharged and oriented to a mental rehabilitation institution. Factitious Disorder is an underdiagnosed and confounding condition and possibly correlated to Borderline Personality Disorder. Despite some literature demonstrating a comorbidity relation between Borderline Personality Disorder and Factitious Disorder, there is still controversy among authors, as well as sparse data. This patient showed a clear comorbidity between these two disorders, which corroborates their connection.
Enquadramento: A dotação de enfermeiros é, atualmente, um dos elementos essenciais na gestão de recursos humanos em enfermagem. Quando adequada, permite a manutenção da segurança dos pacientes, a qualidade dos cuidados de enfermagem e ganhos efetivos em saúde, permitindo ainda alcançar objetivos organizacionais, com qualidade e segurança, algo apenas possível com a correta alocação de recursos. Objetivo: Mapear a evidência científica existente sobre a influência das dotações seguras em enfermagem na segurança dos cuidados prestados ao paciente internado. Metodologia: Revisão sistemática da literatura (RSL), realizada durante os meses de dezembro de 2000 e janeiro de 2021, segundo o modelo JBI, com análise de artigos publicados entre 2018 e 2021 nas bases de dados B-ON e Google Académico, recorrendo a descritores MeSH/DeCs, conjugados com o booleano “AND”. Esta revisão partiu da questão “Qual a influência das dotaçoes de recursos humanos em enfermagem na segurança do paciente em unidades de internamento?”. Resultados: Do universo de 14995 artigos obtidos, foram selecionados 3, após aplicação dos critérios de inclusão. Conclusão: Corroboramos que se revela fulcral a implementação de dotações seguras em enfermagem, de modo a garantir a segurança dos pacientes internados, visando diminuir as comorbilidades e efeitos adversos, exponenciando ganhos em saúde.
