Activity Report - Hospital da Luz · 2019. 11. 18. · Luz Saúde. These courses are certified by DGERT. Cardiopulmonary resuscitation courses We offer a variety of cardiopulmonary

Activity Report2 0 1 8 | 2 0 1 9

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WHERE ITALL STARTS

3

Health is all about the people.

Beyond the glittering surface of modern technology, the core space of every health system is occupied by the

unique encounter between one set of people who need

services and another who have been entrusted to

deliver them.

by Frenk, Chen and Bhutta, The Lancet, 2010

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Amazing evolution with great impact

Medicine has witnessed a remarkable evolution in all areas: in diagnosis, with increasingly less invasive methods and technologies allowing greater resolution in observation of anatomical and functional structures and the quantification of relevant biomarkers; in surgery, with progressively less invasive techniques, robotic surgery, and nanobots; in tissue engineering and regenerative medicine, with better designed prostheses linked to brain activity, artificial skin and other tissue and organ regeneration techniques and 3D bioprinting; precision medicine, with genetic editing techniques, individualized therapeutics and immunotherapy; digitization, with telemedicine, sensors, wearable and mobile applications that allow remote monitoring of diseases and quantification of physiological variables.

As a result, each of us in the developed world benefits from improved access to a more advanced medical care, and, on average, can expect to live a longer life.

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Health care unique challenges

Nevertheless, while we are still struggling to bring every corner of the world to achieve similar standards

of care, population ageing is leading to a significant increase in chronic diseases with high impact

in the quality of life of patients who need to be monitored on an ongoing basis. Even in developed

countries a flat world and science skepticism have been contributing to the reappearance of

infectious diseases that we thought long gone. At the same time, antibiotic resistance is growing in

ways that seem to defy evolutionary theories, and compounding all this with climate change effects,

the final picture is quite challenging.

The complexity of health care is also increasing, not only because of ageing, age-related diseases and

multi-morbidity, but also because of the enormous evolution and proliferation of diagnostic methods

and the myriads of new treatments with more precise indications. Consequently, clinical pathways in hospitals are increasingly complex and managed by multidisciplinary teams, making communication

and cooperation essential to the quality of care provided.

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Value-based health care

Complexity often leads to variation in clinical practice, one of the biggest challenges healthcare organizations need to overcome in order to improve outcomes. Reducing clinical variation means delivering the right care in the right venue at the right time and at the right costs.

To achieve this, health care has been moving toward value-based models. The ultimate goal of these models is to increase patient value by providing a truly patient centered care. The implementation of value-based health care models implies redesigning the value chain, in order to provide evidence-based care, improve care coordination, align incentives and contain costs.

Hospital da Luz Learning Health plays a central role in this implementation because, ultimately, the evolution toward a patient-centered model will depend on training, research and innovation.

The Value agendaThe strategic agenda for moving to a high-value health care delivery system

has six components. They are interdependent and mutualy reinforcing. Progress will be greatest if multiple components advance together.

1Organize into

Integrated Practice Units

6Build an enabling information technology platform

2Measure outcomesand costs for every

patient

5Expand excellentservices across

geography

3Move to bundled

payments forcare cycles

4Integrate care delivery

across separatefacilities

Source: M.E. Porter et al. The Strategy that will fix health care. Harvard Business Review 2013

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True essence of medicine

Despite all breakthroughs and challenges, the true essence of medicine remains the same: to provide

the best patient care.

In a world full of singularities, where the spread of information and adoption of innovation is exponential, only the organizations with the

best professionals can keep up with the pace of technology without compromising clinical

excellence. Those organizations are responsible for dreaming and shaping the future with training,

research and innovation, improving value for patients.

Sir William Osler teaching Medical Residents(info copyrights)

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OUR VISION

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The birth of Hospital da Luz Learning Health

Established in 2000, Luz Saúde is one of the largest health care groups in the Portuguese market. Its

network is composed by 14 private hospitals, 1 Public-Private Partnership Program, 13 private

outpatient clinics and 2 senior residences located in mainland Portugal and Madeira Island. The group

aims at achieving the best health outcomes from the perspective of patients through rapid and

effective diagnosis and treatment, with absolute respect for the patients’ individuality, and to build an

organization capable of attracting, developing and retaining exceptional people.

With a high commitment to excellence in health care, technology and innovation, talent and training,

the group is widely known by its technological portfolio and by being an early adopter of several

innovations (e.g. in 2010 the first Da Vinci robot was installed in Portugal, the constant introduction of

cutting edge imaging instruments and techniques in clinical routine, among others). In order to move

forward, from early adopter to developer, and further materialize Luz Saúde mission and vision, Hospital da Luz Learning Health was born in September of 2015.

LUZ SAÚDE EXECUTIVE COMMITTEE

CORPORATE PARTNERS

ACADEMIA AND RESEARCH

INSTITUTES

LUZ SAÚDEEDUCATION

AND TRAINING COMMITTEE

LUZ SAÚDECLINICAL

RESEARCH COMMITTEE

LUZ SAÚDEDATA SCIENCE & ADVANCED

ANALYTICS GROUP

RESEARCH

TRAINING

NHS AND OTHERS PRIVATE

HOSPITALS AND CLINICS

NATIONAL AND

INTERNATIONAL HEALTH

PROFESSIONALS

PATIENTS/CLIENTS

HOSPITAL DA LUZ NETWORKAND HBA

INNOVATION

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RESEARCH

Our strategyFirst and foremost, people are the fabric of health care.To advance health care we need to prepare our people to deliver the best value and thrive through the challenges ahead. Therefore, Hospital da Luz Learning Health aims at transforming from individuals to teams, integrate talent with technology and foster creativity and positive attitude toward change.

Through these pillars we will empower our professionals to be up-to-date on cutting- edge knowledge, enable new practices and methodologies, redesign processes, facilitate adoption of new technologies or create new products and services.

Our work is built around three pillars, training, research and innovation, supported by a cutting-edge medical simulation center.

SIMULATION

TRAINING INNOVATION

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TrainingLifelong learning is crucial to achieve high levels of performance and clinical excellence. At Hospital da Luz Learning Health we plan, develop and evaluate training and simulation programs for professionals working in health care – inside and outside the Luz Saúde Group – that optimize learning and maximize transference to daily work activity. We offer a wide spectrum of learning and training opportunities, from scientific events to advanced simulation training courses, addressing different competency levels in a dynamic and safe environment.

ResearchConstant questioning existing knowledge and practices is critical to move medicine forward. At Hospital da Luz Learning Health we develop, promote and support research that adds value to patients. Based on a strong component of advanced analytics methods and human factors engineering, we aim to maximize value for patients by addressing challenges in clinical research, operations, clinical practice and patient experience.

InnovationAs the innovation gateway for Luz Saúde, innovation is in our DNA. At Hospital da Luz Learning Health, we develop, promote and support an open innovation environment, providing the necessary resources for the creation of new products and services, from idea conception, prototyping and piloting, to market positioning.

Our vision is to become an international reference in advanced training, research and innovation in

health care, by promoting the creation and dissemination of knowledge,

technologies and advanced practices, positively impacting care quality

and value for patients.

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OUR BUILDING BLOCKS

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Promote continuous measurement of impact of training, research and innovation initiatives

In order to fully realize our vision, we operate along seven dimensions:

Develop fluid training paths for all staff categories, including technical skills and human factors

Enable the development of teaching hospitals, leveraging on our expertise and talent

Use and abuse of simulation training to reach high levels of learning efficacy

Promote research that matters to patients to become a reference research center

Go digital and mobile in order to optimize learning opportunities

Foster innovation by inspiring internal creativity and developing external networks

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Develop fluid training paths

Lifelong learning promotes career progression, high levels of performance and clinical excellence. In a

clinical environment it is essential to train all types of professionals in a wide range of subjects, ranging

from technical skills, human factors, critical thinking, creativity, scientific method, among others. We are

developing fluid training paths for all professionals working at Luz Saúde, from medical doctors to

customer service technicians.

Wherever possible, we ensure quality training through a wide range of certifications for students

and teachers.

Additionally, it is critical to evaluate training at various levels, from learner satisfaction, level of learning

achieved and transference to practice, and impact on outcomes.

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#highlights

In parallel to the definition of the training paths, we have been developing individual courses or programs, aimed at health care professionals, that fit within these paths.

Ser Estrela programOne of the courses developed in this context is “Ser Estrela - Service Excellence and Conflict and Stress Management”, a course dedicated to customer service technicians, from front office and contact center, to customer service managers. The purpose of this course is to empower our employees with the tools to achieve excellence in service and a better customer experience.

With the 1st edition held in March 2018, by the end of June 2019 over 80 courses were conducted and attended by over 900 employees throughout Luz Saúde. These courses are certified by DGERT.

Cardiopulmonary resuscitation coursesWe offer a variety of cardiopulmonary resuscitation courses certified by the

Conselho Português de Ressuscitação (CPR) and the European Resuscitation Council (ERC), from basic to advanced courses, for adult and pediatric

specialists. Specifically, we offer Basic Life Support and External Automatic Defibrillation (BLS / AED); Immediate Life Support (ILS); Immediate Pediatric

Life Support (EPILS); and Advanced Adult Life Support (ALS).

From January 2018 until the end of June 2019, we conducted over 110 courses and trained over 1,600 health care professionals, primarily nurses and

physicians.

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TeAM coursesTeAM courses, where TeAM stands for Theory

Applied to Medicine, were developed by two physicians (Daniel Ferreira and José Ferreira Santos) to bridge the gap between new medical knowledge

and clinical practice. These courses are of interest to medical professionals, interns or specialists. In a

clinical simulation environment, students discuss the best diagnostic and treatment strategies, and

strengthen their ability to address major acute and chronic diseases.

Each TeAM course template is developed by a small core of physicians with recognized experience in the field concerned and who ensure continuous review and updating of the course’s pedagogical content.

There are currently 7 types of TeAM courses available:

Oral Anticoagulation, Heart Failure, Acute Coronary Syndromes, Chronic Obstructive Pulmonary Disease,

Venous Thromboembolism, Diabetes and Asthma.

From the beginning of TeAM courses in 2016 until the end of June 2019, we conducted 259 courses

and trained over 4.300 medical doctors, both interns and specialists across many medical specialities,

in particular Internal Medicine, Cardiology, Endocrinology, Pneumology and General

and Family Medicine.

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Hospital da Luz Learning Health Gynecological Endoscopy CenterHospital da Luz Learning Health is the 2nd center in Portugal to achieve certification in Gynecological Endoscopy. We are therefore able to carry out the Gynecological Endoscopic Surgical Education and Assessment (GESEA) program. The GESEA Program is aimed at interns and specialists in Gynecology and was created through a partnership between the European Academy of Gynecological Surgery and the European Society of Gynecological Endoscopy. The GESEA Program is based on the idea that doctors should train and evaluate their psychomotor skills for endoscopy in a simulation center before working with patients in the operating room. This is the best way to ensure that the surgeon has the knowledge necessary for a clinical practice that provides the best quality assurance. Trainees can practice various exercises over and over, and their competencies are objectively measured through a variety of evaluation criteria.

From January 2018 through the end of June 2019, we conducted 10 courses and trained 26 gynecologists.

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ERAS® programERAS® - Enhanced Recovery After Surgery is a

multidisciplinary, evidence-based, patient-centered training program. The goal is to reduce complications

and improve surgical recovery.

The Hospital Beatriz Ângelo, run by Luz Saúde Group, started this program in all patients proposed

for elective colorectal surgery in January 2017. For a while it was the only hospital in the country to

do so. After specific training, the hospital received the International certification as ERAS® Center of

Excellence; and the recognition by the ERAS® Society as responsible for the dissemination and training of

other national hospitals.

Hospital da Luz Learning Health developed, in collaboration with Hospital Beatriz Ângelo, a specific

training program for national hospitals that wish to implement this certification. The core trainers

received specific training, being highly qualified professionals for the development of these topics.

From October 2017 through the end of June 2019, four other Portuguese hospitals were trained

in the ERAS program.

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School of study coordinatorsWe have partnered with W4Research, a Clinical Research Organization with extensive experience in clinical trials, to design a course for individuals who wish to work in the field of clinical research, particularly in coordinating clinical trials in the hospital context. The course consists of research modules, communication modules and management, decision and emotional intelligence modules, and involves a 3-month internship at one of the partner hospitals.

Starting in April 2018, we have held two editions of the school and trained 27 individuals.

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Human factors trainingThe progressive complexity of health care

- increasingly dependent on broader clinical teams that must work in a coordinated and effective way - requires training in human factors considered to

be core to good care practices. A user-centered perspective is essential, considering the physical,

cognitive and organizational variables, to improve the interactions of the different elements that make up

the entire socio-technical system, namely: patients, professionals, tasks, equipment and technologies,

physical and environmental involvement, and organization.

To start preparing professionals to be able to improve their personal and interpersonal skills, we have partnered with Go Coaching, a company that specializes in personal skills training workshops, to

develop a variety of courses aimed specifically at health care professionals, for example: Leadership,

Emotional Intelligence, Change Management, Unstress, Client-Centered Practice, Mindfulness, Communication and Agile Methodology, among

others.

We have trained 78 health care professionals since this partnership began in July 2018.

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Train-the-trainersA key step in the development of high-quality

training opportunities is a solid training pathway for instructors. At Hospital da Luz Learning Health,

we leverage Luz Saúde’s talented professionals to develop teams of excellent instructors. To this end, train-the-trainers programs were developed

and implemented, for example, initial pedagogical training program, instructor training in health care

simulation, Ser Estrela instructor program, among others.

We currently have more than 150 trained instructors, ranging from health care simulation to customer

service excellence.

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Other certified coursesWhenever possible our courses are certified by independent entities, ensuring excellence in training.

GESEAS

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Use and abuse of simulation training

Health care simulation is currently the gold standard for training health care students, professionals and

teams. It effectively promotes the dissemination of good practices and optimization of clinical

performance and promotes the incorporation of technological innovation in clinical practice, without

risks to either patients or professionals.

At Hospital da Luz Learning Health, health care professionals have access to a cutting-edge

simulation center for practical training. Within the largest clinical simulation center in Portugal, we

intend to cater to the training needs of the various medical specialties, nursing and other professional

groups in the health care sector, offering a wide range of training opportunities. We also provide support in designing, developing, delivering and

evaluating simulation programs.

The simulation center also provides an unique setting to develop research projects in many service areas, as well as a safe environment to develop and

test innovative products and services.

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#highlights

Simulation CenterThe Simulation Center serves health care students, residents, professionals and staff across the Luz Saúde Group in a 13,000 square foot facility and through “in-situ” simulation within selected clinical areas. The simulation center facility has 12 simulation rooms and 4 debriefing rooms plus an inventory of cutting-edge technology, 14 high fidelity simulators of all ages, from newborn to adult, dozens of advanced task trainers, several virtual reality trainers and audio-visual recording capabilities to enhance debriefing and facilitate reflective learning. The activities held at the Simulation Center use programmed scenarios that cover individuals and teams training needs, throughout the continuum of care, developed by our experts in conjunction with content specialists, to promote standardization of the simulation experience among different groups of learners.

In order to build the simulation center, we secured substantial funding through the Portugal 2020 Incentive System. For a total eligible investment of EUR 2,797,232.50, we received financial support of EUR 1,118,893.00.

Simulation coursesWe have already established unique courses to enhance the skills of health care professionals, for instance, Ophthalmologic Surgery Simulation courses, focused on cataract surgery and vitreoretinal surgery, Postpartum Hemorrhage Simulation courses, Ultrasound-Guided Vascular Access and Ultrasound-Guided Regional Anesthesia courses and Advanced Laparoscopic Suturing courses, among others.

Some available simulatorsPediatric HAL

World’s most advanced pediatric patient simulator, Pediatric HAL has unique features such as the ability to direct the eye and express realistic emotions

through facial expressions, movement and speech. It simulates various disease conditions and supports the practice of multiple clinical cases and

advanced techniques using real monitors and sensors.

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SimMan 3G ASL 5000™

This simulator allows for advanced individual and multidisciplinary team training in complex scenarios. It automatically recognizes drugs, has pupillary reflex and allows to practice various techniques in critical situations. It breathes spontaneously and can be connected to a ventilator through the ASL 5000™ lung. SimMan enhances clinical practice in anesthesia, intensive care, emergency medicine, pulmonology and respiratory care. Resistance and compliance are meticulously adjustable, allowing to simulate a wide range of disease conditions, with real chest expansion.

BodyWorks Eve and HeartWorks TEE & TTE

The new BodyWorks Eve is an ultra-realistic female patient simulator designed for interactive Point of Care Ultrasound (PoCUS) scenario training. Complete

with 100 real patient scans and over 10,000 pathology variations across cardiac, lung, transabdominal and pelvic ultrasound, BodyWorks Eve is designed to meet

the training needs in emergency medicine and critical care. HeartWorks TEE & TTE functionality includes a comprehensive education in cardiac anatomy, echocardiography and lung ultrasound. It integrates an anatomically correct,

virtual, beating 3D heart. Realistic doppler functions for quantitative assessment are available with pulsed and continuous wave doppler information can be

obtained from any intra-cardiac region.

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Go digital and mobile

Nowadays it is possible to learn anytime, anywhere. Framed in the digital age, Hospital da Luz Learning Health aims to have a strong presence in distance

learning and online education, promoting the necessary flexibility to lifelong learning. Our digital ecosystem enables synchronous or asynchronous

distance learning, simulation of clinical cases, measurement of impact on clinical practice,

training management, active participation in on-site training, among other tools. In addition, we also

offer consultancy services for the development of multimedia training content.

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#highlights

E-learning coursesWe have been developing large scale online courses to cater to the needs of Luz Saúde group. Our largest course so far was about the General Data Protection Regulation and its implications in health care, and we trained over 8000 professionals in less than 2 months.

UpSimWe are greatly invested in the development of online

clinical simulation cases, using a platform called UpSim that promotes learning and adoption of

clinical guidelines and trains decision making.

Blended learningWe have just launched an online course on infection

control and antibiotic resistance integrating e-learning and UpSim. We will also add simulation

components soon, moving toward blended learning formats.

Promote development of teaching hospitals

Evidence-based health care can only be built outside the walls of research labs with real-world data and practice. The knowledge generated and applied in a clinical practice of excellence must be disseminated so that the entire community can benefit from improved patient outcomes.

Leveraging on the clinical excellence of Luz Saúde group, our goal is to transform the Hospital da Luz units into a network of teaching hospitals, addressing the training needs felt by health professionals, both clinical and non-clinical, throughout their careers.

Therefore, at Hospital da Luz Learning Health we have been implementing several scientific and training events, in partnership with Luz Saúde professionals.

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#highlights

Excellence in undergraduate education and trainingThe hospitals of Luz Saúde group are systematically sought out by students from several schools for curricular internships. Although most students are from medical and nursing schools, with more than 380 students rotating each year in our main units, we also receive students from other areas, such as Pharmacy; Clinical Psychology; Nutrition Sciences; Physiotherapy, Imaging, Pathological Anatomy and Cardiopneumology technicals degrees; several Engineering areas, for example, Biomedical Engineering; and Business.

Our medical students typically study at Nova Medical School, Faculty of Medicine of the University of Lisbon, or Algarve University. In fact, Hospital Beatriz Ângelo is responsible for the training of the 6th year of the undergraduate degree of Nova Medical School, and the 6th year surgical module at the same school, currently enrolling 248 students (144 doing their training in this unit, 56 at Hospital da Luz Lisboa, 48 elsewhere).

All in all, we have about 590 students doing part of their studies at our two

main hospitals every year.

Medical students Nursing students Other students

DISTRIBUTION OF STUDENTS PER UNDERGRADUATE DEGREE IN 2018/2019

56

71 76

132

111

144

2

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Cutting-edge graduate and post-graduate trainingThe hospitals of the Luz Saúde group are systematically chosen by medical students with the highest grades of access to the medical specialty, which attests to the tremendous quality of teaching and the excellence of the medicine performed.

Hospital da Luz Lisboa has been the first choice of candidates for internships in Internal Medicine, Pathological Anatomy and Nuclear Medicine. Hospital Beatriz Ângelo has also been the first choice of candidates for specific training in Gastroenterology, Pulmonology, Obstetrics/Gynecology, Medical Oncology, Pediatrics and Internal Medicine, among other specialties.

In total, there are 71 medical doctors doing the foundation year at Luz Saúde group, as well as 135 medical doctors doing specific training.

Hospital da Luz Lisboa

Hospital Beatriz Ângelo

Hospital da Luz Arrábida

NUMBER OF INTERNS AND SPECIALTIES RECOGNIZED BY THE PORTUGUESE MEDICAL ASSOCIATION IN 2018/2019

Number of medical doctors doing Foundation Year

33 38 0

Number of medical doctors doing Specific Training

34 98 3

Number of medical specialties recognized by the Portuguese Medical Association

6 18 1

Medical specialties recognized by the Portuguese Medical Association

Anesthesiology

Internal Medicine

Medical Oncology

Neurology

Nuclear Medicine

Pathological Anatomy

Anesthesiology

Endocrinology

Gastroenterology

General Surgery

Obstetrics/Gynecology

Infectious Disease

Internal Medicine

Medical Oncology

Nephrology

Neurology

Neuroradiology

Ophthalmology

Orthopedics

Otorhinolaryngology

Pathological Anatomy

Pediatrics

Pulmonology

Psychiatry

Radiology

Rheumatology

Urology

Internal Medicine

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In 2018/2019, we also accepted 284 medical doctors in training at other hospitals, either doing their residency in Primary Care (169) or other specialties (115), for specific internships at Hospital Beatriz Ângelo, as well as 19 medical doctors doing a master in nursing at the same hospital.

In addition there are many professionals doing their postgraduate studies while working in our group:

• 70 nurses in specialty training at HBA and 45 at Hospital da Luz Lisboa

• More than 46 professionals enrolled in PhD studies: at least 36 medical doctors and 7 nurses

Finally, we already employ at least 45 professionals with a PhD degree, most of them medical doctors (39) and engineers (4).

All in all, we have over 660 postgraduate students employed by, or doing part of

their studies, at Luz Saúde group.

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More and better eventsYear after year we have been developing more and more scientific and training events, consistently more sought after and better evaluated by health care professionals.

Number of events

Number of participants

Number of learning hours

Course satisfaction (0 to 5)

2017 2019 (until end of June)

2018

239

6.746Over 56.000

3.9 / 5.0

299

7.517Over 50.000

4.4 / 5.0

189

4.457Over 34.000

4.4 / 5.0

Only 6

months

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Leaping ForwardOne of the largest international clinical events that Hospital da Luz Learning Health organizes is the Leaping Forward. The Leaping Forward series is the ideal forum for Portuguese experts to share knowledge and experiences in various clinical areas of interest, in intensive interaction with the international medical and scientific community of reference.

The last edition of the series was the Leaping Forward Oncology, that took place from 9 to 13 May 2017, at Centro Cultural de Belém in Lisbon. Leaping Forward Oncology counted with the participation of many of the most renowned world experts in the field, who debated the latest and more innovative topics in oncology over 20 sessions: gastrointestinal malignant neoplasms, lung cancer, breast cancer, urologic tumors, gynecologic tumors, central nervous system cancer, and blood cancer; transversal topics, such as immunotherapy, palliative care, nutrition and nursing in oncology; advanced techniques, such as robotic surgery, interventional radiology, and endoscopy. Simulation sessions and a special session dedicated to ERAS® program (Enhanced recovery after surgery) complemented the agenda.

1.800 participants

239 speakers and moderators

35 sponsors

20 news and posts in social media

4 out 5 stars rating

140 internationals

21 Scientific societies

> 5.000 likes in social media

> 280

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Médicos AssociadosMédicos Associados is a referral program for external physicians that provides different channels – phone, mail or digital platform - to enable fast and secure access to Hospital da Luz physicians and network. Médicos Associados team is composed by a clinician and an operations manager, in every unit, that ensure quick triage and response and, if needed, recommend - according to patients’ clinical situation - the best Hospital da Luz physician to receive referrals / patients. To promote the program, we organize free monthly clinical training sessions: Encontros na Luz. We choose interesting topics to the Primary Care community and invite them to join an Hospital da Luz multidisciplinary team to discuss clinical cases.

Link de inscrição:

ttps //learning ealt up events/e/ma- ospitaldaluzguimaraes-1 out

Inscrição obrigatória gratuita

Palestra tesFau to Fernande l torri olari olo iaPedro e e a l eurolo ia

2 h

2 h

ENCONTROS NA U Médicos Associados22 de ovem ro de 201 Auditório Hospital da Luz uimar es

SÍNDROMA VERTIGINOSO - Avaliação primária

ENCONTROS NA LUZ

11 de outu ro de 201Hotel lia ia

ttps //learning ealt up events/e/morte-subita-como-prevenir-na-atualidade

Apoio

Palestra te | Cardiologista | Hospital da Luz Clínica de Oiã

ENCONTROS NA U

2 de maio de 2019 Auditório do Hospital da Luz Lisboa

ENCONTROS NA U

2 de maio de 2019 Auditório do Hospital da Luz Lisboa

ENCONTROS NA U Médicos Associados2 de ovem ro de 201 Auditório do Hospital da Luz Oeiras


ttps //learning ealt up events/e/ma- ospitaldaluzoeiras- 7nov


na antessala do auditório às 20h00

| Coordenadora da Equipa de Pneumologia do Hospital da Luz Oeiras

| Coordenadora da Equipa de ORL do Hospital da Luz Oeiras

| Coordenadora Clínica da Equipa de M dicos Associados | Hospital da Luz Oeiras

- Conceitos clínicos- Exame físico- Exames Auxiliares de Diagnóstico / Polisonografia- Abordagem terapêutica

- Medidas gerais e CIPAP- Situações com indicação cirúrgica

- Referenciação à consulta de especialidade- Apresentação de 1 caso clínico para discussão interativa- Take home message

MÉDICOS ASSOCIADOS de 201 | 20h30

Auditório do Hospital Beatriz Ângelo

ENCONTROS NOHOSPITAL BEATRIZ ÂNGELO

S S












ENCONTROS NA LUZ Médicos Associados

de mar o de Auditório do Hospital da Luz l i a da Amadora

REA I ITA O CAR IORRESPIRATÓRIAporqu , como e para quem

ENCONTROS NA LUZ Médicos Associados

de mar o de Auditório do Hospital da Luz l i a da Amadora

REA I ITA O CAR IORRESPIRATÓRIAporqu , como e para quem












ENCONTROS NA LUZ Médicos Associados 20 de fevereiro de 2019

Auditório do Hospital da Luz Póvoa de Varzim (piso 2)

PROVAS FUNCIONAIS RESPIRATÓRIASO que pedir, como interpretar

ENCONTROS NA LUZ Médicos Associados 20 de fevereiro de 2019

Auditório do Hospital da Luz Póvoa de Varzim (piso 2)

PROVAS FUNCIONAIS RESPIRATÓRIASO que pedir, como interpretar

35

Promote research that matters for patients

The development of basic, translational and clinical research is critical in improving health care. At

Hospital da Luz Learning Health we support and develop research in three main areas: clinical

research, clinical practice and patient experience, and operations.

We function as a link between hospitals and academia, promoting brainstorming

opportunities, joint projects and R&I partnerships in our areas of interest.

• Improve prevention and early diagnosis• Develop personalized / precision medicine• Develop clinical pathways and outcomes research• Promote innovation in health technologies

• Increase the quality of the doctor-patient relationship

• Reduce workload of health professionals

• Improve patient experience

• lncrease hospital efficiency• Anticipate problems /

implement alerts• Automate procedures

Clinical research

Value forPatient Clinical

practice &Patient

experienceOperations

Research processWe provide research support in studies initiated by the researcher or sponsored by the industry. Services offered cover all phases of research, from applying to external funding to managing grants, designing studies and protocols, contacting with regulatory authorities, monitoring and coordinating studies, conducting statistical analysis, among others.

Hospital da Luz Learning Health is currently developing business intelligence tools to track study submission and subsequent implementation. These tools will help us expedite the process and better identify bottlenecks and needs.

We have also developed a Researcher Guide to help researchers in developing and conducting clinical research. Chapters include: Clinical research definition, Development of a research project, Types of studies, Phases of clinical trials, Classification of medical devices, GDPR, Funding, Publications, Hospital da Luz Learning Health submission process and services offered.

Every clinical trial or clinical study submitted follows a standard process

Online submission

Clinical Research

Committee

Competent Ethics

Committee

Data Protection

Impact Assessment

(DPIA)

Executive Committee

Annual review

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Clinical trialsWe have a core team of study coordinators that manage clinical trials and studies from start to finish, in close coordination with the research team and the sponsor, and are an invaluable resource for patients in trials.

In addition to background training in related areas, all study coordinators have completed the ICH Good Clinical Practices E6(R2) and IATA certification for handling and shipping infectious and biological substances and related hazards, and have solid experience in various clinical trial plataforms such as: INFORM, Medidata / Rave, Oracle, RDC, ALMAC, Cenduit, Perceptive, S-clinic, etc. We have a senior team of study coordinators, on average with over 4 years of experience, and two junior study coordinators.

We have dedicated investigators, nurses and pharmacists per therapeutic area, also with ICH Good Clinical Practices E6(R2) certification, and all pathology lab technicians have also completed IATA training.

At Hospital da Luz Lisboa and Hospital Beatriz Ângelo we have a dedicated pharmacy room for IMP storage with temperature control and monitoring, a dedicated fridge for cold medication, also with temperature control and monitoring, an ambient and refrigerated laboratory centrifuge and a dedicated -20º and -80º freezer with temperature control and monitoring. We also have a dedicated archival storage room for clinical trials documents.

At the new center at Hospital da Luz Lisboa, we have additional dedicated facilities, including two monitoring

rooms for sponsors and a consultation room exclusively for clinical trial patients.

Finally, at each site we have easy and fast access to cutting edge diagnostic imaging equipments, such as CT scans,

MRI (1,5T and 3T), Bone Scans and PET Scans.

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In terms of methodologies, at Hospital da Luz Learning Health we have been exploring two main

areas described next.

Engineering and data scienceIn a digital world with large amounts of data, information-driven methodologies are crucial to achieving a sustainable health sector. Our goal is to fully understand data, from the original signal source to predictive / prescriptive models, in order to develop actionable value-added tools for providers and patients.

Human factors engineeringAt Luz Saúde, human factors engineering has focused primarily on the topic of operational communication, both between health professionals and between them and patients, during care delivery. Methodologies have been developed and applied to evaluate, map and structure the communication network, in order to optimize the effectiveness and efficiency of the processes, safety and patient experience.

38

39

#highlights

Program-oriented fundingLeveraging the Luz Saúde network, Hospital da Luz Learning Health has created program-oriented funding to support research activities. Framed in well-defined clinical research programs, this initial funding aims to promote research that improves value for patients, in collaboration with partners of excellence and increasingly supported through external funding.

SIFIDE qualification for R&IBased on our experience in research and value-added services, Hospital da Luz Learning Health is currently in the process of obtaining SIFIDE qualification for research and development activities.

Partnering with AcademiaWe have been partnering with leading universities in Portugal to solve complex health care problems and create value. With Instituto Superior Técnico, we have partnered in several projects funded by the National Science Foundation, applying advanced methodologies to health care challenges and participating in the oversight of several master students. In total, from 2018 onwards, we have supervised 12 master students from Instituto Superior Técnico, Catholic University, Faculty of Sciences of the University of Lisbon,

Faculty of Science and Technology of the NOVA University of Lisbon, among others. This close collaboration with leading universities has also enabled the co-creation of

training courses to address emerging challenges, such as the “Artificial Intelligence and Health Data Science” course

promoted with Tecnico +.

40

Number and complexity of clinical trials is increasingClinical research activity has been steadily increasing at the main hospitals of the Luz Saúde group. The main numbers for Hospital da Luz Lisboa, Hospital da Luz Arrábida and Hospital Beatriz Ângelo are as follows:

Average enrollment rates in clinical trials at the two main hospitals in the group are equal to 62% at Hospital da Luz

Lisboa and 69% at Hospital Beatriz Ângelo. However, in both cases, patient screening efforts are much higher, with

average screening rates of 97% at Hospital da Luz Lisboa and 130% at Hospital Beatriz Ângelo.

Year after year, we have seen a steady increase in the number of active trials, with a large increase about to be registered

in 2019, as shown below.

NUMBER OF ACTIVE CLINICAL TRIALS PER YEAR

CLINICAL TRIALS OVERALL ACTIVITY

2011 (Year of first trial)



Number of trials(until end of June 2019) Hospital da Luz network

Number of enrolled patients(until end of June 2019) Hospital Beatriz Ângelo

79

44

28

231

161

2013 2015 2017 2019 (until end of June)

2014 2016 2018

15

2024

31

35

40 39

2

811

18

25

2832

Only 6

months

41

Most clinical trials have been phase 2 and phase 3. In 2019, we had the first phase 1 clinical trial approved at Hospital Beatriz Ângelo and have two phase 1 trial about to start at Hospital da Luz Lisboa.

While the majority of clinical trials have been in Oncology, other therapeutic areas have been growing in the number

of clinical trials, such as Gastroenterology, Neurology, Internal Medicine, Endocrinology, Nephrology,

Cardiology and Pneumology.

Also noteworthy are three researcher-initiated clinical trials developed at Luz Saúde, in the areas of Oncology and Precision Medicine.

-

1

-

14

10

-

58

Oncology 35 14 -

Neurology 6 11 -

Internal Medicine 15 1 -

Gastroenterology 8 6 -

Endocrinology 7 1 1

Nephrology - 8 -

Pneumology 3 3 -

Cardiology 3 - -

Gynecology 1 1 -

Oftalmology 1 - -

Rheumatology - 1 -

Infectiology - 1 -

Intensive Medicine - 1 -

Allergology - - 1

34

2

7

3

-

Phase 1 Phase 2 Phase 3 Phase 4

35

6

15

8

7

-

3

3

1

1

-

-

-

-

14

11

1

6

1

8

3

-

1

-

1

1

1

-

-

-

-

-

1

-

-

-

-

-

-

-

-

1

Hospital da Luz Lisboa

Hospital Beatriz Ângelo

Hospital da Luz Arrábida

NUMBER OF CLINICAL TRIALS PER PHASE AT EACH SITE NUMBER OF CLINICAL TRIALS PER THERAPEUTIC AREA AT EACH SITE

Note: Clinical trials classification based on PI speciality

42

Research studies with external fundingHospital da Luz Learning Health has been actively pursuing external funding opportunities, with numerous applications to FCT, P2020, H2020, etc.

Currently, Hospital da Luz Learning Health is an active partner in several scientific projects funded by the National Science Foundation (FCT):

• Multimodal neuroimaging biomarkers throughout the migraine cycle: towards neurofeedback training for personalized anti-migraine treatment, lead by IST (LISBOA-01-0145-FEDER-029675);

Number of clinical studies also increasingThe number of new clinical studies has been steadily increasing at Luz Saúde.

Hospital da Luz Lisboa Hospital Beatriz Ângelo Other hospitals in the network

2017 2018 2019 (until end of June)

24

33

38

43

39

24

n/a n/a

6

Only 6

months

NUMBER OF NEW CLINICAL STUDIES

Hospital Beatriz ÂngeloHospital da Luz Network

2014 2015 2016 2017 2018 2019(until end of June)

3641

48

60

96

75

25 22 19

44

5654

Only 6

months

NUMBER OF INDEXED PUBLICATIONS IN PUBMED

• Myocardium T1 Quantification in Atrial Fibrillation Patients Enabled by Highly Accelerated Acquisitions and Robust Motion Correction,

lead by IST (LISBOA-01-0145-FEDER-029686);

• Revolutionizing Healthcare: Empowering patients by valuing innovation and promoting entrepreneurship, lead by Catholic University

(PTDC/EGE-OGE/32573/2017).

Increased scientific productivityA steady increase in the number of indexed publications has been observed,

with Luz Saúde professionals becoming increasingly active researchers. A complete list of indexed publications can be found in the annex of this report.

43

Inspire innovation

We believe that everyone can create innovative solutions. Halfway between a concept incubator and a living lab, with a unique infrastructure in Portugal consisting of a medical innovation and simulation laboratory, we enable and promote testing and prototyping of ideas in a safe environment to make them come true, with positive impact on patients. With an active role in internal and external innovation, we are responsible for stimulating and developing Luz Saúde’s innovation culture.

43

44

#highlights

Prémio Luz InovaçãoTo foster internal innovation, we have organized the 1st edition of “Prémio Luz Inovação” where everyone in the organization could present their innovative ideas. This is a success story with 479 ideas submitted and 43 winners, whose ideas are being implemented in the context of Luz Saúde strategic projects.

Startup accelerators: Protechting and MAZE-X

We believe in an open innovation ecosystem. In this way, we collaborate with different startup accelerators, Protechting

and MAZE-X, to support new concepts and solutions that add value to patients. We collaborated with more than 15 startups for proof of concept and created protocols with four startups

to build evidence through large clinical studies.

45

Luz Saúde invested in UpHillIn 2019, Luz Saúde has invested for the first time in a startup. UpHill has been a long-term partner of Hospital da Luz Learning Health, and the impact of UpSim and other UpHill products, such as UpEvents, is enormous. We could not be more excited with this investment and all the doors it opens.

Health hackathonsHospital da Luz Learning Health organized a first Health

Hackathon where, for 24 hours, 50 college students worked hard to prototype an idea on how to empower patients

with chronic diseases. Luz Saúde employees participated as mentors to provide feedback and help participants with their

ideas. Winners will have the opportunity to develop their ideas in our Innovation Lab.

46

Promote continuous measurement of impact

Measuring the impact of training, research and innovation initiatives is critical to enable continuous

improvement. The results of these activities often occur over the long term, so it is crucial to develop

tools and metrics to accurately measure their impact.

47

Learning evaluation modelThe courses developed by Hospital da Luz Learning Health follow an evaluation process based on Kirkpatrick’s four levels of training evaluation (reaction, learning, behavior and results). By establishing concrete key performance indicators for each course, it is possible to measure the impact of training activities on learners satisfaction, learning efficacy, transference to practice and outcomes. Leveraging digital platforms such as UpSim, assessment can be done anywhere and with direct feedback to the trainee, accelerating the learning curve.

Advanced AnalyticsIn a connected system, such as the brain, networks play an important role in the generation and dissemination of knowledge and understanding their patterns is critical. At Hospital da Luz Learning Health, we explore network analysis and advanced analytical methodologies to find patterns that enable us to understand and measure the impact of training, research and innovation activities.

Clinical pathways complianceTo ensure the best patient care, Luz Saúde is implementing

value-based health care. This involves, among other processes, restructuring clinical pathways and measuring

clinical and patient relevant outcomes. This poses many challenges, from leveraging knowledge to clinical pathway

design to successful implementation, adoption, and control in everyday practice. Data is key in monitoring these tasks.

Using process mining methodologies in real world data, we are developing tools to assess compliance of the clinical

pathways followed against the defined models and to collect insights into variations to improve service delivery.

4848

WITH WHOM ARE WE PAVING THE WAY TO A

BRIGHT FUTURE

49

The challenges facing our health care system are increasingly complex as result of the rapid pace of technology and digitization. Consequently, ideas and insights from individuals are often insufficient to meet the challenges with significant impact. Today’s and tomorrow’s challenges require multidisciplinary team approaches to brainstorm ideas and solve problems, across organizations and boarders, to move health care forward.

In order to contribute to the knowledge ecosystem, we collaborate with leading universities, societies, companies and startups in order to address challenges and opportunities in health care. We work hard to create knowledge bridges between institutions to complement and strengthen training and research portfolios across the partner ecosystem, elevating the quality of results. In this way, we also contribute to an open innovation and open science environment.

If you want to go fast go alone. If you want to go far,

go together.

by Robin Jones Gunn

5050

WHO WE ARE

51

Risk more than others think is safe, care more than others think is wise, dream more than others think is practical, expect more than others think is possible.

by Claude T. Bissel

Transversal areas

Francisca LeiteDirector

PhD in Medical Engineering and Medical Physics

Mckinsey alumna

Leiza LopesAccounting and Finance Specialist

Degree in Accounting and Finance

Postgraduate in Accounting

Cátia Botelho CostaDeputy Director

of the Simulation Center

Degree in Nursing

Master of Health Management

Specialization in Biomedical Simulation

Bárbara SalgadoDeputy Director of Marketing

and Communication, Events and Partnerships

Degree in Business Management

Postgraduate Diploma in Quality Audit in Tourism, Hospitality and

Catering

Ana MoratoMarketing and Communication

Specialist

Degree in Educational Sciences

Mafalda França MartinsMarketing, Communication and Partnerships Specialist

MI Degree and Post Graduation in Marketing and Advertising

Brand Activation Specialization

Motivated, skilled and enthusiastic, we are a team that believes that positive changes in health care can be accelerated though training, research and innovation.

52

Célia Coelho PereiraTraining Coordinator

Degree in Public Administration Management

Postgraduate in New Technologies Management Human Resources

Cátia GuerreiroTraining Specialist

Degree in Educational Sciences

Master in Educational Administration

Elaine GonçalvesEvent and Resource Management

Coordinator

Professional training as Information Systems Technician and innovation

Ana Carvalho SantosEvent Manager

Degree in Social Communication

Postgraduate in Event Management

Catia Luisa Galvão SantosEvent Manager

Degree in Public Relations and Advertising

Daniela Sofia LopesEvent Manager

Degree in Journalism

José Armando MarquesEvent Manager

Bachelor of Business Administration

Transversal areas

Training

João Paulo BaptistaTraining Specialist

Degree in Human Resource Management

Master in Human Resources Management and Organizational

Consulting

Marisa MendesTraining Specialist

Degree in Human Resource Management

Master of Science in Human Resource Development Policies

53

Gonçalo LuísInnovation Coordinator

Integrated Master in Biomedical Engineering

We stand on the shoulders of Luz Saúde group whose unwavering

support is fundamental.

Research

Innovation

Sara MoreiraStudy Coordinator

Degree in Human and Health Biology

Master in Molecular Genetics and Biomedicine

Poison Biology Mini Course

Learning Health Study Coordinator Course

Sandra Cristina Lourenço Macedo

Study Coordinator

Master of Science in Biopharmaceutical Sciences

Sara PinheiroStudy Coordinator

Degree and Master in Biochemistry, Clinical Trials Coordination Course (EuroTrials)

Pedagogical Competence Certification

Medical Writting Experience

Susana CordeiroStudy Coordinator

Degree in pharmacy

Clinical Trials Monitoring Course (EuroTrials)

Carla Filipa RodriguesStudy Coordinator

Degree in Biomedical Sciences

Master in Pharmaceutical Biomedicine

Rita EçaResearch Coordinator

Degree in Clinical Psychology

Specialist degree in Health Psychology

“Online Training in Clinical Research in Professional Breast Cancer: Trial

Coordinator”

Nuno André da SilvaDeputy Director of Research

Post-graduation in Knowledge management and business intelligence

PhD in Biomedical Engineering

Vera Catarina VilarContract Manager

Degree in Sociology

Postgraduate Diploma in Statistical Treatment of Quantitative Health Data

Carlota LucenaStudy Coordinator

Master in Molecular Biology and Genetics

Filipa Sofia NunesStudy Coordinator

Integrated Master in Architecture

54

Annex

Hospital da Luz network indexed publications

[1] Costa Santos M, Cunha C, Velho S, Ferreira AO, Costa F, Ferreira R, Loureiro R, Santos AA, Maio R, Cravo M. Preoperative biliary drainage in patients performing pancreaticoduodenectomy: guidelines and real-life practice. Acta Gastroenterol Belg. 2019 Jul-Sep;82(3):389-395.

[2] Nunes G, Pinto-Marques P, Sequeira P, Mendonça E. Primary Extrarenal Renal Cell Carcinoma: A Unique Diagnosis Performed through Endoscopic Ultrasound. GE Port J Gastroenterol. 2019 Aug;26(5):378-380. doi: 10.1159/000496279.

[3] Oliveira R, Oliveira S. Letter to the Editor - Late-onset neuromyelitis optica associated with cryptogenic organizing pneumonia. Mult Scler Relat Disord. 2019 Sep 16;36:101398. doi: 10.1016/j.msard.2019.101398.

[4] Han D, Beecy A, Anchouche K, Gransar H, Dunham PC, Lee JH, Achenbach S, Al-Mallah MH, Andreini D, Berman DS, Bax JJ, Budoff MJ, Cademartiri F, Callister TQ, Chang HJ, Chinnaiyan K, Chow BJW, Cury RC, DeLago A, Feuchtner G, Hadamitzky M, Hausleiter J, et al. Risk Reclassification With Coronary Computed Tomography Angiography-Visualized Nonobstructive Coronary Artery Disease According to 2018 American College of Cardiology/American Heart Association Cholesterol Guidelines (from the Coronary Computed Tomography Angiography Evaluation for Clinical Outcomes.. Am J Cardiol. 2019 Aug 23. pii: S0002-9149(19)30876-8. doi: 10.1016/j.amjcard.2019.07.045.

[5] Teodoro T, Oliveira R, Afonso P. Atypical Lyme Neuroborreliosis, Guillain-Barré Syndrome or Conversion Disorder: Differential Diagnosis of Unusual Neurological Presentations. Case Rep Neurol. 2019 Apr 30;11(1):142-147. doi: 10.1159/000499901.

[6] Mendes L. Relieved by the alcohol. Rev Port Cardiol. 2019 Jul;38(7):481-483. doi: 10.1016/j.repc.2019.08.005.

[7] Alshahrani AM, Mahmood H, Wells GA, Hossain A, Rybicki FJ, Achenbach S, Al-Mallah MH, Andreini D, Bax JJ, Berman DS, Budoff MJ, Cademartiri F, Callister TQ, Chang HJ, Chinnaiyan K, Cury RC, DeLago A, Feuchtner G, Hadamitzky M, Hausleiter J, Kaufmann PA, Kim YJ, et al. Point of Care Clinical Risk Score to Improve the Negative Diagnostic Utility of an Agatston Score of Zero: Averting the Need for Coronary Computed Tomography Angiography. Circ Cardiovasc Imaging. 2019 Sep;12(9):e008737. doi: 10.1161/CIRCIMAGING.118.008737.

[8] Ferreira H, Smith AV, Vilaça J. Ghost ileostomy in anterior resection for bowel endometriosis: technical description. J Minim Invasive Gynecol. 2019 Sep 12. pii: S1553-4650(19)31180-X. doi: 10.1016/j.jmig.2019.09.769.

[9] Al'Aref SJ, Maliakal G, Singh G, van Rosendael AR, Ma X, Xu Z, Alawamlh OAH, Lee B, Pandey M, Achenbach S, Al-Mallah MH, Andreini D, Bax JJ, Berman DS, Budoff MJ, Cademartiri F, Callister TQ, Chang HJ, Chinnaiyan K, Chow BJW, Cury RC, DeLago A, et al. Machine learning of clinical variables and coronary artery calcium scoring for the prediction of obstructive coronary artery disease on coronary computed tomography angiography: analysis from the CONFIRM registry. Eur Heart J. 2019 Sep 12. pii: ehz565. doi: 10.1093/eurheartj/ehz565.

[10] Gil-Gouveia R, Martins IP. Cognition and Cognitive Impairment in Migraine. Curr Pain Headache Rep. 2019 Sep 11;23(11):84. doi: 10.1007/s11916-019-0824-7.

[11] Barra S, Narayanan K, Boveda S, Primo J, Gonçalves H, Baran J, Agarwal S, Marijon E, Providência R. Atrial Fibrillation Ablation and Reduction of Stroke Events: Understanding the Paradoxical Lack of Evidence. Stroke. 2019 Oct;50(10):2970-2976. doi: 10.1161/STROKEAHA.119.026890.

[12] Donal E, Delgado V, Bucciarelli-Ducci C, Galli E, Haugaa KH, Charron P, Voigt JU, Cardim N, Masci PG, Galderisi M, Gaemperli O, Gimelli A, Pinto YM, Lancellotti P, Habib G, Elliott P, Edvardsen T, Cosyns B, Popescu BA; 2016–18 EACVI Scientific Documents Committee. Multimodality imaging in the diagnosis, risk stratification, and management of patients with dilated cardiomyopathies: an expert consensus document from the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2019 Oct 1;20(10):1075-1093. doi: 10.1093/ehjci/jez178.

[13] Boveda S, Garcia R, Defaye P, Piot O, Narayanan K, Barra S, Gras D, Providencia R, Algalarrondo V, Beganton F, Perier MC, Jacob S, Bordachar P, Babuty D, Klug D, Leclercq C, Fauchier L, Sadoul N, Deharo JC, Marijon E; DAI-PP investigators. Implantable cardioverter defibrillator therapy for primary prevention of sudden cardiac death in the real world: Main findings from the French multicentre DAI-PP programme (pilot phase). Arch Cardiovasc Dis. 2019 Aug - Sep;112(8-9):523-531. doi: 10.1016/j.acvd.2019.05.005.

[14] Santos AP, Vinagre J, Soares P, Claro I, Sanches AC, Gomes L, Fernandes I, Catarino AL, Preto J, Pereira BD, Marques AP, Rodrigues F, Amaral C, Rocha G, Mellidez JC, Simões H, Lopes JM, Bugalho MJ; On behalf of the NETs Study Group of the Portuguese Society of Endocrinology, Diabetes and Metabolism . Gastroenteropancreatic Neuroendocrine Neoplasia Characterization in Portugal: Results from the NETs Study Group of the Portuguese Society of Endocrinology, Diabetes and Metabolism. Int J Endocrinol. 2019 Aug 1;2019:4518742. doi: 10.1155/2019/4518742.

[15] Santos T, Lopes MDC, Gershkevitsh E, Vinagre F, Faria D, Carita L, Pontes M, Vieira S, Poli E, Faustino S, Ribeiro F, Trindade M, Ponte F, Marcelino C, Batista C, Oliveira S, Figueira R, Lencart J, Diaz EG, Jacob K, Brás S, Pirraco R, et al. IMRT national audit in Portugal. Phys Med. 2019 Sep;65:128-136. doi: 10.1016/j.ejmp.2019.08.013.

[16] Teodoro T, Oliveira R. Fahr's Syndrome and Neuropsychiatric Symptoms: Differential Diagnosis in Neuropsychiatry. Acta Med Port. 2019 Aug 1;32(7-8):558. doi: 10.20344/amp.12427.

[17] Almeida A, Pierdomenico F, Guerrero BP, Saraiva F, Montalvão A, Coutinho J, Mariz M, Melo T, Santos MJ, Pereira A, Cerveira N. Recommendations from a Portuguese Expert Group for Discontinuation of Tyrosine Kinase Inhibitors in Chronic Myeloid Leukemia Patients in Clinical Practice. Acta Med Port. 2019 Aug 1;32(7-8):550-557. doi: 10.20344/amp.11823.

[18] Freitas P, Ferreira AM, Arteaga-Fernández E, de Oliveira Antunes M, Mesquita J, Abecasis J, Marques H, Saraiva C, Matos DN, Rodrigues R, Cardim N, Mady C, Rochitte CE. The amount of late gadolinium enhancement outperforms current guideline-recommended criteria in the identification of patients with hypertrophic cardiomyopathy at risk of sudden cardiac death. J Cardiovasc Magn Reson. 2019 Aug 15;21(1):50. doi: 10.1186/s12968-019-0561-4.

[19] Manganaro R, Marchetta S, Dulgheru R, Sugimoto T, Tsugu T, Ilardi F, Cicenia M, Ancion A, Postolache A, Martinez C, Kacharava G, Athanassopoulos GD, Barone D, Baroni M, Cardim N, Hagendorff A, Hristova K, Lopez T, de la Morena G, Popescu BA, Penicka M, Ozyigit T, et al. Correlation between non-invasive myocardial work indices and main parameters of systolic and diastolic function: results from the EACVI NORRE study. Eur Heart J Cardiovasc Imaging. 2019 Aug 13. pii: jez203. doi: 10.1093/ehjci/jez203.

[20] Cavaco D, Adragão P. Mapping the diastole: ultra-high-density substrate mapping in ventricular tachycardia. Europace. 2019 Aug 1;21(Supplement_3):iii21-iii23. doi: 10.1093/europace/euz167.

[21] Tavares J, Ivo R, Gonzalez F, Lamas T, Mendes JJ. Global Ultrasound Check for the Critically lll (GUCCI)-a new systematized protocol unifying point-of-care ultrasound in critically ill patients based on clinical presentation. Open Access Emerg Med. 2019 Jul 10;11:133-145. doi: 10.2147/OAEM.S199137.

[22] Foltz L, Pica GM, Zerazhi H, Van Droogenbroeck J, Visanica S, Báez de la Fuente E, Leber B, de Almeida AM, Ranta D, Kiladjian JJ, Chrit L, Kandra A, Morando J, Devos T. Safety and efficacy findings from the open-label, multicenter, phase 3b, expanded treatment protocol study of ruxolitinib for treatment of patients with polycythemia vera who are resistant/intolerant to hydroxyurea and for whom no alternative treatments are available. Leuk Lymphoma. 2019 Jul 30:1-10. doi: 10.1080/10428194.2019.1636985.

[23] Ferreira da Silva F, de Lurdes Orvalho M, Gaspar A, Viana Lopes P, Leal de Faria J, Catarino A, Nave M, Passos-Coelho JL. Preoperative axillary lymph node staging in early breast cancer: Diagnostic efficacy and histopathology correlation. Breast J. 2019 Jul 23. doi: 10.1111/tbj.13471.

[24] Ferreira AR, Ribeiro J, Miranda A, Mayer A, Passos-Coelho JL, Brito M, Fernandes J, Gouveia J, Costa L, Vaz-Luis I. Effectiveness of Adjuvant Ovarian Function Suppression in Premenopausal Women With Early Breast Cancer: A Multicenter Cohort Study. Clin Breast Cancer. 2019 Oct;19(5):e654-e667. doi: 10.1016/j.clbc.2019.06.003.

[25] Nunes G, Pinto-Marques P, Mendonça E, Gargaté L. First case report of pancreatic myeloid sarcoma diagnosed through EUS-FNA. Gastroenterol Hepatol. 2019 Jul 16. pii: S0210-5705(19)30141-4. doi: 10.1016/j.gastrohep.2019.04.008.

[26] Hoeks M, Yu G, Langemeijer S, Crouch S, de Swart L, Fenaux P, Symeonidis A, Čermák J, Hellström-Lindberg E, Sanz G, Stauder R, Holm MS, Mittelman M, Mądry K, Malcovati L, Tatic A, Almeida AM, Germing U, Savic A, Gredelj Šimec N, Culligan D, Itzykson R, et al. Impact of treatment with iron chelation therapy in patients with lower-risk myelodysplastic syndromes participating in the European MDS registry. Haematologica. 2019 Jul 5. pii: haematol.2018.212332. doi: 10.3324/haematol.2018.212332.

[27] Alves R, Gonçalves AC, Jorge J, Marques G, Luís D, Ribeiro AB, Freitas-Tavares P, Oliveiros B, Almeida AM, Sarmento-Ribeiro AB. MicroRNA signature refine response prediction in CML. Sci Rep. 2019 Jul 4;9(1):9666. doi: 10.1038/s41598-019-46132-9.

[28] Campos-Correia D, Sudoł-Szopińska I, Diana Afonso P. Are We Overcalling Sacroillitis on MRI? Differential diagnosis that every rheumatologist should know - Part II. Acta Reumatol Port. 2019 Jan-Mar;44(1):42-56.

55

[29] Campos-Correia D, Sudoł-Szopińska I, Diana Afonso P. Are we overcalling sacroiliitis on MRI? Differential diagnosis that every rheumatologist should know - Part I. Acta Reumatol Port. 2019 Jan-Mar;44(1):29-41.

[30] Cerveira N, Diamond J, Matos S, Amorim ML, Coucelo M, Bizarro S, Simões AT, Pierdomenico F, Lopes M, Ribeiro L, do Carmo-Fonseca M, Guimarães JE, Almeida A, Teixeira MR. Negative MR(4·0) chronic myeloid leukaemia and its possible implications for treatment-free remission. Br J Haematol. 2019 Sep;186(6):e181-e184. doi: 10.1111/bjh.16058.

[31] Stocker TJ, Leipsic J, Hadamitzky M, Chen MY, Rubinshtein R, Deseive S, Heckner M, Bax JJ, Kitagawa K, Marques H, Schmermund A, Silva C, Mahmarian J, Kang JW, Grove EL, Lesser J, Massberg S, Hausleiter J. Application of Low Tube Potentials in CCTA: Results From the PROTECTION VI Study. JACC Cardiovasc Imaging. 2019 Jun 7. pii: S1936-878X(19)30449-8. doi: 10.1016/j.jcmg.2019.03.030.

[32] Nunes G, Patita M, Pinto-Marques P. Avoiding Stent-in-Stent Retrieval Strategy for Partially Covered Stents in Anastomotic Leakages: An Innovative Approach. GE Port J Gastroenterol. 2019 May;26(3):212-214. doi: 10.1159/000490922.

[33] Sousa PA, Barra S, António N, Gonçalves L. HD Coloring for assessment of block along an ablation line. J Cardiovasc Electrophysiol. 2019 Sep;30(9):1692-1693. doi: 10.1111/jce.14022.

[34] Gyan E, Almeida AM. Less iron improves MDS haematopoiesis. Br J Haematol. 2019 Oct;187(1):11-12. doi: 10.1111/bjh.16012.

[35] de Swart L, Crouch S, Hoeks M, Smith A, Langemeijer S, Fenaux P, Symeonidis A, Čermák J, Hellström-Lindberg E, Stauder R, Sanz G, Mittelman M, Holm MS, Malcovati L, Mądry K, Germing U, Tatic A, Savic A, Almeida AM, Gredelj-Šimec N, Guerci-Bresler A, Beyne-Rauzy O, et al. Impact of red blood cell transfusion dose density on progression-free survival in lower-risk myelodysplastic syndromes patients. Haematologica. 2019 Jun 6. pii: haematol.2018.212217. doi: 10.3324/haematol.2018.212217.

[36] Mineiro MA, Guimarães MJ, Winck JC. Organization of Home Mechanical Ventilation in Portugal: Characterization of current centers and a pathway to uniformization. Pulmonology. 2019 Jun 1. pii: S2531-0437(19)30098-4. doi: 10.1016/j.pulmoe.2019.05.006.

[37] Afonso PD, Weber MA, Isaac A, Bloem JL. Hip and Pelvis Bone Tumors: Can You Make It Simple? Semin Musculoskelet Radiol. 2019 Jun;23(3):e37-e57. doi: 10.1055/s-0039-1684023.

[38] Rego P, Beaulé PE, Ayeni OR, Tey M, Marin-Peña O, Dantas P, Wilkin G, Grammatopoulos G, Mafra I, Smit K, Kurz AZ. Femoroacetabular Impingement: What the Surgeon Wants to Know. Semin Musculoskelet Radiol. 2019 Jun;23(3):257-275. doi: 10.1055/s-0039-1683967.

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[182] Gil-Gouveia R, Martins IP. Clinical description of attack-related cognitive symptoms in migraine: A systematic review. Cephalalgia. 2018 Jun;38(7):1335-1350. doi: 10.1177/0333102417728250.

[183] Osório F, Alves J, Pereira J, Magro M, Barata S, Guerra A, Setúbal A. Obturator Internus Muscle Endometriosis with Nerve Involvement: a Rare Clinical Presentation. J Minim Invasive Gynecol. 2018 Feb;25(2):330-333. doi: 10.1016/j.jmig.2017.07.013.

[184] Dores H, Freitas A. ECG in athlete: Normal or pathalogic variant? Ann Noninvasive Electrocardiol. 2018 May;23(3):e12438. doi: 10.1111/anec.12438.

60

Hospital Beatriz Ângelo indexed publications

[1] Baptista RB, Almeida E. The emerging challenge of sickle cell nephropathy. Nephrol Dial Transplant. 2019 Oct 3. pii: gfz197. doi: 10.1093/ndt/gfz197.

[2] Costa Santos M, Cunha C, Velho S, Ferreira AO, Costa F, Ferreira R, Loureiro R, Santos AA, Maio R, Cravo M. Preoperative biliary drainage in patients performing pancreaticoduodenectomy : guidelines and real-life practice. Acta Gastroenterol Belg. 2019 Jul-Sep;82(3):389-395.

[3] Falcão LP, Colaço I, Cruz D, Góis M, Raimundo M. Acute Kidney Injury, Anemia, and Recurrent Dark Red Urine. Am J Kidney Dis. 2019 Oct;74(4):A14-A16. doi: 10.1053/j.ajkd.2019.04.024.

[4] Magro F, Lopes S, Silva M, Coelho R, Portela F, Branquinho D, Correia L, Fernandes S, Cravo M, Caldeira P, Tavares de Sousa H, Patita M, Lago P, Ramos J, Afonso J, Redondo I, Machado P, Philip G, Lopes J, Carneiro F. Soluble human Suppression of Tumorigenicity 2 is associated with endoscopic activity in patients with moderate-to-severe ulcerative colitis treated with golimumab. Therap Adv Gastroenterol. 2019 Aug 30;12:1756284819869141. doi: 10.1177/1756284819869141. e

[5] Carneiro AC, Ruiz MM, Freitas S, Isenberg D. A comparison of three classification criteria sets for Systemic Lupus Erythematosus - a study looking at links to outcome and mortality. Arthritis Care Res (Hoboken). 2019 Sep 10. doi: 10.1002/acr.24061.

[6] Magro F, Lopes J, Borralho P, Lopes S, Coelho R, Cotter J, Dias de Castro F, Tavares de Sousa H, Salgado M, Andrade P, Vieira AI, Figueiredo P, Caldeira P, Sousa A, Duarte MA, Ávila F, Silva J, Moleiro J, Mendes S, Giestas S, Ministro P, Sousa P, et al. Comparing the Continuous Geboes Score With the Robarts Histopathology Index: Definitions of Histological Remission and Response and their Relation to Faecal Calprotectin Levels. J Crohns Colitis. 2019 Sep 4. pii: jjz123. doi: 10.1093/ecco-jcc/jjz123.

[7] Cardoso A, Amaro P, Barbosa L, Coelho AM, Alonso R, Pires L. Diagnostic accuracy of clinical tests directed to the long head of biceps tendon in a surgical population: a combination of old and new tests. J Shoulder Elbow Surg. 2019 Sep 6. pii: S1058-2746(19)30480-X. doi: 10.1016/j.jse.2019.07.007.

[8] Santos Silva J, Torres C, Clemente S, Calvinho P. Isolated Pulmonary Mucormycosis in an immunocompetent patient. Rev Port Cir Cardiotorac Vasc. 2019 Apr-Jun;26(2):151-153.

[9] Mahmoud R, Shah SC, Torres J, Castaneda D, Glass J, Elman J, Kumar A, Axelrad J, Harpaz N, Ullman T, Colombel JF, Oldenburg B, Itzkowitz SH. Association Between Indefinite Dysplasia and Advanced Neoplasia in Patients With Inflammatory Bowel Diseases Undergoing Surveillance. Clin Gastroenterol Hepatol. 2019 Aug 22. pii: S1542-3565(19)30907-3. doi: 10.1016/j.cgh.2019.08.032.

[10] Sabino J, Torres J, Colombel JF, Peter I. Neonatal life events and the risk of inflammatory bowel disease. Gastroenterology. 2019 Aug 20. pii: S0016-5085(19)41234-1. doi: 10.1053/j.gastro.2019.04.055.

[11] Faias S, Pereira L, Luís Â, Chaves P, Cravo M. Genetic testing vs microforceps biopsy in pancreatic cysts: Systematic review and meta-analysis. World J Gastroenterol. 2019 Jul 14;25(26):3450-3467. doi: 10.3748/wjg.v25.i26.3450.

[12] Fontes-Carvalho R, Marques Silva P, Rodrigues E, Araújo F, Gavina C, Ferreira J, Morais J. Practical guide for the use of PCSK9 inhibitors in Portugal. Rev Port Cardiol. 2019 Jun;38(6):391-405. doi: 10.1016/j.repc.2019.05.005.

[13] Guerreiro M, Sousa Guerreiro C, Cravo M. Irritable bowel syndrome: how can symptoms and quality of life be improved with diet? Curr Opin Clin Nutr Metab Care. 2019 Sep;22(5):377-382. doi: 10.1097/MCO.0000000000000589.

[14] Ladeira F, Braz L, Salgado P, Vaz S, Leitão L, Félix C, Correia AS, Silva AMD, Salgado V, Ferreira F, Vale J, Sá MJ, Capela C. A multicenter, non-interventional study to evaluate the disease activity in Multiple Sclerosis after withdrawal of Natalizumab in Portugal. Clin Neurol Neurosurg. 2019 Sep;184:105390. doi: 10.1016/j.clineuro.2019.105390.

[15] Gameiro R, Gomes R, Jorge V, Picado B, Gonçalves FM, Araújo JL. A Paraneoplastic Syndrome to Remember: A Case of Disseminated Intravascular Coagulation in Lung Cancer. Eur J Case Rep Intern Med. 2019 Jun 3;6(6):001134. doi: 10.12890/2019_001134.

[16] Freitas S, Mozo Ruiz M, Costa Carneiro A, Isenberg DA. Why do some patients with systemic lupus erythematosus fail to respond to B-cell depletion using rituximab? Clin Exp Rheumatol. 2019 Jul 8.

[17] Barbosa RP, Mendonça MD, Caetano AP, Lampreia TM, Miguel R, Bugalho PM. Cognitive complaints in Parkinson's disease patients: from subjective cognitive complaints to dementia and affective disorders. J Neural Transm (Vienna). 2019 Oct;126(10):1329-1335. doi: 10.1007/s00702-019-02042-8.

[18] Torres J, Peter I. Neonatal Exposures and Risk of Inflammatory Bowel Disease: When Does the Clock Start Ticking? Gastroenterology. 2019 Aug;157(2):577-578. doi: 10.1053/j.gastro.2019.06.010.

[19] Faria Anjos J, Heitor Dos Santos MJ, Ribeiro MT, Moreira S. Connor-Davidson Resilience Scale: validation study in a Portuguese sample. BMJ Open. 2019 Jun 27;9(6):e026836. doi: 10.1136/bmjopen-2018-026836.

[20] Campos-Correia D, Sudoł-Szopińska I, Diana Afonso P. Are We Overcalling Sacroillitis on MRI? Differential diagnosis that every rheumatologist should know - Part II. Acta Reumatol Port. 2019 Jan-Mar;44(1):42-56.

[21] Campos-Correia D, Sudoł-Szopińska I, Diana Afonso P. Are we overcalling sacroiliitis on MRI? Differential diagnosis that every rheumatologist should know - Part I. Acta Reumatol Port. 2019 Jan-Mar;44(1):29-41.

[22] Estevinho F, Felizardo M, Fernandes G, Figueiredo A, Lopes JA. Treatment of advanced EGFR-mutant NSCLC patients: Sequencing matters. Pulmonology. 2019 Sep - Oct;25(5):306-309. doi: 10.1016/j.pulmoe.2019.04.005.

[23] Meneses-Oliveira C. [Use of Electronic Medical Records for Research: New Ethical Challenges and Possible Solutions]. Acta Med Port. 2019 May 31;32(5):332-334. doi: 10.20344/amp.11280.

[24] Afonso PD, Weber MA, Isaac A, Bloem JL. Hip and Pelvis Bone Tumors: Can You Make It Simple? Semin Musculoskelet Radiol. 2019 Jun;23(3):e37-e57. doi: 10.1055/s-0039-1684023.

[25] Rego P, Beaulé PE, Ayeni OR, Tey M, Marin-Peña O, Dantas P, Wilkin G, Grammatopoulos G, Mafra I, Smit K, Kurz AZ. Femoroacetabular Impingement: What the Surgeon Wants to Know. Semin Musculoskelet Radiol. 2019 Jun;23(3):257-275. doi: 10.1055/s-0039-1683967.

[26] Oliveira M, Saura C, Nuciforo P, Calvo I, Andersen J, Passos-Coelho JL, Gil Gil M, Bermejo B, Patt DA, Ciruelos E, de la Peña L, Xu N, Wongchenko M, Shi Z, Singel SM, Isakoff SJ. FAIRLANE, a double-blind placebo-controlled randomized phase II trial of neoadjuvant ipatasertib plus paclitaxel for early triple-negative breast cancer. Ann Oncol. 2019 May 30. pii: mdz177. doi: 10.1093/annonc/mdz177.

[27] Aires A, Barros A, Machado C, Fitas D, Cação G, Pedrosa R, Cerqueira J, Perdigão S, Silva AM, Vale J, Sá MJ, Andrade C. Diagnostic Delay of Multiple Sclerosis in a Portuguese Population. Acta Med Port. 2019 Apr 30;32(4):289-294. doi: 10.20344/amp.11187.

[28] Alvarenga Santos M, Esquinas AM. Survival after ward-based non-invasive ventilation for chronic obstructive pulmonary disease exacerbations: Ceiling treatment or causality? Clin Respir J. 2019 Aug;13(8):538-539. doi: 10.1111/crj.13035.

[29] Briosa F, Valsassina R, Mira C, Zagalo A. Zinner and Mayer-Rokitansky-Küster-Hauser syndromes: when unilateral renal agenesis meets genital anomalies. BMJ Case Rep. 2019 May 6;12(5). pii: e229034. doi: 10.1136/bcr-2018-229034.

[30] Palmela C, Gouveia C, Fidalgo C, Ferreira AO. Rare case of a giant duodenal ulcer penetrating the pancreas during antiangiogenic treatment. BMJ Case Rep. 2019 May 6;12(5). pii: e228612. doi: 10.1136/bcr-2018-228612.

[31] Torres J, Hu J, Seki A, Eisele C, Nair N, Huang R, Tarassishin L, Jharap B, Cote-Daigneault J, Mao Q, Mogno I, Britton GJ, Uzzan M, Chen CL, Kornbluth A, George J, Legnani P, Maser E, Loudon H, Stone J, Dubinsky M, Faith JJ, et al. Infants born to mothers with IBD present with altered gut microbiome that transfers abnormalities of the adaptive immune system to germ-free mice. Gut. 2019 Apr 29. pii: gutjnl-2018-317855. doi: 10.1136/gutjnl-2018-317855.

61

[32] Velho S, Moço S, Ferreira A, Cruz R, Agostinho L, Cabral MS, Luz G, Lopes F, Teixeira JA, Strecht J, Coelho JLP, Maio R, Cravo M, Baracos VE. Dietary patterns and their relationships to sarcopenia in Portuguese patients with gastrointestinal cancer: An exploratory study. Nutrition. 2019 Jul - Aug;63-64:193-199. doi: 10.1016/j.nut.2019.01.014.

[33] Agostinho L, Horta M, Salvador JC, Cunha TM. Benign ovarian lesions with restricted diffusion. Radiol Bras. 2019 Mar-Apr; 52(2):106-111. doi: 10.1590/0100-3984.2018.0078.

[34] Alves LJ, Gameiro CD, Lopes SP, Ascensão JB, Sousa RC. Prostate Leiomyosarcoma: A Rare Misleading Tumor. Urology. 2019 Aug;130:13-16. doi: 10.1016/j.urology.2019.04.014.

[35] Magro F, Lopes S, Silva M, Coelho R, Portela F, Branquinho D, Correia L, Fernandes S, Cravo M, Caldeira P, Tavares Sousa H, Patita M, Lago P, Ramos J, Afonso J, Redondo I, Machado P, Cornillie F, Lopes J, Carneiro F; portuguese IBD group (GEDII). Low Golimumab Trough Levels at Week 6 are Associated with Poor Clinical, Endoscopic and Histological Outcomes in Ulcerative Colitis Patients: Pharmacokinetic and Pharmacodynamic Sub-analysis of the Evolution Study. J Crohns Colitis. 2019 Apr 16. pii: jjz071. doi: 10.1093/ecco-jcc/jjz071.

[36] Paralta Branco F, Brito CB, Luz G, Teixeira JA. Central venous catheter misplaced in the epidural space. BMJ Case Rep. 2019 Apr 8;12(4). pii: e229295. doi: 10.1136/bcr-2019-229295.

[37] Gomes HH, Lourenço I, Ribeiro J, Martins D, Ribeiro R, Francisco C. Cell-free DNA and contingent screening: Our first year. J Gynecol Obstet Hum Reprod. 2019 Sep;48(7):509-514. doi: 10.1016/j.jogoh.2019.04.001.

[38] Fernandes S, Teixeira C, Falcão LP, Costa AC, Raimundo M, Silva S, Cardoso J, Almeida E. Anca negative pauci-immune crescentic glomerulonephritis and mixed connective tissue disease: a case study. J Bras Nefrol. 2019 Mar 18. pii: S0101-28002019005012104. doi: 10.1590/2175-8239-JBN-2019-0003.

[39] Karim HMR, Burns KEA, Ciobanu LD, El-Khatib M, Nicolini A, Vargas N, Hernández-Gilsoul T, Skoczyński S, Falcone VA, Arnal JM, Bach J, De Santo LS, Lucchini A, Steier J, Purro A, Petroianni A, Sassoon CS, Bambi S, Aguiar M, Soubani AO, Taniguchi C, Mollica C, et al. Noninvasive ventilation: education and training. A narrative analysis and an international consensus document. Adv Respir Med. 2019;87(1):36-45. doi: 10.5603/ARM.a2019.0006.

[40] Torres J, Ellul P, Langhorst J, Mikocka-Walus A, Barreiro-de Acosta M, Basnayake C, Ding NJS, Gilardi D, Katsanos K, Moser G, Opheim R, Palmela C, Pellino G, Van der Marel S, Vavricka SR. European Crohn's and Colitis Organisation Topical Review on Complementary Medicine and Psychotherapy in Inflammatory Bowel Disease. J Crohns Colitis. 2019 May 27;13(6):673-685e. doi: 10.1093/ecco-jcc/jjz051.

[41] Miranda RN, Leonardo Gordinho AJ, Visconti V, Oliveira I. Arterioportal fistula after partial gastrectomy treated with coil embolisation. BMJ Case Rep. 2019 Feb 26;12(2). pii: e226721. doi: 10.1136/bcr-2018-226721.

[42] Bill O, Inácio NM, Lambrou D, Wintermark M, Ntaios G, Dunet V, Michel P. Focal Hypoperfusion in Acute Ischemic Stroke Perfusion CT: Clinical and Radiologic Predictors and Accuracy for Infarct Prediction. AJNR Am J Neuroradiol. 2019 Mar;40(3):483-489. doi: 10.3174/ajnr.A5984.

[43] East JE, Boyapati RK, Torres J, Parker CE, MacDonald JK, Chande N, Feagan BG. Controversies in Inflammatory Bowel Disease: Exploring Clinical Dilemmas Using Cochrane Reviews. Inflamm Bowel Dis. 2019 Feb 21;25(3):472-478. doi: 10.1093/ibd/izy268.

[44] Fidalgo C, Torres J. 5-Aminosalicilates: Old Habits Die Hard. Gastroenterology. 2019 Mar;156(4):1213-1214. doi: 10.1053/j.gastro.2019.02.019.

[45] Guaraldi G, Zona S, Silva AR, Menozzi M, Dolci G, Milic J, Carli F, Mussini C. The dynamic association between Frailty, CD4 and CD4/CD8 ratio in people aging with HIV. PLoS One. 2019 Feb 14;14(2):e0212283. doi: 10.1371/journal.pone.0212283.

[46] Serpa MJ, Franco S, Repolho D, Branco F, Gramaça J, Júnior JF. An Unusual Case of Primary Retroperitoneal Germ Cell Tumour in a Young Man. Eur J Case Rep Intern Med. 2018 Jul 26;5(7):000900. doi: 10.12890/2018_000900.

[47] Evangelista V, Gonçalves CV, Almeida R, Henriques C, Baptista AM, da Graça JP, Araújo JL. Klebsiella pneumoniae Invasive Syndrome. Eur J Case Rep Intern Med. 2018 Mar 21;5(3):000800. doi: 10.12890/2018_000800.

[48] Serpa MJ, Franco S, Repolho D, Araújo I, Mateus S, Baptista AM, Araújo JL. A Challenging Diagnosis of Leg Ulcer. Eur J Case Rep Intern Med. 2018 Oct 24;5(10):000952. doi: 10.12890/2018_000952.

[49] Serpa MJ, Falcão L, Franco S, Repolho D, Ferreira NR. Metabolic Acidosis Due To Pyroglutamic Acid. Eur J Case Rep Intern Med. 2018 Oct 24;5(10):000949. doi: 10.12890/2018_000949.

[50] Machado MC, Sousa R, Stone R, Barreto MI, Garcês F, Cruz C, Gomes S, Rodrigues M, Guerreiro AI. [Informed Consent - Vision and Perspectives of Adolescents, Parents and Professionals: Multicentric Study in Six Hospitals]. Acta Med Port. 2019 Feb 1;32(1):61-69. doi: 10.20344/amp.10826.

[51] Gillard DM, Proudfoot JA, Simões RM, Litvan I. End of life planning in parkinsonian diseases. Parkinsonism Relat Disord. 2019 May;62:73-78. doi: 10.1016/j.parkreldis.2019.01.026.

[52] Briosa F, Oliveira S, Sousa R, Oom P. Stickler syndrome: a possible presentation of Pierre Robin sequence. BMJ Case Rep. 2019 Jan 31;12(1). pii: e228702. doi: 10.1136/bcr-2018-228702.

[53] Afonso PD, Isaac A, Villagrán JM. Chondroid Tumors as Incidental Findings and Differential Diagnosis between Enchondromas and Low-grade Chondrosarcomas. Semin Musculoskelet Radiol. 2019 Feb;23(1):3-18. doi: 10.1055/s-0038-1675550.

[54] Batista S, Silva AM, Sá MJ, Sousa L, De Sá J, Pedrosa R, Cerqueira J, Pinheiro J, Abreu P, Simões RM, Dias E, Veríssimo C, Vale J. [Recommendations About Multiple Sclerosis Management During Pregnancy, Partum and Post-Partum: Consensus Position of The Portuguese Multiple Sclerosis Study Group and The Portuguese Society of Obstetrics and Maternal-Fetal Medicine]. Acta Med Port. 2018 Dec 28;31(12):785-795. doi: 10.20344/amp.10752.

[55] D'Ancona C, Haylen B, Oelke M, Abranches-Monteiro L, Arnold E, Goldman H, Hamid R, Homma Y, Marcelissen T, Rademakers K, Schizas A, Singla A, Soto I, Tse V, de Wachter S, Herschorn S; Standardisation Steering Committee ICS and the ICS Working Group on Terminology for Male Lower Urinary Tract & Pelvic Floor Symptoms and Dysfunction. The International Continence Society (ICS) report on the terminology for adult male lower urinary tract and pelvic floor symptoms and dysfunction. Neurourol Urodyn. 2019 Feb;38(2):433-477. doi: 10.1002/nau.23897.

[56] Debroy P, Sim M, Erlandson KM, Falutz J, Prado CM, Brown TT, Guaraldi G, Lake JE. Progressive increases in fat mass occur in adults living with HIV on antiretroviral therapy, but patterns differ by sex and anatomic depot. J Antimicrob Chemother. 2019 Apr 1;74(4):1028-1034. doi: 10.1093/jac/dky551.

[57] Novo A, Castelo J, de Sousa A, Amorim I, Alves JN, Calejo M, Monteiro A, Arenga M, Shamasna M, Vale J, Sá MJ, Palavra F. Pregnancy outcomes in Portuguese women with multiple sclerosis: The PREGNIMS study. Mult Scler Relat Disord. 2019 Feb;28:172-176. doi: 10.1016/j.msard.2018.12.033.

[58] Sá-Sousa A, Fonseca JA, Pereira AM, Ferreira A, Arrobas A, Mendes A, Drummond M, Videira W, Costa T, Farinha P, Soares J, Rocha P, Todo-Bom A, Sokolova A, Costa A, Fernandes B, Chaves Loureiro C, Longo C, Pardal C, Costa C, Cruz C, Loureiro CC, et al. The Portuguese Severe Asthma Registry: Development, Features, and Data Sharing Policies. Biomed Res Int. 2018 Nov 21;2018:1495039. doi: 10.1155/2018/1495039.

[59] Mahmoud R, Shah SC, Ten Hove JR, Torres J, Mooiweer E, Castaneda D, Glass J, Elman J, Kumar A, Axelrad J, Ullman T, Colombel JF, Oldenburg B, Itzkowitz SH; Dutch Initiative on Crohn and Colitis. No Association Between Pseudopolyps and Colorectal Neoplasia in Patients With Inflammatory Bowel Diseases. Gastroenterology. 2019 Apr;156(5):1333-1344.e3. doi: 10.1053/j.gastro.2018.11.067.

[60] Almada AL, Casquinha P, Cotovio V, Heitor Dos Santos MJ, Caixeiro A. The potential role of psychosocial rehabilitation in palliative care. J R Coll Physicians Edinb. 2018 Dec;48(4):311-317. doi: 10.4997/JRCPE.2018.405.

62

[61] Marques H, de Araújo Gonçalves P, Ferreira AM, Cruz R, Lopes J, Santos RD, Radu L, Costa F, Mesquita J, Carmo P, Cavaco D, Parreira L, Pisco J, Goyri O'Neill J, Adragão P. Cardiac computed tomography previous to atrial fibrillation ablation - effects of technological improvements and protocol optimization. Rev Port Cardiol. 2018 Nov;37(11):873-883. doi: 10.1016/j.repc.2018.03.011.

[62] Fiorino G, Allocca M, Chaparro M, Coenen S, Fidalgo C, Younge L, Gisbert JP. ‘Quality of Care' Standards in Inflammatory Bowel Disease: A Systematic Review. J Crohns Colitis. 2019 Jan 1;13(1):127-137. doi: 10.1093/ecco-jcc/jjy140.

[63] Fernandes MGO, Santos VF, Martins N, Sucena MC, Passos MM, Marques MM, Magalhães AM, Bugalho A. Endobronchial Ultrasound under Moderate Sedation versus General Anesthesia. J Clin Med. 2018 Nov 8;7(11). pii: E421. doi: 10.3390/jcm7110421.

[64] Shah SC, Glass J, Giustino G, Hove JRT, Castaneda D, Torres J, Kumar A, Elman J, Ullman TA, Itzkowitz SH. Statin Exposure Is Not Associated with Reduced Prevalence of Colorectal Neoplasia in Patients with Inflammatory Bowel Disease. Gut Liver. 2019 Jan 15;13(1):54-61. doi: 10.5009/gnl18178.

[65] Gonçalves A, Brito C, Simões R, Vale J. Air Embolism: An Unusual Cause of Ischemic stroke and Myoclonic Status Epilepticus. Eur Neurol. 2018;80(3-4):128-129. doi: 10.1159/000494668.

[66] Strambo D, Sirimarco G, Inácio N, Eskandari A, Michel P. Skiing Associated Stroke: Causes, Treatment, and Outcome. J Stroke Cerebrovasc Dis. 2019 Feb;28(2):288-294. doi: 10.1016/j.jstrokecerebrovasdis.2018.09.049.

[67] Fonseca AC, Marto JP, Alves PN, Inácio N, Viana-Baptista M, Pinho E Melo T, Ferro JM, Almeida AG. Women Who Have Ischemic Strokes Have a Higher Burden of Left Atrial Fibrosis Than Men. Stroke. 2018 Nov;49(11):2584-2589. doi: 10.1161/STROKEAHA.118.022105.

[68] Sousa C, Rigueiro-Neves M, Miranda T, Alegria P, Vale J, Passos AM, Langdon D, Sá MJ. Validation of the brief international cognitive assessment for multiple sclerosis (BICAMS) in the Portuguese population with multiple sclerosis. BMC Neurol. 2018 Oct 17;18(1):172. doi: 10.1186/s12883-018-1175-4.

[69] Santos Silva J, Torres C, Teixeira JA, Garcia P, Calvinho P. Manubrium resection and reconstruction for mediastinal tumor: a case report. Rev Port Cir Cardiotorac Vasc. 2018 Jan-Jun;25(1-2):87-89.

[70] Cabral G. [The change is here, the future is now]. Rev Port Cir Cardiotorac Vasc. 2018 Jan-Jun;25(1-2):11-12.

[71] Oliveira JA, Moeda S, Contreiras M, Costa-Lima S, Ferrão A. Extreme reactive thrombocytosis in an infant: Much ado about nothing? Pediatr Blood Cancer. 2019 Jan;66(1):e27467. doi: 10.1002/pbc.27467.

[72] Vacas SM, Stella F, Loureiro JC, Simões do Couto F, Oliveira-Maia AJ, Forlenza OV. Noninvasive brain stimulation for behavioural and psychological symptoms of dementia: A systematic review and meta-analysis. Int J Geriatr Psychiatry. 2019 Sep;34(9):1336-1345. doi: 10.1002/gps.5003.

[73] Barata PC, Alpuim Costa D, Passos Coelho JL, Da Luz R. The Costly War Against Cancer Treatment: The Example of Metastatic Renal Cell Carcinoma in Portugal. Acta Med Port. 2018 Aug 31;31(7-8):373-375. doi: 10.20344/amp.9969.

[74] Falcão LP, Fernandes S, Costa AC, Teixeira C, Raimundo M, Silva S, Miranda M, Almeida E. An atypical presentation of a severe and massive atheroembolic disease. J Bras Nefrol. 2019 Jan-Mar;41(1):142-144. doi: 10.1590/2175-8239-JBN-2018-0013.

[75] Reis AJ, Alves C, Furtado S, Ferreira J, Drummond M, Robalo-Cordeiro C; GI DPOC-Grupo de Interesse na Doença Pulmonar Obstrutiva Crónica. COPD exacerbations: management and hospital discharge. Pulmonology. 2018 Nov - Dec;24(6):345-350. doi: 10.1016/j.pulmoe.2018.06.006.

[76] Gomes CF, Sousa M, Lourenço I, Martins D, Torres J. Gastrointestinal diseases during pregnancy: what does the gastroenterologist need to know? Ann Gastroenterol. 2018 Jul-Aug;31(4):385-394. doi: 10.20524/aog.2018.0264.

[77] Frias Gomes C, Colombel JF, Torres J. De-escalation of Therapy in Inflammatory Bowel Disease. Curr Gastroenterol Rep. 2018 Jul 2;20(8):35. doi: 10.1007/s11894-018-0643-8.

[78] Freire G, Cruz R, Valentim MH, Marques TG, Afonso PD. Post-traumatic cyst-like lesion of cortical bone in children. Skeletal Radiol. 2019 Jan;48(1):167-174. doi: 10.1007/s00256-018-2993-6.

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