Acta medica portuguesa最新文献

Multiple myeloma is a neoplasm of plasma cells that in most cases is associated with the secretion of monoclonal immunoglobulins and can involve multiple organs. Its timely diagnosis is essential to limit or avoid irreversible damage and dysfunction of target organs. Appropriate initial stratification of patients allows for optimization in the selection and sequence of therapy, as well as proper follow-up during treatment and monitoring, impacting survival. These laboratory guidelines from the Portuguese Multiple Myeloma Group provide recommendations for the diagnosis and laboratory follow-up of patients with multiple myeloma. The follow-up and diagnosis of patients with other clinically significant monoclonal gammopathies were not included in this text. This article was based on international guidelines, scientific publications, and the experience of a panel of specialists in clinical and laboratory fields dedicated to the study and treatment of multiple myeloma.

Introduction: Clinical practice guidelines are essential for standardizing care, yet adherence in primary care remains inconsistent globally. The aim of this study was to assess the use of clinical guidelines by family physicians in Slovenia for diagnosing and managing common conditions, to explore factors influencing guideline awareness and decision-making, and to identify barriers to adherence.

Methods: A nationwide cross-sectional study surveyed family medicine specialists and trainees across public and private practices in rural and urban Slovenia. Participants completed an online questionnaire to evaluate their awareness of professional guidelines (27 guidelines made by Slovenian healthcare professionals). Furthermore, they were tested on guideline-aligned decisions (five clinical vignettes). The last question in the survey was an open-ended question on the main obstacles associated with the use of clinical guidelines.

Results: Out of 660 physicians surveyed, only 57 respondents completed the questionnaire in full (8.6% response rate). Guideline awareness varied significantly (average 60.8%), with higher knowledge of guidelines for relatively common conditions (e.g., 96% for arterial hypertension versus 12% for polycythemia vera). Correct clinical decisions according to guidelines were made in 65.2% of cases (lowest average scores for osteoporosis, 57.9%, highest for dyspepsia, 69.7%). Minimal statistically significant differences emerged between family medicine specialists and trainees (decisions regarding peripheral arterial occlusive disease, p = 0.024), public or private practice types (decisions regarding low urinary tract symptoms, p = 0.037), and urban or rural practice settings (decisions regarding chronic obstructive pulmonary disease, p = 0.008 and p = 0.016). Answers to the open-ended question were divided into six categories according to the content: organizational limitations (lack of time and availability of guidelines), limitations related to the characteristics and quality of guidelines, team members' lack of knowledge or work based on experience, complex patients, non-cooperative patients, and financial limitations.

Conclusion: On average, family physicians in Slovenia make clinical decisions according to guidelines in 65.2% of cases. Organizational constraints, notably workload and time pressures, are the leading obstacles to guideline adherence. Interventions such as extended consultation times, centralized digital guideline repositories, and annual update seminars are recommended. Our study highlights the need for broader research to validate strategies for enhancing guideline implementation and adherence in primary care.

Introduction: Scientific evidence regarding salivary gland cancer systemic treatment is limited and the therapeutic approach to locally advanced or metastatic disease is mainly based on consensus. This study aimed to evaluate treatment patterns and outcomes in patients with advanced salivary gland cancer.

Methods: We conducted a retrospective cohort study in a comprehensive cancer center in Portugal, including adult patients diagnosed with primary malignant salivary gland tumors between 2012 and 2021. Data on demographics, tumor characteristics, treatments, and outcomes were collected from institutional cancer registries and electronic medical records. The study was approved by the institutional Ethics Committee.

Results: A total of 116 patients with salivary gland cancer were identified and, of these, 45 had locally advanced or metastatic disease: 24 received systemic anti-neoplastic treatment and 21 received best supportive care. One-year overall survival in systemic anti-neoplastic treatment group was 70% (versus 14% in best supportive care group, p < 0.001) and progression-free survival was 37%. The most commonly used systemic treatment was chemotherapy (n = 29, 59%). Seven patients (14%) received androgen deprivation therapy, and two patients (4%) received other targeted therapy (olaparib and erdafitinib).

Conclusion: Systemic treatment was associated with significantly improved survival in patients with advanced salivary gland cancer. Despite the heterogeneity of therapeutic approaches, including emerging biomarker-driven therapies, clinical decision-making remains largely consensus-based. These findings underscore the need for further research to support personalized treatment strategies and guide evidence-based care.

Introduction: The development and validation of reliable and valid instruments to assess chronic pain and its impact on daily functioning are crucial in both clinical and research settings. The aim of this study was to develop and validate the scale 'Physical Function Impact Index on Chronic Pain' - PFIICP, a novel 12-item questionnaire designed to evaluate the physical functional impact of chronic pain.

Methods: A formative measurement model was used. In comparison with other established scales that have emotional, cognitive and social considerations, PFIICP is designed to be more objective, as it focuses only on the relationship between physical performance and the subject's pain.

Results: Data were collected from n = 285 patients at baseline and n = 58 patients at follow-up (3 - 6 months later). Spearman's rho correlations between the 12 items ranged from 0.153 to 0.793, all statistically significant (p < 0.05), indicating that each item contributes uniquely to the construct. The intraclass correlation coefficient (ICC) for test-retest reliability was 0.788 (95% CI: 0.731 - 0.833), demonstrating good stability over time. Convergent validity was supported by strong Pearson correlations with established measures, including the Brief Pain Inventory (BPI; r = 0.739, p < 0.05) and the Pain Disability Index (PDI; r = 0.739, p < 0.05).

Conclusion: These findings suggest that the PFIICP is a robust tool for assessing the functional impact of chronic pain through a formative model approach.