Pedro M. Teixeira

A laparoscopic surgery training interface

Laparoscopy is a surgical procedure on which operations in the abdomen are performed through small incisions using several specialized instruments. The laparoscopic surgery success greatly depends on surgeon skills and training. To achieve these technical high-standards, different apprenticeship methods have been developed, many based on in vivo training, an approach that involves high costs and complex setup procedures. This paper explores Virtual Reality (VR) simulation as an alternative for novice surgeons training. Even though several simulators are available on the market claiming successful training experiences, their use is extremely limited due to the economic costs involved. In this work, we present a low-cost laparoscopy simulator able to monitor and assist the trainees surgical movements. The developed prototype consists of a set of inexpensive sensors, namely an accelerometer, a gyroscope, a magnetometer and a flex sensor, attached to specific laparoscopic instruments. Our approach allows repeated assisted training of an exercise, without time constraints or additional costs, since no human artificial model is needed. A case study of our simulator applied to instrument manipulation practice (hand-eye coordination) is also presented.

Community Psychology in Portugal: From “Revolution” to Empowered Citizenship

In this chapter, we discuss the evolution of CP in Portugal by demonstrating its connections with the historical and political developments in the past four decades, particularly the dictatorship that ruled the country from 1928 to 1974, the democratic revolution of April 1974, and the entrance into the European Community in 1985. This has been a period for the successful institution of psychology both as a theoretical domain, a research field, and a profession, and, particularly since the mid-1980s, for the expansion of CPoriented values and practice. Examples of intervention projects and research reveal that although it is probably too soon to speak of a uniquely Portuguese theoretical contribution to the field of CP, the influence of North American and European authors are combined to assert the need for a more political community psychology.

Palco: A multisensor realtime 3D cartoon production system

This paper presents Palco, a prototype system specifically designed for the production of 3D cartoon animations. The system addresses the specific problems of producing cartoon animations, where the main objective is not to reproduce realistic movements, but rather animate cartoon characters with predefined and characteristic body movements and facial expressions. The techniques employed in Palco are simple and easy to use, not requiring any invasive or complicated motion capture system, as both body motion and facial expression of actors are captured simultaneously, using an infrared motion detection sensor, a regular camera and a pair of electronically instrumented gloves. The animation process is completely actor-driven, with the actor controlling the character movements, gestures, facial expression and voice, all in realtime. The actor controlled cartoonification of the captured facial and body motion is a key functionality of Palco, and one that makes it specifically suited for the production of cartoon animations.

Are pharmacological randomised controlled clinical trials relevant to real-life asthma populations? A protocol for an UNLOCK study from the IPCRG.

Are pharmacological randomised controlled clinical trials relevant to real-life asthma populations? : A protocol for an UNLOCK study from the IPCRG

Linking Learning Contexts: The Relationship between Students’ Civic and Political Experiences and Their Self-Regulation in School

This paper considers the relationship between self-regulation strategies and youth civic and political experiences, assuming that out-of-school learning can foster metacognition. The study is based on a sample of 732 Portuguese students from grades 8 and 11. Results show that the quality of civic and political participation experiences, together with academic self-efficacy, are significant predictors of young people’s self-regulation, particularly regarding cognitive and metacognitive strategies (elaboration and critical thinking). Such effects surpass even the weight of family cultural and school variables, such as the sense of school belonging. Therefore, we argue that the pedagogical value of non-formal civic and political experiences is related to learning in formal pedagogical contexts. This is because civic and political participation with high developmental quality can stimulate higher-order cognitive engagement and, thus, contribute to the development of learning strategies that promote academic success.

COPD: understanding patients’ adherence to inhaled medications

Background and objective Adherence to inhaled medications by COPD patients is a challenging issue, but relatively understudied. The aim of this study is the characterization of adherence to inhaled medications by COPD patients, with a focus on patient-related determinants. Methods Stable COPD outpatients ≥40 years of age from a respiratory unit and diagnosed according to the Global Initiative for Chronic Obstructive Lung Disease criteria were included in a cross-sectional study. The Measure of Treatment Adherence (MTA), the Beliefs about Medications Questionnaire (BMQ) and demographic, clinical, and COPD questionnaires were used. After completing these questionnaires, semi-structured interviews were carried out and participants were encouraged to justify their opinions and behaviors. Field notes were made during the interviews and each interview was analyzed before the next one. Quantitative and qualitative analyses of the variables were then performed. Results A total of 300 out of 319 participants (mean age =67.7 years, 78.1% males) completed the MTA questionnaire. Of these, 31.3% were considered poorly adherent and 16.7% as non-adherent to the inhaled therapy. A statistically significant negative association was found between adherence and current smoking status (P=0.044), and between adherence and FEV1% (P=0.000). The mean BMQ Necessity score was higher in adherent patients (P=0.000), but the the mean Concern score was similar for both (P=0.877). We found nine patterns of poor-adherence, six reasons given for poor-adherence behaviors, five reasons for good-adherence behaviors and three patient-related domains on adherence to medications. Conclusion Adherence is related to need perception and to the functional severity of the disease. A non-adherent patient is usually a current smoker with lower degree of airflow limitation and lower perception of medication necessity. New information obtained was related to the patterns and reasons for different adherence behaviors, which are based on three major groups of patient related-determinants: health-related experiences, health-related behaviors and health-related beliefs.

The modified patient enablement instrument: a Portuguese cross-cultural adaptation, validity and reliability study

Enabling patients with asthma to obtain the knowledge, confidence and skills they need in order to assume a major role in the management of their disease is cost effective. It should be an integral part of any plan for long-term control of asthma. The modified Patient Enablement Instrument (mPEI) is an easily administered questionnaire that was adapted in the United Kingdom to measure patient enablement in asthma, but its applicability in Portugal is not known. Validity and reliability of questionnaires should be tested before use in settings different from those of the original version. The purpose of this study was to test the applicability of the mPEI to Portuguese asthma patients after translation and cross-cultural adaptation, and to verify the structural validity, internal consistency and reproducibility of the instrument. The mPEI was translated to Portuguese and back translated to English. Its content validity was assessed by a debriefing interview with 10 asthma patients. The translated instrument was then administered to a random sample of 142 patients with persistent asthma. Structural validity and internal consistency were assessed. For reproducibility analysis, 86 patients completed the instrument again 7 days later. Item-scale correlations and exploratory factor analysis were used to assess structural validity. Cronbach’s alpha was used to test internal consistency, and the intra-class correlation coefficient was used for the analysis of reproducibility. All items of the Portuguese version of the mPEI were found to be equivalent to the original English version. There were strong item-scale correlations that confirmed construct validity, with a one component structure and good internal consistency (Cronbach’s alpha >0.8) as well as high test–retest reliability (ICC=0.85). The mPEI showed sound psychometric properties for the evaluation of enablement in patients with asthma making it a reliable instrument for use in research and clinical practice in Portugal. Further studies are needed to confirm its responsiveness.

Misuse of inhalers devices in clinical practice

In COPD, therapeutic success depends on a correct inhalation technique, and the choice of inhaler devices (ID) can be as determinant as the drug itself. We present the preliminary results of an ongoing prospective cross-sectional study aimed to assess the patient’s inhaler technique in COPD patients, diagnosed according to GOLD guidelines. We defined a check-list with five steps for each ID, for a correct inhalation technique, as well as essential steps and critical errors, and patient were asked to demonstrate their inhaler technique. A statistics analysis was then performed. We studied 203 COPD outpatients over 40 years-old (median 67,16 years), performing a total of 336 inhalations (30,4% incorrect). Ten types of IDs were examined, and misuse access according to priming/loading and inhalation procedures. Misuse ranged from 27,6% for soft-mist inhaler to 50,0% for pMDI, and in DPIs group from 0% for Aeroliser® to 48,3% for Handihaler®. Preference reasons for an inhaler were the ease of use (39,8%), their characteristics (25,2%) and seem more practical to use (25,2%). No significant relationship was found between correct use and patient preference (p=.236). There was also no significant relationship between the correct use and the number of inhalers used per patient (p=.531). Despite technological advances, inhalers mishandling remains an important clinical issue. A good inhalation technique depends on the type of ID. Poor coordination and inhalation failure remain cause of pMDI misuse. Soft-mist inhaler is the type of ID with the low rates of incorrect use. Misuse was not associated with multiple inhalers use nor to patient’ preference. Copyright ©the authors 2017

The prevalence of comorbidities in COPD patients, and their impact on health status and COPD symptoms in primary care patients: a protocol for an UNLOCK study from the IPCRG

Funding The IPCRG provided funding for this research project as an UNLOCK Group study for which the funding was obtained through an unrestricted grant by Novartis AG, Basel, Switzerland. Novartis has no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. This study will include data from the Optimum Patient Care Research Database, and is undertaken in collaboration with Optimum Patient Care and the Respiratory Effectiveness Group, which will provide the data for this initiative without charge to the UNLOCK Group.

The respiratory research agenda in primary care in Portugal: a Delphi study

BackgroundA research agenda can help to stimulate and guide research. The International Primary Care Respiratory Group (IPCRG) published a Research Needs Statement (RNS) in 2010 in which 145 research questions were identified. In 2012, priorities for respiratory research were established, based on these questions. To date, there has been no statement on primary care respiratory research needs in Portugal. The aim of the study was to develop a national consensus on research priorities in respiratory diseases in primary care in Portugal and to assess the applicability of the priorities for respiratory research set by the IPCRG.MethodWe conducted a Delphi study by electronic mail with a panel of experts on respiratory disease from primary and secondary care in Portugal. In the first round, the research needs in respiratory disease in Portugal were identified. In the second round, 196 research questions in six disease areas, derived from the first round and from the IPCRG Respiratory needs statement, were prioritised on a five-point Likert-type scale. In the third round, the questions were prioritized again with feed-back provided on the median scores for each item in the second round. Consensus was considered to have been reached when 80 % of the participants gave a score of 4 or 5 out of five on a given item.ResultsThe 40 experts identified 121 respiratory research questions in Round 1 and expressed their views on 196 questions in Rounds 2 and 3. Twelve research questions (6 %) reached consensus. There were five questions in the asthma domain on early diagnosis, pulmonary function tests, the use of inhalers, and adherence to treatment. There were four questions in the chronic obstructive pulmonary disease domain on vaccinations, on routine monitoring and evaluation of treatment, on diagnosis, and on adherence to treatments. There was one question in the smoking domain on the effects of brief counselling. There were two questions on respiratory tract infections on the treatment of children and on the prescription of antibiotics. An additional 23 research questions (12 %) achieved consensus between 75 and 79 %.ConclusionThe results reflect the Portuguese reality in response the international agenda for research on respiratory diseases published by the IPCRG. They can support the development of future respiratory disease research in Portugal.