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PurposeThe aim of this study was to compare the Ilizarov circular fixator (IL) and locked intramedullary nailing (IM).Patients and methodsPatients with isolated tibia shaft fractures were randomly allocated to either the IL (n = 31) or IM (n = 27) method. Conventional radiographs, postoperative pain assessment, self-appraisal scores and complications were evaluated. At the clinical 1-year follow-up, the patients were also evaluated by an independent observer.ResultsThe minority of patients had open fractures, two and nine patients in the IM and IL groups, respectively. Eight patients in the IM group and four in the IL group sustained major complications (p = 0.107). In the IM group, two patients developed compartment syndrome, one deep infection, one hardware failure, one delayed union, one pseudarthrosis and two had a malunion. In the IL group, two patients developed pseudarthrosis and two had a malunion. Superficial pin-site infections were observed in 16 patients in the IL group. The fractures had healed radiographically at 12 weeks in both groups. At the 1-year follow-up, there were differences in pain (VAS) and satisfaction (VAS) scores in favor of IL treatment (VAS, p = 0.03 and p = 0.02, respectively). There were no differences between the groups with regard to range of motion (ROM) in the knee and ankle joints. The registration of local tenderness and pain revealed that there were 19 patients with anterior knee pain in the IM group and one in the IL group at the 1-year follow-up (p < 0.001).ConclusionThe IL is a safe and reliable alternative to IM for the treatment of tibial shaft fractures, with a low complication rate and good clinical outcome. Both treatments were well tolerated, but at the 1-year follow-up the patients in the IM group had more pain and were less satisfied. Finally, there was a high frequency of anterior knee pain in the IM group.

Background In dislocated proximal tibial fractures, the most frequently used treatment is ORIF with screws and plates. Minimally-invasive techniques using external fixation are an alternative. The aim of this study was to analyse the clinical and radiological results using the Ilizarov technique in both uni- and bicondylar tibial fractures. Methods Thirty consecutive patients with isolated fractures of the proximal tibia were treated with the Ilizarov technique, 11 Schatzker I-IV with 2–3 rings and 19 Schatzker V-VI with 3–4 tibial rings and a femoral, hinged, two-ring extension. Unrestricted weight-bearing was allowed. Pre and post-operatively, conventional radiographs, computerized tomography scans, post-operative pain assessments and complications were evaluated. The knee function was evaluated with the EQ-5D, NHP and KOOS scores, as well as self-appraisal. Results All the fractures healed. Twenty-five patients achieved a range of motion better than 10-100º. The type I-IV fractures had a shorter operating time and hospital stay, as well as better knee flexion, and the self-appraisal indicated that they tolerated the treatment better. Pin infections occurred in 4% of the pin sites, but only two patients required debridement. Two patients developed compartment syndrome and underwent fasciotomy. No patient complained of functional knee instability. Two patients underwent a total knee arthroplasty because of residual pain. The overall result was judged as satisfactory in twenty-seven patients. Conclusions The Ilizarov method produces a good clinical outcome and is a valuable treatment alternative in proximal tibial fractures of all types.

Background The management of displaced distal tibial fractures is still controversial. The different internal fixation techniques are often burdened by relatively high complication rates. Minimally invasive techniques with ring fixators have been introduced as an alternative allowing immediate reduction and stabilization, avoiding a staged protocol. The aim of this prospective study was to analyze the clinical and radiographic outcome the Ilizarov technique in patients with distal metaphyseal tibial fractures, with or without intra-articular involvement. Methods Thirty-nine consecutive patients with isolated fractures treated with the Ilizarov technique were followed prospectively for one year. Depending on the type of fracture, 4 or 5 rings were used, in some cases with additional foot extension. Unrestricted weight-bearing was allowed in all cases. Pre- and post-operatively conventional radiographs, post-operative pain assessment and complications were evaluated. The function was evaluated clinically and with self-appraisal protocols: EQ-5D, NHP and FAOS. Results No patient developed compartment syndrome or deep venous thrombosis. Pin infections were frequent, but they were mostly superficial and were treated with antibiotics and/or the removal of isolated pins. Two patients required debridement. One of them had a deep infection and developed a residual deformity which was corrected and healed after re-operation. Another patient had a severe residual deformity. The fixator was removed after a median period of 16 weeks (range 11–30). The radiological results were poor in 5 patients but the overall self-appraisal showed satisfactory results in 36 patients. Conclusions The Ilizarov method allowed early definitive treatment with a low complication rate and a good clinical outcome.

A principal razão para a admissão de uma Pessoa numa unidade de saúde é segundo Joseph (2007) a procura de cuidados de enfermagem. Para análise do impacto da profissão de Enfermagem na Pessoa e nos resultados da organização a autora estabelece um modelo, onde a perspetiva do cuidar deve ser central e as características do profissional são influenciadoras da prestação de cuidados à Pessoa, do estabelecimento de uma relação Enfermeiro/Pessoa e Família, devendo ser analisados os resultados obtidos com a Pessoa ou Família. Collière (1999) refere uma reciprocidade temporária ou definitiva com a Pessoa e o processo de cuidar está inserido num sistema de crenças e valores, possuídos pelo cuidador e a quem são prestados os cuidados. O acesso a resultados na prática de Enfermagem avançada assume cada vez mais um papel de maior relevância. Segundo Williams referenciado por Marques (2000), a satisfação dos utentes pelos cuidados de enfermagem tem influência direta na satisfação com os cuidados hospitalares. Segundo a autora a Pessoa possui expectativas relativamente aos cuidados de enfermagem, influenciadas por fatores sociais, culturais, de personalidade e estado de saúde. A perceção sensorial e a interpretação da informação por parte da Pessoa, constitui a subjetividade da experiência dos cuidados de enfermagem. Estabeleço o conceito de Pessoa enquadrado no Paradigma da Transformação, definida segundo Kérouac, Pepin, Ducharme, Duquette e Major (2002) como um parceiro nos cuidados, encarado de uma forma singular, compreendendo um todo, de forma holística, onde a saúde e a doença é compreendido de forma contínua. Defino a minha intervenção na aquisição de competências como Enfermeiro Especialista, na perspetiva de responder às necessidades da Pessoa e Família, com intervenções de Enfermagem que podem ser classificadas no seu resultado, considerando os indicadores para avaliação da prestação dos cuidados de enfermagem. O controlo sobre as práticas estabelece a uniformização de procedimentos, com garantia da melhoria da qualidade dos cuidados prestados. Na perspetiva de prevenção e controlo da infeção, a abordagem da gestão de risco, identificando áreas de potencial risco de desenvolvimento de eventos não expectáveis, veio determinar a minha intervenção neste estágio, na análise e ação nos cuidados específicos ao acesso vascular central. Este fator deve ser considerado como um indicador determinante na qualidade dos cuidados de enfermagem prestados, evidenciada pela taxa de infeção relacionada com cateteres vasculares centrais. Este relatório engloba as três perspetivas, estabelecendo uma abordagem direta sobre a intervenção de um Enfermeiro Especialista nos diferentes contextos, com um enquadramento geral da prestação de cuidados à Pessoa e Família, análise do desempenho e compreensão do seu efeito, com a aquisição de novas competências. Considero que o efeito dos cuidados de enfermagem na Pessoa pode ser considerado como um indicador da qualidade dos cuidados prestados, qualificando o papel do Enfermeiro Especialista e avaliando a ação da equipa de Enfermagem

A avaliação da performance é essencial numa organização para orientação da estratégia e definição de recursos para o cumprimento da missão, proporcionando uma avaliação de diagnóstico e operacional. As equipas devem ser orientadas para sistemas de trabalho flexíveis, com capacidade de absorver mudanças na perspectiva da melhoria contínua, através do estabelecimento de objectivos e medidas para avaliação da eficiência dos planos estabelecidos. As alterações provocadas pelas restrições económicas e o aumento da qualidade dos cuidados motivaram uma reavaliação das medidas para avaliação da performance.Com base numa amostra de 74 colaboradores de uma instituição de índole privada que presta tratamentos de hemodiálise, o presente estudo que procurou analisar o impacto do clima de serviço, fiabilidade organizacional, coordenação relacional e aprendizagem organizacional na percepção do desempenho da organização. O modelo de análise explica 21% da variância da percepção do desempenho da organização. Destaca-se como preditor significativo a aprendizagem organizacional(β = 0,30; ρ <0,05). Numa análise adicional, foi verificado o impacto da percepção do desempenho dos profissionais de enfermagem na percepção do desempenho da organização, concluindo-se que a percepção do desempenho dos profissionais de enfermagem não influencia positivamente a percepção do desempenho da organização.Pese embora esta clínica seja muito representativa devido à sua dimensão e importância estratégica, não é possível extrapolar conclusões para todas as instituições pertencentes ao grupo. Propomos um trabalho de investigação englobando mais instituições, com a definição de indicadores de desempenho adequados para avaliação da percepção dos profissionais do desempenho das organizações.

Mid-ocean ridges generate a myriad of physical oceanographic processes that favor the supply of food and nutrients to suspension- and filter-feeding organisms, such as cold-water corals and deep-sea sponges. However, the pioneering work conducted along the Mid-Atlantic Ridge failed to report the presence of large and dense living coral reefs, coral gardens, or sponge aggregations. Here, we describe the densest, near-natural, and novel octocoral garden composed of large red and white colonies of Paragorgia johnsoni Gray, 1862 discovered at 545–595 m depth on the slopes of the Mid-Atlantic Ridge, in the Azores region. This newly discovered octocoral garden is a good candidate for protection since it fits many of the FAO criteria that define what constitutes a Vulnerable Marine Ecosystem. The observations described here corroborate the existence of a close relationship between the octocoral structure and the ambient currents on ridge-like topographies, providing new insights into the functioning of mid-ocean ridges' ecosystems. The ubiquitous presence of biogenic and geological topographies associated with mid-ocean ridges, which could act as climate refugia, suggests their global importance for deep-sea biodiversity. A better understanding of the processes involved is, therefore, required. Our observations may inspire future deep-sea research initiatives to narrow existing knowledge gaps of biophysical connections with benthic fauna at small spatial scales along mid-ocean ridges.

Seamounts are among the most common physiographic systems in the global deep ocean, defining habitat for a hugely diverse biome. Great Meteor Seamount is located in the subtropical Northeast Atlantic and is considered one of the largest seamounts worldwide. Despite its remoteness, it remains one of the few seamounts globally with a long research history dating back more than 50 years. In this study, we aim to review the recent history of scientific research at Great Meteor Seamount, integrating multidisciplinary datasets of the entire seamount ecosystem, including data on plankton, benthos, fishes, and physical oceanography. The interaction of the seamount topography with background low-frequency and tidal currents creates a unique dynamical response due to its location at the critical latitude for seamount trapped diurnal waves, and the high amplitudes of semidiurnal tides. Biological observations show elevated patchiness on horizontal scales smaller than the seamount, which compares well to other seamounts with shallow summits. Regardless of ecosystem pressures associated with geographic isolation and the nutrient and organic matter deprivation inside the North Atlantic Subtropical Gyre, Great Meteor Seamount hosts a diverse species composition including megafaunal taxa such as sponges and corals, as well as species rich fish populations and meiofaunal groups of copepods and nematodes. Due to the ecological vulnerability of seamount habitats to unsustainable exploitation and their important role as open ocean hotspots of marine life, the Portuguese government plans to designate Great Meteor Seamount as a Marine Protected Area (MPA) under the European Marine Strategy Framework Directive. Here, we summarize and recount important results from the long history of research at Great Meteor Seamount in the context of present-day challenges and the initiatives to protect vulnerable ecosystems.

The identification of areas that fit the Food and Agriculture Organization of the United Nations (FAO) criteria to define what constitutes a Vulnerable Marine Ecosystem (VME) has been the main policy driver for the protection of deep-sea environments in Areas Beyond National Jurisdictions (United Nations General Assembly, 2006; FAO, 2009) in relation to bottom fisheries. At the same time, the Convention on Biological Diversity advocates for the implementation of representative networks of Marine Protected Areas (MPAs) in the open ocean and the deep sea, and calls for the identification of Ecologically or Biologically Significant marine Areas (EBSAs; Convention on Biological Diversity, 2008, Decision IX/20). Although VMEs and EBSAs are conceptually different, Ardron et al. (2014) argue that the designation of VMEs, EBSAs, and large open-ocean MPAs should be aligned to ensure that VMEs are incorporated within area-based management tools. The International Council for the Exploration of the Sea (ICES) adopted a Multi-Criteria Assessment (MCA) methodology for informing the identification of VMEs in the North-East Atlantic (ICES, 2016a,b; Morato et al., 2018). The MCA is a taxa-dependent spatial method that incorporates the fact that not all VME indicators are equally vulnerable to human impacts, and thus should not be weighted equally. By including a measure of the confidence associated with each VME record, this methodology also considers some of the uncertainties associated with the sampling methodologies, the reported taxonomy, and data quality issues. Equally important, it highlights areas in the North Atlantic that have been poorly sampled and that require further attention. Finally, this methodology also allows for the evaluation and comparison of VME index with spatial fisheries data that may directly generate significant adverse impacts on VMEs. Although the VME Index has been used since 2018 in ICES advice, several caveats and limitations have been identified (ICES, 2018, 2019, 2020). The main criticism refers to the fact that the VME index signals the presence of VME indicator taxa that are considered to be the most important rather than showing the likelihood of an area containing a spatially explicit VME. Also, concerns over the abundance scores adopted have been raised and it has been suggested that abundance thresholds should be defined for each VME indicator. It is, therefore, recognized that improvements of the VME index and the way actual VMEs are identified are still necessary. The identification of representative areas that can form a network of MPAs in the deep sea requires ocean basin-scale approaches grounded on ocean basin-scale datasets. In this regard, the H2020 ATLAS project (GA 678760) performed a unique trans-Atlantic assessment of deep-water ecosystems to inform Atlantic Ocean basin-scale governance. The ATLAS project compiled the best available data on VME indicator taxa for the North Atlantic (Ramiro-Sánchez et al., 2020) in order to assist with the identification of locations that may constitute VMEs and EBSAs, as a precursor to the development of a North Atlantic wide network of MPAs. Here, we applied the ICES MCA method to the ATLAS VME indicator taxa database to produce and make publicly available a new “North Atlantic Ocean basin-scale VME index dataset,” facilitating further consultation and use by scientists, managers, or other relevant stakeholders.