FM - Contribuições em Revistas Científicas / Contribution to Journals
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- Delayed intervention in a giant coronary bypass saphenous graft aneurysm: a case reportPublication . Passos, Mariana; Gerardo, Filipa; Loureiro, José; Magno, Pedro; Augusto, João Bicho
- Dexamethasone in brain tumor patients: a real-world pharmacovigilance auditPublication . Prasad, Vindhya; Elhag, Ali; Onyiriuka, Louis; Mthunzi, Engelbert; Hatch, Sarah; Naeem, Awais; Noureldin, Fatmahelzahraa; Marchi, Francesco; Raslan, Ahmed; Chowdhury, Yasir A.; Shapey, Jonathan; Gullan, Richard; Bhangoo, Ranjeev; Vergani, Francesco; Ashkan, Keyoumars; Lavrador, José PedroIntroduction: Dexamethasone is routinely prescribed for the management of peritumoral edema in brain tumor patients. Despite available orientations for its management in neuro-oncology patients, the individual needs according to the natural history of the disease and treatment options allied to a hierarchical system with multiple teams involved poses significant challenges in its real-world application. Methods: We conducted a retrospective single-centre observational study of 316 brain tumor referrals to a tertiary neurosurgical center over a 3-month period. Data was extracted from referral notes, multidisciplinary team (MDT) documentation and clinical records. Steroid-related variables such as indication, dose, duration, weaning plan, complications, and follow-up practices were collected alongside demographic and clinical data. Results: Of 316 referrals, 210 patients (66.5%) were started on steroids at baseline, yet only 6% had a documented weaning plan at that point. MDT referral occurred in 252 patients (79.7%), where steroid initiation was significantly associated with surgical management (χ2 = 13.1, p < 0.001). However, only 28.8% of MDT-referred patients had a documented steroid plan, with higher rates in surgical patients (41.3%) than those managed conservatively or with best supportive care (BSC) (16.5%, p < 0.001). Steroid-related complications occurred in 11.4% (24/210) of patients, most commonly wound infections. Prolonged steroid use (>2 weeks) (OR = 3.5, [95% CI: 1.1–11.0], p = 0.04), and absence of an MDT steroid plan (OR = 4.2, [95% CI: 1.2–15.0], p = 0.03) were significant predictors of complications, particularly of Common Terminology Criteria for Adverse Events (CTCAE) Grade 2–3 severity. Nurse-led clinic follow-up was more common in surgical patients (91%) than BSC patients (24.6%, p < 0.001) and supported steroid monitoring. Discussion: Prolonged steroid use and incomplete documentation of steroid plan were associated with increased steroid-related complications highlighting the need for more robust prescribing protocols and improved multidisciplinary follow-up.
- Large language models in cardiovascular prevention: a narrative review and governance frameworkPublication . Ferreira Santos, José; Dores, HélderBackground: Large language models (LLMs) are becoming progressively integrated into clinical practice; however, their role in cardiovascular (CV) prevention remains unclear. This review synthesizes current evidence on LLM applications in preventive cardiology and proposes a governance framework for their safe translation into practice. Methods: We conducted a comprehensive narrative review of literature published between January 2015 and November 2025. Evidence was synthesized across three functional domains: (1) patient applications for health literacy and behavior change; (2) clinician applications for decision support and workflow efficiency; and (3) system applications for automated data extraction, registry construction, and quality surveillance. Results: Evidence suggests that while LLMs generate empathetic, guideline-concordant patient education, they lack the nuance required for unsupervised, personalized advice. For clinicians, LLMs effectively summarize clinical notes and draft documentation but remain unreliable for deterministic risk calculations and autonomous decision-making. System-facing applications demonstrate potential for automated phenotyping and multimodal risk prediction. However, safe deployment is constrained by hallucinations, temporal obsolescence, automation bias, and data privacy concerns. Conclusions: LLMs could help mitigate structural barriers in CV prevention but should presently be deployed only as supervised “reasoning engines” that augment, rather than replace, clinician judgment. To guide the transition from in silico performance to bedside practice, we propose the C.A.R.D.I.O. framework (Clinical validation, Auditability, Risk stratification, Data privacy, Integration, and Ongoing vigilance) as a roadmap for responsible integration.
- Transforming mental health care - policy implementationPublication . Ribeiro, H. Prata; Mackay, P.; Azevedo, E.; Bettencourt, N.Introduction: The Autonomous Region of the Azores faced considerable challenges in providing comprehensive, efficient, and integrated mental health care services, exacerbated by geographical isolation, resource constraints, and the absence of a cohesive system for referrals and quality assessment in mental health care. Objectives: Despite the recognized need, the integration of mental health services into primary health care (PHC) and the broader health system in the Azores was fragmented. Key issues included lengthy waiting lists, inadequate referral systems between primary care and specialized psychiatric services, and a lack of standardized quality assessment and performance indicators for mental health care. Additionally, there was a significant need for community mental health teams, emergency management of agitated patients, and comprehensive training for health professionals in psychiatric care. Methods: Through collaborative efforts, the region achieved notable advancements, including the creation of referral criteria from PHC to psychiatry services, structuring inter-service referrals, reactivation of Community Mental Health Teams, and establishment of a “Physician’s Bank.” Noteworthy was the elimination of a waiting list of over 1,000 patients and the development of quality assessment and performance indicators. The construction of a courtyard for involuntarily hospitalized patients and the creation of an emergency room on Faial Island further exemplified the tangible improvements in patient care and system efficiency. Training programs were extensively implemented across various professional groups, enhancing the capacity for mental health care delivery at all levels. Results: The integration efforts underscored the value of cross-sector collaboration, stakeholder engagement, and the adaptation of models like the SURE framework and COM-B theory to address the multifaceted barriers to mental health care integration. Key facilitators included the development of guidelines, training, and clinical supervision, alongside innovative approaches to public health interventions. Conclusions: The transformative work in the Azores exemplifies how integrated care models, supported by strategic collaborations and policy reforms, can significantly enhance mental health service delivery in geographically isolated regions. It underscores the importance of systemic approaches to training, infrastructure development, and stakeholder engagement in achieving sustainable improvements in mental health care.
- Structural versus functionally-informed supratotal resection: where do we stand?Publication . Chowdhury, Yasir A.; Gullan, Richard; Ashkan, Keyoumars; Vergani, Francesco; Bhangoo, Ranjeev; Lavrador, José Pedro
- Troponin/lymphocyte ratio: anticipating immunotherapy-induced myocarditisPublication . Miranda, Inês; Augusto, João Bicho
- Physical impact and health-related quality of life of SCD in adults: the real-world Portuguese ASCEND StudyPublication . Saunders, Christopher J.; Martins, Madalena; Major, Marinela; Favas, Catarina; Tomé, Ana; Vargas, Fernanda; Martins, Joana Rosa; Costa, Ryan Silva; Deveza, Maria Manuel; Pires, Filipa; Maia, Tabita Magalhães; Santos, João Gaião; Bento, Celeste; Fonseca, Inês; Moital, Inês; Brás, DanielObjectives: SCD negatively impacts patient’s health-related quality of life (HRQoL). The ASCEND study investigated how SCD impacts the HRQoL of adults in Portugal, focusing on its physical, emotional, and social burdens. Methods: This non-interventional, cross-sectional study included two cohorts of adult SCD patients from seven Portuguese Reference Centers (Cohort 1) and the Portuguese Patient Association (Cohort 2). Sociodemographic and patient-reported outcomes were collected for both cohorts, along with clinical data for Cohort 1, between February and September/2022. Results: 211 adult SCD patients (Cohort 1: 200; Cohort 2: 11) were included (median age of 33.0 years, 58.8% male). Nearly 90% reported complications. Patients were diagnosed at a median age of 2.0 years, mainly with the HbSS variant (89.0%), and 86.0% were under treatment (73.5% on hydroxyurea, 45.0% on chronic transfusion). All had lifetime pain episodes, with 72.6% experiencing at least one in the previous year. Most (91.9%) adopted daily strategies to prevent pain episodes, 67.1% had pain management plans, and 46.7% self-managed crises at home. Pain/discomfort (60.6%) and anxiety/depression (51.0%) were major problems (median EQ-5D-5L score = 0.91), affecting emotional well-being (53.8%) and/or social life (49.0%). Indeed, less frequent pain significantly correlated with improved HRQoL (P = .001). While 40.0% felt neglected, 70.5% rarely or never experienced solitude, and 84.6% reported a sense of support. Conclusion: The ASCEND study reveals the multifaceted impact of SCD on adults in Portugal and its influence on HRQoL, emphasizing the need for a multidisciplinary care approach and effective self-management education to improve patient outcomes.
- Twenty years of courage and compassion: leading palliative care with dignity and visionPublication . Neto, Isabel Galriça
- Disrupções na força de trabalho e redefinição dos papéis clínicos: o estado da arte da inteligência artificial em saúdePublication . Frutuoso, João; Pina, Ana; Maria, Ana Rita; Pereira, Manuel; Neves, Bernardo Duque; Donato, Helena; Carneiro, António VazO nosso objetivo foi analisar o impacto da integração da inteligência artificial na saúde, com foco nas alterações da força de trabalho, redefinição de papéis clínicos e implicações éticas e organizacionais. Foram realizadas pesquisas nas bases de dados PubMed, Scopus e Web of Science Core Collection, bem como em documentos institucionais, a partir das quais se desenvolveu uma revisão narrativa centrada na aplicação da inteligência artificial em contextos clínicos, administrativos e educacionais e nas suas implicações para a força de trabalho em saúde. A evidência mostra maturidade de implementação em áreas como imagiologia médica e sistemas de apoio à decisão clínica. As aplicações administrativas expandem-se em registos, faturação e planeamento. Entre os benefícios descritos destacam-se maior precisão diagnóstica, personalização terapêutica, eficiência organizacional e melhoria da segurança do doente. Entre os riscos identificados salientam-se a substituição de funções, erosão de competências, precarização laboral e sobrecarga cognitiva quando a tecnologia é mal integrada. A adoção sustentável da inteligência artificial em saúde requer avaliação de desempenho em cenários do mundo real, interoperabilidade, transparência algorítmica e governação ética robusta. A integração deve ser sociotécnica, equilibrando inovação tecnológica com preservação de competências humanas essenciais, proteção de valores éticos e estabilidade da força de trabalho.