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- 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.
- Therapeutic plasma exchange-a practical guidePublication . Pais, Mariana Dias; Gaspar, Ana; Coelho, SilviaTherapeutic plasma exchange is a procedure in which plasma is removed and replaced with another fluid to correct blood abnormalities. There is growing evidence of its benefit in certain clinical conditions, including thrombotic thrombocytopenic purpura, hematological diseases, and immune-mediated neurological disorders. Therapeutic plasma exchange prescription includes the choice of technique (centrifugation or membrane filtration) and the choice of vascular access, as well as the total plasma volume to be exchanged, the type of replacement fluid, the number and frequency of sessions, and the method of anticoagulation. These patients may be critically ill and undergo this technique in an intensive care unit, where the intensivist manages the procedure independently or in collaboration with other specialists. We aim to make an easy-to-follow general prescription of this procedure, by offering a practical revision that empowers physicians, such as nonautonomous intensivists, to autonomously prescribe and manage this procedure, reducing delays in initiating treatment and addressing complications.
- Inconsistent risk stratification thresholds across European guidelines: a call for harmonizationPublication . Santos, José Ferreira; Ladeiras-Lopes, Ricardo; Dores, Hélder
- Thromboembolic disease in testicular germ cell tumors-real-world evidence of three Portuguese institutionsPublication . Albuquerque, Joana; Oliveira, Martim; Neto-Silva, Diana; Margarido, Inês; Correia, Jorge; Baptista, Carlota; Machete, Madalena; Bizarro, Rita; Rato, João; Godinho, João; Teixeira, José Alberto; Passos-Coelho, José LuísIntroduction: Testicular germ cell tumors (TGCTs) are highly curable malignancies with long-term overall survival (OS) exceeding 90%. Thromboembolic (TE) events are a relevant treatment-related complication, reported in approximately 10% of patients. This study aimed to evaluate the incidence, risk factors, and prognostic impact of TE in TGCT. Methods: We performed a retrospective multicenter cohort study including 136 post-pubertal male patients with histologically confirmed TGCT treated between 2007 and 2021 at three Portuguese centers. The primary endpoint was to characterize the population of TGCT patients with TE. Secondary endpoints included TE incidence and its impact on OS and progression-free survival (PFS). Identification of clinical, pathological, and treatment-related factors associated with increased TE risk was an exploratory endpoint. Results: Seven patients (5.1%) developed a TE event, all in advanced/recurrent disease (14.6% in this subgroup). No TE occurred in stage I patients, including those treated with adjuvant chemotherapy. Visceral metastases (pulmonary and extra-pulmonary) and poor IGCCCG prognosis were associated with TE (p < 0.05). All TE patients had a central venous catheter (CVC), although only two had catheter-related thrombosis (p = 0.019). For advanced stages, survival outcomes did not differ significantly, with 5-year OS of 71.4% vs. 86.2% (p = 0.22) and PFS of 47.6% vs. 75.5% (p = 0.23) in TE versus non-TE groups, respectively. Most events (86%) occurred within 30 days of chemotherapy initiation, with pulmonary embolism as the most frequent presentation. Neither the Khorana nor the ONKOTEV scores predicted TE. Discussion: TE in TGCT occurred only in patients with advanced disease, was linked to tumor burden and CVC use, and was not predicted by current models. These findings highlight the need for TGCT-specific risk tools and prospective studies on risk-adapted prophylaxis.
- Importance of coronary artery lumen size in the relationship between coronary artery plaque and vessel-specific ischemia: a post hoc analysis of CREDENCE and PACIFIC-1Publication . CREDENCE and PACIFIC-1 Investigators; Marques, HugoBackground: While coronary artery plaque burden and stenosis are important for development of ischemia, the role of lumen size remains underexplored. This study evaluated the relationship between average lumen area (ALA) and vessel-specific ischemia beyond diameter stenosis (DS) and percent atheroma volume (PAV). Methods: This post-hoc analysis included coronary arteries from the CREDENCE (n ?= ?1716) and PACIFIC-1 (n ?= ?612) trials, involving patients with suspected stable coronary artery disease (CAD) who underwent coronary computed tomography angiography (CTA) and invasive fractional flow reserve (FFR) measurement. AI-enabled quantitative CTA was used to assess plaque burden and composition. Ischemia was defined as FFR?0.80. Each major coronary artery was analyzed. ALA was stratified into tertiles. Results: Larger ALA was associated with younger age, higher body mass index, and more nitrate use in both cohorts (all p ?< ?0.05). Increasing ALA correlated with lower diameter stenosis, reduced ischemia prevalence, and smaller plaque burden despite greater total plaque and non-calcified plaque volumes. In both cohorts, ischemia prevalence increased with stenosis severity, yet within each stenosis category, vessels with smaller ALA showed consistently higher ischemia rates. E.g., in CREDENCE vessels with 50 ?%–70 ?% stenosis, ischemia was observed in 60.0 ?% of small, 43.8 ?% of medium, and 27.8 ?% of large vessels (all p ?< ?0.05). Similar patterns were observed within PAV strata across all plaque subtypes. Multivariable analysis confirmed ALA independently associated with lower ischemia prevalence in both studies (both p ?< ?0.001). Conclusions: Coronary artery lumen size significantly attenuates the relationship between atherosclerosis/stenosis and ischemia. These findings support integrating lumen assessment in coronary CTA-based risk stratification.
- Caregiver perceptions of the impact and effect of family conferences for patients with complex and high-level palliative care needs: a cross-sectional survey studyPublication . Nascimento, Ana; Brandão-Silva, Joana; Cunha, Daniela; Ramos, Iliana; Pereira, Cristina; Semedo, Valéria; Andrade, José Paulo; Rocha-Neves, João; Dourado, Marília; Ribeiro, HugoIntroduction: Family conferences (FC) are a structured and therapeutic tool in palliative care, promoting effective communication between the healthcare team, patient and family. They are especially relevant for patients with high clinical complexity, both in hospital settings and in primary care. Objective: To evaluate caregivers’ perceptions of the impact of FC on patients cared for by palliative care teams and/or primary healthcare clinicians (PHC). This included measuring quality of care, communication effectiveness, interprofessional collaboration, successful implementation of care strategies, clarity of information received, and overall satisfaction and confidence. Secondary objectives were to assess caregivers’ perceptions of the importance of FCs for their knowledge and attitudes/skills, and to evaluate their perception of the overall quality of care provided to the patient, including the concordance between desired and actual place of death as an indicator of effective end-of-life planning. Methods: Observational, analytical and cross-sectional study, with application of a specific questionnaire to caregivers of patients followed by a community palliative care team and a family health team. Sociodemographic and clinical variables and perceptions of the impact of FC on the understanding of the disease and its trajectory, on satisfaction and on the feeling of security and trust were analysed. Results: The total sample included 38 caregivers, of whom 20 were accompanied by a team specialized in palliative care and 18 by a family health team. There was a high percentage of female caregivers (78.9%), with a mean age of 58.1 years, and the mean age of patients was 80.7 years. FC was associated with improved perception of communication (9.36 ± 0.65), collaboration (9.50 ± 0.86) and implementation of care strategies (9.45 ± 0.83). The presence of professionals such as social workers and psychologists in the FC of the palliative care team associated with greater family participation (p = 0.002) and greater perceived support (p = 0.001). Among the patients who died, there was a significant correspondence between the desired and actual place of death (p = 0.007), demonstrating FC as a potential effective instrument for planning. The presence of more family members in the FC correlated with greater hospital use in the previous month (p < 0.001) and with greater case complexity. Discussion: Despite being an exploratory study with inherent limitations, FCs were perceived as effective in improving communication, planning and aligning care with patient and family preferences. Their regular implementation, especially in PHC, should be promoted with multidisciplinary teams and specific training.
- CASPR2 autoimmune antibodies induce neuronal hyperactivity in human brain organoidsPublication . Cammarata, Giuseppe; Cardoso, Ana Luísa; Cardoso, Ana Maria; Carvalho, Ana Luísa; Coutinho, Ester; Fernandes, Dominique; Ferreira, Lino; Guedes, Joana; Leite, Maria Isabel; Oliveira, Ana Rafaela; Oliveira, Guiomar; Peça, João; Santos, Henrique J.; Santos, João Miguel Marques; Seabra, Catarina; Sequeira, DianaGestational transfer of brain-reactive antibodies is a risk factor for neurodevelopmental disorders. Contactin-associated protein-like 2 (CASPR2) is a known target for pathogenic maternal autoantibodies which have been proposed to interfere with fetal neurodevelopment. However, the impact of CASPR2 antibodies on human brain development remains largely unknown. Here, to better understand the neurophysiological changes that occur in the presence of these pathogenic autoantibodies, we cultured unguided human neural organoids for a period of 6-months in media containing anti-CASPR2 antibodies. We then performed neurophysiological characterization via whole-cell patch-clamp and calcium imaging in acute organoid slices. Our results reveal that CASPR2 antibody exposure increased spontaneous synaptic activity, enhanced the maximal frequency of action potential firing and of spontaneous network activity. These findings are consistent with a state of neuronal hyperexcitability, a phenotype which is observed in several models of neurodevelopmental disorders. Mechanistically, the alterations observed in action potential waveform are in accordance with a role for CASPR2 in the regulation of voltage-gated potassium channels and a pathological role for CASPR2 autoantibodies in driving neuronal hyperexcitability.
- The first year of generic non-vitamin K oral anticoagulants: implications for patients and the healthcare systemPublication . Sousa, Rita Barbosa; Oliveira, Afonso Félix de; Oliveira, Eduardo Infante de
- Managing schizophrenia with affective, sexual, metabolic and substance-use comorbidities: pharmacological considerations from an expert consensusPublication . Vieta, Eduard; Montejo, Ángel L.; Pillinger, Toby; Dell’Osso, Bernardo M.; Dimitraka, Maria; Farooq, Saeed; Jesus, Gustavo; Torres, Carlos Parro; Wobrock, Thomas; Pappa, SofiaBackground: Schizophrenia is a complex psychiatric disorder frequently complicated by comorbidities that contribute to functional impairment, poor treatment adherence, and elevated mortality. Among the most prevalent and burdensome are affective symptoms, sexual dysfunction, metabolic disturbances, and substance use disorders, which remain underrecognized and insufficiently addressed in routine care. Objectives: This expert consensus aimed to develop comorbidity-informed pharmacological strategies for schizophrenia, grounded in real-world challenges and individualized treatment needs. Methods: A multidisciplinary panel of 10 European psychiatrists convened for an in-person meeting. Four expert-led presentations, each addressing a key comorbidity, were followed by open discussion. A modified two-round Delphi process was subsequently used to validate the consensus statements, which were thematically synthesized into actionable recommendations. Results: Consensus-based recommendations were developed across four comorbidity domains, integrating current evidence with real-world clinical expertise. The panel emphasized the importance of individualized, patient-centered pharmacological strategies that balance efficacy, tolerability, and long-term functional outcomes. Partial dopamine agonists and other metabolically or hormonally favorable agents were identified as clinically useful across several comorbid profiles. Recommendations also addressed the optimization of antipsychotic selection, management of treatment-emergent side effects, and coordinated care for patients with dual diagnosis (also referred to as co-occurring disorders). Measurement-based monitoring and integrated service models were consistently highlighted as essential for improving outcomes. Conclusions: Effective management of schizophrenia requires a shift toward comorbidity-informed, recovery-oriented pharmacological care. These expert recommendations provide practical strategies to support individualized treatment planning in real-world clinical settings.