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- Hope-centred care approach: strategies for nursing educationPublication . Charepe, Zaida
- AI-driven quantitative coronary CT angiography in suspected coronary artery diseasePublication . Rosendael, Alexander van; Nakanishi, Rine; Bax, Jeroen J.; Pontone, Gianluca; Mushtaq, Saima; Buechel, Ronny R.; Gräni, Christoph; Feuchtner, Gudrun; Lacaita, Pietro G.; Patel, Amit R.; Singulane, Cristiane C.; Choi, Andrew D.; Al-Mallah, Mouaz; Andreini, Daniele; Karlsberg, Ronald P.; Cho, Geoffrey W.; Rochitte, Carlos E.; Alasnag, Mirvat; Hamdan, Ashraf; Cademartiri, Filippo; Maffei, Erica; Marques, Hugo; Gonçalves, Pedro de Araújo; Gupta, Himanshu; Hadamitzky, Martin; Khalique, Omar; Kalra, Dinesh; Mills, James D.; Nurmohamed, Nick S.; Knaapen, Paul; Budoff, Matthew; Shaikh, Kashif; Martin, Enrico; German, David M.; Ferencik, Maros; Oehler, Andrew C.; Deaño, Roderick; Nagpal, Prashant; Assen, Marly van; Cecco, Carlo N. De; Kamperidis, Vasileios; Foldyna, Borek; Brendel, Jan M.; Cheng, Victor Y.; Branch, Kelley R.; Bittencourt, Marcio; Bhatti, Sabha; Polsani, Venkateshwar; Wesbey, George; Cardoso, Rhanderson; Blankstein, Ron; Delago, Augustin; Pursnani, Amit; Alsaid, Amro; Bloom, Stephen; Aquino, Melissa; Danad, IbrahimBackground: Plaque assessment by quantitative coronary CT angiography has demonstrated to correlate highly with intravascular ultrasound and optical coherence tomography, and these modalities have shown strong prognostic value.ObjectivesThe purpose of this study was to identify the prognostic value of artificial intelligence–guided quantitative CCTA (AI-QCT) for major adverse cardiovascular events (MACE) against the risk factor–weighted clinical likelihood model. Methods: The CONFIRM2 (COroNary CT Angiography Evaluation For Evaluation of Clinical Outcomes: An InteRnational, Multicenter Registry) is a multicenter, international, observational cohort study that included patients with clinically indicated CCTA and follow-up for MACE. Patients without cardiac symptoms and prior coronary artery disease (CAD) were excluded. Across the entire coronary artery tree, the presence, extent, and composition of CAD were analyzed by an AI-QCT software, and 24 variables at a patient, vessel, and plaque level were derived, including percent luminal narrowing, remodeling index, plaque volumes (total, calcified, noncalcified, low attenuation), and plaque composition. The primary MACE endpoint was defined as a composite of all-cause death, myocardial infarction (MI), stroke, congestive heart failure, late revascularizations, and hospitalization for unstable angina. The secondary MACE endpoint was defined as all-cause death and MI. Results: A total of 3,551 patients (age 58.8 ± 12.5 years, 50.5% male) were followed for a median of 4.27 (IQR: 3.47-5.08) years during which 167 (4.7%) events occurred. After excluding collinear variables, diameter stenosis (HR: 1.25 [95% CI: 1.18-1.32]) per 10% increase and noncalcified plaque volume (HR: 1.07 [95% CI: 1.03-1.11]) per 50 mm3 increase were the only independent predictors for MACE. In multivariable modeling, the discriminatory value defined by area under the curve (AUC) improved from 0.63 (95% CI: 0.58-0.67) based on the risk factor–weighted clinical likelihood model to 0.76 (95% CI: 0.77-0.80), P < 0.001 when adding AI-QCT-based diameter stenosis and noncalcified plaque volume. A similar improvement in risk prediction was seen when adding AI-QCT (AUC 0.77; P < 0.001) to a model with traditional risk factors, age, and sex (AUC: 0.67). In addition, AI-QCT significantly improved discrimination compared to the atherosclerotic cardiovascular disease risk score (AUC: 0.63; 95% CI: 0.58-0.68) to 0.75 (95% CI: 0.69-0.80; P < 0.001). Similar results were seen for the secondary MACE endpoint of death/MI. Conclusions: This first multicenter global registry with AI-guided quantitative CT identified noncalcified plaque burden and increment in stenosis severity as the most powerful predictors of MACE, demonstrating the interplay between traditional and novel measures of the severity of CAD. Standardized and rapid quantitative assessment of CAD may improve clinical implementation of multidimensional assessment of CAD as a cornerstone for risk assessment.
- Reabilitação respiratória à pessoa adulta com fibrose quística: protocolo de revisão scopingPublication . Nabais, Ana; Queiroz, Soraia; Cardoso, Tiago; Ferreira, António; Ornelas, Sílvia; Viana, Maria Clara Roquette; Sousa, Patrícia PontifíceA Fibrose Quística é uma doença genética e autossómica recessiva. Caracteriza-se por um aumento da viscosidade das secreções, sendo a sua principal manifestação a nível respiratório, nomeadamente a dispneia, a tosse e a broncorreia excessiva. O tratamento e gestão da doença, incluem a Reabilitação Respiratória, realizada por equipas multidisciplinares, tendo como efeitos a melhoria da função respiratória, condição física, tolerância ao esforço e qualidade de vida. A metodologia seguirá as orientações da JBI Manual for Evidence Synthesis. Tendo por base o acrónimo PCC, serão considerados na revisão scoping estudos que façam referência a intervenções de Reabilitação Respiratória (Conceito) dirigidas à pessoa adulta com Fibrose Quística (População) independentemente do contexto. A pesquisa será realizada em três etapas nas bases de dados MEDLINE Complete, CINAHL Complete, Scopus, RCAAP e ProQuest Dissertations & Thesis (acesso através da plataforma Web of Science). A revisão será levada a cabo por dois revisores de forma independente e a extração dos dados será realizada através de um instrumento criado pelos mesmos. Os resultados serão apresentados numa tabela síntese. Esta revisão permitirá mapear a evidência disponível sobre as intervenções de Reabilitação Respiratória dirigidas à pessoa adulta com Fibrose Quística, de forma a contribuir para a tomada de decisão no planeamento de cuidados individualizados e efetivos, promovendo a melhoria da sua qualidade de vida.
- Hope in adults with inflammatory diseases: scoping review protocolPublication . Guedes, Ana; Santos, Joana; Torres, Joana; Capelas, Manuel Luís; Charepe, ZaidaObjective: This review seeks to map, analyse and describe in national and international literature the concept of hope in adults with inflammatory bowel disease to answer the following question: What do we know about hope in adults with inflammatory bowel disease? Introduction: Inflammatory bowel disease (IBD) is a chronic, progressively evolving disease whose prevalence is increasing, which demonstrates the need for more and better interventions to prevent and control these diseases in order to promote a better quality of life and overall well-being for those affected by them. Promoting hope is a spiritual necessity and understanding this need is crucial for improving patient-centred care and for promoting appropriate supportive intervention. Inclusion criteria: The review will include all the evidence identified that describes hope in adults (male and female, aged 18 or over) in outpatient, inpatient, or day hospital settings. Methods: The databases where the search was conducted are Pubmed, CINAHL complete (by EBSCO); JBI Database of Systematic Reviews and Implementation Reports; Cochrane Library, including Cochrane Database of Systematic Reviews (CDSR), Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effects (DARE); PsycINFO and PROSPERO-International prospective register of systematic reviews, as at November 2024.
- Dasatinib and quercetin senolytic treatment delays early onset intervertebral disc degeneration in SM/J micePublication . Novais, Emanuel J.; Ottone, Olivia K.; Jagannath, Sanjana; Akande, Esther Jesutofunmi; Barve, Ruteja A.; Risbud, Makarand V.Genetic background is a major determinant of disc degeneration, a leading cause of chronic back pain and disability. Herein, we demonstrate that premature disc cell senescence contributes to early-onset degeneration in SM/J mice and test two systemic senotherapeutic strategies to mitigate it: Navitoclax (Nav.) and a cocktail of Dasatinib and Quercetin (DQ). While Nav. treatment did not improve severe degeneration in SM/J mice or senescence status, DQ-treated mice showed lower grades of degeneration and a decreased abundance of senescence markers, including p19ARF, p21, and the senescence-associated secretory phenotype (SASP). DQ improved disc cell viability and phenotype retention and retarded fibrosis of the nucleus pulposus tissue. Transcriptomic analysis revealed tissue-specific effects of the treatment, with cell cycle regulation and JNK signaling being commonly affected across different tissue types. A comparison of SM/J data with DQ-mediated aging-dependent amelioration of disc degeneration in C57BL/6 N mice identified Junb and Zfp36l1 signaling as shared DQ targets in the mouse disc. Notably, the in vitro inhibition studies of the JUN pathway in human degenerated NP cells mimicked the benefits of DQ, namely, a reduction in senescence and SASP. This study reinforces the efficacy of senolytic treatment in ameliorating local senescence and intervertebral disc fibrosis.
- Effectiveness of nursing interventions on preventing the risk of infection in hospitalized adults: a systematic reviewPublication . Bom, Luís Filipe Pereira Todo; Mata, Ema Soraia Fazenda; Cunha, Helena Margarida Pereira; Santos, Ana Rita Melo; Pereira, Ana Sofia Ferreira; Castanheira, Joana Antunes; Dixe, Maria dos Anjos Coelho Rodrigues; Marquês, Maria do CéuBackground Healthcare-associated infections (HAIs) remain a global challenge for patient safety and quality of care, affecting millions of individuals each year and resulting in substantial morbidity, mortality, and financial burden. In Europe alone, over 4.2 million episodes of HAI occur annually. Nurses play a pivotal role in infection prevention through the implementation of evidence-based interventions aimed at disrupting transmission chains and reducing infection risk. Despite the widespread dissemination of preventive strategies, marked heterogeneity persists in their implementation and effectiveness, influenced by institutional, behavioural, and contextual factors. Objective To critically evaluate the effectiveness of nursing interventions in preventing infection risk among hospitalised adults through a systematic review of the literature. Methods A systematic review of Randomised Controlled Trials (RCTs) was conducted following the Joanna Briggs Institute (JBI) methodology and PRISMA 2020 guidelines, with prior registration in PROSPERO (CRD42024582820). Searches were performed across MEDLINE, CINAHL, Scopus, Web of Science, and the Cochrane Library up to January 2025. Methodological quality was assessed using JBI critical appraisal tools, and the certainty of the evidence was rated using the GRADE approach. Given the heterogeneity of the included studies, a narrative synthesis was undertaken. Results Out of 8,123 records identified, 22 RCTs (1979–2024) met the inclusion criteria. Nursing interventions, including daily body bathing with chlorhexidine, prevention bundles for catheters and other devices, promotion of hand hygiene, educational strategies, and environmental disinfection (e.g. ultraviolet-C light) demonstrated a significant reduction in HAI incidence compared with usual care. Multimodal and integrated interventions proved more effective than isolated measures. The overall certainty of evidence was moderate for infection reduction and adherence improvement, but inconsistent for patient mortality and satisfaction outcomes. Conclusions Evidence-based nursing interventions, particularly when applied in a coordinated and multimodal manner, substantially reduce infection risk among hospitalised adults. These findings support the integration
- The emerging role of chemokines and chemokine receptors in the biological and clinical behaviour of pituitary neuroendocrine tumours: an exploratory transcriptomic studyPublication . Silva, Ana Luísa; Barry, Sayka; Hipólito, Ana; Severino, Mariana de Griné; Joaquim, Rita; Hall, Charlotte; Oliveira, Tiago; López-Presa, Dolores; Borrecho, Gonçalo; Tortosa, Francisco; Nobre, Ema; Faria, Claudia C.; Korbonits, Márta; Marques, PedroThe chemokine network in the microenvironment of pituitary neuroendocrine tumours (PitNETs) may modulate tumour biology, aggressiveness, and treatment responses. We aimed to study the role of various chemokines and chemokine receptors in defining PitNET phenotype and clinical outcomes. We included 96 patients (51 females) with available snap-frozen PitNET tissue from surgery between 2014 and 2020. Chemokine and chemokine receptors were studied by RT-qPCR. Fold difference in mRNA expression was calculated using the ΔΔCt method; chemokine and receptor expression levels were normalised to the expression of the control gene TBP, and expressed relative to a reference sample. Ten chemokines and receptors were studied (CCL2, CCL3, CCL4, CXCL8, CX3CL1, CCR2, CCR4, CCR5, CXCR1, CXCR2), and their expression correlated with clinico-pathological and outcome data, as well as other available microenvironment-related data. We found strong positive correlations between all chemokines and chemokine receptors. Higher chemokine and receptor expression levels were seen in patients who had pituitary apoplexy (CCR2, CXCR1), hypopituitarism at diagnosis (CCL2, CCR4), Ki-67 >3% (CCL4, CXCR2), as well as in patients who required re-operation (CCL3, CXCL8, CXCR2), multimodal therapy (CCL2), and had active disease at last-follow-up (CCL2). There was a positive correlation between the number of pituitary surgeries and expression levels of CCL3, CXCL8, CX3CL1, CXCR1, and CXCR2. Compared to nonfunctioning-PitNETs, somatotropinomas had higher expression of CCL2, CCL4, and CCR2, and lower expression of CX3CL1 and CCR4. Expression of CDH1 (encoding E-cadherin) correlated negatively with CCL2, CCL4, CCR2, CCR4, and CXCR2, while the expression of ZEB1 (mesenchymal marker) positively correlated with CCL3, CCL4, and CX3CL1. PitNETs expressing higher levels of CCL4, CX3CL1, CCR4, CCR5, and CXCR1 had more and bigger vessels. Somatotropinomas treated pre-operatively with somatostatin analogues were associated with higher expression of CCL2, CCR4, CXCR1, and CXCR2, while nonfunctioning-PitNETs pre-surgically treated with dopamine agonists were associated with lower expression of CCL3, CCL4, CX3CL1, CCR5, CXCR1, and CXCR2. Our data suggests that chemokines and chemokine receptors may be involved in the modulation of different tumorigenic mechanisms in PitNETs, including tumour proliferation, epithelial-to-mesenchymal transition, and angiogenesis, and may be associated with more aggressive and difficult-to-treat disease.
- Same-day discharge after electrophysiological and cardiac implantable electronic device procedures: a clinical consensus statement of the European Heart Rhythm Association (EHRA) and the Association of Cardiovascular Nursing & Allied Professions (ACNAP) of the ESCPublication . Scherr, Daniel; Frausing, Maria Hee Jung Park; Maciejewski, Cezary; Barisone, Michela; Boriani, Giuseppe; Breitenstein, Alexander; Delgado, Bruno; Hendriks, Jeroen M.; Hovakimyan, Tatevik; Kollias, Georgios; König, Sebastian; Lenarczyk, Radoslaw; Letsas, Konstantinos P.; Malaczynska-Rajpold, Katarzyna; Manninger, Martin; Merino, Jose L.; Mores, Benoit; Ollitrault, Pierre; Potter, Tom J. R. de; Rao, Archana; Sarkozy, Andrea; Sattler, Stefan M.; Svennberg, Emma; Tilz, Roland Richard; Zylla, Maura M.; Vogler, JuliaSame-day discharge (SDD) following electrophysiology (EP) and cardiac implantable electronic device (CIED) procedures has emerged as a contemporary care model driven by improvements in procedural safety, efficiency, and healthcare resource constraints. Despite growing evidence supporting its safety in selected patients, adoption of SDD across Europe remains heterogeneous. This clinical consensus statement, developed by the European Heart Rhythm Association (EHRA) of the ESC in collaboration with the Association of Cardiovascular Nursing & Allied Professions (ACNAP) of the ESC, provides an evidence-based and practice-oriented framework for the implementation of SDD pathways after EP and CIED interventions. Based on a structured review of contemporary trials, registries, and expert consensus, the document addresses patient selection, peri-procedural management, early complication surveillance, discharge criteria, and post-discharge follow-up. Procedure-specific considerations are provided for catheter ablation and device implantation. This consensus aims to harmonize clinical practice, reduce variability in care, and support the safe and sustainable expansion of SDD across diverse European healthcare systems.
- Sintomas musculoesqueléticos nos estudantes de enfermagem em ensino clínico: um estudo pilotoPublication . Gomes, Jacinta; Matos, Maria João; Fonseca, Maria José; Soares, SaleteIntrodução: Os sintomas musculosqueléticos nos estudantes de enfermagem a realizar ensino clínico são frequentes. A intervenção do Enfermeiro Especialista em Enfermagem de Reabilitação é fundamental na capacitação dos estudantes através de um programa integrador. Este estudo tem como objetivos descrever os sintomas musculoesqueléticos em estudantes de enfermagem antes e após o ensino clínico e analisar as implicações e o grau de satisfação da formação em ergonomia. Metodologia: Integrado num projeto de investigação no âmbito da sintomatologia músculoesquelética, a presente investigação constitui um estudo piloto de natureza quantitativa, exploratória e longitudinal. Amostra não probabilística de conveniência, incluiu estudantes do Curso de Licenciatura em Enfermagem em ensino clínico em contexto hospitalar. Instrumentos: Questionário sociodemográfico; Questionário de Satisfação e o Questionário Nórdico Músculo-Esquelético. Este ultimo questionário, foi aplicado antes e após a realização de vários ensinos clínicos em contexto hospitalar, com cerca de um ano de intervalo. Realizou-se uma intervenção formativa sobre ergonomia entre o primeiro e segundo momento de recolha de dados. Realizada estatística descritiva com recurso SPSS 28.0. Resultados: A amostra foi constituída por 71 estudantes do Curso de Licenciatura em Enfermagem (3º ano) no início e 33 no final, maioritariamente do género feminino e sem formação/informação em Ergonomia, com idades entre 20 a 25 anos. Antes de iniciar os ensinos clínicos constatou-se que nos últimos 12 meses as suas queixas se situam maioritariamente a nível das regiões lombar, cervical e torácica, com nível de dor entre 2 e 4 da escala numérica que integra o Questionário Nórdico Músculoesquelético. Após realização de vários ensinos clínicos em contexto hospitalar, verificou-se que a área mais problemática foi a região lombar e o nível de dor situou-se entre 2 e 5. Conclusão: Após a intervenção formativa, verificou-se diminuição do número de queixas em todas as áreas.