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Percorrer ULSALG por Objetivos de Desenvolvimento Sustentável (ODS) "04:Educação de Qualidade"
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- Adherence to pharmacological therapy for hypertension in Portugal: insights from patients’ focus groupsPublication . Silva, Beatriz Rosendo; Vieira, Diogo; Ferreira, Ana Sofia Fernandes; Santos, Bárbara; Pratas, Carolina; Soares, Carolina A.; Coito, Catarina; Santeiro, Catarina; Gomes, Hugo Amorim; Pereira, João Pedro; Gato, Maria Martins; Martins, Susana Patrícia; Sousa, Tânia; Prazeres, Filipe; Santiago, Luiz Miguel; Rosendo, InêsPurpose: Medication adherence is crucial for blood pressure control. Knowledge of medication adherence and its influencing factors, particularly within cultural and healthcare contexts, is essential for developing effective strategies to enhance medication adherence. Qualitative studies have explored patients' perspectives globally. Few have focused on strategies to improve adherence, and such research is lacking in Portugal. This study aimed to gather the perspectives of Portuguese patients with Arterial Hypertension (HTN) concerning the most effective strategies to enhance adherence to antihypertensive medication and to understand its contributing factors. Methods: We conducted qualitative research through online focus groups of four to ten participants each. Participants were adult patients with HTN taking at least one antihypertensive drug from the primary care setting. The number of focus groups was achieved through theoretical saturation. Purposive sampling was used, with patients recruited through their family doctors. Participants were recruited from all seven Portuguese regions, representing both sexes, controlled and uncontrolled HTN, and a diverse range of educational levels, employment statuses, living arrangements, and socioeconomic statuses. Meetings were audio-recorded and transcribed. Two researchers conducted content analyses using MAXQDA 2023 through comparative analyses and consensus. Results are presented narratively. Results: Four focus groups were conducted. Findings reported patients' strategies to improve adherence to pharmacological therapy for HTN. These included changes to medication and blister packs, such as a color-coded system. Other strategies involved reducing medication costs and making specific suggestions for primary healthcare. Patients additionally proposed psychological support and technological aids. Barriers such as difficulties in accepting medication and facilitators, such as fears of complications associated with HTN, were also identified. Conclusion: These results highlight the multifaceted perspectives of Portuguese patients with HTN and emphasise the role of technology, family support, and primary health services in promoting adherence. Such insights should be incorporated when addressing medication adherence in HTN.
- Assessment of European health professionals’ educational needs in basic principles of geriatric medicine: a focus group qualitative analysis from the PROGRAMMING COST Action 21122Publication . Frost, Rachael; Viegas, Ana; Tsamasiotis, Georgios-Konstantinos; Gugu, Mitilda; Mougakou, Efterpi; Savas, Sumru; Kupis, Robert; Piotrowicz, Karolina; Arranhado, Susana Ganhão; Farinha, Ana; Herghelegiu, Anna Marie; Bajenaru, Ovidiu Lucian; Nuta, Catalina Raluca; Fonseca, João; Rudzińska, Anna; Popov, Vesna; Milosavljevikj, Pavlinka; Sakellari, Vasiliki; Yilmaz, Nilufer Demiral; Przybył, Helena Lesz; Prada, Ana Gabriela; Tampaki, Maria; Pérez, Laura M.; Martín, Yolanda Barrado; Avgerinou, Christina; Hadziabdic, Maja Ortner; Christakou, Anna; Moumtzi, Eleni; Arsov, Stefan; Rodeles, Santiago Cotobal; Kravvariti, Evrydiki; Kotsani, Marina; Yellon, TamarPurposeIn many countries, geriatrics is still emerging as a speciality, with limited training options for healthcare professionals (HCPs). This international qualitative study aimed to explore the geriatric educational needs of HCPs, focussing on countries where geriatric medicine (GM) is emerging or underdeveloped.MethodsFourteen focus groups (n = 125 participants, 82% female, mean age 41.6 years) were carried out representing ten European countries and a range of HCPs and settings. Focus group discussions were recorded, transcribed verbatim, and inductively coded in the original language. Codes were aggregated into a shared English codebook applied to all transcripts. Descriptive and subsequently analytical themes were then developed.ResultsThree themes were identified. (1) Current experiences of geriatric care: participants described caring for older adults as medically and socially complex, requiring strong communication skills and interprofessional collaboration. (2) Structural and contextual challenges: limited staffing, fragmented care pathways, and GM's emerging status hindered effective care delivery. (3) Uncertainties and unmet training needs: key uncertainties included distinguishing ageing from disease, applying assessment tools, recognising red flags, and safe medication management. Participants emphasised the need for practical training during undergraduate studies, standardised interprofessional courses for non-specialists, and structural support (e.g. accessible programmes, protected time for training).ConclusionCurrently, geriatrics training is limited and there are multiple contextual challenges, especially in countries with emerging GM. There is significant unmet need for HCP basic training in GM. Our study contributes to an empirical basis for developing relevant and feasible GM training for HCPs. Structural support is needed for these initiatives.
- Description of the Hamburg Alexander Leukodystrophy Cohort—Insights into Practical Classification and the Care SituationPublication . Kokaly, Nadia; Guerreiro, Helena; Bredow, Janna; Dreha-Kulaczewski, Steffi; Ohlenbusch, Andreas; Köhler, Wolfgang; Reinhardt, Tabea; Schön, Gerhard; Volk, Alexander E.; Sigel, Helen; Bley, AnnetteBackground: Alexander disease (AxD) is a rare severe leukodystrophy that has no cure to date. A pathogenic gain-of-function variant in the GFAP gene affects the astrocytes and subsequently the function of the white matter in the CNS. Methods: We retrospectively analyzed the most frequent symptoms of nine AxD cases, classified them according to published classifications, and described the need of care and support. Results: The description of the courses of disease of nine cases with AxD reflects the broad spectrum of different phenotypes of AxD, with often occurring apnoea. Data about care and support for AxD patients indicate a high and heterogeneous need of support. Treatment with steroids reduced symptoms in two patients. Some patients showed lasting improvement during their course of disease. Conclusions: The course of AxD is very heterogeneous. Thus, we extracted relevant key features to describe the severity of the disease, namely feeding problems, epilepsy, age-appropriate motor function, failure to thrive, age-appropriate language and apnoea. We recommend early evaluation for clinical care and support. For some AxD patients, treatment with steroids may alleviate symptoms. Further development of efficient treatments is necessary
- Functional respiratory re-education interventions in people with respiratory disease: a systematic literature reviewPublication . Dias, Pedro Miguel Martins; Teixeira, Helena Margarida dos Santos; Palma, Magali Cavaco; Messias, Patrícia Alexandra Lopes; Vieira, João Vítor da Silva; Ferreira, Rogério Manuel FerrinhoObjectives: to identify nursing interventions in rehabilitation, within the scope of functional respiratory reeducation, which allow a respiratory function improvement in people with respiratory disease. Methods: systematic literature review using the MEDLINE database search, adopting the PICO mnemonic and the Joanna Briggs Institute’s assessment of the level of evidence and methodological quality. The search for randomized controlled trials was carried out in June 2021 considering the period from 2015 to 2020, in English or Portuguese. Results: a sample of nine randomized controlled trials with methodological quality was obtained which highlighted the use of positive expiratory pressure devices as an important component and intervention for respiratory functional reeducation. Conclusions: nursing interventions in rehabilitation with an emphasis on functional respiratory reeducation are essential, showing improvements in people’s general health.
- Home mechanical ventilation in adults: clinical practice recommendations from the Portuguese respiratory society home mechanical ventilation assemblyPublication . Ribeiro, Carla; Gomes, Rita; Carreiro, Alexandra; Vieira, Ana Luísa; Seabra, Bárbara; Conde, Bebiana; Nogueira, Carla; Jácome, Cristina; Lages, Joana; Aguiar, Margarida; Grafino, Mónica; Pamplona, Paula; Cysneiros, Ana; Durães, Célia; Rodrigues, Cidália; Pimenta, Cidália; Cristóvão, Cristina; Rodrigues, Daniela; Ferreira, Diva; Gonçalves, Filipe; helena Chaves Ramos; Cravo, João; Silva, João Paulo; da Silva Cunha Granatin, Karl Jonathan; Méndez, Lucía; Zeller, Mafalda Van; Araújo, Márcia; Barata, Margarida; Raposo, Margarida; Redondo, Margarida; Jacob, Maria; Araújo, Maria João; Gonçalves, Miguel R.; Guia, Miguel; Faria, Nuno; Viegas, Pedro; Conde, Sara; Drummond, Marta; Pinto, PaulaBackground: The use of home mechanical ventilation (HMV) has been increasing worldwide, driven by widening of clinical applications and improved patient survival rates. In Portugal, recent data indicate an even faster growth, although national HMV recommendations have remained unchanged for 25 years. Research question: We aimed to provide an update in clinical practice guidelines for HMV in adults, applicable to the Portuguese context, grounded on the latest available evidence and experts' opinion. Study design and methods: A multidisciplinary panel with experience in HMV in the adult population was assembled. A comprehensive literature search was conducted during March 2023 regarding specific topics: equipment, ventilatory modes and interfaces, HMV initiation, follow-up and monitoring, disease specificities (neuromuscular diseases, obesity-hypoventilation syndrome, restrictive chest wall diseases; chronic obstructive pulmonary disease, and other diseases), home mechanical invasive ventilation, and palliative and end of life care. A 2-round Delphi process was conducted to establish consensus among panel members. A minimum agreement threshold of 80% was required. Results: Out of 88 recommendations initially included in the Delphi process, 61 were selected by consensus. Conclusion: Final recommendations grounded in the current level of evidence are outlined, and the key limitations and proposals for future research are discussed.
- Impact of bariatric and metabolic surgery on sarcopenia-related parameters according to the EWGSOP2 consensus criteria in persons living with obesityPublication . Cardoso, Paulo Alexandre e Castro; Santos, Tânia V.; Ramon-Krauel, Marta; Pais, Sandra; De Sousa-Coelho, Ana LuísaAlthough bariatric and metabolic surgery (BS) has proved effective in the treatment of obesity based on the reduction in fat mass and the remission of comorbidities, there is also loss of lean mass after BS which could compromise muscle functionality. According to the European Working Group on Sarcopenia in Older People (EWGSOP), sarcopenia is a disease associated with loss of muscle mass, strength, and function. Through a comprehensive review of the literature, we identified a range of studies focusing on evaluating sarcopenia-related parameters according to the EWGSOP2 consensus criteria, before and after BS. Although most studies reported reductions in skeletal muscle mass and absolute muscle strength after surgery, improvements in muscle functionality were generally achieved, independent of the type of BS.
- Minimally invasive surgery for inflammatory Bowel Disease: a systematic review and meta-analysis of robotic versus laparoscopic surgical techniquesPublication . Cunha, Miguel F.; Roseira, JoanaWe read with great interest the article ‘Minimally invasive surgery for inflammatory bowel disease: a systematic review and meta-analysis of robotic versus laparoscopic surgical techniques’, recently published in the Journal of Crohn’s and Colitis. 1 Zaman and colleagues performed the first comprehensive systematic review and meta-analysis to examine the outcomes of robotic versus conventional laparoscopic colorectal resections in patients with inflammatory bowel disease [IBD], focusing on the comparative effectiveness, safety pro files, and surgical performance metrics of these two minimally invasive approaches.
- Mismatch repair deficiency or microsatellite instability in locally advanced rectal cancer patients treated with total neoadjuvant therapyPublication . Benhima, Nada; Audisio, Alessandro; Gallio, Chiara; Ricco, Gianluca; Meillat, Hélène; Velenik, Vaneja; Carmen Riesco, Maria; Suárez Alecha, Javier; Rasschaert, Gertjan; López-Bravo, David Páez; Tougeron, David; Carvalho, Carlos; Borelli, Beatrice; Famiglietti, Federico; De la Pinta, Carolina; Manuel O’Connor, Juan; Artaç, Mehmet; Braam, Pètra M.; Puccini, Alberto; Waldhorn, Ithai; Vanden Bulcke, Alexander; Loi, Mauro; De Felice, Francesca; Eid, Michal; Deleporte, Amélie; Rossini, Chiara; Montenegro, Paola; Fiore, Michele; Van Den Eynde, Marc; Shamseddine, Ali; Geboes, Karen P.; Messina, Marco; Mulet Margalef, Núria; Houlzé-Laroye, Constance; Kirac, Iva; Pastorino, Alessandro; Salati, Massimiliano; Argalácsová, Soňa; Morano, Federica; Capdevila, Jaume; Garajovà, Ingrid; Antoun, Claire; Pinto, Cidália Maria Sousa; Lutz, Manfred P.; Adams, Richard A.; Chau, Amélie; Siebenhuener, Alexander; Dermine, Alexandre; Ghidini, Michele; Dulskas, Audrius; Papamichael, Demetris; Javed, Muhammad Ahsan; Ruiz-Garcia, Erika; Tomášek, Jiří; Petrillo, Angelica; Baratelli, Chiara; Vandamme, Timon; Spolverato, Gaya; Bock, Felix; Diaz, Marie; Campana, Luca Giovanni; Sur, Daniel; Karampeazis, Athanasios; Patsko, Veronika; Puleo, Francesco; Bounedjar, Adda; Fiorica, Francesco; Gilliaux, Quentin; Bernardini, Ilaria; De Stefano, Alfonso; Guren, Marianne Grønlie; Jakubauskas, Matas; Sert, Fatma; Gomez Galdon, Maria; Veron Sanchez, Ana; Vierasu, Ortansa-Irina; Assaf, Irene; Moretti, Luigi; Martinive, Philippe; Liberale, Gabriel; Van Laethem, Jean-Luc; Sclafani, FrancescoBackground: Data on the prognostic value of dMMR/MSI-H in locally advancer rectal cancer (LARC) are inconsistent and mostly from patients treated with conventional neoadjuvant therapy. We sought to evaluate oncological outcomes by mismatch repair/microsatellite (MMR/MS) status in LARC patients treated with total neoadjuvant therapy (TNT). Methods: Patients from the International Real-World Study of TNT in Rectal Cancer tested for dMMR/MSI-H by immunohistochemistry and/or molecular testing were included. Pathological complete response (pCR), complete response (CR, pCR + clinical complete response), event-free survival (EFS) and overall survival (OS) were assessed by MMR/MS status in the overall and matched populations. For the latter, variable-ratio matching according to nine variables (age, year of diagnosis, tumour location, staging modality, cT stage, cN stage, presence of lateropelvic lymphadenopathy, distance from the mesorectal fascia, TNT regimen) was applied. Results: Of 1911 patients, 1320 (69.1%) (09/2012-09/2025) had information on the MMR/MS status, 46 (3.5%) having dMMR/MSI-H tumours. No outcome differences were found by MMR/MS status in the overall population. In the matched population (n = 372), pCR was 14.2% among patients with pMMR/MSS tumours versus 12.5% among those with dMMR/MSI-H tumours (adjusted OR 1.07, 95%CI 0.39-2.91, p = 0.899), while CR was 18.9% and 16.7%, respectively (adjusted OR 0.95, 95%CI 0.35-2.58, p = 0.917). 3-year EFS and 5-year OS were 65.8% and 79.2%, and 67.6% and 93.5% in patients with pMMR/MSS and in those with dMMR/MSI-H tumours, respectively (adjusted HR EFS 1.30, 95%CI 0.57-2.89, p = 0.527; adjusted HR OS 2.52, 95%CI 0.67-9.42, p = 0.171). Conclusions: In this study, the dMMR/MSI-H phenotype did not hold prognostic value in LARC patients treated with TNT.
- On the run—comparing bioimpedance analysis (BIA) using portable devicesPublication . Dias, Carina Vieira; Dias, Joana C.; Laranjo, Céu; Cardoso, Paulo; De Sousa-Coelho, Ana LuísaBioelectrical impedance analysis (BIA) is a non-invasive indirect method that allows for measurement of lean and fat body mass. The main goal of this exploratory study was to compare the results from two different portable BIA devices. We found that only fat-free mass and body fat mass were directly comparable between InBodyS10 (Teprel, Porto, Portugal) and seca mBCA 525 (Bacelar, Porto, Portugal) medical portable BIA devices.
- Optimizing the input: can large language models standardize radiology requisitions?Publication . Santinha, João; Guerreiro, HelenaRadiology stands as a central pillar of modern healthcare, non-invasively visualizing anatomy and physiology to guide critical diagnostic and treatment decisions. Over the last decade, the radiology community has made significant strides in standardizing its “outputs,” the radiology report [1]. Through initiatives like the various Reporting and Data Systems (RADS) for breast, liver, prostate, and thyroid imaging, we have improved communication, reduced ambiguity, and enhanced the clinical utility of our findings. However, a high-quality output depends fundamentally on a high-quality input.