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- High vs low protein intake in chronic critical illness: a systematic review and meta-analysisPublication . Castro, Sílvia; Tome, Ana Maria; Granja, C.; Macedo, A.; Binnie, AlexandraBackground & aims: Patients with persistent organ dysfunction after the first week of intensive care unit (ICU) admission are considered to have chronic critical illness (CCI). Acquired muscle weakness is a common feature of CCI that is accompanied by loss of muscle mass and electromyographic features of myopathy. Optimizing protein intake may help prevent acquired muscle weakness and/or promote muscle recovery, however, the optimal level of protein intake in CCI is uncertain and there is a lack of consensus in published nutritional guidelines. This systematic review focuses on the impact of high versus low protein intake as part of a nutritional strategy for patients with CCI. Methods: The terms “protein intake” and “critically ill” were systematically searched in PUBMED, CENTRAL (Cochrane Central Register of Controlled Trials), and WEB OF SCIENCE on 06/01/2023. We included studies that (1) enrolled critically ill adults (aged 18 years or over) who were in the ICU for more than 7 days and that compared (2) protein intake above and below 1.3 gr/kg administered by any route (enteral and/or parenteral), (3) had an intervention period that occurred primarily after the first 7 days of critical illness and (4) reported clinical outcomes including length of ICU and hospital stay, duration of invasive mechanical ventilation (IMV), mortality, ICU acquired infections, muscle mass and physical function. Studies pertaining to elective surgery, those with intervention periods shorter than 7 days or occurring primarily within the first 7 days of critical illness, those measuring only laboratory parameters as outcomes, and safety and feasibility studies were excluded. Results: Four studies were included (N ¼ 1730) in the meta-analysis and systematic review. Higher (>1.3 g/kg/d) versus lower protein intake was associated with a decrease in early mortality (defined as ICU or 28-day mortality) hazard ratio (HR) 0.42 (95 % confidence interval (CI): 0.26e0.70, P < 0.001), but had no impact on late mortality (defined as the latest mortality timepoint in each study): HR 0.93 (95 % CI 0.76e1.15, P ¼ 0.51). There was no significant difference between intervention and control groups with respect to duration of IMV, duration of ICU or hospital stay, muscle mass, or the incidence of ICUacquired infections. One study reported improvements in physical function at 3 and 6 months in the intervention group. Conclusion: After the first week of critical illness, increasing protein intake to >1.3 g/kg/d may improve early mortality but not late mortality or other clinical outcomes. The small number of relevant studies and the heterogeneity of outcomes assessed, weaken these conclusions. Further studies are warranted to discern whether higher protein intake is beneficial in chronic critical illness. PROSPERO registration number: CRD42023403554; PROSPERO registration name: “The effect of higher than 1,3 g/kg of protein versus lower intake in chronic critically ill patients”
- Reporting of participant race and ethnicity from COVID-19 randomized controlled drug and biologicals trials: a scoping reviewPublication . Pranić, Shelly Melissa; Estêvão, Maria Dulce da Mota Antunes de Oliveira ; Vasanthan, Lenny T; Pérez-Neri, Iván; Pulumati, Anika; Junior, Fábio Antonio Serra de Lima; Malih, Narges; Mishra, Vinayak; Thompson, Jacqueline; Nnate, DanielRacial and ethnic minorities have been disproportionally burdened by hospitalization and death due to COVID-19. Participation of individuals of diverse races and ethnicities in clinical trials, according to study-level characteristics of randomized controlled trials (RCTs) that test effectiveness of COVID-19 drugs, could be insightful for future researchers. Our objective for this scoping review was to describe the frequency of race and ethnicity reported as demographic variables and specific reporting of race and ethnicity according to COVID-19 RCT characteristics. We conducted comprehensive searches in PubMed, ProQuest, World Health Organization Database, and Cochrane Central Register of Controlled Trials, and gray literature via preprint servers from January 1, 2020, to May 4, 2022. We included RCTs on emergency- or conditionally approved COVID-19 drug interventions (remdesivir, baricitinib, and molnupiravir) with or without comparators. Self-reported race as American Indian/Pacific Islander, Asian, Black/African American, or White, ethnicity as Hispanic/Latinx, study design characteristics, and participant-relevant data were collected. In total, 17 RCTs with 17 935 participants were included. Most (n = 13; 76%) reported at least 1 race and ethnicity and were US-based, industry-funded RCTs. Asian, Black, Latinx, and White participants were mostly enrolled in RCTs that studied remdesivir. Native American and Hawaiian participants were mostly assessed for progression to high-f low oxygen/noninvasive ventilation. Time to recovery was assessed predominantly in Black and White participants, whereas hospitalization or death was mostly assessed in Asian, Latinx, and multirace participants. Trialists should be aware of RCT-level factors and characteristics that may be associated with low participation of racial and ethnic minorities, which could inform evidence-based interventions to increase minority participation.
- Prescribed hospital diet influence on dietary intake of hospitalised patients: a cross-sectional studyPublication . Gameiro, Joana; de Oliveira, Raquel; Baltazar, Ana Lúcia; Rocha, Clara; Pereira, Marta; Martins, Diana; Lima, João P. M.; Mendes, FernandoThe dietary intake of hospitalised patients is often compromised during hospitalisation, which can be a causal factor for hospital malnutrition. This is considered a public health problem worldwide and is associated with an increased risk of other complications. Objectives: Our objective was to determine the dietary intake of hospitalised individuals and if the prescribed diet influences it. Methods: Food intake data were collected from 299 lunches of patients admitted to a hospital, using the visual estimation method with a five-point scale. Three existing diets were considered, and the energy and macronutrient values of the meal were calculated. The minimum energy and protein requirements were also calculated. Results: The components of the tray with the highest intake were soup and dessert; no significant differences were found between the percentage intake of each element and the prescribed diet. More than 50% of the individuals did not meet their minimum energy requirements, and only 36.5% had a protein intake that was within the recommendations. Conclusions: Dietary intake is much lower than prescribed, and nutritionists need to act to reduce the prevalence of hospital malnutrition.
- Commentary on: nurses’ perceptions of artificial intelligence (AI) integration into practice: an integrative reviewPublication . Xavier, Tânia; Oliveira, ClaudiaWe are writing this letter to congratulate you on the paper ‘Nurses’ perceptions of artificial intelligence (AI) integration into practice: An integrative review’ by Lora and Foran, recently published in your journal. In this paper the authors synthesise remarkable, valuable and challenging aspects of the new era of artificial intelligence (AI) in the clinical practice of nursing. AI has been introduced into the most diverse areas of knowledge, opening a vast range of possibilities. This integrative review makes a timely and relevant contribution to the growing body of literature on the intersection between nursing and AI. The authors show that the practice of nursing, especially in the perioperative environment, is no exception.
- 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.
- Serviços de alimentação no Ensino Superior: Saúde e sustentabilidadePublication . Braz, Nídia Maria Dias Azinheira Rebelo; Soares, Aldina; Farinha, Carla; Sarreira, Pedro; Melo, Nuno; Andrade, Graça; Lima, João; Lopes, Cristiana; Avelar, David; Neto, Belmira; Oliveira, Heitor; Alves, ElsaA sustentabilidade alimentar assumiu uma relevância central nos desafios globais atuais. As Instituições de Ensino Superior (IES) desempenham um papel estratégico neste contexto, através dos seus serviços de alimentação. Este artigo examinou as práticas de sustentabilidade alimentar nas IES portuguesas entre 2020 e 2024, através de um estudo em três fases: um inquérito inicial em 2020/21, entrevistas realizadas entre 2021 e 2023, e um questionário aplicado em 2024. Os resultados revelaram avanços significativos na implementação de práticas sustentáveis, destacando-se a oferta universal de opções vegetarianas/veganas e iniciativas para redução do desperdício alimentar. Contudo, persistiram desafios como a dificuldade de integração dos diferentes intervenientes do sistema alimentar e barreiras nos processos de compras públicas. As principais iniciativas implementadas focaram-se na promoção da alimentação saudável, da redução de resíduos plásticos e do desperdício alimentar. O estudo evidenciou também a importância da monitorização regular dos indicadores de gestão e da formação das equipas. Este trabalho contribuiu para a compreensão das barreiras e estratégias facilitadoras na transição para sistemas alimentares mais sustentáveis no Ensino Superior português.
- Patterns, advances, and gaps in using ChatGPT and similar technologies in nursing education: a PAGER scoping reviewPublication . Amankwaa, Isaac; Ekpor, Emmanuel; Cudjoe, Daniel; Kobiah, Emmanuel; Diebieri, Maximous; Fuseini, Abdul-Karim Jebuni; Gyamfi, Sebastian; Brownie, SharonBackground and aim: Generative AI (GenAI) can transform nursing education and modernise content delivery. However, the rapid integration of these tools has raised concerns about academic integrity and teaching quality. Previous reviews have either looked broadly at artificial intelligence or focused narrowly on single tools like ChatGPT. This scoping review uses a structured framework to identify patterns, advances, gaps, evidence, and recommendations for implementing GenAI in nursing education. Methods: This scoping review followed the JBI methodology and PRISMA-ScR guidelines. We searched PubMed, CINAHL, SCOPUS, ERIC, and grey literature (October to November 2024). Data synthesis utilised the PAGER framework as a mapping tool to organise and describe patterns, advances, gaps, evidence for practice, and recommendations. Results: Analysis of 107 studies revealed GenAI implementation across four key domains: assessment and evaluation, clinical simulation, educational content development, and faculty/student support. Three distinct implementation patterns emerged: restrictive, integrative, and hybrid approaches, with hybrid models demonstrating superior adoption outcomes. Technical advances showed significant improvement from GPT-3.5 (75.3 % accuracy) to GPT-4 (88.67 % accuracy) in NCLEX-style assessments, with enhanced capabilities in multilingual assessment, clinical scenario generation, and adaptive content creation. Major gaps included limited methodological rigour (29.0 % of empirical studies), inconsistent quality control, verification challenges, equity concerns, and inadequate faculty training. Geographic distribution showed North American (42.1 %) and Asian (29.9 %) dominance, with ChatGPT representing 83.2 % of tool implementations. Key recommendations include developing institutional policies, establishing quality verification protocols, enhancing faculty training programs, and addressing digital equity concerns to optimise GenAI integration in nursing education. Conclusions: GenAI has transformative potential in nursing education. To realise its full potential and ensure responsible use, research should focus on developing standardised governance frameworks, empirically validating outcomes, developing faculty in AI literacy, and improving technical infrastructure for low-income contexts. Such efforts should involve international collaboration, highlighting the importance of the audience's role in the global healthcare community.
- Frailty and outcomes in elderly ICU patients: insights from a portuguese cohortPublication . Lourenço, Eva; Rodrigues, Isabel; Sampaio, Mário; da Costa, EmiliaBackground: Frailty is a key determinant of outcomes in critically ill elderly patients, but data from Portugal remain limited. To our knowledge, this is the first study to examine the prevalence and prognostic impact of frailty among elderly ICU patients in a Portuguese hospital setting. Objective: To determine the prevalence of frailty among elderly patients admitted to an intensive care unit (ICU) in southern Portugal and to examine its crude associations with illness severity, organ support, and mortality outcomes. Methods: We conducted a retrospective cohort study including 125 patients aged ≥ 65 years admitted to the polyvalent ICU of Hospital de Faro over the last six months of 2024. Data included demographics, comorbidities, Charlson Comorbidity Index (CCI), severity scores (SOFA, SAPS II, APACHE II), and frailty status assessed by the Clinical Frailty Scale (CFS). Outcomes were the need for organ support, ICU and hospital mortality, and length of stay. Results: Frailty (CFS ≥ 5) was identified in 30.4% of patients. Frail patients were older, had higher comorbidity burden (CCI), and presented with significantly higher severity scores at admission. They also required more invasive support, including vasopressors and invasive mechanical ventilation, while acute kidney injury (AKI) requiring renal replacement therapy (RRT) was similar between groups. ICU mortality was significantly higher among frail patients (50.0% vs. 31.0%), as was hospital mortality (76.3% vs. 33.3%). Length of ICU stay did not differ, although frail patients tended to have longer hospitalizations overall. Conclusions: Frailty was highly prevalent and strongly associated with increased severity, greater need for organ support, and higher mortality. Routine frailty assessment at ICU admission may enhance prognostic accuracy and support patient-centered decision-making.
- Valorisation of gilthead seabream by-products through recovery of antimicrobial proteins for active biopolymer formulationsPublication . Maurizzi, Enrico; Anjos Guerreiro, Liliana Isabel Tomé; Bigi, Francesco; Quartieri, Andrea; Mateus, Ana Patrícia; Volpelli, Luisa Antonella; Pulvirenti, Andrea; Power, Deborah MaryIn the seafish sector, industrial processing and by-catch currently lead to the waste of over 36 % of global fish production by weight. This is largely due to insufficient revalorization of by-products and the underdevelopment of sustainable practices to manage these discarded volumes, which are often disposed of or released into the environment, contributing to pollution. In this study, antimicrobial proteins were extracted from fish by-products for incorporation into biopolymer formulations. Specifically, the focus was on lysozyme, which was targeted using a molecular-proteomic approach. Protein extractions were conducted at various pH levels from Gilthead seabream (Sparus aurata) tissues (skin with scales and mucus, liver, and intestine) normally discarded during processing, to assess recovery of proteins from the selected tissues. The extracted proteins were separated using mild ion-exchange chromatography, followed by quantification and qualitative analysis via SDS-PAGE. The expression levels of lysozyme types-g and-c were quantified through Real-Time qPCR. The antimicrobial activity of the extracted proteins was assessed against Gram-positive (Listeria monocytogenes) and Gram-negative (Escherichia coli) bacteria using a Minimal Inhibitory Concentration (MIC) assay. The proteins were subsequently incorporated into biodegradable film-forming solutions based on hydroxypropyl methylcellulose/chitosan and hydroxypropyl methylcellulose/guar gum mixtures. These films were further tested against the same human pathogens. The results demonstrate the feasibility of extracting proteins from fish by-products using a non-targeted buffer pH extraction approach, which, even without further chromatographic purification, exhibited promising intrinsic antimicrobial activity for potential applications in the food industry.
- The influence of a 12-week yoga program on military aviation pilots' decision-making capacity for operational effectivenessPublication . Santos, Sara; Fernandes, Orlando; Cabo, Carolina A.; Parraca, José A.; Melo, FilipeMilitary aviation demands cognitive performance, emotional stability, and resilience under pressure. Portuguese Airforce pilots face additional challenges: maintaining fitness and readiness independently, without structured exercise regimens. Yoga’s capacity to enhance mindfulness makes it a promising intervention. Despite potential benefits, research on yoga’s impact in military aviation remains limited. This study investigates incorporation of yoga into the training regimen of Portuguese Airforce to verify decision-making effectiveness and performance. A randomized controlled trial was conducted with 18 Portuguese Air Force pilots: Control Group (n = 8) followed standard military training, and Intervention Group (n = 10) received aditional yoga training twice a week, for 12 weeks. Assessments included Five Facet Mindfulness Questionnaire (FFMQ), Multidimensional Assessment of Interoceptive Awareness (MAIA), Aviation Safety Attitude Scale (ASAS), Risk Perception To Self (RPTS), Trail Making Test (TMT) and aviation simulator performance. Data analysis used Jamovi v2.6.13. The yoga group showed significant improvements in mindfulness (FFMQ), interoceptive awareness (MAIA), self-confidence and safety attitudes (ASAS), cognitive flexibility (TMT-B), and simulator performance (fewer flight errors). Enhancements in attention regulation, body awareness, and emotional self-regulation reflect greater readiness for stress management. Improvements in decision-making, calculated risk-taking, and operational safety suggest yoga’s potential to reinforce psychophysiological resilience in high-demand environments. Yoga contributes meaningfully to enhanced performance and safety in high-pressure aviation environments. These findings may inform policy-level decisions toward integrating mandatory mind-body training programs that are cost-effective and time-efficient. The benefits observed may be applicable to Air Force teams globally, as well as commercial aviation, civil aviation, and other high-stress, high-performance domains, including elite sports. Clinical Trial Registry number and website where it was obtained: ClinicalTrials.gov identifier NCT05821270.