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- Telehealth for integrated cardiovascular and diabetes management: a scoping reviewPublication . Estêvão, Maria Dulce da Mota Antunes de Oliveira ; Teotónio Fernandes, Mónica Alexandra; De Sousa-Coelho, Ana Luísa; Neto Espírito-Santo, Margarida de Fátima; Nascimento, Tânia; Alfredo CaturanoCardiovascular disease (CVD) and diabetes mellitus represent major global health challenges, frequently co-occurring and mutually exacerbating. Telehealth interventions offer a promising approach for their management, with potential to improve patient outcomes, enhance access to care, and increase cost-effectiveness. This review synthesized existing evidence from randomized controlled trials (RCTs) and observational studies to evaluate the effectiveness of telehealth interventions for the management of diabetes, focusing on CVD risk, and to identify critical research gaps. A systematic literature search was conducted across major databases (PubMed, Web of Science, and Scopus) to identify studies meeting predefined eligibility criteria, considering digital tools for remote monitoring, consultation, education, and medication management. After the screening of 3041 articles, six studies met the inclusion criteria. Telehealth interventions utilized a range of digital health tools, including mobile applications, artificial intelligence–powered clinical decision aids, electronic consultations, and integrated remote monitoring platforms. Although direct assessment of composite cardiovascular risk was largely absent, the included studies reported several clinical parameters associated with cardiovascular health, namely, blood pressure, lipid profile, and glycated hemoglobin. Telehealth interventions implemented for individuals with Type 2 diabetes mellitus demonstrated promising potential in improving glycemic control and supporting self-management. However, their effectiveness in managing broader cardiovascular risk factors remains less clear due to inconsistent reporting and heterogeneous intervention designs.
- The effect of nutritional intervention in nutritional risk screening on hospitalised lung cancer patientsPublication . de Oliveira, Raquel; Cabrita, Bruno; Cunha, Ângela; Silva, Sónia; Lima, João P. M.; Martins, Diana; Mendes, FernandoBackground: Lung cancer (LC) patients are prone to suffer from malnutrition. Malnutrition negatively affects patients’ response to therapy, increases the incidence of treatment-related side effects, and decreases survival. Early identification of LC patients who are malnourished or at risk of malnutrition can promote recovery and improve prognosis. Objective: This study aimed to assess the risk and nutritional status of lung cancer patients who are hospitalised, as well as to evaluate the impact of nutritional intervention on the risk of malnutrition. Methods: From January 2022 to December 2023, 53 LC patients hospitalised in a pulmonology department had their nutritional risk (initial and final) and nutritional status (initial) assessed. All were selected for nutritional intervention. Nutrition counselling was the first intervention option, along with dietary changes with/without oral nutritional supplements. Results: At the time of hospitalisation, 90.6% of the patients were at nutritional risk, 45.3% were classified as moderately malnourished, and 35.8% were classified as severely underweight. After the hospitalisation, 73.6% were at nutritional risk at the time of discharge, suggesting a statistically significant decrease in the number of patients with nutritional risk. Conclusions: Most LC patients hospitalised presented an altered nutritional status. Our study suggests that a nutritional intervention must be implemented to reduce malnutrition risk, which may impact prognosis. The comprehensive nutritional problems experienced by LC patients require nutritional assessment and improved individually tailored nutritional support.
- 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.