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- Moral Distress, Work Engagement, and Meaningful Work in HealthcarePublication . Santos, Catarina; Da Ponte, Guida; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); Biblioteca Nacional de Portugal, Centro de Estudos Históricos, CELOMThe psychological well-being of healthcare professionals is increasingly recognized as a critical determinant of patient safety, quality of care, and healthcare system sustainability. Among the constructs most relevant to this domain are moral distress, work engagement, and meaningful work. This narrative review aimed to synthesize conceptual and empirical evidence on these three constructs and to examine their interrelations and implications for healthcare practice. A selective narrative review of the literature was conducted, integrating theoretical frameworks, systematic and integrative reviews, and empirical studies, resulting in a final synthesis of 41 articles. Moral distress arises when clinicians are prevented from acting in accordance with their ethical convictions, often due to institutional or systemic constraints, and has been consistently associated with burnout, turnover, and compromised quality of care. In contrast, work engagement - characterized by vigor, dedication, and absorption - and meaningful work - reflecting the perception that professional activities have meaning and purpose - function as protective factors that enhance resilience and sustain intrinsic motivation. Evidence highlights the central role of organizational climate, leadership, resource availability, and ethical culture in shaping experiences of distress, engagement, and meaningfulness, a dynamic further intensified during the COVID-19 pandemic. The synthesis emphasizes that organizational and systemic interventions, including ethics consultation, supportive leadership, workflow redesign, and resilience-building programs, are essential to mitigate moral distress and promote engagement and meaningful work. The integration of these constructs aligns with the Quadruple Aim, reinforcing the premise that caring for healthcare professionals is indispensable to caring for patients.
- Serão preço e custo coincidentes na cirurgia cardíaca do idoso?Publication . Coelho, Pedro Nuno Martins Pires; Rodrigues, Vanessa; Miranda, Luís; Fragata, José Inácio Guerra; Barros, Pedro Pita; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); NOVA School of Business and Economics (NOVA SBE); Sociedade Portuguesa de Cardiologia | ElsevierIntroduction Payment for cardiac surgery in Portugal is based on a contract agreement between hospitals and the health ministry. Our aim was to compare the prices paid according to this contract agreement with calculated costs in a population of patients aged ≥65 years undergoing cardiac surgery in one hospital department. Methods Data on 250 patients operated between September 2011 and September 2012 were prospectively collected. The procedures studied were coronary artery bypass graft surgery (CABG) (n=67), valve surgery (n=156) and combined CABG and valve surgery (n=27). Costs were calculated by two methods: micro‐costing when feasible and mean length of stay otherwise. Price information was provided by the hospital administration and calculated using the hospital's mean case‐mix. Results Thirty‐day mortality was 3.2%. Mean EuroSCORE I was 5.97 (standard deviation [SD] 4.5%), significantly lower for CABG (p<0.01). Mean intensive care unit stay was 3.27 days (SD 4.7) and mean hospital stay was 9.92 days (SD 6.30), both significantly shorter for CABG. Calculated costs for CABG were €6539.17 (SD 3990.26), for valve surgery €8289.72 (SD 3319.93) and for combined CABG and valve surgery €11 498.24 (SD 10 470.57). The payment for each patient was €4732.38 in 2011 and €4678.66 in 2012 based on the case‐mix index of the hospital group, which was 2.06 in 2011 and 2.21 in 2012; however, the case‐mix in our sample was 6.48 in 2011 and 6.26 in 2012. Conclusion The price paid for each patient was lower than the calculated costs. Prices would be higher than costs if the case‐mix of the sample had been used. Costs were significantly lower for CABG.
- Lynch SyndromePublication . Rodrigues, Pedro; Matos, Paulo; Gonçalves, João; Jordan, Peter; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); MDPI AGIn 2022, colorectal cancer (CRC) was the third most common type of cancer worldwide and the second most common in Europe. CRC ranked as the second leading cause of cancer-related deaths both worldwide and in Europe, with 904,019 and 247,966 deaths, respectively. The majority of CRC cases are sporadic (60–75%); however, 10–35% of CRC are estimated to result from the interaction of heritable and environmental factors. Among these, 5–6% are caused by inherited variants in genes that predispose to the development of CRC. Among the known inherited causes, Lynch Syndrome (LS), formerly known as Hereditary Nonpolyposis Colorectal Cancer (HNPCC), is the most frequent and accounts for approximately 3% of all CRC. Here we review and update on multiple aspects of LS in the context of CRC, including its genetic and molecular basis, current guidelines for molecular screening and variant classification. Furthermore, we review functional assays that have been used to determine the biological impact of genetic variants of uncertain significance (VUS) and discuss future perspectives in the field.
- Universal Screening for Sexually Transmitted Infections in PregnancyPublication . Bandeira, Swasilanne; Vasconcelos, Joana; Teixeira, Mariana; Costa, Beatriz; Rocha, Paula; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); Biblioteca Nacional de Portugal, Centro de Estudos Históricos, CELOM
- Effects of digoxin in modern heart failure treatmentPublication . Valentim Gonçalves, António; Cardim, Nuno; Fiarresga, António; Pereira-da-Silva, Tiago; Ilhão-Moreira, Rita; Galrinho, Ana; Rio, Pedro; Carvalheiro, Ricardo; Ferreira, Fernando; Lopes, Julien; Marques Antunes, Miguel; Selas, Mafalda; Viana, Bruno; Domingues, Lúcia; Cruz Ferreira, Rui; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); Sociedade Portuguesa de Cardiologia | ElsevierAims: Even though it is the oldest heart failure (HF) medication still in use, digoxin has not been evaluated alongside the updated algorithm for treating HF with reduced ejection fraction patients. This could help explain the low use of digoxin in recent HF studies. The main objective is to assess the effectiveness of digoxin in functional capacity and cardiac function when combined with modern HF therapy. Methods: An interventional, open-label, randomised, crossover trial among adults with chronic Heart Failure and reduced ejection fraction (≤45%) was designed to allocate 50 patients for 24 weeks in each arm (48 weeks of study). The arms are daily intake of digoxin 0.125 mg plus standard of care versus standard of care alone. Both patients with sinus rhythm and atrial fibrillation were enrolled. At the end of each 24-week arm, patients will undergo the co-primary outcome measurement of the peak oxygen consumption, evaluated through cardiopulmonary exercise test, and the global work index, measured by transthoracic echocardiography. Key secondary outcome includes a safety composite of death, need for urgent heart transplantation or mechanical assist device, total hospitalizations and sustained ventricular arrhythmias. The study completed recruitment in April 2025 and will complete follow up in March 2026. Conclusions: The use of digoxin could be significantly affected by evidence that it still has a considerable effect on functional capacity and cardiac function in HF patients. EU CT Number: 2024-513448-26-00.
- Metabolic reprogramming and molecular crosstalk at the cancer-endothelial interface in ovarian carcinomaPublication . Sousa, Bruna; Chiavassa, Adele; Delgado, Leonor; Gomes, Rafael; Mendes, Cindy; Serpa, Jacinta; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); BioMed Central (BMC)
- Practical guide on acute heart failure managementPublication . Pimenta, Joana; Ferreira, João Pedro; Vasques-Nóvoa, Francisco; Roque, David; Araújo, Inês; Lourenço, César; Dias da Costa, Susana; Gonçalves, Sara; Neto, Ana; Almeida, Filipa; Moraes Sarmento, Pedro; Agostinho, João; Marques, Irene; Martins, Elisabete; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); Sociedade Portuguesa de Cardiologia | ElsevierAcute heart failure (AHF) presents significant clinical and economic challenges that require a comprehensive, evidence-based strategy extending from in-hospital management to post-discharge care. Patients with AHF usually require prompt initiation or intensification of HF-directed treatment, which commonly includes intravenous diuretics, and frequently culminates in unplanned hospitalization. Despite therapeutic advances, AHF is still associated with poor outcomes, with in-hospital mortality in Portugal reaching 12.4%. Based on the expertise and clinical experience of a panel of cardiology and internal medicine specialists, this paper provides a practical guide to AHF management over the patient journey, which has been adapted to align with the specificities of the Portuguese national healthcare system: hospital admission, initial management of AHF, in-hospital management of stable phase, pre-discharge and transition of care. This practical guide highlights the importance of optimizing guideline-directed medical therapy by tailoring and rapidly uptitrating treatments to reduce mortality and readmissions. It is equally essential that structured, multidisciplinary transition-of-care programs are established that promote continuity and coordination across care settings.
- As Humanidades no ensino médicoPublication . Gonçalves-Pereira, Manuel; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); Universidade Nova de Lisboa, Faculdade de Ciências Sociais e Humanas, Centro de História da CulturaPartindo de uma definição operacional das Humanidades no ensino da Medicina, o autor discorre sobre vertentes dos programas das Escolas Médicas em que o papel das Humanidades é crucial. Em seguida, no contexto das experiências internacionais e nacionais, descreve alguns dados da Faculdade de Ciências Médicas da Universidade NOVA de Lisboa para discutir potencialidades e limitações. Finalmente, levanta questões sobre as dificuldades da integração das Humanidades no ensino médico e aborda caminhos possíveis. Numa época de pressão social sobre o ensino da Medicina e de reflexão sobre opções curriculares, este debate deverá recorrer à investigação e exige consistência nos argumentos.
- Predictors of Response to Anti-CGRP Monoclonal AntibodiesPublication . Ferreira, Vítor Mendes; Serôdio, Miguel; Caetano, André; Viana-Baptista, Miguel; Cabral, Gonçalo; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); Sociedade Portuguesa de NeurologiaIntroduction: Anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies are effective and well-tolerated therapies for migraine prevention. However, up to 30%–40% of patients do not respond. While some clinical features have been associated with treatment outcomes, evidence remains limited. Methods: We conducted a retrospective study of patients with episodic or chronic migraine followed at a tertiary headache center who initiated anti-CGRP therapy for the first time between April 2021 and April 2024. Patients received either erenumab 70 mg or fremanezumab 225 mg. Demographic and clinical data were collected. Treatment response was defined as a ≥50% reduction in monthly headache days at 3 months. Patients were classified as responders or non-responders. Group comparisons were performed using chi-squared tests for categorical variables and Student’s t-test or Mann–Whitney test for continuous variables, according to data distribution. Results: Sixty-eight patients were included (80.9% female; mean age 43.5 ± 11.5 years). Chronic migraine was present in 48.5%. Responders and non-responders did not differ significantly in age, sex, migraine type, baseline headache frequency, aura, unilateral pain, psychiatric comorbidities, medication overuse, prior preventive failures, or type of anti-CGRP antibody. Responders were more likely to report nausea and/or vomiting (76.6% vs 52.4%, p=0.008), whereas non-responders had a higher prevalence of vascular risk factors (33.3% vs 12.8%, p=0.046). Conclusion: In our study, nausea/vomiting were associated with a favorable response to anti-CGRP therapy, replicating previous literature findings, while vascular risk factors were associated with non-response. These results suggest a potential interaction between vascular risk factors and CGRP-mediated mechanisms.
- NeurologiaPublication . Viana-Baptista, Miguel; Maia, Luís F.; Batista, Sónia; Alves, Pedro Nascimento; Mendonça, Marcelo; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); Sociedade Portuguesa de Neurologia