Acta medica portuguesa最新文献

{"title":"[Delayed Cutaneous Reaction to a Jellyfish Sting].","authors":"Manuel Bernardo Rodrigues Costa, Ana Filipa Silva, Alberto Mota","doi":"10.20344/amp.24463","DOIUrl":"10.20344/amp.24463","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":"409-410"},"PeriodicalIF":1.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147759511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subacute Combined Degeneration as the Initial Manifestation of Folate Deficiency.","authors":"Joana Sousa Varela, Patrícia Ramos Santos, Miguel Simões Rodrigues, Mário Amaro, Maria Francisca Delerue","doi":"10.20344/amp.24329","DOIUrl":"https://doi.org/10.20344/amp.24329","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"39 6-7","pages":"431-432"},"PeriodicalIF":1.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148203625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Management of the Patient with Suspected Sepsis or Septic Shock: Clinical Recommendations for the Portuguese Prehospital Setting].","authors":"Adelaide Moutinho, Fábio Martins, Joana Fontes, José Lopes, Lénia Ferreira, Solange Mega, Ana Vaz Cristino, Eduardo Cernadas, Francisco Abecacis, João Gonçalves Pereira, João João Mendes, Paulo Almeida, Paulo Mergulhão, Ana Margarida Correia","doi":"10.20344/amp.24178","DOIUrl":"10.20344/amp.24178","url":null,"abstract":"<p><p>Sepsis is a time-dependent medical emergency associated with high morbidity and mortality. Early recognition and appropriate prehospital management are critical for prognosis. Despite the existence of the Sepsis Fast Track standardized by the Directorate-General of Health (Direção-Geral da Saúde), there has been underreporting of suspected sepsis cases, highlighting the urgent need to review the alert criteria. In addition, Portugal lacked specific guidelines for its activation and management in the pre-hospital setting. Considering these facts, this article aims to produce evidence-based recommendations for the standardization of the recognition and treatment of sepsis and septic shock in the Portuguese pre-hospital context, in line with the latest international guidelines and the operational capabilities of the Integrated Medical Emergency System. This guideline is the result of a comprehensive review of the literature, integrating international consensus and adapting it to the Portuguese context. For that matter, inclusion and exclusion criteria are defined for sepsis alert in the pre-hospital context, prioritizing early identification through suspected infection or changes in temperature and organ dysfunction or clinical indicators of severity, such as NEWS/NEWS2 ≥ 5, Shock Index ≥ 0.7, Mottling ≥ 2, capillary refill time > 2 seconds. Treatment depends on the type of intervention, including oxygen therapy, positioning, and temperature control for basic life support teams; balanced crystalloids, parenteral antipyretics, and early initiation of vasopressor support for differentiated teams, subject to certain assumptions for immediate life support teams. Empirical antibiotic therapy is also recommended in cases of septic shock handled by teams with a physician, namely Emergency Medical and Resuscitation Vehicles and Emergency Helicopter Service. The article also standardizes both clinical records and alert activation via the iTeams® platform and manual registries. This first national guideline for sepsis in the pre-hospital setting establishes uniform, evidence-based procedures for early recognition and treatment in this context, contributing to improved clinical outcomes, optimization of resources, and strengthened inter-hospital coordination within the sepsis fast track.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":"411-421"},"PeriodicalIF":1.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147759505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Greener Lisbon: The Role of Tree Planting in Mitigating the Effects of Heat].","authors":"Diogo Neves, Henrique Rosado, João Tiago Correia","doi":"10.20344/amp.24375","DOIUrl":"10.20344/amp.24375","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":"383-386"},"PeriodicalIF":1.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147727971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Airway Clearance Devices in Pediatrics: A Future Reality?]","authors":"Filomena Santos, Alberto Nascimento Santos","doi":"10.20344/amp.24099","DOIUrl":"10.20344/amp.24099","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":"422-423"},"PeriodicalIF":1.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147759550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Acting Reversible Contraception in Primary Care: A Cross-Sectional Study on the Perspectives of Portuguese Family Physicians.","authors":"Ana Beatriz De Almeida, Ana Sofia De Sá Monteiro, Daniel Bertoluci Brito, Pedro Gouveia, Joaquim Santos, Rosa Zulmira Macedo","doi":"10.20344/amp.24370","DOIUrl":"10.20344/amp.24370","url":null,"abstract":"<p><p>Long-acting reversible contraceptives (LARC) are recommended as first-line methods due to high efficacy and safety. Family Medicine (FM) physicians are ideally positioned to provide counseling and LARC-related services; however, their implementation in primary care is hindered by multiple constraints. The aim of this nationwide cross-sectional study was to characterize family planning practices among FM physicians in Portugal, to identify the main obstacles to LARC provision, and to propose strategies to enhance clinical autonomy. In this manner, an anonymous online questionnaire was distributed among FM physicians (specialists and residents), currently working within the Portuguese National Health Service. A total of 220 responses were collected over six weeks. While nearly all physicians (99.5%) routinely conducted family planning consultations, only 31.8% of respondents reported feeling fully prepared to perform LARC insertions autonomously. Among those who rarely insert LARC (18.7%), the main barriers identified were related to organizational constraints (38.0%) and gaps in practical training (37.0%). The majority (98.2%) expressed interest in further training, particularly in practical insertion/removal techniques. In conclusion, this study highlighted a significant gap in confidence among Portuguese FM physicians regarding LARC provision. Strengthening simulation-based training and promoting structured mentorship with gynecology specialists may help overcome these barriers.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":"394-397"},"PeriodicalIF":1.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147653424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Insomnia Management in the Burn Unit: What Options Are Left?]","authors":"Marta Moura Neves, Daniel Henriques, Inês Amado, Vítor Santos","doi":"10.20344/amp.24482","DOIUrl":"10.20344/amp.24482","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":"426"},"PeriodicalIF":1.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147697084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Moral Distress, Work Engagement, and Meaningful Work in Healthcare: A Narrative Review.","authors":"Catarina Santos, Guida Da Ponte","doi":"10.20344/amp.24197","DOIUrl":"https://doi.org/10.20344/amp.24197","url":null,"abstract":"<p><p>The 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.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148004198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Value-Based Healthcare in the Treatment of Age-Related Macular Degeneration: Clinical and Patient-Reported Outcomes from a Portuguese Multicenter Study].","authors":"Ana Gama-Castro, António Ferrão-Mendes, Rita Rodrigues, Inês Figueiredo, Francisca Bragança, Rita Laiginhas, Ana Maria Cunha, Miguel Lume, Rufino Silva, Ângela Carneiro","doi":"10.20344/amp.24246","DOIUrl":"10.20344/amp.24246","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to describe and compare patient-reported outcome measures (PROMs) and objective clinical outcome measures (CROMs) in the treatment of age-related macular degeneration (AMD), exploring the concordance between these measures within a value-based healthcare (VBH) framework.</p><p><strong>Methods: </strong>This prospective, multicenter, observational, real-world study was conducted at three tertiary referral hospitals specializing in the treatment of neovascular AMD. Clinical outcomes (CROMs) and patient-reported outcomes (PROMs) were analyzed using the National Eye Institute Visual Functioning Questionnaire 25 (NEI VFQ-25) questionnaire as a functional assessment tool. Data were collected at baseline and at three, six, and 12 months following initiation of intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy. Statistical analysis was primarily descriptive. The comparison between baseline and 12 months in the global NEI VFQ-25 score was performed using the Wilcoxon signed-rank test for paired samples. Concordance between CROMs and PROMs was assessed using the intraclass correlation coefficient (ICC).</p><p><strong>Results: </strong>A total of 235 eyes were included, receiving 2338 intravitreal injections. The mean age of participants was 81 years (SD = 8.57), and 55.8% were female. The mean baseline NEI VFQ-25 score was 67.83 (SD = 10.39). The median best-corrected visual acuity was 63 ETDRS letters (interquartile range [P25 - P75]: 41 - 75) at baseline, increasing to 65 letters at three months and remaining stable through 12 months of follow-up. The comparison between baseline and 12 months revealed a statistically significant difference in visual acuity (Wilcoxon signed-rank test, Z = 4.2; p < 0.001). A reduction in the proportion of patients classified as legally blind was observed, together with an increase in the proportion of patients in the reading-vision and driving-vision categories. At 12 months, 58.7% of patients reported stabilization or improvement in visual function on the NEI VFQ-25 questionnaire. Concordance between the variation in visual acuity and the variation in the global NEI VFQ-25 score showed good agreement between CROMs and PROMs (ICC = 0.76; p < 0.001).</p><p><strong>Conclusion: </strong>The integrated analysis of CROMs and PROMs suggests that anti-VEGF treatment for neovascular AMD is associated with stabilization or improvement in visual acuity and patients' perceived visual function. The implementation of the VBH-AMD model proved feasible in a real-world clinical setting, reinforcing the importance of integrating patient-centered measures into the evaluation of therapeutic outcomes.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"39 5","pages":"332-339"},"PeriodicalIF":1.2,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Primary Cutaneous Diffuse Large B-Cell Lymphoma, Leg Type].","authors":"Inês Tribolet de Abreu, Miguel Reis","doi":"10.20344/amp.24251","DOIUrl":"https://doi.org/10.20344/amp.24251","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"39 5","pages":"364-365"},"PeriodicalIF":1.0,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}