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Evidence-based medicine (EBM) supplies the best available data, yet clinicians still face low-value care, surrogate-driven reversals, and pseudoscientific claims. We propose Semi-Imperative Evidentialism (SIE), a normative framework that links evidential warrant to proportionate professional duties while preserving patient autonomy. Using a targeted narrative review in philosophy of science, bioethics, and clinical epidemiology, we distilled six binary attributes to classify activities as Science, Pseudoscience, or Non-science. Scientific items enter a two-tier ladder—Tier 1 (established clinical evidence) or Tier 2 (emerging or preclinical evidence)—with status re-scored as randomized trials, living meta-analyses, and post-marketing safety signals accrue. SIE maps tiers to action: Tier 1 should be offered or strongly recommended, with reasons documented if declined; Tier 2 should be discussed with explicit consent, preferably within trials or registries; Pseudoscience should be refused or discontinued with corrective education; Non-science may be acknowledged as contextual support when safe and non-substitutive. Worked examples—antiarrhythmic suppression post–myocardial infarction (CAST) and “complementary cancer cures”—illustrate earlier and more transparent course-correction. SIE provides a fallibilist bridge from evidence to duty, constraining discretion without eroding autonomy; prospective audits and cluster trials should test its impact on prescribing and consent.

Background During COVID-19 pandemic, healthcare workers (HCWs) have had high workload and have been exposed to multiple psychosocial stressors. The aim of this study was to evaluate HCWs in terms of the relative contributions of socio-demographic and mental health variables on three burnout dimensions: personal, work-related, and client-related burnout. Methods A cross-sectional study was performed using an online questionnaire spread via social networks. A snowball technique supported by health care institutions and professional organizations was applied. Results A total of 2008 subjects completed the survey. Gender, parental status, marriage status, and salary reduction were found to be significant factors for personal burnout. Health problems and direct contact with infected people were significantly associated with more susceptibility to high personal and work-related burnout. Frontline working positions were associated with all three dimensions. Higher levels of stress and depression in HCWs were significantly associated with increased levels of all burnout dimensions. Higher levels of satisfaction with life and resilience were significantly associated with lower levels of all burnout dimensions. Conclusions All three burnout dimensions were associated with a specific set of covariates. Consideration of these three dimensions is important when designing future burnout prevention programs for HCWs.

Background/Objectives: The integration of artificial intelligence (AI) in healthcare has been progressively expanding, with growing interest in its potential application in palliative care, particularly in exercise prescription. However, there is limited scientific evidence addressing professionals’ perceptions of this use. This study aimed to explore Portuguese healthcare professionals’ perceptions of AI in exercise prescription for palliative care and to identify related ethical implications and training needs. Methods: A cross-sectional, descriptive, and analytical study was conducted using an online questionnaire applied to health professionals. Sociodemographic data, knowledge, and perceptions of AI in exercise prescription in palliative care were collected. Descriptive and inferential statistical analyses were performed, including Mann–Whitney and Spearman correlation tests. Results: The sample consisted mainly of young female professionals with backgrounds in physiotherapy. Most participants reported little knowledge and experience with AI in clinical practice but expressed a strong interest in learning. Perceptions regarding the usefulness of AI were neutral to slightly positive, particularly concerning quality of life and personalization of interventions. Ethical aspects were viewed positively, especially the complementarity of AI to human clinical judgement, transparency, and explicability. Spearman correlations indicated that greater AI literacy and longer clinical experience were associated with more positive perceptions. Conclusions: The findings highlight the importance of developing structured training programmes that integrate practical, ethical, and technical components for the safe and responsible use of AI in palliative care. Ethical guidelines are proposed to ensure the humanization of care and the preservation of patient autonomy when implementing AI in exercise prescription.

Background Decision-making in palliative care can be complex due to the uncertain prognosis and general fear surrounding decisions. Decision-making in palliative care may be influenced by spiritual and cultural beliefs or values. Determinants of the decision-making process are not completely understood, and spirituality is essential for coping with illness. Thus, this study aims to explore the influence of spirituality on the perception of healthcare decision-making in palliative care outpatients. Methods A cross-sectional study was developed. A battery of tests was administered to 95 palliative outpatients, namely: sociodemographic questionnaire (SQ), Decisional Conflict Scale (DCS), Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being scale (FACIT-Sp), and a semi-structured interview (SSI) to study one’s perception of spirituality and autonomy in decision-making. Statistical analyses involved descriptive statistics for SQ and SSI. The Mann-Whitney test was used to compare scale scores between groups and correlations were used for all scales and subscales. The analysis of patients’ definitions of spirituality was based on the interpretative phenomenological process. Results Spiritual wellbeing significantly correlated with greater levels of physical, emotional and functional wellbeing and a better quality of life. Greater spiritual wellbeing was associated with less decisional conflict, decreased uncertainty, a feeling of being more informed and supported and greater satisfaction with one’s decision. Most patients successfully implemented their decision and identified themselves as capable of early decision-making. Patients who were able to implement their decision presented lower decisional conflict and higher levels of spiritual wellbeing and quality of life. Within the 16 themes identified, spirituality was mostly described through family. Patients who had received spiritual care displayed better scores of spiritual wellbeing, quality of life and exhibited less decisional conflict. Patients considered spirituality during illness important and believed that the need to receive spiritual support and specialised care could enable decision-making when taking into consideration ones’ values and beliefs. Conclusion The impact of spiritual wellbeing on decision-making is evident. Spirituality is a key component of overall wellbeing and it assumes multidimensional and unique functions. Individualised care that promotes engagement in decision-making and considers patients’ spiritual needs is essential for promoting patient empowerment, autonomy and dignity.

Lasiodiplodia theobromae is one of the most aggressive agents of the grapevine trunk disease Botryosphaeria dieback. Through a dual RNA-sequencing approach, this study aimed to give a broader perspective on the infection strategy deployed by L. theobromae, while understanding grapevine response. Approximately 0.05% and 90% of the reads were mapped to the genomes of L. theobromae and Vitis vinifera, respectively. Over 2500 genes were significantly di erentially expressed in infected plants after 10 dpi, many of which are involved in the inducible defense mechanisms of grapevines. Gene expression analysis showed changes in the fungal metabolism of phenolic compounds, carbohydrate metabolism, transmembrane transport, and toxin synthesis. These functions are related to the pathogenicity mechanisms involved in plant cell wall degradation and fungal defense against antimicrobial substances produced by the host. Genes encoding for the degradation of plant phenylpropanoid precursors were up-regulated, suggesting that the fungus could evade the host defense response using the phenylpropanoid pathway. The up-regulation of many distinct components of the phenylpropanoid pathway in plants supports this hypothesis. Moreover, genes related to phytoalexin biosynthesis, hormone metabolism, cell wall modification enzymes, and pathogenesis-related proteins seem to be involved in the host responses observed. This study provides additional insights into the molecular mechanisms of L. theobromae and V. vinifera interactions.

Spiritual Intelligence (SI) is an independent concept from spirituality, a unifying and integrative intelligence that can be trained and developed, allowing people to make use of spirituality to enhance daily interaction and problem solving in a sort of spirituality into action. To comprehensively map and analyze current knowledge on SI and understand its impact on mental health and human interactions, we conducted a scoping review following the Joanna Briggs Institute methodology, searching for 'spiritual intelligence' across PubMedCentral, Scopus, WebOfScience, and PsycInfo. Quantitative studies using validated SI instruments and reproducible methodologies, published up to 1 January 2022, were included. Selected references were independently assessed by two reviewers, with any disagreements resolved by a third reviewer. Data were extracted using a data extraction tool previously developed and piloted. From this search, a total of 69 manuscripts from 67 studies were included. Most studies (  = 48) were conducted in educational (  = 29) and healthcare (  = 19) settings, with the Spiritual Intelligence Self Report Inventory (SISRI-24) emerging as the predominant instrument for assessing SI (  = 39). Analysis revealed several notable correlations with SI: resilience (  = 7), general, mental, and spiritual health (  = 6), emotional intelligence (  = 5), and favorable social behaviors and communication strategies (  = 5). Conversely, negative correlations were observed with burnout and stress (  = 5), as well as depression and anxiety (  = 5). These findings prompt a discussion regarding the integration of the SI concept into a revised definition of health by the World Health Organization and underscore the significance of SI training as a preventative health measure.

The objective of this article is to broaden the discussion on the factors that constitute adolescent healthcare decisional capacity, ensuring that adolescents are recognized as capable of refusing treatments or procedures. Materials from different sources were analyzed, including articles from reputable databases and documents from government agencies, forming a purposefully selected sample. The research was conducted in two phases: document selection and reflective analysis, followed by a report. The discussion was approached from a phenomenological perspective, with reflections grounded in human rights principles. Healthcare decisional capacity must be sufficiently robust to allow adolescents to refuse treatments or procedures. It is essential to respect the right of capable adolescents to refuse treatments and procedures. Protecting the vulnerability of adolescent patients involves honoring their growing autonomy. Data from field research regarding the refusal of treatments and procedures in adolescence are scarce, which limits the scope of the proposed discussion. It cannot be argued that adolescents should have different abilities to refuse a treatment or procedure compared to those required to give consent. The importance of these skills seems to vary between these situations. This difference is justified by the need to consider potential harm to health, even though it could be argued that damage to health should be part of the bioethical deliberation surrounding the decision, rather than a factor in the assessment of decisional capacity.

The obstetrics field is undergoing transformation and committing to ensuring the autonomy of pregnant women in decisions related to birth based on scientific information. The physiological process of birth typically results in vaginal delivery, but medicine has evolved to include obstetric surgeries that are safe and result in few perioperative complications, especially when cesarean section is performed from 39 weeks of gestational age. Thus, the question is whether clinicians should interfere with pregnant women’s freedom to choose their mode of delivery by trying to persuade them to choose vaginal delivery. The objective was to analyze the perinatal complications of the maternal–fetal dyad in primiparous women subjected to vaginal delivery versus elective cesarean section with respect to the bioethical precepts of autonomy, beneficence and nonmaleficence. In total, 2,507 women, including 1,807 (72.1%) with vaginal deliveries and 700 (27.9%) with cesarean deliveries, were analyzed between 2017 and 2020. There was no difference between the types of delivery in maternal readmission, death, admission to the intensive care unit, an Apgar score <7 in the 5th minute of life, maternal blood transfusion or comorbidities of the mothers or newborns. The elective cesarean section group showed less need for therapeutic uterotonics. In primigravidae, it was observed that elective cesarean section did not present a higher risk of complications than vaginal delivery. Therefore, this guarantees the autonomy and right of the individual to choose the mode of delivery.

Background and objective Telemedicine holds promise for older adults with chronic and complex conditions, particularly those in need of palliative care. However, more information is needed about the perceptions of patients and their caregivers regarding this technology for providing care. Therefore, this study aims to explore the experience of non-oncologic older adult patients in palliative care with telemedicine. Methods We followed Arksey and O'Malley's five-stage scoping review approach and conducted searches in Medline, Scopus, and Web of Science databases. Key concepts included: \"telemedicine\" or \"telehealth\"; \"elderly\" or \"old age\" or \"geriatric\"; \"palliative care\" and NO \"cancer\" and were included articles written in English or Portuguese from the last five years. Results Eighteen articles were included out of 137 abstracts selected. Most studies focused on elderly individuals in homebound settings, nursing homes, or long-term care facilities. The experiences reported in many articles were positive, with patients and caregivers expressing a willingness to use telemedicine. It was particularly convenient for patients in rural areas. However, several barriers were identified, such as difficulties in using and accessing technology and concerns about privacy, influencing the willingness to use telemedicine. Conclusions Telemedicine can be beneficial in the care of older adults with non-oncologic chronic disease, multimorbidity, and life-threatening conditions. Nevertheless, understanding this barrier and searching for solutions from the patients' perspectives is essential for integrating telemedicine into their care. More studies involving older adults palliative care patients are needed to explore this area further.

Background The influence of demographic factors on the completion and knowledge of the Portuguese Advance Directives (PAD) and the Health Care Proxy’s (HCP) role is still not clear. Objectives To identify sociodemographic features associated with knowledge and adherence to PAD and HCP in palliative care. Design Cross-Sectional analysis of the sociodemographic data, PAD and HCP role knowledge, and PAD Register from a group of Portuguese palliative patients and their caregivers enrolled on the DAVPAL trial to test the PAD efficacy in promoting better concordance between patients and caregivers. Participants One hundred twenty participants (60 palliative patients and 60 caregivers). Methods After enrollment, the participants' sociodemographic data was acquired, their knowledge of PAD and the role of an HCP was questioned, and their prior register of the PAD was asked. Results 60 patients and 60 caregivers were included ( n =120), with differences among them regarding age ( p <.001), gender ( p =.003), education ( p <.001), job ( p <.001), marital status ( p =.043), and access to the internet ( p =.003), but not regarding religion ( p =.21). Only 13.3% of the participants were aware of PAD, 15.0% were aware of the HCP role, and 5.0% had previously filled a PAD. Religious beliefs (Non-Catholic) were the only sociodemographic factor significantly related to these three topics. Conclusions There is low awareness of PAD and the HCP’s role in palliative care, and there is higher knowledge on these topics among non-Catholic individuals. End-of-life decisions seem to be influenced by similarities in religious beliefs between patients and HCP. Improving education is necessary, namely in palliative care. Trial registration ClinicalTrials.gov ID NCT05090072 . Retrospectively registered on 22/10/2021.