Introduction: The Modified British Medical Research Council Questionnaire is considered an adequate and simple measure of breathlessness in chronic obstructive pulmonary disease. It is widely used in clinical practice in Portugal, but it still lacks confirmatory evaluation for the Portuguese setting. The aim of this study was to perform a cultural adaptation and validation of the Modified British Medical Research Council Questionnaire so that its most suitable version can be made available to researchers and clinicians in Portugal.Material and Methods: We performed a cross-sectional descriptive study involving patients with chronic obstructive pulmonary disease aged 40 years or older. We applied the Modified British Medical Research Council Questionnaire and the previously validated Portuguese-language version of the clinical questionnaire for chronic obstructive pulmonary disease between January and June 2019. We determined the agreement between the two questionnaires with kappa agreement, with a 95% confidence interval, and we used Spearman correlation to find a correlation between two scores.Results: The study included 65 patients managed in a hospital pulmonology clinic (aged 68 ± 7 years; with predicted FEV1 of 49.86% ± 16.5%). The Modified British Medical Research Council scale correlated significantly with all the domains and the overall score of the clinical questionnaire for chronic obstructive pulmonary disease (0.46 < r < 0.68; p < 0.001). In bilingual patients, interclass correlation coefficient was 0.912 (p < 0.001).Conclusion: The Portuguese version of the Modified British Medical Research Council Questionnaire is a valid instrument for measurement of breathlessness in chronic obstructive pulmonary disease.

Background: Aggravated by the COVID-19 pandemic, the provision of palliative care for patients with palliative care needs emerges as a necessity more than ever. Most are managed in primary care by their family physicians (FP). This study aimed to understand the perspectives of specialist and trainee FPs about their role in palliative care. Methods: we conducted a double focus-group study consisting of two separate online focus-groups, one with FP specialists (n = 9) and one with FP trainees (n = 10). Results: FPs already gather two fundamental skills for the provision of palliative care: the capacity to identify patients’ needs beyond physical symptoms and the recognition that the patient belongs to a familiar, psychosocial, and even spiritual environment. They perceive their role in palliative care to be four-fold: early identification of patients with palliative care needs, initial treatment, symptom management, and patient advocacy. Participants recognized the need for palliative care training and provided suggestions for training programs. Conclusion: FPs share a holistic approach and identify multiple roles they can play in palliative care, from screening to care and advocacy. Organizational barriers must be addressed. Short training programs that combine theory, practice, and experiential learning may further the potential for FPs to contribute to palliative care.

Objectives Our systematic review aimed to summarise non-pharmacological interventions applicable in primary care that improve the quality of life of older patients with palliative care needs. Design Systematic review. Primary and secondary outcome measures The primary outcome was patients’ quality of life. Secondary outcomes were symptoms relief and patients’ well-being measures. Methods and analysis We searched MEDLINE, EMBASE, PsycINFO, Cochrane and CINAHL up to October 2022 for randomised controlled trials (RCTs). We also handsearched abstract books of relevant congresses and scientific meetings in the last 5 years. Screening, data extraction and quality evaluation (Cochrane risk-of-bias (RoB) V.2.0 tool and Grading of Recommendations, Assessment, Development and Evaluations (GRADE)) were done independently by two reviewers, with disagreements solved by a third reviewer. Findings were narratively synthesised. Results We identified 4 RCTs, including 268 patients. One study used a broad criteria of palliative care needs (‘progressive, life-threatening disease’), two studies focused on advanced cancer and one study on heart failure. The non-pharmacological interventions evaluated were advance care planning conducted by general practitioners (GPs); social worker-aided palliative care; online primary palliative care training for GPs and spiritual history taking by nurses and GPs. No intervention showed a statistically significant impact on quality of life and the evidence was low according to GRADE. Conclusion The results highlight a dearth of evidence on what non-pharmacological interventions can be effectively done in primary care to improve the quality of life of older persons with palliative care needs. The results should be interpreted with caution, as the search more comprehensively covers interventions delivered by GPs. PROSPERO registration number CRD42020154216.

Artificial intelligence (AI) is increasingly being recognized as a transformative force in healthcare, showing significant promise in supporting healthcare professionals. AI has many applications in healthcare, including providing real-time decision support, diagnosing diseases, and advancing personalized medicine. However, clinical trials and further research are needed to evaluate the practical effectiveness of AI in primary healthcare. This study aims to assess the accuracy of ChatGPT, an AI-powered chatbot, in therapeutic decision-making during acute disease consultations in primary care and compare its performance to that of general family physicians. The goal was to determine how well ChatGPT could replicate the decisions made by physicians based on standard clinical guidelines. A cross-sectional study was conducted at three primary healthcare units in the Central Region of Portugal. The analysis involved three phases: (1) collecting data from healthcare professionals, (2) gathering therapeutic proposals from ChatGPT v3.5 based on physician-defined diagnoses, and (3) comparing the treatments proposed by both ChatGPT v3.5 and the physicians, using the Dynamed platform as the gold standard for correct prescriptions. Out of a total of 860 consultations, 138 were excluded due to non-compliance with the inclusion criteria. The analysis showed that the diagnostic accuracy of ChatGPT v3.5 and physicians co-occurred in 26.2% of cases. In 29.1% of cases, there was no agreement between the AI and the physicians’ diagnoses. The therapeutic decisions made by ChatGPT v3.5 were correct in 55.6% of the cases, while physicians made correct decisions in 54.3% of the cases. The therapeutic decisions of ChatGPT v3.5 were incorrect in 5.2% of the cases, compared to 11% for physicians. Furthermore, the therapeutic proposals of ChatGPT v3.5 were ‘approximate’ to the correct treatment in 24% of the cases, while physicians had a 17.1% approximation rate. This study suggests that AI – specifically ChatGPT v3.5 – can match or even outperform physicians in terms of therapeutic decision accuracy, with a similar or slightly better success rate than human doctors. This highlights the potential for AI to act as an effective auxiliary tool rather than a replacement for healthcare professionals. AI is most effective when used in collaboration with healthcare professionals, augmenting their capabilities and improving overall healthcare delivery. Ultimately, AI can serve as a powerful aid to healthcare professionals, helping improve patient care and healthcare outcomes, particularly in primary care.

Background: Evidence suggests that involving General Practitioners in the care of patients with palliative care needs may improve patient outcomes. Aim: To evaluate whether a two-tiered intervention involving training in palliative care and a new consultation model in primary care for patients with palliative care needs is feasible and could reduce patients’ symptom burden. Design: Before-after study including an internal pilot. Setting/participants: Nine general practitioners working in a health region in Portugal and 53 patients with palliative care needs from their patient lists were recruited. General Practitioners received training in palliative care and used a new primary palliative care consultation model, with medical consultations every 3 weeks for 12 weeks. The primary outcome was physical symptom burden, self-reported using the Integrated Palliative care Outcome Scale (IPOS) patient version (min.0–max.1000). Secondary outcomes included emotional symptoms (min.0–max.400) and communication/practical issues (min.0–max.300). Results: Of the 35/53 patients completed the 12-week intervention (mean age 72.53 years, SD = 13.45; 54.7% female). All had advanced disease: one third had cancer ( n = 13), one third had congestive heart failure ( n = 12); others had chronic kidney disease and chronic obstructive pulmonary disease. After the 12 weeks of intervention, there was a reduction in physical symptom burden [mean difference from baseline of 71.42 (95%CI 37.01–105.85) with a medium-large effect size (0.71], and in emotional symptom burden [mean difference 42.86 (95%CI 16.14–69.58), with a medium effect size (0.55)]. No difference was found for communication/practical issues. Conclusions: Our intervention can be effective in reducing patients’ physical and emotional symptoms. Trial registration: ClinicalTrials.gov ID – NCT05244590. Registration: 14th February 2022.

Introduction In the last decades, the number of older people living with chronic diseases has rapidly increased. The prevalence of palliative care needs in this population can reach 17%, making the general practitioner a cornerstone in the identification and first medical intervention delivery. Therefore, knowing the primary care interventions that effectively improve the quality of life of these patients can play an important role in the delivery of healthcare. Methods and analysis We will systematically review randomised controlled trials evaluating the effect of non-pharmacologic primary care interventions on the quality of life of older patients (≥65 years) with palliative care needs. PsycINFO, EMBASE, MEDLINE, Cochrane and CINAHL will be searched until December 2021. Screening, data extraction and quality evaluation (using the Cochrane RoB 2.0 tool) will be done by independently by two reviewers, with disagreements solved by a third reviewer. We will conduct meta-analysis if appropriate. In case of high heterogeneity, findings will be analysed by subgroup according to intervention type, main disease/symptoms and care context. Evidence will be graded using the Grading of Recommendations Assessment, Development and Evaluation approach. We will perform a sensitivity analysis based on study quality. Publication bias will be assessed using funnel plots. Ethics and dissemination Formal ethical approval is not required as primary data will not be collected. The results will be disseminated through a peer-reviewed publication, conference presentation and the press. PROSPERO registration number CRD42020154216.