Search Results (1,958)

Background: Adverse event reporting is a critical component of patient safety systems; however, nurses’ engagement in reporting is influenced not only by reporting procedures but also by broader organizational characteristics of the nursing practice environment. Although previous studies have examined reporting behaviors in various healthcare settings, limited evidence is available regarding how organizational factors influence nurses’ perceptions of adverse event reporting in post-Soviet primary healthcare systems. Objective: To examine the relationship between the nursing practice environment and nurses’ perceived benefits of adverse event reporting in primary healthcare settings in Kazakhstan and to explore the underlying factor structure of the nursing practice environment within this context. Methods: A cross-sectional survey was conducted among 468 primary healthcare nurses from six major cities in Kazakhstan. Participants were recruited through professional and educational networks using a targeted convenience sampling strategy. The nursing practice environment was assessed using the Revised Professional Practice Environment (RPPE) scale, while attitudes toward adverse event reporting were measured using the Reporting of Clinical Adverse Events Scale (RoCAES), focusing on the perceived benefits of reporting dimension. Exploratory factor analysis was performed to identify the underlying structure of the RPPE scale. Associations between EFA-derived factors and perceived benefits of adverse event reporting were examined using Spearman correlation analysis and multivariable logistic regression with adjustment for age, gender, city, and professional position. Results: Exploratory factor analysis identified three dimensions of the nursing practice environment: Professional Motivation and Teamwork, Interprofessional Conflict and Workplace Relationships, and Staffing Adequacy. Spearman correlation analysis demonstrated significant associations between all three factors and perceived benefits of adverse event reporting. Factor 1 (Professional Motivation and Teamwork) showed the strongest negative correlation with the outcome (r = −0.562, p < 0.001), followed by Factor 3 (Staffing Adequacy) (r = −0.434, p < 0.001), whereas Factor 2 (Interprofessional Conflict and Workplace Relationships) demonstrated a positive correlation (r = 0.227, p < 0.001). In the multivariable logistic regression model adjusted for age, gender, city, and professional position, Factor 1 was negatively associated with favorable perceptions of adverse event reporting (OR = 0.389, p < 0.001), whereas Factor 2 demonstrated a positive association (OR = 1.763, p = 0.002). Factor 3 and demographic variables were not statistically significant. Conclusions: The findings suggest that nurses’ perceptions of the benefits of adverse event reporting are influenced by multiple dimensions of the nursing practice environment. Exploratory factor analysis identified three organizational dimensions—Professional Motivation and Teamwork, Interprofessional Conflict and Workplace Relationships, and Staffing Adequacy—that were associated with reporting perceptions. After adjustment for demographic characteristics, Professional Motivation and Teamwork and Interprofessional Conflict and Workplace Relationships remained independently associated with perceived benefits of adverse event reporting, whereas demographic factors did not demonstrate significant associations. These findings highlight the importance of organizational conditions, communication processes, and professional engagement in shaping nurses’ attitudes toward adverse event reporting. Efforts to strengthen patient safety reporting systems should therefore extend beyond reporting procedures alone and include broader organizational strategies aimed at improving communication, teamwork, and supportive work environments within primary healthcare settings. Full article

Background: Sepsis remains a leading cause of morbidity, mortality, and healthcare expenditure worldwide. Despite international guidelines and diagnostic criteria, real-world variability in coding, treatment, and outcomes persist. This retrospective study analyzed 13,994 coded sepsis-related hospitalizations identified through administrative ICD-9-CM algorithms between 2016 and 2024 to evaluate the burden of sepsis, temporal trends, clinical outcomes, and healthcare costs within a regional health system. Methods: Hospitalization data across four local health authorities (ASL 201–204) over an 8-year period were analyzed. The coded sepsis cases were identified using validated ICD-9-CM-based algorithms and classified into four groups according to available microbiological coding: Gram-positive, Gram-negative, anaerobic and unspecified. Variables included patient demographics, length of stay, costs, outcomes (in-hospital and post-discharge mortality) and presence of septic shock. Comparative analyses were conducted using descriptive statistical methods and One-way ANOVA test and chi-squared tests were applied to evaluate the significance of differences. Multivariable logistic regression models were used to identify independent predictors of 6- and 12-month mortality. Results: The dataset included 13,994 coded sepsis-related hospitalizations, with the largest subgroup being ‘unspecified’ (48.0%). Among cases with specified etiology, coded anaerobic sepsis categories, though rare (0.7%), were associated with higher in-hospital mortality (45.5%) and economic burden (avg. € 8563). Mortality remained high at 6 and 12 months across all types, exceeding 50% post-discharge. Increasing age (OR ≈ 1.06 per year) and septic shock (OR ≈ 4.5–4.8) were the strongest independent predictors of mortality. Differences across microbiological groups should be interpreted cautiously given the high proportion of cases without organism-specific coding. Despite a modest reduction in mortality over time, sepsis was associated with persistently high 6- and 12-month mortality, highlighting a substantial long-term burden beyond the acute phase of illness. These findings suggest that sepsis-related hospitalizations are associated with substantial long-term mortality beyond the acute phase of illness. Discussion: These findings underscore the clinical and economic impact of sepsis in hospitalized patients, across microbiological coding categories. The high mortality rate at 6–12 months may support the need for further investigation into structured post-discharge follow-up strategies. Sepsis represents a substantial clinical and economic burden within the regional healthcare system, with persistently elevated short- and mid-term mortality. Incomplete organism-level documentation limits direct etiologic comparisons and highlights the need for improved integration between clinical, microbiological, and administrative data systems. Future research should integrate clinical variables and lab results to enable risk stratification and intervention planning. Full article

Background and Objectives: Artificial intelligence (AI) is increasingly integrated into healthcare management and pharmaceutical marketing workflows, yet determinants of AI adoption intention among non-clinical professionals remain under-studied in Central and Eastern Europe. This cross-sectional study quantified AI adoption intention (AAI) across three professional groups and examined its organizational, cognitive, attitudinal, and regulatory correlates. Methods: We surveyed 127 Romanian professionals (43 hospital administrators, 42 pharmaceutical marketing professionals, 42 community pharmacy managers) using a 46-item structured instrument. The instrument combined items adapted from UTAUT/TAM and organizational-readiness measures with study-specific AI-marketing, AI-literacy, and regulatory-literacy items; Analyses included ANOVA with Tukey HSD, Spearman correlations, age-adjusted OLS regression with HC3 robust standard errors, bootstrap indirect-effect analysis, moderation, exploratory k-means clustering, and exploratory logistic/ROC analysis. Results: AAI differed across groups: pharmaceutical marketing 4.33 ± 0.50, hospital administrators 3.39 ± 0.47, and pharmacy managers 2.88 ± 0.54; all pairwise Tukey contrasts p < 0.001. In the multivariable model (R² = 0.833)—interpreted cautiously because conceptually related adoption constructs may overlap despite acceptable collinearity diagnostics—perceived usefulness, organizational readiness, and perceived ease of use were the strongest associated factors, while data governance concern was the main negative correlate. Perceived usefulness statistically accounted for 61.7% of the AI literacy–AAI indirect association, and regulatory literacy moderated the AI literacy–AAI association. An exploratory age-adjusted logistic model showed high within-sample discrimination for top-tertile AAI but should be interpreted as convergent validity among survey constructs rather than as a validated screening tool. Conclusions: AI adoption intention in Romanian medical management and pharmaceutical marketing is associated mainly with perceived usefulness and organizational readiness, tempered by data governance concern and regulatory knowledge. Longitudinal, multi-site, real-world implementation studies with external validation are needed. Full article

Background: Over the years, it has become increasingly clear that neurological conditions, such as multiple sclerosis (MS), commonly exhibit other health problems. Therefore, this is the first study aimed at investigating the prevalence of and factors associated with three binary outcomes: depression, anxiety, and an overactive bladder (OAB) among MS patients in the Qassim region, Saudi Arabia. Methods: This cross-sectional study was conducted in the neurological department of King Fahad Specialist Hospital in the Qassim region, Saudi Arabia, from January to December 2024. Data on age, sex, marital status, occupation, body mass index (BMI), MS duration, comorbidities, anxiety, depression, and OAB symptoms (frequency, nocturia, urgency, and urge incontinence) were obtained. Results: Of the 262 MS patients in this study, 184 (70.2%) were females, and 78 (29.8%) were males. The median values [IQR] of age and MS duration were 34 [26–40] and 5 [2–9] years, respectively. The prevalence of depression, anxiety, and OAB were 53.4%, 43.9%, and 50%, respectively. Nocturia was the most frequent urinary symptom, and urge incontinence was significantly higher among females. Multiple logistic regression analyses were conducted to assess factors associated with three binary outcomes: depression, anxiety, and OAB. For depression, being single and anxiety were associated with increased risk. Regarding anxiety, being a student was related to decreased risk, while being female and having depression were associated with increased risk. For OAB, only anxiety was associated with increased risk. Conclusions: Approximately one in two MS patients experience either depression or OAB, while anxiety was reported by fewer than half of the patients. This high prevalence of the three outcomes has critical implications for healthcare policy and resource allocation. Thus, screening, early diagnosis, and intervention, as well as integrated care, should be prioritized by healthcare institutions and practitioners to address these conditions and improve MS patients’ quality of life. Full article

Background/Objectives: Postoperative pulmonary complications (PPCs) significantly contribute to surgical morbidity, mortality, and healthcare costs, yet their definition remains heterogeneous in clinical literature. We aimed to develop and apply a standardized system for defining and measuring PPCs and their severity among a general, low-risk surgical population. Methods: A retrospective, observational design evaluated data from 95,808 adult patients undergoing elective surgery with general anesthesia between 2015 and 2023 at a large tertiary medical center. PPCs were identified using a curated list of ICD-10 codes based on the StEP-COMPAC consensus and were categorized into mild, moderate, or severe based on the intensity of postoperative oxygen delivery. Multivariable logistic and ordinal regression models were utilized to identify risk factors for the occurrence and clinical severity of PPCs. Results: The overall incidence of PPCs was 7.52% (n = 7206), with mild cases accounting for the majority (5.65%), followed by moderate (1.47%), and severe (0.40%) cases. Key risk factors for PPCs included ASA class 3 or 4, OSA, COPD, increased case duration, and the use of home oxygen devices. Higher mean pre-operative oxygen saturation was identified as a protective factor against PPCs. Conclusions: A feasible and promising framework for standardizing PPC measurement using EHR data and interprofessional collaboration is presented for use in ongoing initiatives aimed at reducing rates of PPCs. Identified risk factors may serve as critical triggers for implementing perioperative strategies to mitigate complications in the general surgical population. Full article

Background: Clostridioides difficile infection (CDI) remains a leading cause of hospital-acquired infection. Metabolic-dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease worldwide and has been associated with increased infectious susceptibility. However, whether non-cirrhotic MASLD independently worsens inpatient CDI outcomes and whether this differs across the MASLD spectrum remain unclear. Methods: We conducted a retrospective cohort study using the National Inpatient Sample (NIS) 2017–2023, identifying adult hospitalizations with a principal diagnosis of CDI. Patients with cirrhosis and alcoholic liver disease were excluded. Propensity score matching (1:1) was performed for the primary MASLD vs. non-MASLD comparison in the principal-diagnosis CDI cohort. To evaluate whether outcomes differ across the MASLD spectrum, survey-weighted multivariable logistic regression was used to compare K76.0-coded (MASLD without steatohepatitis) and K75.81-coded (MASH) hospitalizations against non-MASLD/MASH hospitalizations within the principal-diagnosis CDI cohort. The primary outcome was in-hospital mortality; secondary outcomes included complications, healthcare utilization, and discharge disposition. Results: The principal-diagnosis CDI cohort comprised 76,103 discharges (weighted ~380,515). MASLD prevalence among non-cirrhotic CDI hospitalizations nearly doubled from 1.98% in 2017 to 3.74% in 2023 (OR per year 1.089; p < 0.001). After propensity score matching (1756 pairs), MASLD was not associated with significantly higher in-hospital mortality (OR 1.252; p = 0.574) or most adverse outcomes, but was associated with lower odds of non-routine discharge (OR 0.794; p = 0.003). In the matched utilization analysis, length of stay and total charges were not significantly different, although the adjusted pre-match analysis showed higher charges among MASLD hospitalizations (+$4431; p = 0.001). Within the same principal-diagnosis cohort, K76.0-coded MASLD (n = 1988) was associated with lower odds of acute kidney injury (aOR 0.821; p = 0.004) and non-routine discharge (aOR 0.805; p = 0.001). K75.81-coded MASH (n = 197) was independently associated with higher in-hospital mortality (aOR 2.840, 95% CI 1.154–6.985; p = 0.023) and peritonitis (aOR 4.136, 95% CI 1.543–11.082; p = 0.005), although confidence intervals were wide and the number of MASH-coded hospitalizations was modest. Conclusions: The prevalence of MASLD among CDI hospitalizations is rising. Non-cirrhotic MASLD without steatohepatitis does not independently worsen inpatient CDI outcomes after adjustment, whereas K75.81-coded MASH may identify a higher-risk subgroup with increased mortality and peritonitis, pending confirmation in larger cohorts. These findings suggest that hepatic inflammatory activity, rather than steatosis alone, may drive adverse CDI outcomes and support further investigation of MASLD phenotyping in CDI risk stratification. Full article

Background/Objectives: Children of families facing unmet social needs experience higher rates of adverse outcomes compared to those not experiencing unmet social needs. This study aimed to identify factors associated with families’ unmet social needs as reported by parents or guardians at their children’s primary care visits. Methods: This cross-sectional study recruited English-speaking primary caregivers of children less than 18 years of age from the Southwestern Ohio Ambulatory Research Network (SOAR-Net) who were surveyed between January 2023 and August 2024. Surveys included the Maternal Social Support Index, Social Capital Scale, RAND Depression Screener, Children with Special Health Care Needs Screener, Medical Expenses of Children Survey, a 10-item social needs screener, and demographics. Data were analyzed with chi-square or Fisher’s exact tests, adjusted logistic regression, and ANOVA. Results: Among 1167 respondents (78% response rate), 1114 provided complete data. Primary caregivers were predominantly mothers (79.9%) or fathers (13.6%), White (72.0%) or Black (16.0%), and had an associate’s degree or less (65.1%). The mean (SD) index child’s age was 6.4 (5.3) years, and 52.4% were female. Underinsurance, positive depression screens, and poor child health were positively associated with unmet social needs. Higher scores for social support and social capital were associated with fewer social needs. Multinomial logistic regression revealed significant relationships with reporting two or more unmet social needs with the following variables: childhood underinsurance, household annual income < $50,000, positive depression screens, raising a child with a chronic health condition, and Black race/ethnicity. Conclusions: Several significant social factors were independently associated with a greater number of unmet social needs. These findings highlight the complex interplay among social factors in children’s healthcare. Future research should explore the putative longitudinal stability of these relationships. Full article

Background: Unmet healthcare needs are a significant public health concern among older adults, particularly those with chronic conditions such as osteoporosis. This study aimed to identify several key factors associated with unmet healthcare needs among older adults with osteoporosis using Andersen’s behavioral model. Methods: This observational, cross-sectional study examined data from the 2025 Korea Community Health Survey, analyzing responses from 20,988 individuals aged ≥ 65 years with physician-diagnosed osteoporosis. General characteristics were analyzed using descriptive statistics in terms of frequencies and percentages. Variables were categorized into predisposing, enabling, and need factors. Complex sample analyses were performed using the Rao–Scott chi-square test and multivariable logistic regression. Results: In the multivariable analysis, female sex (adjusted odds ratio [aOR] = 1.44, 95% confidence interval [CI]: 1.08–1.91), poor health literacy (aOR = 1.56, 95% CI: 1.31–1.87), and rural residence (aOR = 1.36, 95% CI: 1.18–1.58) were significantly associated with higher odds of unmet healthcare needs. Among the need factors, fall experience (aOR = 1.56, 95% CI: 1.34–1.83), pain or discomfort (aOR = 2.40, 95% CI: 1.93–2.99), and elevated stress (aOR = 2.37, 95% CI: 2.02–2.79) were also significantly associated with unmet healthcare needs. Conclusions: Beyond accessibility, unmet healthcare needs among older adults with osteoporosis in Korea were associated with cognitive, health-related, and regional factors. Interventions should prioritize improving health literacy, managing pain and psychological distress, and strengthening osteoporosis care pathways, specifically focusing on follow-up care and fragility fracture prevention. Full article

Background: Psoriasis is a chronic systemic disease affecting over 60 million people. While phototherapy is effective, its demanding schedule imposes a significant treatment burden. This study explores the lived experiences and healthcare expectations of patients in specialized nursing-led phototherapy units. Methods: A descriptive phenomenological study was conducted (2019–2022) with 72 participants at a Spanish tertiary hospital. Data from semi-structured interviews were analyzed using inductive thematic content analysis. Results: Nine subtopics emerged within four main thematic areas: (1) a gap between psychological awareness and low knowledge of systemic comorbidities; (2) psychological stress as the primary disease trigger; (3) an adherence-stress cycle causing biographical disruption; and (4) a collective demand for a permanent nursing referent to overcome systemic barriers. Conclusions: Phototherapy’s clinical efficacy is often undermined by its logistical rigor. Achieving skin clearance is insufficient if biographical and systemic gaps remain. Integrated care models, led by specialized dermatology nurses, are essential to provide clinical navigation and support beyond conventional skin treatment. Full article

Objectives: We aimed to examine associations between social marginalization, defined by the Ontario Marginalization Index (“ON-Marg”), and overall survival (OS) in epithelial ovarian cancer (EOC). Methods: This was a population-based retrospective cohort study using linked administrative data in Ontario, Canada, including adults ≥ 18 years diagnosed with stage II-IV EOC (2010–2022). ON-Marg dimensions included Material Resources (economic disadvantage), Households and Dwellings (housing type/density), Age and Labour Force (workforce participation), and Racialized and Newcomer Populations (recent immigrants/visible minorities), and were categorized into quintiles (Q1 least marginalized, Q5 most marginalized). The primary outcome was OS. Multivariable Cox models estimated adjusted hazard ratios (aHR) for each ON-Marg dimension. Wald χ² statistics identified the dimension most strongly associated with OS. Results: Material Resources was most strongly associated with OS. Compared with Q1 (least marginalized), higher mortality was observed in Q3 (aHR 1.10; 95%CI 1.02–1.19), Q4 (aHR 1.13, 95%CI 1.05–1.22), and Q5 (aHR 1.25, 95%CI 1.15–1.35). Greater marginalization in the Racialized and Newcomer Populations dimension was associated with improved OS (Q5 aHR 0.87, 95%CI 0.80–0.94). The association between Material Resources and OS persisted in patients undergoing cytoreductive surgery with chemotherapy, but not among those receiving chemotherapy alone or no treatment. Conclusions: Material Resources is an independent predictor of survival in EOC within a universal, publicly funded healthcare system, with greatest impact among patients undergoing multimodal oncologic care. Residence in highly racialized or newcomer communities was associated with improved survival. Material marginalization is highlighted as a key driver of inequity, supporting targeted system-level interventions to address financial and logistical barriers to care. Full article

Background: Risk stratification models are widely used in clinical research; however, their development becomes methodologically challenging in settings characterized by low outcome incidence. In coronary care unit (CCU) populations, healthcare-associated infections (HAIs) occur relatively infrequently, limiting the feasibility of conventional multivariable predictive modeling. Methods: A retrospectively assembled CCU cohort comprising 870 patients with 16 HAI events (1.8%) was used as an illustrative example to examine methodological constraints associated with low events-per-variable (EPV) ratios. The implications of limited event frequency for multivariable logistic regression were evaluated, including risks of overfitting, coefficient instability, and reduced reproducibility. As an alternative strategy, a prespecified cumulative additive framework integrating baseline vulnerability and exposure-related variables was conceptually and analytically explored. Results: With four candidate predictors and 16 outcome events, the resulting EPV was approximately four, indicating a high risk of instability for conventional multivariable modeling. The cumulative framework allowed structured cumulative stratification without coefficient optimization. Infection occurrence increased progressively across cumulative framework levels, illustrating a graded pattern of increasing HAI occurrence with accumulating vulnerability and exposure-related burden. Conclusions: In clinical datasets with limited outcome events, modeling strategies should be aligned with the informational capacity of the data. Cumulative additive frameworks may represent a pragmatic structural alternative to coefficient-based modeling approaches in rare-event clinical settings. The present work provides a structured methodological framework for risk stratification under low-events-per-variable conditions rather than proposing a novel clinical scoring system. Full article

Background: Parvovirus B19 (B19V) has a well-established tropism for erythroid progenitor cells and is a recognized cause of anemia in immunocompromised individuals. Patients with end-stage renal disease (ESRD) receiving maintenance hemodialysis are predisposed to anemia due to multiple mechanisms and are frequently exposed to healthcare settings, raising concern that prior B19V infection may contribute to anemia severity or resistance to erythropoiesis-stimulating agents (ESAs). However, data regarding the clinical relevance of B19V seroprevalence in hemodialysis patients remain limited. Methods: We conducted a single-center, observational cross-sectional study including 131 adult patients on maintenance hemodialysis and 50 healthy controls. Parvovirus B19 IgG serostatus was assessed by enzyme-linked immunosorbent assay (ELISA) and used exclusively as a marker of prior (past) exposure rather than active infection; our aim was to determine whether IgG-defined prior exposure leaves a measurable long-term imprint on erythropoiesis. None of the participants had clinical features suggestive of acute parvovirus infection or an unexplained aplastic episode at enrollment. Demographic data, comorbidities, dialysis characteristics, ESA use, and laboratory parameters (hemoglobin, hematocrit, mean corpuscular volume, inflammatory markers, and albumin) were collected. Between-group and within-cohort comparisons used non-parametric tests, and multivariable logistic and linear regression models were used to adjust for age, sex, and other relevant covariates. Results: Parvovirus B19 IgG seropositivity was common in both groups (64.9% of hemodialysis patients vs. 48% of controls; crude odds ratio [OR] 2.00, 95% confidence interval [CI] 1.03–3.88, p = 0.043). However, hemodialysis patients were substantially older and more often male; after adjustment for age and sex, dialysis status was no longer independently associated with seropositivity (adjusted OR 1.4, 95% CI 0.8–2.3, p = 0.20), and within the hemodialysis cohort seropositivity was not associated with age or sex. Hemodialysis patients exhibited significantly lower hemoglobin and hematocrit and higher inflammatory markers than controls, consistent with ESRD-related anemia. Within the hemodialysis cohort, B19 IgG-positive and IgG-negative patients did not differ in hemoglobin, hematocrit, mean corpuscular volume, C-reactive protein, albumin, or ESA use, and IgG serostatus remained unrelated to hemoglobin in a multivariable model adjusting for age, sex, inflammation, nutrition, dialysis vintage, and ESA use (adjusted β = −0.20 g/dL, 95% CI −0.68 to 0.28, p = 0.42). Past Parvovirus B19 exposure was therefore not associated with anemia severity or treatment requirements. Conclusions: In this cohort of stable maintenance hemodialysis patients, prior Parvovirus B19 exposure, as indicated by IgG seropositivity, was not associated with increased anemia severity, inflammation, or ESA use, and the higher crude seroprevalence in dialysis patients was attributable to their older age rather than to dialysis itself. Because IgG reflects past exposure only and IgM and viral DNA were not assessed, these findings apply strictly to past (IgG-defined) exposure and cannot address active or persistent B19V infection. They suggest that routine Parvovirus B19 IgG screening in asymptomatic hemodialysis patients is unlikely to be useful for anemia management, whereas active or persistent infection—detectable only by molecular testing—remains the more plausible contributor to unexplained or refractory anemia and merits study in selected patients. Full article

Purpose: Variation in knee MRI diagnostic yield is often interpreted as reflecting imaging effectiveness. However, in real-world healthcare systems, diagnostic yield may instead be driven by referral behavior and patient selection. Understanding this distinction is essential for evaluating imaging utilization, healthcare efficiency, and potential overuse of advanced imaging. This study examines whether differences in MRI yield reflect imaging pathways or underlying referral patterns in routine clinical practice. Materials and Methods: This retrospective cohort study included consecutive patients undergoing knee MRI between January 2020 and December 2024. Patients with red flag indications were excluded to focus on discretionary imaging. The primary outcome was clinically relevant MRI findings based on final report impressions. The primary exposure was prior X-ray before MRI. Multivariable logistic regression was used for adjusted analysis, including age, sex, trauma status, mechanical symptoms, and symptom duration. Results: Among 486 patients, 59.5% had prior X-ray. Clinically relevant MRI findings were less frequent among patients with prior X-ray (40.1%) than among those without (49.7%), corresponding to an absolute difference of 9.6%. After adjustment for sex and clinical covariates, prior X-ray showed lower odds of clinically relevant findings, although this association was attenuated and no longer statistically significant (aOR 0.74, 95% CI 0.50–1.10; p = 0.138). Male sex was independently associated with higher odds of clinically relevant MRI findings (aOR 2.48, 95% CI 1.61–3.83; p < 0.001). Formal interaction testing did not demonstrate significant effect modification by trauma status (p = 0.317). These findings suggest that variation in MRI yield may reflect differences in referral pathways, patient selection, and healthcare utilization patterns. Conclusions: MRI yield in routine practice may be influenced by differences in clinical context and referral-related patient selection. Further studies are needed to better understand the contribution of imaging pathways to observed variation in diagnostic yield. Full article

Background and Objective: Perioperative antibiotics are widely used in pediatric surgical practice; however, inappropriate selection and prolonged use may contribute to antimicrobial resistance and unnecessary exposure. Appropriate use of perioperative antibiotics is essential to prevent surgical site infections while minimizing antimicrobial resistance, adverse drug reactions, and unnecessary healthcare costs. Despite existing international recommendations, deviations from guideline-based practice remain frequent in pediatric surgical settings. This study aimed to describe patterns of perioperative antibiotic use and assess the appropriateness of prescribing practices in a tertiary care setting, and to identify factors associated with inappropriate antibiotic use. Methods: A retrospective pharmacoepidemiological study was conducted by reviewing medical records of pediatric patients admitted to a tertiary care hospital in Kosovo between January 2022 and December 2025 (data lock: December 2025). A total of 650 patients aged 0–18 years who underwent surgical interventions and received perioperative antibiotics for prophylaxis or empirical treatment (defined as antibiotic therapy initiated in the presence of suspected infection) were included. Data collected comprised demographic characteristics, surgical diagnoses, type of surgery, antibiotics prescribed, weight-adjusted dosing, route of administration, timing of initiation, and duration of therapy. Appropriateness of antibiotic use was evaluated based on available documentation and compliance with WHO (2018) and CDC (2017) guidelines regarding indication, antibiotic selection, dosage, timing, and duration. Statistical analyses included descriptive statistics, chi-square tests, and multivariable logistic regression to estimate adjusted odds ratios (ORs) with 95% confidence intervals (CIs), with statistical significance set at p < 0.05. Results: Among the 650 patients, 378 (58.2%) were male and 272 (41.8%) were female, with a mean age of 6.8 ± 4.3 years. The most common types of surgery were abdominal (35.7%), otorhinolaryngological (29.4%), urological (19.1%), and orthopedic (15.8%). Perioperative antibiotics were administered predominantly for prophylaxis (91.5%), while 8.5% of patients received empirical treatment. The most frequently prescribed antibiotics were cefazolin (42.6%), ceftriaxone (34.8%), ampicillin/sulbactam (12.3%), and gentamicin (6.1%). Notably, ceftriaxone was frequently prescribed for prophylactic purposes despite international recommendations generally favoring narrow-spectrum first-line agents for perioperative prophylaxis. Intravenous administration was used in 87.9% of cases. Antibiotic duration was ≤24 h in 61.2% of patients, whereas 38.8% received antibiotics for more than 24 h. Overall, appropriate antibiotic use was identified in 62.9% of cases, while 37.1% were classified as inappropriate. Prolonged antibiotic use beyond 24 h (adjusted OR = 3.87; 95% CI: 2.68–5.58; p < 0.001) and ceftriaxone use (adjusted OR = 2.41; 95% CI: 1.63–3.55; p < 0.001), were independently associated with inappropriate antibiotic use. Conclusions: Perioperative antibiotic use in pediatric tertiary care is highly prevalent, with more than one-third of prescriptions not fully aligned with international recommendations. Prolonged antibiotic duration and the preferential use of broad-spectrum agents, particularly ceftriaxone, were the factors most strongly associated with inappropriate prescribing patterns. These findings highlight the need for improved adherence to guideline-based perioperative antibiotic protocols; however, causal inferences regarding stewardship interventions cannot be drawn from this retrospective study. The findings should be interpreted within the limitations inherent to retrospective observational studies. Full article

Background: Health accessibility is a key determinant of equitable cancer care. In many countries, specialized oncology services are concentrated in urban and socioeconomically advantaged regions, forcing many patients to travel long distances for treatment. Consequently, geographic and social characteristics may be impactful in determining cancer healthcare outcomes. Objective: The aim of this study was to evaluate the association between the municipal-level Social Progress Index (SPI) and geographic travel burden, stage at diagnosis, treatment, and survival in patients with pancreatic cancer in São Paulo state, Brazil. Methods: We conducted a population-based study using data from “Fundação Oncocentro” on adults with pancreatic adenocarcinoma (2005–2025). The SPI (0–100 scale), a composite measure of municipal social and environmental development, was the primary exposure. It is structured into 3 dimensions and 12 components: Basic Human Needs (nutrition, medical care, water and sanitation, housing, safety); Foundations of Well-being (education, information access, health, environmental quality); and Opportunity (rights, freedom of choice, social inclusion, higher education). Municipal residence and cancer center locations were geocoded, and travel distance (km) was estimated. Multivariable Cox, logistic, and linear regression models assessed associations between SPI and overall survival, stage IV at diagnosis, surgery, and travel distance. Results: A total of 13,478 patients were included (mean follow-up 15.1 ± 27.2 months; mean age 62.3 years; 50.4% male). Stage IV disease was frequent (46.3%), and surgery was performed in 33% of cases. Over half of patients (53.2%) traveled more than 10 km for treatment. Increasing SPI was strongly associated with shorter travel distance (β −62.6 km per SPI unit; p < 0.001) and higher odds of surgery (OR 1.04; p < 0.001) and remained independently associated with a higher likelihood of undergoing surgical treatment (adjusted OR 1.04; p < 0.001). The proportion of stage IV disease did not decrease with increasing SPI and was slightly higher in the highest quartile (49.3%). In survival analysis, SPI demonstrated a protective effect in univariate modeling (HR 0.987; p < 0.001), but lost significance in multivariable analysis (p = 0.125). Travel burden was not retained as an independent predictor of survival after adjustment. Conclusions: Municipal-level SPI was a strong determinant of healthcare access and the likelihood of receiving surgical treatment for pancreatic cancer. Social and geographic vulnerability directly influence care pathways, revealing structural inequities in access to treatment. SPI-based stratification may serve as a practical tool to identify priority regions for transport support and equitable allocation of oncology services. Full article