Search Results (2,546)

Background/Objectives: Central line-associated bloodstream infection (CLABSI) remains a major healthcare-associated infection in intensive care units (ICUs). This study evaluated changes in CLABSI incidence following the implementation of a multimodal infection control intervention in the ICU. Methods: We conducted a quasi-experimental study in the adult ICUs of a referral hospital from January 2023 to December 2025. The interventions included staff education, performance feedback, infection control-led rounds, optimization of catheter practices, and reinforcement of environmental hygiene. The primary outcome was CLABSI incidence per 1000 central line-days. An interrupted time-series analysis using segmented Poisson regression with robust standard errors was used to assess temporal trends. Results: A total of 17 CLABSI cases occurred during the pre-intervention period, and 25 during the post-intervention period. There was no significant difference in CLABSI incidence between the two periods (incidence rate ratio, 1.07; 95% confidence interval, 0.58–1.98). However, interrupted time-series analysis demonstrated a significant decreasing trend in CLABSI incidence following the intervention (rate ratio, 0.89 per month; 95% confidence interval, 0.81–0.97; p = 0.01). This trend was observed despite the higher patient severity and increased use of advanced supportive therapies in the post-intervention period. The device utilization ratio and monthly blood culture rate remained unchanged. Avoidance of femoral venous access increased, and adherence to catheter-handling protocols significantly improved. Conclusions: A staged, multimodal intervention was associated with a significant decreasing trend in CLABSI incidence over time, suggesting a potential benefit of comprehensive infection prevention strategies in ICU settings. Full article

This study proposes a Behavior-Calibrated Endogenous Choice 2SFCA (BCEC-2SFCA) framework for assessing spatial accessibility to tertiary hospitals. Using large-scale taxi trajectory data from Ningbo, China, we empirically calibrate the Huff model parameters (α =1.1758, β =2.9608) based on observed hospital choices and construct travel time and distance matrices from observed trips. Unlike existing Huff-based FCA approaches that assume parameter values, BCEC-2SFCA jointly estimates the attractiveness elasticity and distance-decay coefficient directly from local healthcare travel behavior and integrates these calibrated probabilities into a 2SFCA structure where hospital catchments are endogenously generated rather than exogenously imposed. Compared with conventional Gaussian 2SFCA, the BCEC-2SFCA model produces a continuously varying and behaviorally plausible accessibility surface and better replicates the relative order of hospital attractiveness (ρ = 0.527, p < 0.05), although its RMSE is slightly higher (0.02700 vs. 0.02211) while MAPE is clearly lower (32.17% vs. 42.12%). Robustness checks using all 22 hospitals confirm stable estimates, and subgroup analyses show consistent advantages across hospital scales. The framework is specifically designed for high-order medical services with strong inter-facility competition—such as tertiary hospitals—and its applicability to proximity-based services is limited. Full article

Introduction: This study evaluated the implications of intravenous acetaminophen (Ofirmev) on perioperative outcomes in patients undergoing robotic-assisted laparoscopic prostatectomy (RALP) for prostate cancer. The primary objective was to determine whether adding IV acetaminophen to standard analgesia could reduce hospital length of stay (LOS), pain intensity, and opioid use compared with placebo. Methods: This study was conducted as a secondary descriptive analysis of publicly available aggregate results from a previously completed randomized, double-blind, placebo-controlled Phase IV trial (NCT02369211). No individual patient-level data were accessed, and no new independent statistical analyses were performed. Eighty-six male patients were randomly assigned to receive either 1 g IV acetaminophen or saline placebo every six hours for four doses during the perioperative period. Primary endpoints were hospital and post-anesthesia care unit (PACU) LOS; secondary endpoints included postoperative pain scores and opioid consumption (morphine milligram equivalents). Results: Baseline characteristics were similar between groups (n = 43 each). Mean PACU stay was slightly shorter with IV acetaminophen (124 ± 58 min) than placebo (132 ± 63 min; not significant). Median hospital LOS was 0.81 days versus 0.82 days (p = 0.006), a statistically significant difference reported in the original trial dataset, although the absolute difference was clinically minimal. Pain scores and opioid requirements were lower with IV acetaminophen but not significantly different. No adverse events occurred in either group. Conclusions: IV acetaminophen was safe and well tolerated as part of multimodal analgesia for RALP. Although pain scores and opioid use numerically favored IV acetaminophen, these differences were not statistically significant. The reported difference in hospital LOS was statistically significant in the original trial record but clinically minimal; therefore, the findings should be interpreted as exploratory and hypothesis-generating regarding potential operational and economic implications. Full article

Background/Objectives: Pneumonia remains a leading cause of emergency department visits worldwide, requiring rapid and objective risk stratification. While traditional scoring systems like CURB-65 and the Pneumonia Severity Index (PSI) are well-established, there is a constant need for dynamic biomarkers reflecting the underlying pathophysiology. This study aims to investigate the prognostic value of the hemoglobin-to-lactate ratio (HLR) in predicting mortality among pneumonia patients. Methods: This retrospective cohort study included 183 adult patients diagnosed with pneumonia at a tertiary training and research hospital between October 2024 and November 2025. Demographic data, clinical findings, laboratory parameters, and prognostic scores (CURB-65, PSI) were recorded. The impact of HLR on mortality was evaluated using univariate and multivariate logistic regression, while its predictive performance was assessed via Receiver Operating Characteristic (ROC) analysis and compared with clinical scores using DeLong’s method. Results: The overall mortality rate was 32.8%. HLR values were significantly lower in the exitus group compared to survivors (4.68 vs. 6.92, p < 0.001). Multivariate analysis revealed that an HLR ≤ 5.65 was an independent predictor of mortality, associated with a 10-fold increase in risk (OR: 10.0; 95% CI: 4.15–24.19; p < 0.001). HLR demonstrated high predictive power (AUC = 0.802), comparable to CURB-65 (AUC = 0.807) and PSI (AUC = 0.829). Notably, the combined HLR + CURB-65 model provided the highest diagnostic accuracy (AUC = 0.857, p = 0.037). Conclusions: HLR is a low-cost and easily accessible biomarker for predicting mortality in pneumonia. It effectively reflects the physiological balance between tissue oxygenation and metabolic failure. Integrating HLR into clinical practice, particularly when combined with traditional scores, can enhance risk (decision of discharge, admission unit [ward, ICU], evaluation of prognosis) in the emergency department. Full article

Background/Objectives: The autologous arteriovenous fistula (AVF) is the primary vascular access (VA) method for hemodialysis (HD), with superior patency and a lower complication rate than arteriovenous graft (AVG) or central venous catheter (CVC). The primary objective of this study is to analyze the impact of dialysis on the CVC at the time of AVF creation on its long-term primary patency. Methods: This retrospective, single-center, observational study included 248 patients admitted for AVF creation. Demographic characteristics, comorbid conditions, and laboratory parameters were retrieved from the hospital’s electronic medical records. The primary outcome of the study was long-term AVF failure, defined as the inability to perform hemodialysis through the newly created AVF. Results: A total of 132 (53.2%) were receiving dialysis via a CVC at the time of AVF creation. During a mean follow-up of 2.21 ± 1.54 years, 47 patients (18.95%) failed to achieve functional maturation at 6 weeks, and 81 patients (32.66%) developed long-term AVF failure. Demographic characteristics were similar between patients with and without CVC at AVF creation, with no significant differences in age (p = 0.358) or sex (p = 0.574). Comorbidities and risk factors were also similarly distributed, showing no significant variation. The types of AVF varied by CVC status, with fewer RC-AVF (p = 0.038) and more BC-AVF (p = 0.032) in patients with a CVC. Failure was significantly more frequent in patients with CVC use at the time of AVF creation than in those without CVC (p < 0.001). Kaplan–Meier analysis demonstrated lower long-term patency in patients dialyzed via CVC (p < 0.001). In Cox regression analysis, dialysis via CVC at AVF creation was associated with AVF failure (HR: 2.53, p < 0.001), and the association remained significant after full adjustment (HR: 3.13, p < 0.001). Female sex, active smoking, smaller arterial and venous diameters, and RC-AVF were additional risk factors associated with failure. Conclusions: Dialysis via a CVC at the time of AVF creation was associated with an increased risk of long-term AVF failure, even after full adjustment models. Full article

Peripheral nerve blocks can effectively reduce the use of general anesthesia and opioids in situations where robust pain management is critical, such as severe extremity trauma and hip, femur, and knee surgeries. Despite these benefits, nerve blocks are underutilized due to the high skill required to accurately insert a needle and safely deliver local anesthetic. To overcome this challenge, ultrasound image guidance enabled by artificial intelligence (AI) offers a semi-automated solution for regional anesthesia delivery by non-specialists. As a first step towards realizing an integrated platform for AI-guided nerve blocks, the main objective of this study is to develop and characterize deep learning algorithms to interpret anatomical landmarks on ultrasound images in real time and identify aimpoints for needle placement. Our AI system was trained on over 55,000 images from 20 porcine models and demonstrated an average area under the precision–recall curve of 0.92 (SD = 0.03) for in vivo landmark detection in the femoral nerve region. In prospective live animal testing, aimpoint identification had a 98.3% success rate with an average time of 40.5 s (SD = 33.5). Future work will focus on integrated testing with handheld robotics towards a more accessible method for delivering regional anesthesia in settings from point of injury to medical transport to hospitals. Full article

Background/Objectives: Vaccine-preventable diseases remain a persistent public health challenge in regions characterized by structural vulnerabilities, including suboptimal vaccination coverage, socioeconomic deprivation, and limited access to healthcare. In structurally vulnerable regions, such as the South-West Romanian region, characterized by persistent vaccination gaps and recurrent outbreaks, these conditions generate a sustained public health burden that requires ongoing preventive risk management strategies. In such contexts, digital risk stratification tools may support preventive decision-making by enabling early identification of patients at increased risk of severe outcomes. This study applied machine learning techniques to routinely collected measles surveillance data from South-West Romania to identify severe disease cases and determine key predictors of severity, offering a pragmatic alternative to outbreak forecasting in a resource-constrained setting. Methods: An open epidemiological dataset of laboratory-confirmed measles cases reported by the Regional Center for Public Health Surveillance Craiova was analyzed. The dataset defined severe cases as those with pneumonia, thrombocytopenia, a hospital stay exceeding three days, or other documented complications requiring medical intervention. Random Forest (RF) and Logistic Regression (LR) classifiers were trained and compared using a 10-fold cross-validation framework across 200 resampling iterations. Model performance was assessed using accuracy, AUC-ROC, sensitivity, specificity, positive predictive value, and F1-score. Feature importance was quantified using permutation-based measures, and the highest-ranked predictors were further evaluated through chi-square tests of independence. Results: RF significantly outperformed LR in accuracy (0.84 vs. 0.82), AUC (0.87 vs. 0.80), specificity (0.87 vs. 0.84), positive predictive value (0.89 vs. 0.86), and F1-score (0.84 vs. 0.83), with p ≤ 0.001 for most metrics. Sensitivity was equivalent between models (approximately 0.81; p = 0.328). Feature importance analysis identified seven key predictors: county of residence, vaccination status, outbreak status, presence of other symptoms, occupation, cough, and conjunctivitis. All seven were significantly associated with disease severity, and six showed significant geographic variation across counties. Vâlcea County had the highest concentration of severe cases. The model was trained on a regional surveillance cohort in which symptomatic and hospitalized cases are over-represented and should be interpreted as a triage-support tool within this surveillance context rather than as a population-level severity estimator. Conclusions: Machine learning, particularly RF, can effectively identify severe measles cases using routinely collected surveillance data in settings where robust outbreak prediction is not feasible. The county of residence functioned as a composite proxy for structural determinants, including healthcare access, vaccination coverage, and socioeconomic deprivation. These findings support the use of ML-based severity classification as a pragmatic tool for clinical risk stratification and targeted public health intervention in resource-constrained environments. Full article

Background/Objectives: Carbapenem-resistant Klebsiella pneumoniae (CRKp) remains a critical driver of antimicrobial resistance (AMR) in hospital settings worldwide. Methods: This study examined trends in CRKp bloodstream infections over a seven-year period (2019–2025) in a tertiary care hospital in Greece, with particular attention given to resistance patterns and patient outcomes, including the impact of the COVID-19 pandemic. Results: A total of 671 non-duplicate CRKp isolates were analyzed and classified into three groups: KPC producers (67.4%), dual carbapenemase producers (dual CP) (17.4%), and single metallo-β-lactamase (MBL) producers (15.2%). Overall incidence showed a slight but non-significant increase over time. KPC-producing strains rose significantly until 2022 (p < 0.001), followed by a marked decline (p < 0.001). In contrast, dual CPs—mainly KPC combined with VIM or NDM—and single-MBL producers, particularly NDM, increased steadily, indicating a notable epidemiological shift. Resistance to aminoglycosides and tigecycline increased around 2021, followed by partial declines, whereas colistin resistance demonstrated a continuous upward trend throughout the study period. Despite phenotypic differences, overall mortality remained high, with no statistically significant differences between groups (p = 0.37), likely reflecting either the severity of patients’ clinical condition or inadequate empirical antibiotic therapy. Conclusions: This study highlights a dynamic evolution in CRKp epidemiology with decreasing KPC dominance and increasing prevalence of MBL- and dual CP strains. This transition, which became evident during and after the COVID-19 pandemic, underscores ongoing epidemiological adaptation and the urgent need for improved antimicrobial stewardship, rapid diagnostics, and broader access to effective therapies. Full article

Background: Glucagon-like peptide-1 receptor agonist (GLP-1 RA) use has increased exponentially as studies show significant benefits in cardiovascular and renal diseases and obesity. Accessibility to the public also increased after compounding pharmacies began direct-to-consumer distribution. Gastrointestinal side effects are common; however, hypersensitivity reactions are rare. Case Presentation: A 50-year-old female with a history of obesity, hypertension, and lisinopril-induced angioedema presented to the Emergency Department with swelling of the lips, tongue, and throat developing four hours after her first injection of compounded semaglutide for weight loss. She was treated with epinephrine, corticosteroids, and antihistamines, but due to progressive airway edema, she required intubation and mechanical ventilation for four days. After extubation, she reported accidentally injecting a ten-fold higher dose (2 mg) of semaglutide than was appropriate for the first dose. The hospitalization was complicated by hypoglycemia requiring dextrose infusion, but was otherwise unremarkable, and she was discharged home on day 7. Based on the temporal onset after semaglutide injection, this presentation was most consistent with GLP-1 RA-induced angioedema. While she also had a history of lisinopril-induced angioedema five years earlier, and had been taking valsartan for hypertension, the remoteness of the lisinopril exposure made this less likely. Conclusions: Semaglutide use may be associated with severe angioedema within hours of administration. Given the overlapping indications and patient populations, angioedema appearing in patients taking both GLP-1 RAs and ACE inhibitors may become increasingly common and present a diagnostic dilemma. Diagnosis of hypersensitivity to GLP-1 RAs can be supported with history and positive skin testing. Clinicians should be aware that inexperienced patients are at the highest risk of dosing errors. Full article

Background: Echinococcosis, caused by the Echinococcus granulosus, primarily affects the liver and lungs and remains an important public health problem in endemic regions. Surgical treatment remains the main therapeutic approach. Objectives: We aimed to analyze nationwide trends and regional disparities in the treatment and surgical management of echinococcosis in Kazakhstan and to identify factors associated with emergency surgical care. Methods: A retrospective analysis of national healthcare records of treated echinococcosis cases in Kazakhstan from 2017 to 2024 was conducted. The dataset included information on age distribution, hospitalization characteristics, surgical interventions (elective and emergency), and regional patterns. Organ-specific stratification was available in the national database. Descriptive and comparative statistical analyses were performed to evaluate temporal and regional differences. Results: Between 2017 and 2024, the number of treated echinococcosis cases demonstrated a decreasing trend. Significant regional differences in surgical management were identified, with southern regions, particularly Turkistan, showing a higher proportion of emergency surgical interventions (p < 0.05). Forecasting analysis suggested a further decline in treated case numbers; however, widening 95% confidence intervals and the appearance of negative projected values in later years indicated substantial uncertainty and limitations of the predictive model. Conclusions: The decline in treated echinococcosis cases may reflect improvements in disease control, but may also be associated with underdiagnosis or reduced access to healthcare services. Marked regional disparities in emergency surgical care highlight the need to strengthen surveillance systems and improve equitable access to timely diagnosis and treatment. Full article

Background: Providing optimal parenteral nutrition to extremely preterm babies in the first week after birth is challenging, and different strategies may be associated with both short- and long-term outcomes. Methods: In a secondary cohort analysis of the ProVIDe trial, a multicentre, randomised, controlled trial in extremely-low-birthweight babies of increased amino acid intake in the first five days after birth, we explored the associations between parenteral amino acid and lipid intakes and blood spot amino acid concentrations, clinical outcomes and neurodevelopment. The cohort comprised 382 babies born in six New Zealand hospitals of whom 342 survived to 28 days. Nutritional intake data in the first week and newborn metabolic screening data on days 1, 5, 14, and 28 were retrieved, and 294 children were assessed for neurodevelopmental outcome at 2 years’ corrected age. Results: Blood spot amino acid concentrations were positively associated with amino acid intake (p < 0.005). Higher amino acid intakes were associated with increased odds (OR), 95% confidence intervals (CIs) of bronchopulmonary dysplasia (tyrosine: OR 2.2, CI 1.2–3.9; proline: OR 2.3, CI 1.3–4.0), patent ductus arteriosus and probable sepsis. No significant associations were found for necrotising enterocolitis. Higher lipid intakes were associated with lower odds of intraventricular haemorrhage (0.33 [0.16, 0.66]), bronchopulmonary dysplasia (0.31 [0.13, 0.73]) and retinopathy of prematurity (0.29 [0.12, 0.72]). Unlike short-term outcomes, neurodevelopment did not differ according to blood spot or intake quartile for any amino acid in week 1. Conclusions: Parenteral nutritional intakes in the first week after birth are associated with short-term outcomes. Further research is needed to optimise the composition of amino acid solutions. Trial Registration: ACTRN12612001084875, (accessed on 10 October 2012). Full article

Background: Antimicrobial stewardship in Neonatal (NICU) and Pediatric Intensive Care Units (PICUs) is complicated by rapid physiological maturation and the high vulnerability of the developing gut microbiome. Traditional metrics fails to capture the true utilization density of antibiotics in these settings. This study evaluated antimicrobial consumption patterns and alignment with the WHO AWaRe framework in two Indonesian hospitals and its impact towards patients’ length of stay. Methods: A retrospective multicenter study was conducted at a public hospital (Haji Hospital) and a private university hospital (HU Hospital) across 2024–2025. The study population includes all admitted patients (n = 315 in NICU and n = 12 in PICU) to calculate utilization density. Consumption was quantified using Defined Daily Dose (DDD)/100 bed-days, and qualitative assessment was performed using the WHO AWaRe classification. Results: Generalized linear modeling revealed that appropriate antibiotic therapy was significantly associated with a 17% reduction in hospital length of stay (β = −0.187, p = 0.035). At HU Hospital, PICU exhibited a seven-fold higher antimicrobial density (37.56 DDD/100) compared to NICU (5.22 DDD/100). At Haji Hospital, NICU density was 4.95 DDD/100 bed-days. Weight-normalized simulations revealed weight-based dosing disparity with low absolute DDD values in neonates mask a significant biological burden and intense selection pressure on the gut resistome due to immature renal clearance. While Haji Hospital maintained high “Access” category adherence (92.21%), HU Hospital’s PICU showed a high reliance on “Watch” agents (71.27%), specifically Ceftriaxone and Meropenem, which are known drivers of multidrug resistance. Conclusions: Low absolute dosing in neonates does not equate to low therapeutic density or reduced environmental pressure. The heavy use of broad-spectrum agents in the PICU acts as a primary driver for microbiome disruption. To mitigate the emergence of multidrug-resistant organisms, stewardship must transition from adult-indexed metrics (DDD) to more precise measures like Days of Therapy (DOT) and prioritize “Access” protocols to preserve microbiome integrity. Full article

Background: Robotic-assisted surgery (RAS) has progressively expanded in gynecologic practice. Although its technical advantages are recognized, its economic sustainability and equitable accessibility remain debated. Methods: This clinical update provides a critical narrative review of current evidence on RAS in gynecology, integrating data on clinical outcomes, cost-effectiveness, diffusion patterns, and health equity across different healthcare settings. Results: In both benign and oncologic indications, RAS demonstrates consistent perioperative advantages over open surgery, including reduced blood loss, shorter hospital stay, and lower conversion rates. In routine cases, outcomes are largely comparable to conventional laparoscopy. However, robotic approaches appear particularly beneficial in complex scenarios, such as obesity, advanced malignancy, and technically demanding procedures. Economic evidence is heterogeneous. Short-term hospital-based studies report higher direct costs for RAS, especially in benign surgery. Conversely, cost–utility models in oncologic settings suggest that RAS may achieve acceptable cost-effectiveness when long-term outcomes, quality-adjusted life years, and institutional volume are considered. Accessibility remains strongly influenced by reimbursement policies, procedural volume, infrastructure, and workforce training. In the absence of structured reimbursement frameworks, robotic surgery may contribute to socioeconomic and geographic disparities. Conclusions: RAS represents an important component of modern gynecologic surgery, particularly in high-complexity and high-risk cases in which its technical advantages may translate into meaningful perioperative benefit. Its long-term sustainability depends on appropriate patient selection, institutional volume, reimbursement models, and health system organization. Future research incorporating long-term and societal economic perspectives is required to support balanced and equitable implementation. Full article

Background and Objectives: Electrolyte abnormalities are frequently observed in hospitalized patients with acute infections and may reflect underlying disease severity. This study aimed to investigate the association between baseline electrolyte disturbances and clinical outcomes in patients with COVID-19, with a particular focus on albumin-corrected calcium levels. Materials and Methods: This retrospective study included 348 hospitalized patients with COVID-19. Primary analyses were restricted to RT-PCR-confirmed cases (n = 272) to minimize misclassification bias, while the full cohort was evaluated in sensitivity analyses. Baseline electrolyte levels at admission were recorded, and corrected calcium levels were calculated using serum albumin. Clinical outcomes included prolonged hospitalization (defined relative to the cohort median), intensive care unit (ICU) admission, invasive mechanical ventilation (IMV), and in-hospital mortality. Multivariable logistic regression analyses were performed adjusting for age, sex, and renal function (eGFR). Results: In the PCR-confirmed cohort, corrected hypocalcemia was present in 37.3% of patients. In univariate analyses, hypocalcemia, hyponatremia, and hypophosphatemia were significantly associated with adverse outcomes. However, after adjustment, corrected hypocalcemia did not retain independent significance. Hyponatremia remained independently associated with ICU admission (OR: 9.45, 95% CI: 2.12–42.1, p = 0.003), while hypophosphatemia was independently associated with prolonged hospitalization (OR: 2.83, 95% CI: 1.36–5.91, p = 0.005). No electrolyte abnormality demonstrated a stable independent association with IMV requirement or mortality after adjustment. Sensitivity analyses in the full cohort yielded consistent findings. Conclusions: Electrolyte abnormalities are common in hospitalized COVID-19 patients and are associated with worse clinical outcomes; however, they primarily reflect overall disease severity rather than acting as independent prognostic determinants. Routine electrolyte measurements may provide accessible and clinically informative markers but should be interpreted in conjunction with other clinical parameters. Full article

Background: Although technology is rapidly transforming many industries, the healthcare industry remains comparatively conservative and slow to adopt new technologies due to patient safety concerns. Notwithstanding the abundance of research on technology acceptance, most studies overlook departmental variations, making it impossible to enhance technology adoption in the medical sector. Thus, the purpose of this study is to bridge this gap by concentrating on the emergency department (ED). Methods: This study examined the factors influencing Malaysian ED healthcare professionals’ acceptance of new medical technology by introducing organisational support and training with the Technology Acceptance Model (TAM). The study’s target population comprised ED healthcare professionals in Malaysian hospitals who were at least 25 to 60 years old. In total, 140 valid surveys were gathered by email and WhatsApp from Malaysian hospital EDs, and SPSS and SmartPLS were utilised for analysis. Results: Perceived usefulness and training have a significant impact on attitude towards use, whereas attitude towards use is the sole variable that directly influences behavioural intention to use and acts as a mediator in certain paths. Conclusions: Hospital administration should concentrate on the actual needs of ED healthcare professionals, improve their understanding of technology, and offer targeted training in order to promote its effective adoption and utilisation. In the meantime, technology providers should improve the innovation’s design to make it more accessible to EDs. These findings also show that incorporating organisational support and training enhances TAM’s explanatory power and reveals its flexibility in high-stress, fast-paced environments. Full article