Search Results (13,408)

Modern inpatient care generates irregular streams of heterogeneous clinical events, yet most predictive models require fixed feature matrices, predefined time windows, or discretization of continuous measurements. We developed CHaRT, a decoder-only autoregressive transformer designed to jointly forecast the identity of the next clinical event and, when applicable, its associated continuous value. CHaRT was trained and internally validated on structured electronic health record data from adult acute-care encounters across a 12-hospital health system in Minnesota from 2001 to 2025. The final corpus included 4,447,625 encounters from 1,301,502 patients and 701,556,877 non-padding clinical event tokens spanning vital signs, laboratory values, medications, diagnoses, microbiology, virology, imaging, fluids, and outcomes (ICU transfer or death). Encounters were split into training, validation, and test sets before vocabulary construction, normalization, and windowing. On the held-out test set, CHaRT achieved Top-1, Top-5, and Top-10 next-event accuracies of 51.61%, 87.34%, and 93.22%, respectively, with perplexity 4.50 and expected calibration error 0.0109. For numeric prediction, z-score MSE was 0.3812 for vital signs and 0.5713 for laboratory values. Seeded examples generated clinically coherent trajectories. Using model representations, a linear probe predicted deterioration (ICU transfer or in-hospital death) at a 6 h landmark with AUROC 0.95–0.97, indicating that learned representations transfer to downstream clinical risk prediction. Full article

Background: Cervical cancer remains a significant health issue in Indonesia, where structural barriers, fragmented information, and sociocultural norms continue to hinder timely diagnosis and treatment. Families play a central role throughout the illness journey, yet their perspectives are often overlooked in the development of digital patient navigation systems. This study explored family experiences, caregiving challenges, and expectations for a family-centered digital navigation model, DIVA.ID, by integrating Digital Health frameworks and Family Systems Theory. Methods: A qualitative descriptive approach was employed through semi-structured, in-depth interviews with 18 purposively selected family caregivers of women with cervical cancer at a major referral hospital in West Java. Participants were selected because they were directly involved in daily care, treatment decisions, logistical support, or emotional assistance. Interviews were conducted between August and October 2025 and continued until thematic saturation was reached, as indicated by repetition of categories and the absence of new major codes in the final interviews. Data were analyzed using inductive–deductive content analysis guided by Elo and Kyngäs, with five researchers conducting independent coding, iterative code comparison, consensus meetings, and theoretical mapping. Results: Four main themes emerged: (1) family involvement in decision-making, including collective discussion, shifting authority roles, and patient autonomy; (2) caregiver burden, involving physical exhaustion, psychological distress, social restriction, stigma, financial pressure, and employment disruption; (3) psycho-spiritual coping mechanisms, including emotional sharing, prayer, crying, patience, and surrender to God; and (4) digital healthcare needs, covering BPJS guidance, treatment information, scheduling, communication pathways, shelter support, and mental–spiritual support. Mapping these themes to Digital Health frameworks and Family Systems Theory clarified how DIVA.ID could translate family experiences into practical navigation functions. Conclusions: This study provides empirical foundations for a culturally sensitive, family-centered digital navigation model in Indonesia. Rather than demonstrating effectiveness, the findings identify design requirements for DIVA.ID that should be tested in subsequent feasibility, usability, and intervention studies. Full article

Background: Sustainable head and neck cancer (HNC) surgery is challenged by environmental impact, workforce shortages, inequitable access to advanced techniques, and policy constraints. Addressing these areas is critical for equitable, high-quality care. Methods: This structured narrative review synthesizes evidence on environmental sustainability, workforce development, technological innovation, health policy, and socioeconomic determinants in HNC surgery, without aiming to provide a systematic or exhaustive evidence synthesis. Sources included peer-reviewed literature, global workforce surveys, and international policy reports, with a focus on disparities between high-income countries (HICs) and low- and middle-income countries (LMICs). Results: Operating rooms produce up to 70% of hospital solid waste and consume 3–6 times more energy than other units; reusable instruments and improved waste segregation can reduce carbon footprints by over 50%. Workforce shortages are severe in LMICs, where subspecialty training is scarce; global partnerships, bidirectional education, and simulation-based learning can expand local capacity. Telemedicine, artificial intelligence, and three-dimensional printing enhance surgical planning, training, and access but may widen disparities without equitable deployment. Policy tools—including diagnosis-related groups, bundled payments, and universal coverage—affect access and innovation uptake. Pandemic preparedness underscores the value of resilient systems with flexible staffing and telehealth integration. Conclusions: HNC surgery requires coordinated action across environmental, workforce, technological, socioeconomic, and policy domains; however, future systematic reviews are needed to comprehensively map the evidence base and assess its methodological quality. Embedding sustainability in clinical practice, ensuring equitable innovation access, and aligning reimbursement with high-value care can strengthen system resilience, improve outcomes, and support long-term surgical service viability. Full article

Mitral valve regurgitation is the second most common valvular heart disease in Europe, and an estimated 10% of individuals older than 75 years have severe mitral regurgitation. Mitral valve repair is the preferred strategy to treat mitral regurgitation and is associated with better outcomes than mitral valve replacement. Despite the proven efficacy of surgical repair, available data in functional aetiologies reported a non-negligible rate of echocardiographically detected severe mitral regurgitation within ten years of the index procedure, in some cases resulting in redo interventions. Data on the optimal management of patients with failed mitral repair remain limited. The aim of this review is to present the available approaches for treating failed mitral valve repair and to describe criteria for selecting the most appropriate strategy on the basis of the underlying mechanism of repair failure, with respect to possible surgical re-repair and novel transcatheter edge-to-edge repair techniques in the presence of favourable mitral valve anatomies. Full article

Background/Objectives: Given the limited evidence internationally, this qualitative study employed discovery interviews to explore the lived experience of patients who developed Hospital-Acquired Malnutrition (HAM) and that of their carers. Methods: Seven (two patients [(n = 1 female] and five carers [n = 3 female]) completed discovery interviews with an experienced independent interviewer. Carers were either spouses or parents. Responses were thematically analyzed using a constant comparative approach. Results: A key theme was ‘It’s not about the food, it’s the hospital system’ with the needs of the system dominating, including when patients were feeling at their worst. Subthemes were ‘integration of care’ and ‘patient acuity’, including symptoms that impacted food intake. Another theme was ‘Who is looking out for the patient?’, exploring ‘reliance on carer advocacy’, and ‘variation in staff involvement’. One carer said, “… the girl that delivered the meal tray was the only one in our hospital stay who actually said to [the patient], ‘I’m so glad you’re sitting up. I was worried about you because you hadn’t eaten for so long?” A persistent but comparatively less strong theme was ‘When it is about the food’ which explored ‘the quality of the food’ and ‘receiving information on eating and drinking’. Conclusions: The three key themes identified from carers and patients were hospital system impacts, care co-ordination and, less strongly, experiences with food quality and information. The key opportunities to prevent, or better support the nutritional care of patients with, HAM may be through improving systems and care co-ordination. Full article

Background: Live music, understood as real-time musical performance delivered in the physical presence of patients or other participants, is increasingly incorporated into healthcare settings as an arts-based, non-pharmacological practice intended to support well-being and humanize care. While previous reviews have examined a broad range of music-based interventions in healthcare, limited attention has been given specifically to live music, its contextual characteristics, and the values attributed to its use within hospital environments. Objectives: This scoping review aims to map and synthesize the literature on live music in healthcare settings, focusing on clinical contexts, populations involved, and the therapeutic, psychosocial, and environmental values reported. Methods: A scoping review was conducted following the framework of Arksey and O’Malley. Searches were performed in Web of Science, Scopus and Pubmed using terms related to live music and healthcare settings. Studies published in English or Spanish over the past 20 years were considered. After screening titles, abstracts, and full texts, 81 studies met the inclusion criteria. Results: The studies covered diverse hospital units and patient groups, particularly oncology, neonatal and intensive care, palliative care, and haemodialysis. Reported outcomes were mainly psychological and emotional, including reductions in anxiety, stress, and distress, alongside improvements in mood, well-being, and quality of life. Cognitive, physiological, and environmental benefits were also identified, emphasizing the role of live music in creating supportive and humanized care environments. Most studies were conducted in Europe and North America. Conclusions: Live music is widely implemented in healthcare settings and is associated with benefits extending beyond symptom reduction to experiential and humanizing dimensions of care. This scoping review provides an overview of the existing evidence base and identifies directions for future research in arts and health. Full article

Ventilator-associated pneumonia (VAP) is linked to high mortality rates, especially in developing countries. This cross-sectional survey study was conducted across three central hospitals in the Hail region of Saudi Arabia, King Salman Specialist Hospital, Hail General Hospital, and King Khalid Hospital, to assess the knowledge and adherence of intensive care unit (ICU) healthcare practitioners to the ventilator bundle (VB) for VAP prevention. It also looked at the practitioners’ perceived barriers to effective VB deployment. The study (n = 86) revealed significant disparities in VAP prevention knowledge across educational levels regarding the recommended degree of head-of-bed (HOB) elevation (p < 0.001), the use of endotracheal tubes with extra lumens for subglottic drainage (p < 0.001), and the protective effects of 0.12% chlorhexidine gluconate antiseptic oral rinse (p = 0.019). Professional experience significantly influenced knowledge of non-standard VB components (p < 0.001), the recommended frequency of awakening and spontaneous breathing trials (SBTs) (p < 0.001), and knowledge of extra-lumen tubes (p = 0.038) and kinetic beds vs. standard beds (p = 0.005). Significant differences were found between professional categories regarding knowledge of hand hygiene performance (p = 0.032), the correct degree of HOB elevation (p = 0.007), and patient positioning (semi-recumbent vs. supine) (p = 0.023). Years of experience significantly impacted reported compliance with institutional VB (p = 0.013), adherence to oral care protocols (p = 0.035), and the assessment of sedation depth (p = 0.002). While basic measures like HOB elevation practice and DVT prophylaxis showed universal reported compliance (100%), significant performance gaps were identified in more complex tasks, such as interrupting continuous sedative infusions and performing SBTs as recommended (p < 0.001), particularly among novice practitioners. The primary implementation barrier preventing full compliance with the VB was identified as educational deficit, which was prioritized as the most important area for quality improvement, highlighting the need for targeted training for newly hired ICU staff. Full article

Background/Objectives: Patient experience is increasingly recognised as a key dimension of healthcare quality, yet most tools fail to capture its temporal and processual nature, limiting its contribution to system improvement. This study aimed to demonstrate how a biographical approach to patient experience can generate actionable insights for improving care pathways. Specifically, we sought to: (i) identify and characterise distinct types of prehospital care pathways among patients hospitalised for COVID-19; (ii) identify patient-perceived significant events and safety issues; and (iii) generate structured variables to inform a subsequent quantitative phase. Methods: We conducted semi-structured biographical interviews with 31 patients hospitalised for COVID-19 in two French university hospitals. Data were collected using a life-events calendar (LEC), enabling day-by-day reconstruction of symptoms, healthcare contacts, and decision-making processes. Thematic analysis was performed with multidisciplinary triangulation. The qualitative phase identified three pathway types and the key mechanisms underlying each; these patterns were subsequently confirmed in a separate quantitative follow-up study (n = 312) using state sequence analysis. Results: Three distinct pathway types emerged: short (≤3 days), intermediate (4–9 days), and long (≥10 days). Delayed pathways were associated with repeated false-negative tests, underestimation of severity, and silent hypoxaemia. Across all pathways, patient experience suggested critical system-level failures, including diagnostic delays and inadequate escalation of care. Notably, in many cases, hospitalisation was triggered by a relative rather than a healthcare professional. These findings highlight the role of patient and social context as key components of care pathways. Conclusions: When captured longitudinally, patient experience may provide actionable insights into healthcare system functioning, suggesting structural mismatches between clinical trajectories and care responses. The life-events calendar method offers a replicable framework for transforming patient experience data into clinically and organisationally relevant knowledge. Integrating such approaches into healthcare evaluation could enhance patient safety, improve care coordination, and support more responsive care systems beyond COVID-19. Full article

Healthcare-associated infections (HAIs) remain a major public health concern, contributing to increased morbidity, mortality, and antimicrobial resistance. Healthcare workers (HCWs) are recognized as key vehicles in the transmission of nosocomial pathogens, primarily via contaminated hands and medical devices. This study assessed the effectiveness of hand hygiene protocols among HCWs, their correlation with bloodstream infections, and the potential of natural antimicrobial agents as complementary preventive measures. Between January and June 2025, 128 hand samples were collected from HCWs in surgical, intensive care, and internal medicine units of hospitals managed by ASL Caserta (Marcianise, n = 65; Piedimonte Matese, n = 30; Sessa Aurunca, n = 18; Maddaloni, n = 15). Sampling was performed upon entry to clinical areas and after antiseptic handwashing, using Rodac TSA plates to quantify microbial load (CFU/cm²). Isolates were identified via MALDI-TOF, and multidrug resistance was confirmed using the Phoenix BD system. Microbial growth was detected in 54.7% of samples. Coagulase-negative staphylococci, mainly Staphylococcus epidermidis and S. hominis, accounted for 67.1% of positive cultures, followed by Enterobacteriaceae (28.6%). Comparison with concurrently collected blood cultures revealed potential overlapping pathogens, with Staphylococcus spp. prevalence ranging from 35 to 56% and Gram-negatives from 18 to 39. Selected isolates were further tested for susceptibility to natural antimicrobial agents, derived from hop, red vine leaf, green tea, and pomegranate fruit, as well as thyme essential oil. Thyme essential oil (Thymus vulgaris) demonstrated notable antimicrobial activity, in several cases surpassing that of standard hygiene agents. These findings highlight not only that maintaining high standards of hand hygiene, proper care of invasive devices, and continuous microbiological surveillance is critical for preventing HAIs, but also that incorporating natural antimicrobial compounds into hygiene protocols may provide an effective and sustainable adjunct to reduce microbial contamination and combat infections caused by multidrug-resistant organisms. Full article

Objective: Rapid assessment of early treatment-related physiological improvement in emergency department (ED) patients with respiratory failure (RF) remains challenging. Blood gas analysis is informative but invasive and not ideal for repeated use. The vertical displacement index (VDI), an ultrasound-derived parameter based on pleural motion, may provide dynamic bedside information on early physiological change. This study evaluated whether changes in VDI are associated with early physiological improvement in ED patients with RF. Methods: This prospective observational study was conducted in the EDs of two tertiary care hospitals. Adult patients presenting with dyspnea and clinical evidence of RF were included. VDI was measured by lung ultrasound at baseline and 30 min after initial treatment. The primary endpoint was the change in VDI 30 min after the initial treatment, calculated as the difference between pre-treatment and post-treatment VDI. The expected direction was a post-treatment decrease in VDI, with greater VDI reduction expected to be associated with greater early physiological improvement. Secondary analyses included comparisons of VDI changes across oxygen saturation and diagnostic groups, as well as correlations between ΔVDI and physiological changes. Patients were grouped by admission oxygen saturation (<80%, 80–90%, and ≥90%). Results: Seventy-nine patients were included. Pre-treatment VDI differed significantly between oxygen saturation groups, with the highest values in the most hypoxemic patients (p = 0.028). VDI decreased significantly after treatment in all groups (p < 0.001 for all), with the greatest reduction in the <80% group. By diagnosis, VDI decreased significantly in pulmonary edema, COPD/asthma, and pneumonia, but not in pulmonary embolism (p = 0.138). VDI reduction correlated positively with improvements in oxygen saturation (r = 0.27, p = 0.016) and pH (r = 0.24, p = 0.037), but not with CO₂. Conclusions: VDI may be explored as a practical ultrasound-derived bedside parameter associated with early physiological improvement in ED patients with RF. Full article

Chromosomal microarray analysis (CMA) is widely used to detect chromosomal aneuploidies and copy number variants (CNVs) in pediatric patients with congenital anomalies or developmental concerns. However, its diagnostic utility in critically ill neonates and children admitted to intensive care units (ICUs) remains undercharacterized. We conducted a retrospective review of 679 patients admitted to the neonatal, pediatric, or cardiovascular intensive care units (NICU, PICU, CVICU) at Phoenix Children’s Hospital between 2019 and 2024 who underwent CMA. Demographic data, clinical indications, and CMA results were extracted from electronic medical records to assess diagnostic yield and variant patterns. CMA identified a clinically relevant finding in 102 of 679 patients, resulting in an overall diagnostic yield of 15.0% (95% CI: 12.3–17.7%). Clinically relevant findings included pathogenic (P) variants (n = 88), likely pathogenic (LP) variants (n = 12), and large regions of absence of heterozygosity (AOH) consistent with uniparental disomy (UPD) (n = 2). A variant of uncertain significance (VUS) was detected in 139 patients (20.5%). Among the pathogenic and likely pathogenic variants, CMA identified recurrent CNVs (n = 49), nonrecurrent CNVs (n = 17), aneuploidies (n = 22), and patients with two pathogenic or likely pathogenic CNVs (n = 10). Diagnostic yields of 48.4% (95% CI: 38.5–58.4%) and 8.4% (95% CI: 6.0–11.5%) were observed in patients with single or multiple congenital anomalies including a congenital heart defect (CA + CHD), and in patients with an isolated CHD, respectively. CMA demonstrates significant diagnostic value in critically ill neonates and children, particularly among those with multisystem congenital anomalies. These findings support the routine integration of CMA in genomic evaluation protocols for ICU populations to guide diagnosis, management, and counseling. Full article

Background/Objectives: Nurses’ engagement in research is essential to strengthen evidence-based practice, knowledge translation, and quality of care. However, individual, organisational, and cultural barriers may limit nurses’ participation in research activities. This study aimed to cross-culturally adapt and psychometrically test the Italian version of the Barriers to Nurses’ Participation in Research Questionnaire within the Italian cultural and healthcare organisational context, and to explore perceived obstacles to research engagement among nurses in Italy. Methods: A cross-sectional methodological study was conducted. The instrument was translated, back-translated, reviewed by the original instrument developer and an expert panel, and evaluated for content validity by 12 clinical research professionals. Data were collected online between September and October 2024 from 196 nurses working across Italian healthcare settings, including hospitals, university hospitals, IRCCS, primary care, and private hospitals. Exploratory Structural Equation Modelling was used to examine the factor structure. Results: A total of 196 nurses were enrolled in the study. A two-factor structure was identified, comprising Research Resources and Personal Relevance of Research, which explained 35.37% and 25.14% of the variance, respectively. Both factors demonstrated good reliability. The most prominent barrier was the lack of incentive or reward for nurses to engage in research, whereas the least relevant barrier was the perception that research was not interesting or valuable. Greater barriers were reported by younger nurses, those with fewer years of experience, and those without specific research training. Lack of time to conduct research emerged as a pervasive obstacle across the sample. Conclusions: The Italian version of the Barriers to Nurses’ Participation in Research Questionnaire provides preliminary evidence of validity and reliability for assessing perceived barriers to research participation among Italian nurses. Owing to the structural modifications introduced during adaptation, the instrument should be interpreted as a culturally adapted and modified Italian version rather than as a direct replication of the original structure. Its use may support organisational diagnosis, research mentorship, training planning, and future research-capacity-building initiatives, although further validation in larger and more heterogeneous samples is warranted. Full article

Introduction: Compassion is defined as the emotional response that arises when an individual perceives another’s suffering and is motivated to alleviate it. Purpose: To explore levels of self-compassion among nurses working in pediatric hospitals and examine their associations with nurses’ characteristics. Materials and Methods: This cross-sectional study included a convenience sample of 208 nurses from a public pediatric hospital. Data were collected through interviews using the Neff Self-Compassion Scale (SCS) which includes the following subscales: Self-Kindness, Common Humanity, Mindfulness, Self-Judgment, Isolation, and Over-Identification. The Greek-validated version of the instrument was used with acceptable internal consistency in the present sample (Cronbach’s alpha = 0.849). Data analysis included descriptive statistics and inferential tests (non-parametric comparisons and multiple linear regression), with statistical significance defined as p < 0.05. Results: The mean total Self-Compassion score was 83.24 ± 12.6 (range: 26–130). Regarding family-related factors, total Self-Compassion (p = 0.029), Common Humanity (p = 0.033), and Over-Identification (p = 0.041) were associated with the number of children. In relation to age, Self-Kindness (p = 0.033), Isolation (p = 0.005), and Over-Identification (p = 0.005) showed significant associations. Professional factors were also relevant, as Isolation was associated with total years of nursing experience (p = 0.032) and choice of nursing as a profession (p = 0.004), while Over-Identification was associated with years of experience in pediatric settings (p = 0.004) and choice of nursing as a profession (p = 0.049). Additionally, marital status was associated with Over-Identification (p = 0.045). Conclusions: Demographic and professional characteristics appear to influence the expression of Self-compassion. Healthcare organizations should implement targeted training programs to individualize professional development. Future research should explore work-related and personal factors influencing self-compassion to improve care quality and outcomes. Full article

Objectives: To evaluate the impact of Point-of-Care Ultrasound (POCUS) performed by family physicians on the management of abdominal pain in the emergency department, assessing its effect on length of stay, performance of complementary diagnostic tests, diagnostic concordance, and patient satisfaction. Methods: Quasi-experimental pilot study with a control group conducted in a hospital emergency department. A total of 222 adult patients with abdominal pain were included and allocated according to the attending professional (with or without ultrasound training). Clinical, care-related, and patient-satisfaction variables (SERVPERF questionnaire) were analyzed. Non-parametric statistical tests were used, and multiple linear regression analyses were performed. Results: The POCUS group showed a shorter length of stay (3.46 vs. 4.41 h; p = 0.022) and a lower number of plain radiographies (16.8% vs. 69.9%; p < 0.001) and CT scans (p = 0.034). Diagnostic concordance was significantly higher in the experimental group (99.2% vs. 75.7%; p < 0.001). Overall satisfaction with received care was also higher in the intervention group (p < 0.001), with significant differences observed across all evaluated dimensions. The multivariate model explained 26.6% of the variability, with patient satisfaction emerging as a positive predictor. Conclusions: POCUS improves the quality of care in emergency departments by reducing length of stay and the use of complementary diagnostic tests while increasing diagnostic accuracy and patient satisfaction. Its implementation can be considered an effective and potentially cost-effective strategy; however, further studies with greater methodological robustness are required to validate the development of standardized composite indexes. Full article

Background: Hypotonic–hyporesponsive episode (HHE) is a recognised adverse event following immunisation (AEFI) in infants, characterised by sudden hypotonia, hyporesponsiveness, and pallor or cyanosis. Although considered benign, its abrupt and often dramatic presentation often leads to acute medical evaluation. Contemporary data on HHE are limited, and awareness among healthcare professionals needs attention. Methods: We conducted a retrospective analysis of all spontaneous reports of HHE submitted to the national pharmacovigilance centre Lareb between 1 January 2012 and 22 July 2025. Cases were included only when meeting Brighton Collaboration (BC) Level 1 criteria, requiring clear documentation of hypotonia, hyporesponsiveness, and pallor or cyanosis in children younger than 24 months. Demographic and clinical characteristics, vaccine combinations, latency, duration, seriousness, and medical care utilisation were described. Results: A total of 294 Level 1 HHE cases were identified. Most episodes followed combinations of hexavalent vaccines with pneumococcal conjugate vaccines. The median age at onset was 9 weeks, with slightly more reports involving boys. The median latency to onset was 5 h (range 4–8 h), and the median episode duration was 10 min (range 3–30 min), aligning with the historical literature. All children recovered fully, and no long-term sequelae were reported. Although HHE is clinically benign, 27% of cases were classified as serious, primarily due to hospital admission. Among non-serious cases, one third involved medical assessment or emergency services. Healthcare professionals submitted 44% of reports, notably community child health physicians. Conclusions: Contemporary Dutch pharmacovigilance data confirm that the clinical characteristics of HHE remain highly consistent with long-standig evidence. Despite its benign and self-limiting nature, HHE frequently triggers substantial medical care consumption. Improved awareness of the typical presentation, course, and prognosis, supported by the Brighton Collaboration criteria, may help clinicians recognise HHE more readily, reduce unnecessary medical consumption, and provide reassurance to caregivers. Full article