Search Results (2,047)

The pursuit of mergers and acquisitions (M&A) is often an acclaimed strategy for firm growth, resource sharing, and extended reach into new market segments. However, in the healthcare marketplace, there are two very different perspectives related to M&A. On the one hand, the American Hospital Association commends M&A activity as a tool to reduce healthcare costs, drive quality, and serve rural markets. On the other hand, a recent United States’ Presidential executive order suggests that M&A in the healthcare space is harmful to healthcare due to its restrictions on competition and adverse impacts on patients. These conflicting perspectives reflect differing M&A views in mainstream management research, as well. The purpose of the current study is twofold. First, we aim to explore these two seemingly paradoxical perspectives by examining the degree of hospital network geographic dispersion that results from M&A activity. Second, we contribute to the broader M&A literature by drawing attention to the importance of considering geographic influences on M&A performance. Using a spatial analysis of 147 nationwide hospital networks comprising 1713 hospitals, we propose and find support for the notion that the degree of network dispersion, as measured by actual driving distances in healthcare networks, are correlated with patient experiences. Using ordinary least squares (OLS) regression to examine relationships between patient experiences and overall hospital network geographic dispersion, we found support for the hypothesis that more spatially dispersed healthcare networks are associated with lower overall performance outcomes, as measured by customer (patient) satisfaction. The implications of these findings suggest that growth strategies that involve M&A activity should carefully consider the spatial influences on M&A entity selection. Our exploratory findings also provide a foundation for future research to bridge the gap between industry and governmental perspectives on healthcare M&A practices. Full article

Background/Objectives. Carbapenemase production is the most diffused carbapenem-resistance mechanism among Enterobacterales, with Klebsiella pneumoniae carbapenemase (KPC), Verona-imipenemase (VIM), New-Delhi metallo-β-lactamase (NDM), imipenemase (IMP), and oxacillinase (OXA-48) being reported as the main types within Europe. Particularly, Southern Italy holds a concerningly high percentage of carbapenemases-producing Enterobacterales diffused among different hospital settings. These strains may colonize critical patients’ gastrointestinal tracts, often causing disseminations and severe complications. Scientific data recently reported carbapenemase variants’ worldwide diffusion and several double-carbapenemases reports. The diagnostic routine needs devices whose detection rates are extended to similar epidemiological conditions, avoiding a lack of specificity and potential negative results. Methods. We planned a retrospective study including carbapenem- and/or ceftazidime/avibactam-resistant Enterobacterales (62) which were tested with the KPC/IMP/NDM/VIM/OXA-48 Combo Test Kit (KINVO, Medomics Medical Technology, Nanjing, Jiangsu, China) based on the lateral flow assay (LFA) method. Results. We compared its results to the phenotypic antimicrobial susceptibility testing (AST) MIC results, obtaining a 100% agreement rate. The LFA kit reported carbapenemases in all the tested strains, also identifying cases of KPC variants and double-carbapenemases production. Conclusions. Our data demonstrated how LFAs may represent a reliable alternative requiring minimum economic and personnel resources along with simple result interpretations. Future studies will be necessary to further investigate the system effectiveness on a larger isolates’ number and a broad carbapenemase variant spectrum. Full article

Background/Objectives: Comparative analysis of work ability factors between German nurses without a migration background and Kosovar nurses working in Germany as nurses with a migration background. Methods: This is an observational cross-sectional study. We surveyed 814 nurses from hospitals in Kosovo and Germany using self-administered questionnaires. We used the Nurses Working Capability (WiN) Screening Manual to analyze work ability factors. Data analysis involved descriptive statistics, ANCOVA, and Bonferroni multiple comparison tests. Results: Of the 40 target factors, 17 showed significant differences. There were notable distinctions between German and Kosovar nurses in Germany. Concerning health and personal resources, Kosovar nurses in Germany reported poorer physical (M = 3.71) and social health (M = 3.83) but better mental health (M = 3.53) and fewer cognitive stress symptoms (M = 3.60) than German nurses (M = 3.97, M = 4.05, M = 3.40, and M = 4.00, respectively). As to the work-related factors, Kosovar nurses in Germany faced higher emotional demands (M = 3.33), felt greater time pressure (M = 3.43), and had a more negative view of the organizational structure (M = 2.09) but rated supervisor feedback more positively (M = 3.24) and faced fewer patient-related stressors (M = 2.16) relative to German nurses (M = 2.64, M = 2.64, M = 2.82, M = 2.76, and M = 3.09, respectively). Conclusions: Kosovar immigrant nurses in Germany face distinct challenges related to physical and social health, higher emotional demands, and time constraints; they also have a more negative view of organizational structure than native German nurses. The possible causes of these differences may be attributed to migration-related stress, cultural and environmental adaptations, varying job expectations, or organizational experiences. Full article

Background and Objectives: Although psychiatric disorders in early childhood are increasingly recognized, comprehensive clinical data from large samples in this age group remain limited. This study presents one of the largest and longest-term evaluations in Türkiye of children aged 0–72 months referred to child psychiatry. It aims to identify the most common presenting complaints, diagnostic patterns, and key predictors of psychotropic medication initiation in a previously understudied age group. Materials and Methods: This retrospective analysis included 3312 children aged 0–72 months who presented to the outpatient child psychiatry clinic of Trakya University Medical Faculty Hospital in Edirne, Türkiye. Clinical records were reviewed to extract data on presenting complaints, psychiatric diagnoses, psychotropic medication initiation, and demographic details, including age and sex. Results: The most common presenting complaints were “delayed speech development”, “irritability/frustration”, “hyperactivity”, “requests for medical reports”, and “stuttering.” These complaints were more prevalent among children who received psychiatric diagnoses. Psychiatric diagnoses were more common in boys. Boys also presented at older ages and had longer follow-up durations. Psychotropic medications were initiated in 26.9% of the cases. The most frequently reported side effects were loss of appetite and drowsiness. Logistic regression analysis revealed that specific complaints were significantly predictive of initiating medication. These included “inability to speak”, “irritability/frustration”, “hyperactivity”, “lack of eye contact”, “aggression”, “school refusal”, “sleep problems”, and “fears.” Conclusions: This study revealed that some early childhood complaints, such as “inability to speak”, “restlessness”, “hyperactivity”, and “not making eye contact”, are strong predictors of both psychiatric diagnosis and initiation of psychotropic medication. The findings highlight the usefulness of structured assessment protocols in early childhood psychiatric services. The implementation of systematic screening for risk symptoms may facilitate early diagnosis and support more appropriate and timely treatment approaches, especially in resource-limited regions. Full article

Healthcare institutions are under increasing pressure to deliver high-quality, patient-centered care while reducing their environmental footprint. Integrating quality and environmental management systems (ISO 9001 and ISO 14001) into a unified integrated management system (IMS) offers a potential pathway to meet these dual imperatives. This study investigates the effects of IMS implementation in three European hospitals through a comparative qualitative analysis of institutional reports, audit documentation, and performance indicators. The methodology combines a literature-informed conceptual framework with a multi-case analysis guided by four domains: environmental impact, care quality, process efficiency, and stakeholder engagement. The data were collected from institutional documentation over a six-year period (three years before and after IMS implementation), covering key indicators such as energy and water consumption, medical waste recycling, audit compliance, and patient satisfaction. The findings show that IMS adoption was associated with a 20–28% improvement in resource efficiency, increased recycling rates, and consistent gains in compliance and satisfaction metrics. These results were supported by strategic leadership, cross-functional training, and digital monitoring tools. The study concludes that IMS enhances institutional performance and sustainability while aligning healthcare operations with broader governance and policy goals. Further research is recommended to explore the long-term impacts and generalize the findings across healthcare systems. Full article

Background: Opioid dependence is prevalent among patients undergoing lumbar spinal fusion and has been linked to poor postoperative outcomes. However, its specific impact on surgical complications and hospital resource utilization remains unclear. This study evaluates the association between opioid dependence and postoperative complications, length of stay (LOS), and hospital charges in lumbar fusion patients. Methods: A retrospective analysis was conducted using the National Inpatient Sample (NIS) database from 2016 to 2021. Adult patients (aged > 18 years) who underwent lumbar fusion surgery were identified and categorized based on opioid dependence using ICD-10 codes. Propensity score weighting (PSW) was employed to balance baseline characteristics. Primary outcomes included inpatient mortality, LOS, hospital charges, and postoperative complications. Statistical analyses were performed using survey-weighted generalized linear models. Results: Among 597,455 lumbar fusion patients, 7715 (1.3%) had documented opioid dependence. After PSW, opioid-dependent patients had significantly increased odds of blood loss anemia (OR 1.79, p < 0.001), respiratory complications (OR 2.17, p < 0.001), surgical site infections (OR 3.94, p = 0.001), and cardiac complications (OR 1.53, p = 0.002). They also had higher hospital charges (mean difference USD 17,739.2, p < 0.001) and prolonged LOS (mean difference 0.83 days, p < 0.001). Differences in urinary tract infections, acute renal failure, and stroke were not statistically significant after PSW. Conclusions: Opioid dependence is associated with increased postoperative complications, longer hospital stays, and higher healthcare costs in lumbar fusion patients. These findings highlight the need for improved perioperative pain management and opioid stewardship strategies to optimize surgical outcomes. Full article

Background: Depression and anxiety are common in patients with chronic respiratory diseases (CRDs), but their prevalence in intensive care settings, particularly in low-resource regions, remains underexplored. Objective: To assess the prevalence and severity of depression and anxiety in patients with CRDs admitted to an intensive care unit (ICU) and identify associated factors. Methods: A cross-sectional study was conducted at Gulab Devi Teaching Hospital, Lahore, Pakistan. Adult patients with CRDs admitted to the ICU were assessed using the Hamilton Depression Rating Scale. Statistical analyses included Fisher’s exact test, Mann–Whitney/Kruskal–Wallis tests, and logistic regression. Results: Depression was highly prevalent across all CRD categories: 83%, 89%, 84%, and 93% in obstructive, restrictive, infectious, and other respiratory disease categories, and severe depression in 16%, 18%, 14%, and 37%, respectively. Anxiety symptoms were also widespread (77–100%), with no significant differences across disease groups. Depression was significantly associated with older age (p < 0.001, OR 1.08) and anxiety symptoms (p < 0.001, OR 47.07). Female gender was linked to anxiety (p = 0.034, OR 4.17). Conclusion: The high burden of depression and anxiety in ICU patients with CRDs underscores the need for routine psychiatric screening and integrated mental health care in critical-care settings. Full article

Background: Liver transplantation has become the standard of care for patients with end-stage liver disease. Despite advances in surgical techniques, immunosuppression, and perioperative care, disparities in access and outcomes persist across demographic and socioeconomic lines. Objective: To assess trends and disparities in liver transplant admissions in the United States from 2016 to 2021, examining demographic patterns, in-hospital mortality, hospital charges, length of stay, and socioeconomic factors. Methods: Using the National Inpatient Sample (NIS) from 2016 to 2021, we identified liver transplant admissions using ICD-10 PCS codes 0FY00Z1 and 0FY00Z2. Demographic characteristics (age, sex, race, insurance status, and income quartile), clinical outcomes, and resource utilization metrics were analyzed. One-way ANOVA and Hensel’s test were used to assess variance and distribution homogeneity, with a significance threshold of p < 0.05. Results: A total of 9677 liver transplant admissions were analyzed. The mean recipient age remained stable (51–52 years), with males comprising ~62% of transplants. White patients constituted the largest group of recipients (~66–68%), followed by Hispanic (~14–17%) and Black patients (~7–10%). The proportion of transplants relative to liver failure admissions remained stable across racial groups, indicating no widening racial gap during the study period. In-hospital mortality post-transplant remained low (2.37–3.52%) and did not differ significantly by race (p = 0.23), sex (p = 0.24), or income quartile (p = 0.13). Similarly, Charlson Comorbidity Index > 5 did not predict inpatient mortality (p = 0.154). Hospital charges ranged from $578,000 to $766,000, with an average stay of ~21 days. Conclusions: Liver transplantation outcomes, including in-hospital mortality, appear consistent across demographic and socioeconomic groups once patients are admitted for transplant. However, broader disparities in access persist, necessitating further research into pre-transplant barriers and long-term outcomes. These findings support the need for equitable healthcare strategies aimed at optimizing transplant candidacy and survival across all populations. Full article

Introduction: This study evaluated the impact of parallel-level patient transfers on bed utilization efficiency within the Mayo Clinic Health System in Southern Minnesota, focusing on optimizing resources across tertiary and critical access hospitals. Methods: A retrospective analysis of 179,066 Emergency Department visits (2018–2022) was conducted, with ~2% involving parallel-level transfers for observation or admission. Machine learning was utilized to identify patients suitable for parallel transfers based on demographics, comorbidities, and clinical factors. A Random Forest model with an AUROC of 0.87 guided transfer decisions. Saved patient days were calculated as the difference between the actual LOS and the benchmark LOS based on Diagnosis-Related Groups (DRGs). Generalized estimating equations analyzed length of stay (LOS) differences, adjusted for confounders, with 95% confidence intervals (CI). Statistical analyses were conducted using SPSS (v.26). Results: The mean patient age was 56 years (SD = 17.2), with 51.4% being female. Saved patient days increased from ~600 to 5200 days over the study period. Transferred patients had a 5.7% longer unadjusted LOS compared to non-transferred patients (95% CI: 2.9–8.6%, p < 0.001). After adjustment for demographics and comorbidities, the LOS difference was not significant (adjusted mean difference: 0.4%, 95% CI: −1.7–2.5%, p = 0.51). Conclusions: Parallel-level transfers increased saved patient days, reflecting enhanced resource utilization. However, the adjusted LOS differences were not significant, highlighting the need for robust transfer protocols and controlled studies to confirm these findings. Full article

Pediatric Intensive Care Units (PICUs) provide specialized care for critically ill children. Developing and managing these units in South Asia remains challenging. Resource limitations and infrastructural disparities are leading to challenging conditions. Above all, nurses play a pivotal role in delivering quality critical care. Effective nursing practices can curb hospital-acquired infections (HAIs), ensure medication safety, and enable protocols such as the ICU Liberation Bundle. In South Asia, another challenge is the proper management of the nursing workforce. Nurse-to-patient ratios are highly disproportionate, contributing to nurse burnout. This review highlights the country-specific challenges and circumstances. There is no one-size-fits-all solution; effective strategies vary based on each country’s context. With context-specific solutions, nurses can bridge the gap between healthcare teams and families, ultimately improving patient outcomes. Full article

Aim: To understand dementia care knowledge, attitudes, and confidence among acute-care support staff following a dementia education intervention titled Dementia Workforce Excellence in Acute Care. Design: A convergent parallel mixed-methods pilot study. Methods: Data were collected from 30 participants using an online survey and three individual interviews between January and March 2024. Survey data were analysed using descriptive statistics, and a thematic analysis underpinned by Kirkpatrick’s framework was used to analyse the qualitative data from interviews. Results: The online survey established good levels of dementia knowledge, attitudes, and confidence among support staff with enhanced attitudes among staff who completed the training. Analysis of interviews resulted in three themes: dementia in the acute care setting; motivation for learning; and evaluation of the intervention on four levels [satisfaction, learning gains, behaviours, and results]. Conclusion: Findings suggest that the dementia education intervention used in this study is a comprehensive dementia training resource that promotes person-centred and compassionate dementia care across all stages of the dementia journey. Dementia is a public health priority with workforce education identified as a key response for capacity building. This pilot evaluation offers insight and new learning on the pedagogical approaches that are inclusive of peer-supported reflective learning in small groups that remain untapped for dementia workforce development. Dementia inclusive and enabling environments with a knowledgeable and skilled workforce are crucial to mitigate stigma and discrimination. This can be best achieved by raising awareness through targeted staff education and training to make hospital environments more dementia inclusive. Patient or Public Contributions: Dementia care scenarios used in this study were co-designed by experts with lived experience of dementia. Additionally, these experts along with family carers of people living with dementia were involved in the delivery of the training where appropriate. Full article

Background: Pathology is essential for cancer diagnosis, bridging clinical and surgical fields, and requires adequate infrastructure, technology, and skilled staff to meet standards of care. In Romania, healthcare underfunding limits pathology laboratories’ capacity to provide timely and accurate diagnoses, leading to delays that could negatively impact treatment and patient outcomes. Our study aimed to assess the status of publicly funded pathology laboratories in Romania and identify key areas for improvement. Methods: We analyzed public hospitals in Romania, excluding specialized and non-general care institutions, to evaluate pathology laboratories. A 10-item survey was distributed over 12 months via email, phone, administrative offices, and professional networks to pathologists working in these laboratories, regardless of their hierarchical position. A total of 154 pathology services were represented. The questionnaire assessed technical capabilities, diagnostic techniques, automation, staffing, infrastructure, and satisfaction with funding and resources. Responses were gathered with both predefined and open-text fields to capture comprehensive insights. Results: The findings revealed that many pathology laboratories faced significant challenges, including a lack of automation, limited integration of modern technologies, and barriers to digitalization. Despite these issues, pathologists reported higher-than-expected levels of satisfaction with their laboratories. Conclusions: A comprehensive understanding of existing practices is necessary to drive the modernization of pathology services, establish national standards, and improve collaboration both within and across specialties. Without such foundational insight, efforts to enhance the integration and effectiveness of pathology services are likely to remain constrained. Full article

Background: Hypothermia at admission and in the following days is a major risk factor for neonatal mortality in both high- and low-resource settings. Implementing hypothermia prevention procedures is not an easy goal to achieve, and the few studies currently available in low-income countries focus mainly on temperature at admission. Deviation from normothermia does not exhaust its effects upon admission, with a demonstrated negative impact of hypothermia also during the first days of life. Objective: The aim of this study was to evaluate the effectiveness of bundled interventions in preventing neonatal hypothermia at admission and during hospitalization in a low-resource setting. Methods: This was a retrospective, observational, before–after study comparing a pre- (December 2023–February 2024) and a post-quality improvement intervention period (April–June 2024). The outcome measures included admission temperature, average temperature during hospitalization, number of hypothermia episodes, temperature checks per day during hospitalization, and mortality. Results: From the pre- to the post-intervention period, the median admission temperature increased from 35.6 °C to 36.0 °C (p = 0.004). Median temperature during hospitalization increased from 36.3 °C to 36.7 °C (p < 0.0001). Mild and moderate hypothermia episodes decreased from 1.0 to 0.5 and from 0.7 to 0.2 episodes per day (p < 0.0001). Conclusions: In a Sub-Saharan referral hospital, the implementation of bundled interventions to maintain the warm chain improved neonatal temperature at admission and during hospitalization, and reduced hypothermia episodes during hospitalization. Full article

Background: Roughly 18% of all patients discharged from hospitals in the United States experience an unplanned hospital readmission (UHR) within 30 days of discharge. This can be life-threatening for patients and costs the U.S. health care system billions of dollars. The Centers for Medicare and Medicaid Services is seeking continued research to identify factors contributing to UHR. Research has viewed the transition from hospital to home in three stages: the pre-discharge stage where the patient is being diagnosed and treated in the hospital, the bridging stage where the patient is being prepared for discharge, and the post-discharge stage where the patient is recovering at home. Objectives: Our aims were: (1) to identify factors perceived by patients to influence their recovery during at least one of the three stages of the hospital to home transition and (2) to identify factors perceived by patients as important across all three stages of the transition. Methods: To accomplish this, we analyzed information obtained from in-depth, home interviews with 62 participants who had been discharged from a regional hospital roughly 30 days prior to the interview. Our analysis included open-ended readings and the use of qualitative analysis software. Results: Factors reported to influence recovery at the pre-discharge stage include appropriate diagnosis, treatment, and financial resources. Factors at the bridging stage include access to health information and social supports. Factors perceived to influence recovery at post-discharge include personal characteristics, social supports, and the environment. Conclusions: Participants identified factors at the pre-discharge, bridging, and post-discharge stages believed to be influencing their ability to recover from a hospital stay. Four of these factors were perceived to influence their recovery across multiple stages of the hospital to home transition. These included financial resources, social supports, access to health services, and personal stress. Full article

Background: This study investigated hematological and biochemical parameters, including cell population data (CPD), to evaluate their association with severity in COVID-19 and non-COVID-19 patients. Identifying these parameters could aid in disease monitoring and clinical decision-making. Methods: A retrospective analysis of 8401 patients, including 603 COVID-19 cases and 7546 non-COVID-19 cases, were conducted. Complete blood count (CBC) and routine chemistry results obtained near the time of real-time polymerase chain reaction testing were analyzed to assess their associations with disease severity. A matched cohort analysis was performed to adjust for potential confounding factors, such as age and sex. Results: COVID-19 patients with elevated neutrophil side fluorescence light (NE-SFL), platelet-to-lymphocyte ratio (PLR), glucose, and aspartate aminotransferase (AST), along with decreased plateletcrit, were more likely to experience severe outcomes, such as hospitalization or death. In addition, decreased hemoglobin, lymphocyte side scatter (LY-SSC), and albumin, as well as increased leukocyte and monocyte side scatter (MO-SSC), were associated with a greater severity, regardless of COVID-19 status. Conclusions: We identified hematologic and chemical assay biomarkers that correlate with severe COVID-19. These findings may provide important information regarding the disease progression and clinical management. Incorporating these biomarkers into clinical decision support systems could facilitate personalized treatment strategies, optimize resource allocation, and enable real-time severity stratification. Full article