Search Results (2,742)

Background/Objectives: Complex chronic patients represent a heterogeneous and high-risk population, for whom accurate prognostic tools are essential to guide clinical decision-making, optimize resource allocation, and support tailored interventions. The PROFUND index was developed for mortality prediction in polypathological patients, but its performance has not yet been evaluated in an ambulatory integrated care model. Methods: A retrospective observational study was conducted using two cohorts. Cohort H included complex chronic patients admitted to the Internal Medicine Department between March 2023 and February 2024. Cohort A comprised complex chronic patients followed by a multidisciplinary chronic care program between November 2016 and December 2023. PROFUND scores were derived from electronic health records. Discrimination for 12-month mortality was assessed using Kaplan–Meier curves, log-rank tests, and receiver operating characteristic curve analysis. Calibration was evaluated by comparing observed mortality with expected mortality based on the original PROFUND index and improved through intercept and slope recalibration. Results: A total of 660 patients were included in cohort H and 540 in cohort A. One-year mortality was 38.0% and 30.2%, respectively. Discriminatory performance was good in hospitalized patients (AUC 0.760; 95% CI 0.724–0.797) and moderate to good in ambulatory patients (AUC 0.705; 95% CI 0.656–0.754). Calibration analyses demonstrated systematic overestimation of mortality, particularly in the ambulatory cohort and intermediate–high risk strata, while recalibration improved agreement between predicted and observed risks. Conclusions: The PROFUND index provides useful risk stratification for 12-month mortality in CCP across care settings but overestimates absolute risk, particularly in ambulatory case management populations. Local recalibration may improve prognostic accuracy, support individualized care planning, and advance care planning discussions and allocation of multidisciplinary follow-up intensity. Full article

Previous studies have shown that, after postoperative recovery from upper and lower gastrointestinal surgery for cancer, patients use peculiar modalities to describe their health. The purpose of this study is to determine how upper and lower gastrointestinal cancer surgery is considered by patients when they set their health. A structured interview was developed and 47 consecutive patients were interviewed postoperatively. Answers were analyzed through M.A.D.I.T., a quantitative and qualitative methodology that allows for the detection of discursive processes comprising the text, beyond thematic analysis. Four dimensions have been analyzed: representation of the postoperative period in daily life; use of resources; participation in achieving the clinical objective after hospital discharge; and continuing to respect the surgeons’ indications. A corpus of 2374 text occurrences was analyzed. Without differences between types of surgery, surgical patients described the time after surgical intervention as a critical scenario. Patients expressed their personal opinions, expecting normality after surgery and having difficulty envisioning the future: their representation of inflexibility in the postoperative period prevented them from finding new coping strategies. Overall, across all four dimensions, participants used stabilization discursive modalities in more than 50% of cases, representative of a situation bound within strict ties and personal theories. When defining their health, cancer surgery patients tend not to consider their condition as a new and different one from before; they imagine that they will be able to fully resume their previous habits. However, this can risk undermining the achievement of the clinical objective. Thus, during early surgical consultations, as well as in surgical recovery, exploring differences after surgery and solutions could help patients in their engagement with surgical outcomes and consequences. Full article

This study examines smart technology adoption in foodservice microbusinesses by moving beyond intention-based explanations to examine how adoption and post-adoption unfold in practice. Hospitality technology research has largely emphasised attitudes and behavioural intentions, offering limited insight into how technologies become embedded in everyday operations, particularly in resource-constrained microbusiness contexts. Focusing on foodservice microbusinesses in Malaysia, this study goes beyond pre-adoption intention and examines the nuances of actual technology implementation, guided by adaptive training as the central adoption-enabling mechanism. Using an action research approach, this study implemented a one-month adaptive training intervention that enabled operators to engage in hands-on, experiential learning within their own business environments. The findings uniquely indicate that technology adoption is shaped by capability asymmetry, with differences in technological literacy, prior experience, and resources producing varied adoption pathways. These differences were addressed through adaptive training that aligned the pace and intensity of learning with operators’ capabilities. This study also identifies specialist mediation as a key mechanism supporting adoption, as guidance from a knowledgeable intermediary reduced complexity, facilitated learning, and enabled the transfer of trust. The findings suggest that smart technology adoption in microbusiness settings is not only a matter of intention but also a situated learning process shaped by unequal capabilities, adaptive training, and specialist-guided trust formation. Full article

Background: Antimicrobial stewardship programs (ASPs) are critical for promoting rational antibiotic use. While early implementation outcomes have been reported, extended follow-up sustainability and the impact on high-priority broad-spectrum antibiotics in South Korean secondary/tertiary hospitals require further validation. This study aimed to evaluate the extended outcomes and sustainability of an ASP over a 14-month period. Methods: This retrospective, single-center study analyzed ASP activities from January 2025 to February 2026 at a tertiary hospital in South Korea. Interventions included prospective audit and feedback (PAF) for restricted antibiotics and recommendations for prolonged prescriptions (≥14 days). Primary outcomes were the monthly rejection rate of restricted antibiotics and the acceptance rate of ASP interventions. Secondary outcomes included the days of therapy (DOT) per 1000 patient–days for meropenem and piperacillin/tazobactam (Pip/Taz). Results: During the 14-month period, the ASP intervention acceptance rate increased significantly from a mean of 72.0% in the implementation phase (January–April 2025) to 81.2% in the stabilization phase (May 2025–February 2026) (p = 0.035). The DOT for Pip/Taz decreased significantly from 169.4 to 151.8 per 1000 patient–days (p = 0.002), with a significant negative correlation identified between the intervention acceptance rate and Pip/Taz consumption (r = −0.625, p = 0.017). Although overall meropenem DOT showed seasonal fluctuations without reaching statistical significance across phases, a year-over-year comparison revealed a 7.5% reduction in meropenem DOT (January–February 2025: 54.8 vs. January–February 2026: 50.7 per 1000 patient–days). The rejection rate for restricted antibiotics declined from 3.8% to 2.6%, suggesting that clinicians increasingly self-regulated inappropriate prescribing attempts. Conclusions: The ASP demonstrated extended follow-up sustainability with a significant reduction in the consumption of key broad-spectrum antibiotics. A progressive increase in clinician acceptance of ASP interventions from 72.0% to 81.2%, combined with a concurrent decline in the restricted antibiotic rejection rate, reflected a measurable shift in institutional prescribing culture and confirmed the successful transition to a stabilized program. These findings support the necessity of sustained multidisciplinary ASPs, even in resource-limited settings, to combat antimicrobial resistance effectively. Full article

This study examines the leadership skills of business executives and the skills considered important for employees in the tourism and cultural sectors in Crete, Greece. The findings show that the sample is concentrated mainly in Heraklion and Chania, where there is a strong presence of hospitality and food service businesses. The most important leadership skills identified are professional competence, integrity, and problem-solving, while for employees, the most significant skills are communication, collaboration, responsibility, and professionalism. Overall, the findings indicate that the effective operation of businesses depends both on high-quality leadership and on the strong soft skills of their human resources. Full article

The healthcare sector is a major contributor to global greenhouse gas emissions. Little is known about the impact of individual clinical practices on overall emissions; more granular healthcare emissions data are needed to identify opportunities for resource stewardship. Our objective was to deploy an interdisciplinary team to perform Life Cycle Assessments (LCAs) comparing carbon emissions attributable to a novel home-care program for premature infants to those attributable to routine care in the Neonatal Intensive Care Unit (NICU). We used LCA methodology to compare the carbon footprint of two weeks of traditional care of infants in our NICU to that of those enrolled in an institutional alternative care program known as “Hope Grows at Home,” which transitions eligible infants requiring nasogastric feeds to the home setting with ongoing NICU team support. Our analysis showed that in-home care produces 77 kg of CO₂ emissions (kgCO₂e) per infant over a 14-day period, as compared to in-hospital care, which produced 338 kgCO₂e. Transportation to a healthcare facility accounted for the majority of emissions in both groups (292 kgCO₂e for NICU care and 58 kgCO₂e for home care). This finding is likely impacted by our facility’s rural location. Home care reduced solid waste emissions by approximately 94% relative to NICU care (1.74 vs. 26.97 kgCO₂e per term), reflecting the home setting’s reuse of feeding syringes and bottles that are routinely single-use in the hospital. Prospective data collection strategies for infants enrolled in home care will further refine our results. Exploring additional interdisciplinary collaborations may facilitate similar analyses, offering more insight into environmental stewardship opportunities within healthcare. Full article

Background: Family-centered care (FCC) is a foundational principle in pediatric healthcare, yet its implementation in culturally specific contexts remains poorly understood. In Saudi Arabia, Islamic values, collective family structures, and gendered caregiving norms shape how mothers engage with pediatric intensive care in ways that existing Western-derived FCC models do not fully capture. The aim of this study was to explore Saudi mothers’ experiences of family-centered care during their children’s pediatric intensive care unit (PICU) admissions, focusing on perceived barriers, cultural negotiations, and evolving advocacy strategies. Methods: A qualitative descriptive study was conducted with 17 Saudi mothers whose children had been admitted to PICUs across major hospitals in Saudi Arabia within the preceding 12 months. Semi-structured interviews lasting 40–70 min were conducted in Arabic using a pilot-tested, 15-item guide. Data were analyzed through Braun and Clarke’s six-phase reflexive thematic analysis. Trustworthiness was strengthened through member checking, reflexive journaling, negative case analysis, and investigator triangulation. Reporting adheres to the Consolidated Criteria for Reporting Qualitative Research (COREQ). Result: Five interconnected themes emerged: (1) confronting crisis and uncertainty, (2) renegotiating maternal identity, (3) brokering culture within biomedicine, (4) forging trust with care teams, and (5) evolving into advocates. These themes trace a developmental arc from initial disorientation through progressive empowerment, shaped at every stage by culturally grounded resources and constraints. Mothers functioned as cultural brokers performing invisible labor that healthcare systems neither recognized nor supported. Conclusions: Saudi mothers in PICUs engage in sophisticated cultural mediation between family systems and biomedical institutions under conditions of acute stress. Findings underscore the need for structurally embedded cultural responsiveness in PICU policy, including continuous cultural assessment, care-team continuity, and family advocacy support. Full article

Background: The role of primary anastomosis in rectal cancer surgery remains debated, particularly due to concerns regarding postoperative morbidity. Evidence from randomized trials is limited, and observational studies are frequently affected by selection bias. Methods: We conducted a retrospective observational study including patients undergoing rectal cancer surgery with or without primary anastomosis. To reduce confounding, propensity scores were estimated using relevant clinical and oncologic covariates, and overlap weighting was applied to estimate treatment effects in a population with clinical equipoise. The primary outcome was any postoperative complication. Secondary outcomes included severe postoperative complications, reintervention, in-hospital mortality, and measures of healthcare resource utilization. Absolute risk differences (RDs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated. Stabilized inverse probability of treatment weighting was used as a sensitivity analysis. Results: A total of 173 patients were included. After overlap weighting, primary anastomosis was not associated with a statistically significant difference in overall postoperative complications compared with no anastomosis (RD +0.01, 95% CI −0.14 to +0.17). Severe postoperative complications were numerically more frequent in the primary anastomosis group, while reintervention rates were numerically lower; however, these differences did not reach statistical significance. In-hospital mortality was significantly lower among patients undergoing primary anastomosis (RD −0.08, 95% CI −0.16 to −0.02). No significant differences were observed in length of hospital stay or intensive care unit utilization. Conclusions: Postoperative outcomes after rectal cancer surgery appeared broadly comparable between patients managed with or without primary anastomosis after adjustment for measured baseline characteristics. These findings should be interpreted in the context of residual confounding and surgical selection, and support individualized decision-making rather than routine use of either restorative or non-restorative strategy. Full article

Background: This study aimed to evaluate the association between comorbidity and hospital admission, hospital length of stay (LOS), and in-hospital mortality among adult trauma patients across the injury severity spectrum in South Korea, and to assess whether these associations vary according to injury severity. Methods: We conducted a retrospective cohort study using the national Community-Based Severe Trauma Survey (2019–2023). Adult patients (≥18 years) with trauma were included after excluding records with missing key exposure or outcome variables. Comorbidity was defined using the ICD-10–based Elixhauser comorbidity framework. In addition to a binary classification (any vs. none), comorbidity burden was categorized into 0, 1, 2, and ≥3 conditions to evaluate dose–response relationships. The primary outcomes were hospital admission, LOS, and in-hospital mortality. Multivariable logistic regression models were used for admission and mortality, and regression models were applied for LOS, adjusting for demographic characteristics, injury mechanism, physiologic status, and system-level factors. Effect modification by injury severity was assessed using interaction terms and ISS-stratified analyses. Results: Among 49,259 patients, 32,999 (67.0%) had at least one comorbidity. Patients with comorbidities were older, had higher injury severity, and showed higher admission rates, longer LOS, and higher in-hospital mortality compared with those without comorbidities. After adjustment, comorbidity remained independently associated with increased odds of admission, prolonged LOS, and in-hospital mortality. A dose–response relationship was observed, with increasing comorbidity burden associated with progressively worse outcomes (p for trend < 0.001). In addition, substantial heterogeneity was identified across individual comorbidities, with conditions such as metastatic cancer, liver disease, coagulopathy, renal disease, and fluid and electrolyte disorders showing stronger associations with adverse outcomes. The magnitude of these associations varied across ISS strata, indicating injury severity-dependent effects. Conclusions: In this nationwide cohort, comorbidity burden and type were important determinants of acute-care utilization and in-hospital mortality among trauma patients. Incorporating comorbidity information into early risk stratification may improve prognostic accuracy and support more efficient resource allocation and clinical decision-making across the trauma care continuum. Full article

Background: Recreational motorized vehicles, including all-terrain vehicles (ATVs), dirt and motor bikes, snowmobiles, and e-scooters, are an increasingly recognized source of severe trauma among children. Adult provincial data from Alberta demonstrate high morbidity, mortality, and more than $6 million in acute care costs from ATV-related injuries over a decade; however, pediatric injury patterns remain under-characterized despite rising exposure. Methods: We conducted a retrospective cohort study of pediatric patients presenting with major trauma (Injury Severity Score > 12) to the Stollery Children’s Hospital between December 2019 and June 2023. Recreational motorized vehicle-related cases were analyzed for demographics, injury mechanisms, injury severity, hospital resource utilization, and clinical outcomes. Available Abbreviated Injury Scale data were reviewed descriptively for a subset of ATV-related injuries. Results: Of 345 pediatric major trauma cases, 55 (16%) involved recreational motorized vehicles, accounting for 17% of major blunt trauma presentations. ATVs were the most common mechanism (58%), followed by dirt/motor bikes (23.6%), snowmobiles (14.5%), and e-scooters (3.6%). Patients were predominantly male (72.7%) with a mean age of 13.1 years. Operative intervention was required in 58.2% of cases, 30.9% required pediatric intensive care unit admission, and mortality was 5.5%. Helmet status was incompletely documented; only 36.4% of patients were recorded as wearing helmets. Children from rural regions accounted for 43.6% of injuries. In the ATV subset with available AIS data, head, facial, and extremity injuries were most common, and all patients sustained at least one serious injury (AIS ≥ 3). Conclusions: Recreational motorized vehicles represent a substantial and preventable cause of severe pediatric trauma in Alberta. When contextualized with adult provincial data demonstrating significant mortality and healthcare costs, these findings support strengthened injury-prevention strategies, improved safety enforcement, and evidence-informed policy approaches. Full article

Objectives: We aimed to implement a multi-modal resuscitation curriculum that first focuses on mastering individual skills, followed by team communication training, and study its effect on adherence to neonatal resuscitation steps, including effective bag mask ventilation (BMV) during high-risk deliveries. Methods: This was a single-center prospective observational manikin study conducted in a low-resource regional referral hospital. It included three phases: 1. pre-assessment; 2. individual BMV skill assessment followed by BMV skill testing; and 3. team training with simulation practice. Clinical observations of high-risk deliveries followed. Results: During the pre-assessment, midwives and residents knew when to start BMV but not the parameters for efficacious BMV (such as rate and inflation pressure). Midwives initially outperformed residents in individualized manikin assessments with 88% vs. 27%, p < 0.01, respectively, demonstrating efficacious BMV on the first attempt. However, on BMV testing, midwives more often demonstrated poor BMV performance, as evidenced by a persistent heart rate <100 bpm (31% vs. 8%, p = 0.04, respectively). Ineffective BMV in both groups was often related to low inflation pressures presumed to be in part secondary to a mask leak. Clinical observations demonstrated close adherence to pre-delivery preparation, basic neonatal stabilization, and resuscitation interventions. BMV was effective in most observed resuscitations as evidenced by chest rise and an increase in heart rate. Debriefing was the least performed team-training skill. Conclusions: A multi-modal approach combining individual skills training with team training that focuses on preparation, communication, and immediate skill feedback may enhance neonatal resuscitation in low-resource settings. Full article

Background/Objectives: Nursing organizational well-being has important implications for nurses, patients, and healthcare organizations. From a nursing-specific perspective, it arises from the balance between nursing demands and nursing resources in the work environment. However, most available instruments are not grounded in explicit nursing theory and do not allow the identification of well-being profiles through person-centered approaches. This study aimed to develop and evaluate the psychometric properties of the Nursing Organizational Well-being Questionnaire (NOW_Q). Methods: Following COSMIN guidelines, a two-phase design was adopted. Phase 1 involved item generation and expert evaluation, resulting in a 28-item instrument rated on a 5-point frequency scale. Phase 2 consisted of a multicenter cross-sectional study. Construct validity was examined through exploratory and confirmatory factor analyses using cross-validation. Reliability was assessed using ordinal omega coefficients, concurrent validity through associations with a global organizational well-being item, and cluster analysis to explore practical utility. Results: Findings (n = 461 nurses; 7 hospitals) supported an eight-dimension structure: workload, emotional demands, work–family conflict, autonomy, available resources, nurse–nurse relationship, nurse–head nurse relationship, and nurse–physician relationship. The confirmatory model showed good fit (RMSEA = 0.051; CFI = 0.938; TLI = 0.927; SRMR = 0.067), and all dimensions demonstrated satisfactory internal consistency (ordinal omega = 0.75–0.87). Significant associations with global organizational well-being were observed. Three distinct profiles emerged (Nurturing, Observed-Detached, and Withstanding), reflecting different configurations of nursing demands and resources. Conclusions: The NOW_Q is a theory-based, nursing-specific instrument with satisfactory psychometric properties and practical utility for identifying organizational well-being profiles and supporting targeted interventions in clinical settings. Full article

Background/Objectives: Although comprehensive transthoracic echocardiography (TTE) is part of the diagnostic workup in acute ischemic stroke, it is not cost-effective to use it for all patients. Guidelines recommend using it only for selected patients to guide secondary prevention. Neurologist-led, stroke-focused cardiac ultrasound (S-FoCUS) is an emerging bedside screening tool that optimizes cardiac evaluation in acute stroke care. We hypothesize that the implementation of S-FoCUS screening may reduce resource utilization in terms of hospital stay and TTE procedures. Methods: We conducted a retrospective before-and-after cohort study of patients with suspected acute ischemic stroke or TIA admitted to our comprehensive stroke center. We compared two 6-month periods: the pre-S-FoCUS period, during which patients underwent TTE as the initial cardiac imaging modality; and the post-S-FoCUS period, during which patients initially underwent S-FoCUS, with subsequent TTE performed only in the presence of abnormal findings or at the clinician’s discretion. We compared the time from admission to first cardiac ultrasound assessment, length of stay, relative reduction in TTE procedures and estimated in-hospital costs. Results: The pre-S-FoCUS period included 224 patients, and the post-S-FoCUS period included 229 patients. The S-FoCUS protocol reduced the median time to first cardiac ultrasound assessment by two days (median [IQR] 3 [2–5] vs. 1 [1–2], p < 0.001) and the median length of stay by one day (6 [4–9] vs. 5 [3–10], p = 0.014). Implementing the S-FoCUS protocol was associated with an exploratory estimate of lower in-hospital costs (approximately €716 per screened patient) driven mainly by a shorter length of stay. The distribution of the frequency of predefined cardioembolic sources was similar between both periods. There was a high agreement rate between the S-FoCUS and TTE findings in patients who underwent both tests: mitral stenosis (κ = 0.78), left atrial severe enlargement (κ = 0.74), left ventricular hypokinesia/akinesia (κ = 0.84), and depressed LVEF (κ = 0.88). Conclusions: Neurologist-led S-FoCUS is a feasible triage strategy to improve efficiency in the acute stroke pathway. 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

Real-time psychological stress detection on wearable and edge devices requires models that are accurate, computationally efficient, and small enough for on-device deployment. This paper proposes a Micro-Attention CNN Hybrid Architecture for stress recognition using wearable bio-signals. The model uses six sensor channels, namely tri-axial acceleration, electrodermal activity, heart rate, and skin temperature, and classifies three stress levels: no stress, low stress, and high stress. This study is conducted on a public wearable sensor dataset collected from 15 nurses during hospital work, providing a realistic benchmark for continuous stress monitoring under practical conditions. The proposed architecture combines one-dimensional and depthwise separable convolutions with a lightweight attention module to emphasize the most informative temporal patterns in short multivariate signal segments. To support deployment on resource-constrained devices, we further apply structured pruning, selective quantization-aware training, and post-training quantization. The full-precision model achieves a Macro-F1 score of 99.63%, while the final compressed model retains 98.03% Macro-F1 with a model size of 1.76 kilobytes and a CPU inference latency of 0.40 ms. Additional analyses show that most residual errors occur near the boundary between low stress and neighboring classes, while simple post-compression calibration improves reliability. These results demonstrate that accurate and low-latency stress detection using wearable bio-signals is feasible on compact edge hardware without transmitting raw sensor streams off-device. Full article