Search Results (3,239)

Postoperative pain management after hospital discharge remains one of the main clinical challenges. The use of digital and telemedicine tools offers new opportunities for the continuous monitoring of, and timely intervention in, patients discharged and followed at home. This scoping review, conducted according to the PRISMA-ScR checklist and the Joanna Briggs Institute methodology, analyzed 26 studies selected through a search of PubMed, Scopus, and Web of Science databases. Inclusion criteria comprised studies published between 2015 and 2025 that involved patients discharged home after surgery, that used digital or telemedicine tools for pain management, and that included active involvement of healthcare professionals and reported clinical outcomes. Studies show the use of a variety of digital tools, including mobile applications, web platforms, wearable sensors, automated messaging systems, and virtual reality technologies, alternating across settings for the assessment and management of pain at home, educational and therapeutic support, and to enhance communication between healthcare professionals and patients. Most reported outcomes focus on improved home-based pain control, a reduction in opioid consumption, and a high level of patient satisfaction. However, some challenges remain, particularly the low level of digital literacy among certain segments of the population. In conclusion, the implementation of telemedicine and digital technologies for managing postoperative pain at home proves to be a promising strategy. Nonetheless, it requires further scientific investigation and, from policymakers, significant investments in professional training and technological infrastructure to ensure an increasingly equitable and sustainable distribution of home healthcare services. Full article

(1) Background: Geospatial associations for COVID-19 mortality were estimated using a cohort of 28,128 hospitalized Medicaid patients identified from the 2020–2021 Kentucky Health Facility and Services administrative claims data. (2) Methods: County-level patient information (age, sex, chronic obstructive pulmonary disease [COPD], and mechanical ventilation use [96 hrs. plus]); social deprivation index (SDI) scores; physician and nurse rates per 100,000; and annual average particulate matter 2.5 (PM_2.5) were used as the predictors. Ordinary least-squares (OLS) regression and multiscale geographically weighted regression (MGWR) with the dependent variable, COVID-19 mortality per 100,000, were performed to compute global and local effects, respectively. (3) Results: MGWR (adjusted R²: 0.52; corrected Akaike information criterion [AICc]: 292.51) performed better at explaining the association between the dependent variable and predictors than the OLS regression (adjusted R²: 0.36; AICc: 301.20). The percentages of patients with COPD and who were mechanically ventilated (96 hrs. plus) were significantly associated with COVID-19 mortality, respectively (OLS standardized βCOPD: 0.22; βventilation: 0.53; MGWR mean βCOPD: 0.38; βventilation: 0.57). Other predictors were not statistically significant in both models. (4) Conclusions: A risk of COVID-19 mortality was observed among patients with COPD and prolonged mechanical ventilation use, after controlling for social determinants, the healthcare workforce, and PM_2.5 in rural and Appalachian counties of Kentucky. These counties are characterized by persistent poverty, healthcare workforce shortages, economic distress, and poor population health outcomes. Improving population health protection through multisector collaborations in rural and Appalachian counties may help reduce future health burdens. Full article

Background: Intra-abdominal infections (IAIs) caused by Stenotrophomonas maltophilia have rarely been reported. This study aimed to describe the clinical characteristics and risk factors for mortality among patients with S. maltophilia IAIs. Methods: A retrospective study was conducted on inpatients with IAIs caused by S. maltophilia at Tri Service General Hospital from 2004 to 2017. Clinical and microbiologic data of the included cases were reviewed via medical charts and microbiology databases. Multivariable logistic regression analyses were performed to identify risk factors for in-hospital death. Results: In total, 110 patients were diagnosed with S. maltophilia IAIs. Malignancy (56.3%) and liver cirrhosis (35.3%) were the most commonly identified underlying diseases. The major causes of S. maltophilia IAIs were biliary tract infection (42.7%), recent abdominal surgery (35.4%), and spontaneous bacterial peritonitis (20.0%). Polymicrobial infections were observed in 84 (76.4%) patients. In addition to S. maltophilia, co-cultured bacteria (n = 140) included Enterobacterales, representing 19.3% (27/140) of the total isolates, and non-fermentative aerobes, comprising 29.3% (41/140). In addition, anaerobic bacteria and fungi accounted for 9.2% (13/140) and 10% (14/140), respectively. The overall mortality rate was 40.9%. Multivariable logistic regression analysis revealed that high Sequential Organ Failure Assessment scores and malignancies were independent risk factors for mortality, while the immediate administration of appropriate antibiotics targeting S. maltophilia was a protective factor (p < 0.05). Conclusions: Patients with an underlying malignancy or liver cirrhosis were at risk for IAIs caused by S. maltophilia. The prompt initiation of effective antibiotics against S. maltophilia is critical for achieving favorable outcomes. 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

Objectives: We aimed to investigate how receiving integrated healthcare services from a case manager via instant messaging affected patients with disabilities. Methods: This database-matched case–control study was conducted at one medical center. Patients with officially certified disabilities were recruited and assigned to either the LINE-based group or the control group, which accessed services in the traditional manner. Their baseline characteristics were collected through chart reviews. Medical service utilization data—including their number of outpatient visits, prescribed medications, and hospitalizations—were obtained at baseline and 3, 6, and 12 months into the intervention. In the LINE group, quality of life, caregiver burden, and perceived social support were also assessed. A repeated-measures ANOVA was used to analyze within- and between-group differences over time. Results: Both the LINE group and the control group contained 66 patients. The number of outpatient visits (p < 0.001) and quantity of medication taken (p = 0.026) were significantly lower in the LINE group than in the control group. Furthermore, the caregiver burden in the LINE group (p = 0.024) was significantly lower 12 months after receiving integrated healthcare services. Conclusions: Providing integrated healthcare services via instant messaging enabled patients with disabilities to access medical services promptly and efficiently, thus enhancing the accessibility of healthcare and improving care for the disabled population. Full article

Firework-related injuries remain a serious public health issue in Germany, especially during New Year’s Eve. While many injuries are minor, the misuse of illegal or homemade fireworks can cause severe trauma resembling military combat injuries and can heavily burden emergency services. Notably, injury rates declined during the COVID-19 firework bans, underscoring the impact of preventive measures. We report two cases of young males with severe injuries from illicit fireworks. The first is a case of a 16-year-old that detonated an illegal Polish firework ball bomb, sustaining 9% total body surface area (TBSA) burns (second- to third-degree), hand fractures, compartment syndrome of the hand, and soft-tissue trauma. He underwent multiple surgeries, including fasciotomy, osteosynthesis, and skin grafting. The other case presented is a 19-year-old man who was injured by a homemade device made of bundled firecrackers, suffering deep facial and bilateral hand burns. He required prolonged ventilation, surgical debridement, and treatment with Kerecis^® fish skin and Epicite^® dressings. Both required intensive ICU care, interdisciplinary management, and lengthy rehabilitation. Total hospital costs amounted to €58,459.52 and €94,230.23, respectively, as calculated according to the standardized German DRG. These cases illustrate the devastating impact of illegal fireworks. The devastating consequences of explosive trauma are often difficult to treat and may lead to long-term functional and psychological impairments. Prevention through public education, stricter regulations, and preparedness is essential. Pandemic-era injury reductions support sustained policy efforts. Full article

Background/Objectives: Persistent breathlessness impacts people living with advanced chronic obstructive pulmonary disease (COPD) and carers. Accessible services are limited. This translational pilot study evaluated the feasibility, impacts on patient and carer-reported outcomes, and hospital use of a home-based breathlessness intervention service (BLIS). Methods: People with stable COPD, ≥1 COPD-related hospital admissions in the previous year, and persistent breathlessness participated in a pre–post study. The BLIS program involved home visits/phone contacts by a nurse/physiotherapist (average 8 contacts, 7 weeks). Uptake, retention, and fidelity were recorded prospectively, and participant experience was explored (post-program interviews). Breathing discomfort (Multidimensional Dyspnea Profile A1 scale), threat (Brief Illness Perception Questionnaire), and carer stress/strain (Zarit Burden Interview) were compared pre- and post-program (week 9, 3 and 6 months) using mean difference and 95% confidence intervals (CIs). Hospital use for COPD-related causes in 12 months before/after participation was reported. Results: A total of 16/19 eligible people agreed to participate, and 15/16 completed the program. In participants with COPD (73 [9] years, FEV1%pred 42% [15], mean [SD]; a median of 3 COPD-related hospital admissions in the previous year) and carers (n = 6), BLIS was highly (in 95%) acceptable. Compared to pre-program, breathing discomfort was reduced in week 9 and 6 months; breathlessness threat was reduced in week 9 and 3 months; and carer burden was reduced at 6 months. Compared to the 12 months prior, hospital admissions decreased in the 12 months post-program. Conclusions: Translation of this service to the local setting was feasible, with high program uptake and retention. Post-program improvements in key patient- and carer-reported outcomes and a reduction in public hospital admissions support the implementation of the BLIS program for this cohort in this setting. Full article

The adoption of healthcare technologies has grown significantly, with real-time location systems (RTLSs) gaining particular attention. Despite decades of research, gaps persist in understanding the current state of the field and its future directions. This scoping review, conducted by PRISMA guidelines, identified 1718 articles retrieved from six databases, from which 83 were included. The findings reveal a dominance of U.S.-based case studies and a lack of systematic literature reviews. While RFID is the most commonly used technology, alternative solutions are emerging, though few studies explore their combined use. The emergency department is the most studied setting, focusing on patient flow. However, case study quality varies, which affects replicability, and literature reviews often fail to justify technological choices adequately. RTLS benefits include improved efficiency, enhanced patient safety, and cost reduction, but challenges such as precision issues and signal interference persist. RTLS also serves as a foundation for digital twins, integrating AI and Industry 4.0 technologies for more sustainable healthcare operations. Technological advancements may shift perceptions of RTLS challenges and benefits, highlighting the need for analysis by technology type and release date. Additionally, current MeSH terms fail to adequately cover healthcare technologies, resulting in the exclusion of relevant studies. Full article

Service quality is important for the survival of all businesses, including the hospitality business. Service quality can be measured by a model referred to as SERVQUAL, which comprises five parameters, namely, tangibility, reliability, assurance, empathy, and responsiveness. It is very important to examine publications to ascertain trends in service quality in the hospitality industry during the previous decade (2014–2024). Data were collected from the Scopus database, the article search having yielded 876 documents. The eligibility criteria were as follows: papers had to be published between 2014 and 2024, had to be written in English, and were restricted to articles, conference papers, book chapters, and review papers. The collected data were analyzed with the biblioshiny package in RStudio. The results revealed that the journal with the highest number of articles published during the period under study was Sustainability (Switzerland). Hong Kong Polytechnic was the institution with the highest number of publications vis-à-vis service quality in the hospitality industry, followed by Bina Nusantara University and Eastern Mediterranean University. It is notable that customer satisfaction featured prominently in different clusters, which emphasizes the fact that service quality is targeted at satisfying customers. 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: 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: In Italy, public health investments have not kept pace with the rising demand for cancer care. Hospitalization costs are increasing, and length of stay (LOS) remains a critical metric for hospital efficiency and care quality. Methods: An ecological study analyzed hospital discharge records of patients admitted to “Policlinico Tor Vergata” (Rome, Italy) in 2022. Associations between cancer types and key variables influencing inpatient care were analyzed using logistic regression models (AOR; 95% CI), along with discharge patterns. Results: Among 14,451 ordinary hospitalizations, cancer diagnoses accounted for 16.4%, with blood cancers as the largest subgroup (20.1%). LOS outliers (5%) contributed to 11,342 excess hospitalization days. Blood cancers were associated with prolonged LOS (2.031; 1.499–2.753), while blood (2.368; 1.911–2.933), gastric (2.216; 1.603–3.062), and bladder cancers (2.661; 2.133–3.319) had a higher infection risk. Patients with bladder cancers were more likely to be ≥65 years old (2.661; 2.133–3.319). Secondary diagnoses were more likely to occur in gastric cancer types (1.637; 1.486–1.802). A discharge analysis revealed that 46.8% of cancer patients were discharged home without activation of home care services, and only 0.2% received home care activation. Cancer patients were more likely to be discharged home (2.150; 1.911–2.418) while awaiting completion of diagnostic or therapeutic processes. Conclusions: Our findings highlight the significant variability in hospitalization patterns across cancer types and the inadequacy of current discharge planning processes. The burden of prolonged LOS highlights the unsustainability of current care models. An urgent transition toward integrated, community-based simultaneous care models is needed to reduce healthcare costs, prevent prolonged hospitalizations, and improve outcomes, particularly for vulnerable elderly patients. Full article

Background: Nursing leadership is associated with a host of benefits for patient outcomes and health services. Pressures relating to the COVID-19 pandemic saw many relatively inexperienced nurses thrust into leadership roles, often with little notice. In response to this situation, The Tasmanian Health Service—Hospitals South created the Leadership Excellence in Practice Program (L-EPP) as a way of developing the leadership skills of its nurses and midwives. This study aimed to describe the development of the L-EPP and to evaluate it from the perspective of its participants and their peers. Methods: A longitudinal mixed-methods study was conducted using data from the first two offerings of the L-EPP. The L-EPP employs a blended learning model comprised of e-learning, work-integrated learning and face-to-face workshops. Surveys targeting the participants’ leadership abilities were completed at numerous time points by participants themselves, their peers, and their managers. Results: A total of 57 participants completed the program. Workshop surveys indicated that these sessions were generally well-received by participants. Significant improvements were observed in several domains of leadership, from the perspective of the participants themselves and their peers and managers. Conclusions: The program was well-received by its participants, and would serve as a useful template for other organisations seeking to build the leadership capacity of their nurses and midwives. This may be particularly useful to organisations seeking to upskill their existing staff and prevent further attrition of nurses and midwives in the wake of the pandemic. Full article

The growing adoption of the Internet of Things (IoT) in healthcare has led to a surge in real-time data from wearable devices, medical sensors, and patient monitoring systems. This latency-sensitive environment poses significant challenges to traditional cloud-centric infrastructures, which often struggle with unpredictable service demands, network congestion, and end-to-end delay constraints. Consistently meeting the stringent QoS requirements of smart healthcare, particularly for life-critical applications, requires new adaptive architectures. We propose ML-RASPF, a machine learning-based framework for efficient service delivery in smart healthcare systems. Unlike existing methods, ML-RASPF jointly optimizes latency and service delivery rate through predictive analytics and adaptive control across a modular mist–edge–cloud architecture. The framework formulates task provisioning as a joint optimization problem that aims to minimize service latency and maximize delivery throughput. We evaluate ML-RASPF using a realistic smart hospital scenario involving IoT-enabled kiosks and wearable devices that generate both latency-sensitive and latency-tolerant service requests. Experimental results demonstrate that ML-RASPF achieves up to 20% lower latency, 18% higher service delivery rate, and 19% reduced energy consumption compared to leading baselines. Full article

Background/Objectives: To assess the incidence and factors associated with urethral stricture following monopolar transurethral resection of the prostate (mTURP) and open simple prostatectomy (OSP) over a 21-year period. Methods: We conducted a retrospective cohort study of adult male patients insured by Clalit Health Services in Israel, who underwent either mTURP or OSP at multiple centers. Key baseline characteristics, including age, body mass index (BMI), socioeconomic status, Charlson comorbidity index score, and the incidence of urethral stricture, were collected. Postoperative urethral strictures were identified using the ICD-10 code N35.9 (urethral stricture, unspecified). Results: Between January 2000 and December 2021, 54,872 patients underwent simple prostatectomy across 29 hospitals, with 43,525 (79%) undergoing mTURP and 11,347 (21%) undergoing OSP. The median age of patients undergoing mTURP was 73.6 years, while those undergoing OSP had a median age of 72.1 years (p < 0.0001). The incidence of urethral strictures was 1.15% (500) following mTURP and 0.538% (61) following OSP, with an incidence rate ratio (IRR) of 2.139 (p < 0.0001). On multivariable analysis, factors associated with the development of urethral stricture included the type of procedure (HR = 2.349, 95% CI: 2.081–2.653, p < 0.0001), older age at surgery (HR = 1.012, 95% CI: 1.007–1.018, p < 0.0001), higher Charlson Index score (HR = 1.128, 95% CI: 1.109–1.148, p < 0.0001), and lower BMI (HR = 0.990, 95% CI: 0.982–0.999, p = 0.027). Conclusions: Our study highlights a higher incidence of urethral stricture following mTURP compared to OSP. Additionally, older age and a higher Charlson comorbidity index were associated with increased risk of stricture development postsurgery. Full article