Search Results (90)

Background/Objectives: Surgical site infections (SSIs) are serious complications in orthopedic implant-associated procedures, increasing morbidity, mortality, and hospital costs. The purpose of this study was to evaluate the impact of a structured infection prevention and control (IPC) service on SSI incidence and cost savings across hip arthroplasty (HA), knee arthroplasty (KA), and open reduction and internal fixation (ORIF). Methods: A retrospective analysis included 6930 patients treated between 2019 and 2024, divided into pre-intervention (2019–2022) and post-intervention (2023–2024) cohorts. Preventive methods (PMs) comprised enhanced antibiotic prophylaxis, Staphylococcus aureus screening, chlorhexidine bathing, intraoperative audits, and behavioral interventions. Economic evaluation used literature-based costs, standardized to 2024 US dollars (USD 2024), with sensitivity analyses performed. Results: SSI incidence decreased from 5.6% to 1.1% overall (p < 0.001), with consistent reductions across procedures: ORIF (5.2%→1.0%), HA (9.2%→2.4%), and KA (4.8%→1.2%). In 2023, approximately 31 SSIs and one infection-related death were prevented, avoiding 308 hospital days. Cost savings ranged from USD 209,188 to USD 376,898, with cost saving confirmed in 93% of simulations. Conclusions: Comprehensive infection-prevention protocols, delivered through a structured IPC service, significantly reduced SSIs and generated substantial cost savings. These findings support wider use of these PMs in orthopedic surgery. Full article

With the steady global progress in integrating technology into healthcare delivery, doctors’ behavioral patterns on online healthcare platforms have increasingly become a focal point in the fields of digital health and healthcare service management. Grounded in Job Crafting Theory, this study constructs a proactive crafting index, which captures doctors’ proactive behaviors on the platform across three dimensions: consultation rate, number of consultations, and response speed. We systematically examine the multidimensional impacts of such behaviors on performance outcomes, including online consultation volume, offline service volume, and user evaluation performance. This study collects publicly available records from a major online healthcare platform in China and conducts empirical analysis using the entropy weight method and econometric techniques. The results reveal that there is an optimal level of proactive engagement: moderate proactivity maximizes online consultation volume, while both insufficient and excessive proactivity reduce it. Offline service volume, in contrast, follows a U-shaped relationship, where moderate proactive engagement minimizes offline visits, while too little or too much engagement leads to more offline service needs. These nonlinear patterns highlight the importance of framing doctors’ proactive behavior to optimize both online engagement and offline service. The findings enrich Job Crafting Theory by identifying boundaries in platform-based service environments and provide actionable insights for platform operators to design behavior management and incentive systems tailored to doctors’ professional rank, patient condition, and regional context. Full article

Background/Objectives: Strengthening antimicrobial stewardship (AMS) programs is an invaluable intervention in the ongoing efforts to contain the threat of antimicrobial resistance (AMR), particularly in low-resource settings. This study evaluates the impact of the Telementoring, Education, and Advocacy Collaboration initiative for Health through Antimicrobial Stewardship (TEACH AMS), which uses the virtual Extension for Community Healthcare Outcomes (ECHO) learning model to enhance AMS capacity in Kenya, Ghana, and Malawi. Methods: A mixed-methods approach was used, which included attendance data collection, facility-level assessments, post-session and follow-up surveys, as well as focus group discussions. Results: Between September 2023 and February 2025, 77 virtual learning sessions were conducted, engaging 2445 unique participants from hospital-based AMS committees and health professionals across the three countries. Participants reported significant knowledge gain, and data showed facility improvements in two core AMS areas, including the implementation of multidisciplinary ward-based interventions/communications and enhanced monitoring of antibiotic resistance patterns. Along those lines, participants reported that the program assisted them in improving prescribing and culture-based treatments, and also evidence-informed antibiotic selection. The evidence of implementing ward-based interventions was further stressed in focus group discussions, as well as other strengthened practices like point-prevalence surveys, and development or revision of stewardship policies. Substantial improvements in microbiology services were also shared by participants, particularly in Malawi. Other practices mentioned were strengthened multidisciplinary communication, infection prevention efforts, and education of patients and the community. Conclusions: Our findings suggest that a virtual case-based learning educational intervention, providing structured and tailored AMS capacity building, can drive behavior change and strengthen healthcare systems in low resource settings. Future efforts should aim to scale up the engagements and sustain improvements to further strengthen AMS capacity. Full article

Background: Since the current increase in antimicrobial resistance globally, parasitic infectious diseases have become a greater public health crisis than ever before and an absolute priority. The Egyptian community pharmacist, as a health care provider and advisor, has a potential role to play in deworming. Objective: To evaluate the outcomes of community pharmacist-led deworming-related counseling services. Methods: A prospective randomized controlled study was conducted in Damanhur, Behera, Egypt. The intervention group received community pharmacy counseling, and the control group received the usual care. Both groups were monitored for 12 months for recurrence evaluation. Results: A total of 173 patients were included, of whom 96 (55.5%) received patient counseling. The types of infection included Oxyuris (44.5%), Entamoeba histolytica (28.9%), Ascaris (8.7%), Entamoeba Cyst (8.7%), Giardiasis (4.6%), Schistosomiasis (2.9%), and pinworm (1.7%). A total of 119 participants (68.8%) reported a need for dose repetition. Personal hygiene practices were reported by 71 participants (41%). Recurrence of infection was observed in 101 cases (58.4%). Patient counseling was significantly associated with lower recurrence rates and higher rates of personal hygiene application (p < 0.001). Multivariate logistic regression analysis revealed that patient counseling and personal hygiene measures were the only significant predictors of infection recurrence rate. Conclusions: Community pharmacists’ deworming-related counseling had positive behavioral and clinical outcomes. Full article

Background/Objectives: This study assessed Knowledge and Practices related to Food Safety (KPFS) among nutrition services employees in hospitals across the Al-Ahsa Governorate, Kingdom of Saudi Arabia. The objective was to evaluate the staff’s understanding of key food safety principles, including foodborne illness prevention, food handling, personal hygiene, and food storage and preparation practices. Methods: A descriptive survey method was used, and data were collected using an electronic questionnaire, which was either self-administered by the participants or completed with the assistance of the researcher in cases involving employees who did not speak Arabic or English. This study included 302 staff members involved in the preparation, service, and supervision of food provided to hospital patients. Results: The results indicated a high level of knowledge among nutrition services employees regarding food safety principles, critical temperature control, cross-contamination prevention, and proper hygiene practices. The employees also demonstrated a strong commitment to personal hygiene behaviors, such as handwashing, wearing appropriate clothing, and avoiding unsafe practices. Additionally, a high degree of knowledge and understanding was found regarding food storage procedures and contamination prevention. The study also highlighted a very high level of awareness concerning the cleaning and sterilization of equipment, tools, and food storage surfaces, as well as maintaining a clean and healthy environment. These findings emphasize the importance of continuous training in enhancing food safety knowledge among nutrition services employees. Conclusions: It is recommended that all employees, regardless of education level, experience, or role, participate regularly in food safety training programs to sustain and improve food safety practices within hospital environments. Full article

Background: The COVID-19 pandemic has had a profound impact on pediatric mental health, contributing to a global surge in psychiatric emergencies among children and adolescents. This study aimed to evaluate trends in pediatric emergency department (PED) visits for three key psychiatric conditions—anxiety disorders (ADs), self-injury behaviors (SIBs), and psychomotor agitation (PMA)—before and after the onset of the COVID-19 pandemic. Methods: We conducted a retrospective observational study at a tertiary pediatric hospital in Italy, analyzing all psychiatric presentations to the PED from 1 January 2018 to 31 December 2024. The data were divided into pre-COVID and post-COVID periods and included patient demographics, recurrence of visits, clinical features, hospital admissions, and pharmacological management. Diagnoses were confirmed by chart review. Results: Of 233,867 total PED visits, 1082 were due to primary psychiatric concerns. A marked increase in visits was observed postCOVID: SIB incidence rose from 3.6 to 15.1 per 10,000 visits (p < 0.0001), PMA from 9.4 to 17.8 (p < 0.0001), and AD from 17.7 to 21.6 (p = 0.018). SIB cases showed increased recurrence (from 3.4% to 27.4%, p = 0.004) and greater pharmacological intervention, whereas PMA was associated with a rise in heteroaggression (from 14.3% to 39.8%, p < 0.0001). Pharmacological treatment remained largely consistent, with benzodiazepines and neuroleptics most frequently used. The emerging use of intranasal ketamine was noted in select cases. Conclusions: This study highlights the increasing burden of pediatric psychiatric emergencies in the wake of the COVID-19 pandemic. The findings underscore the urgent need to implement standardized emergency care protocols, strengthen outpatient mental health services, and develop pediatric-specific pharmacological guidelines to improve outcomes in this vulnerable population. Full article

Background and Clinical Significance: Herein, we describe the clinical case of a 17-year-old patient with psychotic disorder secondary to cerebral venous thrombosis due to primary thrombophilia, which was related to protein S deficiency and a heterozygous MTHFR gene mutation with the p.Ala222Val variant. Case presentation: A 17-year-old female, with no history of previous illnesses, was admitted to the emergency service department due to a psychotic break. Psychiatric evaluation detected disorganized thought, euphoria, ideas that were fleeting and loosely associated, psychomotor excitement, and deviant judgment. On the fifth day, an inflammatory process in the parotid gland was detected, pointing out a probable viral meningoencephalitis, prompting antiviral and antimicrobial treatment. One week after antiviral and steroidal anti-inflammatory treatments, the symptoms’ improvement was minimal, which led to further neurological workup. MRI venography revealed a filling defect in the transverse sinus, consistent with cerebral venous thrombosis. Consequently, anticoagulation treatment with enoxaparin was initiated. The patient’s behavior improved, revealing that the encephalopathic symptoms were secondary to thrombosis of the venous sinus. Hematological studies indicated the cause of the venous sinus thrombosis was a primary thrombophilia caused by a heterozygous MTHFR mutation variant p.Ala222Val and a 35% decrease in plasmatic protein S. Conclusions: This case highlights the possible relationship between psychiatric and thrombotic disorders, suggesting that both the MTHFR mutation and protein S deficiency could lead to psychotic disorders. Early detection of thrombotic risk factors in early-onset psychiatric disorders is essential for the comprehensive management of patients. Full article

Background and Objectives: In Germany, access to medical care is often hindered by long wait times for specialist appointments and emergency department care. Inappropriate utilization of emergency services further exacerbates delays for truly urgent cases. To evaluate the utilization of the statutory ophthalmic emergency service in Freiburg and identify patient- and system-level factors contributing to inappropriate use. Materials and Methods: A paper-based, anonymous questionnaire was distributed to patients attending the ophthalmologic emergency practice (Notfallpraxis) of the Association of Statutory Health Insurance Physicians (Kassenärztliche Vereinigung), which is located within the premises of the Eye Center of the University Hospital Freiburg, Germany, at selected periods between July and September 2020, alongside a short physician assessment. Standardized instruments were used to assess symptom severity, urgency perception, and healthcare-seeking behavior. Statistical analyses were performed using R and Excel. Results: A total of 157 questionnaires were included (response rate: 63%). Most visits occurred on weekends (47%) and before 10 p.m. (83%). While 68% of patients believed their symptoms required same-day treatment, physicians assessed only 30% of cases as clinically urgent. A total of 60% of patients did not attempt to contact an outpatient ophthalmologist beforehand, and only 38% reported having a regular ophthalmologist. Patients’ perceived urgency was significantly associated with symptom severity and older age, whereas physician-assessed urgency was strongly linked to symptom duration. Conclusions: A substantial proportion of ophthalmic emergency visits in Freiburg are for non-urgent conditions. These findings underscore the need for improved coordination with outpatient care providers, better patient education, and structural reforms to reduce inappropriate utilization and ensure timely access for truly urgent cases. Full article

This study investigates the evolutionary game dynamics of medical knowledge sharing (KS) among Chinese hospitals under government regulation, focusing on the strategic interactions between general hospitals, community health service centers, and governmental bodies. Leveraging evolutionary game theory, we construct a tripartite evolutionary game model incorporating replicator dynamics to characterize the strategic evolution of the involved parties. Our analysis examines the regulatory decisions of the government and the strategic choices of Chinese hospitals, considering critical factors such as KS costs, synergistic benefits, government incentives and penalties, and patient evaluations. The model is analyzed using replicator dynamic equations to derive evolutionary stable strategies (ESSs), complemented by numerical simulations for sensitivity analysis. Key findings reveal that the system’s equilibrium depends on the balance between KS benefits and costs, with government regulation and patient evaluations significantly influencing Chinese hospital behaviors. The results highlight that increasing government incentives and penalties, alongside enhancing patient feedback mechanisms, can effectively promote KS. However, excessive incentives may reduce willingness to regulate, suggesting the need for balanced policy design. This research provides novel theoretical insights and practical recommendations by (1) pioneering the application of a tripartite evolutionary game framework to model KS dynamics in China’s hierarchical healthcare system under government oversight, (2) explicitly integrating the dual influences of government regulation and patient evaluations on hospital strategies, and (3) revealing the non-linear effects of policy instruments. These contributions are crucial for optimizing Chinese medical resource allocation and fostering sustainable collaborative healthcare ecosystems. Full article

Objectives: The global rise in dementia prevalence is escalating the socioeconomic burden, prompting efforts in prevention and treatment. This study aimed to evaluate the effects of an 8-week oral nutrition supplement (ONS) program with or without a multi-domain intervention program (MIP) in patients with mild cognitive impairment. Methods: Forty-nine patients with mild cognitive impairment were divided into three groups: (1) ONS (ONS), (2) ONS+MIP (ONS+MIP), and (3) control (CON). Korean-style dementia prevention MIP was used in the ONS+MIP group. Two packs of ONS per day were provided to the ONS group during the intervention period. Cognitive function, nutritional evaluation, body composition analysis, and physical performance were measured. The paired t-test and one-way analysis of variance were used for statistical analyses. Results: A final analysis was performed on the final 46 participants. After intervention, the cognitive function test (Repeatable Battery for the Assessment of Neuropsychological Status, RBANS) scores of the ONS+MIP group were significantly increased compared to the baseline scores. However, no significant changes were observed in the ONS and CON groups. Eating behavior and food quality also improved in the ONS+MIP group, with a significant difference among the three groups. There was no significant change in body composition in all groups; however, grip strength (left hand), muscular endurance, and the total SPPB score improved in the ONS+MIP group. The total SPPB score decreased in the CON group. Conclusions: Along with ONS intake, intensive education and continuous monitoring through multi-domain interventions are important to improve cognitive function. Trial registration: Clinical Research Information Service identifier: KCT0007253. Full article

Background/Objectives: The outcomes of diabetes therapy depend largely on how well patients can implement medical advice in their lives. The main aim of the DiabPeerS study was to evaluate a peer support instant messaging service (IMS) approach to diabetes self-management education and support (DSMES) for people with type 2 diabetes mellitus (T2DM). Methods: Participants with T2DM took part in a randomized controlled trial. Both the intervention group (IG) and the control group (CG) received standard therapy, but the IG additionally participated in the peer support IMS intervention. The duration of the intervention was 7 months, succeeded by a follow-up 7 months later. Eleven biochemical, six behavioral, and six psychosocial parameters were measured at four times. Results: The targeted sample size could not be reached, and 68 participants took part. The following results have been found for the main hypotheses: No influence on HbA1c was detected (IG: −0.27, CG: +0.06, p > 0.05). Diabetes self-management behaviors were unaffected (IG_diet: +0.02, CG_diet: +0.46, p > 0.05; IG_exercise: −0.72, CG_exercise: +0.44, p > 0.05; IG_bloodsugar: −0.21, CG_bloodsugar: +0.65, p > 0.05; IG_footcare: +0.37, CG_footcare: +1.13, p > 0.05). Quality of life increased during the intervention in both the IG (KSK: +8.92, PSK: +7.41, p < 0.001) and the CG (KSK: +8.73, PSK: +7.48, p < 0.001). Medication adherence increased in the IG (+3.31, p < 0.01), although these participants were still classified as non-adherent. Conclusions: A peer support IMS intervention is a promising approach, but we recommend combining the online setting with an initial face-to-face situation. Full article

In the evolving landscape of healthcare, telemedicine has emerged as a transformative solution, effectively bridging gaps in medical service delivery across diverse geographic regions. Particularly in rural areas, where access to immediate and specialized care remains limited, store-and-forward telemedicine provides a powerful and practical approach. In rural emergency healthcare settings, resource limitations, specialist shortages, and unreliable connectivity frequently delay critical medical interventions. To address these challenges, this study proposes a store-and-forward telemedicine framework optimized through the use of queueing networks, aiming to enhance emergency response efficiency. The proposed model is structured as a four-node system comprising initial registration, consultation, diagnosis, and treatment. Each node operates as a service queue where patient data are sequentially collected, prioritized, and forwarded. By employing an open queueing network structure, the model devises steady-state probabilities for the number of patients at each node, facilitating a detailed performance analysis of patient flows. Symmetry plays a critical role in maintaining patient flow balance and system stability within the store-and-forward telemedicine model. When the routing probabilities between nodes are balanced, the queueing network exhibits probabilistic symmetry, ensuring consistent transition behavior. Moreover, the directed graph representation of the system demonstrates structural symmetry, reflecting identical service times at all nodes and uniform transition probabilities between nodes. Incorporating the concept of symmetry enables a simplified analytical approach, reduces computational complexity, and provides a more accurate approximation model for evaluating system performance. Full article

Background: Fatigue failure of artificial leaflets significantly limits the durability of prosthetic valves. However, the costs and complexities associated with in vitro testing and conventional clinical trials to investigate the fatigue life of leaflets are progressively escalating. In silico trials offer an alternative solution and validation pathway. This study presents in silico trials of prosthetic valves, along with methodologies incorporating nonlinear behaviors to evaluate the fatigue life of artificial leaflets. Methods: Three virtual patient models were established based on in vitro test and clinical trial data, and virtual surgeries and physiological homeostasis maintenance simulations were performed. These simulations modeled the hemodynamics of three virtual patients following transcatheter valve therapy to predict the service life and crack propagation of leaflets based on the fatigue damage assessment. Results and Conclusions: Compared to traditional trials, in silico trials enable a broader and more rapid investigation into factors related to leaflet damage. The fatigue life of the leaflets in two virtual patients with good implantation morphology exceeded 400 million cycles, meeting the requirements, while the fatigue life of a virtual patient with a shape fold in the leaflet was only 440,000 cycles. The fatigue life of the leaflets varied considerably with different implant morphologies. Postoperative balloon dilation positively enhanced fatigue life. Importantly, in silico trials yielded insights that are difficult or impossible to uncover through conventional experiments, such as the increased susceptibility of leaflets to fatigue damage under compressive loading. Full article

Background/Objective: To address the growing demand for mental health services, Nova Scotia Health introduced the Rapid Access Stabilization Program (RASP) through its Mental Health and Addictions Program (MHAP) in April 2023. RASP is designed to help reduce long wait times, frequent emergency department visits, and admissions to provide early intervention for individuals experiencing mental health problems. The RASP focuses on rapid access and early mental health intervention, aiming to prevent the worsening of patients’ symptoms, improve access to psychiatric care, and reduce service pressures on programs like the Community Mental Health Program (CMHP), which provide more extended, ongoing mental health support. This study compared participants’ sociodemographic and clinical profiles in the RASP and the CMHP. Methods: Data were collected from 1392 participants accessing mental health support either through the RASP or CMHP. A comparative analysis of sociodemographic factors (e.g., age, education, and income) and clinical characteristics (e.g., depression, anxiety, resilience, and substance use) was conducted. Chi-square tests and independent sample t-tests were used to evaluate the mean differences between the groups. Results: Significant sociodemographic and clinical differences emerged between the RASP and CMHP participants. The RASP group was older (M = 40.10 vs. 34.52 years) and more socioeconomically stable, with higher rates of employment (55.3% vs. 47.9%) and homeownership (36.5% vs. 17.7%). In contrast, the CMHP group had higher unemployment (25.7% vs. 16.5%) and lower income levels, with 47.5% earning <CAD 29,590 compared to 30.3% in the RASP group. Clinical profiles differed markedly: depression was more prevalent in the RASP (48.2% vs. 19.3%), whereas the CMHP had higher rates of psychosis (10.6% vs. 2.5%) and substance use disorder (7.8% vs. 1.9%). The RASP participants exhibited higher anxiety (GAD-7: M = 14.17 vs. 11.81) and depression symptoms (PHQ-9: M = 16.62 vs. 14.20) but lower resilience (BRS: M = 2.47 vs. 2.77). The CMHP participants had more adverse childhood experiences (ACE: M = 3.92 vs. 3.16) and lower suicidal intent (81.4% vs. 99.4% had no intention to act). Conclusions: The findings highlighted the unique profiles between the RASP and CMHP participants, suggesting the need for program-specific interventions. While the CMHP participants may benefit from integrated social support and trauma-informed care, the RASP participants may require cognitive behavioral therapy and resilience-building interventions. Tailoring mental health services to meet these unique needs could enhance program effectiveness and patient outcomes across both groups. Full article

Background: Effective communication in healthcare is essential for ensuring teamwork that is continuous, effective, and efficient. It plays a crucial role in supporting comprehensive and holistic care for patients while also guaranteeing the safety and satisfaction of the services provided. Objective: To determine the relationship between effective communication (as well as its dimensions: transmission of institutional culture, source of employee motivation, and facilitation of teamwork and conflict resolution) and teamwork among nurses in a national hospital in Peru. Methods: The research employed a quantitative, correlational, cross-sectional approach with a non-experimental design. The study population consisted of 328 nurses working in various hospital departments between January and October 2024. Data were collected using two questionnaires: The first assessed effective communication through three dimensions: transmission of institutional culture, source of employee motivation, and facilitation of teamwork and conflict resolution. The second instrument evaluated teamwork across three dimensions: institutional context, composition, and process. Results: A very strong positive correlation was observed between effective communication and teamwork among nurses, with a coefficient of 0.925 and a p value < 0.01. Conclusions: The study found a strong link between effective communication and teamwork among nurses. It underscores the role of communication, organizational culture, and motivation in strengthening teamwork, which enhances patient care and healthcare delivery. The findings highlight the impact of institutional culture, motivation, and conflict resolution, emphasizing soft skills and ethical behavior in improving team dynamics and organizational strategies. Full article