Search Results (276)

Background/Objectives: Effective teamwork is crucial for minimizing human error in healthcare settings. Medical teams, typically composed of physicians and nurses, supported by auxiliary professionals, achieve better outcomes when they possess strong collaborative competencies. High-quality teamwork is associated with fewer adverse events and complications and lower mortality rates. Based on this background, the objective of this study is to analyze the perception of non-technical skills and immediate learning outcomes in interprofessional simulation settings based on E-CRM items. Methods: A cross-sectional observational study was conducted involving participants from the official postgraduate Medicine and Nursing programs at the Catholic University of Murcia (UCAM) during the 2024–2025 academic year. Four interprofessional E-CRM simulation sessions were planned, involving randomly assigned groups with proportional representation of medical and nursing students. Teams worked consistently throughout the training and participated in clinical scenarios observed via video transmission by their peers. Post-scenario debriefings followed INACSL guidelines and employed the PEARLS method. Results: Findings indicate that 48.3% of participants had no difficulty identifying the team leader, while 51.7% reported minor difficulty. Role assignment posed moderate-to-high difficulty for 24.1% of respondents. Communication, situation awareness, and early help-seeking were generally managed with ease, though mobilizing resources remained a challenge for 27.5% of participants. Conclusions: This study supports the value of interprofessional education in developing essential competencies for handling urgent, emergency, and high-complexity clinical situations. Strengthening interdisciplinary collaboration contributes to safer, more effective patient care. Full article

Background/Objectives: Clinical stability within 24 h prior to discharge is a key metric for safe care transitions in hospitalised patients with community-acquired pneumonia (CAP). However, its association with post-discharge outcomes, particularly readmissions, remains underexplored. This study assessed whether clinical instability before discharge is associated with 30-day mortality, readmissions, or a composite of both in hospitalised CAP patients. Methods: This retrospective cohort study included adults (≥18 years) admitted with CAP to two tertiary Australian hospitals between 1 January 2020 and 31 December 2023. Clinical instability was defined as abnormal vital signs (temperature, heart rate, respiratory rate, blood pressure, or oxygen saturation) within 24 h before discharge. Pneumonia severity was assessed using the CURB-65 score and frailty using the Hospital Frailty Risk Score. Multilevel logistic regression models were used to evaluate associations with outcomes, adjusting for age, sex, comorbidities, frailty, disease severity, microbiological aetiology, antibiotics prescribed during admission, and prior healthcare use. Competing risk regression accounted for death when analysing readmissions. Results: Of 3984 patients, 20.4% had clinical instability within 24 h before discharge. The composite outcome occurred in 21.9% patients, with 15.8% readmitted and 6.1% dying within 30 days. Clinical instability was significantly associated with the composite outcome (adjusted odds ratio [aOR] 1.73, 95% CI 1.42–2.09, p < 0.001), primarily driven by increased mortality risk (aOR 3.70, 95% CI 2.73–5.00, p < 0.001). However, no significant association was found between clinical instability and readmissions (aOR 1.16, 95% CI 0.93–1.44, p > 0.05). Conclusions: Clinical instability within 24 h before discharge predicts worse outcomes in CAP patients, driven by increased mortality risk rather than readmissions. Full article

Background/Objectives: Fish eggs activated with UV-irradiated spermatozoa and exposed to the High Hydrostatic Pressure (HHP) shock to inhibit first cell cleavage develop as gynogenetic Doubled Haploids (DHs) that are fully homozygous individuals. Due to the expression of the recessive genes and side effects of the gamete treatment, survival of fish DHs is rather low, and most of the mitotic gynogenotes die before hatching. Nevertheless, as maternal gene products provided during oogenesis control the initial steps of embryonic development in fish, a maternal effect on the survival of gynogenotes needs to be also considered to affect efficiency of gynogenesis. Thus, the objective of this research was to apply an RNA-seq approach to discriminate transcriptional differences between rainbow trout (Oncorhynchus mykiss) eggs with varied abilities to develop after gynogenetic activation. Methods: Gynogenetic development of rainbow trout was induced in eggs originated from eight females. Maternal RNA was isolated and sequenced using RNA-Seq approach. Survival rates of gynogenotes and transcriptome profiles of eggs from different females were compared. Results: RNA-seq analysis revealed substantial transcriptional differences between eggs originated from different females, and a significant correlation between the ability of the eggs for gynogenesis and their transcriptomic profiles was observed. Genes whose expression was altered in eggs with the increased survival of DHs were mostly associated (GO BP) with the following biological processes: development, cell differentiation, cell migration and protein transport. Some of the genes are involved in the oocyte maturation (RASL11b), apoptosis (CASPASE 6, PGAM5) and early embryogenesis, including maternal to zygotic transition (GATA2). Conclusions: Inter-individual variation of the transcription of maternal genes correlated with the competence of eggs for gynogenesis suggest that at least part of the mortality of the rainbow trout DHs appear before activation of zygotic genome and expression of the lethal recessive traits. Full article

Background/Objectives: Venous thromboembolism (VTE) and major hemorrhagic events are significant complications in hospitalized leukemia patients, but contemporary analyses of their epidemiology, predictors, and impact on clinical outcomes remain limited. Methods: We conducted a cross-sectional study using the National Inpatient Sample (NIS) database from 2016 to 2020. Hospitalized leukemia patients were identified using ICD-10 codes. Trends in the incidence of venous thromboembolism (VTE) and bleeding were assessed across the years, and multivariable logistic regression models were used to evaluate the predictors of VTE and bleeding. We assessed the influence thromboembolic and hemorrhagic complications on length of stay, cost, and mortality outcomes. Results: Among 430,780 leukemia hospitalizations, the overall incidence of VTE was 5.4% and remained stable throughout the study period (p = 0.09), while hemorrhagic events = 5.6%) showed a significant upward trend (p = 0.01). Cerebrovascular accidents, central venous catheter insertion, and protein calorie malnutrition (PCM) were significant predictors of both VTE and hemorrhage. PCM demonstrated a dose-dependent relationship with both complications. VTE was associated with a 33.5% increase in length of stay (LOS) and a 35% increase in cost of care (COC). Hemorrhage was associated with 23.2% increase in LOS and 32.6% increase in COC. Only hemorrhagic events were independently associated with increased mortality (adjusted OR 2.88, p < 0.001). Conclusions: The incidence of VTE in hospitalized leukemia patients has remained stable while hemorrhagic complications have increased significantly. Nutritional status represents a potentially modifiable risk factor for both VTE and bleeding complications. The competing risk between thrombosis and hemorrhage varies with age and nutritional status, suggesting the need for nuanced thromboprophylaxis strategies in this vulnerable population. Full article

Background: Delirium is a frequent yet pathophysiologically still poorly understood complication in the intensive care unit (ICU) and is associated with adverse outcomes for the patients. Currently, guidelines give several recommendations for treating delirium in the ICU, but to date no sufficient drug treatment exists. Dexmedetomidine, primarily used for anesthesia and sedation in ICUs has shown a preventive effect of delirium compared to other sedatives, such as propofol. We hypothesize that overnight administration of dexmedetomidine may prevent and/or shorten the duration of delirium in ICU patients. Methods: The Basel propofol dexmedetomidine (BaProDex) Study was a single-center, prospective, randomized controlled trial. We included adult ICU patients with hyperactive or mixed delirium. Patients with delirium prior to ICU admission, advanced heart block, uncontrolled hypotension, or status epilepticus were excluded. The participants were randomly assigned 1:1 to either receive dexmedetomidine (study group) or propofol (control group) as a continuous infusion overnight. The Intensive Care Delirium Screening Checklist (ICDSC) was applied at least three times per day. Delirium was defined as an ICDSC ≥ 4. The study drug was administered until the end of delirium or ICU discharge. The primary endpoint was the time to delirium episode end, which was analyzed using cumulative incidence curves and a cause specific Cox proportional hazards regression with death as a competing risk. Secondary endpoints included recurrence of delirium until 28 days after ICU discharge, death until day 28, severity of ICU delirium, number of ventilation days, ICU length of stay (LOS) in hours, hospital length of stay in days and survival after three and twelve months after ICU discharge. Due to insufficient recruitment the trial needed to be stopped prematurely. Results: In total, 38 patients were enrolled and randomized in the two groups. The median duration of delirium was shorter in the dexmedetomidine group as compared to the propofol group (ITT: 34 vs. 66 h; PP: 31 vs. 66 h), resulting in a hazard ratio of 1.92 (95% CI 0.89–4.15, p = 0.097) in the ITT and 2.95 (95% CI 1.27–6.86, p = 0.012) in the PP analysis. In the PP analysis, the 28-day mortality was lower in the dexmedetomidine group (1 vs. 5 deaths) and fewer patients needed ventilation (7 vs. 15 patients). Both ICU and hospital LOS were shorter in the dexmedetomidine group (ICU LOS: median 43 vs. 128 h; hospital LOS: median 12 vs. 22 days). Further, mortality up to three and twelve months was lower in the dexmedetomidine group compared to the propofol group (PP: 2 vs. 8 patients died within twelve months, 2 vs. 7 patients died within three months). The recurrence of delirium until 28 days after ICU discharge and severity of delirium were similar in both groups. Conclusions: Despite premature termination, BaProDex provides preliminary evidence for a reduction in the duration of delirium by nocturnal infusion of dexmedetomidine compared to propofol. Therefore, dexmedetomidine may be considered an option to treat hyperactive or mixed delirium in ICU patients. However, due to the small sample size, the study is rather of exploratory nature due to the premature termination, and we cannot rule out that the observed treatment effect is overly optimistic or by chance. Full article

Background and Objective: Delirium, a prevalent neurocognitive disorder, frequently affects critically ill patients hospitalized in intensive care units (ICUs), leading to increased mortality, prolonged hospital stays, and higher healthcare costs. This quasi-experimental study assessed the effect of an educational program relating to ICU nurses’ knowledge of delirium in a university hospital in Nablus, Palestinian Authority. Methods: A pre-test–post-test design was employed, utilizing a 25-item questionnaire for 114 ICU nurses. The educational intervention included a presentation on delirium, the distribution of educational materials, and follow-up video sessions. Our study aim was to evaluate nurses’ understanding of ICU delirium and the impact of the educational program on their ability to identify and evaluate the delirium. Results: Pre-intervention assessments indicated limited awareness among nurses regarding delirium diagnosis and management tools, i.e., the Confusion Assessment Method for the ICU (CAM-ICU) and the Intensive Care Delirium Screening Checklist. Post-intervention results showed a significant improvement in knowledge; median scores increased from 6 (range: 3–13) to 15 (range: 12–20) (p < 0.001). Nurses also reported greater confidence in identifying and managing delirium, and 50% found CAM-ICU easy to use. However, knowledge gaps remained concerning mixed delirium types and modifiable risk factors. Conclusions: Continuous educational programs are essential for ensuring long-term knowledge retention. We recommend integrating routine delirium education with hospital policies and emphasizing the use of delirium assessment tools during each shift. Findings show that targeted education can enhance ICU nurses’ competencies and thereby improve patient outcomes through more effective delirium management. Full article

Background/Objectives: High-flux online hemodiafiltration (OL-HDF) appears to be associated with better survival than hemodialysis (HD). In Brazil, OL-HDF is only affordable for patients with private health insurance. Although observational studies have shown a survival advantage with OL-HDF, even in Brazil, it is unclear whether this benefit applies to patients without private health insurance. We compared overall and cardiovascular mortality between OL-HDF and HD in patients treated exclusively through the public health care system. We hypothesized that patients on OL-HDF would have a higher survival rate than those on HD. Methods: This is an observational cohort study. Adult patients on maintenance hemodialysis or OL-HDF for at least one month during the period between 1 September 2022 and 1 December 2024 were enrolled into the study. The primary outcome was all-cause mortality. The secondary outcome was cardiovascular mortality. Fine-Gray sub-distribution hazard models were used to evaluate survival in the presence of competing events (kidney transplant and recovery of renal function). Results: Patients on HD (N = 321) and OL-HDF (N = 48) were similar in age, race, sex, and vascular access. Patients on HD were more likely to have diabetes (54.0% vs. 29.2%, p = 0.001) and spent more hours per week on dialysis (11.2 ± 1.8 vs. 10.5 ± 1.6 h, p = 0.006). In an adjusted Fine-Gray model, the hazard of death for patients on OL-HDF was 68% lower than that for patients on HD, and the risk of death for patients with an arteriovenous fistula was 55% lower compared to those with a catheter. Cardiovascular mortality did not differ between the groups. Conclusions: These findings suggest that OL-HDF is associated with an overall higher survival rate compared to HD, even for patients without private health insurance. Full article

Structural competency (SC) is a framework that assists clinicians in naming and analyzing the structural drivers that fundamentally contribute to morbidity and mortality. Undergraduate and graduate medical education is grounded in the experiential learning model where trainees learn through supervised, hands-on, real-world training and caring for patients within hospital and clinic settings. However, our present-day clinical settings fail to create a learning environment in which SC skills can be effectively taught and operationalized. The SC framework is designed to engender praxis, but to make this move upstream, healthcare institutions and medical education leaders need to do more to adapt their learning environment. We posit five elements and associated key actions that are essential to an SC learning environment: (1) the structural analysis of institutional policies and practices; (2) academic freedom and interdisciplinary discourse; (3) redefining medical education standards and metrics; (4) collective action to drive effect change; and (5) community integration and accountability. Full article

Background: Cryptococcus species constitute opportunistic fungi that seldom cause infections in individuals with competent immune systems. In the rare case of cryptococcal endocarditis, the fungus infiltrates the endocardium. This disease occurs almost exclusively in patients with active immunosuppression, implanted cardiac devices, or prosthetic valves. Objectives: This study aims to analyze all documented cases of Cryptococcus spp. endocarditis in humans, emphasizing the epidemiology, microbiology, clinical manifestations, therapeutic approaches, and infection outcomes. Methods: A comprehensive review was performed by searching the PubMed and Scopus databases. Results: A total of 16 studies reported data on 16 patients diagnosed with cryptococcal endocarditis. The mean patient age was 46.6 years, with males comprising 81.25% of cases. Immunosuppression was the most prevalent predisposing factor (31.25%), followed by a history of end-stage renal disease and prosthetic cardiac valves (25%). The most commonly affected intracardiac sites were the mitral (60%) and aortic valve (46.6%), while in 33.3% of cases, multiple-valve infection was observed. Cryptococcus neoformans was detected as the causative organism in the majority of cases (87.5%). The most frequently administered antifungal treatments included amphotericin B (87.5%) and fluconazole (43.75%), with combination therapy used in 62.5% of cases. Overall mortality was relatively high at 56.25%, with 50% of deaths directly attributed to the infection. Conclusions: Considering the ability of Cryptococcus spp. to induce severe systemic infections, healthcare providers should consider this pathogen in the differential diagnosis when yeast microorganisms are identified in microbiological samples. This is particularly crucial for patients with underlying comorbidities or immunodeficiency, as early recognition is crucial to ensure precise diagnosis and treatment. Full article

The Gompertz distribution has long been a cornerstone for analyzing growth processes and mortality patterns across various scientific disciplines. However, as the intricacies of real-world phenomena evolve, there is a pressing need for more versatile probability distributions that can accurately capture a wide array of data characteristics. In response to this demand, we introduce the Marshall–Olkin Power Gompertz (MOPG) distribution, an innovative and powerful extension of the traditional Gompertz model. The MOPG distribution is crafted by enhancing the Power Gompertz cumulative distribution function through the Marshall–Olkin transformation. This distribution yields two pivotal contributions: a power parameter (c) that significantly increases the model’s adaptability to diverse data patterns and the Marshall–Olkin transformation, which modifies tail behavior to enhance predictive accuracy. Furthermore, we derived the distribution’s essential statistical properties and evaluate its performance through extensive Monte Carlo simulations, along with a maximum likelihood estimation of model parameters. Our empirical validation, utilizing three real-world data sets, compellingly demonstrated that the MOPG distribution not only surpasses several well-established lifetime distributions but is also superior in terms of flexibility and tail behavior characterization. The results highlight that the proposed MOPG stands out as a superior choice, delivering the most precise fit to the data when compared to various competing models, and its performance makes it a compelling option worth considering. Full article

Background: RPS are rare tumors requiring complex surgery. The impact of postoperative complications on long-term outcomes is still debated. This study aimed to identify predictors of severe complications and assess their influence on overall survival (OS) and disease-free survival (DFS). Methods: We retrospectively analyzed 61 patients who underwent curative surgery for primary RPS between 2013 and 2023 at a tertiary cancer center. Patients with pelvic or recurrent sarcomas were excluded. Severe complications were defined as Clavien–Dindo (CD) grade ≥ 3A. Cox regression and Fine–Gray competing risk models were used for OS and DFS, respectively. Sarculator and P-POSSUM scores were included in multivariable models. Results: Severe complications occurred in 14.8% of patients; 30-day mortality was 1.6%. Predictive factors for complications included longer operative time, gastric resection, intraoperative complications, and transfusions. In multivariable analysis, Sarculator was significantly associated with both DFS (HR 0.97; p = 0.004) and OS (HR 0.97; p = 0.008). The P-POSSUM mortality score predicted OS (HR 1.12; p = 0.002). Severe complications were not independently associated with DFS or OS. Conclusions: In this cohort, severe complications did not impact long-term oncological outcomes. Prognostic tools such as Sarculator and P-POSSUM may enhance risk stratification in RPS surgery. Prospective validation is warranted. Full article

There is an exponential increase in the global prevalence of non-alcoholic fatty liver disease (NAFLD) in all populations. The objective of this review is to examine how different cultures and molecular entities influence the progression of NAFLD. Research databases, including PubMed, Scopus, the American Diabetes Association, the American Liver Foundation, and Diabetes UK, were used to retrieve information. Our data analysis showed that cultural norms shape the perceptions of health, illness, and mortality, thus influencing how individuals view themselves and express their experiences and may also affect decisions related to treatment and healthcare. Cultural competence, the ability to understand and navigate cultural differences, is essential for eliciting patient and practitioner perspectives and integrating this understanding into diagnostic and treatment plans. By acknowledging and respecting a patient’s cultural background, healthcare providers can foster trust, improve care quality, enhance acceptance of diagnoses, and boost treatment adherence. Although cultural factors play a crucial role in the progression of NAFLD, the disease is also shaped by genetic predispositions, molecular mechanisms, and comorbidities. Molecular pathways involved in the development and progression of NAFLD include alterations in lipid metabolism, insulin signaling, insulin resistance, oxidative stress, defective gut microbiome, and inflammation. This study concludes that a combination of cultural preferences and molecular factors has contributed to the worldwide exponential rise in the prevalence of NAFLD, which in turn has led to an increase in the prevalence of comorbidities such as cardiovascular diseases, diabetes mellitus, and metabolic syndrome. Full article

Background: Cardiovascular diseases (CVDs) and their risk factors are increasing with associated disability and mortality burden globally, especially in low- and middle-income countries, including Cameroon. Physiotherapist-led health promotion (PLHP) interventions provide opportunities to improve health and reduce this burden. Understanding physiotherapists’ practice, confidence, and perception is crucial for designing effective, context-specific PLHP interventions. Methods: This qualitative study explored physiotherapists’ practice, perceptions, and confidence in delivering PLHP to pwCVDs in Cameroon. Results: Sixteen participants completed the interviews, and analyses of the transcripts generated three main themes, which included (1) the perception of physiotherapists’ roles in health promotion (HP), (2) current practice of PLHP, and (3) competence in the delivery of PLHP. Physiotherapists believe that delivering HP interventions in practice is within their professional role. Current HP practice was limited to exercise, physical activity, and dietary/nutritional interventions. Participants reported a lack of knowledge and formal training in PLHP delivery. Conclusions: Despite intense interest in HP, HP practice among physiotherapists is limited in scope, is under-resourced, and is limited by a lack of confidence in delivering behavioural change interventions. These findings are relevant for the design of appropriate clinical training and policies for the care of pwCVDs. Full article

Background/Objectives: The arterial switch operation (ASO) has been performed in the neonatal period as an anatomical correction for d-transposition of the great arteries since the 1980s. As the population of adult congenital heart disease patients grows, it is essential for healthcare providers across various disciplines to comprehend the complexities of these patients. We report on outcomes up to the third decade after ASO. Methods: All patients who underwent ASO from May 1985 to December 2020 were included, and a retrospective chart review with follow-up until December 2021 was conducted. Additionally, vital status verification (90.3% complete) was performed through the national health insurance. Survival analysis and competing risk analysis were performed to determine outcomes in the third decade after ASO. Results: One-hundred-ninety-five patients (72.3% male; median age at surgery 6 days; median weight at surgery 3.4 kg) underwent ASO from May 1985 to December 2020. Patients with a prenatal diagnosis showed a lower rate of preoperative cardiac decompensation (p = 0.017). Early in-hospital mortality was 8.7%, and no early in-hospital deaths occurred in the study era from 2006 to 2020. Four late deaths occurred, and the Kaplan–Meier estimated survival of the 178 hospital survivors was 98.3% ± 1.2% at 10 years, 96.8% ± 1.9% at 20 years and 92.4% ± 4.7 at 30 years. The cumulative incidence of left ventricular outflow tract (LVOT) reoperation after ASO was 1.3% at 10 years, 3.4% at 20 years and 11.3% at 30 years. The cumulative incidence of right ventricular outflow tract (RVOT) reoperation after ASO was 7.2% at 10 years and 17.5% at 20 and 30 years. Conclusions: Overall long-term survival of the hospital survivors is good. The reoperation rate on the LVOT is favorable. Percutaneous interventions, if feasible after the Lecompte maneuver, might pose an option to delay the more common reoperations on the RVOT, though further studies are needed to determine their long-term impact. Full article

Trimethylamine N-oxide (TMAO) is an endogenous osmolyte produced by enzymatic reactions starting in the human gut, where microbiota release trimethylamine (TMA) from foods, and ending in the liver, where TMA is oxidized to TMAO by flavin-containing monooxygenase 3 (FMO3). While physiological concentrations of TMAO help proteins preserve their folding, high levels of this metabolite are harmful and promote oxidative stress, inflammation, and atherosclerosis. In humans, elevated levels of circulating TMAO predispose individuals to cardiovascular diseases and chronic kidney disease and increase mortality risk, especially in the elderly. How TMAO exerts its negative effects has been only partially elucidated. In hypertensive rats, the eNOS substrate L-arginine and Taurisolo^®, a nutraceutical endowed with TMAO-reducing activity, act synergistically to reduce arterial blood pressure. Here, we investigate the molecular mechanisms underpinning this synergism and prove that TMAO, the target of Taurisolo^®, acts as direct inhibitor of endothelial nitric oxide synthase (eNOS) and competes with L-arginine at its catalytic site, ultimately inhibiting NO production and acetylcholine (Ach)-induced relaxation in murine aortas. Full article