Search Results (8,093)

Dog-assisted interventions (DAIs) are an established procedure to support military staff, but their implementation during active warfare has not yet been systematically studied. In addition, the welfare of therapy dogs participating in DAIs during war remains unexplored. Therapy dogs may develop clinically relevant emotional disorders, including trauma-related stress responses, analogous to human psychopathologies. The present study sought to monitor physiological arousal in therapy dogs performing DAI sessions with their handlers in two Ukrainian military hospitals (Vinnyzja and Kyiv). Biomarkers of hypothalamic–pituitary–adrenal (HPA) axis activity, including salivary, urinary, and hair cortisol concentrations, were assessed in Ukrainian (UA) therapy dogs to capture their acute and long-term stress responses. Additionally, cortisol levels in German (GE) therapy dogs performing similar DAIs under peaceful conditions were measured to compare cortisol levels between dogs from both regions. Results suggest that GE therapy dogs exhibited significantly higher urinary and hair cortisol levels and significantly lower salivary cortisol concentrations, reflecting alterations in longer-term glucocorticoid secretion that is possibly caused by war-related stimulation in the UA cohort. In contrast, no significant differences in salivary cortisol emerged as a consequence of performing DAIs. The present findings suggest that the environment rather than involvement in DAIs has an impact on therapy dogs’ cortisol secretion. Full article

Background/Objectives: Carbapenem-resistant Klebsiella spp. (CRK) causes healthcare-associated infections with high mortality. This study evaluated the clinical outcomes of ceftazidime–avibactam (CZA) therapy in CRK infections. Methods: Patients hospitalized in a tertiary care hospital in Türkiye between June 2021 and December 2022 with CRK-positive cultures, CZA susceptibility, and ≥72 h of CZA treatment were retrospectively analyzed. Results: Ninety-nine patients (61.6% male; mean age 63.7 ± 17.5 years) were included, 89.9% of whom were treated in the intensive care unit (ICU). Hypertension (29.3%), diabetes (28.3%), and malignancy (26.3%) were the most frequent comorbidities. The main infection types were bloodstream infection (56.6%) and ventilator-associated pneumonia (29.3%). CZA was used as monotherapy in 49.5%, and in combination in 50.5% of cases. The mean treatment duration was 13.2 ± 6.3 days. Clinical improvement occurred at 3.4 ± 1.2 days and microbiological eradication at 4.7 ± 2.1 days. Treatment success was achieved in 76.8% of patients, while 30- and 90-day mortality rates were 48.5% and 72.7%, respectively. Only treatment duration significantly affected clinical outcome (p < 0.001). Conclusions: CZA demonstrates favorable outcomes in CRK infections, with no significant difference between monotherapy and combination therapy. These findings support the use of CZA as an effective treatment option for severe CRK infections in real-world clinical settings and may help guide antimicrobial stewardship strategies in high-risk hospitalized patients. Full article

U.S. hospitals generate considerable food waste, contributing to environmental degradation strategies. This study evaluated the feasibility, impact, and perception of a novel composting program implemented at Rhode Island Hospital over six months beginning in December 2024. Compostable waste bins were installed in the cafeteria with educational signage. Surveys assessing composting knowledge, attitudes, and roles in waste management were distributed to staff, patients, and administrators. Collected food waste was transported to Bootstrap Compost, which provided daily weight data used to estimate greenhouse gas emissions reductions, compare composting with landfill disposal costs, and project annual outcomes. Over the study period, 490.6 kg of food waste were diverted from landfills, corresponding to a reduction of 0.35 metric tons of CO₂-equivalent emissions. While composting was more expensive than landfill disposal ($6.45/kg vs. $0.24/kg), cost neutrality could be achieved with diversion rates at or above 116 kg per day. Surveys revealed strong support for composting but limited awareness of its relevance to healthcare’s environmental footprint. Respondents suggested improvements in education, signage, and infrastructure. This program demonstrated how hospital-based composting initiatives align with healthcare institutions’ environmental stewardship goals while highlighting financial and logistical challenges relevant for pilot–scale efforts. Full article

Background/Objectives: Severe traumatic brain injury (TBI) carries high mortality, and outcomes are particularly poor when prehospital cardiopulmonary resuscitation (CPR) is required. Because these patients are often excluded from research, epidemiological data and prognostic insights are limited. This study aimed to describe characteristics and outcomes of patients with suspected severe TBI who received prehospital CPR. Methods: We performed a sub-analysis of the prospectively collected multicenter BRAIN-PROTECT registry, including all patients with suspected severe TBI who underwent prehospital CPR and were transported to a participating trauma center. Results: A total of 256 patients with suspected severe TBI who received prehospital CPR were included. Early mortality was high, with 22.6% declared dead in the emergency department and an additional 28.9% within 24 h, resulting in 48.5% 24 h survival. Thirty-day mortality was 79.9%. Among survivors, 45.7% achieved moderate disability or good recovery at discharge. Outcomes, 30-day mortality, and neurological status at discharge did not differ between isolated and non-isolated TBI. Characteristics often seen in survivors included shockable initial rhythm, reactive pupils, and lack of anisocoria. All patients without prehospital return of spontaneous circulation died. Conclusions: Although overall 30-day mortality was high, survival among patients for whom resuscitation was attempted and who reached hospital care was not negligible, and a substantial proportion of the survivors achieved moderate to good neurological recovery. Prehospital ROSC and shockable rhythms were associated with better outcomes, suggesting that resuscitation may be valuable and warranted in selected patients with potentially reversible conditions. Further studies are needed to better define prognostic factors and guide management in this highly vulnerable population. Full article

Background/Objectives: Water pollution caused by human activities disrupts ecosystems and promotes the spread of antimicrobial resistance genes (ARGs), posing a public health threat. This study investigated the presence of resistant Gram-negative bacteria and resistance genes in water from two sites occasionally exposed to domestic and hospital effluents, the Carioca River (CR) and Rodrigo de Freitas Lagoon (RFL), both used for recreation. Methods: Physicochemical parameters and coliform levels were measured. Bacterial isolates were identified by Matrix-Assisted Laser Desorption Ionization–Time-of-Flight Mass Spectrometry (MALDI-TOF MS) and tested for antimicrobial susceptibility using disk diffusion. The Minimum Inhibitory Concentration (MIC) was determined using the E-test^® and broth microdilution methods. PCR was used to detect carbapenem resistance and other ARGs from the DNA of bacterial isolates obtained from water samples. Results: CR presented signs of environmental degradation, with low dissolved oxygen and high coliform counts. One Citrobacter braakii isolate showed resistance to all tested antimicrobials, raising concern for untreatable infections. Carbapenem-resistant isolates accounted for 49.4% of the total, harboring bla_KPC (20%), bla_TEM (5%), bla_VIM (5%), and bla_SPM (5%). The intl1 gene was found in 10% of isolates, indicating potential horizontal gene transfer. Conclusions: The findings from a one-day sampling reveal the presence of multidrug-resistant bacteria that carry antimicrobial resistance genes in polluted aquatic systems. These highlight the connection between water contamination and antimicrobial resistance. The evidence underscores the urgent need for environmental monitoring and effective management strategies to reduce public health risks. Full article

Background: Not all ambulance missions result in patient transport, often referred to as non-conveyance. However, in some cases, patients discharged at the scene may require further examination and treatment. Patient sex, age, and psychiatric disease seem to be factors associated with non-conveyance. This study aimed to identify and characterise patients not transported following an urgent ambulance mission, and to examine subsequent hospital admission and mortality rates. In addition, we wanted to examine their reasons for calling the Emergency Medical Communication Centre (EMCC). Methods: This retrospective study was conducted for the emergency medical system of Norway’s second-largest city. Data, including information from non-conveyed patients involved in acute or urgent ambulance missions over 1 year, were obtained from the EMCC. The frequency of non-conveyance, patient demographics, and incidence of hospital admissions within 72 h were analysed. Furthermore, the 30-day mortality, predictive factors, and reasons for contacting the EMCC were determined. Results: Out of a total of 22,183 ambulance missions, 7.3% of patients were not conveyed, of whom 5.8% were admitted to hospital within 72 h. The 30-day mortality rate among all non-conveyed patients was 2.4%, whereas 2.1% of hospitalised patients died within 30 days. Psychiatric conditions were frequently observed in both groups. The mortality rate increased significantly with age but was not associated with the number of ambulance requests. Furthermore, 30-day mortality was not significantly associated with sex, time of day, day of the week, or rurality. Conclusions: Our data suggests that there is no difference between the short-term outcomes of non-conveyed and conveyed patients; both groups are equally likely to come to harm. Therefore, the factors influencing non-transportation decisions warrant further investigation. Subsequent events following patient discharge should be routinely collected by ambulance services and monitored for learning and to improve the quality of patient care. Full article

Objectives: The diagnosis of infective endocarditis (IE) is clinically challenging. This study aimed to examine an endocarditis network and the effects of delayed diagnosis. Methods: We reviewed the patients who were admitted for infective endocarditis at our institution between January 2012 and December 2021. Infective endocarditis was diagnosed according to ESC/EACTS guidelines for the management of endocarditis. Details of admitting hospitals were obtained from the German Hospital Directory. Data are presented as medians (25th–75th quartiles) or absolute values (percentages) unless otherwise specified. Results: A total of 812 consecutive patients were admitted to our centre for IE. Exact records on the time to diagnosis were available for 707 patients (87.1%). The patients were divided into two groups based on the time to diagnosis, i.e., up to 7 days (n = 509; 72.0% group ED) and more than 7 days (n = 198; 28.0% group LD). The EuroSCORE II (p = 0.001) and the EndoSCORE (p = 0.019) were significantly higher in the LD group. The median time to diagnosis was shorter in university hospitals as compared to non-teaching hospitals (p = 0.008) and among patients admitted to cardiology and cardiac surgery departments (p < 0.001). Patients diagnosed later had higher rates of tracheostomy (p < 0.001), longer ICU (p = 0.004) and hospital stays (p < 0.001) and higher in-hospital mortality (p = 0.027). We found that a delayed diagnosis (p = 0.040), stroke (p = 0.004), age > 75 years (p = 0.044) and atrial fibrillation (p < 0.001) were independently associated with in-hospital mortality. Furthermore, survival at 1 and 5 years was significantly higher in the ED group (p < 0.001). Conclusions: The diagnosis of IE may be influenced by a multitude of factors. Our results indicate that a delayed diagnosis is independently associated with an increased rate of in-hospital mortality. According to our results, an early diagnosis of IE may be associated with improved outcomes. Full article

Snakebite envenomation (SBE) is a major public health issue in sub-Saharan Africa (SSA), particularly in Cameroon. This Phase IV, multicenter, open-label study was conducted from June 2024 to December 2024 to evaluate the safety and efficacy of PANAF-Premium™, a World Health Organization (WHO)-approved polyvalent antivenom that was introduced in Cameroon in 2023, given that prospectively gathered data and studies on this antivenom’s safety in SSA are limited. In total, 130 victims admitted to four district hospitals in North Cameroon with confirmed SBE were included. Data on envenomation syndromes, clinical outcomes, adverse events, and treatment response were recorded. Echis species were responsible for most bites, while clinical syndromes included hemotoxic (68.5%), cytotoxic (30.8%), and neurotoxic (0.8%) presentations. On average, victims required 3.34 vials and 5.55 days for clinical recovery. Early antivenom administration significantly reduced the number of antivenom vials required to manage the symptoms (p = 0.003) and hospital stay (p = 0.049). Seventeen patients experienced mild to moderate adverse events. Two deaths and a case of kidney injury were noted, all unrelated to antivenom use. These study findings indicate the safety and effectiveness of PANAF-Premium™ antivenom, meeting WHO performance targets. The results highlight the importance of timely antivenom administration in treating SBEs. Full article

Background/Objectives: Growing concerns about antibiotic-associated adverse events, including Clostridioides difficile infection, prompted implementation of an antibiotic stewardship program (ASP) in South Korea in November 2024. One year post-implementation, we evaluated changes in antibiotic consumption and C. difficile infection incidence. Methods: This study was conducted at Chung-Ang University Gwangmyeong Hospital, South Korea. Segmented regression and interrupted time series analyses were performed using weekly data on antibiotic use (days of therapy [DOT] per 1000 patient-days) and C. difficile infection or colonization (cases per 1000 patient-days) over 157 weeks (November 2022–October 2025). Weeks 1–105 defined the pre-ASP period, and weeks 106–157 the post-ASP period. A 4-week lag between antibiotic use and subsequent C. difficile infection was hypothesized. Results: Before ASP, weekly total antibiotic use increased (β₁ = 1.14, 95% CI, 0.76 to 1.51, p < 0.001). After ASP, the slope decreased significantly (β₃ = −1.50, 95% CI −2.62 to −0.39, p = 0.009), consistent across anti-pseudomonal penicillins and cephalosporins and fluoroquinolones. Pre-ASP C. difficile incidence increased (α₁ = 0.01, 95% CI, 0.01 to 0.02, p < 0.001); the upward trend attenuated post-ASP, though slope change was not significant (α₃ = −0.01, 95% CI, −0.03 to 0.004, p = 0.13). An increase of 1 DOT per 1000 patient-days was associated with a 0.005-case increase in C. difficile infection incidence after 4 weeks. Conclusions: The observed effects of proactive ASP strategies underscore the importance of maintaining stewardship in clinical practice. Further studies are warranted to assess the sustainability of these findings and evaluate additional factors influencing C. difficile infection incidence. Full article

Background: The albumin–bilirubin (ALBI) grade provides an objective assessment of hepatic reserve, but the need for calculation by means of a formula has hampered its use at the bedside. This study aimed to develop simple cut-off values for ALBI grade and validate its performance in a large multi-center real-world cohort. Methods: A mathematical simulation evaluated every possible ALBI pair that falls within the Child–Pugh classification (CP) A range, discretized to 0.1 increments. Cut points for patient stratification without equation-based calculation were derived. Validation was conducted with the Chang Gung Research Database (CGRD), which contains data from 10 hospitals in Taiwan. Patients with same-day albumin and bilirubin measurements in 2024 were included. Results: Mathematical modeling identified clinically applicable cutoffs—albumin ≥ 4.4 g/dL or ≤3.5 g/dL and bilirubin ≥ 2.4 mg/dL—with further refinement at albumin 4.0 g/dL and bilirubin ≥ 1.0 mg/dL. Among 7583 CP-A patients, 82% were directly classifiable without computation, with consistent applicability across chronic liver disease and hepatocellular carcinoma (HCC) subgroups. Equation dependence increased only slightly in the HCC group, confirming robustness across disease severities. Conclusions: Simplified cutoff rules derived from mathematical modeling and validated in a multi-center cohort enable rapid recognition of ALBI grade in most CP-A patients. This approach enhances the clinical usability of ALBI and supports its integration into patient care, clinical trials, and treatment allocation. Full article

Background/Objectives: Pauls Stradins Clinical University Hospital in Riga, Latvia, introduced an ECMO program in 2008. Since the program’s start, countless patients have had their lives saved by this necessary technology. Our goal was to review the ECMO program results and gain insight into the organization’s operations. We wanted not only to assess the program’s efficiency in terms of time, but also to visualize patient outcomes at least a month after decannulation from ECMO and discharge from the hospital. Methods: A retrospective observational study was performed using hospital patient data files from October 2024 to October 2025. The selected patient group was those who had suffered an in-hospital cardiac arrest and successfully had ECMO inserted; this criterion fit fifteen patients. Data were collected on multiple factors, including from collapse to flow time, the number of days spent in the ICU, and post-ECMO complications. Afterwards, the data were analyzed to understand the program’s and patients’ outcomes. Results: Of the fifteen patients analyzed, seven did not survive to hospital discharge. The statistically significant quantitative results were the first lactate levels after ECMO cannulation and the first troponin levels after cardiac arrest. In terms of qualitative results, CHF, survival to ECMO decannulation, cannulation failure, and survival to ICU discharge were statistically significant. Conclusions: The ECMO program at Pauls Stradins Clinical University Hospital provides patients with a necessary technology after an intra-hospital cardiac arrest. This study highlights data about these patients and their outcomes, as well as areas for improvement within the hospital’s ECMO/ECPR program. Full article

Background/Objectives: Nurses are at high risk for burnout. Identification of biomarkers associated with early manifestations of distress is essential to support effective intervention efforts. Methods: Fifty nurses from a large hospital system participated in a 30-day study of biopsychosocial factors that may contribute to burnout. Nurses wore an Oura ring that collected behavioral data and they completed a self-report burnout questionnaire at baseline and the end of the study period. Machine learning models were developed to evaluate whether objective measures could predict burnout states and changes at the end of the study period. Analyses were exploratory and hypothesis-generating for future work. Results: Data for 45 participants were included in the analyses. Participants with burnout had significantly higher sleep variability. Sleep measures provided 75.75% accuracy in ability to discriminate between burnout states. Heart rate-based measures better modeled changes in symptomatic components of burnout (Emotional Exhaustion, Depersonalization) over time. Heart rate-based measures provided a R-squared value of 0.13 (p < 0.05) (RMSE of 7.41) in a regression model of changes in Emotional Exhaustion evaluated in a leave-one-participant-out cross-validation. Conclusions: Sleep measures’ association with a state of burnout may reflect the longer-term manifestations of chronic exposure to workplace stress. Short-term changes in burnout symptoms are associated with disturbances in heart rate measures. Wearable technology may support monitoring/early identification of those at risk for burnout. Full article

Background: Epidural analgesia (EA) is widely used in pancreatic surgery but is associated with hypotension and delayed recovery. The shift towards minimally invasive surgery has led to the exploration of alternative multimodal analgesia strategies. Methadone, with its unique pharmacological properties, may further optimize recovery. Methods: This retrospective cohort study included 213 patients undergoing pancreatic resection, receiving EA (n = 63), multimodal analgesia without methadone (MA; n = 92), or with methadone (MM; n = 58). MA and MM included intravenous ketamine, lidocaine and continuous wound infiltration. Primary outcome was maximum daily postoperative pain scores. Secondary outcomes included opioid consumption, vasopressor use, mobilization, bowel recovery, urinary catheter duration, and ICU/hospital stay. Results: Compared with EA, pain scores were slightly higher in MM (mean difference 2.22; 95% CI 1.22–3.90; p = 0.01) and in MA (mean difference 2.06; 95% CI 0.99–4.30; p = 0.06). Opioid use was comparable between MM and EA (OR 0.99, 95% CI [0.98, 1.00], p = 0.20), and significantly lower in MA (OR 0.97, 95% CI [0.96, 0.98], p < 0.001). Both MA and MM demonstrated reduced vasopressor requirements (both 0 vs. 2.0 median days) and shorter urinary catheterization durations (MA 1.2 MM 1.9 vs. EA 4.0 median days). MA improved mobilization (0 vs. 1 median days; OR 0.52, p = 0.03) and bowel recovery (OR 0.76, p = 0.02). ICU stay was longer in EA due to routine ICU admission for open surgery. Conclusions: Multimodal analgesia, with or without methadone, offers alternative strategies in pancreatic surgery. While EA provides superior pain control, multimodal regimens are associated with improved functional recovery. Full article

Background: Thrombocytopenia (platelet count < 100 × 10⁹/L) occurs in 20–40% of critically ill patients with sepsis and is associated with adverse outcomes. Most prior studies have treated thrombocytopenia as a static risk indicator rather than a dynamic process. We investigated whether platelet recovery within 7 days provides independent prognostic information in patients with sepsis. Methods: We performed a retrospective cohort study using the MIMIC-IV database. Among 22,513 adults with sepsis admitted to intensive care units, 5401 developed thrombocytopenia within 24 h of admission and had sufficient follow-up data. The primary exposure was sustained platelet recovery to ≥100 × 10⁹/L within 7 days. The primary outcomes were 28-day and in-hospital mortality. Propensity-score matching and overlap weighting were used to adjust for demographic characteristics, comorbid conditions, illness severity, and organ-support therapies. Results: Among 5401 septic ICU patients with thrombocytopenia, 3193 (59%) achieved platelet recovery within 7 days. A total of 2056 patients (38%) recovered by day 3, and 1137 (21%) recovered between days 4 and 7. After multivariable adjustment, platelet recovery was independently associated with markedly lower mortality (adjusted risk ratio, 0.56; 95% CI, 0.53–0.67 for in-hospital death; and 0.60; 95% CI, 0.53–0.67 for 28-day death) and more than a doubling of survival time (adjusted ratio, 2.08; 95% CI, 1.65–2.63). Early and intermediate recovery conferred similar benefits. Higher baseline platelet counts, antiplatelet therapy, and heparin use were associated with recovery, whereas cirrhosis, greater illness severity, and continuous renal replacement therapy were associated with non-recovery. Conclusions: In patients with sepsis and thrombocytopenia, platelet recovery within 7 days was a strong and independent predictor of survival. Exploratory timing-stratified analyses yielded similar associations across subgroups. These findings support platelet recovery as a useful prognostic marker reflecting broader physiologic stabilization in sepsis. Full article

Objective: The emergence and spread of multi-drug-resistant (MDR) bacteria pose a growing threat in veterinary medicine, particularly in equine hospitals. This study investigated the colonization and infection dynamics of horses undergoing emergency laparotomy with two distinct antibiotic protocols (single-shot versus 5-day protocol) during hospitalization. Methods: Nasal swabs and fecal samples were collected from 67 horses undergoing emergency laparotomy at clinic admission as well as on postoperative days 3 and 10. These were screened for multi-drug-resistant indicator pathogens. As multi-drug-resistant indicator pathogens, methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum β-lactamase (ESBL)-producing Enterobacterales (ESBL-E), and bacteria belonging to the Acinetobacter baumannii complex were defined. Results: Preoperatively, 6.2% of horses tested positive for MRSA and 13% for ESBL-E. An increase in colonization was observed on day 3 postoperatively, with 62.1% of nasal swabs and 86.4% of fecal samples testing positive for MDR organisms. On day 10, 53.4% of nasal swabs and 62.5% of fecal samples tested positive for indicator pathogens. Surgical site infection developed in five horses, two of which tested positive for MRSA in both nasal and wound samples during hospitalization, supporting the potential role of nasal carriage as a source of infection. Furthermore, all horses tested positive for ESBL-E during at least one time-point during hospitalization, and Enterobacterales (MDR in two surgical site infections (SSI)) were involved in all surgical site infections. No significant differences were observed between the two antibiotic treatment groups regarding colonization rates with indicator pathogens during hospitalization. However, the results indicate that hospitalization itself contributes to increased colonization with resistant bacteria. A clear limitation of the study is the restricted number of sampled horses and the lack of environmental contamination data. Non-sampled hospitalized horses with and without antibiotic treatment may have acted as reservoirs for MDR bacteria. Conclusion: The findings emphasize the need for routine environmental monitoring and strict adherence to hygiene protocols in equine clinics to reduce the risk of nosocomial transmission. Ongoing surveillance and infection control strategies are essential to mitigate the spread of MDR pathogens in veterinary settings. Full article