Search Results (5,205)

Hospital infection prevention is critical to patient safety, yet data on the prevalence and contributing factors of healthcare-associated infections (HAIs) in Aljouf, Saudi Arabia, are scarce. This retrospective cross-sectional study aimed to investigate the prevalence, microbiological profile, and associated risk factors of HAIs among intensive care unit (ICU) patients in a referral hospital between January 2020 and December 2023. Medical records of 260 ICU patients were reviewed for demographic details, comorbidities, infection types, pathogens, and invasive device use. Forty patients (15.38%) developed HAIs with the highest prevalence in 2020 (50.0%). Infections were more common in males (56.5%) and those aged ≥56 years (54.6%). The predominant infections were catheter-associated urinary tract infections (47.5%), ventilator-associated pneumonia (35.0%), and central line-associated bloodstream infections (17.5%). Klebsiella pneumoniae (35.0%) and Acinetobacter baumannii (27.5%), pathogens commonly associated with multidrug resistance, were the most frequently isolated organisms. All HAI cases involved invasive device use with the use of three or more devices significantly increasing infection risk (p < 0.05). Additionally, 85% of infected patients had chronic conditions, primarily hypertension or diabetes. These findings emphasize the urgent need for strengthened infection control practices and targeted antimicrobial strategies to reduce HAIs and improve ICU patient outcomes in underreported regions. Full article

Background: Antimicrobial stewardship programs (ASPs) are essential for promoting the rational use of antibiotics and combating resistance. In South Korea, implementation has recently accelerated, but real-world data on short-term program performance remain limited. This study evaluated the early outcomes of a newly launched ASP at a tertiary hospital. Methods: This retrospective, single-center study analyzed ASP activity from January to April 2025. Interventions included prospective audit and feedback for restricted antibiotics and recommendations for prolonged antibiotic prescriptions (≥14 days). The primary outcome was the monthly rejection rate of restricted antibiotics. Secondary outcomes included days of therapy (DOT) for restricted antibiotics and the acceptance rate of interventions for prolonged prescriptions. Results: The monthly rejection rate of restricted antibiotics remained stable between 3.65% and 4.68%. Although the DOT values did not show statistical significance, they demonstrated a moderate inverse correlation with the rejection rate (Pearson’s r = –0.868, p = 0.132). Among 826 prolonged prescriptions, 513 (62.1%) received ASP intervention. Acceptance of recommendations increased over time, from 67.0% in January to 82.5% in April. Interventions were primarily based on insufficient evidence of infection or inappropriate antibiotic selection. Conclusions: The newly implemented ASP demonstrated feasibility and early impact in improving antibiotic oversight. Despite the short observation period, the findings suggest a positive influence on prescribing practices. Longer-term studies are needed to evaluate sustained clinical outcomes and broader applicability in diverse healthcare settings. Full article

Background/Objectives: Early identification of terminally ill patients is crucial for enhancing care, patient and care partner satisfaction, and healthcare staff confidence in discussing disease trajectories. Yet, timely recognition remains challenging. To address this, we developed a minimally invasive intervention (MINI) for general hospital wards. We aimed to evaluate the MINI’s feasibility in facilitating an earlier identification of terminally ill patients and improving patient reported outcomes in a hospital setting. Methods: This prospective, two-arm pre-post intervention study at a university hospital evaluated the MINI alongside usual care. Patient-reported outcomes, including quality of life (SF-12), palliative care needs (IPOS), and functional status (ECOG), were collected at baseline and every three months over 12 months. Participants were allocated to a control or intervention group. Results: Of 188 patients identified using the Surprise Question, 58 completed the baseline assessment. While physical functioning (SF-12 PCS) remained comparable, the intervention group experienced clinically meaningful improvements in mental health (SF-12 MCS) at three months, with positive trends at six months. This group also showed a decline in palliative care needs, reduced emotional symptoms, and improved performance status, evidenced by significant differences in non-parametric analyses. These findings underscore the MINI’s potential to significantly improve patient well-being. Conclusions: This pilot study demonstrated the feasibility of the MINI and suggests it may foster meaningful system-wide change in patient-centred care within acute hospital settings, leading to improved patient outcomes and more confident healthcare staff in identifying terminally ill patients. However, given the small sample size, these findings should be interpreted with caution. Future research with larger cohorts and extended intervention periods is warranted to fully elucidate the MINI’s impact and refine strategies for improving care for terminally ill patients. Full article

Hand hygiene is a key measure to prevent healthcare-associated infections (HAIs), yet compliance remains low in Sub-Saharan Africa (SSA), due to limited resources, insufficient training, and behavioral challenges. Simulation-based education offers a promising approach to enhance technical and non-technical skills in safe learning environments, promoting behavioral change and patient safety. This study aimed to develop and pilot a contextually adapted hand hygiene simulation-based learning scenario for nursing students in SSA. Grounded in the Medical Research Council (MRC) Framework and Design-Based Research principles, a multidisciplinary team from European and African higher education institutions (HEIs) co-created this scenario, integrating international and regional hand hygiene guidelines. Two iterative pilot cycles were conducted with expert panels, educators, and students. Data from structured observation and post-simulation questionnaires were analyzed using descriptive statistics. The results confirm the scenario’s feasibility, relevance, and educational value. The participants rated highly the clarity of learning objectives (M = 5.0, SD = 0.0) and preparatory materials (M = 4.6, SD = 0.548), reporting increased knowledge/skills and confidence and emphasizing the importance of clear roles, structured facilitation, and real-time feedback. These findings suggest that integrating simulation in health curricula could strengthen HAI prevention and control in SSA. Further research is needed to evaluate long-term outcomes and the potential for wider implementation. Full article

Background/Objectives: Maintaining proper oral hygiene is particularly challenging for individuals with autism spectrum disorder (ASD) due to sensory sensitivities, communication difficulties, and anxiety. Traditional oral hygiene education methods may be ineffective for this population, thereby necessitating innovative solutions. This study evaluates the effectiveness of a virtual reality (VR)-based educational program in improving home oral hygiene practices among children and adolescents with ASD. Methods: Sixty-four children with ASD (Level 1) were recruited and divided into two groups. Group 1 received traditional oral hygiene education, while Group 2 used a VR-based intervention featuring a virtual domestic bathroom with an avatar demonstrating proper brushing and flossing techniques. The intervention lasted eight weeks, with two one-hour sessions per week. The oral health assessment tool (OHAT) was used to evaluate oral hygiene status before and after the intervention. An unpaired t-test compared outcomes between groups. Results: Both groups showed improvements in oral hygiene, but the VR intervention group exhibited a significantly greater reduction in OHAT scores compared to the traditional education group (p < 0.001) due to a greater improvement in oral health. The VR-based approach enhanced engagement and adherence to oral hygiene routines, particularly benefiting children with ASD who struggle with conventional methods. Conclusions: VR-based education appears to be a promising tool for improving oral hygiene habits in children with ASD by providing an interactive and immersive learning experience. Future research should explore long-term adherence and the broader application of VR in healthcare education. Full article

A new human pathogen triggering a pandemic can impact health directly through disease resulting from infection and indirectly through health system disruption. The COVID-19 pandemic is hypothesised to have impacted pathology testing by impacting healthcare and pathology operations and reducing healthcare attendance for fear of infection. The impacts of COVID-19 incidence and pandemic control measures on non-COVID pathology testing were assessed in four Australian states/territories using pathology data (histology, prostate-specific antigen, gynaecological cytology, complete blood count, haemoglobin A1c, and human immunodeficiency virus) from a large national private pathology provider (January 2019–December 2024). Weekly testing volumes from lockdown periods were compared to the equivalent weeks in 2019. All pathology tests demonstrated a substantial decline during the initial national lockdown in March 2020. Subsequent lockdowns were also associated with disruption. For example, complete blood count testing in Victoria was −22% in March 2020 and −5% in the second wave that year. Total annual testing volumes were lower for all tests in 2020 compared to 2019, excluding haemoglobin A1c, and reduced testing persisted through to 2024. The findings indicate substantial and sustained negative pandemic impacts on pathology testing. Reductions in pathology testing signal heightened risk of delayed disease diagnosis, disrupted chronic disease management, and poorer health outcomes. Full article

Frailty is a complex biological process that is associated with adverse outcomes in community-dwelling and hospitalized patients. While clinical evaluation is the current gold standard for screening and diagnosis, such an approach is not without its limitations (such as personnel and resource requirement). In this review, we will discuss prospective biomarkers for frailty. Opportunistic and deliberate radiological testing could provide important information that complements clinical frailty evaluation. Novel biochemical panels may yield additional methods for frailty screening in the future. It is known that early frailty intervention could lead to better outcomes for patients. Integration of electronic medical records, laboratory and radiological results, as well as clinical informatics infrastructure could result in augmented clinical decision-making and more optimized healthcare resources utilization. Full article

Cardiovascular Disease (CVD) remains the number one cause of morbidity and mortality, accounting for 17.9 million deaths every year. Precise and early diagnosis is therefore critical to the betterment of the patient’s outcomes and the many burdens that weigh on the healthcare systems. This work presents for the first time an innovative approach using the DenseNet architecture that allows for the automatic recognition of CVD from clinical data. The data is preprocessed and augmented, with a heterogeneous dataset of cardiovascular-related images like angiograms, echocardiograms, and magnetic resonance images used. Optimizing the deep features for robust model performance is conducted through fine-tuning a custom DenseNet architecture along with rigorous hyper parameter tuning and sophisticated strategies to handle class imbalance. The DenseNet model, after training, shows high accuracy, sensitivity, and specificity in the identification of CVD compared to baseline approaches. Apart from the quantitative measures, detailed visualizations are conducted to show that the model is able to localize and classify pathological areas within an image. The accuracy of the model was found to be 0.92, precision 0.91, and recall 0.95 for class 1, and an overall weighted average F1-score of 0.93, which establishes the efficacy of the model. There is great clinical applicability in this research in terms of accurate detection of CVD to provide time-interventional personalized treatments. This DenseNet-based approach advances the improvement on the diagnosis of CVD through state-of-the-art technology to be used by radiologists and clinicians. Future work, therefore, would probably focus on improving the model’s interpretability towards a broader population of patients and its generalization towards it, revolutionizing the diagnosis and management of CVD. Full article

Background: Clostridioides difficile infection (CDI) is one of the most common healthcare-associated infections in the United States with increasing rates in younger patients and those in the community. CDI incidence may also be on the rise in peripartum women. Methods: We conducted a literature review to assess the incidence and outcomes of CDI in the peripartum population and review treatment options. Results: Peripartum patients have a high risk of complications and adverse events associated with CDI. Most patients have been treated with vancomycin or metronidazole; however, cases of patients recurring on standard treatment have been described, with patients having successful outcomes with fidaxomicin or fecal microbiota transplantation (FMT). Probiotics have been shown to be safe in peripartum women; however, the role in preventing primary and secondary CDI has not been studied. Conclusions: Peripartum women that develop CDI are at increased risk for complications. Treatment includes vancomycin, metronidazole, or fidaxomicin or FMT for recurrent cases. Full article

Background and Clinical Significance: Pituitary adenomas, also termed pituitary neuroendocrine tumors, pose a significant risk of hypogonadotropic hypogonadism (HH) after surgical resection, with profound consequences for fertility and sexual function in young patients. Case Presentation: We present the case of a 29-year-old man from rural Japan who developed severe HH and azoospermia following two transsphenoidal resections for a large pituitary adenoma. Despite early engagement with neurosurgery teams, fertility management was delayed by the absence of on-site endocrinology expertise and limited local oncofertility resources. After comprehensive endocrine evaluation and counseling, the patient began combined human chorionic gonadotropin and recombinant follicle-stimulating hormone therapy, resulting in full recovery of sexual function and normalization of semen parameters, ultimately leading to spontaneous conception and the birth of a healthy child. Building on this real-world case, we provide a narrative review of current practical management strategies for HH after pituitary surgery, including the utility of hormone-stimulation tests, Japanese guideline-based subsidy systems, and best-practice approaches to hormonal replacement. Conclusions: This case underscores not only the necessity for early, interdisciplinary collaboration and preoperative counseling but also highlights a rare instance in which a patient with a benign tumor received care that did not address his fertility-related needs, emphasizing that such considerations should be integrated into preoperative counseling even for non-malignant conditions. Strengthening regional oncofertility networks and improving healthcare providers’ awareness of fertility-preservation options remain essential for improving outcomes. Full article

Background/Objectives: Medication-related osteonecrosis of the jaw (MRONJ) is a serious complication in patients treated with antiresorptive or antiangiogenic agents, particularly those with cancer-related comorbidities. This systematic review and meta-analysis aimed to estimate the prevalence of free flap failure in patients undergoing microvascular reconstruction for MRONJ. Methods: A comprehensive literature search was conducted across Medline/PubMed, Scopus, and Web of Science up to 30 January 2025. Inclusion criteria were observational studies involving MRONJ patients treated with free flap reconstruction. Risk of bias was assessed using the Newcastle–Ottawa Scale. The pooled prevalence of free flap failure was calculated using a random-effects model with Freeman–Tukey double arcsine transformation. Results: Twelve studies were included in the quantitative analysis. The fibula free flap was the most frequently used flap. The pooled prevalence of free flap failure was 0.1% (95% CI: 0–2.3%), with no significant associations observed in meta-regression analyses for publication year, patient age, or sex. All included studies were of moderate methodological quality. Conclusions: These findings suggest that free flap reconstruction is a reliable and effective surgical option for managing advanced MRONJ in well-resourced and specialized healthcare settings; however, limitations such as small sample sizes and heterogeneity in protocols must be considered. Further high-quality, multicenter studies are needed to evaluate long-term outcomes and refine perioperative management strategies. Full article

The early detection of neurological and psychiatric disorders is critical for optimizing patient outcomes and improving the efficacy of healthcare delivery. This study presents a novel multiclass machine learning (ML) framework designed to classify epilepsy, migraine, and schizophrenia simultaneously using electroencephalography (EEG) signals. Unlike conventional approaches that predominantly rely on binary classification (e.g., healthy vs. diseased cohorts), this work addresses a significant gap in the literature by introducing a unified artificial neural network (ANN) architecture capable of discriminating among three distinct neurological and psychiatric conditions. The proposed methodology involves decomposing raw EEG signals into constituent frequency subbands to facilitate robust feature extraction. These discriminative features were subsequently classified using a multilayer ANN, achieving performance metrics of 95% sensitivity, 96% specificity, and a 95% F1-score. To enhance clinical applicability, the model was optimized for potential integration into real-time diagnostic systems, thereby supporting the development of a rapid, reliable, and scalable decision support tool. The results underscore the viability of EEG-based multiclass models as a promising diagnostic aid for neurological and psychiatric disorders. By consolidating the detection of multiple conditions within a single computational framework, this approach offers a scalable and efficient alternative to traditional binary classification paradigms. Full article

Background: Healthcare systems are increasingly strained by limited operating room resources and rising demand, a situation intensified by the COVID-19 pandemic. These pressures have resulted in overcrowded surgical departments, prolonged waiting times for elective procedures, worsened patient health outcomes, and increased hospital expenditure costs. Methods: To address these challenges, this study proposes a multi-objective mathematical optimization model as the analytical core of a decision support approach for OR resource allocation. The model considers multiple constrained resources, including OR time, intensive care units, medium care units, and nursing staff, and aims to minimize both elective patients’ waiting times and total incurred costs over a one-week planning horizon. Developed using real hospital data from a large facility in Thailand, the model was implemented in LINGO version 16.0, and a sensitivity analysis was conducted to assess the impact of surgical department priorities and overtime allowances. Results: Compared to current practices, the optimized OR schedule reduced average waiting times by approximately 7% and total costs by 5%, while balancing resource utilization. Conclusions: This study provides a data-driven tool to support hospital resource planning, improve OR efficiency, and respond effectively to future healthcare crises. Full article

Background: The COVID-19 pandemic magnified long-standing health disparities in the United States, particularly among rural, disadvantaged populations. These communities experience greater barriers to healthcare access, a higher prevalence of chronic illness, and increased vaccine hesitancy factors that collectively contribute to poorer health outcomes. Methods: This narrative review examines rural–urban disparities in COVID-19 vaccine uptake and their impact on mortality, with a focus on cardiovascular disease (CVD) outcomes. We synthesized the peer-reviewed literature, CDC data, and U.S. Census reports to assess factors contributing to vaccine hesitancy, vaccination coverage, COVID-19-related mortality, and CVD mortality trends. Results: Rural residents were less likely to initiate COVID-19 vaccination, showed greater vaccine hesitancy, and experienced higher rates of both COVID-19 and CVD mortality. These disparities were further driven by safety concerns surrounding mRNA technology, misinformation, infrastructural barriers, and sociodemographic factors including political affiliation, education, poverty, and religion. Notably, pre-existing CVD increased vulnerability to severe COVID-19 outcomes in rural communities. Conclusions: Expanding vaccination efforts and improving healthcare infrastructure are essential for addressing these widening health inequities. Future public health strategies should prioritize culturally tailored interventions and rural-specific outreach to reduce vaccine hesitancy and improve mortality outcomes in underserved populations. Full article

Tuberculosis (TB) remains a critical public health issue in Johannesburg, South Africa, driven by a complex interplay of individual, social, and structural factors. This study assessed the syndemic relationship between these determinants to understand their collective impact on TB burden and treatment outcomes. A cross-sectional survey was conducted among TB patients attending selected clinics, examining behavioural risks (e.g., smoking, alcohol use, HIV co-infection), social conditions (poverty, overcrowding, stigma), and structural challenges (access to healthcare, migration status). The results revealed a significant co-occurrence of TB and HIV (56.1%), alongside high rates of smoking (33.1%) and alcohol use (45.2%). Unemployment (50.2%), inadequate housing, and limited healthcare access, particularly for undocumented migrants (26.2%), were also prominent. Factor analysis demonstrated a syndemic interaction between behavioural and social determinants, underscoring the compounded vulnerability of affected populations. The findings highlight the necessity of integrating medical interventions with social and structural reforms. Recommendations include TB-HIV co-management, substance abuse programmes, improved housing, and inclusive healthcare access. A multisectoral approach addressing both health and socioeconomic inequalities is critical for comprehensive TB control in urban South African contexts. Full article