Search Results (281)

Background: Deep surgical site infections (SSIs) represent a serious complication following abdominal trauma surgery; however, comprehensive risk factor analysis in large trauma populations remains limited. Although surgical site infections are recognized as preventable complications, little is known about the specific risk factors and clinical outcomes associated with deep SSIs in trauma patients at the national level. Methods: A retrospective cohort study analyzed data from the National Trauma Data Bank from 2020–2022, including 1,198,262 trauma patients with complete demographic, injury severity, and surgical procedure data. Deep SSI development, length of hospital stay, intensive care unit utilization, duration of mechanical ventilation, discharge disposition, and in-hospital mortality were assessed. Multivariate logistic regression was used to identify independent risk factors and quantify associations between patient characteristics and deep SSI occurrence. Results: Deep SSIs occurred in 601 patients (0.05%). Affected patients were younger (median 41 vs. 54 years, p < 0.001), predominantly male (73.7% vs. 61.8%, p < 0.001), and exhibited higher injury severity scores (median 17.0 vs. 5.0, p < 0.001). Major abdominal surgery was the strongest independent predictor (OR 3.08, 95% CI: 2.21–4.23, p < 0.001), followed by injury severity score (OR 1.05, 95% CI: 1.04–1.06, p < 0.001) and ICU length of stay (OR 1.04 per day, 95% CI: 1.03–1.05, p < 0.001). Patients with deep SSIs demonstrated dramatically increased hospital stays (89.5% vs. 4.5% exceeding 21 days, p < 0.001), reduced home discharge rates (28.5% vs. 48.9%, p < 0.001), and higher mortality (4.2% vs. 1.2%, p < 0.001). Conclusions: Major abdominal surgery and injury severity are primary risk factors for deep SSIs in trauma patients, with profound impacts on clinical outcomes and healthcare resource utilization. These findings highlight the importance of targeted prevention strategies for high-risk trauma patients undergoing major abdominal procedures and emphasize the significant burden that deep SSIs place on healthcare systems. Full article

This study provides a detailed dataset from two modern homes constructed inside an environmentally controlled chamber. These data are used to carefully calibrate a dynamic thermal simulation model of these homes. The calibrated models show good agreement with measurements taken under controlled conditions. The two case study homes, “The Future Home” and “eHome2”, were constructed within the University of Salford’s Energy House 2.0, and high-quality data were collected over eight days. The calibration process involved updating U-values, air permeability rates, and modelling refinements, such as roof ventilation, ground temperatures, and sub-floor void exchange rates, set as boundary conditions. Results demonstrated a high level of accuracy, with performance gaps in whole-house heat transfer coefficient reduced to 0.5% for “The Future Home” and 0.6% for “eHome2”, falling within aggregate heat loss test uncertainty ranges by a significant amount. The study highlights the improved accuracy of calibrated dynamic thermal simulation models, compared to results from the steady-state Standard Assessment Procedure model. By providing openly accessible calibrated models and a clearly defined methodology, this research presents valuable resources for future building performance modelling studies. The findings support the UK’s transition to dynamic modelling approaches proposed in the recently introduced Home Energy Model approach, contributing to improved prediction of energy efficiency and aligning with goals for zero carbon ready and sustainable housing development. Full article

As the demand for energy-efficient homes continues to rise, the importance of advanced mechanical ventilation systems in maintaining indoor air quality (IAQ) has become increasingly evident. However, challenges related to energy balance, IAQ, and occupant thermal comfort persist. This review examines the performance of mechanical ventilation systems in regulating indoor climate, improving air quality, and minimising energy consumption. The findings indicate that demand-controlled ventilation (DCV) can enhance energy efficiency by up to 88% while maintaining CO₂ concentrations below 1000 ppm during 76% of the occupancy period. Heat recovery systems achieve efficiencies of nearly 90%, leading to a reduction in heating energy consumption by approximately 19%. Studies also show that employing mechanical rather than natural ventilation in schools lowers CO₂ levels by 20–30%. Nevertheless, occupant misuse or poorly designed systems can result in CO₂ concentrations exceeding 1600 ppm in residential environments. Hybrid ventilation systems have demonstrated improved thermal comfort, with predicted mean vote (PMV) values ranging from –0.41 to 0.37 when radiant heating is utilized. Despite ongoing technological advancements, issues such as system durability, user acceptance, and adaptability across climate zones remain. Smart, personalized ventilation strategies supported by modern control algorithms and continuous monitoring are essential for the development of resilient and health-promoting buildings. Future research should prioritize the integration of renewable energy sources and adaptive ventilation controls to further optimise system performance. Full article

We surveyed the air quality conditions in 18 homes with gas stoves for PM_2.5, CO₂, NO₂ and CO using calibrated low-cost sensors. In each home, participants were asked to cook as usual, but to record their cooking activities and mitigation efforts (windows, ventilation fans, etc.). All homes showed enhanced pollutants during, and immediately after, times of cooking or stove use. For each home, we quantified the minutes per day and minutes per minute of cooking over known health thresholds for each pollutant. On average, homes exhibited 38 min per day over one or more of these thresholds, with PM_2.5 and NO₂ being the pollutants of greatest concern. Six homes had much higher occurrences over the health thresholds, averaging 73 min per day. We found an average of 1.0 min over one or more of the health thresholds per minute of cooking when no mitigation was used, whereas when mitigation was used (filtration or vent fan), this value was reduced by 34%. We further investigated several mitigation methods including natural diffusion, a commercial HEPA filter unit, a commercial O₃ scrubber and a ventilation fan. We found that the HEPA unit was highly effective for PM_2.5 but had no impact on any of the gaseous pollutants. The O₃ scrubber was moderately effective for NO₂ but had little impact on the other pollutants. The ventilation fan was highly effective for all pollutants and reduced the average pollutant lifetime significantly. Under controlled test conditions, the pollutant lifetime (or time to reach 37% of the original concentration), was reduced from an average of 45 min (with no ventilation) to 7 min. While no commercial filter showed efficacy for both PM_2.5 and NO₂, the fact that each could be removed individually suggests that a combined filter for both pollutants could be developed, which would significantly reduce health impacts in homes with gas stoves. Full article

The type of non-professional or professional support received affects the quality of life of the patient and their caregivers. Social support is the type of interaction that is taken by the patient and his caregivers in a problematic, difficult, stressful, or critical situation. Aim: The aim of the study was to assess the impact of social support on the functioning of patients under nursing home care. Material and methods: The study included 148 chronically ill patients under home nursing care. The study used the diagnostic survey method; the research technique was a questionnaire containing basic data about the respondent and the Social Support Scale (SWS) by Krystyna Kmiecik-Baran. Results: The need to continue the causal treatment at home means that the main source of support for care beneficiaries are nurses who provide medical services at the patient’s home, supported by doctors and family members of the patient. According to patients’ subjective assessment of the support they received from nurses, patients rated the informational support provided by nurses highest at 14.3 points and emotional support at 13.3 points (SD 1.776). on a scale where the maximum score was 16 points. In the opinion of the surveyed patients, the value-added support provided was the lowest-rated category by patients, 9.74 points (SD 2.505). Instrumental support was also rated very poorly by the respondents (10.17 points (SD 2.069). In each category, there was no statistically significant difference at the p < 0.05 level in the respondents’ evaluation, which means that the expressed opinion on each type of support from the highest to the lowest evaluation: informational, emotional, instrumental, and evaluative—overlapped in the patient group and the family group. Conclusions: Patients under home care highly appreciated the support provided to them by the nursing staff. Social support for a chronically ill person who requires constant care and care by the nursing staff is a form of direct impact that relieves stress and tension, minimizes the effects of the disease, directly affects the course of treatment and care, and prevents stigmatization. Full article

Despite spending a substantial proportion of their time indoors, the mental health effects of indoor air pollution on children and adolescents remain inadequately explored. This study aimed to elucidate the spatiotemporal variations and sociodemographic inequalities in exposure to multiple indoor pollutants and to assess their potential associations with depressive symptoms among school-aged children in Beijing. Using real-time portable monitors, concentrations of fine particulate matter (PM_2.5), coarse particulate matter (PM₁₀), carbon dioxide (CO₂), formaldehyde (HCHO), total volatile organic compounds (TVOC), temperature, and humidity in classrooms and bedrooms were measured during both weekdays and weekends. Moreover, substantial spatiotemporal heterogeneity was observed. It was found that concentrations of PM_2.5, PM₁₀, and TVOC peaked in classrooms during weekday daytime, while CO₂ levels were highest in bedrooms on weekend nights. Exposure levels were notably higher among children whose mothers had lower educational attainment and those living in recently renovated homes, indicating marked socio-demographic disparities. In multivariable logistic regression models, indoor exposure to CO₂ and TVOC was significantly associated with increased odds of depressive symptoms. These findings highlight the critical need to improve indoor air quality through enhanced ventilation and the mitigation of emissions from indoor sources, particularly within school and residential settings. The results offer valuable empirical evidence to guide the development of targeted environmental interventions and public health policies designed to support and enhance the psychological well-being of children. Full article

Background/Objectives: Weaning failure remains a major challenge in patients requiring prolonged mechanical ventilation. This study aimed to describe outcomes in patients ventilated for >14 days and identify specific predictors of weaning success. Methods: A retrospective analysis of 88 patients from the Soroka University Medical Center database was conducted. Outcomes in the successful weaning (SW) group were compared to those in the failed weaning (FW) group. Predictors of weaning success were analyzed using multivariate logistic regression. Results: Forty patients (45%) were successfully weaned and discharged to rehabilitation or home. In-hospital mortality was 28%, with deaths occurring exclusively in the FW group (p < 0.001). One-month and one-year post-discharge all-cause mortality rates were 11% and 28%, respectively, with no group differences. Hypoalbuminemia and the Sequential Organ Failure Assessment (SOFA) score at admission significantly predicted weaning failure (odds ratio: 5.71 and 0.54, respectively). Demographics, comorbidities, ventilation indications, admission data, and diuretic use were not predictive. Conclusions: Hypoalbuminemia and the SOFA score at admission were key predictors of weaning success in patients ventilated for more than 2 weeks. Age and comorbidities were not significant. Prospective studies on albumin supplementation and high-protein diets are warranted to assess their impact on weaning outcomes. Full article

This case series presents four pediatric patients who developed tracheal complications after prolonged invasive mechanical ventilation. The first case involved an 11-year-old girl with severe hypoxic encephalopathy who developed extensive ulcerative granulation tissue obstructing 60% of the tracheal lumen. The second case was that of a 6-year-old boy with ACTA1-related nemaline myopathy who experienced recurrent tracheal obstruction due to granulomatous tissue formation. The third case involved a 9-year-old boy with hydroxyglutaric aciduria and a large plug obstructing his trachea. The last case involved a 19-year-old female with lissencephaly who developed a tracheoesophageal fistula. These cases highlight the importance of regular surveillance and early intervention in managing tracheal complications in pediatric patients with complex chronic conditions requiring long-term mechanical ventilation. The authors emphasize the need for specialized care and routine endoscopic examinations in order to prevent and address potentially life-threatening complications in this vulnerable patient population. Full article

Background: Transcutaneous CO₂ (TcCO₂) measurement is widely used in the diagnosis and monitoring of ventilatory failure. Robust data on the success rates of measurement is scant. We aimed to discern the factors affecting the success rate of TcCO₂ measurement in a regional LTV service. Methods: Patients undergoing TcCO₂ measurement between October 2019 and January 2022 were identified retrospectively. Notes were analysed for basic demographics, indications for TcCO₂ measurement, measurement outcome, device used (Radiometer TCM5 or Sentec, based on availability), setup (self, carer, or clinician), inpatient or domiciliary study, and number of TcCO₂ measurement attempts occurred. Statistical comparisons were made by Fisher’s exact test. Results: We identified 435 recording events on 288 patients, mean age of 53, and 56% were males. A total of 189 (66%) had a neuromuscular disorder (NMD). The commonest indications for TcCO₂ measurement were ‘assessing ventilatory failure’ (43%) in treatment-naïve patients and ‘adequacy of ventilation therapy due to persistent symptoms’ (26%) in those established on LTV. Over 80% of our recording events were applied by patients or their carers. Overall, TCM5 devices had statistically higher successful recording rates (197/268, 73.5%) than Sentec (100/165, 60.6%) [p = 0.0056]. In domiciliary studies, TCM5’s success rate of 187/253 (73.9%) versus Sentec’s 94/154 (61.0%) was significantly better [p = 0.0079]. The success rate of each measurement attempt ranged between 62.9 and 67.0%, with up to three attempts on each subject. Conclusions: Home TcCO₂ is helpful in managing those with respiratory failure. Repeating tests after initial failure of recording is worthwhile. There may be differences in performance across devices which warrants further study. Full article

Current research on aged housing prioritizes community planning and environmental enhancement over older adults’ needs, creating a retrofit mismatch amid population aging. To investigate the relationship between indoor environmental quality and residential satisfaction among elderly occupants, this study examines 72 households in aged residential buildings, analyzing four environmental indicators (thermal, lighting, acoustic environments, and air quality). The environmental measurements reveal that 81.9% of thermal environment parameters fall below the ASHRAE-55 comfort range, with winter average temperatures reaching only 13.94 °C. Insufficient illumination exists in kitchen and bedroom areas. Lifestyle patterns including infrequent air conditioning use (87%) and window ventilation substituting range hoods (32%) may deteriorate thermal comfort and air quality. An ordered logistic regression analysis demonstrates significant correlations between all four environmental indicators and elderly satisfaction levels. Thermal comfort emerges as the priority focus for aging-adapted retrofitting. Air quality improvement shows particularly significant potential for enhancing residential satisfaction. Although prolonged window opening (73%) exacerbates low-temperature/high-humidity conditions and noise exposure, it still contributes positively to overall satisfaction. This research provides crucial insights for aligning aged residential retrofitting with home-based elderly care requirements, promoting housing development that better accommodates the lifestyle patterns of older populations, thereby improving quality of life for aging-in-place residents. Full article

Background/Objectives: The present study aimed to analyze changes in symptom intensity during the recovery period of COVID-19 survivors and patients with post-COVID syndrome. Methods: Initially, we described a new remote patient monitoring system to track the intensity of specific symptoms in individuals’ home environments. Remote patient monitoring (RPM) was implemented over 15 days in a cohort of 133 individuals aged 20 to 78 years, divided into four groups: mild (MG, n = 40), Hospital Discharge Without Invasive Mechanical Ventilation (WIMV, n = 40), Hospital Discharge With Invasive Mechanical Ventilation (IMV, n = 13), and reinfected (RG, n = 40). Results: The most prevalent symptoms reported across all groups, based on average intensity, were shortness of breath, fatigue, cough, headache, and body pain. The WIMV group exhibited the highest average intensities in six symptoms (p < 0.01), while the IMV group reported the highest averages in four symptoms (p < 0.05). Fatigue was the symptom with the highest overall intensity, followed by memory lapses. The hospitalized groups demonstrated the highest intensities and most persistent symptoms (p < 0.05). Blood pressure was significantly higher in the MG group compared to the RG group (p < 0.0001), although all values remained within the normal range. Conclusions: These results provide novel insights, revealing distinct differences in the symptom profiles among the studied groups. These findings hold significant implications for developing more personalized care strategies and informing future pandemic preparedness and response efforts. Full article

Background/Objectives: Home non-invasive ventilation use is the primary treatment for improving respiratory function in people with chronic hypercapnic respiratory failure. Non-invasive ventilation has also been studied to understand users’ perspectives. However, no studies have been conducted on how users adapt to non-invasive ventilation in their homes from the early phase of their diagnosis as a long-term utility. Methods: The study employed a descriptive qualitative design guided by Roy’s adaptation model. A purposive sample was used. People with chronic hypercapnic respiratory failure who had used NIV at home for a minimum of six months would be eligible. They were interviewed at a sleep and assisted ventilation centre. Their interviews were audio recorded before proceeding with transcription. Each transcript was thematically analysed. Results: Twenty participants were included in the study, from which six themes emerged. They experienced a common transition, from denying the need for non-invasive ventilation to integrating them into their daily lives at home. Throughout this process, they had emotional turmoil, faced difficulties in keeping their masks on, and improved sleep quality. They also adjusted their social interactions before fully accepting the use of non-invasive ventilation. Their coping strategies in their role functions at home and social interaction were also narrated. Their family members were pivotal in their adaptation period. Conclusions: Gaining insight into individuals’ adaptation experiences can facilitate early identification of potential challenges faced by new users of non-invasive ventilation. This study calls for healthcare professionals to assess users’ understanding of long-term commitment and their living conditions early for a successful NIV adaptation. Full article

Background: Kyphoscoliosis is a restrictive thoracic disorder frequently associated with chronic respiratory failure. While home non-invasive ventilation (NIV) improves short-term outcomes, long-term mortality predictors remain underexplored in this context. Methods: This retrospective cohort study evaluated 88 kyphoscoliosis patients with chronic respiratory failure who were initiated on home-based NIV between 2008 and 2018 at a tertiary ICU outpatient clinic. The demographic, clinical, and laboratory data were analyzed. Survival was assessed using Kaplan–Meier analysis, and independent predictors of mortality were identified via Cox regression. Results: Among the 88 patients (52% male), 28 (32%) died during long-term follow-up. Age, BMI, pulmonary function, and arterial blood gas values were similar between survivors and non-survivors. Non-survivors had significantly higher mMRC dyspnea scores, were more likely to be active smokers, and had a higher prevalence of coronary artery disease (CAD) (p = 0.015). The Kaplan–Meier survival analysis revealed significantly lower survival in patients with CAD (p = 0.021) and active smokers (p = 0.034). Cox regression analysis indicated that the presence of CAD (HR: 5.69, 95% CI: 1.34–24.08, p = 0.018) and hospital admission after the initiation of home-based NIV therapy (HR: 1.97, 95% CI: 1.01–3.85, p = 0.040) increased the risk of mortality. Conversely, a higher pH at the last outpatient visit was associated with improved survival (HR: 0.50, 95% CI: 0.00–0.692, p = 0.003). Conclusions: CAD, pH value, and increased ICU admissions after the initiation of home-based NIV are predictors of mortality in kyphoscoliosis patients. The study results highlight reduced survival associated with the presence of coronary artery disease and smoking, emphasizing the importance of routine cardiovascular assessment and close clinical follow-up in this high-risk population. Full article

The hospital-at-home (HaH) model offers hospital-level care within patients’ homes and has proven effective for managing conditions such as pneumonia. The point-of-care ultrasonography (PoCUS) is a key diagnostic tool in this model, especially when traditional imaging modalities are unavailable. This review explores how PoCUS can be optimized to manage pneumonia in HaH settings, focusing on its diagnostic accuracy in patients with comorbidities, differentiation from mimickers, and role in assessing disease severity. Pulmonary comorbidities, such as heart failure and interstitial lung disease (ILD), can complicate lung ultrasound (LUS) interpretation. In heart failure, combining lung, cardiac, and venous assessments (e.g., IVC collapsibility, VExUS score) improves diagnostic clarity. In ILD, distinguishing chronic changes from acute infections requires attention to B-line patterns and pleural abnormalities. PoCUS must differentiate pneumonia from conditions such as atelectasis, lung contusion, cryptogenic organizing pneumonia, eosinophilic pneumonia, and neoplastic lesions—many of which present with similar sonographic features. Serial LUS scoring provides useful information on pneumonia severity and disease progression. Studies, particularly during the COVID-19 pandemic, show correlations between worsening LUS scores and poor outcomes, including increased ventilator dependency and mortality. Furthermore, LUS scores correlate with inflammatory markers and gas exchange metrics, supporting their prognostic value. In conclusion, PoCUS in HaH care requires clinicians to integrate multi-organ ultrasound findings, clinical context, and serial monitoring to enhance diagnostic accuracy and patient outcomes. Mastery of LUS interpretation in complex scenarios is crucial to delivering personalized, high-quality care in the home setting. Full article

Objective: To assess the experience and educational needs of hospital staff who care for pediatric patients with tracheostomies. Study Design: Staff were surveyed and participated in semi-structured, facilitated focus groups regarding their experiences caring for children with tracheostomies and their educational needs. Survey data were analyzed using descriptive statistics and Kruskal–Wallis nonparametric tests. Focus groups were transcribed verbatim and coded for thematic analysis. Results: Pediatric advanced practice providers, nurses, physicians, and respiratory therapists (152/353, 43%) completed the survey. Within the last year, 76% of staff had worked with a tracheostomy-dependent child. However, up to 59% of staff had not performed at least one tracheostomy skill (e.g., tracheostomy site assessment, tube change, etc.). Staff reported the least confidence in changing tracheostomy tubes and using home ventilators and rated these skills as most important for additional education. Forty-three staff members participated in 1 of 10 focus groups. Three themes were identified: building staff competencies in tracheostomy care, promoting the caregiver development of tracheostomy skills, and building caregiver preparedness for home life. Staff emphasized the need for participating in emergency simulations and developing their skills to better prepare caregivers for home life. They indicated a need to streamline the discharge process, gain knowledge of community resources, and develop a standardized team to provide discharge teaching. Conclusions: Hospital staff responsible for providing care to tracheostomy-dependent pediatric patients had limited opportunities to learn and maintain their skills. Survey and focus group findings can guide development of continuing education to optimize the care of tracheostomy-dependent children. Full article