Search Results (840)

Background/Objectives: Postoperative cognitive dysfunction (POCD) represents a significant and potentially preventable complication in elderly patients undergoing colorectal cancer surgery, with reported incidence ranging from 2.8% to 62.2% depending on perioperative management strategies and assessment methods. This narrative review synthesizes current evidence on the epidemiology, pathophysiology, risk factors, and prevention strategies for POCD in this vulnerable population. Methods: A comprehensive narrative review was conducted to examine the current literature on POCD in elderly colorectal cancer patients. Evidence was synthesized from published studies addressing epidemiology, assessment tools, risk factors, pathophysiological mechanisms, and prevention strategies, with a particular focus on Enhanced Recovery After Surgery (ERAS) protocols and multicomponent interventions. Results: Advanced age, pre-existing cognitive impairment, frailty, and surgical complexity emerge as key risk factors for POCD. ERAS protocols demonstrate substantial protective effects, reducing POCD incidence from 35% under conventional care to as low as 2.8% in optimized pathways. The pathophysiology involves multifactorial mechanisms, including neuroinflammation, blood–brain barrier disruption, neurotransmitter dysregulation, and oxidative stress, with surgical trauma triggering systemic inflammatory cascades that activate microglial responses within the central nervous system. Evidence-based prevention strategies include preoperative cognitive and frailty screening, minimally invasive surgical techniques, multimodal opioid-sparing analgesia, regional anesthesia, depth-of-anesthesia monitoring, and structured postoperative care bundles adapted from the Hospital Elder Life Program. Conclusions: The integration of comprehensive perioperative cognitive care protocols represents a critical priority as surgical volumes in elderly populations continue to expand globally. Emerging directions include biomarker development for early detection and risk stratification, precision medicine approaches targeting individual vulnerability profiles, and novel therapeutic interventions addressing neuroinflammatory pathways. Standardized assessment tools, multidisciplinary collaboration, and implementation of evidence-based preventive interventions offer substantial promise for preserving cognitive function and improving long-term quality of life in elderly colorectal cancer patients. Full article

Background/Objectives: Missed Nursing Care is a global concern that affects nurses’ well-being and patients’ safety. Despite global recognition of Missed Nursing Care, there is limited synthesized evidence that determines its characteristics in a Middle Eastern context. The purpose of the study is to synthesize the existing evidence about the prevalence of Missed Nursing Care among nurses in hospitals, the types of care missed, and reasons for Missed Nursing Care in the Middle East. Methods: A systematic literature review is conducted by using a comprehensive search in CINAHL, Scopus, and ScienceDirect databases for studies published between 2020 and 2025 and utilizing the MISSCARE Survey. Results: 25 studies met the inclusion criteria. The reported prevalence of Missed Nursing Care ranged between 1.06 and 2.9 out of five, indicating a low to moderate level. Frequent missed care activities included ambulation, hygiene, mouth care, and patient teaching. Contributing factors were staffing shortages, heavy workload, resource limitations, and communication issues. Missed Nursing Care critically affected patients’ outcomes, reduced job satisfaction, and caused moral distress and a higher intent to leave the profession. Conclusions: Missed Nursing Care remains a significant, complex challenge in the Middle East. Therefore, understanding this phenomenon in the region is needed. Collaborative efforts among policymakers, administrators, and nursing leaders are essential to implement targeted interventions, supportive policies, and ongoing research to minimize Missed Nursing Care across the Middle East. Full article

Background/Objectives: Donor kidney function measured by glomerular filtration rate (GFR) is widely used as a selection criterion in kidney transplantation (KT). This study addresses the knowledge gap regarding the relationship between donor GFR at organ procurement and graft function in deceased donor KT. Methods: We retrospectively analyzed 918 deceased donor KTs and compared donor GFRs at procurement and recipient GFRs after KT at hospital discharge and in the one-year follow-up. The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula was used to estimate and compare GFRs. Donor baseline GRF was defined as the last available estimated GRF prior to organ procurement. The Kaplan–Meier analysis was used to estimate recipient and graft survival. Results: The median donor GFR was 92.8 mL/min/1.73 m², while the median recipient GFR at hospital discharge was 37.5 mL/min/1.73 m² (−60% to donor baseline, p < 0.001), increasing to 51.4 mL/min/1.73 m² (+37%, p < 0.001) at one-year follow-up. One-year graft and patient survival rates were 95.3% and 98.1%, respectively. Except for grafts from donors with a GFR < 15 mL/min/1.73 m² due to acute renal failure that resulted in a significantly higher delayed graft function (DGF) rate and inferior graft survival (71.4%), no correlation was observed between baseline GFRs and DGF occurrence nor graft survival. Conclusions: Excellent results can be achieved in KT with subnormal donor GFR. The decision to refuse a kidney offer for KT should not solely be based on donor GFR. Kidneys from donors with very low GFR (<15 mL/min/1.73 m²) may be transplanted, but our observation is based on a very small sample (n = 7) and should therefore be interpreted with caution, particularly given the associated higher risk of DGF and lower graft survival. Full article

Background: Intravascular hemolysis is a common complication in patients undergoing extracorporeal membrane oxygenation (ECMO), with plasma free hemoglobin (pfHb) serving as a biomarker for detection. Without standardized protocols, laboratories face challenges in interpreting and reporting results. Hemolysis indices may enhance reporting accuracy. Methods: This retrospective observational study at University Hospital Center Zagreb included 61 lithium heparin plasma samples from ECMO patients. pfHb was measured using the Harboe method (fHb) and estimated from hemolysis indices on Abbott Alinity c analyzer (efHb). Total and conjugated bilirubin, hemolysis, icterus, and lipemia indices (HIL) were recorded. Method comparison used Passing-Bablok regression and Bland–Altman analysis. An algorithm for pfHb reporting accounting for HIL interferences was developed. Results: Significant differences were observed between methods, with Harboe yielding higher median fHb (261 mg/L) versus efHb (58 mg/L). Regression analysis showed constant negative bias of −91 mg/L (95% CI: −143 to −16) for efHb relative to fHb. Bland–Altman analysis demonstrated wide limits of agreement. Correlation between fHb and efHb was moderate (Spearman’s rho = 0.618, p < 0.001). The delta between methods increased with higher bilirubin concentrations. An algorithm integrating HIL indices with the Harboe method was developed to guide result validation and reporting. Conclusions: Accurate hemolysis assessment in ECMO patients requires careful interpretation, appropriate method selection, and laboratory–clinician collaboration. The proposed algorithm improves the clinical utility of pfHb testing by accounting for analytical interferences and supporting informed decision-making. Full article

Background: Adverse Drug Reactions (ADRs) are a significant public concern because of their impact on healthcare systems. Spontaneous reporting of ADRs is crucial for monitoring drug safety and recognizing possible risk factors. The objective of this study was to characterize ADR reports from the Allergy and Clinical Immunology Unit of the G. Martino University Hospital, Messina, Italy. Methods: A retrospective analysis was conducted, including all ADRs spontaneously reported from patients attending the clinic because of at least one previous ADR, from June 2022 to June 2024. Results: A total of 388 reports were collected, mainly from females (71.1%) and adult patients (84.3%). ADRs were mostly immediate, from antibiotics and anti-inflammatory drugs (61.5%), with a high prevalence of cutaneous and respiratory disorders. Delayed reactions were mostly from endocrine therapies, vaccines, and antiepileptics. Anaphylactic shock was present only in 13 ADR reports (3.35%). A higher risk of developing serious ADRs was found in elderly patients aged ≥65 years (p = 0.012). An original finding was that a positive history of allergies (p = 0.023) and past medical history of ADRs (p = 0.045) were negatively correlated to the occurrence of a serious ADR, probably because patients had been previously followed in an allergy setting and alerted about ADRs. Conclusions: This study underlines the role of ADR follow-up in allergy settings to identify preventable traits and related risk factors; appropriate ADR reporting and collaboration between allergists and pharmacovigilance centers can be a winning strategy for ADR prevention. Full article

Replantation of an amputated finger is a complex microsurgical procedure that is rarely attempted in low-resource settings due to limited infrastructure and expertise. We report a case of complete amputation of a finger in rural Kenya that was successfully replanted during a humanitarian surgical mission. A 28-year-old man sustained a severe crush avulsion agricultural machine injury resulting in the amputation of all ten digits; only one digit was deemed suitable for replantation. The replantation was performed under loupe and microscope magnification by a visiting specialist team in collaboration with local staff. Intraoperatively, bony fixation with Kirschner wires, extensor and flexor digitorum profundus tendon repair, arterial and venous anastomoses, and neurorrhaphy of the digital nerve were achieved. Postoperatively, the finger survived with adequate perfusion. At one-month follow-up, the replanted finger was viable with progressing wound healing and early joint motion; further rehabilitation was arranged to maximize functional recovery. This case, which is, to our knowledge, one of the first documented digital replantations in East Africa, illustrates that successful microsurgical limb salvage is feasible in a non-specialized hospital setting. Our experience underscores that, with proper planning, training, and teamwork, advanced reconstructive procedures like finger replantation can be safely carried out even in resource-constrained hospitals, offering patients in low-income regions outcomes previously achievable only in high-resource centers. Full article

Background/Objectives: Blood thinners (anticoagulants) remain the first line pharmacotherapy for the management of cardiovascular and thromboembolic disorders. The increased utilization of polypharmacy, likely driven by the greater burden of comorbidities, elevates the risk of potential drug–drug interactions (pDDIs) and creates a significant challenge in anticoagulant management. The aim of the study was to assess the prescribing trend and impact of polypharmacy and pDDIs in patients receiving anticoagulant drug therapy in a public hospital providing secondary care. Methods: A cross-sectional observational study was undertaken between January–June 2023. Data from electronic medical records of prescriptions for anticoagulants were collected, analyzed for prescribing patterns, and checked for pDDIs using Micromedex database 2.0^®. Utilizing binary logistic regression, the relationship between polypharmacy and sociodemographic factors was assessed. Multivariate logistic regression analysis served to uncover determinants linked to pDDIs. Results: Of the total 130 patients, females were predominant (58.46%), with a higher prevalence among those aged 61–90 years. Atrial fibrillation emerged as the main clinical reason and apixaban (51.53%) ranked as the top prescribed anticoagulant in our cohort. Among the 766 pDDIs identified, the majority [401 (52.34%)] were categorized as moderate in severity. Polypharmacy was strongly linked to age (p = 0.001), the Charlson comorbidity index (CCI) (p = 0.040), and comorbidities (p = 0.005) in the binary logistic regression analysis. In the multivariable analysis, the number of medications remain a strong predictor of pDDIs (adjusted OR: 30.514, p = 0.001). Conclusions: Polypharmacy and pDDIs were exhibited in a significant segment of cohort receiving anticoagulant therapy, with strong correlations to age, CCI, comorbidities, and the number of medications. A multidimensional approach involving collaboration among healthcare providers assisted by clinical decision support systems can help optimize the management of polypharmacy, minimize the risks of pDDIs, and ultimately enhance health outcomes. Full article

Background/Objectives: Anti-mGluR1 encephalitis is a rare form of autoimmune encephalitis predominantly manifesting as acute/subacute cerebellar ataxia. We describe a newly diagnosed case series from our center and conduct a comprehensive review of reported cases worldwide to compare clinical manifestations, treatment options, and outcomes. Methods: We consecutively identified 11 patients at Peking Union Medical College Hospital, and additionally extracted clinical data from 42 previously published cases identified via PubMed and Google Scholar (search updated to 1 August 2025). Demographics, phenotypes, laboratory findings, imaging, treatment, and outcomes were systematically summarized. This pooled review was not prospectively registered, and extracted data from 21 published articles were analyzed alongside our 11 newly diagnosed cases. Results: The integrated cohort comprised 53 patients with anti-mGluR1 encephalitis, including 29 males and 24 females, with patients reported from Asia (n = 18), North America (n = 11), and Europe (n = 24). The median age at onset was 50 years (IQR 29.5–58.5; range 3–81), with North American patients presenting later than their Asian and European counterparts (median 60 vs. 48 and 45 years, respectively; all p < 0.05). Disease onset was subacute in most cases (58.7%). Comorbid tumors were present in nine patients, most commonly lymphomas. Clinical phenotypes were classified as pure cerebellar syndrome (n = 31), cerebellar ataxia with encephalitic features (n = 20), and non-cerebellar presentations (n = 2). Baseline severity differed across phenotypes (χ² = 35.7, p < 0.001). Regional variability in severity was observed but did not reach significance. CSF analyses revealed pleocytosis in 59% (23/39), elevated protein in 31.3% (5/16), and oligoclonal bands in 52.2% (12/23). MRI abnormalities were detected in 34.7% (17/49) of patients, with 21.9% (7/32) developing cerebellar atrophy on follow-up. Therapeutic strategies varied significantly across regions (p = 0.041), with Asian cohorts more frequently receiving long-term immunosuppression, European cohorts favoring combined regimens, and North American cases relying predominantly on first-line therapies. Overall, 65.9% (29/44) of patients clinically improved, 13.6% (6/44) relapsed and 20.5% (9/44) remained unaffected. Conclusions: Anti-mGluR1 encephalitis presents with significant clinical heterogeneity, ranging from cerebellar-dominant ataxia to neuropsychiatric or non-cerebellar phenotypes, and demonstrates differences in reported age of onset, disease severity, and therapeutic approaches across publication regions. Our findings underscore the importance of early recognition, sustained immunotherapy, and international collaboration to establish standardized, evidence-based management for this rare but disabling disorder. Full article

With emerging improvement in screening and treatment, most patients with prostate cancer (PCa) live for a long period beyond their diagnosis. Erectile dysfunction (ED) and bowel and urinary incontinence have been shown to be the most bothersome side-effects of most PCa treatment options for patients. With increasing long-term survival, most PCa patients face the prospect of experiencing symptoms, side-effects of available treatment options, and diminished quality of life. The objective of the study was to explore the impact of treatment-induced ED on masculinity among Black South African PCa patients. Twenty (20) prostate cancer patients, selected through purposive sampling and receiving some form of treatment at Pietersburg tertiary Hospital, with ages ranging from 67 to 85 years (mean age = 76 years; SD = 5.3), participated in the study. In-depth, individual semi-structured interviews were used to collect data and analyzed through Interpretative Phenomenological Analysis (IPA). The findings indicate that ED threatens or adversely impacts the participants’ perceptions of their sense of masculinity leading to diminished quality of life. The results demonstrate that loss of masculinity brought about by PCa treatment-induced ED is experienced both physically as well as psychologically. The results highlight a need for collaboration between medical and psychological professionals in the management of PCa patients. This is crucial for improving the overall health related quality of life for patients. Full article

Background: Hospitalisation for paediatric oncohaematological diseases entails significant physical and psychological stress, often compromising children’s emotional regulation and daily functioning. In this context, complementary interventions can provide additional support to the clinical work conducted with children and adolescents undergoing treatment, fostering emotional awareness and well-being. This study evaluates the feasibility and perceived benefits of an animal-assisted psychoeducational intervention to enhance emotional coping during hospitalisation. Methods: A single-centre observational study was conducted at Regina Margherita Children’s Hospital in Italy in collaboration with the ZOOM Foundation (Turin, Italy), between September 2023 and May 2025. Sixty patients aged 6–15 years participated in an intervention combining observation of an in-ward aquarium, virtual animal encounters, and completion of a psychoeducational booklet promoting emotional reflection through symbolic identification with animal behaviours. Results: The intervention showed high feasibility and acceptability: 90% of participants (54/60) reported positive emotions and enjoyment, 80% (48/60) found the booklet engaging, and all participants (100%) perceived care and attention from facilitators. The activities fostered engagement, curiosity, and well-being, though their impact on deeper emotional processing appeared limited. Conclusions: Animal-assisted psychoeducational interventions are feasible and well-received in paediatric oncohaematology, offering complementary support to clinical care by promoting emotional resilience and enriching the hospital experience. Full article

Background/Objectives: Postoperative Delirium (POD) is a frequent complication in older patients undergoing elective surgery. Although multicomponent interventions are effective, deficits in interdisciplinary communication and intersectoral collaboration persist. This study developed and evaluated the “Geriatric Delirium Pass (GeDePa)”, a paper-based tool to systematically document risk factors for POD across care settings. Methods: A multi-method design was applied, comprising (i) a structured literature review, (ii) semi-structured expert interviews, and (iii) a standardized online survey utilizing the RAND/UCLA Appropriateness Method (RAM). A total of 21 healthcare professionals (general practitioners, geriatricians, anaesthetists, surgeons, and nurses) were recruited from Salzburg, Austria, and South Tyrol, Italy (2023–2024). Results: Healthcare professionals confirmed the GeDePa’s practical applicability for early POD risk detection across care settings. The expert rating using the RAM Disagreement Index (DI) method deemed all 45 risk factors as sufficiently relevant and, with the exemption of two risk factors (alcohol use, intraoperative complications), feasible. A detailed analysis provided a more differentiated picture, with full consensus reached for only 18 items. Several factors with uncertain consensus (e.g., cognitive impairment and polypharmacy) were retained based on strong evidence in the literature. Others were excluded despite high ratings if they were considered redundant or impractical (e.g., detailed intraoperative complications). In total, 38 of the 45 risk factors were retained. Conclusions: The GeDePa is a feasible and relevant tool for structured delirium risk assessment and enhancing interdisciplinary communication between primary and hospital care. The finalized German and Italian versions are now available and will undergo further testing and implementation in clinical practice. Full article

Background: China is currently developing standards for Food for Special Medical Purposes (FSMP) targeting for oncology patients. However, substantial challenges remain in defining optimal fortification levels of omega-3 polyunsaturated fatty acids (ω-3 PUFAs). Accumulating evidence suggests that ω-3 PUFA intake improves postoperative prognosis by modulating oncological parameters in colorectal cancer (CRC) patients. This meta-analysis aimed to evaluate the therapeutic efficacy of ω-3 PUFA supplementation in enhancing postoperative safety and recovery stability following CRC surgery, to address critical gaps in nutritional interventions for optimizing clinical outcomes. These findings are expected to FSMP standard development, clinical nutrition protocols and product innovation. Methods: A systematic literature search was conducted, in accordance with PRISMA guidelines, across major databases until June 16, 2025. Data were analyzed using RevMan v5.4 (Cochrane Collaboration). Results: Thirty-four randomized controlled trials (RCTs) (n = 2889) were included. Compared to controls, the ω-3 PUFAs group showed significantly increased levels of nutritional markers: total protein (p < 0.00001), albumin (p = 0.001); immunological parameters: CD3⁺/CD4⁺/CD8⁺ T-cells, CD4⁺/CD8⁺ ratio (all p < 0.0001); Karnofsky Performance Status (KPS) scores (p = 0.04); and serum ω-3 PUFA concentrations (p = 0.0004). Significant reductions were observed in inflammatory markers, such as procalcitonin, C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) (p = 0.004 to < 0.00001); and clinical outcomes, such as hospitalization duration (p < 0.00001), infectious complications (p < 0.00001), anastomotic leakage (p = 0.0005), surgical site infections (p = 0.03). No significant intergroup differences were detected for white blood cells, transcription factor activity, mortality, or crypt cell proliferation indices (p = 0.06–0.55). Conclusions: Overall, ω-3 PUFA supplementation significantly attenuates postoperative inflammation, enhances immune function, shortens hospitalization, and improves the quality of life in CRC patients, though without mortality benefit. Notably, post hoc dose–response analysis identified a supplementation range of 0.16–0.30 g/kg/day as a potentially optimal supplementation range for Chinese CRC populations, providing foundational evidence for clinical practice and FSMP standardization. Full article

Blood culture remains the gold standard for identifying bloodstream infections caused by bacteria and fungi. Isolation of the culprit microorganism onto agar plates also facilitates antimicrobial susceptibility testing. The purpose of this study was to determine the contamination rates, pathogen profile, and antimicrobial resistance in a secondary healthcare setting in a two-year timeframe. In this study, data regarding blood cultures of the years 2023 and 2024 were retrospectively analyzed to address the above questions. Blood cultures were incubated for seven days before being discarded as negative. The percentage of positive blood cultures for both years was 14.3%. Most positive cultures contained Gram-positive cocci, with a prevalence of coagulase-negative Staphylococci. In descending order, 72.72% were coagulase-negative Staphylococci, 15.15% were Staphylococcus aureus, and 12.12% were Streptococci. One strain of S. aureus was methicillin-resistant (MRSA), and one strain of Enterococcus faecium was vancomycin-resistant (VRE). Of the Gram-negative rods, 78.3% were Enterobacterales. Of these, Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis were the top pathogens. The remainder comprised eight strains of Pseudomonas aeruginosa, four strains of Acinetobacter baumannii (one pandrug-resistant), three strains of Stenotrophomonas maltophilia, one strain of Sphingomonas paucimobilis, and one strain of Campylobacter jejuni. The isolated fungi comprised Candida parapsilosis, Candida glabrata, and Candida tropicalis. Of the isolated Escherichia coli strains, 39.5% were resistant to ciprofloxacin regardless of origin (outpatient or hospitalized patients). Outpatient samples were taken in a Hemodialysis Unit that collaborates with our laboratory, obtained from patients with fever or other signs of infection. Distinguishing true bacteremia from contamination remains challenging. The contamination rate in our study was quite high at 5.3%. Since there is no dedicated phlebotomy team in our healthcare setting, in light of our results, educational courses have been conducted to demonstrate the best practices for sample collection. Full article

The rapid integration of artificial intelligence (AI) and smart technologies is transforming hospitality operations, yet guest acceptance remains uneven, shaped by utilitarian, experiential, ethical, and cultural evaluations. This study develops and empirically tests a multicomponent framework to explain how these factors jointly influence two behavioral outcomes: whether AI-enabled features affect hotel choice and whether guests are willing to pay a premium. A cross-sectional survey of 689 hotel guests in Tirana, Albania, an emerging hospitality market and rapidly growing tourist destination in the Western Balkans, was analyzed using cumulative link models, partial proportional-odds models, nonlinear and interaction extensions, and binary robustness checks. Results show that prior experience with smart or AI-enabled hotels, higher awareness, and trust in AI, especially trust in responsible data handling, consistently increase both acceptance and willingness to pay. Perceived value, operationalized through the breadth of identified benefits and desired features, also exhibits robust positive effects. In contrast, privacy concerns selectively suppress strong acceptance, particularly financial willingness, while cultural–linguistic fit and support for human–AI collaboration contribute positively but modestly. Interaction analyses indicate that trust can mitigate concerns about reduced personal touch. Open-ended responses reinforce these patterns, highlighting the importance of privacy, human interaction, and staff–AI coexistence. Overall, findings underscore that successful AI adoption in hospitality requires aligning technological innovation with ethical transparency, experiential familiarity, and cultural adaptation. Full article

Heart failure (HF) and chronic kidney disease (CKD) are prevalent conditions in older adults, often coexisting and significantly increasing the risk of hospitalization, cardiovascular events, and mortality. Traditional hospital-based care, while essential for acute management, is often insufficient to ensure continuity of care and optimal long-term outcomes. Home-based care, although promising for improving quality of life and reducing hospital-acquired complications, faces challenges related to treatment adherence, monitoring, and caregiver support. Recent evidence highlights the potential of multidisciplinary, patient-centered care models integrating physicians, nurses, pharmacists, and family caregivers. Technological innovations, including telemedicine, remote monitoring, mobile health applications, and artificial intelligence, have shown efficacy in early detection of clinical deterioration, improving adherence, and reducing cardiovascular events in HF and CKD patients. Structured patient education, caregiver training, and proactive follow-up are key elements to optimize transitions from hospital to home and to improve long-term outcomes, including reduced rehospitalizations and better quality of life. Future care strategies should focus on personalized, integrated approaches that combine technology, education, and multidisciplinary collaboration to address the complex needs of HF and CKD patients, while mitigating healthcare costs and enhancing overall patient well-being. Full article