Search Results (2,873)

Hospital in the Home (HITH) programs are emerging as a key pillar of smart city healthcare infrastructure, leveraging technology to extend care beyond traditional hospital walls. The global healthcare sector has been conceptualizing the notion of a care without walls hospital, also called HITH, where virtual care takes precedence to address the multifaceted needs of an increasingly aging population grappling with a substantial burden of chronic disease. HITH programs have the potential to significantly reduce hospital bed occupancy, enabling hospitals to better manage the ever-increasing demand for inpatient care. Although many health providers and hospitals have established their own HITH programs, there is a lack of research that provides healthcare executives and HITH program managers with management models and frameworks for such initiatives. There is also a lack of research that provides strategies for improving HITH management in the health sector. To fill this gap, the current study ran a systematic literature review to explore state-of-the-art with regard to this topic. Out of 2631 articles in the pool of this systematic review, 20 articles were deemed to meet the eligibility criteria for the study. After analyzing these studies, nine management models were extracted, which were then categorized into three categories, namely, governance models, general models, and virtual models. Moreover, this study found 23 strategies and categorized them into five groups, namely, referral support, external support, care model support, technical support, and clinical team support. Finally, implications of findings for practitioners are carefully provided. These findings provide healthcare executives and HITH managers with practical frameworks for selecting appropriate management models and implementing evidence-based strategies to optimize program effectiveness, reduce costs, and improve patient outcomes while addressing the growing demand for home-based care. Full article

Background/Objectives: Accurate diagnosis of thyroid cancer is critical but challenging due to overlapping ultrasound (US) features of benign and malignant nodules. This study aimed to evaluate the diagnostic performance of non-invasive and minimally invasive US techniques, including B-mode US, shear wave elastography (SWE), color Doppler, superb microvascular imaging (SMI), and TI-RADS, in patients with suspected thyroid lesions and to assess their reliability and cost effectiveness compared with fine needle aspiration (FNA) biopsy. Methods: A prospective, single-center study (October 2023–February 2025) enrolled 300 patients with suspected thyroid cancer at a Spanish tertiary hospital. Of these, 296 patients with confirmed diagnoses underwent B-mode US, SWE, Doppler, SMI, and TI-RADS scoring, followed by US-guided FNA and Bethesda System cytopathology. Lasso-penalized logistic regression and a bootstrap analysis (1000 replicates) were used to develop diagnostic models. A utility function was used to balance diagnostic reliability and cost. Results: Thyroid cancer was diagnosed in 25 patients (8.3%). Elastography combined with SMI achieved the highest diagnostic performance (Youden index: 0.69; NPV: 97.4%; PPV: 69.1%), outperforming Doppler-only models. Intranodular vascularization was a significant risk factor, while peripheral vascularization was protective. The utility function showed that, when prioritizing cost, elastography plus SMI was cost effective (α < 0.716) compared with FNA. Conclusions: Elastography plus SMI offers a reliable, cost-effective diagnostic rule for thyroid cancer. The utility function aids clinicians in balancing reliability and cost. SMI and generalizability need to be validated in higher prevalence settings. Full article

Background: Mediastinal staging plays a critical role in guiding treatment decisions for non-small cell lung cancer (NSCLC). While mediastinoscopy has been the gold standard for assessing mediastinal lymph node involvement, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has emerged as a minimally invasive alternative with comparable diagnostic accuracy. This systematic review evaluates the diagnostic performance, safety, cost-effectiveness, and feasibility of EBUS-TBNA versus mediastinoscopy for mediastinal staging. Methods: A systematic literature review was conducted in accordance with PRISMA guidelines, including searches in Medline, Scopus, EMBASE, and Cochrane databases for studies published from 2010 onwards. A total of 1542 studies were identified, and after removing duplicates and applying eligibility criteria, 100 studies were included for detailed analysis. The extracted data focused on sensitivity, specificity, complications, economic impact, and patient outcomes. Results: EBUS-TBNA demonstrated high sensitivity (85–94%) and specificity (~100%), making it an effective first-line modality for NSCLC staging. Mediastinoscopy remained highly specific (~100%) but exhibited slightly lower sensitivity (86–90%). EBUS-TBNA had a lower complication rate (~2%) and was more cost-effective, while mediastinoscopy provided larger biopsy samples, essential for molecular and histological analyses. The need for general anaesthesia, longer hospital stays, and increased procedural costs make mediastinoscopy less favourable as an initial approach. Combining both techniques in select cases enhanced overall staging accuracy, reducing false negatives and improving diagnostic confidence. Conclusions: EBUS-TBNA has become the preferred first-line mediastinal staging method due to its minimally invasive approach, high diagnostic accuracy, and lower cost. However, mediastinoscopy remains crucial in cases requiring posterior mediastinal node assessment or larger tissue samples. The integration of both techniques in a stepwise diagnostic strategy offers the highest accuracy while minimizing risks and costs. Given the lower hospitalization rates and economic benefits associated with EBUS-TBNA, its widespread adoption may contribute to more efficient resource utilization in healthcare systems. Full article

Heart failure (HF) is a major global health challenge, characterized by high morbidity, mortality, and frequent hospital readmissions. Despite the advent of guideline-directed medical therapies (GDMTs), the burden of HF continues to grow, necessitating a shift toward comprehensive, multidisciplinary care models. Heart Failure Disease Management Programs (HF-DMPs) have emerged as structured frameworks that integrate evidence-based medical therapy, patient education, telemonitoring, and support for social determinants of health to optimize outcomes and reduce healthcare costs. This review outlines the key components of HF-DMPs, including patient identification and risk stratification, pharmacologic optimization, team-based care, transitional follow-up, remote monitoring, performance metrics, and social support systems. Incorporating tools such as artificial intelligence, pharmacist-led titration, and community health worker support, HF-DMPs represent a scalable approach to improving care delivery. The success of these programs depends on tailored interventions, interdisciplinary collaboration, and health equity-driven strategies. Full article

Background and Objectives: Hysterectomy is a common non-obstetric procedure. Minimally invasive techniques, such as laparoscopy and robot-assisted surgery, have replaced open surgery for benign gynecologic conditions. Robotic surgery offers reduced blood loss and shorter hospital stays but is limited by high costs. Articulating laparoscopic instruments aim to replicate robotic dexterity cost-effectively. However, comparative data on these two approaches in hysterectomy are limited. Materials and Methods: This multicenter study analyzed the outcomes of hysterectomies for benign gynecological diseases using articulating laparoscopic instruments (prospectively recruited) and robot-assisted surgery (retrospectively reviewed). The surgeries were performed by minimally invasive gynecological surgeons in South Korea, Japan, and Taiwan. The baseline characteristics, operative details, and outcomes, including operative time, blood loss, complications, and hospital stay, were compared. Statistical significance was set at p < 0.05. Results: A total of 151 patients were analyzed, including 67 in the articulating laparoscopy group and 84 in the robot-assisted group. The operating times were comparable (114.9 vs. 119.9 min, p = 0.22). The articulating group primarily underwent dual-port surgery (79.1%), whereas the robot-assisted group required four or more ports in 71.4% of the cases (p < 0.001). Postoperative complications occurred in both groups, without a significant difference (9.0% vs. 3.6%, p = 0.17). No severe complications or significant differences in the 30-day readmission rates were observed. Conclusions: Articulating laparoscopic instruments provide outcomes comparable to robot-assisted surgery in hysterectomy while reducing the number of ports required. Further studies are needed to explore the learning curve and long-term impact on surgical outcomes. Full article

Background: Minimally invasive cardiac surgery (MICS) via right minithoracotomy is a safe, reproducible approach with excellent outcomes and reduced costs compared to median sternotomy. Despite careful patient selection, conversion to sternotomy occurs in 1–3% of cases and is associated with significantly higher morbidity and mortality. Small body habitus, particularly a short anteroposterior (AP) diameter, may increase the risk of conversion, but this has not been previously studied. This study aims to identify preoperative factors associated with conversion to improve patient selection for MICS. As cardiovascular surgery becomes increasingly personalized, identifying anatomical factors that predict technical complexity is essential. Methods: This retrospective study included 254 adult patients who underwent elective MICS between 2015 and 2024 at a tertiary hospital. Patient characteristics, computed tomography (CT) scans, intraoperative parameters, and postoperative outcomes were reviewed. AP diameter was defined as the distance from the posterior sternum to the anterior vertebral body at the mitral valve level on CT. Statistical analyses included Mann−Whitney and Fisher’s exact/chi-square tests. Results: Conversion to sternotomy occurred in 1.6% of patients (n = 4). All converted patients were female. The converted group had a significantly shorter median AP diameter (100 mm vs. 124 mm, p = 0.020). Conversion was associated with higher rates of stroke and infection (25.0% vs. 0.8%, p = 0.047 for both), but no significant differences in hospital stay, bleeding, or renal failure. Conclusions: An AP diameter of less than 100 mm was associated with a higher risk of conversion to sternotomy in MICS. Incorporating simple, reproducible preoperative imaging metrics into surgical planning may advance precision-guided cardiac surgery and optimize patient outcomes. Full article

Nosocomial infections caused by ESKAPE pathogens represent a significant burden to global health. These pathogens may exhibit multidrug resistance (MDR) mechanisms, of which mechanisms such as efflux pumps and biofilm formation are gaining significant importance. Multidrug resistance mechanisms in ESKAPE pathogens have led to an increase in the effective costs in health care and a higher risk of mortality in hospitalized patients. These pathogens utilize antimicrobial efflux pump mechanisms and bacterial biofilm-forming capabilities to escape the bactericidal action of antimicrobials. ESKAPE bacteria forming colonies demonstrate increased expression of efflux pump-encoding genes. Efflux pumps not only expel antimicrobial agents but also contribute to biofilm formation by bacteria through (1) transport of molecules and transcription factors involved in biofilm quorum sensing, (2) bacterial fimbriae structure transport for biofilm adhesion to surfaces, and (3) regulation of a transmembrane gradient to survive the difficult conditions of biofilm microenvironments. The synergistic role of these mechanisms complicates treatment outcomes. Given the mechanistic link between biofilms and efflux pumps, therapeutic strategies should focus on targeting anti-biofilm mechanisms alongside efflux pump inactivation with efflux pump inhibitors. This review explores the molecular interplay between efflux pumps and biofilm formation, emphasizing potential therapeutic strategies such as efflux pump inhibitors (EPIs) and biofilm-targeting agents. Full article

Background: Cardiac implantable electronic device (CIED) infections necessitate extraction and subsequent pacing interventions. Conventional methods after removing the infected CIED system involve temporary or semi-permanent pacing followed by delayed permanent pacemaker (PPM) implantation. Leadless pacemakers (LPs) may offer an alternative, allowing immediate PPM implantation without increasing infection risks. Our objective is to evaluate the safety and cost-effectiveness of LP implantation during the same procedure of CIED extraction, compared to conventional two-stage approaches. Methods: Pacemaker-dependent patients with systemic or pocket infection undergoing device extraction and LP implantation during the same procedure at Sheba Medical Center, Israel, were compared to a historical group of patients undergoing a semi-permanent (SP) pacemaker implantation during the procedure, followed by a permanent pacemaker implantation. Results: The cohort included 87 patients, 45 undergoing LP implantation and 42 SP implantation during the extraction procedure. The LP group demonstrated shorter intensive care unit stay (1 ± 3 days vs. 7 ± 12 days, p < 0.001) and overall hospital days (11 ± 24 days vs. 17 ± 17 days, p < 0.001). Rates of infection relapse and one-year mortality were comparable between groups. Economic analysis revealed comparable total costs, despite the higher initial expense of LPs. Conclusions: LP implantation during CIED extraction offers significant clinical and logistical advantages, including reduced hospital stays and streamlined treatment, with comparable safety and cost-effectiveness to conventional approaches. Full article

Objective: This study aimed to develop a performance evaluation index system for a district-level public hospital in Chongqing, China, based on Diagnosis-Related Groups (DRGs), to provide a benchmark for performance assessment in similar hospitals. The system was constructed using a literature analysis, the Delphi method, and the Analytic Hierarchy Process (AHP) to identify and weight relevant indicators. Results: The evaluation system consists of three primary indicators and eighteen secondary indicators. Key secondary indicators include the Case Mix Index (CMI), cost consumption index, low-risk group mortality rate, the proportion of patients with three- or four-level surgeries at discharge, and the proportion of medical service revenue to medical income. In 2020, significant improvements were observed in several indicators, such as a decrease in the low-risk group mortality rate to 0% and increases in the proportion of patients with three- or four-level surgeries and CMI by nearly 10% and 13%, respectively. Conclusions: This study successfully developed a comprehensive and scientifically sound performance evaluation index system for a district-level public hospital in Chongqing. The system has proven effective in objectively assessing inpatient medical care performance and providing valuable guidance for improving healthcare services in similar settings. Full article

Cervical cancer remains a major health burden among women in sub-Saharan Africa, where screening is often limited. Persistent high-risk human papillomavirus (HR-HPV) infection is the principal cause, highlighting the need for accurate molecular diagnostics. This cross-sectional study evaluated the analytical performance of one mRNA assay, APTIMA^® HPV assay (APTIMA mRNA), and two DNA-based assays, the Abbott RealTime High Risk HPV assay (Abbott DNA) and Seegene Allplex™ II HPV28 assay (Seegene DNA), in 527 cervical samples from a South African tertiary hospital, focusing on 14 shared HR-HPV genotypes. Seegene DNA yielded the highest detection rate (53.7%), followed by Abbott DNA (48.2%) and APTIMA mRNA (45.2%). APTIMA mRNA showed a strong agreement with Abbott DNA (87.9%, κ = 0.80), 89.9% sensitivity, 91.2% NPV, and the highest accuracy (AUC = 0.8804 vs. 0.8681). The agreement between APTIMA mRNA and Seegene DNA was moderate (83.4%, κ = 0.70), reflecting target differences. Many DNA-positive/mRNA-negative cases likely represent transient infections, though some may be latent with reactivation potential, warranting a follow-up. In resource-constrained settings, prioritizing transcriptionally active infections through mRNA testing may enhance screening efficiency and reduce burden. Scalable, cost-effective assays with strong clinical utility are essential for broadening access and improving cervical cancer prevention. Further studies should assess the integration of mRNA testing into longitudinal screening algorithms. Full article

Background/Objectives: Antibiotic use is common among hospitalized pediatric patients. However, inappropriate use, including excessive use of Watch antibiotics, can contribute to antimicrobial resistance, adverse events, and increased healthcare costs. Consequently, there is a need to continually assess their usage among this vulnerable population. This was the objective behind this study. Methods: The medical records of all pediatric patients (under 12 years) admitted and treated with antibiotics at a Ghanaian Teaching Hospital between January 2022 and March 2022 were extracted from the hospital’s electronic database. The prevalence and appropriateness of antibiotic use were based on antibiotic choices compared with current guidelines. Influencing factors were also assessed. Results: Of the 410 admitted patients, 319 (77.80%) received at least one antibiotic. The majority (68.65%; n = 219/319) were between 0 and 2 years, and males (54.55%; n = 174/319). Ceftriaxone was the most commonly prescribed antibiotic (20.69%; n = 66/319), and most of the systemic antibiotics used belonged to the WHO Access and Watch groups, including a combination of Access and Watch groups (42.90%; n = 136/319). Neonatal sepsis (24.14%; n = 77/319) and pneumonia (14.42%; n = 46/319) were the most common diagnoses treated with antibiotics. Antibiotic appropriateness was 42.32% (n = 135/319). Multivariate analysis revealed ceftriaxone prescriptions (aOR = 0.12; CI = 0.02–0.95; p-value = 0.044) and surgical prophylaxis (aOR = 0.07; CI = 0.01–0.42; p-value = 0.004) were associated with reduced antibiotic appropriateness, while a pneumonia diagnosis appreciably increased this (aOR = 15.38; CI = 3.30–71.62; p-value < 0.001). Conclusions: There was high and suboptimal usage of antibiotics among hospitalized pediatric patients in this leading hospital. Antibiotic appropriateness was influenced by antibiotic type, diagnosis, and surgical prophylaxis. Targeted interventions, including education, are needed to improve antibiotic utilization in this setting in Ghana and, subsequently, in ambulatory care. Full article

Patient blood management (PBM) is a multidisciplinary approach aimed at improving patient outcomes through targeted anemia treatment that minimizes allogeneic blood transfusions, employs blood conservation techniques, and avoids inappropriate use of blood product transfusions. Viscoelastic testing (VET) techniques, such as thromboelastography (TEG) and rotational thromboelastometry (ROTEM), have led to significant advancements in PBM. These techniques offer real-time whole-blood assessment of hemostatic function. This provides the clinician with a more complete hemostasis perspective compared to that provided by conventional coagulation tests (CCTs), such as the prothrombin time (PT) and the activated partial thromboplastin time (aPTT), which only assess plasma-based coagulation. VET does this by mapping the complex processes of clot formation, stability, and breakdown (i.e., fibrinolysis). As a result of real-time whole-blood coagulation assessment during hemorrhage, hemostasis can be achieved through targeted transfusion therapy. This approach helps fulfill an objective of PBM by helping to reduce unnecessary transfusions. However, challenges remain that limit broader adoption of VET, particularly in hospital settings. Of these, standardization and the high cost of the devices are those that are faced the most. This discussion highlights the potential of VET application in PBM to guide blood-clotting therapies and improve outcomes in patients with coagulopathies from various causes that result in hemorrhage. Another aim of this discussion is to highlight the limitations of implementing these technologies so that appropriate measures can be taken toward their wider integration into clinical use. Full article

Background: Core laboratory chemistry analyzers typically use plasma and serum samples, while blood gas instruments use whole blood for electrolyte and metabolite tests. Due to high costs to back up the core lab chemistry analyzers, especially in the remote small community hospitals, we have verified the interchangeability of serum/plasma electrolytes and metabolites on blood gas instruments (GEM4000 and Radiometer ABL90) vs. chemistry analyzers. In this study, we sought to extend the investigation to another blood gas device—Radiometer ABL837. Methods: One plasma separator tube and one serum separator tube were drawn from 20 apparently healthy individuals and outpatients and 20 intensive care unit patients. All the samples were run on Roche Cobas8000, and then were run on three Radiometer ABL837 analyzers for sodium (Na⁺), potassium (K⁺), chloride (Cl⁻), glucose, lactate (plasma only), and creatinine parameters. Paired measurements between the ABL837 and Cobas8000 were compared, and their difference were assessed for statistical and clinical significance. Results: ABL837 demonstrated statistical significance (p < 0.05) vs. Cobas8000 on all the plasma and serum parameters. However, no parameter differences were found when comparing the plasma/serum results on ABL837 to those on Cobas8000, indicating that none were clinically significant. ABL837 also demonstrated good–excellent correlations with Cobas8000 on all the parameters. Conclusions: When comparing metabolite and electrolyte values with plasma and serum sample types, the ABL837 blood gas instruments and Cobas 8000 chemistry analyzer are interchangeable. These data proves that ABL837 can be used as a backup for a chemistry analyzer in measuring plasma and serum electrolyte and metabolite concentrations. Full article

Introduction and Aim: Sarcopenia has emerged as a key prognostic factor in patients with chronic limb-threatening ischemia (CLTI), with potential implications for clinical decision-making. This study aimed to assess the association between sarcopenia and clinical outcomes, mortality, and amputation, using simple, accessible screening tools in a CLTI population. Methods: In this prospective, single-center study conducted between December 2023 and December 2024, 170 patients with CTLI were enrolled. Sarcopenia screening was performed using the SARC-F (strength, assistance in walking, rising from a chair, climbing stairs, falls) questionnaires, handgrip strength measurement, and calf circumference, adjusted for body mass index and sex. The primary outcome was 6-month all-cause mortality and/or major amputation. Results: Sarcopenia was identified in 77 patients (45.3%). Compared to non-sarcopenic individuals, sarcopenic patients were significantly older. They exhibited greater functional impairment, as well as poorer nutritional and muscle status. They also had significantly higher in-hospital mortality (16.9% vs. 3.2%, p = 0.002), 30-day mortality (24.7% vs. 4.3%, p = 0.001), and 6-month mortality (50.6% vs. 15.1%, p = 0.001). Sarcopenia was significantly associated with the primary outcome in univariate analysis (HR: 2.05; 95% CI: 1.31–3.20; p = 0.002) and remained an independent predictor after multivariate adjustment (HR: 1.95; 95% CI: 1.01–3.79; p = 0.048). Conclusions: Sarcopenia is a strong, independent predictor of poor outcome in patients with CLTI. Its detection through simple tools offers an easy and cost-effective strategy to improve risk stratification and guide early intervention through exercise-based therapy. Full article

In recent years, data augmentation techniques have become the predominant approach for addressing highly imbalanced classification problems in machine learning. Algorithms such as the Synthetic Minority Over-sampling Technique (SMOTE) and Conditional Tabular Generative Adversarial Network (CTGAN) have proven effective in synthesizing minority class samples. However, these methods often introduce distributional bias and noise, potentially leading to model overfitting, reduced predictive performance, increased computational costs, and elevated cybersecurity risks. To overcome these limitations, we propose a novel architecture, FADEL, which integrates feature-type awareness with a supervised discretization strategy. FADEL introduces a unique feature augmentation ensemble framework that preserves the original data distribution by concurrently processing continuous and discretized features. It dynamically routes these feature sets to their most compatible base models, thereby improving minority class recognition without the need for data-level balancing or augmentation techniques. Experimental results demonstrate that FADEL, solely leveraging feature augmentation without any data augmentation, achieves a recall of 90.8% and a G-mean of 94.5% on the internal test set from Kaohsiung Chang Gung Memorial Hospital in Taiwan. On the external validation set from Kaohsiung Medical University Chung-Ho Memorial Hospital, it maintains a recall of 91.9% and a G-mean of 86.7%. These results outperform conventional ensemble methods trained on CTGAN-balanced datasets, confirming the superior stability, computational efficiency, and cross-institutional generalizability of the FADEL architecture. Altogether, FADEL uses feature augmentation to offer a robust and practical solution to extreme class imbalance, outperforming mainstream data augmentation-based approaches. Full article