Search Results (3,668)

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and fibromyalgia (FM) are debilitating disorders with overlapping symptoms such as chronic pain and fatigue. Dysregulation of the endogenous opioid system, particularly µ-opioid receptor function, may contribute to their pathophysiology. This study examined whether epigenetic modifications, specifically µ-opioid receptor 1 gene (OPRM1) promoter methylation, play a role in this dysfunction. Using a repeated-measures design, 28 ME/CFS/FM patients and 26 matched healthy controls visited the hospital twice within four days. Assessments included blood sampling for epigenetic analysis, a clinical questionnaire battery, and quantitative sensory testing (QST). Global DNA (hydroxy)methylation was quantified via liquid chromatography–tandem mass spectrometry, and targeted pyrosequencing was performed on promoter regions of OPRM1, COMT, and BDNF. ME/CFS/FM patients reported significantly worse symptom outcomes. No differences in global (hydroxy)methylation were found. Patients showed significantly higher OPRM1 promoter methylation, which remained after adjusting for symptom severity and QST findings. Across timepoints, OPRM1 methylation consistently correlated with BDNF Promoter I and Exon III methylation. This is, to the best of our knowledge, the first study examining OPRM1 methylation in ME/CFS/FM. Increased OPRM1 methylation in patients, independent of symptoms or pain sensitivity measures, supports the hypothesis of dysregulated opioidergic signaling in these conditions. Full article

This study addresses a pivotal strategic issue in hospitality e-commerce: how hotels can optimize cooperation with heterogeneous online travel agencies (OTAs). Moving beyond the conventional question of whether to cooperate, we investigate the interrelated decisions of which OTA type to partner with (quality-focused vs. price-focused) and which business model to adopt (merchant vs. agency). We develop a game-theoretic model that incorporates key e-commerce factors, including hotel capacity constraints, cross-channel spillover effects, and differential consumer acceptance of OTA types. Our analysis yields a contingent decision framework. We demonstrate that OTA cooperation becomes beneficial only when a hotel’s room capacity exceeds its direct-channel demand. The optimal strategy evolves with capacity: hotels with moderate capacity should partner with a single OTA type—predominantly the quality-focused one—while larger hotels should engage both types to maximize market coverage. In terms of business models, smaller hotels benefit from the risk-shifting merchant model, whereas larger hotels capture higher margins through the agency model. A key finding is the general superiority of a differentiated approach: applying the agency model to quality-focused OTAs and the merchant model to price-focused OTAs. This research provides a structured analytical framework to guide hotel managers in crafting e-commerce platform strategies and offers scholars a foundation for further inquiry into platform competition and contract design in digital marketplaces. Full article

This study examines the social determinants of the digital divide in pre-service teacher education through the design and validation of the Digital Hospitality Scale (DSBD-HD-FID). The instrument was developed to diagnose social inequalities across six key dimensions: socioeconomic status, geographic location, gender, age, disability status, and interculturality. These dimensions are understood as structural factors shaping access to, use of, and participation in digital environments within teacher education. The research followed a non-experimental, quantitative, and cross-sectional design, including content validation through expert judgment and statistical analysis based on a pilot sample of education students from Chile and Portugal. An exploratory factor analysis was conducted, and internal consistency was assessed using Cronbach’s alpha coefficient. The results confirm strong content and construct validity, as well as high reliability (α = 0.93). Empirical findings indicate that socioeconomic status and geographic location significantly condition access to connectivity and digital literacy, while gender differences emerge mainly in recreational uses and frequency of digital training. Beyond these results, the study highlights the relevance of addressing digital inequalities in teacher education through inclusive and equity-oriented training policies. The findings support the integration of digital hospitality, human rights education, and the Sustainable Development Goals into initial teacher training curricula as measurable and evaluable dimensions, providing an evidence-based framework to inform future teacher education policies aimed at reducing digital divides and promoting social cohesion. 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/Objectives: Healthcare workers at the frontline of managing pandemics are at increased risk for adverse physical and mental health outcomes, which has been shown to result in burnout. The relationship between personal resilience and burnout among clinical and non-clinical healthcare staff working in an acute care setting was assessed at the start of the COVID-19 pandemic. Methods: A prospective cross-sectional survey design with electronic questionnaires was used to measure resilience (Connor-Davidson Resilience Scale,) and burnout (Maslach Burnout Inventory—Human Services Survey). Linear regression analyses were conducted to examine the relationship between resilience and emotional exhaustion, depersonalization, and personal accomplishment. Results: A significant inverse relationship between resilience and both emotional exhaustion and depersonalization, and a positive relationship between resilience and personal accomplishment were identified. Higher resilience scores were significantly associated with lower emotional exhaustion and depersonalization and higher personal accomplishment under pandemic conditions. Conclusions: Strategies to boost resilience organization-wide amongst healthcare staff providing patient care are critical for providing skills to reduce the onset of burnout and support employee mental health. From a pandemic preparedness lens, organizational-level emergency management should consider the importance of resilience-building among staff to proactively prevent burnout and its subsequent effects on patient-care and general hospital functioning. Full article

Background: Approximately half of U.S. adults have ≥1 cardiovascular disease (CVD) risk factors. Exercise is universally recommended as a first-line lifestyle therapy to prevent and treat CVD. Objective: We will conduct a feasibility and pilot efficacy randomized controlled trial to test the usability and user satisfaction of an evidence-based digital health tool we developed for physicians—the Prioritizes Personalizes Prescribes EXercise algorithm (P3-EX)—to treat patients with CVD risk factors (ClinicalTrials.gov: NCT07238556). Methods: We will recruit 24 physicians who do not prescribe written exercise prescriptions (ExRx) from two local CT hospitals. Physicians will recruit two patients each (N = 48); both patients must have CVD risk factors. Each physician will deliver a P3-EX ExRx to one patient (n = 24) and the Physical Activity Vital Sign ExRx to the other patient (n = 24) in a random sequence crossover design. Physicians and patients will rate the feasibility and acceptability of each ExRx method using validated questionnaires. Patients will perform their ExRx for 12 weeks and complete an exercise diary to monitor exercise adherence with weekly virtual oversight by Research Assistants. Before and after the exercise intervention, we will measure patient CVD risk factors and physical activity levels via accelerometry. Results: This trial has received Institutional Review Board approval (E-HHC-2025-0198) and will begin in January 2026, with findings published in 2027. Conclusions: This protocol provides the scientific rationale and methodology to test P3-EX within a real-world clinical setting, to inform the feasibility of using P3-EX as a digital health support tool by physicians, and preliminary efficacy of P3-EX to improve patient cardiovascular health and physical activity levels. Full article

Background and Objectives: Implant-supported rehabilitation after oral cancer surgery remains technically and biologically demanding due to altered anatomy, scar tissue, and prior radiotherapy. Digital workflows and hospital-based point-of-care (POC) manufacturing now enable personalized, prosthetically driven implant placement with static surgical guides fabricated within the clinical environment. This study reports the initial clinical experience of an academic POC manufacturing unit (UPAM3D) implementing static guided implant surgery in oral cancer patients and compares this approach with conventional outsourcing and dynamic navigation methods. Materials and Methods: A retrospective review of 30 consecutive cases (2021–2024) treated with POC-manufactured static guides was conducted using data from the UPAM3D registry. Each record included design, fabrication, and sterilization parameters compliant with ISO 13485 standards. Demographic, surgical, and prosthetic variables were analyzed, including anatomical site (maxilla or mandible), guide type, material, radiotherapy history, number of Ticare Implants^®, and loading strategy. Results: All surgical guides were designed and 3D printed in-house using biocompatible resins (BioMed Clear, Dental SG, or LT Clear). The annual number of POC procedures increased progressively (2 → 6 → 6 → 16). Most cases involved oncologic reconstructions of the maxilla or mandible, including irradiated fields. When recorded, primary stability values (mean ISQ ≈ 79) allowed immediate or early loading (ISQ ≥ 70). No major intraoperative or postoperative complications occurred, and all guides met sterilization and traceability standards. Conclusions: Point-of-care manufacturing enables efficient, accurate, and patient-specific guided implant rehabilitation after oral cancer surgery, optimizing functional and esthetic outcomes while reducing procedural time and dependence on external providers. Integrating this process into clinical workflows supports personalized treatment planning and broadens access to advanced implant reconstruction within multidisciplinary oncology care. Full article

Background: Dysglycemia remains a persistent challenge in hospital care. Despite advances in outpatient diabetes technology, inpatient insulin management largely depends on intermittent point-of-care glucose testing, static insulin dosing protocols and rule-based decision support systems. Artificial intelligence (AI) offers potential to transform this care through predictive modeling and adaptive insulin control. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines, a scoping review was conducted to characterize AI algorithms for insulin dosing and glycemic management in hospitalized patients. An interdisciplinary team of clinicians and engineers reached consensus on AI definitions to ensure inclusion of machine learning, deep learning, and reinforcement learning approaches. A librarian-assisted search of five databases identified 13,768 citations. After screening and consensus review, 26 studies (2006–2025) met the inclusion criteria. Data were extracted on study design, population, AI methods, data inputs, outcomes, and implementation findings. Results: Studies included ICU (N = 13) and general ward (N = 9) patients, including patients with diabetes and stress hyperglycemia. Early randomized trials of model predictive control demonstrated improved mean glucose (5.7–6.2 mmol/L) and time in target range compared with standard care. Later machine learning models achieved strong predictive accuracy (AUROC 0.80–0.96) for glucose forecasting or hypoglycemia risk. Most algorithms used data from Medical Information Mart for Intensive Care (MIMIC) databases; few incorporated continuous glucose monitoring (CGM). Implementation and usability outcomes were seldom reported. Conclusions: Hospital AI-driven models showed strong algorithmic performance but limited clinical validation. Future co-designed, interpretable systems integrating CGM and real-time workflow testing are essential to advance safe, adaptive insulin management in hospital settings. Full article

Background/Objectives: Medication incidents remain a significant concern in hospital settings. Integrated medication systems, regarding organized processes, policies, technologies and professional practices are designed to enhance patient safety; however, their safety performance is still suboptimal. The use of valid and reliable instruments to assess hospital medication system safety can be a valuable resource for health care management. The aim of this study was to describe the development and psychometric validation of the Hospital Medication System Safety Assessment Questionnaire (HMSSA-Q) for assessing the safety of hospital medication systems and its processes in Portugal. Methods: The HMSSA-Q was developed through a literature review and two rounds of expert panel consultation. Following consensus, a pilot methodological study was conducted in 95 Portuguese hospitals. Construct validity was assessed using principal component factor analysis, and reliability was evaluated through internal consistency (Cronbach’s alpha). Results: The instrument is theoretically structured into five predefined domains/subscales: Organizational Environment, Safe Medication Prescribing, Safe Medication in Hospital Pharmacy, Safe Medication Preparation and Administration, and Information and Patient Education. Principal component analyses performed separately for each domain supported their internal structure. The overall scale showed excellent internal consistency (Cronbach’s α = 0.97), with Cronbach’s alpha values for the domains ranging from 0.86 to 0.94. Conclusions: The HMSSA-Q is a valid and reliable instrument for assessing the safety of hospital medication systems and has the potential to serve as an innovative management tool for improving patient safety. Full article

Background: Patient-centered care (PCC) is a cornerstone of quality, yet its translation into managerial decision-making remains underexplored. Middle nurse managers (MNMs) play a pivotal role in enabling patient-centeredness, but their perspectives on PCC decisions are rarely investigated. Aim: This study explored MNMs’ perceptions of what constitutes a patient-centered decision in hospital settings and identified the essential dimensions underpinning such decisions. Methods: A qualitative descriptive design was adopted using semi-structured interviews. Thirty-eight MNMs from three hospitals in central Italy were included. Data were analyzed using Elo and Kyngäs’ content analysis approach. Results: Two overarching themes emerged as central to patient-centered managerial decision-making (PCMDM): “Meaning and definition of PCMDM,” and “Influencing dimensions of PCMDM”. MNMs described PCMDM as an evolving and adaptable process shaped by patient needs and organizational constraints and unfolding across distinct phases. Key influencing dimensions included the manager’s role, organizational environment, human resource management and knowledge of the patient. Conclusions: PCMDM is a continuous, ethical, and reflective process mediated by MNMs, who reconcile institutional priorities, team dynamics, and patient needs to create conditions for high-quality PCC. Implications for Practice: Strengthening PCMDM requires coordinated action aimed at equipping nurse managers with advanced leadership capabilities, building organizational structures that sustain patient-centered decisions, and empowering patients to actively co-shape the care process. Full article

Background/Objectives: Providing children with information about their treatment can help reduce uncertainty and anxiety associated with hospital procedures. The aim of this study was to develop and evaluate an app designed to prepare young children and their parents for a hearing examination in a playful and engaging way. Methods: This exploratory study adopted a participatory design approach. Children, parents, and clinicians co-created the app, and evaluations were conducted through focus group meetings, dialogue meetings, and surveys. Results: Children, parents, and clinicians evaluated the app positively. Findings indicated that children who used the app before their hearing examination met audiologists’ expectations to a greater extent than those who did not. However, no significant differences were found between the two groups regarding satisfaction with the examination, the children’s sense of safety, or parents’ prior knowledge of the procedure. The study also revealed implementation challenges: only 20% of children visiting the department had used the app beforehand, and funding for ongoing maintenance was not adequately addressed. Conclusions: Preparing children for hearing examinations with an app appears promising. However, to ensure the quality, accessibility, and sustainability of digital healthcare solutions, challenges related to implementation and maintenance must be considered in future studies. Full article

On 2021, in the intensive care unit of a County Emergency Hospital where oxygen therapy treatment was applied to COVID patients, located in the municipality of Ploiesti, Prahova County, a fire occurred that resulted in the destruction by burning of the ICU room, the death of two people, and the injury of a medical professional. In order to elucidate the accelerating causes of the combustion phenomenon of materials in the ICU room, a combustion stand was designed whose atmosphere can be controlled in terms of achieving high oxygen concentrations of 40% vol., in accordance with the treatment schemes applied to the patients and with the configuration of the room and the frequency of use of the access door. In this experimental stand, a series of combustion tests of flexible polyurethane foam samples were performed, which highlighted the acceleration of combustion and the complete consumption of the mass. The purpose of this work is to explain the rapidity of the fire in a hospital ward, both with experimental methods and with the help of FDS. Full article

Background: Perianal infections (PIs) are a serious threat in patients with acute myeloid leukemia (AML). While CPX-351 is designed to reduce gastrointestinal toxicity, its impact on the incidence of PIs is unknown. This study aims to evaluate the incidence and characteristics of PIs in a cohort of CPX-351-treated AML patients. Methods: We enrolled 22 adult patients diagnosed with secondary AML receiving CPX-351 between May 2020 and July 2025 at Policlinico Tor Vergata Hospital. Statistical analysis used descriptive statistics and multivariate analysis. Results: The incidence of PIs in the cohort was 31.8%. Microbiological cultures from the lesions commonly yielded Klebsiella pneumoniae and Enterococcus species. The development of a PI was associated with a significantly longer hospital stay (mean, 49.6 vs. 37.7 days; p = 0.034). An increased odds ratio of having PIs was noted for mucositis and positive rectal swabs (17.961, p = 0.062; 5.554, p = 0.391, respectively), with two patients (28.5%) having a positive pre-infection swab for Klebsiella pneumoniae. Surgical intervention was guided by patient pain levels and hematological criteria. Surgical patients had significantly higher pain levels (p = 0.001) and a platelet count greater than 20 × 10⁹/L (p = 0.028). All patients were alive at 30 days, with low rates of septic shock (14.2%, n = 1) and no infection-related mortality or recurrence. Conclusions: Despite CPX-351’s known reduced gastrointestinal toxicity, our study showed a significantly higher incidence of PIs compared to literature data. While the outcomes were favorable, PIs led to prolonged hospitalization. Routine rectal swab surveillance could be a valuable tool for risk stratification and preemptive strategies. Full article

Turkey is located on an active seismic belt, making the accurate determination of soil properties and earthquake effects essential for safe and reliable structural design. This study investigates the influence of ground improvement on the dynamic behavior of the soil at the construction site of the 950-bed Aydın City Hospital. Evaluations were carried out in terms of the dominant period, local site class and spectral characteristics to assess the effectiveness of the improvement applications. For this purpose, field tests conducted before the improvement were repeated afterward and the obtained data were compared. Local site classes were determined for both unimproved and improved soil conditions based on the relevant seismic code provisions. Furthermore, using site-specific data, nonlinear time-history analyses were performed and site-specific response spectra were obtained for 11 earthquake records at DD-1 and DD-2 seismic hazard levels (return periods of 475 and 2475 years). These spectra were then compared with the corresponding design spectra. The analyses revealed that ground improvement significantly affects not only the bearing capacity and liquefaction potential but also the dynamic behavior, dominant period and local site class of the soil. Full article

Study Design: Retrospective cohort study. Objective: To determine the association of social determinants of health with rates of closed nasal bone reduction. Methods: A retrospective analysis of the National Trauma Data Bank (NTDB) from 2011 to 2019 was performed, including only adult patients with isolated nasal bone fractures. Logistic regression modeling was used to estimate the association between closed nasal bone reduction and sociodemographic variables. Results: A total of 149,312 patients were included, with an average age of 50. Most patients were male (68%), White (72%), and non-Hispanic/Latino (77%), with Medicare insurance (25%). Most patients were cared for at non-university (54%) and non-profit hospitals (88%). A total of 39% were cared for at an ACS level 1 trauma center. Finally, 3.3% of the patients in this study underwent closed reduction. The odds of undergoing reduction decreased with increasing age (OR: 0.99, CI: (0.99, 0.99)). Compared to White patients, Asian and Black/African American patients had decreased odds of closed reduction (Asian: OR (CI) 0.71 (0.53, 0.95); Black: OR (CI): 0.71 (0.65, 0.79)). Patients with government insurance or who were uninsured had lower odds of closed reduction compared to private/commercial insurance, with Medicaid, Medicare, and not billed/self-pay odds ratios of 0.83 (CI: (0.76, 0.90)), 0.81 (CI: (0.73, 0.89)), and 0.79 (CI: (0.72, 0.86)), respectively. Conclusions: Social determinants of health are associated with differential rates of inpatient closed nasal bone reduction. Further studies in the outpatient setting are needed to determine if these associations remain consistent. Full article