Search Results (626)

Background: In-hospital cardiac arrest (IHCA) constitutes a high-impact clinical event, associated with substantial mortality, frequent neurological and functional impairment. There is a pressing need for primary IHCA studies that evaluate risk predictors, given the inherent challenges of IHCA data collection, previously unharmonized reporting frameworks, and the predominant focus of prior investigations on other domains. Among potential contributors, the “off-hours effect” has consistently been linked to poorer IHCA outcomes. Accordingly, we sought to examine whether in-hospital mortality after IHCA varies according to the time and day of occurrence within a tertiary academic center in Northern Greece. Methods: We conducted a single-center observational cohort study using a prospectively maintained in-hospital resuscitation registry at AHEPA University General Hospital, Thessaloniki. All adults with an index IHCA between 2017 and 2019 were included, and definitions followed Utstein-style recommendations. Results: Multivariable logistic regression adjusted for organizational, patient, and process-of-care factors demonstrated that afternoon/night arrests, weekend arrests, heart failure comorbidity, and need for mechanical ventilation were independent predictors of higher in-hospital mortality. Conversely, arrhythmia as the cause of IHCA and arrests occurring in the intensive care unit or operating room were associated with improved survival. Subgroup analyses confirmed consistent off-hours differences, with weekend events showing reduced 30-day and 6-month survival and worse functional status at discharge. Afternoon/night arrests were more frequent, characterized by longer response intervals and lower survival at both time points. Conclusions: Organizational factors during nights and weekends, rather than patient case mix, drive poorer IHCA outcomes, underscoring the need for targeted system-level improvements. Full article

Background: Pulmonary infarction (PI) is the result of the occlusion of distal pulmonary arteries resulting in damage to downstream lung areas that become ischemic, hemorrhagic, or necrotic, and it is often a complication of an underlying condition such as pulmonary embolism (PE). Since in most of cases it is located peripherally, lung ultrasound (LUS) can be a good evaluation tool. The typical radiological features of PI are well-known; however, there are limited data on its sonographic characteristics and its evolution. Methods: The aim of this study is to evaluate, using LUS, a convenience sample of patients with acute PE with computed tomography (CT) consolidation findings consistent with PI. Patients’ clinical characteristics were collected and LUS findings at baseline and their short-term progression was assessed. LUS was performed within 72 h of PE diagnosis (T0) and repeated after one (T1) and four weeks (T2). Each procedure started with a focused examination of the areas of lesions based on CT findings, followed by an exploration of the other posterior and lateral lung fields. The convex probe was used for initial evaluation integrating LUS evaluation with the linear one was employed for smaller and more superficial lesions and when appropriate. Color Doppler mode was added to study vascularization. Results: From June to October 2023, 14 consecutive patients were enrolled at the Respiratory Unit of the University Hospital of Pisa. The main population characteristics included the absence of respiratory failure and prognostic high-risk PE (100%), the absence of significant comorbidities (79%), and the presence of typical symptoms, such as chest pain (57%) and dyspnea (50%). The average number of consolidations per patient was 1.4 ± 0.6. Follow-up LUS showed the disappearance of some consolidations and some morphological changes in the remaining lesions: the presence of hypoechoic consolidation with a central hyperechoic area (“bubbly consolidation”) was more typical at T1 while the presence of a small pleural effusion often persisted both at T1 and T2. A decrease in wedge/triangular-shaped consolidations was observed (82% at T0, 67% at T1, 24% at T2), as was an increase in elongated shapes, representing a residual pleural thickening over time (9% at T0, 13% at T1, 44% at T2). A reduction in size was also observed by comparing the mean diameter, long axis, and short axis measurements of each consolidation at the three different studied time points: the average of the short axes and the median of the mean diameters showed a statistically significant reduction after four weeks. Additionally, a correlation between lesion size and pleuritic pain was described, although it did not achieve statistical significance. Conclusions: Patients’ clinical characteristics and ultrasound features are consistent with previous studies studying PI at PE diagnosis. Most consolidations detected by LUS change over time regarding size and form, but a minority of them do not differ. LUS is a safe and non-invasive exam that could help to improve patients’ clinical approach in emergency rooms as well as medical and pulmonology settings, clinically contextualized for cases of chest pain and dyspnea. Future studies could expand the morphological study of PI. Full article

Controlling pre-analytical conditions for medical biology tests, particularly during transport, is crucial for complying with the ISO 15189 standard and ensuring high-quality medical services. The use of drones, also known as unmanned aerial vehicles, to transport clinical samples is growing in scale, but requires prior validation to verify that there is no negative impact on the test results provided to doctors. This study aimed to establish a secure, high-quality solution for transporting biological samples by drone in a coastal region of France. The 80 km routes passed over several densely populated urban areas, with take-off and landing points within hospital grounds. The analytical and clinical impact of this mode of transport was compared according to two protocols: an interventional clinical trial on 30 volunteers compared to the reference transport by car, and an observational study on samples from 126 hospitalized patients compared to no transport. The system enabled samples to be transported without damage by maintaining freezing, refrigerated, and room temperatures throughout the flight, without any significant gain in travel time. Analytical variations were observed for sodium, folate, GGT, and platelet levels, with no clinical impact on the interpretation of the results. There is a risk of time-dependent alterations of blood glucose measurements in heparin tubes, which can be corrected by using fluoride tubes. This demonstrated the feasibility and security of transporting biological samples over long distances in line with the ISO 15189 standard. Controlling transport times remains crucial to assessing the quality of analyses. It is imperative to devise contingency plans for backup solutions to ensure the continuity of transportation in the event of inclement weather. Full article

(1) Background: In hospitals, mattresses are often relocated for cleaning or patient transfer, leading to mismatches between actual and recorded bed locations. Manual updates are time-consuming and error-prone, requiring an automatic localization system that is cost-effective and easy to deploy to ensure traceability and reduce nursing workload. (2) Purpose: This study presents a pragmatic, large-scale implementation and validation of a BLE-based localization system using RSSI measurements. The goal was to achieve reliable room-level identification of smart mattresses by leveraging existing hospital infrastructure. (3) Results: The system showed stable signals in the complex hospital environment, with a 12.04 dBm mean gap between primary and secondary rooms, accurately detecting mattress movements and restoring location confidence. Nurses reported easier operation, reduced manual checks, and improved accuracy, though occasional mismatches occurred when receivers were offline. (4) Conclusions: The RSSI-based system demonstrates a feasible and scalable model for real-world asset tracking. Future upgrades include receiver health monitoring, watchdog restarts, and enhanced user training to improve reliability and usability. (5) Method: RSSI–distance relationships were characterized under different partition conditions to determine parameters for room differentiation. To evaluate real-world scalability, a field validation involving 266 mattresses in 101 rooms over 42 h tested performance, along with relocation tests and nurse feedback. 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: Venous thromboembolism (VTE) is associated with high morbidity and mortality. The activation of multiple pathways of venous thrombosis occurs after an injury. A prophylaxis protocol is necessary to prevent early and late venous thrombotic complications. Methods: This study aimed to evaluate the outcomes of venous thromboembolism using the Greenfield risk assessment profile score and its association with bleeding complications. This was a retrospective cohort study conducted on trauma cases who were aged 15 years or older. The study was conducted from January 2020 through December 2022. Patients who were admitted to hospital for less than 24 h or those who died during resuscitation or treatment in an emergency room were excluded from this study. Results: We enrolled 580 cases. Among them, 46.6% were categorized as high-risk for developing venous thromboembolism, and 30.4% of these high-risk patients received pharmaco-mechanical thromboprophylaxis. All VTE cases were high risk according to the Greenfield risk assessment profile, accounting for 3% of the entire group and 1.4% of all enrolled cases. All major bleeding complications occurred with a previously diagnosed large subdural hematoma. Conclusions: Assessing VTE risk was crucial for optimal management of prophylaxis. Proper use of pharmacological prophylaxis had to be balanced against the risk of bleeding complications. Full article

Background/Objectives: Bioresorbable polylactic acid (PLA) matrices have shown promise in supporting wound healing through their biocompatibility, tissue integration, and potential involvement in immune regulatory mechanisms. This study aimed to analyze the clinical performance of a PLA-based matrix in the treatment of chronic wounds under real-world conditions in a single-center setting. Methods: This retrospective study included patients with chronic wounds treated with the polylactic acid matrix at Evangelisches Waldkrankenhaus Spandau between February 2023 and February 2025. Wounds were surgically debrided in the operating room prior to matrix application. The matrix remained in place until resorption or detachment, with reapplications occurring at a mean interval of approximately 14 days. Data was anonymized and analyzed descriptively. Results: A total of 14 patients with 16 chronic wounds were treated in this study. The mean patient age was 76.1 years. The most common underlying causes were ischemia and trauma, with an average wound size of 23.6 cm². Complete wound closure was achieved in 15 out of 16 cases (93.8%), with a mean time to complete wound closure of 72.9 days. The average duration of hospitalization was 24.8 days. Conclusions: The polylactic acid matrix demonstrated a high rate of short-term wound closure in a heterogeneous cohort of chronic wounds, with a mean time to closure of 73 days and no requirement for skin grafting. Further prospective studies with standardized long-term follow-up are warranted. Full article

Background/Objectives: The optimal surgical approach for kidney stones (KS) measuring 15–20 mm remains debated. RIRS and mini-PCNL are both effective options, but they differ in invasiveness, resource use, and cost. This study aimed to compare perioperative outcomes and hospital costs of RIRS and mini-PCNL using a micro-costing approach. Methods: This retrospective study included patients with KS > 15 mm in diameter who were treated between January 2021 and December 2023 at the Department of Urology, Sapienza University of Rome-Polo Pontino. Clinical parameters, operative time (OT), length of stay (LoS), complications, and stone-free rate (SFR) were compared. Costs were estimated using a micro-costing method, including disposable materials, operating room (OR) time (3.9 EUR/min), imaging, and hospitalization (334 EUR/day). The total cost per treated and per SF patient was calculated for both techniques. Results: A total of 119 patients were analyzed: 62 underwent RIRS, and 57 underwent mini-PCNL. Mean OT was shorter for RIRS (87 vs. 113 min; p < 0.001), and LoS was longer for mini-PCNL (2.24 vs. 1.22 days; p = 0.008). Final SFR was higher for mini-PCNL (94.7% vs. 88.7%; p = 0.043). Complication rates were comparable, with most events classified as Clavien–Dindo I–II. Disposable materials represented the main cost driver (EUR 1097 for RIRS vs. EUR 806 for mini-PCNL). The total cost per treated patient was EUR 3689 for RIRS and EUR 3154 for mini-PCNL (p = 0.009). The cost per SF patient was EUR 4159 for RIRS and EUR 3331 for mini-PCNL (p = 0.007). Conclusions: Both RIRS and mini-PCNL are safe and effective for the management of KS ≥ 15 mm. Mini-PCNL achieves higher SFR and greater cost-efficiency than RIRS. These findings support the use of mini-PCNL as the preferred option in centers with adequate expertise and resources. Full article

Background: To ensure smooth surgical procedures, patient safety, and quality of perioperative care, perceived perioperative competence (PPC) is a daily and urgent requirement for operating room (OR) nurses. Understanding the status of PPC among OR nurses and its associated factors is essential for OR nurses/people in charge/researchers to pinpoint weaknesses and formulate interventions. Therefore, we aim to investigate the status of PPC and its associated factors. Furthermore, we explore the relationship between PPC, self-efficacy, and job burnout among OR nurses. Methods: Tertiary-A hospitals in various districts of Chengdu, China, were recruited using a stratified convenience sampling method. A cross-sectional survey was then administered to OR nurses in the selected hospitals. Data analysis included descriptive analysis, T-tests, one-way analysis of variance (ANOVA), multiple linear regression analysis, correlation analysis, and mediation analysis. Results: A survey of 640 OR nurses across 18 hospitals (with a 98.00% valid response rate) revealed an average PPC score of 3.66 ± 1.12/124.55 ± 26.54. Marital status, OR specialty education, and age significantly influenced PPC levels (p < 0.05). Self-efficacy was positively correlated with PPC, while job burnout was negatively correlated with PPC. Self-efficacy fully mediated the relationship between these two variables. Conclusions: The performances of PPC among Chinese OR nurses were acceptable. Marital status, OR specialty education, and age significantly influenced PPC levels. Self-efficacy fully mediates the relationship between job burnout and PPC. Full article

Background and Objectives: Unplanned return to the operating room (URTOR) is a sensitive indicator of surgical quality; however, data in neurosurgery are limited. This retrospective study analyzed patients who underwent URTOR following neurosurgical procedures over an eight-year period to define early and late patterns, identify underlying causes, and evaluate the distribution of cases according to surgeon experience. Materials and Methods: Records of 18,258 consecutive surgeries including both elective and emergency procedures in adult and pediatric patients, performed at a single center between 2010 and 2018 were retrospectively reviewed. Unplanned reoperations within 30 days of the index surgery were defined as URTOR; those occurring within ≤7 days were classified as “early,” and those occurring between 8 and 30 days were classified as “late.” Demographic data, surgical characteristics, causes of URTOR, and surgeons’ seniority were examined. Results: Among 18,258 neurosurgical procedures, 324 URTORs (1.8%) were identified. The median patient age was 38 years; 37% were children. Early URTOR comprised 59% and was primarily associated with hemorrhagic–vascular complications, whereas late URTOR accounted for 41% and was dominated by cerebrospinal fluid-related and infectious complications. Late events prevailed in significantly younger cases and were disproportionately followed by ventriculo–peritoneal shunt or endoscopic third ventriculostomy index operations. Junior surgeons performed 74% of later operations requiring URTOR versus 30% of early failures. Sex, weekday/weekend timing, and surgeons’ experience did not affect the overall URTOR classification categories. The median interval was six days. Conclusions: Centers worldwide have begun to examine URTOR rates, which are directly associated with hospital quality measurements. These results may inform targeted education and prevention by identifying patient groups at higher reoperation risk within a specific timeframe. Full article

Background/Objectives: Hospital visits for the treatment of coronary heart disease primarily consist of routine outpatient (OP) or unscheduled emergency room (ER) visits. This study compared the effectiveness of cardiac rehabilitation (CR) based on the routes of hospital visits after percutaneous coronary intervention (PCI). Methods: Only men who completed three CR center visits (baseline, 6 months, 12 months) during the 12 months after PCI were analyzed. A total of 300 male patients were analyzed, with 206 patients in the OP group and 94 in the ER group, and their socioeconomic status, blood lipids, blood pressure, volume of oxygen peak (VO₂ peak), physical activity, and quality of life (QoL) were compared. This study is a retrospective analysis. Results: The ER group was older and had lower economic income than the OP group (p < 0.05). In the OP and ER groups, total cholesterol (OP −10.4%, and ER −8.6%) and low-density lipoprotein cholesterol (OP −10.9% and ER −8.2%) improved in the third visit compared to the first visit (p < 0.05). Additionally, VO2 peak (OP 16.5%, and ER 14.3%), physical activity (OP 25.1%, and ER 4.4%), and body fat (OP −5.8%, and ER −4.5%) ultimately improved in both groups (p < 0.05). The interaction effect by time and group showed that the OP group significantly improved compared to the ER group in terms of high-density lipoprotein cholesterol, VO₂ peak, exercise duration, grip strength, physical activity, body fat, and quality of life (p < 0.05). Conclusions: The 12-month CR program tended to improve outcomes in both groups, but the OP group showed greater improvements in high-density lipoprotein cholesterol, VO₂ peak, and QoL compared to the ER group. Full article

Introduction: In the emergency room, it is essential to quickly and accurately classify the patients’ various severities. However, existing five-stage classification systems, such as the Korean Emergency Patient Classification Tool (KTAS), do not sufficiently reflect the physiological and clinical heterogeneity of all patients, so there is a possibility of under-classification in some age groups or specific symptom groups. Methods: A retrospective cross-sectional study was conducted using KTAS and the physiological and clinical data of 41,728 patients who visited the emergency room of a university hospital in Incheon in 2022. K-prototypes unsupervised cluster analysis incorporating demographic, physiological, and clinical variables was applied, and the number of clusters was determined as the optimal value through the Silhouette, Dunn, and Davies–Bouldin indicators. Dimension reduction was performed by UMAP, and differences between clusters were compared by t-test, Mann–Whitney U, and chi-square test. Results: Two different clusters were identified. Cluster 0 was a stable patient group with a mean age of 58 years and an average arterial pressure of 104 mmHg. On the other hand, Cluster 1 was a young but physiologically unstable patient group with an average age of 46 years and an average arterial pressure of 90 mmHg. There were significant differences in age, MAP, heart rate, respiratory rate, body temperature, and pain scores between clusters (p < 0.001), and a moderate association was observed between KTAS classification and clusters (Cramer’s V = 0.208). Discussion: This study suggested the possibility of early identification of high-risk groups in the emergency room and efficient resource allocation by identifying potential patient heterogeneity that KTAS cannot detect through unsupervised learning. This approach can be used as a basis for precision triage and patient-centered emergency medical policy establishment by supplementing rather than replacing the existing classification system. Full article

Background/Objectives: Asthma exacerbations are among the most frequent causes of pediatric emergency department (ED) visits, with over 700,000 annual cases in the United States and a significant number in Europe. Children under five years of age are particularly vulnerable to hospitalization. Methods: As timely assessment of exacerbation severity in the ED is critical, this review synthetizes data about tools such as the Pediatric Respiratory Assessment Measure (PRAM) and the Asthma Severity Score (ASS) aid in evaluating clinical status based on respiratory rate, oxygen saturation, accessory muscle use, and response to treatment. We also analyzed the proper management following established guidelines from GINA, NAEPP and other articles. Results: First-line therapy includes oxygen supplementation, short-acting beta-agonists (SABAs) administered frequently during the first hour, and early systemic corticosteroids. In moderate to severe cases, ipratropium bromide is added. For refractory or life-threatening presentations, intravenous magnesium sulfate, epinephrine, or ventilatory support may be required. Discharge is appropriate when symptoms resolve, oxygen saturation remains >94% on room air, and the child demonstrates adequate inhaler use. Hospitalization is indicated in cases of persistent hypoxemia, poor response, feeding difficulties, or social concerns. Post-discharge care includes thorough caregiver education, medication access, and a personalized asthma action plan to reduce recurrence risk. Conclusions: The effective diagnosis, appropriate exacerbation treatment, monitoring of patients in the post-attack period, as well as successful preventive medication play a key role in the management of pediatric patients with asthma. Full article

Background and Objectives: Intraoperative hypotension (IOH) is of great importance in preventing diseases such as postoperative myocardial infarction, acute kidney injury, and mortality. This study aimed to develop and validate machine learning and deep learning models that predict IOH using both biosignals and personalized clinical information for each patient. Materials and Methods: In this retrospective observational study, we used the VitalDB open dataset, which included intraoperative biosignals and clinical information from 6388 patients who underwent non-cardiac surgery between June 2016 and August 2017 at Seoul National University Hospital, Seoul, South Korea. The predictive performances of models trained with four waveforms (arterial blood pressure, electrocardiography, photoplethysmography, and capnography) and clinical information were evaluated and compared at time points at 5 min before the hypotensive event. To predict hypotensive events during surgery, we developed two predictive models: machine learning and deep learning. In total, 2611 patients were enrolled in this retrospective study. Machine and deep learning algorithms were developed and validated using raw waveforms and clinical information as inputs. Results: Gradient boosting machine showed predicted IOH with an AUROC and accuracy of 0.94 (0.93–0.95) and 0.88 (0.86–0.89). A hybrid CNN-RNN model also showed similar performance with an AUROC and accuracy of 0.94 (0.93–0.95) and 0.88 (0.87–0.89). Conclusions: This study developed and validated machine and deep learning models to predict IOH using waveform data and covariate values. In the future, we anticipate that the results of our study will contribute to predicting IOH in real time in the operating room and reducing the occurrence of IOH. Full article

Hospital design greatly influences patient recovery. Evidence indicates that daylight enhances recovery, but hospital designs in Erbil need further optimization of window configurations to provide sufficient daylight. This suboptimal design can result in longer patient stays, negatively affecting recovery outcomes. The study aims to develop a localized daylight optimization model for inpatient hospital rooms in Erbil via integrating window size, shape, and orientation to enhance patient well-being and recovery. This is accomplished through a mixed-method approach: qualitatively, a hypothetical case study has been analyzed using drawings in Revit, and quantitatively, daylighting analysis is conducted using IES-VE 2024 software for a hypothetical inpatient room case study. Results show that orientation has the most significant impact on daylight parameters. Regarding window size and aspect ratio, horizontal window ratios significantly exceeded vertical ratios (p = 0.001), emphasizing the importance of aspect ratio in optimizing daylight distribution. However, window placement did not have a statistically significant effect on illuminance levels (p = 0.182). The study concludes that window orientation and size substantially influence daylighting in hospital patient rooms. It also evaluates alternative configurations—including variations in window size, proportion, orientation, and placement—to explore potential daylighting improvements achievable in similar urban and climatic environments. Full article