Search Results (13,738)

Background: Long-acting monoclonal antibodies have become an important strategy for preventing respiratory syncytial virus (RSV) disease in infants. Nirsevimab is the first product for which substantial post-licensure implementation data are available, whereas real-world evidence on clesrovimab remains limited. Although nirsevimab has demonstrated high efficacy, its uptake varies considerably across countries, healthcare systems, delivery settings, and population subgroups. This World Association for Infectious Diseases and Immunological Disorders (WAidid) consensus document examines the policy, organizational, economic, and equity-related determinants that shape real-world implementation of long-acting monoclonal antibodies for infant RSV prevention. Methods: This study was conducted as a structured narrative review and WAidid expert consensus document. A structured literature search was performed in PubMed and Embase for English-language publications relevant to nirsevimab uptake and implementation, complemented by targeted review of surveillance reports, policy documents, and public health guidance from the ECDC, UKHSA, and CDC, as well as reference lists of selected publications. Eligible sources included observational and real-world implementation studies, systematic reviews and meta-analyses, economic evaluations, guidelines, policy statements, surveillance reports, and relevant narrative reviews. Evidence was synthesized qualitatively according to policy frameworks, financing and reimbursement, delivery pathways, demographic and socioeconomic determinants, and healthcare-system factors influencing uptake. No statistical software was used because no quantitative re-analysis or meta-analysis was performed. Results: Nirsevimab uptake was strongly influenced by national RSV prevention policies, particularly whether countries adopted universal infant monoclonal antibody programs, maternal RSV vaccination strategies, dual maternal–infant approaches, or targeted risk-based models. Universal, publicly funded programs integrated into neonatal care achieved the highest and most homogeneous coverage, especially when administration occurred before hospital discharge and was supported by registry-based recall systems for infants born outside the RSV season. In contrast, fragmented, outpatient-only, insurance-dependent, or partially reimbursed models were associated with lower, delayed, or more variable uptake. Additional determinants included product cost, reimbursement pathways, provider practices, caregiver awareness and health literacy, insurance status, income, race and ethnicity, geographic deprivation, and access to primary pediatric care. Most available evidence comes from high-income countries, limiting generalizability to low- and middle-income settings, where RSV burden is greatest and implementation constraints may differ. Conclusions: Successful implementation of long-acting monoclonal antibodies for infant RSV prevention requires more than regulatory approval and demonstrated efficacy. Equitable uptake depends on clear national recommendations, sustainable public financing, reliable product supply, integration into neonatal and primary pediatric care, proactive identification and recall of eligible infants, and targeted strategies to reduce socioeconomic and geographic disparities. Although many determinants identified in high-income settings are likely relevant globally, their feasibility, relative importance, and impact require dedicated evaluation in low- and middle-income countries. Full article

Background: The urea-to-creatinine ratio (UCR) is used to support the differential diagnosis of acute kidney injury (AKI); however, its diagnostic utility remains debated. We explored the clinical relevance of UCR in the initial etiological assessment of AKI, also considering relevant clinical modifiers. Methods: We retrospectively analyzed 590 hospitalized patients classified as pre-renal (n = 319), parenchymal (n = 135), or post-renal (n = 136) AKI. UCR was compared across AKI subtypes and stratified by pre-existing chronic kidney disease (CKD). Logistic regression models assessed the association between UCR and pre-renal AKI, excluding post-renal cases. Diagnostic performance was evaluated using receiver operating characteristic curve analysis. An exploratory analysis was performed within parenchymal AKI according to histopathological patterns and the presence of nephrotic syndrome. Results: Baseline characteristics differed across AKI subtypes, including age, sex, and CKD. UCR was higher in pre-renal than in parenchymal and post-renal AKI (p < 0.001), despite substantial overlap. Stratification by CKD did not reveal differences within AKI subtypes; however, in pre-renal AKI, UCR decreased progressively with advancing CKD stage (p < 0.001). UCR was significantly associated with pre-renal AKI, and diagnostic performance improved when combined with age and advanced CKD. Within parenchymal AKI, higher UCR values were observed in glomerular disease, particularly with nephrotic syndrome. Conclusions: UCR varies across AKI etiologies and is influenced by age and baseline kidney function. Although its standalone diagnostic performance is limited, integration with simple clinical variables improves discrimination between pre-renal and parenchymal AKI, supporting its use as a complementary tool in early AKI evaluation while emphasizing the need for comprehensive clinical assessment. Full article

Introduction: Chimeric Antigen Receptor T (CAR-T) cell therapy and autologous stem cell transplantation (ASCT) are both associated with significant physical and psychological challenges during post-transfusion recovery. To date, most assessments of physical recovery rely on subjective measures, which are prone to individual perception and bias. Direct comparative data on objective physical function between these therapies remain lacking. Objective: The study aims to compare physical recovery trajectories following CAR-T cell therapy and ASCT using objective and standardized rehabilitation assessments to identify promising endpoints for future trials. Methods: a total of 331 intraindividual rehabilitation assessments conducted at hospital admission and discharge were retrospectively screened for the Berg Balance Scale (BBS), muscle strength (MS), Timed Up and Go (TUG), 5-Times Sit-to-Stand (5×STS), and 6-minute Walk Test (6MWT). Subjective assessments including self-reported health status and fatigue measured by a Visual Analog Scale were also recorded. Results: Twelve patients met the inclusion criteria and completed all rehabilitation assessments (five CAR-T, seven ASCT). In the ASCT group, 6MWT performance declined significantly from admission to discharge (median change −84 m; range −415 to −31 m; p = 0.016), while CAR-T recipients showed a non-significant numerical improvement (median change +79 m; range −40 to +148 m; p = 0.19). Between-group comparison of 6MWT change favored CAR-T therapy (p = 0.005). For BBS, TUG, 5×STS and MS, no statistically significant within-group changes were observed, although trends suggested better preservation of balance and mobility in the CAR-T group. Conclusions: This pilot study provides preliminary comparative evidence suggesting that patients receiving CAR-T therapy may better preserve functional endurance than those undergoing ASCT, measured by the 6MWT. These findings are consistent with the existing literature highlighting the sensitivity and clinical relevance of the 6MWT in detecting functional changes, supporting its inclusion in standard rehabilitation assessments. Full article

Background: Precision diagnostics are more and more important in intensive care units (ICUs), where rapid identification of infectious agents and antimicrobial resistance determinants is crucial for timely and appropriate treatment. Conventional microbiological methods are frequently limited by long turnaround times and reduced sensitivity, which may delay appropriate treatment. Nanopore sequencing allows rapid, direct, and long-read sequencing of DNA/RNA molecules without the need for amplification, avoiding biases introduced by NGS during amplification and library preparation and generating data in real time. Objectives: This narrative review aims to summarize current knowledge of nanopore technology in the ICU, discuss nanopore principles and current clinical applications in intensive care medicine, highlight its advantages and limitations, and explore future perspectives for integrating nanopore-based diagnostics into precision critical care. Methods: A literature search was performed using PubMed and Web of Science. The literature search was conducted with no lower restriction, covering English-language publications. Results: Nanopore sequencing enables real-time, long-read, single-molecule analysis of native nucleic acid molecules, rapid pathogen identification, antimicrobial resistance profiling, metagenomic analysis, and direct sequencing without amplification. Recent studies have proved the clinical utility of nanopore sequencing in critically ill patients with sepsis, bloodstream infections, hospital-acquired pneumonia, ventilator-associated pneumonia, and fungal and viral infections. Its portability, rapid turnaround time, and potential for point-of-care implementation make it particularly attractive for ICU settings. Conclusions: Nanopore sequencing technology represents a promising molecular diagnostic tool, but wider clinical implementation warrants further larger studies with clinical outcome endpoints, standardized bioinformatic pipelines, and clearer validation pathways. Full article

Wi-Fi Channel State Information (CSI) provides a privacy-preserving modality for human activity recognition (HAR), particularly in environments where activity classes vary in complexity and temporal scale. This work presents an integrated framework that combines multi-scale Fourier operator learning with manifold-aware density refinement for coarse-grained CSI-based HAR. The adaptive Multi-Scale Fourier Neural Operator (MS-FNO) models CSI trajectories as structured stochastic processes and learns activity mappings directly in the function space. Its multi-scale design enables the model to capture both simple, quasi-periodic macro-activities and more complex multi-person interactions by adjusting its receptive field according to the intrinsic structure of each activity class. To address class imbalance and representation collapse, the framework incorporates a Manifold-Preserving Local Density Oversampling (MPLDO) module that performs locality-constrained interpolation in a correlation-projected latent subspace, followed by classifier-guided pruning to maintain decision-boundary consistency. Experimental results show that the combined MS-FNO and MPLDO pipeline improves class-conditional separability and enhances recognition accuracy across both low-complexity and high-complexity activities. The findings highlight the effectiveness of this integrated operator-learning pipeline for privacy-aware activity monitoring in cafés, elder-care facilities, hospitals, and other real-world environments where coarse-to-complex activity understanding is required. Full article

Background: Tetralogy of Fallot with absent pulmonary valve syndrome (TOF-APVS) is a rare variant of tetralogy of Fallot marked by aneurysmal pulmonary artery dilatation and variable tracheobronchial compression. The identification of clinical indicators that predict perioperative risk in this patient population remains challenging. We aimed to review the surgical outcomes and reintervention requirements of patients with TOF-APVS over a 15-year single-center experience, with particular focus on two indicators of disease severity: preoperative mechanical ventilation (MV) and computed tomography (CT)-detected airway compression. Methods: We retrospectively reviewed 27 patients with TOF-APVS who underwent surgical repair at a single center between January 2010 and January 2025. Airway compression was assessed by CT in 20 patients. The primary outcome was the need for any reintervention during follow-up. Secondary outcomes comprised early and overall mortality and postoperative duration of intubation, ICU stay, and hospital stay. Subgroup comparisons were performed using the Fisher exact test and the Mann–Whitney U test. Results: The median age at surgery was 8 months (IQR, 4.5–16). Preoperative MV was required in 5 patients (18.5%), and CT revealed airway compression in 13 of 20 patients (65.0%). Early postoperative mortality was 7.4%, and overall mortality during follow-up was 18.5%. At least one reintervention was required in 9 patients (33.3%). Preoperative MV was significantly associated with early mortality (40.0% vs. 0%; p = 0.028) and with prolonged ICU stay (median 15 vs. 4 days; p = 0.008). CT-detected airway compression was not significantly associated with either mortality or reintervention. Conclusions: In this 15-year single-center experience with 27 patients, preoperative mechanical ventilation was associated with markedly higher early postoperative mortality and prolonged ICU stay, and may thus serve as a practical clinical indicator of disease severity in TOF-APVS. CT-detected airway compression was a frequent and often severe finding, but its association with early mortality and reintervention could not be statistically confirmed, likely reflecting the selective use of CT and small subgroup size. These findings support the integration of preoperative ventilation status into perioperative risk assessment and highlight the need for larger, preferably multicenter, studies with standardized airway assessment to clarify the prognostic role of anatomical airway compression. Full article

Background: Assessment of lymph node involvement was incorporated into the 2023 International Federation of Gynecology and Obstetrics (FIGO) staging system as a critical determinant of patient management and prognostication. This study aims to validate the prognostic significance of metastatic lymph node characteristics and their correlation with molecular classification. Methods: We conducted a retrospective analysis of 131 patients with stage IIIC endometrial carcinoma who underwent surgical intervention at the Tianjin Medical University Cancer Institute and Hospital from 2010 to 2025. The patients were stratified based on various characteristics of metastatic lymph nodes. Progression-free survival (PFS) was estimated using Kaplan–Meier curves, and group comparisons were performed using the log-rank test. Univariate Cox proportional hazards regression was conducted to identify independent prognostic factors for PFS. Results: In accordance with the 2023 FIGO staging system, within the stage IIIC cohort, patients with concurrent pelvic and para-aortic lymph node metastases and those in the stage IIIC1 cohort with macrometastasis demonstrated decreased PFS (HR = 2.748; 95% CI = 1.227–6.151; p = 0.011, and HR = 4.039; 95% CI = 1.232–13.240; p = 0.021, respectively). Furthermore, patients with lymph nodes showing extracapsular extension had significantly reduced PFS in the stage IIIC, stage IIIC1, and stage IIIC1ii cohorts (HR = 10.12; 95% CI = 2.38–42.99; p < 0.001; HR = 3.58; 95% CI = 1.242–10.31; p = 0.011; and HR = 2.32; 95% CI = 0.83–6.71; p = 0.037, respectively). The number of involved lymph nodes, the largest diameter of metastatic foci in lymph nodes, and the presence or absence of extracapsular extension of metastatic lymph nodes were significantly different among the NSMP, MMRd, and p53abn molecular classifications (p = 0.033, p < 0.001, and p = 0.002, respectively). Patients with extracapsular extension of metastatic lymph nodes had worse PFS than those without in the MMRd group (p = 0.018). Conclusions: Extracapsular extension (ECE) of metastatic lymph nodes is the strongest predictor of worse progression-free survival in stage IIIC endometrial carcinoma, especially in the IIIC1 and MMRd subgroups, supporting its value for risk stratification and prognostic assessment. Full article

Background/Objectives: Minimally invasive approaches are increasingly used in right colectomy for colon cancer; however, comparative data, including open, laparoscopic, and robotic techniques, remain limited, particularly regarding postoperative recovery and oncological outcomes. Methods: This retrospective monocentric study included 89 patients undergoing elective right colectomy for colon cancer between July 2018 and December 2022. Of these, 30 patients underwent open, 29 laparoscopic, and 30 robotic-assisted surgery. The primary endpoint was postoperative recovery, defined as the time to first bowel movement. Secondary endpoints included length of hospital stay, complete mesocolic excision (CME) quality, lymph node yield, C-reactive protein (CRP) on postoperative day one, operative time, overall survival (OS), and disease-free survival (DFS). Multivariable regression analyses were performed adjusting for age, sex, BMI, ASA score, UICC stage, and tumor size. Results: Time to first bowel movement was shorter after minimally invasive surgery (median robotic 3.5, laparoscopic 4 vs. open 5 days) and length of hospital stay was numerically shorter (mean 9.1 vs. 10.1 days). CME quality and lymph node yield did not differ significantly between the approaches, and postoperative day-one CRP was numerically lower after robotic (median 4.9 mg/dL) and laparoscopic (5.1 mg/dL) than after open surgery (7.1 mg/dL), without reaching statistical significance after adjustment. Operative time was significantly longer with minimally invasive surgery (robotic +50 min; laparoscopic +43 min vs. open; both p < 0.001). Disease-free (open 51.6%, laparoscopic 66.5%, robotic 66.9%) and overall survival did not differ significantly after adjustment (robotic HR 1.16; laparoscopic HR 1.01 vs. open). Conclusions: No statistically significant difference in surgical quality between the approaches was detected, while operative time was significantly longer after minimally invasive surgery. No statistically significant independent association between the surgical approach and postoperative recovery or three-year oncological outcomes was detected; given the limited precision of the estimates, clinically important differences cannot be excluded. Full article

The design of healthcare facilities must comply with applicable regulatory requirements, which significantly influence functional, spatial, and performance aspects of healthcare buildings. However, compliance checking is still predominantly conducted through manual procedures, leading to time-consuming workflows and a high risk of errors. In this context, Computational Compliance Checking (CCC) offers the potential to enhance the efficiency and reliability of regulatory verification processes. The adoption of Building Information Modelling (BIM), supported by the open standard Industry Foundation Classes (IFC), enables the formalisation of Information Delivery Specifications (IDS) as machine-interpretable rules for model validation. Additionally, the buildingSMART Data Dictionary (bSDD) contributes to the semantic structuring and classification of information requirements. This study explores how the IDS standard can enhance CCC processes by supporting the automated verification of regulatory requirements. Complementary solutions based on Python are proposed to address cases where IDS alone proves insufficient. A methodology for the semi-automated compliance checking of healthcare regulatory requirements is developed and applied to a case study based on regional regulations in the Veneto Region (Italy). Tested on the inpatient ward of a hospital BIM model, the procedure processed all 35 accreditation requirements, 91.4% through IDS and 8.6% through complementary Python routines, revealing several design non-conformities. Full article

Machine learning (ML) applied to pediatric intensive care data could enable earlier risk stratification and more precise decision support, but limited shareable pediatric datasets have constrained progress. The Pediatric Intensive Care database (PIC) on PhysioNet provides a de-identified, bilingual electronic health record resource spanning 2010–2018. In this narrative review we synthesize ten PIC-based ML studies identified through forward citation tracking on the original PIC publication and PhysioNet dataset record in PubMed, Web of Science, and Google Scholar. For each study we abstracted the clinical question, cohort, label construction, feature engineering, model class, validation design, calibration reporting, and release of reproducibility artifacts. The reviewed studies addressed catheter-associated thrombosis, sepsis, in-hospital mortality, and organ-dysfunction phenotyping. We organize the synthesis around four substrate properties of PIC: irregular time series, constructed labels, single-center temporal drift, and bilingual identifier semantics. The review advances three claims. First, upstream design choices appear to drive performance at least as much as classifier selection across the studies reviewed. Second, within-site discrimination metrics are insufficient without calibration, decision-curve analysis, and deployment-realistic validation. Third, PIC should be viewed as the seed for a collaborative pediatric ICU data ecosystem. Full article

Urinary incontinence, the involuntary leakage of urine, significantly impacts middle-aged women. Background/Objective: In response to the failure of traditional diagnostic methods, transperineal ultrasound (TPUS) imaging was developed. The aim of our study was to identify the utility of TPUS in combination with a quality-of-life questionnaire in stress urinary incontinence evaluation and its reflection in clinical outcomes. Methods: This retrospective study was conducted between 18 March 2022 and 31 December 2024 in the County Hospital Hunedoara, Romania, Department of Obstetrics and Gynecology. It included 58 patients who underwent surgery for stress urinary incontinence and a control group consisting of 50 patients without SUI. Quality of life scores were recorded preoperatively and 6 months postoperatively, and ultrasound examination was performed. Four variables (Q-type test, the expansion of the funnel shape of the proximal urethra, Doppler assessment, and bladder neck descent) were measured, and their preoperative and postoperative values were compared in the study and control groups. Results: Significant statistical differences were observed in the variables measured through TPUS before and after surgery in the study group (p = 0.0001). These characteristics were significantly different in the study group compared with control group (p = 0.0001). All women in the study group reported a severe impact on their quality of life compared with the control women (10% reported a moderate level) (p = 0.000). Additionally, quality of life was significantly improved in the study group after surgery (p = 0.0001). Conclusions: Transperineal ultrasound is a noninvasive, cost-effective, and highly reliable imaging technique used to assess SUI. Questionnaires are also useful in evaluating patients’ quality of life and satisfaction after surgery. Full article

Introduction: For more than 40 years, obstetricians and midwives worldwide have continued to debate the significance of episiotomy and methods of reducing the rate of obstetric anal sphincter injuries (OASIS). Methods: A concise review of relevant recently published articles on obstetric perineal trauma was conducted, together with an analysis and comparison of the annual rates of episiotomy and OASIS (primary outcomes) at Clinical Hospital “Sveti Duh”, Zagreb (tertiary care level), and Požega General County Hospital, Požega (primary care level), over a ten-year period (2015–2024). Results: Routine (liberal) episiotomy has been abandoned in clinical practice worldwide, and restrictive (selective) episiotomy based on strict medical indications has gained widespread acceptance. Lateralization of episiotomy, slowing the expulsion of the fetal head, and manual perineal protection represent an important set of preventive interventions for avoiding OASIS. Restrictive episiotomy was implemented at Clinical Hospital “Sveti Duh” in 2010 and at Požega General County Hospital in 2012. A statistically significant difference in the episiotomy rate was observed between the two hospitals during the study period 2015–2019 (tertiary care level, 22.0% vs. primary care level, 17.5%), and an even greater difference was observed during 2020–2024 (tertiary care level, 31.0% vs. primary care level, 17.0%). At the tertiary care level, we detected a slight increase in the OASIS rate during 2020–2024 compared with 2015–2019, whereas a slight decrease was observed at the primary care level. No statistically significant difference in OASIS rates was detected between the two hospitals or between the two study periods, indicating that the OASIS rate remained stable at below 1%. Discussion: Nowadays, it is necessary to find a balance (when using mediolateral or lateral episiotomy) between an optimal overall episiotomy rate of <30% (primiparas: <50%; multiparas: <10%) and a corresponding overall OASIS rate of up to 1%. Several measures were important for the successful restrictive approach to episiotomy at Clinical Hospital “Sveti Duh” and, subsequently, at Požega General County Hospital: (1) performing episiotomy strictly according to medical indications; (2) individualized patient assessment; (3) patience during the second stage of labor; (4) critical judgment by both the obstetrician and the midwife, the availability of an experienced and skilled midwife, and the cooperation of the woman in labor; and (5) education of all birth attendants, including the transfer of knowledge and training from the tertiary to the primary care level. The implementation of all these measures resulted in reductions in both episiotomy and OASIS rates at the two hospitals. However, our results clearly show that the discontinuation of staff training and organizational problems can be discouraging for staff members and may result in inappropriate clinical practice, which is not necessarily more likely to occur in small than in large clinical settings. Full article

Background and Objectives: Existing severity scores for acute pancreatitis (AP), such as the Ranson, Glasgow-Imrie, APACHE II, BISAP, Balthazar scores, are limited by complexity, delayed availability, or insufficient discriminative accuracy. We aimed to develop a new prognostic score using parameters available at admission in any primary or regional care setting, suitable for early risk stratification and clinical decision-making in AP. Materials and Methods: We conducted a retrospective observational study of 194 patients admitted with acute pancreatitis, classified as mild (MILD, n = 59), moderately severe (n = 82) and severe (n= 53) course, according to the Revised Atlanta Classification. Candidate predictors—including demographic, clinical, inflammatory, nutritional, and radiological variables—were screened using univariable analysis, and independent predictors were identified by backward stepwise logistic regression. Discriminative performance was assessed using receiver operating characteristic (ROC) curve analysis and compared with six established severity scores (Ranson, Glasgow-Imrie, Balthazar, CTSI, BISAP, and HAPS). APACHE II was not included in this comparison because some of its required physiological variables were not consistently available outside the intensive care unit. Results: MODSEV (moderately severe/severe) patients showed significantly higher inflammatory, nutritional, and metabolic derangement at admission than MILD patients. Six variables—admission white blood cell count, blood urea nitrogen (BUN), pleural effusion, admission blood glucose level, platelet-to-lymphocyte ratio (PLR), and serum albumin—were retained in the final logistic regression model (ProbScore2), which demonstrated excellent discriminative ability (AUC = 0.873; 95% CI: 0.819–0.927), showing, within this retrospective cohort, a numerically higher AUC than the Glasgow-Imrie (AUC = 0.832), CTSI (0.775), Balthazar (0.758), BISAP (0.725), Ranson (0.676) and HAPS (0.574). A simplified, unweighted 0–6 point bedside version of the score retained most of this discriminative ability (AUC = 0.852), with an optimal cut-off of ≥3 points yielding a sensitivity of 77.0% and a specificity of 79.7%. Conclusions: ProbScore2, a novel six-variable prognostic score, demonstrated excellent discriminative performance for the early identification of moderately severe/severe acute pancreatitis, with a numerically higher AUC than established severity scoring systems evaluated within this same retrospective, single-center cohort (excluding APACHE II, which could not be calculated for all patients). These comparative findings require confirmation through prospective external validation before any conclusions about generalizable superiority can be drawn. Five of the six components are derived from routine admission blood tests, and the sixth (pleural effusion) requires only a plain chest radiograph rather than cross-sectional imaging. The score and its simplified bedside adaptation can therefore be calculated within hours of admission using resources available even in hospitals without intensive care or advanced, CT-based imaging capabilities. ProbScore2 is not yet ready for routine clinical use; prospective external validation in independent, multicenter cohorts is required before clinical implementation. Full article

The integration of Artificial Intelligence is transforming luxury hospitality, forcing hotels to balance advanced technology with human-centered management to sustain service excellence. Yet how Human-Centered Leadership shapes Sustained Service Performance through employees’ AI readiness and engagement remains largely unexamined. This study develops and tests an integrated framework addressing that gap. Survey data were collected from 500 employees of four- and five-star luxury hotels in the United Arab Emirates, Saudi Arabia, Qatar, and Lebanon, and analyzed using partial least squares structural equation modeling (PLS-SEM). Human-Centered Leadership was positively associated with both Sustained Service Performance and AI readiness. AI readiness predicted employee engagement, which in turn predicted Sustained Service Performance. AI readiness and employee engagement sequentially mediated the link between Human-Centered Leadership and Sustained Service Performance (β = 0.160, p < 0.001). Digital Organizational Support significantly strengthened the Human-Centered Leadership–AI readiness relationship (β = 0.137, p = 0.004). The study advances hospitality leadership research by establishing Human-Centered Leadership as a driver of Sustained Service Performance in AI-enabled settings, and by revealing the sequential psychological mechanism, AI readiness followed by engagement, through which it operates. The findings help luxury hotel managers combine Human-Centered Leadership with digital support to sustain service excellence during AI-driven transformation. Full article

Background: Preoperative anaemia and perioperative transfusion are associated with adverse outcomes after cardiac surgery with cardiopulmonary bypass (CPB). Coronavirus disease 2019 (COVID-19) may induce persistent haematological and endothelial alterations. Whether previous infection modifies the relationship between haemoglobin and outcomes is unclear. This study evaluated whether previous COVID-19 infection modified the association between preoperative haemoglobin concentration and perioperative transfusion burden after cardiac surgery with CPB. Early postoperative complications were analysed as predefined secondary outcomes. Methods: This study represents a secondary analysis of a prospective observational cohort of adult patients undergoing elective on-pump cardiac surgery between 1 August 2022 and 30 October 2023. Patients were categorised according to previous COVID-19 infection. Surgery was performed at least seven weeks after infection. The primary outcome was perioperative transfusion burden, defined as the total number of blood products administered from the intraoperative period until hospital discharge. An interaction term between previous COVID-19 and preoperative haemoglobin was included in multivariable linear regression. Results: A total of 280 patients were included, of whom 101 (36.1%) had a previous COVID-19 infection. Preoperative haemoglobin was comparable between patients with and without a previous COVID-19 infection (13.4 [12.4–14.8] vs. 13.8 [12.2–14.6] g/dL; p = 0.472). No significant differences in early postoperative complications, transfusion rates, or transfusion burden were observed according to previous COVID-19 infection. The COVID-19 × haemoglobin interaction was not statistically significant in the adjusted model (B = 0.002, 95% CI −0.081 to 0.085; p = 0.958). Lower preoperative haemoglobin, lower baseline platelet count, longer CPB duration, and CKD were independently associated with greater transfusion burden. In an exploratory multivariable analysis, preoperative anaemia remained associated with postoperative AKI after adjustment for relevant covariates (adjusted OR 5.80, 95% CI 2.23–15.06; p < 0.001). Conclusions: No statistically significant interaction between previous COVID-19 and preoperative haemoglobin was demonstrated for perioperative transfusion burden. Lower preoperative haemoglobin was independently associated with greater transfusion burden, while preoperative anaemia remained associated with postoperative AKI after multivariable adjustment in an exploratory analysis. These findings support systematic preoperative anaemia screening and Patient Blood Management in cardiac surgery. Full article