Search Results (1,304)

Background: To evaluate whether the methods of induction of labor (IOL) used for pregnancies complicated with fetal growth restriction (FGR) have different impacts on materno-fetal outcomes. Methods: This was a single-center, retrospective cohort study conducted over a one-year period, from January 2024 to December 2024, in the maternity ward of the Orléans University Hospital, France. The clinical data related to maternal–fetal characteristics and IOL outcomes were recorded. The results were comparable between the Cook^® balloon and Prostaglandin groups. Results: A total of 47 patients met the inclusion criteria; 27 cases underwent the Cook^® balloon and 20 cases received prostaglandin for IOL. There were no substantial differences between Cook balloon and prostaglandin on maternal–fetal characteristics and outcome of IOL. However, the duration of latent labor-delivery phase and duration of onset of labor induction and delivery were longer in the Cook^® balloon group compared with the prostaglandin group (30.05 ± 10.81 versus 22.29 ± 11.94 (hours) and 7.33 ± 3.96 versus 3.74 ± 4.77 (hours), respectively, p < 0.05). The success rate according to criterion 1 (Bishop score greater than 7 after IOL) was approximately 60% (28/47 cases). However, if using criterion 2 (success by vaginal birth), after the application of two or three methods of cervical ripening with amniotomy ± use of oxytocin, the success rate increased by more than 20%, up to 80.85% (38/47 cases). Conclusions: IOL with Cook^® balloon and prostaglandin may both be acceptable methods for pregnancies complicated by FGR. In addition, IOL did not differ in terms of materno-neonatal outcomes between two groups. However, the duration time from IOL to delivery and the duration from latent phase of labor to delivery were longer in the Cook^® balloon group compared with the prostaglandin group. Full article

Background: To assess temporal trends in psychiatric hospitalizations among adolescents admitted to a general pediatric ward in Forlì, Italy, between 2016 and 2025 and to examine diagnostic patterns and their association with sex and age, using the individual patient as the primary unit of analysis. Methods: Single-center retrospective study including all hospitalizations for psychiatric disorders in patients aged 10–17 years over a 10-year period. Each discharge episode was assigned to a single dominant diagnostic category. The primary analyses were conducted at the level of the individual patient (first admission), while episode-level analyses were retained as a pre-specified sensitivity analysis reflecting inpatient burden. Results: A total of 165 adolescents (210 hospitalization episodes) were included; mean (SD) age was 14.47 (1.73) years, and females were 77% of patients (80.5% of episodes). Admissions increased significantly over time (patients: IRR 1.20 per year, 95% CI 1.13–1.27; p < 0.001), with 124/165 (75.2%) patients first admitted in 2021–2025. Suicidal ideation/attempt (27.3%) and eating disorders (15.2%) were the most frequent diagnoses, and both showed a significant upward trend. Overall, diagnosis was associated with sex (p = 0.004): most diagnoses, including the two most frequent, were female-predominant, whereas psychomotor agitation was over-represented in males. Age at admission increased modestly over time and was higher in 2021–2025. Twenty-seven patients accounted for 45 readmissions, concentrated in the most severe diagnoses. Conclusions: Psychiatric hospitalizations of adolescents in a general pediatric ward rose substantially over the decade, especially from 2021, driven mainly by suicidal ideation/attempt and eating disorders. Findings were robust to analysis at the patient level and support the role of the general pediatric ward as a sentinel setting for severe adolescent mental distress. Full article

Background/Objectives: Respiratory intermediate care units (RICUs) manage patients with severe respiratory disease requiring advanced monitoring and non-invasive respiratory support. Early identification of patients requiring RICU care after emergency department (ED) assessment remains challenging. This study assessed whether initial admission to a conventional hospital ward followed by early RICU transfer was associated with in-hospital mortality among patients ultimately admitted to a RICU. Methods: We conducted a 10-year prospective observational cohort study including consecutive patients admitted to the RICU of a tertiary hospital after ED assessment. Patients admitted directly from the ED to the RICU were classified as the direct RICU admission group. Patients initially admitted to a conventional ward and transferred to the RICU within 48 h were classified as the early ward-to-RICU transfer group. The primary outcome was all-cause in-hospital mortality. Secondary outcomes included ICU admission and hospital length of stay. Multivariable logistic regression was used to assess the association between admission pathway and in-hospital mortality. Results: A total of 1784 patients were included: 1285 (72%) in the direct RICU admission group and 499 (28%) in the early ward-to-RICU transfer group. In-hospital mortality was higher in the early ward-to-RICU transfer group than in the direct RICU admission group (13.43% versus 5.76%; p < 0.0001), as were ICU admission rates (6.01% versus 2.57%; p = 0.0004). In the complete-case multivariable model, early ward-to-RICU transfer remained associated with higher in-hospital mortality after adjustment for sex, ECOG performance status, APACHE II score at ED presentation, Charlson Comorbidity Index, heart failure, and interstitial lung disease (OR 2.99, 95% CI 1.96–4.56; p < 0.0001). Conclusions: Among patients ultimately admitted to a RICU after ED assessment, initial ward admission followed by early RICU transfer was associated with higher in-hospital mortality. These findings suggest that initial ward admission followed by early RICU transfer may help identify a clinically vulnerable subgroup among patients ultimately requiring respiratory intermediate care. However, because admission pathway may be influenced by evolving severity, diagnostic uncertainty, treatment decisions, and organisational factors, no causal inference can be made from this observational study. Full article

Delayed discharge represents a persistent challenge in healthcare systems, contributing to inefficiencies in hospital bed utilization, increased costs, and reduced patient flow. In small and centralized healthcare systems, these effects may be further amplified due to limited post-acute care capacity and restricted patient redistribution. This study quantified the prevalence of inappropriate hospital days as a proxy for delayed discharge and examined their relationship with patient demographics, medical specialty, and associated costs in an acute general hospital. A quantitative analysis of 220 medical records was conducted using a modified Appropriateness Evaluation Protocol (AEP). Descriptive statistics and non-parametric tests were applied to identify significant associations between inappropriate hospital days and selected variables. According to the findings, within this intentionally enriched sample of patients with a length of stay exceeding seven days in the selected wards, nearly half of all accumulated inpatient bed days failed to meet acute necessity criteria, with the vast majority of these service backlogs stemming from placement delays in downstream rehabilitation facilities and long-term care institutions. Within this high-risk cohort, inappropriate hospital days, used here as a proxy for delayed discharge, were more common among older patients and among medical specialties than in other specialties, while no consistent relationship was observed with gender. Cost analysis (carried out over a three-month period) indicated an order-of-magnitude estimate of the acute bed day resources associated with inappropriate hospital days in the units studied. These findings are consistent with the interpretation that inappropriate hospital days, used here as a proxy indicator of delayed discharge, may be influenced by a combination of external capacity constraints and internal operational inefficiencies, although causality cannot be established from this observational design. While the findings cannot be generalised to the entire inpatient population or health system, within this intentionally enriched cohort of long stay inpatients the study highlights the need to strengthen post-acute care provision, improve discharge coordination processes, and enhance system integration to optimise hospital efficiency and patient flow in similar operational contexts. Full article

Background: Palliative care is a clinically, relationally and emotionally demanding field. Continuous exposure to suffering and death exposes professionals to compassion fatigue, vicarious trauma and grief, and burnout, while also offering opportunities for compassion satisfaction and meaning-making. How professionals cope is central to sustaining the supporting role in diseases with a poor prognosis. Objectives: To explore the emotional and experiential dimensions of palliative care work and the coping strategies, individual and team-based, that professionals deploy when accompanying patients and families at the end of life. Methods: Reflexive thematic analysis of 16 semi-structured interviews with palliative care professionals (5 physicians, 7 nurses, 3 psychologists, and 1 social-health worker; 14 women and 2 men) recruited from hospices, hospital wards and home-based services in Northern Italy. Sample size was guided by an information power model. Reporting follows the COREQ checklist. Results: Four themes were constructed: (1) the unsustainability of the workload; (2) the pleasure of care between empathic relationship, listening and welcoming; (3) the holistic role of the professional; and (4) the awareness of death. Across themes, participants mobilised a layered repertoire of problem-, emotion- and meaning-focused coping. Narratives fitting a structured moral-distress pattern were comparatively limited in participants’ accounts. Conclusions: Sustaining supporting roles in poor-prognosis care may require more than individual resilience; it depends on organisational support—structured supervision, reflective spaces, and communication and emotional training—that makes professionals’ largely informal coping work a shared and sustainable resource. Full article

Workplace violence (WPV) is a major occupational hazard for nurses in Thailand, negatively affecting psychological well-being, professional confidence, and patient care. In this quantitative cross-sectional analytic study involving 415 nurses, 43.61% reported experiencing at least one incident of WPV during the previous 12 months. Verbal abuse (41.20%) and physical violence (13.25%) were the most frequently reported forms, with a higher prevalence observed in urban hospitals than in rural hospitals (53.66% vs. 33.81%). Higher WPV risk was associated with working in medical wards (adjusted incidence rate ratio [Adj IRR] 3.33) and emergency departments (Adj IRR 2.47), caring for male-only patients (Adj IRR 1.87), younger age (Adj IRR 3.31), divorced or separated status (Adj IRR 3.05), rotating day and night shifts (Adj IRR 2.03), and extreme concern about WPV (Adj IRR 4.57). The psychological impact was considerable. Hypervigilance was the most common response (66.30%), especially following physical violence (76.36%). More than 41% of affected nurses reported intentions to resign or transfer and reduced professional confidence. Reporting incidents was often perceived as ineffective, contributing to underreporting. Nurses identified clear disciplinary measures, increased staffing, improved workplace environments, stronger security systems, and organizational support as key prevention priorities. These findings highlight the urgent need for context-specific interventions, targeted staff training, and organizational strategies to protect nurse well-being, strengthen workforce resilience, and maintain quality patient care. Full article

In the literature, there is a limited number of case reports of Paenibacillus urinalis in adults. However, there is no information available regarding P. urinalis infection in children and infants. Paenibacillus growth in blood and sterile site cultures is generally considered contamination; it is unclear whether P. urinalis is the true cause of the infection. In this retrospective study, we aimed to clinically evaluate P. urinalis growth in the blood cultures of children at a tertiary referral hospital over a 5.5-year period, with identification performed using the MALDI-TOF MS method. A total of 170 hospitalized children showed P. urinalis growth in sterile site cultures (blood: 162; catheter: 7; CSF: 1), with forty percent of all growth occurring in only three wards (neonatal intensive care unit, hematology, oncology). Of 170 cultures, 5 (2.9%) showed further P. urinalis growth in control cultures, which could be considered significant. In cases with a second culture, the average growth time (time to positivity) was relatively short, at 24 + 7 h (mean + SD, min-max: 17–33 h). No mortality was observed in any case. Evaluations were conducted by the Hospital Infection Control Committee to determine the source of P. urinalis contamination. P. urinalis growth was detected in 33% of samples taken from clean, packaged linens before use; 53% of ambient air cultures; and 65% of hospitalized patient skin swabs. In conclusion, P. urinalis blood culture growths are primarily considered contamination; however, these growths should be carefully evaluated in risk groups (especially those admitted in neonatal intensive care units and young infants less than 3 months old). In hospitalized patients, clustered growths may be influenced by environmental (such as clean packaged linens and ambient air) and skin colonization. Full article

Built and ambient features of hospital ward design may influence patient safety and inform future hospital construction and refurbishment. However, evidence on their overall impact remains fragmented. This review synthesised available evidence and highlighted key differences from previous reviews. A comprehensive search identified studies published between 1993 and 2023 involving hospital inpatients. Data were extracted from eligible systematic reviews and subsequently from cited primary studies to synthesise findings and address inconsistencies. Meta-analyses and effect size calculations were performed where appropriate. A total of 31 reviews and 50 primary studies were included. Fall outcomes mainly involved geriatric patients, while infection and delirium outcomes were derived from mixed adult populations. Compared with multi-bedrooms, single-patient rooms were associated with increased fall rates and numbers of fallers, but a lower proportion of patients and rates of hospital-acquired infection and delirium. Natural light and vinyl flooring showed non-significant trends toward reduced delirium and fewer fallers, respectively. Vinyl flooring was associated with higher injurious fall rates. Certainty of evidence was low to very low. Hospital ward design may substantially affect patient safety and quality of care, particularly for older adults. However, effects may be favourable or unfavourable depending on the outcome considered. Further empirical and economic research is needed to balance these competing outcomes. Full article

Background/Objectives: This study examined the impact of data pre-processing on indirectly derived reference intervals for intact parathyroid hormone (iPTH). Routine laboratory data from a single Norwegian site, measured on the Abbott Alinity i analyzer, were processed with different pre-processing steps before applying and comparing three indirect estimation methods. Methods: Data pre-processing consisted of several steps, including filtering based on the number of results per patient, exclusion of specific hospital wards, and the use of predefined biomarkers. Reference intervals were estimated for datasets subjected to different pre-processing strategies using three indirect methods: RefLim, truncated maximum likelihood (TML), and refineR. The impact of pre-processing on the derived reference intervals was systematically evaluated. In addition, vitamin D status and estimated glomerular filtration rate (eGFR) were evaluated as potential partitioning criteria. For comparison, reference intervals were also calculated using both conventional parametric and nonparametric estimation methods. Results: Data pre-processing had a pronounced impact on the estimated reference intervals. Restricting the dataset to subjects with a single measurement proved to be an effective strategy for excluding pathological patients, whereas exclusion of specific hospital wards and biomarker-based filtering had a negligible additional effect. Conclusions: While stringent data pre-processing and large initial datasets are essential for reliable indirect reference interval estimation of complex analytes such as iPTH, the choice of pre-processing strategy must be guided by analyte-specific characteristics, as different analytes may require different approaches. Full article

Background/Objectives: Stenotrophomonas maltophilia is a critical opportunistic pathogen, yet its long-term epidemiology remains underrepresented in global surveillance frameworks like WHO GLASS. We aimed to analyze its six-year epidemiological trend in a large Polish tertiary hospital. Methods: A retrospective study (2020–2025) of 399 non-duplicate isolates was conducted. Identification was performed using MALDI-TOF MS, and susceptibility was analyzed according to EUCAST breakpoints. Antibiotic consumption (DDD/100 patient-days) was correlated with isolation trends. Results: Wound/skin (36.8%) and lower respiratory tract (35.8%) samples predominated. A significant rise in respiratory isolates was observed post-2020, coinciding with peak carbapenem consumption in ICU and surgical wards. Ward-level analysis demonstrated that intensive care unit status (β = 68.9, 95% CI 46.1–91.8, p < 0.001) and carbapenem consumption (β = 0.080, 95% CI 0.004–0.156, p = 0.041) were independently associated with S. maltophilia isolation burden after adjustment for ward type (adjusted R² = 0.80). While trimethoprim–sulfamethoxazole remained highly active, levofloxacin susceptibility showed high interannual variability. Conclusions: S. maltophilia is a stable and clinically significant threat in high-intensity hospital environments. Our findings support the inclusion of this pathogen in international AMR monitoring (GLASS) and emphasize strict carbapenem stewardship to curb its emergence. Full article

The association of atrial fibrillation (AF) and neck of femur fractures (NOF) are common in old people, creating a complex clinical scenario with significant implications for morbidity, mortality, and healthcare systems. This narrative review explores the bidirectional relationship between AF and NOF, focusing on shared risk factors, pathophysiological links, and challenges in clinical management, and also reviews the benefit of an orthogeriatric model. Advanced age, frailty, osteoporosis, polypharmacy, and cardiovascular comorbidities predispose patients to both conditions, while AF itself increases fall risk through haemodynamic instability, syncope, and adverse effects of rate- or rhythm-controlling medications. Importantly, the physiological stress of hip fracture and subsequent surgery can precipitate new-onset or worsening AF via inflammatory, neurohormonal, and metabolic mechanisms. The main challenge for ortho-geriatricians lies in anticoagulation management and preoperative and postoperative management. While anticoagulation reduces thromboembolic risk in AF, it increases perioperative bleeding risk in patients with NOF, often leading to delays in surgery that are independently associated with poorer outcomes. This review examines the current evidence regarding perioperative anticoagulation strategies, timing of surgery, and postoperative resumption of therapy. In addition, the review examines important outcome parameters such as mortality, stroke, bleeding, length of hospital stay, and functional recovery. This highlights the importance of not only improving multidisciplinary care involving orthopaedics, cardiology, geriatrics, and anaesthesia to optimise outcomes, but also enhancing risk stratification. Standardised perioperative pathways and integrated geriatric–cardiac assessment may help mitigate complications. Therefore, understanding how AF and NOF interact is key to delivering holistic, patient-centred care for an increasingly elderly population in orthogeriatric wards. Full article

Background: Post-anesthesia care unit (PACU) duration after total hip arthroplasty (THA) is relevant for ward transfer, early mobilization, and perioperative flow, but is inconsistently reported as a distinct recovery outcome. This study evaluated PACU duration after primary THA under spinal anesthesia in routine hospital-based practice and interpreted the observed duration in relation to contemporary arthroplasty literature. Methods: This retrospective observational cohort study included adult patients undergoing primary THA under spinal anesthesia within two units of a regional hospital. PACU duration was defined as time from PACU arrival until discharge to the orthopedic ward. Demographic, anesthetic, perioperative, and recovery variables were extracted from electronic medical records. Univariate analyses and multivariable linear regression were used to explore factors associated with PACU duration. A focused contextual literature comparison was performed to interpret the observed duration in relation to reported early recovery endpoints, with direct comparison anchored to conventional PACU or recovery-room intervals before ward transfer or immediate pathway progression. Results: Ninety-seven of 150 screened patients were included. Mean PACU duration was 162.3 ± 58.5 min. PACU duration was numerically longer in Unit A than Unit S, but the difference was not statistically significant. Reported early recovery endpoints in the literature were heterogeneous. In univariate analysis, male sex and exploratory spinal local anesthetic dose > 13 mg were associated with longer PACU duration. In multivariable analysis, male sex remained associated with longer PACU duration, whereas spinal dose was not independently associated when analyzed as a continuous variable. Conclusions: PACU duration after THA under spinal anesthesia should be interpreted as a multifactorial, workflow-sensitive outcome rather than a purely anesthetic recovery measure. Differences in discharge criteria, recovery pathways, and endpoint definitions limit direct comparison across studies. PACU duration may be most meaningful as an operational recovery and flow indicator within broadly comparable clinical settings. Full article

This study, based on the WELL Health Building Standard as the theoretical framework, combined with case analyses of 38 geriatric care hospital wards in South Korea and multi-group questionnaires (60 responses each from the medical service, design field, and elderly population groups), systematically explored the design elements and their importance cognition of healing environments in hospital rooms. Through cross-comparison analysis, quantitative (SPSS 25.0 multiple regressions, correlation analysis) and qualitative (ATLAS.ti 9 coding) data fusion methods, the study proposed four core design principles centered on “Beauty and Design,” “Nature Connectedness,” “Privacy,” and “Community and Information” and selected 36 key assessment indicators. The data analysis indicated that the perceived importance of the elderly population (AX) had the greatest impact on the compliance rate of rooms (AR) (β = 0.506, p = 0.002) and the medical staff group (AT) paid more attention to functional design (β = 0.506, p = 0.005), while the designer group (AV) emphasized aesthetic innovation and natural light planning (β = 0.367, p = 0.28). The study further proposed a hierarchical optimization strategy, emphasizing the balanced design of functional requirements, aesthetic innovation, and patient experience through cross-group collaborative design mechanisms. The research results provide theoretical and practical guidance for the healing environmental optimization of hospital rooms in elderly care hospitals. Full article

Background/Objectives: Illness uncertainty is a pervasive psychosocial experience in chronic conditions that is particularly prominent in pediatric oncology. While existing research has explored its psychological impact, a gap remains in understanding how this uncertainty evolves throughout the disease trajectory and how families collectively negotiate and manage this experience over the long term. Methods: This qualitative study was conducted in the hematology ward at a pediatric hospital in Shanghai, China. Using purposive sampling, semi-structured interviews were performed with 32 participants from 12 families of children currently undergoing cancer treatment. Data were collected through in-depth interviews and analyzed using reflexive thematic analysis. The sample was dominated by leukemia cases, with a small number of lymphoma cases; therefore, the findings are most directly transferable to families of children with hematological malignancies. Results: Illness uncertainty is a dynamic and persistent experience permeating the entire pediatric cancer trajectory. Key sources of uncertainty include diagnostic ambiguity and delays, barriers in physician–patient communication, and profound disruptions to family daily life. In response, families proactively develop multidimensional coping strategies: reframing meaning to accept uncertainty, reorganizing family roles and responsibilities, strengthening internal communication, and mobilizing external support networks. These strategies demonstrate both family resilience and inherent vulnerability under sustained pressure. Conclusions: Illness uncertainty in pediatric cancer transcends medical boundaries and is deeply embedded in family life. Healthcare systems should recognize uncertainty as a core experience throughout the disease process and provide family-centered psychosocial and structural support. Strengthening hospital social work services and fostering synergy between peer networks and community resources are essential to enhancing families’ capacity to manage uncertainty and alleviating their long-term psychosocial burden. Full article

Background and Objectives: West Nile virus (WNV) infection has a broad clinical spectrum ranging from asymptomatic or mild disease to severe neuroinvasive forms. Data on hospitalized patients with atypical or non-neurological presentations remain limited. Materials and Methods: We conducted a retrospective multicenter observational study including 30 patients with laboratory-confirmed WNV infection admitted to internal medicine wards during a seasonal outbreak in Southern Italy. Clinical characteristics, hematological parameters, and in-hospital outcomes were analyzed. Results: Median age was 77 years, and 53% of patients were male. Neurological involvement was observed in 50% of patients, whereas 37% presented with septic-like manifestations. Overall in-hospital mortality was 43%, and early mortality within 10 days occurred in 17%. Neurological involvement was significantly more frequent among non-survivors and was associated with increased in-hospital mortality. Higher monocyte percentages were associated with overall mortality, whereas eosinopenia, leukopenia, and thrombocytopenia were associated with early mortality in exploratory analyses. Conclusions: Hospitalized patients with WNV infection may present with heterogeneous clinical phenotypes extending beyond classical neuroinvasive disease. Neurological involvement appears to be the main clinical marker of adverse outcome, while selected hematological parameters may provide preliminary prognostic information. Given the limited sample size and retrospective design, these findings should be considered hypothesis-generating. Full article