Search Results (49,946)

Background/Objectives: The aim of the study was to explore the specific relationships between sleep quality, physical activity levels, and demographic characteristics (age, education level, and work experience) in night shift nurses working at hospitals. Understanding these relationships is critical for developing evidence-based scheduling, educational initiatives for sleep hygiene, and physical activity programs that can mitigate the negative impacts of night work, ultimately promoting nursing workforce sustainability and safer patient health outcomes. Methods: A cross-sectional design was implemented, involving 400 night shift nurses. Data were collected using a questionnaire, which included an Individual Characteristics Form, the Pittsburgh Sleep Quality Index and the International Physical Activity Questionnaire—Short Form. Results: The sleep quality of night shift nurses differed statistically significantly by age in almost all sub-scales (p < 0.001) except for the sub-scale “habitual sleep efficiency”. A significant difference was found across groups, with sleep latency (p = 0.038 *) increasing as work experience grew. Nurses with more experience utilized sleep medications (p = 0.014 *) more frequently than less experienced ones. Physical activity levels differed significantly (p < 0.05): the youngest group showed a higher proportion of high physical activity (52.3%) compared to the oldest (28.9%). A statistically significant negative correlation was found between total physical activity and the total PSQI score (r = −0.162, p = 0.001). Conclusions: The data show that night shifts consistently disrupt nurses’ sleep, and advancing age further compounds these difficulties. The elevated total Pittsburgh Sleep Quality Index (PSQI) scores verify severe sleep disruption across the sample. Physical activity operates as a beneficial behavioral modifier that significantly relates to better sleep quality, lower sleep latency, and less frequent use of sleep medications among night shift nurses. Full article

Background: HIV has been a major global health issue since the 1980s. The proportions of diagnosed and undiagnosed infections are important indicators of HIV control. This study investigated the prevalence and characteristics of HIV based on blood samples from patients presenting for diagnosis and treatment at a tertiary healthcare hospital in the Central Black Sea Region over a four-year retrospective period. Methods: We retrospectively evaluated 271,367 samples submitted for anti-HIV serology testing for pre-operative screening or clinical suspicion between 2020 and 2023. HIV-1/2 antibodies and p24 antigen were screened using chemiluminescence microparticle immunoassay (CMIA), and reactive samples were confirmed by real-time RT-PCR. HIV RNA results and immunological parameters were also analyzed. Results: Among 271,367 samples, 694 were HIV-positive, yielding a prevalence of 0.25%. Of 2207 individuals tested for HIV RNA, 699 (31.7%) were positive. HIV RNA positivity was higher in men than women (35.5% vs. 18.6%). Absolute CD4+ T-cell counts were similar between genders, while the CD4/CD8 ratio was significantly higher in women. Both CD4+ T-cell counts and CD4/CD8 ratios increased significantly after three months of treatment. Conclusions: This study demonstrates a low but increasing HIV seroprevalence in the region, with a clear predominance among males and young adults. The findings also reflect effective viral suppression among treated patients and significant immunological recovery after therapy, providing important regional data to guide HIV monitoring and public health interventions. Full article

Background: Private and community hosting have emerged as important community-based responses to forced displacement, through which host-country citizens provide accommodation, practical support, and relational care to refugees in domestic and community settings. These hosting arrangements extend hospitality beyond commercial and tourism contexts into everyday spaces of welcome, co-living, and social support. Existing literature has examined a range of hosting experiences, including reasons citizens choose to host, ways hospitality is practiced, challenges arising from hosting, and the impacts of hosting on hosts, refugees, and communities. However, the evidence remains fragmented across disciplines, including migration studies, social work, sociology, public health, and hospitality scholarship. Objective: This scoping review aims to map and synthesize the existing literature on why host-country residents and local hosting actors host refugees, with a focus on hosting motivations, hospitality practices, challenges, and impacts in private and community hosting. Methods: This review will follow the Joanna Briggs Institute methodology for scoping reviews and be reported in accordance with the PRISMA-ScR guidelines. Guided by the Population–Concept–Context framework, the review will include studies involving host-country residents and local hosting actors, engaged in refugee hosting. Literature published in English from 2010 onward will be identified through searches in MEDLINE, CINAHL, PsycINFO, Scopus, Web of Science, Sociological Abstracts, Social Services Abstracts, and selected grey literature sources. Two reviewers will independently screen records and extract data, which will be analyzed descriptively and thematically to map motivations, hospitality practices, challenges, and impacts in private and community hosting. Results: The review will generate a comprehensive map of the literature on refugee hosting in private and community settings. It will identify how hosting is conceptualized and practiced, the motivations driving citizen involvement, the relational and structural challenges associated with hosting, and the reported impacts on hosts, refugees, and communities. It will also highlight system-level support, policy considerations, and gaps requiring further attention through research and practice. Conclusions: This scoping review will provide an interdisciplinary synthesis of evidence on refugee hosting as a form of social and domestic hospitality. The findings will inform future research, policy, and community-based hosting initiatives and will contribute to a deeper understanding of the ethical, relational, and structural dimensions of refugee hospitality and hosting in host countries. Full article

Background: Nurse–patient communication is a nurse-associated, interprofessionally delivered care-process indicator captured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), but its hospital-level association with hospital-wide readmission after structural and case-mix adjustment remains incompletely characterized. Methods: We conducted a cross-sectional secondary analysis of publicly available Centers for Medicare and Medicaid Services (CMS) Hospital Compare data. The exposure was the HCAHPS nurse communication composite (April 2024–March 2025), and the outcome was the Hybrid Hospital-Wide All-Cause 30-day Readmission measure (July 2023–June 2024). The primary model adjusted for ownership and US Census region. Robustness was assessed using a six-model hierarchy, including linkage to Provider of Services and HCRIS data to account for teaching intensity, staffing density, and Disproportionate Share Hospital percentage. Additional sensitivity analyses examined survey weighting, survey-volume restriction, lagged HCAHPS scores, HCAHPS-domain specificity, CMS star-rating adjustment, non-linearity, regional interaction, health-system clustering, and alternative functional forms. Findings are interpreted as cross-sectional ecological associations, not causal or predictive effects. Results: Among 2844 acute care hospitals, each 10-percentage-point higher patient-perceived nurse communication score was associated with a 0.289 percentage-point lower 30-day readmission rate (95% CI −0.341 to −0.236; p < 0.001) in the primary model. The association was consistent across sensitivity analyses, although it was attenuated after additional adjustment for linked structural hospital characteristics. Among HCAHPS domains, discharge information showed the largest association with readmission. These findings indicate a modest but consistent hospital-level association rather than evidence of causality. Conclusions: Hospitals with higher patient-perceived nurse communication tended to have lower 30-day readmission rates, although the association was attenuated after adjustment for structural hospital characteristics. Patient-perceived nurse communication may therefore be a useful nurse-associated process indicator for readmission-related benchmarking, although it reflects interprofessional care and residual organizational confounding remains plausible. Longitudinal or interventional studies are needed to determine whether improving nurse communication can reduce readmissions. Full article

Despite the success of antiretroviral therapy, people living with HIV remain at heightened risk of multimorbidity spanning cardiovascular, renal, hepatic, oncologic and neuropsychiatric domains. We investigate whether routinely collected electronic health record data (30 laboratory variables plus seven demographic/social descriptors) can support early, multi-label classification of recorded comorbidities in a real-world cohort of 2200 HIV-positive patients receiving continuous care at a major London hospital. We benchmark classical machine and deep learning models under two settings: a demographic-aware configuration that includes sensitive attributes (age, gender, race and continent of birth) and a demographic-unaware configuration that excludes them. XGBoost yields the best macro-$F_1$ performance, and demographic-aware variants consistently outperform their unaware counterparts. Permutation feature importance revealed physiologically coherent drivers (e.g., creatinine/eGFR for renal and cardiometabolic labels, hemoglobin for hematologic labels, albumin for respiratory labels) and suggested that the relative contribution of demographic variables varied across comorbidity categories. These findings indicate that (i) routinely collected EHR data contain informative patterns associated with the multi-label comorbidity profiles of people living with HIV and (ii) carefully governed use of demographic context can improve accuracy while motivating transparent consideration of fairness and bias. Full article

Background: COVID-19 during pregnancy has been associated with various obstetric complications; however, epidemiological evidence regarding its relationship with hypertensive disorders of pregnancy (HDP) and preterm birth remains inconclusive. Therefore, we aimed to evaluate the association between COVID-19 during pregnancy and the risk of HDP and preterm birth among Mexican pregnant women. Methods: We conducted a retrospective cohort study based on a review of 3710 medical records of women treated at a tertiary hospital between 2020 and 2023. COVID-19 was diagnosed by real-time reverse transcription polymerase chain reaction (RT-PCR) assay. We estimated adjusted risk ratios (aRRs) using robust Poisson regression models, controlling for potential confounders. Results: The COVID-19 rate was 2.5%. We observed that women with COVID-19 had a higher risk of HDP (aRR = 1.59; 95% CI = 1.07–2.36). When HDP subgroups were analyzed separately, COVID-19 was associated with an increased risk of preeclampsia (aRR = 2.04; 95% CI = 1.34–4.20) and preterm birth (aRR = 1.50; 95% CI = 1.02–2.19). The association with gestational hypertension lost statistical significance after adjustment. Conclusions: Our findings suggest that COVID-19 during pregnancy may be associated with hypertensive disorders of pregnancy and preterm birth. However, the observed association with preeclampsia should be interpreted cautiously because diagnostic overlap between severe COVID-19 and preeclampsia cannot be excluded. Full article

Background: Operating rooms generate substantial visual data that is rarely captured systematically. Image-based AI (IBAI) systems using computer vision offer a new approach to real-time perioperative workflow monitoring, but evidence of their impact on surgical case volume remains limited. The aim of this study was to evaluate the association between deployment of an IBAI system and monthly surgical case volume in a high-acuity cardiothoracic operating suite, using synthetic control with difference-in-differences estimation. Methods: We deployed an IBAI system with wall-mounted cameras and a YOLO-based (You Only Look Once) object detection model coupled with a transformer-based event detector in a 15-room cardiothoracic suite at Houston Methodist Hospital (HMH), the tertiary academic hospital of Houston Methodist health system. The deployment was conducted under an IRB-determined quality improvement framework with patient consent for ambient video capture, defined retention limits, and restricted access to recordings. Over a 16-month period spanning 6 months pre-deployment and 10 months post-deployment, the system monitored 5417 surgical cases and automatically detected additional perioperative events including patient entry, draping, and room turnover. Using a synthetic control methodology, we compared post-deployment outcomes at the intervention site against a weighted combination drawn from a pool of 11 Houston Methodist sites that did not yet implement IBAI (116,098 cases across the comparison sites; 121,515 cases in the full analytic dataset). Results: The synthetic control analysis with difference-in-differences estimation showed a statistically significant increase of approximately 25 cases per month (95% CI 8.3 to 41.0; p < 0.01; Bonferroni-adjusted p < 0.05), corresponding to a 7% increase in monthly case volume relative to baseline. Conclusions: Our findings suggest that IBAI can meaningfully improve OR efficiency and support data-driven perioperative management. Future work should evaluate whether case volume gains generalize across other surgical specialties, assess changes in operational outcomes such as turnover time and first-case on-time starts, and examine clinicians’ perceptions of IBAI. Full article

Introduction: Transcatheter aortic valve replacement (TAVR) has become the predominant treatment for severe aortic stenosis across all surgical risk categories. However, its role in patients aged 65 years and younger remains uncertain, and current guideline recommendations continue to favor surgical aortic valve replacement (SAVR) in this population. Despite this, contemporary real-world data demonstrate a marked increase in TAVR utilization among younger patients, creating an important gap between guidelines and clinical practice. Methods: This review synthesizes contemporary observational evidence evaluating TAVR in patients ≤65 years, with a focus on patient selection, clinical outcomes, and lifetime management considerations. Results: Available studies demonstrate that younger patients undergoing TAVR often represent a highly selected and clinically complex population with greater comorbidity burden, higher surgical risk, and shorter life expectancy than age-matched SAVR recipients, yet substantial hospital-level variation in TAVR utilization exists even after risk adjustment. Mid-term observational data suggest higher mortality and heart failure readmission rates following TAVR compared with SAVR, although these findings are likely influenced by substantial baseline differences between treatment groups. No randomized controlled trial has specifically compared TAVR and SAVR in patients ≤65 years. Furthermore, long-term issues including valve durability, coronary access, redo-TAVR feasibility, and THV optimization remain incompletely understood. Conclusions: TAVR recipients ≤65 are often a clinically distinct group characterized by significantly heavier comorbidity burdens than SAVR recipients of the same age with standard surgical risk models possibly underestimating the true clinical risk. Despite this, significant hospital-level variation in TAVR utilization persists even after risk adjustment, suggesting that institutional practice patterns and other non-clinical factors continue to influence treatment selection. Full article

Objectives: To assess whether outcomes differ in patients with aortic graft and endograft infections (AGEIs) according to therapeutic approach (medical treatment alone versus combined medical and surgical treatment) and to describe in detail the radiological and microbiological features of these infections. Methods: This was a single-centre, observational, retrospective study including patients admitted to Monaldi Hospital, Naples, Italy, with a diagnosis of AGEI between 2005 and 2025. All patients fulfilled MAGIC criteria for definite or suspected AGEI. Results: During the study period, 37 patients were enrolled. According to MAGIC criteria, 25 patients had a definite AGEI, while 12 met criteria for suspected infection. A microbiological diagnosis was obtained in 31 patients (84%), mainly from blood cultures (68%). Medical treatment alone was chosen for 19 patients (51%), whereas 18 patients received combined medical and surgical treatment. Crude 30-day, 90-day and 1-year mortality estimates were similar between treatment groups, whereas crude 3-year mortality was numerically higher in patients receiving medical treatment alone. Kaplan–Meier analysis showed a non-significant difference in survival according to treatment strategy (log-rank p = 0.160). Conclusions: AGEIs remain a severe and often fatal complication. In this small retrospective cohort, no statistically significant survival difference was observed between treatment strategies, although a clinically meaningful benefit of surgery cannot be excluded. Graft location was associated with distinct microbiological patterns and may help guide empirical antimicrobial therapy. Full article

Background: Pediatric tracheostomy is a critical airway intervention associated with technical challenges and procedure-related complications, particularly in infants and small children. Body weight may influence perioperative risk, yet weight-based outcome data remain limited. Objective: The study aimed to evaluate the impact of body weight on acute complications and the clinical course following pediatric tracheostomy, with a particular focus on low-weight infants. Methods: This retrospective cohort study included 39 pediatric patients who underwent tracheostomy in a tertiary pediatric intensive care unit. Patients were stratified by body weight into three groups. Demographic data, indications, procedural characteristics, acute complications, and clinical outcomes were analyzed. Results: Acute complications occurred in 7 patients, most commonly cannula-related events. Complication rates were higher in patients < 5 kg. Patients < 5 kg had a longer mean hospital stay than the heavier groups. Conclusions: Low body weight showed a clinically relevant trend toward higher technical risk and prolonged hospitalization following pediatric tracheostomy, although statistical significance was not reached in this cohort. Weight-based procedural planning may support safer postoperative management in this vulnerable population. Full article

Background/Objectives: Therapeutic drug monitoring (TDM) of cyclosporine is essential due to its narrow therapeutic index and pronounced pharmacokinetic variability. Long-term surveillance of patient results may provide insight into analytical stability and clinical practice patterns beyond conventional quality control approaches. Methods: This retrospective observational study included 48,835 routine whole blood cyclosporine concentrations analyzed at a tertiary university hospital laboratory between January 2006 and December 2025. Yearly patient percentiles (10th, 25th, 50th, 75th and 90th percentiles) were calculated to assess longitudinal trends, variability, and potential effects of analytical platform transitions. Results were analyzed overall and by sex. Results: The yearly number of reported cyclosporine results declined modestly over the study period. The overall median cyclosporine concentration was 134.4 µg/L, with negligible differences between female and male patients. The 10th, 25th, and 50th percentiles remained highly stable across the 20-year period, with coefficients of variation between 6.1% and 6.8%. Upper percentiles exhibited greater variability, but the total coefficient of variation for the 90th percentile remained below 8%. No systematic shifts associated with analytical platform transitions were observed. Conclusions: Long-term patient median and percentile analysis demonstrated remarkable temporal stability of cyclosporine concentrations over two decades, despite changes in analytical platforms and clinical practice. Continuous monitoring of patient medians and percentiles may serve as a valuable complementary quality indicator, particularly for assays with limited commutable quality control materials. Full article

Acute aortic syndrome (AAS) comprises acute aortic dissection, intramural haematoma, penetrating atherosclerotic ulcer, and limited intimal tear, conditions that require rapid recognition because mortality and resource use are strongly influenced by time to diagnosis, anatomical extent, malperfusion, and the need for emergency surgical or endovascular intervention. This revised narrative review synthesizes contemporary evidence on clinical, genetic, environmental, and health-system determinants of prolonged hospitalisation, intensive care unit (ICU) utilisation, bed occupancy, and costs in patients with AAS. Beyond summarising established risk factors, the review adds a resource-oriented framework that links hypertension, advanced age, female sex, smoking-related comorbidity, hereditary aortopathies, haemodynamic instability, malperfusion, delayed diagnosis, operative complexity, and postoperative complications to measurable downstream outcomes such as ICU length of stay, total hospital length of stay, reoperation, readmission, and longitudinal imaging surveillance. We searched PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar for relevant studies, registries, guideline documents, and cost analyses published between January 2000 and May 2026, with particular emphasis on studies from the last five years. The review was not designed as a meta-analysis; therefore, effect estimates are interpreted according to study design and generalisability. AAS imposes a disproportionate burden on hospital systems because high-risk patients often require advanced imaging, prolonged haemodynamic monitoring, complex open or endovascular repair, ICU care, and lifelong follow-up. Earlier diagnosis, structured risk stratification, targeted genetic evaluation, aggressive control of modifiable risk factors, and system-level pathways such as dedicated aortic networks may shorten hospital stay and reduce avoidable costs. Full article

Background: Endothelial dysfunction is a central pathophysiological hallmark of preeclampsia. Laboratory and clinical features of preeclampsia can rapidly deteriorate and evidence on appropriate surveillance strategies is scarce. We aimed to evaluate the prognostic value of longitudinal changes in the “Endothelial Activation and Stress Index” (EASIX) for adverse outcomes in patients with preeclampsia. Methods: Patients with preeclampsia who delivered at Heidelberg University Hospital between 2017 and 2022 were included in this retrospective analysis. We assessed EASIX, derived from lactate dehydrogenase, creatinine and platelets, longitudinally between first admission and diagnosis of an adverse outcome. Composite adverse outcomes included pulmonary edema, HELLP syndrome, kidney injury, eclampsia, postpartum hemorrhage and death. We applied logistic and mixed linear regression modeling adjusted for age, gestational age and body mass index. Results: In total, 1733 EASIX measurements of 443 patients were included in the analysis, of which 81 patients experienced an adverse outcome. Both the first EASIX (aOR 2.81 [1.86;4.37]) and the absolute change per day (aOR 4.35 [1.77; 12.05]) were independently associated with adverse outcomes. Addition of the absolute change in EASIX to the model including the first EASIX (AUC 0.74 [0.68–0.81]) did not substantially improve the discriminatory performance (AUC 0.76 [0.70; 0.82]). Linear mixed regression modeling demonstrated that patients with adverse outcomes had a steeper rise in EASIX compared to patients without adverse outcomes (β = 0.024 [0.013, 0.034]). Conclusions: In patients with preeclampsia, EASIX diverged over time with steeper slopes in patients who developed adverse maternal outcomes. Our findings suggest that longitudinal EASIX monitoring may correlate with endothelial dysfunction and capture individual disease dynamics that are not apparent from a single measurement. Full article

Background/Objectives: To evaluate the clinical and demographic characteristics of patients with impaired union of long bone fractures admitted to a specialized orthopedic center and to identify factors associated with infection on admission. Methods: A retrospective, single-center cohort study was conducted at the National Scientific Center of Traumatology and Orthopedics named after Academician N.D. Batpenov. The study included patients hospitalized between 2023 and 2025 with diagnoses of fracture nonunion or delayed union. Demographic characteristics, lesion location, interval from injury to hospitalization, previous treatment, presence of revision osteosynthesis, infection on admission, and length of hospitalization were analyzed. Univariate analysis and multivariate logistic regression were used to identify factors associated with infection. Patients with osteomyelitis were excluded from the regression model to avoid definitional collinearity. Results: During the study period, 360 hospitalizations were recorded in 336 unique patients. The annual incidence increased from 79 in 2023 to 166 in 2025. The median patient age was 50 years, with women accounting for 52.5% of the sample. The most common bone sites were the femur (36.1%), humerus (23.6%), and tibia (15.0%). The median interval from injury to hospitalization at a specialized center was 2 years. Prior revision osteosynthesis was noted in 34.2% of patients. Infection on admission was detected in 20.3% of patients and was associated with a longer hospital stay. In an exploratory multivariable model (EPV ≈ 2.8), previous revision osteosynthesis was associated with infection on admission (OR 8.26; 95% CI 2.76–24.74; p < 0.001). Conclusions: Patients with nonunion and delayed union of long-bone fractures referred to a specialized center represent a clinically complex population characterized by prolonged time from injury, previous surgical interventions, and a substantial burden of infection. In an exploratory multivariable analysis, previous revision osteosynthesis was associated with infection on admission and may represent a marker of clinical complexity and prior treatment burden rather than a causal determinant of infection. Further prospective studies are required to clarify factors associated with infection and treatment outcomes in this patient population. Full article

Background: Healthcare-associated infections (HAIs) and antimicrobial resistance are major burdens in tertiary care hospitals. Repeated point prevalence surveys (PPSs) offer a pragmatic approach to monitor temporal changes and guide infection prevention. Objectives: Characterize healthcare-associated infections (HAI) prevalence trends, microbiological profiles, antimicrobial resistance (AMR) patterns, and risk factors to refine prevention strategies and hospital policy. Methods: Four annual cross-sectional PPSs were conducted between 2022 and 2025 using the standardized ECDC protocol. Data from all eligible inpatients present at 08:00 on survey days were collected through systematic medical record review. Multivariable logistic regression was used to identify factors independently associated with HAI, with additional sensitivity analyses evaluating invasive device burden and hospital ward type. Results: Across the surveys, 3314 patients were included. Overall HAI prevalence was 11.3%. Infections were most frequent in intensive care units (31.2%), followed by medical (14.6%) and surgical (14.2%) wards. Bloodstream infections (25.7%) and lower respiratory tract infections (19.8%) were the most common. Multivariable analysis identified invasive device exposure as the strongest predictor, with central venous and urinary catheters showing robust independent associations and a clear dose–response relationship according to the number of devices. Pathogens were predominantly Gram-positive cocci (40.5%) and Enterobacterales (30.8%), with Klebsiella pneumoniae being the most frequent isolate (13.0%). Notably, 57.6% of K. pneumoniae isolates were resistant to third-generation cephalosporins. All tested Acinetobacter baumannii isolates were resistant to carbapenems. Conclusions: This repeated PPS reveals a persistently high HAI burden, associated with invasive device exposure and resistant pathogens. Because of the repeated cross-sectional design, causal inference cannot be established. Hospital-wide device stewardship and integrated surveillance are essential for guiding targeted prevention measures, refining antimicrobial policies, and adapting local responses to evolving resistance profiles. Full article