Search Results (808)

Sepsis is a life-threatening condition caused by an excessive immune response to infection, and even a one-hour delay in treatment can result in irreversible organ damage and increased mortality. This study aimed to develop an interpretable and efficient machine learning-based system for early sepsis prediction using routinely collected electronic health record (EHR) data. The research question focused on whether high predictive performance could be achieved using only a minimal set of clinical features. Data were obtained from intensive care units and general wards in the PhysioNet Computing in Cardiology Challenge 2019 dataset. Thirty-seven predefined clinical features were extracted and systematically analyzed to assess their predictive contributions. Several machine learning models were trained and evaluated using area under the receiver operating feature curve (ROC-AUC) and accuracy metrics. The proposed model achieved an ROC-AUC of 0.929 and an accuracy of 0.926 when using all features. Remarkably, comparable performance was maintained (ROC-AUC = 0.912, accuracy = 0.907) when only 10 carefully selected features were used. The system outperformed existing state-of-the-art approaches while relying solely on commonly available clinical parameters. An interpretable, feature-efficient sepsis prediction system was successfully developed, demonstrating strong performance with minimal data requirements. The approach is well-suited for resource-limited healthcare settings, such as rural hospitals, and has the potential to reduce diagnostic burden while enabling timely intervention to improve patient outcomes. Full article

Background: Perioperative Cardiac Arrest (POCA) is a rare but catastrophic event with persistently low survival rates. Existing prediction models often fail to capture the perioperative context or predict short-term outcomes. This study aimed to develop and internally validate the POTEC (Platelet count, Oxygen saturation, Time of cardiopulmonary resuscitation (CPR), Elective surgery, and initial end-tidal carbon dioxide (ETCO₂) Score, a simple clinical tool for predicting 24-h survival following perioperative CPR. Methods: We conducted a retrospective cohort study of adult patients (≥18 years) who experienced POCA during or within two hours after non-cardiac surgery under anesthesia at a tertiary university hospital between 2010 and 2023. Multivariable logistic regression was used to identify independent predictors of 24-h survival. The final model’s coefficients were used to construct the POTEC Score, which was internally validated using bootstrapping (1000 replications). Results: Of 321 eligible patients, 65 (20.25%) survived at 24-h. Five variables were independently associated with 24-h survival and included in the POTEC score: preoperative platelet count 100 × 10⁹/L, preoperative oxygen saturation of ≥90% on room air upon arrival in the operating room, CPR duration ≤30 min, elective surgery, and initial end-tidal CO₂ between 35 and 45 mmHg. The score demonstrated good discrimination (AuROC = 0.788, 95% CI: 0.73–0.85) and calibration (Hosmer–Lemeshow p = 0.535). A score of 4 points or higher was associated with significantly higher odds of 24-h survival (adjusted OR = 2.78, 95% CI: 2.05–3.79). Model optimism was minimal (0.009) after bootstrapping. Conclusions: The POTEC Score is a clinically practical tool for early risk stratification in patients undergoing perioperative CPR. Its integration into perioperative workflows may aid in timely decision-making and resource prioritization during critical postoperative care. Full article

Background/Objective: Identifying fluid-responsive patients is essential in managing hemodynamic instability. Traditional static measures like central venous pressure (CVP) are often unreliable. Prior studies suggest that cardiac ultrasound (US), particularly carotid Doppler point-of-care ultrasound (POCUS), may correlate with pulmonary artery catheter (PAC)-derived cardiac output (CO), offering a noninvasive tool to assess fluid responsiveness. We aimed to evaluate the correlation between carotid ultrasound (US) parameters and pulmonary artery catheter (PAC) derived measurements in post cardiac surgery patients. Methods: We conducted a prospective cohort study on 50 postcardiac surgery patients from 2019 to 2022 in a single cardiothoracic ICU. Carotid US and PAC CO measurements were obtained at four intervals: pre- and post-passive leg raise (fluid challenge) on ICU admission, and one hour later. Fluid responsiveness was defined as a ≥10% increase in carotid blood flow, ≥7 ms increase in corrected flow time (FTc), or ≥10% change in respiratory peak carotid systolic velocity (ΔCDPV). Pearson’s correlation and linear regression were used to assess associations between carotid US and PAC changes. Agreement in fluid responsiveness categorization (≥10% CO change) was evaluated using weighted Cohen’s kappa. Significance was set at α = 0.05. Results: No significant correlation was found between changes in carotid US parameters and the PAC cardiac index (CI) at baseline or one hour for ΔCDPV, FTc, or carotid blood flow. A moderate correlation was observed between carotid blood flow and FTc at one hour (r = 0.41, p = 0.005). Regression and sensitivity analyses showed no significant associations. Conclusions: The carotid US parameters did not correlate with PAC-derived CO after passive leg raise. Further studies are needed to validate carotid POCUS in this setting. Full article

Background/Objectives: Time spent with parents and educators encompasses a large portion of a child’s waking hours, with the home and early childhood education and care serving as two of the first settings in which children develop social and cognitive abilities. While previous studies have used social and cognitive tests to examine antecedents of child behavior, we extend such studies to take into account the congruence and incongruence of parents’ and teachers’ views on those antecedents. We examine the importance of parent-teacher alignment on the perceptions of a child’s personality and abilities in early development. Methods: Parents and teachers of 2968 German Kindergarten-aged (4–5 years old) children were surveyed using the National Educational Panel Study (NEPS). Parents and teachers independently rated 10 child behavioral traits, with higher scores indicating more prosocial behavior. Educators also rated children on five developmental abilities (social abilities, ability to concentrate, language abilities, general knowledgeability, and mathematical reasoning) compared to the student’s peers. While previous work has often examined how parental investments in children or teachers’ views of children might be related to development, we provide a new take by examining parents and teachers in conjunction with each other. Research that has looked at both parents and teachers has tended to examine alignment, or lack thereof, on child behaviors and personality traits. We analyzed child developmental abilities using OLS regression models, measures of parent–teacher divergences in ratings of child behavior, and demographic controls. Results: Greater differences in parent and teacher perceptions of desire for knowledge were negatively associated with all five developmental abilities. Differences in parent and teacher perceptions on talkativeness, confidence, good-naturedness, and understanding were negatively associated with at least one developmental outcome. By contrast, differences in perceptions of children’s neatness were positively associated with all five developmental abilities. Conclusions: Using both parent and teacher perceptions of child behaviors and abilities is a unique approach to understanding the relevance of parent and educator perceptions to a child’s development. Our findings indicate the need for collaboration across young children’s home and school or care settings. Establishing congruence in perceptions and the kinds of relationships that can lead to such congruence can help children with behavioral issues receive support in both home and educational settings and encourage mutual respect and partnership between parents and educators. Full article

Background and Objectives: Atrial fibrillation (AF) in critically ill patients (CIP) is associated with worse outcomes and increased mortality in the intensive care unit (ICU). Rhythm control strategies are often unfeasible due to underlying comorbidities, making rate control the preferred initial approach. However, conventional beta-blockers may worsen hemodynamics through negative inotropic effects and peripheral vasodilation. Landiolol, an ultra-short-acting adrenoreceptor antagonist, may offer an alternative due to its high β₁-cardioselectivity and minimal blood pressure (BP) impact. This study evaluated the efficacy and feasibility of landiolol in hemodynamically unstable CIP with tachyarrhythmia, used as add-on therapy after failure of standard treatments. Materials and Methods: Ten CIP, admitted for non-postoperative reasons, were prospectively enrolled for landiolol treatment (L-group) in the ICU of Ulm University Heart Center between July and December 2017. The control group contained 41 patients who had received standard therapy without landiolol (NL-group). The primary composite endpoint was defined as heart rate (HR) reduction while maintaining mean arterial pressure (MAP) above 65 mmHg. Results: The most frequent reason for ICU admission was hemodynamic instability related to tachyarrhythmia in patients with cardiogenic or septic shock. At therapy initiation, all patients exhibited a compromised hemodynamic status, with a median MAP of 68.0 (IQR 60.0–80.0) mmHg and a median HR of 160.0 (IQR 144.0–176.0) bpm. After a three-hour observation period, no significant differences in BP values were observed between the groups. The primary composite endpoint was achieved at comparable rates in both groups (p = 0.525). However, patients in the L-group achieved a greater reduction in HR compared to those in the NL-group (25.3% vs. 21.9%, p < 0.001). Conclusions: Landiolol achieved more effective HR control than standard therapy without adversely affecting BP stability. These findings suggest that landiolol may be a feasible and effective option for HR control in ICU CIP. Full article

Early childhood care (ECC) represents a vital service for the families two supports; however, research on the experiences of young professionals working in this field is lacking. The nature of the work is inherently difficult due to lengthy bureaucratic procedures, limited flexibility to adapt services to individual needs, and a lack of financial and human resources. Background/Objectives: This systematic review is to analyze the existence of scientific literature related to mental health and protective and risk factors in these young professionals. Methods: The PRISMA methodology and a comparative analysis of the selected articles were used, incorporating sources from major scientific databases, such as Scopus, Web of Science, and PsycInfo. Results: A total of 19,943 articles were identified, with a striking 0% specifically addressing early childhood intervention. Only 13 of the articles were selected for the analysis of mental health among young healthcare professionals. Conclusions: The literature reviewed highlights risk factors such as depression, anxiety, and stress among health professionals, as well as protective factors like resilience, social support, empathy and the working conditions themselves (working method, working hours, pay, professional value of the workers themselves, administrative workload and opportunities for teamwork). This study is valuable for establishing a scientific foundation for this population and for enhancing its positive characteristics. Full article

Background: Skin-to-skin contact (SSC) is established as a standard of care due to its demonstrated benefits for preterm newborns, with evidence showing that earlier and more prolonged skin-to-skin contact correlates with reduced morbidity in neonates. Preterm newborns frequently require an umbilical venous catheter, and decisions regarding SSC implementation often depend on nursing staff discretion, given the limited evidence on the safety of SSC in infants with umbilical venous catheters. Aim: The primary endpoint is to explore the experiences and perceptions of parents of preterm infants with umbilical venous catheter (UVC) who engaged in SSC. Methods: This mixed-method, cross-sectional observational study. Conducted from February 2021 to January 2023 at Vall d’Hebron Hospital. The study recruited 190 participants, all progenitors of preterm neonates with umbilical venous catheters, who completed an ad-hoc survey with open and closed questions between the 7th and 10th days of the neonate’s life. Results: Descriptive analysis indicated that 74% of progenitors-initiated skin-to-skin contact within the first 48 h of life; 88.4% reported enhanced emotional well-being during hospitalization while engaging in SSC; 80.4% considered SSC a safe method; and 46.6% were satisfied with the available support furniture. Additionally, 80.4% perceived skin-to-skin contact as beneficial for the developmental progress of their preterm newborn. Phenomenological analysis identified three key categories: perceptions, support and environment. Conclusions: Promoting SSC provides substantial benefits for preterm neonates. Initiating skin-to-skin contact while the infant has an UVC supports earlier initiation and increased hours of SSC. Positive family feedback on SSC with UVC adds value to promoting this practice in neonatal units. SSC with UVC venous catheter is a safe and positive experience for parents. Information, practical support and the integration of the parents’ perspective will be key in the realization of SSC. These findings should encourage other neonatal units to review protocols and actively promote early SSC with UVC. Full article

Tuberculosis (TB) remains a major global health challenge, particularly in resource-limited settings where access to rapid and reliable diagnostics is limited. Conventional diagnostic methods, such as smear microscopy and culture, are either time-consuming or lack adequate sensitivity. This study optimized recombinase polymerase amplification (RPA) using 16 primer combinations targeting IS6110 highly specific to the Mycobacterium tuberculosis complex (MTC). A novel naked-eye assay, TB-GoldDx, was developed by integrating RPA combined with gold nanoparticles (AuNPs), enabling equipment-free diagnostics. TB-GoldDx demonstrated a detection limit of 0.001 ng of MTB H37Rv DNA (~210 bacilli) per 25 µL reaction. Among 100 bacterial strains, it achieved 95.83% sensitivity and 100% specificity among 100 bacterial strains, comprising 72 MTB isolates and 28 nontuberculous bacterial species. In 140 sputum samples, the assay showed 81.43% sensitivity and 58.57% specificity versus acid-fast bacilli (AFB) smear microscopy, with sensitivity improving to 95.45% in high-load AFB 3+ specimens. Compared to a commercial line probe assay (LPA), TB-GoldDx exhibited slightly higher sensitivity (84.78% vs. 82.61%) but lower specificity (54.05% vs. 78.38%). Delivering rapid, visual results in under an hour, TB-GoldDx offers a low-cost, easily deployable solution for point-of-care tuberculosis detection, especially in underserved regions, reinforcing global End TB efforts. Full article

The Complement C3a Receptor (C3aR) plays a multifaceted role along the varying temporal phases of brain injury following cerebral ischemia. C3aR is a G-protein-coupled receptor (GPCR) that binds to its ligand, C3a an anaphylatoxin generated during activation of the complement cascade. During ischemia, complement is activated as part of the initial inflammatory response, with C3aRs playing a time-dependent role in both brain injury and repair mechanisms. In the acute phase (minutes to hours post-ischemia), C3aR activation promotes the recruitment of immune cells and the release of chemokines and cytokines, driving blood–brain barrier (BBB) permeability and brain edema. During the subacute phase (hours to days post-ischemia), C3aR continues to modulate immune cell activity, worsening secondary brain injury, although emerging evidence suggests that C3aR activation in this phase may also aid in the clearance of cellular debris and cell survival. In the chronic phase (days to weeks post-ischemia), chronically elevated C3aR activity can prolong neuroinflammation and impair recovery, whereas controlled C3aR signaling in the subacute/chronic phase can activate reparative pathways (e.g., microglial phagocytosis, astrocyte trophic support). As a result, targeting the C3aR requires careful timing to optimize its benefits. Given the dual impact of C3aR activation, which serves to exacerbate injury in the acute phase but supports repair beginning in the subacute and chronic phases, a targeted therapeutic approach should focus on context- and time-dependent modulation of the C3a/C3aR axis. This strategy would involve blocking the C3aR during the acute phase to reduce inflammation and BBB breakdown while controlling C3a signaling in later phases to promote tissue repair. Full article

Background: In 2023, tuberculosis (TB) caused 1.25 million deaths globally, remaining a leading infectious killer. Central Asia and Southern Caucasus face high TB burdens, particularly Mongolia. This review synthesizes TB prevalence data and diagnostic capabilities in these regions to support public health strategies. Methods: This systematic review aimed to synthesize current data on TB prevalence in Central Asia, Southern Caucasus, and Mongolia to support public health strategies and research priorities. A comprehensive search of PubMed and Google Scholar was conducted for English-language articles published up to 2023. Studies were assessed using a modified Newcastle–Ottawa Scale. Nine studies met the inclusion criteria, covering Kazakhstan, Kyrgyzstan, Uzbekistan, Tajikistan, Turkmenistan, Mongolia, Georgia, Armenia, and Azerbaijan. Results: TB incidence ranged from 67 per 100,000 in Kazakhstan to 190 per 100,000 in Kyrgyzstan, with the highest prevalence of 68.5% in Mongolia. TB affected men more frequently (65.3%), and the key risk factors included HIV (30.5%), comorbidities, and undernutrition. Diagnostic performance varied significantly (microscopy sensitivity, 45–65%; GeneXpert MTB/RIF, 89–96% sensitivity and 98% specificity for rifampicin resistance). Diagnostic turnaround times ranged from hours (molecular) to weeks (conventional). Only 58% of TB facilities had GeneXpert technology, with urban–rural disparities in diagnostic access. Drug-resistant TB imposed a significant economic burden, with treatment costs ranging from USD 106 to USD 3125. Conclusions: Strengthening surveillance, improving data collection, and conducting longitudinal studies are essential for designing effective TB control strategies in these regions. Significant diagnostic gaps persist across these regions, especially with regard to drug-resistant strains. Point-of-care molecular diagnostics, improved algorithms, and expanded laboratory training show promise. Future research should focus on rapid biomarker-based diagnostics, field-deployable technologies for settings with limited resources, and AI integration to enhance diagnostic accuracy and efficiency. Full article

Necrotizing soft tissue infection (NSTI) is a rapidly progressive, life-threatening soft tissue infection that involves the skin, subcutaneous tissue, and fascia, with a natural evolution to septic shock and death if not treated. NSTI is typically associated with trauma, and rarely reported as a complication of aesthetic procedures such as liposuction. We report the case of a previously healthy 34-year-old woman who developed fulminant necrotizing soft tissue infection shortly after undergoing abdominal liposuction in a suspected non-accredited facility. She arrived at our institution with severe thoracoabdominal pain, ecchymosis, and refractory shock within hours postoperatively. Imaging studies performed in the emergency department revealed gas in the soft tissues, confirming the diagnosis. Emergent surgical debridement exposed extensive necrosis affecting a large body surface area. The patient required multiple surgeries, intensive care support, and broad-spectrum antibiotics to achieve infection control. Reconstructive treatment was initiated once stabilization was achieved, leading to full wound closure and a favorable clinical outcome. In addition, we provide a comprehensive review of the current literature regarding necrotizing soft tissue infection, emphasizing this condition as a postoperative complication, including its epidemiology, microbial etiology, pathophysiology, diagnostic challenges, treatment strategies, and reported cases. This review aims to contextualize this rare but severe postoperative complication and to guide clinicians in its early recognition and management, while also raising awareness about the potential consequences of aesthetic procedures performed in unregulated settings. Full article

This cross-sectional study evaluates the potential spatial accessibility of primary percutaneous coronary intervention (pPCI) facilities in the Republic of Serbia (RS) for the year 2030. Cardiovascular diseases, specifically acute myocardial infarction (AMI), are major contributors to mortality, requiring immediate intervention to reestablish blood circulation to the heart. This research employs travel time isochrone analysis to assess the percentage of the population residing within three specific time intervals (30, 60, and 90 min) from a pPCI facility. We project the percentage of the population residing within a 30 min travel time interval to be 50% in 2030. Additionally, the percentage of the population residing within the 90 min travel time interval from a pPCI facility, i.e., known as the “golden hour” travel time distance, is around 96%, with some weekly variations that equate to 1%. We utilized additional spatial analysis to identify population clusters that reside beyond the 90 min travel time from a pPCI facility. These results point to specific regions where either additional pPCI facilities or better road connections would most effectively reduce treatment delays. Additionally, the study highlighted the optimal location for a novel pPCI facility, which is the city of Vršac. Our findings underline the need for careful planning in the health system, where location and transport data can directly guide measures to improve access and lower cardiovascular disease (CVD) mortality. Full article

Barriers to cancer care, including transportation and Internet insecurity, are of special concern in low-resource communities. A patient-centered, telehealth-based, barrier-focused lay navigator program may mitigate such barriers. We share insights from a quality improvement project wherein we developed and delivered a lay navigator program in a low-resource community in the Mojave Desert. We identified 68 patients scheduled for lung cancer detection/management at our institution, 55 of whom completed a barrier assessment, enrolled in the program, and could be evaluated. Participants were predominantly older (76%), White (84%), had a cancer diagnosis at enrollment (69%), and lived in socioeconomically disadvantaged neighborhoods. Thirty-three (60%) patients had ≥1 barrier, the most common being transportation (31%), Internet (24%), and financial (24%) concerns. These barriers were more frequent among patients with a lung cancer diagnosis at enrollment. Crisis-focused and after-hours encounters were more frequently initiated by older and advanced cancer patients. Transportation and Internet concerns were significantly associated with missed appointment rates. While the scope of our findings is limited, the delivery of a telehealth-based, barrier-focused lay lung navigator program in this low-resource setting was feasible. Neighborhood context and barrier resource planning are important for the implementation of similar programs within our institution’s clinical practice network. Full article

Recognizing and understanding the nuances of mental health and how issues can present at various levels of healthcare for both patients and the interprofessional (IP) healthcare team can be crucial for the success and well-being of team members, as well as for achieving positive patient outcomes. Learners from various allied healthcare disciplines participated in a Case-Based Learning-Sequential Disclosure Activity (CBL-SDA) to address navigating appropriate approaches to fostering wellness in the clinical encounter and within healthcare teams from a multidisciplinary perspective. The CBL-SDA was delivered to a cohort of allied health students (N = 90) using a 4-step process during an interprofessional education (IPE) event of (i) Orientation, (ii) Sequential Disclosure, (iii) IPE Forum, (iv) Wrap-up. Pre- and post-activity surveys were voluntarily collected to gauge participants’ perceptions of the content and delivery method, with a response rate of 90% (N = 81). Overall, participants reported gaining confidence in their understanding of wellness, in identifying and providing support for a person struggling with wellness, in having tools to promote wellness, and also rated their own wellness higher, following the one-hour training session. It can be concluded that IPE activities highlighting wellness and mental health are beneficial and necessary in allied health care training. Full article

Objectives: We wished to demonstrate the utility of a novel quantitative assessment tool for the efficacy of regional anesthesia in children. Methods: The authors examined the records of all patients evaluated by the acute pain service during a 6-month period at a large quaternary-care pediatric hospital. The morphine equivalency rate (MER) in mcg/kg/hour was employed to compare the opioid use in children undergoing similar procedures with and without regional anesthesia (RA). Results: A total of 744 patients were included in this study, 333 of whom received RA. The RA group demonstrated a statistical and clinical benefit from having regional anesthesia, as demonstrated by the MER, compared to the non-RA group. Discussion: Objective measurements of RA in adults are overshadowed by subjective evidence of surgical tolerance in awake or lightly sedated patients. However, in pediatrics, objective measures are still needed to highlight the importance and utility of RA. Such objective tools could impact the adoption of RA by our surgical colleagues and have a long-term impact on opioid use and even abuse. We implemented the MER to quantify the benefit of RA. Given the adverse effects of opioids on gut motility, the incidence of nausea and vomiting, hypersensitivity reactions, and ubiquitous potential for abuse, the MER objectively demonstrates RA’s impact on pediatric surgical patients and why its utilization as an assessment tool could ultimately change practice. Full article