Search Results (3,274)

Background: Young children requiring neurosurgical care frequently undergo repeated neuroimaging. Whereas CT involves exposure to ionizing radiation, conventional MRI is time-consuming and often necessitates sedation in non-cooperative children. To address these limitations, ultrafast cranial MRI (UF-MRI) based on T2-HASTE sequences was implemented at our institution in 2019 for selected indications. The aim of this study was to evaluate the real-world implementation of UF-MRI in children younger than six years of age. Methods: We retrospectively analyzed cranial MRI examinations consisting exclusively of ultrafast sequences performed between July 2019 and December 2024 in children younger than six years. Clinical settings, diagnostic adequacy, immediate consequences for patient management, and the impact on MRI and CT utilization were systematically assessed. Results: A total of 404 UF-MRI examinations were performed in 198 inpatients and outpatients (mean age: 2 years 2 months) without the need for dedicated anesthesia team support solely for imaging. Only one examination (0.2%) required same-day repetition after mild oral sedation. In 20 patients (5.0%), UF-MRI was supplemented by conventional MRI under anesthesia, most commonly for preoperative planning. Immediate clinical consequences included no change in management in 54.5% of examinations, early follow-up in 22.8%, shunt valve adjustment in 11.6%, neurosurgical intervention in 7.7%, and other measures in 5.0%. UF-MRI accounted for 24.5% of all cranial MRI examinations in this age group and was associated with a 41% reduction in CT utilization compared with the corresponding period prior to UF-MRI implementation. Conclusions: In routine clinical practice, UF-MRI provides rapid, clinically sufficient neuroimaging in young children without the need for sedation or exposure to ionizing radiation. Its implementation significantly streamlines imaging workflows, optimizes resources utilization, reduces the need for CT, and supports timely clinical decision-making, underscoring its value as a complementary imaging modality in pediatric neuroimaging. Full article

Background/Objectives: Post-COVID-19 muscle weakness is common even after mild or moderate infection, driven by systemic inflammation, prolonged inactivity, and reduced functional reserve. This study aimed to describe changes in global muscle strength assessed using the Medical Research Council (MRC) scale in adults recovering from mild or moderate COVID-19 who participated in a structured two-week rehabilitation program, and to compare these changes with those observed under standard medical follow-up. Methods: This retrospective study included 193 adults recovering from mild or moderate COVID-19: 160 who completed a structured inpatient rehabilitation program (study group) and 33 who received no supervised rehabilitation (control group). Muscle strength was assessed using the MRC scale at baseline and at follow-up. Non-parametric analyses (Wilcoxon signed-rank test, Mann–Whitney U test, and Spearman correlation) were used to evaluate within-group changes, between-group differences, and associations with age and sex. Results: Both groups showed significant within-group improvements in muscle strength. In the study group, median MRC scores increased from 50 (IQR 40–56) to 52 (IQR 50–56), with a mean ΔMRC of 2.76 ± 8.72 (p < 0.001). In the control group, MRC scores rose from 50 (40–56) to 52 (43–56), corresponding to a mean ΔMRC of 1.00 ± 2.09 (p = 0.005). The between-group comparison of ΔMRC did not reach statistical significance overall; however, age-stratified analyses indicated greater muscle strength gains in the rehabilitation group among participants aged ≥60 years. Conclusions: Short-term improvements in global muscle strength were observed both after structured rehabilitation and under standard medical follow-up, indicating a substantial contribution of natural recovery. Although participants in the rehabilitation group showed numerically larger gains—most notably in the ≥60-year subgroup—between-group differences in ΔMRC were not statistically significant. Overall, these findings support the feasibility and potential functional value of early, individualized rehabilitation while underscoring the need for adequately powered prospective studies to clarify its incremental benefit beyond spontaneous recovery. Full article

Background: Osteoporosis is a prevalent metabolic bone disorder characterized by reduced bone mineral density (BMD) and increased fracture risk, particularly among older adults. While individual medications have been implicated in bone loss, the cumulative impact of polypharmacy on skeletal health remains underexplored. Methods: This cross-sectional study included 1155 geriatric inpatients undergoing routine bone mineral density assessment. Medication use, demographic characteristics, and clinical variables were extracted from electronic medical records. BMD at the lumbar spine (L1–L4) and total hip was measured using dual-energy X-ray absorptiometry (DXA). Unadjusted analyses and multivariable linear regression models were used to examine associations between medication use, polypharmacy (defined as the use of ≥5 medications), and BMD, adjusting for age, sex, body mass index, and relevant clinical covariates. Results: The mean age of the study population was 85.0 ± 7.1 years, and 80.1% were female. Polypharmacy was present in 64.5% of patients. In medication-specific analyses, thyroid hormone use was associated with lower lumbar spine BMD (p = 0.032), and concomitant use of diuretics and proton pump inhibitors was associated with lower hip BMD (p = 0.049). Steroid use showed a marginally non-significant correlation with reduced BMD (p = 0.057). Polypharmacy was associated with lower lumbar spine BMD (p = 0.022), whereas no significant association was observed with hip BMD. Increasing age was consistently associated with lower BMD across skeletal sites (p < 0.001). Conclusions: In this geriatric inpatient cohort, polypharmacy and selected medication classes were associated with lower bone mineral density, particularly at the lumbar spine. Given the cross-sectional design, these findings reflect associations rather than causal relationships and may partly capture underlying multimorbidity and clinical complexity. Consideration of medication burden may be relevant when evaluating bone health in older adults. Polypharmacy is increasingly common in older adults and may contribute to bone fragility. In this cohort of 1155 geriatric inpatients, multiple medications and certain drug classes were associated with lower bone mineral density, particularly in the spine. These findings suggest that medication burden should be considered when evaluating osteoporosis risk in aging populations. Full article

Objective: The primary objective of this study is to investigate the prevalence of unexpected findings requiring treatment after routine histological examinations following tonsillectomy, tonsillotomy, adenotomy, or conchotomy (TTAC) in a retrospective study and to discuss whether routine histological examination is useful in patients without clearly defined risk factors or whether it would be better to reduce unnecessary costs and resource utilisation. Materials and methods: The present retrospective study encompasses 5709 patients who underwent routine histological examinations following TTAC and were treated as inpatients at the University Medical Center Freiburg, Department of Otolaryngology, Head and Neck Surgery, between 2011 and 2021. The data was collected based on patient characteristics, including date of birth, gender, age of patients at the time of surgery, date of surgery, indication for surgery, tissue examined, and histological result. Results: Of a total of 6687 patients who underwent TTAC, 5709 with routine histological examinations were included in the analysis, of whom only four showed abnormal findings, corresponding to an overall prevalence of 0.07%. Three of these four patients were adults. These included two cases of granulomatous inflammation, one instance of Burkitt lymphoma, and one instance of chronic lymphocytic leukaemia/small cell B-lymphoma. Following the exclusion of tuberculosis and sarcoidosis, and the lymphoma board’s decision to adopt a watch-and-wait approach in the case of chronic lymphocytic leukaemia/small cell B-cell lymphoma, only n = 1/0.0175% of patients were found to require treatment. Conclusions: The study demonstrated that only four abnormal histological findings occurred in 5709 inpatient TTACs, of which only one, namely Burkitt lymphoma, ultimately required treatment. Consequently, it can be concluded that routine histological examinations following TTAC are not beneficial in patients without clearly defined risk factors, such as blood in the saliva, history of smoking or alcohol consumption, unexplained pain, previous cancer, mucosal changes, or tissue asymmetries. However, in instances where clinical or anamnestic suspicion of malignancy is present, a histological examination should be conducted. Full article

Background and Objectives: Little is known about the final week of life for inpatient pediatric oncology patients. The purpose of this study was to describe inpatient pediatric oncology deaths. Methods: Retrospective chart review of all patients who died in a large pediatric cancer center between 2007 and 2017. Demographic, diagnostic, and proximate cause of death information was extracted. Intensive care unit (ICU) admissions, chemotherapy receipt, medical interventions, and cardiopulmonary resuscitation (CPR) events one week, 48 h, and 24 h prior to death were obtained. Analysis included descriptive and statistical correlations. Results: 344 decedent pediatric oncology patients were included. Half of the patients died in the ICU (51%). The average age was 11.3 years (range 0.13–27.7 years). Most had ongoing evidence of disease (86%) with 20% receiving cure-directed chemotherapy during their final week. Receiving cure-directed chemotherapy was not associated with age, race, ethnicity, or diagnosis but was associated with a significantly increased likelihood of receiving CPR on the last day of life (p = 0.011). The majority (84%) of children did not receive CPR on their final day of life. Receipt of CPR was not associated with race/ethnicity. CPR was associated with younger age (p = 0.006), hematologic malignancies (p = 0.037), and ICU location (p < 0.001). Most patients were not on dialysis (84%), pressors (72%), or ventilated (60%) during the final 24 h of life. Compassionate extubation occurred in <6% of deaths. Conclusions: Most deaths in a pediatric cancer center occur in children with active disease. Continuation of cure-directed chemotherapy, age, diagnosis, and location of death has potential to influence end-of-life inpatient care. Full article

Background: and objective: Globally, breast cancer (BC) raises global health concerns, being the most common cancer. Women with BC experience a significant increase in perception of stress. Therefore, this study aims to evaluate the stress levels and associated sociodemographic and clinical factors among BC women in Saudi Arabia. Methods: A cross-sectional study was conducted between January and May 2025. Women diagnosed with BC, who were at least 18 years old, were recruited conveniently from outpatient and inpatient departments in King Fahad Specialist Hospital, Dammam, Saudi Arabia. Data were collected in the Arabic language through self-reported questionnaires, including sociodemographic/clinical characteristics and the Cohen’s Perceived Stress Scale. The data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 27. Results: A total of 200 participants were included in the study. The mean stress perception score was 26.52 ± 7.34. A high proportion (71.5%) of the sample reported elevated stress. A significant association was observed between age and stress levels. Most women aged 20–40 and 41–60 reported high stress, compared to women in the 61–80 age group (p = 0.003). Among all predictors, age was the only variable significantly associated with stress scores. Increasing age was associated with lower stress levels (B = −0.179, p = 0.013), indicating that younger participants tended to report higher stress. This corresponds to an adjusted decrease of approximately 1.8 points in the PSS-10 score per 10-year increase in age. Although participants with Stage IV cancer showed higher stress scores compared to those with Stage I cancer, this association approached but did not reach statistical significance (p = 0.054). Conclusions: This study highlights the substantial psychological burden experienced by women living with BC in Saudi Arabia. The majority of participants reported high levels of perceived stress. Younger women were particularly vulnerable to elevated stress. These findings highlight the need for targeted psychosocial support within oncology care to improve emotional well-being and quality of life. Full article

Background/Objectives: Inflammatory bowel disease (IBD) has widely been associated with various extraintestinal complications, including kidney disease. The literature suggests that IBD patients are at increased risk of developing chronic kidney disease (CKD). This study aims to assess the relationship between IBD and CKD, and to identify risk factors associated with CKD in patients with IBD. Methods: Data for hospitalized patients with IBD was obtained from The National Inpatient Sample (NIS) database from 2016 to 2020. Baseline risk factors were identified using ICD-10 codes. Patients were stratified into two groups: Crohn’s Disease (CD) and Ulcerative Colitis (UC). Primary outcomes were prevalence and risk factors of CKD. Secondary outcomes were mortality and length of hospital stay (LOS). Univariate and multivariate analyses were conducted using SPSS v. 30. Results: We identified 230,766 patients with IBD: 144,847 (63%) had CD and 85,919 (37%) had UC. After 1:1 matching, 148,498 patients were included: 74,249 with CD and 74,249 with UC. In this study group, the prevalence of CKD in patients with CD and patients with UC was the same (7.2%). CD patients with CKD had lower in-hospital mortality rates and lower in-hospital length of stay compared to UC patients with CKD. Conclusions: While the prevalence of CKD is similar amongst CD and UC patients, the risk factors and outcomes such as mortality and length of hospitalization differ significantly. This study emphasizes the need for tailored approaches and closer monitoring for the risk of developing CKD in IBD patients and especially patients with UC. Full article

Background and Objectives: Rapid physiological decline in terminal cancer is frequently accompanied by accelerated skeletal muscle loss. Although bedside ultrasonography (US) is practical and feasible in palliative care settings, the prognostic relevance of short-term muscle change remains unclear. This study aimed to evaluate whether the rate of muscle loss over a 10-day period, assessed by serial ultrasound, is associated with survival duration in terminally ill cancer patients. Materials and Methods: This single-center retrospective cohort study included 87 inpatients with end-stage cancer who underwent bedside ultrasound measurements of the biceps brachii (BB) and rectus femoris (RF). Baseline US was performed within the first three days of admission, followed by a repeat assessment 10 days after baseline (day-10 follow-up ultrasound). Muscle thickness (MT) measurements were normalized by height squared (m²), and 10-day changes were calculated as delta (Δ) indices, defined as baseline minus day-10 values. Because the exposure of interest (Δ) can only be determined after completion of the day-10 assessment, survival timing analyses were anchored to this prespecified landmark. Survival duration was defined as the number of days from the day-10 follow-up ultrasound to death among patients who died within one year. Associations between muscle changes and survival duration were evaluated using correlation analyses and multivariable linear regression adjusted for age, sex, body mass index, Eastern Cooperative Oncology Group (ECOG) performance status, and nutritional risk. The primary analyses focused on survival timing among decedents. Results: Significant muscle loss was observed over the 10-day interval between baseline and 10 days after baseline. Among the 58 patients who died within one year, greater short-term biceps muscle loss, reflected by higher Δ BB muscle thickness index (Δ BB MT-I), was moderately associated with shorter survival duration (r = −0.437, p = 0.0006). In multivariable linear regression analysis, Δ BB MT-I remained independently associated with survival duration (β = −701.19; 95% CI: −1102 to −301; p = 0.0006), whereas RF muscle changes and baseline clinical variables were not statistically significant. Conclusions: Short-term biceps muscle loss assessed by serial ultrasound, as reflected by Δ BB MT-I, is associated with shorter survival duration in terminally ill cancer patients. These findings suggest that dynamic muscle changes, rather than single-time-point measurements, may provide clinically meaningful insight into short-term survival timing. Serial bedside muscle ultrasound may serve as a low-burden adjunct for prognostic communication in palliative care, although prospective time-to-event studies are required for validation. Full article

Background/Objectives: Efficient allocation of hospital resources is crucial in managing lower extremity trauma. Selected patients with stable injuries may not require inpatient hospitalization while awaiting surgical fixation. This study describes the feasibility and safety of a structured Home-based Preoperative Management (HPM) pathway for such patients. Methods: We conducted a retrospective, single-center observational study of 187 adult patients with isolated lower extremity fractures managed with HPM between 2019 and 2022. All patients were discharged home from the Emergency Department with standardized instructions, immobilization, anticoagulation, and planned follow-up. No comparator group was included. Results: Of 187 patients (mean age 49.7 y), 23 patients (12.3%) returned to the Emergency Department during the preoperative waiting period. The mean time from Emergency Department presentation to surgery was 8.5 days. Overall, 164 patients (87.7%) completed the preoperative waiting period at home without requiring an additional Emergency Department visit. Within one year after surgery, 51 patients (27.3%) presented to the Emergency Department; 29 of these visits (56.9%) were considered surgery-related. Patients who returned to the Emergency Department before surgery had a higher likelihood of postoperative Emergency Department visits within one year compared with those who did not (69.6% versus 21.3%, p < 0.001). Time to surgery was not associated with postoperative Emergency Department visits (p = 0.763). Conclusions: In this retrospective cohort, Home-Based Preoperative Management was feasible and appeared safe for carefully selected patients with lower extremity trauma. Most patients were able to await surgery at home without unplanned Emergency Department visits. Given the absence of a comparator group, no conclusions regarding comparative effectiveness or superiority over inpatient management can be drawn. Full article

Patients presenting with abdominal pain require expedited diagnosis and treatment. Computed tomography (CT) scans, which are frequently ordered in the inpatient and emergency departments, have high diagnostic sensitivity and specificity. However, CTs are costly, have radiation exposure, can create hospital workflow inefficiencies, and create a potential safety risk with patient transport. Point-of-care ultrasound (POCUS) use is growing as an efficient, safe, and bedside assessment tool for diagnosing and treating gastrointestinal (GI) pathologies. This manuscript synthesizes key sonographic findings and techniques for a series of important GI pathologies that physicians should recognize: diverticulitis, hernia, appendicitis, intussusception, and intra-abdominal mass. Full article

Background: Responsive caregiving supports infant and toddler wellbeing. Yet, based on nursing observational data, a significant number of one institution’s inpatient infant and toddler patients with cancer—who are uniquely vulnerable due to the developmental risks associated with their illness and treatment—were not spoken to or held by their caregiver at any time when nursing was present over the course of day shifts. Objective: This clinical quality improvement project aimed to increase caregiver engagement in responsive interactions during inpatient stays. Methods: The Model for Improvement framework was used. Implementation, evaluation, and reporting followed the SQUIRE 2.0 framework. Root causes were analyzed with fishbone and key driver diagrams. Outcomes were tracked with control charts and percentage of nursing shifts during which responsive care was not observed. Statistical process control was used to study interventions. Results: Two intervention cycles were completed and resulted in significant and meaningful (>1 sigma) reductions in nursing shifts during which infants and toddlers were not spoken to or held. Conclusions: Caregiver psychoeducation interventions increased responsive care of infants and toddlers in our oncology inpatient setting. This low-cost intervention may be adaptable across inpatient settings. Full article

As bispecific T-cell engagers (TCEs) gain traction in the oncology treatment landscape, cancer centres must develop robust clinical pathways to ensure their safe and efficient delivery. Given the limited experience of the Canadian medical oncology community with TCEs, collecting and publishing early clinical experiences with these novel agents will be essential to inform best practices and support their safe and effective adoption across the broader Canadian oncology community. The approval of tarlatamab, the first-in-class delta-like ligand 3 (DLL3)-targeted TCE for extensive-stage small cell lung cancer (ES-SCLC), underscores the importance of sharing early clinical experience with this agent, particularly given its unique safety profile, specific monitoring requirements, and use in a population that often has multiple comorbidities. Like other TCEs, tarlatamab is associated with cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS), adverse events (AEs) that necessitate the development of dedicated protocols by medical oncologists and multidisciplinary inpatient and outpatient clinical teams to ensure prompt recognition and management of these associated toxicities. By sharing insights into administration protocols, dose ramp-up procedures, post-cycle 1 monitoring, and AE management strategies implemented at their centres, early adopters of tarlatamab can help other institutions develop and refine their own protocols more efficiently. Lessons learned during the early implementation phase, including the roles of various healthcare providers and the transition from inpatient to outpatient care, should facilitate the smoother integration of tarlatamab and other TCEs for solid tumours into clinical pathways across Canada. Full article

Background: Little is known about the relation between total alcohol intake and beverage types with the risk of heart failure (HF) and its subtypes in the veteran population. This study aims to examine the associations between total and type of alcohol consumption and risk of HF and its subtypes, namely HF with reduced [HFrEF] and preserved [HFpEF] ejection fraction, in a large cohort of US veterans. Methods: The study cohort included 401,348 Million Veteran Program participants with complete alcohol information collected through a survey and no HF at baseline. HF events were defined as 1 inpatient or 1 outpatient diagnosis code together with at least two ejection fraction (EF) measurements. We defined HFrEF as HF with left ventricular ejection fraction (LVEF) of ≤40% and HFpEF as heart failure with LVEF ≥ 50%. The associations between alcohol intake, type of beverage consumed (i.e., beer, wine, or liquor), and incidence of HF, HFpEF, and HFrEF were assessed using Cox proportional hazard models. Restricted cubic spline regression was used to assess for a dose–response association between alcohol consumption and the risk of HF. Results: Mean age was 65 years, and 91% were men. With a mean follow-up of 6.4 years, we observed 38,420 incident HF events (15,356 HFrEF, 19,047 HFpEF, and 4017 HF with an EF value of 41–49%). Compared to never drinkers, multivariable adjusted hazard ratios for HF were 0.90 (95% CI: 0.86, 0.94), 0.88 (95% CI: 0.84, 0.93), 0.86 (95% CI: 0.81, 0.91), 0.92 (95% CI: 0.86, 0.98), 0.95 (95% CI: 0.84, 1.06), and 1.08 (95% CI: 1.01, 1.15) for current drinkers of 0.1–0.5, 0.6–1, 1.1–2, 2.1–3, 3.1–4 drinks/day, and heavy drinkers (i.e., >4 drinks/day and/or those diagnosed with alcohol use disorder), respectively. We found a similar association between alcohol intake and risk of HFpEF and HFrEF, except heavy drinking was significantly associated with HFrEF (HR: 1.13, 95% CI: 1.02, 1.24), not HFpEF (HR: 1.05, 95% CI: 0.96, 1.13). Types of alcoholic beverage preference did not influence the alcohol-HF relation. Conclusions: Our data are consistent with a J-shaped relation between alcohol consumption and risk of heart failure, irrespective of subtypes. Full article

COVID-19 exposed longstanding racial and ethnic inequities among underserved populations. This retrospective cohort study examined inequities across stages of the hospitalization continuum—from COVID-19 diagnosis at admission to in-hospital mortality, including mortality patterns among COVID-19 hospitalizations—among Medicaid beneficiaries in Kentucky during 2020–2021. Statewide hospitalizations were analyzed using multivariable regression models, with propensity score matching (PSM) used as a confirmatory approach. Non-Hispanic Black patients were more likely than non-Hispanic White patients to be hospitalized with COVID-19 (adjusted odds ratio [aOR] = 1.41; 95% confidence interval [CI] = 1.26–1.59). Across the full cohort, COVID-19 hospitalizations were associated with substantially higher in-hospital mortality compared with non-COVID-19 hospitalizations (adjusted hazard ratio [aHR] = 2.38; 95% CI = 2.09–2.70). Additionally, hospitalizations among non-Hispanic Black patients had a modestly lower hazard of in-hospital mortality compared with non-Hispanic White patients (aHR = 0.81; 95% CI = 0.70–0.94). However, in analyses restricted to COVID-19 hospitalizations, adjusted estimates showed no Black–White differences in in-hospital mortality, with consistent findings from PSM analyses. These results indicate that racial inequities were more pronounced at hospital admission than during inpatient care, underscoring the importance of prevention, early diagnosis, and timely outpatient care as COVID-19 enters an endemic phase. Full article

Background/Objectives: Measuring dietary intake through self-reported questionnaires can be inaccurate and influenced by sex, eating behavior, and the environment. Here, we compare self-report dietary intake questionnaire responses to objectively measured ad libitum dietary intake in a large, diverse population, and assess differences by sex and food-group composition. Methods: In our inpatient study, from 1999 to 2023, (n = 279) participants completed three different questionnaires assessing different aspects of food intake. Each questionnaire contained the same 77 food items belonging to one of six groups. Groups were either high-fat (HF) or low-fat (LF), then high complex carbohydrate (HCC), high protein (HP), or high simple sugar (HSS). Intake was measured based on the average percent group (PctGrp) intake over three days of ad libitum intake. General linear models, adjusted for relevant covariates and a PctGrp by sex interaction, assessed the relationship between PctGrp intake and questionnaire scores. Results: We found a weak positive correlation between PctGrp intake and food rating (all r ≤ 0.25). There was an interaction between LF/HP and LF/HCC with sex (significant slopes in males only, p = 0.0078, p ≤ 0.0001, respectively). Conclusions: This large study demonstrated little association between self-report dietary questionnaires and intake, especially in females with regards to low-fat foods. Full article