Search Results (63)

Hospital design plays a pivotal role in improving patient outcomes, enhancing clinical efficiency, and strengthening infection control. Since the outbreak of COVID-19, research in this field has expanded significantly, showing a marked trend toward interdisciplinary integration. In this study, bibliometric analysis was conducted using CiteSpace (version 6.2.R3) as the primary tool, with Excel and Tableau (version 2024.3) as supplementary software. A total of 877 documents on hospital design published between 1932 and 2025 were retrieved from the Web of Science Core Collection and analyzed from multiple perspectives. The analysis examined publication trends, collaborative networks, co-citation structures, disciplinary evolution, and keyword dynamics. The results indicate that the field has entered a phase of rapid development since 2019. Global collaboration networks are becoming increasingly multipolar; yet, institutional and author-level connections remain decentralized, with relatively low overall density. Evidence-based design (EBD) continues to serve as the theoretical foundation of the field, while emerging themes such as healing environments, biophilic design, and patient-centered spatial strategies have become major research hotspots. Increasingly, the field reflects deeper integration across disciplines, including architecture, medicine, nursing, and environmental science. This study provides a clearer picture of the developmental trajectory, knowledge base, and future directions of hospital design research, offering systematic insights and theoretical guidance for both scholars and practitioners. Full article

Turfgrass systems in European urban green spaces, including sports fields, golf courses, and residential lawns, must balance high performance with compliance with stricter pesticide regulations. This review examines Synergistic Pest Management (SPM), an advanced form of Integrated Pest Management (IPM) that integrates monitoring, biological, cultural, and targeted chemical strategies for sustainable control of major turfgrass pests. Focus is placed on key insect pests such as Tipula spp. larvae and chafer beetle grubs (Scarabaeidae) and fungal pathogens, including Microdochium nivale, Clarireedia spp., Laetisaria fuciformis, Gaeumannomyces graminis var. avenae, and Colletotrichum spp., which cause significant losses in Central Europe and similar regions. Effective combinations include entomopathogenic nematodes with fungi, endophyte-infected cultivars with optimized mowing and irrigation, and low-dose insecticides paired with biological agents. The review considers how soil conditions, environmental timing, and maintenance practices influence success. Practical tools such as decision-support matrices and a seasonal calendar are provided for regional use. SPM can reduce chemical inputs, enhance biodiversity, and improve turf resilience, but adoption is limited by biological sensitivity, product availability, costs, and technical demands. SPM aligns with EU Directive 2009/128 and offers a pathway to sustainable turfgrass pest management. Future efforts should focus on regional validation, practitioner training, and precision technologies. Full article

The discontinuation of commercially available saline and hypertonic saline wound dressings for the veterinary market has restricted options available to veterinary practitioners treating contaminated and infected wounds. Clinicians may manufacture their own homemade solutions in clinics or field settings to treat equine or livestock species; however, information is limited on whether autoclave sterilization is necessary or sufficient to eliminate bacterial growth in isotonic and concentrated salt solutions and how long they may subsequently be stored prior to use. The purpose of this study was to assess sterility of saline (0.9%) and hypertonic saline (20%) solutions manufactured three ways (1—autoclaved glass bottle that was autoclaved again following solution preparation; 2—autoclaved glass bottle, not autoclaved again following preparation; 3—non-autoclaved plastic bottle, not autoclaved following preparation). Solutions were stored two different ways (1—solution in sealed bottle or 2—soaked gauze in vacuum-sealed plastic packets). Products were assessed for bacterial growth at four time points (baseline, one week, one month, six months). At each time point, samples of each solution were plated on Luria–Bertani (LB) agar plates and assessed for bacterial growth at 24 h. Vacuum-sealed soaked gauze was placed in antibiotic-free growth media for 24 h, and then media were plated on LB agar plates and assessed for bacterial growth at 24 h. If bacterial growth was detected, qualitative culture with sensitivity was performed to identify bacterial isolates. No bacterial growth was detected in stored solutions for any preparation method, concentration or time point assessed. Bacterial growth was detected from 0.9% saline-soaked gauze at 1 week, 1 month and 6 months in all container types for at least one time point. Bacterial culture revealed Ralstonia, Bacillus, Sphingomonas and Staphylococcus species. Environmental controls (water, containers, salt, biosafety cabinet and benchtop) were submitted for culture to identify the source of contamination, yielding light mixed growth from tap water and no growth from any other locations. These findings provide clinicians with practical information to guide preparation and storage of homemade saline-based products for wound care. Full article

Background: Ocular and periocular tattoos, involving ink application to the eyeball or surrounding skin, have gained popularity as forms of self-expression. However, this trend raises significant concerns about potential complications that can adversely affect ocular health and esthetics. Awareness of these risks is crucial for both patients and practitioners. Methods: A comprehensive literature review was conducted, focusing on studies discussing complications related to ocular and periocular tattooing. Relevant studies were identified through the MEDLINE, PubMed, and Ovid databases. The reviewed papers were evaluated based on study design, including blinding, sample size, control use, randomization, and objective endpoints, and classified according to the Oxford Center for Evidence-Based Medicine evidence hierarchy. Results: The review identified a wide range of complications, including immediate issues like bleeding, infections (conjunctivitis, endophthalmitis), and allergic reactions. Delayed reactions included granuloma formation, often requiring further treatment. The most serious risk identified was potential visual impairment due to improper technique or ink placement. Conclusions: With the growing trend in ocular and periocular tattooing, there is an urgent need for increased awareness of associated risks. It is crucial to ensure that only qualified professionals perform these procedures, emphasizing the importance of understanding ocular anatomy. Developing strict regulatory guidelines and prioritizing research on the long-term effects of these tattoos are essential for patient safety. A collaborative approach among healthcare providers, regulatory bodies, and educational institutions is needed to mitigate risks and promote best practices in cosmetic tattooing. Full article

Salmonellosis in dairy cattle represents an increasing problem for both animal and public health. Nevertheless, in Italy, there is no control plan in place on dairy farms. The aim of this study was to describe a Salmonella Bredeney outbreak that occurred on a dairy farm and the measures that were adopted to control the outbreak. Management consisted in identifying the spread of infection and assessing the environmental contamination of Salmonella spp. and the associated risk factors. After the farm visit, laboratory investigations showed that 48% of rectal swabs collected from calves and 33% of environmental samples were positive for S. Bredeney, and a poor biosecurity level was detected. The farmer and practitioner were provided with a health management plan to control the spread of Salmonella spp., followed by a monitoring period and a follow-up visit in which all samples resulted negative. The results demonstrated the efficacy of indirect prophylaxis measures in reducing the circulation of Salmonella spp., leading to the extinction of the outbreak. Collaboration with farmers, practitioners, and public health veterinarians and the introduction of measures reported in the health management plan constitute a possible model for the management of Salmonella spp. outbreaks in dairy herds, even in complex farm situations. Full article

Mpox, also known as Monkeypox, is an infectious disease known to spread via direct contact and fomites, which poses a significant contagion risk in surgical settings and may increase the challenges already posed by COVID-19. Within the three years following the outbreak of Mpox, we conducted a review of the impact of Mpox on surgical practice. We searched Pubmed/Medline and Scopus, focusing on original studies and case reports in English or German. Our search terms included “Mpox”, “Monkeypox”, and “Surgery”. Out of 60 clinical or epidemiological studies, as well as expert opinions, brief reports, and pertinent literature reviews, eight were included after full-text assessment. We also incorporated two pertinent literature reviews, including a total of 10 papers, in this analysis. The main topics addressed by the literature are 1. manifestations of Mpox for surgical consideration or urgent management, for which it is important to consider whether a surgical approach is needed to address long-term Mpox-related lesions and 2. infection control in surgical settings, especially considering its impact on elective surgery and the well-being of healthcare workers. Mpox could affect surgical services and access to operating theaters. Unlike COVID-19, Mpox, compared to initial concerns, has not substantially compromised surgical delivery. However, limited reports exist on the surgical impact of Mpox. It is crucial to involve surgeons in Mpox diagnosis, educate surgical practitioners on its mimicry of common surgical conditions, enhance infection control during surgery, and ensure access to corrective surgery as a means of tackling the stigmatization associated with Mpox and sexually transmitted diseases in general. Full article

Background: Antibiotics are often overprescribed in children in general practice. We investigated whether the availability of C-reactive protein point-of-care testing (CRP POCT) in daily practice and general practitioner (GP) education reduces antibiotic prescribing for children with acute infections and whether GP education has a long-term effect on antibiotic prescribing. Methods: This was a randomized controlled intervention study with randomization at the GP practice level. Eligible patients were children aged 1 month to 17 years presenting to general practice with an acute infection. Interventions: In the first study period, one GP group received combined interventions (CRP POCT was provided for daily use in combination with a live educational session), while the second GP group continued usual care. During the second study period, the GP groups were switched. During this period, the long-term education effect was evaluated in the GP group, which had previously received both interventions: the CRP POCT was no longer available in their practices in accordance with the study protocol, but education could have a lasting effect. Primary outcome: Antibiotic prescribing at index consultation. Results: GP with combined intervention enrolled 1784 patients, GP with usual care enrolled 886 patients, and GP with long-term education effect enrolled 647 patients. Most of the patients had upper (76.8%) and lower (18.8%) respiratory infections. In total, 29.3% of the study patients received antibiotic prescriptions. Adjusted binary logistic regression analysis showed no differences for the primary outcome between GPs with usual care and GPs with combined intervention (aOR 0.89 (0.74–1.07), p = 0.20), but significantly lower antibiotic prescribing was observed for GPs with long-term education in comparison with GPs with usual care (aOR 0.75 (0.59–0.96), p = 0.02); however, after multilevel analyses, any differences in the antibiotic prescription between intervention groups became non-significant. GPs widely used CRP POCT when it was available in practice (for 69.1% of patients in the combined intervention group), but rarely measured CRP in the laboratory in the usual care group (8.8% (n = 78)) or long-term education group (14.8% (n = 98)). The majority of the tested patients had low CRP levels (below 20 mg/L); despite this, up to 35.4% of them received antibiotic prescriptions. Conclusions: Our results show that the availability of CRP POCT and educational training for GPs together did not reduce antibiotic prescribing, and one-time education did not have a long-term effect on antibiotic prescribing. Full article

The antibiotic stewardship programme (ASP) is a new concept initiated by WHO, but nurses are not yet ready to adopt the program. The training and empowerment of nurses are the best strategies for enhancing their knowledge and engagement in ASP. This mixed-method study was used to assess perceived roles and barriers of nurses’ involvement in ASP. An online survey was conducted among 420 clinical nurses to identify their role, and 23 individual interviews were performed among nurses and infection control practitioners to explore the barriers and recommendations to overcome the identified barriers. The majority of the nurses agreed with the sixteen identified roles in ASP, of which ‘antibiotic dosing and de-escalation’ (82.61%), ‘IV to PO conversion of antibiotic, outpatient antibiotic therapy’ (85.23%), and ‘outpatient management, long-term care, readmission’ of the patients (81.19%) had the lowest agreement from the participants. The major themes generated through the qualitative interviews were a lack of knowledge about ASP, poor communication between multidisciplinary teams, lack of opportunity and multidisciplinary engagement, lack of formal education and training about ASP, lack of ASP competency and defined roles in policy, role conflict or power/position, availability of resources, and lack of protected time. Nurses play an integral role in the successful implementation of antibiotic stewardship programs. The empowerment of nurses will help them to adopt the unique role in ASP. Nurses can significantly contribute to antibiotic stewardship efforts and improve patient outcomes through addressing these challenges. Full article

Background/Objectives: Patients with rheumatoid arthritis (RA) are prone to develop infections. Methods: Accordingly, 195 untreated early (e)RA patients and 398 healthy controls were selected from women in Tatarstan’s cohort to study infectious history in the anamnesis (four criteria) and in the previous year (16 criteria). Information about annual infections was collected face-to-face from year to year by a qualified rheumatologist/general practitioner and included the active use of information from medical records. Results: In the anamnesis, tuberculosis, and pneumonia, and in the previous year, respiratory tract infections, skin infections, and herpes simplex virus reactivation incidence were reported to be increased in eRA patients, as well as the event number and duration of acute and chronic tonsillitis. Moreover, more bacterial-suspected upper respiratory infections and urinary tract infections were retrieved in sporadic eRA patients as compared to familial eRA patients. An elevated immunization against CCP prevented respiratory tract infection in those with HSV exacerbation. Finally, associations were retrieved between infection (event number/delay) and RA indices: (i) chronic tonsillitis exacerbations with disease activity and health assessment (HAQ) in familial eRA; (ii) bacterial-suspected upper respiratory infections with the number of swollen and tender joints in sporadic eRA; and (iii) HSV exacerbation with inflammation in eRA patients with negative/low response against CCP. Here, we demonstrate the complex nature of the interplay of RA with specific infections. Conclusions: For the first time, differences in the patterns of annual trivial infections and their links with RA indices were found in cohorts of familial and sporadic cases of the disease. Additionally, for the first time, we identified a remarkable relationship between early RA and exacerbations of chronic tonsillitis, as well as tuberculosis in the patient’s history. Altogether, this study supports the existence of a complex interplay between infections and RA at onset driven by familial status and the presence of anti-CCP Ab at elevated levels. Full article

Biomedicine is constantly evolving to ensure a significant and positive impact on healthcare, which has resulted in innovative and distinct requisites such as hydrogels. Chitosan-based formulations stand out for their versatile utilization in drug encapsulation, transport, and controlled release, which is complemented by their biocompatibility, biodegradability, and non-immunogenic nature. Stimuli-responsive hydrogels, also known as smart hydrogels, have strictly regulated release patterns since they respond and adapt based on various external stimuli. Moreover, they can imitate the intrinsic tissues’ mechanical, biological, and physicochemical properties. These characteristics allow stimuli-responsive hydrogels to provide cutting-edge, effective, and safe treatment. Constant progress in the field necessitates an up-to-date summary of current trends and breakthroughs in the biomedical application of stimuli-responsive chitosan-based hydrogels, which was the aim of this review. General data about hydrogels sensitive to ions, pH, redox potential, light, electric field, temperature, and magnetic field are recapitulated. Additionally, formulations responsive to multiple stimuli are mentioned. Focusing on chitosan-based smart hydrogels, their multifaceted utilization was thoroughly described. The vast application spectrum encompasses neurological disorders, tumors, wound healing, and dermal infections. Available data on smart chitosan hydrogels strongly support the idea that current approaches and developing novel solutions are worth improving. The present paper constitutes a valuable resource for researchers and practitioners in the currently evolving field. Full article

Southern stem rot (SSR) is caused by Athelia rolfsii and is an economically important disease of peanut (Arachis hypogaea L.). Application of protectant fungicides is an effective management component for reducing levels of this soil-borne disease. The majority of peanut hectarage in South Carolina and Mississippi is rainfed. Timely precipitation has the potential to aid the movement of foliar-applied fungicides through the canopy and into contact with soil interfaces where SSR infections occur. Questions have arisen as to the quantitative relationship of post-application precipitation and fungicide-active ingredient efficacy in managing SSR and protecting associated pod yield potentials. To examine this, fungicide efficacy experiments were screened for inclusion in a meta-analysis, from which eleven experiments conducted from 2015 to 2023 were selected and paired with environmental data from nearby weather stations. Precipitation during the two days following fungicide application was associated with significant reduction in SSR incidence (logit rate of −0.0039/mm) and increased pod yield (log slope of 0.0028/mm). Active ingredient interactions with precipitation among pod yield but not SSR incidence data were present for benzovindiflupyr plus azoxystrobin, flutolanil, and tebuconazole. Fungicides with the greatest levels of control per application at maximum label rates were inpyrfluxam (18.8%), benzovindiflupyr plus azoxystrobin (15.4%), flutolanil (12.3%), and prothioconazole plus tebuconazole (10.5%). Micronized sulfur neither contributed to SSR control nor pod yield increase. Tebuconazole was associated with the greatest % SSR control per fungicide product cost (0.47%/$/ha/application) but was also the treatment with the least amount of control (3.5%) at its maximum label rate. Maximum label rates of benzovindiflupyr plus azoxystrobin (USD 637) and inpyrfluxam (USD 548) were estimated as conferring the greatest returns over the chlorothalonil-only control. Results serve as a helpful reference for farmers and practitioners in selecting fungicide management options and targeting application times, as feasible, to utilize natural precipitation to improve management outcomes. Full article

University education is a leading source of information for dental practitioners. Particular emphasis should be given to determining the extent to which students acquire positive knowledge, attitudes, and practices (KAP) and positive metacompetences beyond the scope of each studied dental discipline. We performed a cross-sectional questionnaire-based study among dentistry students from Romania to assess self-perceived risk of infectious diseases and their KAP on topics related to infectious disease prevention. The surveyed students presented good knowledge regarding personal protective equipment (PPE), and their PPE practices significantly correlated with the perceived usefulness of PPE. Only 45.1% correctly recognized all vaccine-preventable diseases (VPDs), but knowledge regarding VPDs significantly improved with increasing year of study (τ_b = 0.298, p = 0.001), confirming a positive education effect. Awareness regarding the need for screening for bloodborne viruses is poor; the majority of students had never performed a test for hepatitis C virus infection (HCV) (59.4%) or for human immunodeficiency virus (HIV) infection (60.4%). Furthermore, most respondents incorrectly considered themselves at high or very high risk of acquiring BBV, and perceived risk was inversely correlated with willingness to treat patients with hepatitis B virus (HBV) infection (τ_b = −0.214, p = 0.018), HCV infection (τ_b = −0.234, p = 0.013), or HIV infection (τ_b = −0.242, p = 0.006). This led to 3.0% of respondents stating that they would hypothetically deny dental treatment to a patient with HBV infection, 5.0% for HCV infection, and 10.9% for HIV infection, the proportion being significantly higher for HIV (z = −2.2, p = 0.026). In conclusion, better knowledge is needed among dental students regarding their own vaccination history, screening for bloodborne viruses, accurate estimates for their risk of acquiring bloodborne viruses during routine dental practice, and the existence of post-exposure measures following occupational exposure. Improving student knowledge and awareness could translate into a higher willingness to treat patients with chronic viral infections and into a safer and more inclusive dental practice. We propose an adaptation to the university curriculum to cover these key areas for targeted focus to empower future dental practitioners and to facilitate the improvement of across-discipline metacompetences for infection prevention and control. Full article

Since its initial description in the 1960s, methicillin-resistant Staphylococcus aureus (MRSA) has developed multiple mechanisms for antimicrobial resistance and evading the immune system, including biofilm production. MRSA is now a widespread pathogen, causing a spectrum of infections ranging from superficial skin issues to severe conditions like osteoarticular infections and endocarditis, leading to high morbidity and mortality. Biofilm production is a key aspect of MRSA’s ability to invade, spread, and resist antimicrobial treatments. Environmental factors, such as suboptimal antibiotics, pH, temperature, and tissue oxygen levels, enhance biofilm formation. Biofilms are intricate bacterial structures with dense organisms embedded in polysaccharides, promoting their resilience. The process involves stages of attachment, expansion, maturation, and eventually disassembly or dispersion. MRSA’s biofilm formation has a complex molecular foundation, involving genes like icaADBC, fnbA, fnbB, clfA, clfB, atl, agr, sarA, sarZ, sigB, sarX, psm, icaR, and srtA. Recognizing pivotal genes for biofilm formation has led to potential therapeutic strategies targeting elemental and enzymatic properties to combat MRSA biofilms. This review provides a practical approach for healthcare practitioners, addressing biofilm pathogenesis, disease spectrum, and management guidelines, including advances in treatment. Effective management involves appropriate antimicrobial therapy, surgical interventions, foreign body removal, and robust infection control practices to curtail spread within healthcare environments. Full article

Background: Staphylococcus aureus, particularly methicillin-resistant S. aureus (MRSA), has emerged as a leading antimicrobial-resistant pathogen challenging global health systems and antibiotic therapy. Pigs have been identified as important reservoirs for livestock-associated MRSA. The major concern with MRSA occurrence in pigs is the potential for human transmission. Reports on the prevalence and antibiotic sensitivity pattern of methicillin-susceptible S. aureus (MSSA) and MRSA strains in pigs in Nigeria are still limited, hence, the need for this study. This study was designed to investigate the prevalence of MRSA and methicillin-sensitive Staphylococcus aureus in pig farms in Ibadan, Oyo State, Nigeria, and to determine their antibiotic resistance patterns. Methods: We collected 93 composites (n = 5; total n = 465) of faecal samples from pigs in twenty-five farms across five local government areas in Ibadan, Nigeria. Isolation of S. aureus was conducted using standard procedures. Antibiotic sensitivity testing was conducted using the disc diffusion method. The data obtained were analysed using descriptive statistics and compared with the CLSI and EUCAST standards for sensitivity and resistance. Results: The prevalence of S. aureus was 31.2%, with the proportion of MSSA and MRSA isolates being 23.7% and 7.5%, respectively. The antibiotic susceptibility profiles revealed a high multidrug resistance prevalence among both MSSA (86.4%) and MRSA (100%). All MRSA isolates and 40.9% (9/22) of MSSA were found to be resistant to at least five different sub-classes of antibiotics. Conclusions: This study supports the existing reports on pigs being an important reservoir of highly resistant S. aureus strains. The high multidrug resistance and the occurrence of MRSA may be evidence of continuous antimicrobial exposure and substandard hygienic practices on these farms. This is undesirable because it constitutes a health hazard for farmers, veterinarians, abattoir workers, and pork consumers, who may further disseminate these highly resistant strains to their families and society. There is a need for further surveillance and a multisectoral approach involving policymakers, farmers, health practitioners, and the public in implementing good infection control practices and safe antibiotic usage from the grassroots level on farms in line with the vision of the one health approach. Full article

Urinary tract infections (UTIs) are among the most common reasons patients seeking health care and antibiotics to be prescribed in primary care. However, general practitioners’ (GPs) guideline adherence is low. The RedAres randomised controlled trial aims to increase guideline adherence by implementing a multimodal intervention consisting of four elements: information on current UTI guidelines (1) and regional resistance data (2); feedback regarding prescribing behaviour (3); and benchmarking compared to peers (4). The RedAres process evaluation assesses GPs’ perception of the multimodal intervention and the potential for implementation into routine care. We carried out 19 semi-structured interviews with GPs (intervention arm). All interviews were carried out online and audio recorded. For transcription and analysis, Mayring’s qualitative content analysis was used. Overall, GPs considered the interventions helpful for knowledge gain and confirmation when prescribing. Information material and resistance were used for patient communication and teaching purposes. Feedback was considered to enhance reflection by breaking routines of clinical workup. Implementation into routine practice could be enhanced by integrating feedback loops into patient management systems and conveying targeted information via trusted channels or institutions. The process evaluation of RedAres intervention was considered beneficial by GPs. It confirms the convenience of multimodal interventions to enhance guideline adherence. Full article