Search Results (660)

Background: Goals of care discussions are essential communication skills in medical training that bridge patient values with clinical decision-making. Integrating palliative care principles into these conversations enables holistic, patient-centered care, yet medical trainees often lack structured preparation for these critical interactions. Objective: This narrative review examines how medical training can effectively integrate palliative care approaches into goals of care discussions through structured communication frameworks, interdisciplinary collaboration, and emerging innovations to promote patient-centered outcomes. Methods: This narrative review is conducted using a structured literature search that includes relevant studies pertaining to goals of care (GOC) discussions, evidence-based communication frameworks, and communication training curricula. Databases used were PubMed and Google Scholar, using articles published between 2000 and 2025. The following keywords were used in our search: “SPIKES”, “REMAP”, “SUPER”, “serious illness conversation”, “goals of care,” “end of life,” “holistic care,” “palliative care,” and “medical education.” Exclusion criteria were used to select those relevant to inpatient care and training in inpatient settings. Studies in an outpatient setting were excluded. Findings were reviewed and synthesized to identify types of training approaches. An emphasis on clinical outcomes including patient satisfaction, hospice utilization, ICU transfers, and intervention intensity were examined. Educational barriers and facilitators—including communication training curricula, cultural competency, language considerations, and multidisciplinary team involvement—were evaluated. Emerging technologies supporting clinician education and practice were also assessed. Results: Training in structured communication frameworks improves patient–physician relationships, reduces patient anxiety, and increases family satisfaction. Early palliative care integration through effective discussions leads to increased hospice awareness and utilization while reducing burdensome interventions. Key educational facilitators include dedicated communication skills training, multidisciplinary team participation (including chaplains and palliative care specialists), and AI-assisted documentation tools that support learning while preserving humanistic clinician–patient interactions. Conclusions: Integrating palliative care principles into medical training for goals of care discussions is essential for developing patient-centered clinicians. Combining structured communication frameworks, interprofessional education, targeted skills training, and technological support creates a comprehensive educational approach that prepares trainees to elicit patient goals, create individualized care plans, and deliver holistic care that honors patient values. Full article

Background: Pediatric septic shock remains a major cause of morbidity and mortality and requires timely recognition and management across multiple hospital settings. Although intensive care support is critical, outcomes are also influenced by earlier phases of care, including emergency department recognition, first-hour treatment, inpatient monitoring, and timely escalation to the pediatric intensive care unit (PICU). Objective: We aimed to review pediatric septic shock across the full hospital trajectory, from emergency department recognition to PICU management and outcomes, with emphasis on diagnostic challenges, early treatment, escalation of care, and prognostic assessment. Methods: This narrative review was based on a structured literature search of PubMed/MEDLINE, Scopus, and the Cochrane Library, with emphasis on international guidelines, consensus statements, systematic reviews, and clinically relevant pediatric studies addressing recognition, resuscitation, escalation, intensive care management, and outcomes in pediatric septic shock. Results: Pediatric septic shock is best approached as a dynamic continuum rather than a single event. Early recognition is complicated by age-dependent physiology, nonspecific presentation, and delayed hypotension. Timely antimicrobial therapy, individualized fluid resuscitation, early vasoactive support, and repeated reassessment during the first hours are central to management. Ward surveillance and prompt escalation to PICU are critical, as delayed recognition of deterioration may worsen organ dysfunction and resource use. In the PICU, phenotype-informed hemodynamic support, fluid stewardship, respiratory support, and organ support are essential. Outcomes should be evaluated beyond mortality to include organ dysfunction burden, duration of support, length of stay, and longer-term functional recovery. Conclusions: Pediatric septic shock outcomes are shaped by the entire hospital care pathway rather than PICU treatment alone. A trajectory-based, continuum-of-care approach may improve timely diagnosis, escalation, and short- and longer-term outcomes. Full article

Osteoarthritis is a leading cause of lower-limb arthroplasty, and although total hip arthroplasty (THA) and total knee arthroplasty (TKA) reduce pain and improve quality of life, gait impairments often persist after surgery. This study aimed to analyze gait patterns in individuals following THA and TKA using the wearable RunScribe™ sensor system and to examine its sensitivity to short-term changes during rehabilitation. Thirty-seven patients (19 THA, 18 TKA) attending a two-week inpatient rehabilitation program were assessed twice, on the first and final day of rehabilitation. Gait was measured during a 2 min circular walk test, and both global spatiotemporal variables and limb-specific loading-related variables were analyzed. A significant main effect of time was observed for walking speed (p = 0.001, ηp² = 0.284), with improvements of approximately 10% in both groups, as well as for step cadence (p < 0.001, ηp² = 0.429) and contact time (p < 0.001, ηp² = 0.380). Loading-related variables also changed significantly over time, including impact acceleration (p = 0.004, ηp² = 0.226), braking acceleration (p < 0.001, ηp² = 0.419), and rate of force development (p < 0.001, ηp² = 0.412). No statistically significant between-group differences were observed for global gait variables, although participants following THA showed a tendency toward better walking performance (e.g., higher cadence, p = 0.065). These findings suggest that early rehabilitation is associated with measurable improvements in gait after arthroplasty and support the potential of affordable wearable sensors as practical tools for objective gait assessment in clinical settings. Full article

Podiatry residents may benefit from addiction medicine rotations due to substantial overlap between podiatric needs and substance use disorders (SUDs), particularly in the hospital setting. In a semi-structured format, we describe the cases of two podiatry residents, perhaps the first ever documented, who rotated with an inpatient addiction medicine consult team at an urban, academic hospital. These two residents joined the addiction consult team in 2023 and 2024 and rated their confidence in twelve learning objectives via a five-point Likert scale before and after the rotation (2 weeks long). They also rated their attitude toward the value of addiction services. Post-rotation feedback from the module and ad hoc e-mail correspondence are included. Residents 1 and 2 joined the team and engaged well in orientating with the team, eventually providing near-independent addiction medicine consultations for primary inpatient teams. Pre/post data showed large increases in confidence in learning objectives (mean scores 2.1 to 4.9 for Resident 1, and mean scores 1.5 to 4.0 for Resident 2). They both reported positive experiences, and months later reflected on both pragmatic (e.g., available resources) and attitude-related (e.g., understanding the importance of substance use context for patients) educational gains. In summary, residents from surgical specialties like podiatry may benefit from inpatient addiction medicine exposure. It is unclear whether their rotation spots could be better utilized by those in other specialties, but SUDs are prevalent in a multitude of settings, arguing for broad dissemination of SUD treatment education. Full article

Background/Objectives: The use of physical and mechanical restraints and seclusion in psychiatric facilities to manage violent and aggressive behaviours has long been a contentious issue, balancing patient safety with ethical considerations. With advancements in psychiatry and increased understanding of mental illness, there have been expectations that such interventions would no longer be required; however, their use persists in clinical practice. Management policies differ across countries and are largely influenced by legal frameworks. This study aimed to identify the factors influencing the incidence of these interventions across two psychiatric facilities in Saudi Arabia and to examine associations among inpatient variables. Methods: A prospective cohort study was conducted over six months (September 2021–March 2022) across two psychiatric facilities in Saudi Arabia (Eradah Complex, n = 1120; King Fahd University Hospital (KFUH), n = 268). Data from 333 restriction events were analysed using descriptive statistics, chi-square tests, and negative binomial regression to calculate incidence rates and explore associated factors. Results: The findings revealed a complex interplay of factors related to patient characteristics and clinical and environmental conditions within the facilities. Key contributing variables included symptom deterioration and the duration of observation required. Longer observation periods were associated with certain diagnoses, particularly schizophrenia and mood disorders. Conclusions: Restraints and seclusion remain influenced by multiple interacting factors within psychiatric settings. These findings highlight the need to reduce their use and ensure they are applied cautiously, with greater emphasis on minimising patient trauma and promoting safer, person-centred care. Full article

Spiritual care competence (SCC) is increasingly recognized as relevant in mental health, yet no validated tool exists in Slovenia. This study aimed to translate and validate the Spiritual Care Competence Questionnaire (SCCQ) in a Slovene sample of mental-health professionals. Guided by this aim, our research question was the following: to what extent does the SCCQ demonstrate a replicable seven-factor structure, acceptable reliability, construct validity, and coherent group differences in a Slovene sample of mental-health professionals? In a cross-sectional survey (n = 291) across outpatient, inpatient, private, and other settings, we administered the SCCQ together with measures of spiritual sensitivity (SSS), spiritual transcendence (STS), and the BFI-S. Following forward–backward translation and expert review, we conducted item analysis, exploratory and confirmatory factor analyses, and assessed reliability and construct validity. After removing seven psychometrically weak items, a 35-item, seven-factor structure—perception of spiritual needs, team spirit, documentation/tools, spiritual self-awareness, knowledge of other religions, conversation, and empowerment/proactive opening—showed borderline to acceptable fit (TLI = 0.917, CFI = 0.892, RMSEA = 0.068, SRMR = 0.073) and internal consistency (Cronbach’s alpha = 0.67–0.87). Convergent validity was supported by positive associations with SSS/STS, while expected correlations with Big Five traits were small but significant (negative for Emotional Instability). Older age and psychotherapist profession predicted higher SCC. The Slovene SCCQ is a confession-neutral, psychometrically adequate instrument for assessing SCC in mental-health services. Findings highlight curricular needs—especially documentation/tools and team-based engagement—and enable research, education, and quality improvement aligned with international SCCQ validations. Full article

Children with complex care needs represent a growing and highly vulnerable population within inpatient hospital settings. They experience disproportionately long lengths of stay, higher rates of safety incidents, and poorer care experiences than other children. Their increasing prevalence in hospitals reflects broader advances in medical care that have improved survival, yet current inpatient systems remain largely designed around episodic, single-condition models of care. As a result, children with complex care needs and their families frequently encounter inpatient services which are fragmented and stretched and environments which are not adequately suited to their needs. The challenges are well recognised, and current drivers exist to move toward meaningful system change. Recent policy drivers, workforce development agendas, and new funding streams provide an opportunity to reimagine how inpatient services are organised and delivered for this population. This opinion piece, situated within the UK healthcare context, offers a structured analysis of the systemic challenges facing inpatient services for children with complex care needs and identifies priority domains of safe care, workforce development, and knowledge generation, where targeted redesign is both feasible and urgently required. Full article

Early rehabilitation may reduce the likelihood of long-term disability after critical illness, but in high-turnover emergency and critical care settings, benefits other than improved survival may appear at discharge. This retrospective historical cohort study assessed the impact of a standardized rehabilitation system initiated within 24 h of hospital arrival on inpatient and discharge outcomes. The study included consecutive intensive care unit admissions between 2011 and 2023 and compared periods before and after 1 April 2022 when the system was introduced. Outcomes included in-hospital mortality, frequency of a favorable discharge outcome (Glasgow Outcome Scale score indicating good recovery or moderate disability), rate of transfer to a rehabilitation hospital, and length of hospital stay. Between-period differences were adjusted using propensity-score overlap weighting. Among 20,252 patients, adjusted analyses showed no significant differences in in-hospital mortality (odds ratio [OR] 1.17, 95% confidence interval [CI] 0.81–1.69) or length of stay (mean difference −0.12 days, 95% CI −1.28 to 1.04). After implementation, there was a likelihood of a favorable discharge outcome (OR 1.74, 95% CI 1.29–2.36) and transfer to a rehabilitation hospital (OR 1.77, 95% CI 1.23–2.54). This change was associated with a more favorable transition to post-acute rehabilitation without improving short-term mortality. Full article

Background: Recruiting care partners (CPs) of hospitalized people living with dementia is challenging due to rapid discharge timelines and complex inpatient workflows. This study identified barriers to CP recruitment encountered during the first year of a hospital-based randomized controlled trial and the strategies implemented in response to them. Methods: A qualitative descriptive study using thematic analysis of twelve study coordination and implementation meeting transcripts was conducted. Recruitment outcomes were examined to assess changes before and after implementation of the enhanced recruitment workflow. Results: Eight recruitment barriers were identified, including fragmented electronic health record (EHR) documentation, uncertainty in CP presence, limited clinician availability, passive study promotion, and inefficient clinical–research team collaboration. Nine strategies were developed and implemented in response to these barriers. The enhanced recruitment workflow was temporally associated with an increase in average monthly enrollment from 0.25 participants (April–July 2024) to 4 participants (August 2024–December 2025). Over the same periods, the cumulative enrollment rate was 3% and 23%, respectively. Conclusions: Care partner recruitment in inpatient settings is highly context-dependent and requires iterative, implementation-informed adaptation. Effective recruitment may be supported by embedding processes into routine inpatient workflows, clarifying recruitment roles, leveraging EHR-supported identification, and maintaining close clinical–research team collaboration to respond to the unpredictable presence of care partners and short discharge windows. Full article

Inpatient falls often occur at the bedside during unsupervised bed egress or bed exit attempts. Many artificial intelligence methods predict fall risk, but clinical value depends on workflow-ready decision support. This scoping review, reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), mapped AI-driven inpatient fall prevention systems using continuous monitoring data that generate explicit action triggers. We searched PubMed, Scopus, and Web of Science Core Collection for English-language studies published between 2016 and 2026 on 15 February 2026. Of 200 records identified, 32 duplicates were removed, and 168 records were screened. Eighty-three full-text reports were assessed for eligibility. Thirty-eight studies were included in the Tier 1 synthesis as action-trigger decision support systems, and 20 were classified as Tier 2 prediction or detection only to characterize evidence gaps. Tier 1 systems clustered into room-based monitoring with direct nurse alerting, wearable or batteryless sensing for bed egress and bed or chair exit alarms, and bed-centered early warning. Reporting was often incomplete for implementation-critical metrics such as alert burden, false alarms, response times, alert routing, and downstream actions. We propose a minimum operational reporting set to support clearer evaluation and comparison of AI-enabled inpatient fall-prevention systems in real-world ward settings. Full article

Background and Objectives: Physiotherapeutic Scoliosis-Specific Exercises (PSSE) are recognized treatment methods for idiopathic scoliosis, focused on correcting three-dimensional postural abnormalities. Objective indices such as Angle of Trunk Rotation (ATR), Anterior Trunk Symmetry Index (ATSI), and Posterior Trunk Symmetry Index (POTSI) enable precise assessment of clinical changes, while the Trunk Appearance Perception Scale (TAPS) reflects the patient’s subjective perception of their posture. Combining these data allows for a comprehensive assessment of the effects of therapy after intensive 5-day inpatient rehabilitation. We aimed to assess the improvement in the patients’ clinical appearance and compare objective and subjective trunk assessment indicators after intensive 5-day inpatient rehabilitation, treated by PSSE, according to the Functional Individual Therapy of Scoliosis (FITS) Method. Materials and Methods: This retrospective study included 75 patients with idiopathic scoliosis who participated in a 5-day inpatient rehabilitation, treated by FITS Method. The average age was 13.5 years, and 63% of the girls were after menarche. The mean Cobb angle was 27.41° in single-curve scoliosis and 31.03° in double-curve scoliosis (31.24° in the thoracic spine, 30.82° in the lumbar spine), Risser test 2, and ATR was 7.1° in the thoracic spine and 4.6° in the lumbar spine. Forty-nine patients wore a brace. At the beginning and end of inpatient care, objective assessments were performed, including ATR at the peak of the scoliosis using the Adams test and photoregistration of the trunk in the front and back standing positions—ATSI and POTSI. A subjective assessment was also performed using the TAPS. Results: A statistically significant difference was demonstrated after therapy in the ATSI (p < 0.001) and POTSI (p = 0.008) values. A reduction in the ATR in the thoracic spine was observed (p < 0.001). The TAPS questionnaire demonstrated a statistically significant difference in the values of all indicators measured before and after therapy: in the frontal plane SET 1 (p = 0.002), in the transverse plane SET 2 (p = 0.042), and in the frontal plane SET 3 (p = 0.028). A statistically significant negative correlation was demonstrated between objective and subjective indicators after therapy: ATR Th vs. TAPS-SET 2 (−0.45) (p < 0.001) and ATSI vs. SET 3 (−0.29) (p = 0.011). Conclusions: The subjective assessment of trunk appearance correlates with the objective assessment, except for SET 1 vs. POTSI. Patients who noticed a change in their posture can expect confirmation in objective clinical tests. FITS Method positively influences the improvement of subjective and objective assessments of idiopathic scoliosis patients during the short term of intensive care. Full article

Klebsiella species, particularly Klebsiella pneumoniae, are among the most frequently isolated Gram-negative pathogens in surgical departments, associated with a growing trend in multidrug resistance. To identify the types of infections caused by Klebsiella spp. in a general surgery department and to analyze their antimicrobial susceptibility patterns. This retrospective observational study includes bacteriological cultures collected from surgical inpatients between October 2016 and December 2024. Only cases with confirmed Klebsiella spp. isolation were included. Specimen types, infection categories, and antibiotic susceptibility profiles were extracted and analyzed. A total of 138 Klebsiella-positive cultures were identified. Clinical characteristics were analyzed in 38 patients with complete records. The most common infection types included surgical site infections (SSIs), intra-abdominal infections, and biliary tract infections. Sensitivity was highest to carbapenems, while marked resistance was observed to ampicillin-sulbactam and third-generation cephalosporins. Some isolates exhibited ESBL or carbapenemase-producing phenotypes. Reported colistin non-susceptibility was elevated in our cohort; however, these results should be interpreted cautiously because the reference broth microdilution method was not systematically documented. The findings underscore the importance of local surveillance of Klebsiella spp. in surgical settings to info rm empirical treatment and control the spread of multidrug-resistant organisms. Full article

Background: Hospitalizations for hepatocellular carcinoma (HCC) increasingly reflect a complex interplay among chronic liver disease, cardiometabolic comorbidities, and systemic complications, which now exert greater influence on patient outcomes than tumor-specific factors alone. Despite this shift, contemporary data regarding the impact of the evolving comorbidity burden on inpatient resource utilization and procedural care remain limited. This study examines national trends in inpatient characteristics, procedural utilization, and outcomes among patients hospitalized with HCC between 2018 and 2022. Methods: A retrospective, cross-sectional analysis of adult hospitalizations was performed using the National Inpatient Sample (NIS) from 2018 to 2022. Hospitalizations involving HCC were identified through ICD-10 diagnosis codes, encompassing both principal and secondary diagnoses. Survey-weighted analyses were used to estimate national prevalence, in-hospital mortality, length of stay (LOS), and total hospital charges. Temporal trends were evaluated using survey-weighted logistic or linear regression, with calendar year as a continuous variable. Multivariable survey-weighted logistic regression models were constructed to identify adjusted predictors of inpatient mortality and procedural utilization, including liver transplantation, hepatic resection, and transjugular intrahepatic portosystemic shunt (TIPS) placement. Results: During the study period, an estimated 275,000 HCC-related hospitalizations occurred nationwide. The prevalence of cardiometabolic comorbidities increased significantly over time (all p < 0.001), including MASLD (6.6% to 8.7%), obesity (10.6% to 13.7%), diabetes (36.0% to 38.9%), and dyslipidemia (26.4% to 34.4%). In-hospital mortality rose from 8.82% (95% CI, 8.40–9.24%) in 2018 to 9.23% (95% CI, 8.81–9.65%) in 2022, with the highest rate in 2020 (9.42%). In parallel, inpatient resource utilization rose, as reflected by longer lengths of stay and higher hospitalization charges. Utilization of diagnostic endoscopic procedures, such as esophagogastroduodenoscopy and endoscopic retrograde cholangiopancreatography, increased, whereas rates of definitive inpatient oncologic and portal hypertension-directed interventions—including liver transplantation, hepatic resection, and TIPS—remained low and stable. In-hospital mortality was independently associated with markers of hepatic decompensation and systemic illness, including hepatic encephalopathy, acute kidney injury, sepsis, and hepatorenal syndrome. These associations were stronger than those observed for tumor-directed procedures, as reflected by inpatient procedural utilization patterns. Conclusions: Between 2018 and 2022, inpatient resource utilization among patients hospitalized with hepatocellular carcinoma increased in parallel with rising cardiometabolic comorbidity. It was primarily driven by management of hepatic decompensation and systemic illness rather than oncologic intervention. These findings characterize the evolving complexity of HCC hospitalizations in the contemporary inpatient setting. Full article

Objective: Feeding-tube weaning is conducted in both inpatient and outpatient settings, with significant logistical, financial, and structural barriers to both approaches. We sought to assess whether remote patient monitoring (RPM), using a mobile application, which would overcome many of these barriers, could be effective in helping patients tube wean. Methods: We prospectively enrolled patients with a feeding tube, aged 0–3 years. Enrolled families entered data daily into the remote application. Data were monitored by a nurse and reviewed weekly by a multidisciplinary team. A standard hunger provocation protocol was used, paired with medical, behavioral, oral motor, and nutrition interventions, as needed. We conducted a retrospective chart review to identify a comparison cohort. The chart review was collected first, then compared to the prospective, non-randomized trial of RPM tube weaning. Results: The chart review identified 141 children seen with a feeding tube from January 2023–June 2023. Of those, 17 children attempted a tube wean. The post-intervention group consisted of 38 children prospectively enrolled from the same clinic between November 2023–2024. In the pre-intervention group, 41% of the children (7/17) were successful in achieving all calories by mouth and 90% of children (34/38) in the post-intervention group were successful in tube weaning. Conclusions: RPM is a feasible and incredibly promising model for feeding-tube weaning in pediatric patients with a wide range of medical comorbidities, including patients with multiple comorbidities. RPM allowed for high-quality medical monitoring and for a dynamic intervention in response to patient data transferred to the medical team in real time. Full article

Cognitive impairments are a core feature of psychotic disorders and are strongly associated with long-term functional disability. Although Cognitive Remediation Therapy (CRT) is an evidence-based intervention for improving cognition in psychosis, its feasibility and preliminary effects in acute inpatient settings—particularly using web-based platforms—remain underexplored. This single-arm, pre–post pilot study evaluated the feasibility of delivering a web-based CRT program and examined preliminary cognitive outcomes in a secure psychiatric inpatient facility. Thirteen inpatients with psychotic and non-psychotic diagnoses completed a 15-week intervention comprising twice-weekly sessions that included adaptive computerized CRT exercises (Happy Neuron Pro) and therapist-led bridging discussions focused on metacognitive reflection and functional application. Cognitive performance was assessed pre- and post-intervention using the MATRICS Consensus Cognitive Battery. All participants completed the study with no withdrawals or adverse events, attending a mean of 27.77 of 30 sessions (93.0%). Pre–post improvements were observed in processing speed, verbal learning, and overall composite cognition, with large within-sample effect sizes that remained robust in sensitivity analyses. Exploratory analyses suggested potential associations between sex, history of self-harm, and cognitive change, though these findings require cautious interpretation. Findings support the feasibility of inpatient web-based CRT and provide preliminary cognitive effect-size estimates. Given the single-arm design and absence of systematic medication monitoring, results should be interpreted as exploratory signals warranting controlled validation. Overall, findings support the feasibility of inpatient web-based CRT and provide preliminary signals of cognitive benefit, warranting evaluation in larger controlled studies. Full article