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12 pages, 388 KiB  
Article
Evolution of Respiratory Pathogens and Antimicrobial Resistance over the COVID-19 Timeline: A Study of Hospitalized and Ambulatory Patient Populations
by Luigi Regenburgh De La Motte, Loredana Deflorio, Erika Stefano, Matteo Covi, Angela Uslenghi, Carmen Sommese and Lorenzo Drago
Antibiotics 2025, 14(8), 796; https://doi.org/10.3390/antibiotics14080796 - 5 Aug 2025
Viewed by 38
Abstract
Background: The COVID-19 pandemic has profoundly altered the clinical and microbiological landscape of respiratory tract infections (RTIs), potentially reshaping pathogen distribution and antimicrobial resistance (AMR) profiles across care settings. Objectives: The objective of this study was to assess temporal trends in respiratory bacterial [...] Read more.
Background: The COVID-19 pandemic has profoundly altered the clinical and microbiological landscape of respiratory tract infections (RTIs), potentially reshaping pathogen distribution and antimicrobial resistance (AMR) profiles across care settings. Objectives: The objective of this study was to assess temporal trends in respiratory bacterial pathogens, antimicrobial resistance, and polymicrobial infections across three pandemic phases—pre-COVID (2018–2019), COVID (2020–2022), and post-COVID (2022–2024)—in hospitalized and ambulatory patients. Methods: We retrospectively analyzed 1827 respiratory bacterial isolates (hospitalized patients, n = 1032; ambulatory patients, n = 795) collected at a tertiary care center in Northern Italy. Data were stratified by care setting, anatomical site, and pandemic phase. Species identification and susceptibility testing followed EUCAST guidelines. Statistical analysis included chi-square and Fisher’s exact tests. Results: In hospitalized patients, a significant increase in Pseudomonas aeruginosa (from 45.5% pre-COVID to 58.6% post-COVID, p < 0.0001) and Acinetobacter baumannii (from 1.2% to 11.1% during COVID, p < 0.0001) was observed, with 100% extensively drug-resistant (XDR) rates for A. baumannii during the pandemic. Conversely, Staphylococcus aureus significantly declined from 23.6% pre-COVID to 13.7% post-COVID (p = 0.0012). In ambulatory patients, polymicrobial infections peaked at 41.2% during COVID, frequently involving co-isolation of Candida spp. Notably, resistance to benzylpenicillin in Streptococcus pneumoniae reached 80% (4/5 isolates) in hospitalized patients during COVID, and carbapenem-resistant P. aeruginosa (CRPA) significantly increased post-pandemic in ambulatory patients (0% pre-COVID vs. 23.5% post-COVID, p = 0.0014). Conclusions: The pandemic markedly shifted respiratory pathogen dynamics and resistance profiles, with distinct trends observed in hospital and community settings. Persistent resistance phenotypes and frequent polymicrobial infections, particularly involving Candida spp. in outpatients, underscore the need for targeted surveillance and antimicrobial stewardship strategies. Full article
(This article belongs to the Section Antibiotic Therapy in Infectious Diseases)
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13 pages, 1674 KiB  
Article
The Role of the Clinical Pharmacist in Hospital Admission Medication Reconciliation in Low-Resource Settings
by Tijana Kovačević, Sonja Nedinić, Vedrana Barišić, Branislava Miljković, Emir Fazlić, Slobodan Vukadinović and Pedja Kovačević
Pharmacy 2025, 13(4), 107; https://doi.org/10.3390/pharmacy13040107 - 2 Aug 2025
Viewed by 188
Abstract
Medication discrepancies at hospital admission are common and may lead to adverse outcomes. Medication reconciliation is a critical process for minimizing medication discrepancies and medication errors at the time of hospital admission. This study aimed to evaluate the role of clinical pharmacists in [...] Read more.
Medication discrepancies at hospital admission are common and may lead to adverse outcomes. Medication reconciliation is a critical process for minimizing medication discrepancies and medication errors at the time of hospital admission. This study aimed to evaluate the role of clinical pharmacists in identifying pharmacotherapy-related issues upon patient admission in a low-resource setting. A prospective observational study was conducted at a university hospital between 1 March and 31 May 2023. Within 24 h of admission, a clinical pharmacist documented each patient’s pre-admission medication regimen and compared it with the medication history obtained by the admitting physician. Discrepancies and pharmacotherapy problems were subsequently identified. Among 65 patients, pharmacists documented 334 medications versus 189 recorded by physicians (p < 0.01). The clinical pharmacist identified 155 discrepancies, 112 (72.26%) of which were unintentional. The most frequent type was drug omission (91.07%), followed by incorrect dosage (4.46%), incorrect dosing interval (2.68%), and medications with unknown indications (1.79%). Most discrepancies were classified as errors without harm (53.57%), while 41.07% were potentially harmful. These findings underscore the importance of integrating clinical pharmacists into the healthcare team. Their active participation during hospital admission can significantly enhance medication safety and reduce preventable adverse drug events. Full article
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13 pages, 436 KiB  
Article
Hospital Pharmacists’ Perspectives on Adverse Drug Reaction Reporting in Developed and Developing  Countries: A Comparative Pilot Study
by Javeria Khalid, Tarilate Temedie-Asogwa, Marjan Zakeri and Sujit S. Sansgiry
Pharmacy 2025, 13(4), 103; https://doi.org/10.3390/pharmacy13040103 - 29 Jul 2025
Viewed by 247
Abstract
Adverse drug reactions (ADRs) significantly affect patient safety and healthcare spending worldwide. Hospital pharmacists are uniquely positioned to address ADRs due to their crucial role in medication management. However, underreporting remains a global concern, especially in developing countries, where pharmacovigilance systems are inadequately [...] Read more.
Adverse drug reactions (ADRs) significantly affect patient safety and healthcare spending worldwide. Hospital pharmacists are uniquely positioned to address ADRs due to their crucial role in medication management. However, underreporting remains a global concern, especially in developing countries, where pharmacovigilance systems are inadequately developed. Therefore, this pilot study aimed to evaluate and compare the knowledge, attitudes, perceived barriers, and facilitators regarding ADR reporting by hospital pharmacists in a developed (US) and a developing (Pakistan) country. A cross-sectional survey was conducted, using a pre-validated questionnaire. The pharmacists, possessing a minimum of one year’s hospital experience, were selected via convenience sampling. Out of 151 respondents, included in the final analysis (US: n = 51; Pakistan: n = 100), the majority were female (62.3%), aged 29–35 years (38%), and possessed a Pharm. D degree (49.7%). The knowledge (US: 6.03 ± 0.27 vs. Pakistan:5.69 ± 0.25, p-value = 0.193) and attitude scores (US: 32.02 ± 0.73 vs. Pakistan: 32.63 ± 0.67; p-value = 0.379) exhibited no significant differences between the groups. Nonetheless, barriers at both the individual and systemic levels were more pronounced in the developing country. Important facilitators reported were mobile applications for ADR reporting, specialized training, and intuitive reporting tools. In conclusion, we found that pharmacists in both settings exhibit comparable knowledge and positive attitudes towards ADR reporting, though specific contextual barriers are present. Interventions customized to the local hospital infrastructure are crucial for enhancing ADR reporting, particularly in resource-constrained settings. Full article
(This article belongs to the Section Pharmacy Practice and Practice-Based Research)
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25 pages, 1925 KiB  
Article
Distinctive Temporal Profiles of Interferon-Stimulated Genes in Natural Infection, Viral Challenge, and Vaccination
by Hongxing Lei
Viruses 2025, 17(8), 1060; https://doi.org/10.3390/v17081060 - 29 Jul 2025
Viewed by 328
Abstract
Interferon (IFN) signaling plays vital roles in host defense against viral infection. However, a variety of observations have been reported in the literature regarding the roles of IFN signaling in COVID-19. Thus, it would be important to reach a clearer picture regarding the [...] Read more.
Interferon (IFN) signaling plays vital roles in host defense against viral infection. However, a variety of observations have been reported in the literature regarding the roles of IFN signaling in COVID-19. Thus, it would be important to reach a clearer picture regarding the activation or suppression of IFN signaling in COVID-19. In this work, regulation of marker genes for IFN signaling was examined in natural infection, viral challenge, and vaccination based on 13 public transcriptome datasets. Three subsets of interferon-stimulated genes (ISGs) were selected for detailed examination, including one set of marker genes for type I IFN signaling (ISGa) and two sets of marker genes for type II IFN signaling (IFN-γ signaling, GBPs for the GBP gene cluster, and HLAd for the HLA-D gene cluster). In natural infection, activation of ISGa and GBPs was accompanied by the suppression of HLAd in hospitalized patients. Suppression of GBPs was also observed in certain critical conditions. The scale of regulation was much greater for ISGa than that of GBPs and HLAd. In addition, the suppression of HLAd was correlated with disease severity, and it took much longer for HLAd to return to the level of healthy controls than that for ISGa and GBPs. Upon viral challenge, the activation of ISGa and GBPs was similar to that of natural infection, while the suppression of HLAd was not observed. Moreover, GBPs’ return to the pre-infection level was at a faster pace than that of ISGa. Upon COVID-19 vaccination, activation was observed for all of these three gene sets, and the scale of activation was comparable for ISGa and GBPs. Notably, it took a much shorter time for GBPs and ISGa to return to the level of healthy controls than that in COVID-19 infection. In addition, the baseline values and transient activation of these gene sets were also associated with subsequent vaccination response. The intricate balance of IFN signaling was demonstrated in mild breakthrough infection, where attenuated response was observed in people with prior vaccination compared to that in vaccine-naïve subjects. Overall, distinctive temporal profiles of IFN signaling were observed in natural infection, viral challenge, and vaccination. The features observed in this work may provide novel insights into the disease management and vaccine development. Full article
(This article belongs to the Section Viral Immunology, Vaccines, and Antivirals)
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22 pages, 1781 KiB  
Article
Analyzing Heart Rate Variability for COVID-19 ICU Mortality Prediction Using Continuous Signal Processing Techniques
by Guilherme David, André Lourenço, Cristiana P. Von Rekowski, Iola Pinto, Cecília R. C. Calado and Luís Bento
J. Clin. Med. 2025, 14(15), 5312; https://doi.org/10.3390/jcm14155312 - 28 Jul 2025
Viewed by 275
Abstract
Background/Objectives: Heart rate variability (HRV) has been widely investigated as a predictor of disease and mortality across diverse patient populations; however, there remains no consensus on the optimal set or combination of time and frequency domain nor on nonlinear features for reliable prediction [...] Read more.
Background/Objectives: Heart rate variability (HRV) has been widely investigated as a predictor of disease and mortality across diverse patient populations; however, there remains no consensus on the optimal set or combination of time and frequency domain nor on nonlinear features for reliable prediction across clinical contexts. Given the relevance of the COVID-19 pandemic and the unique clinical profiles of these patients, this retrospective observational study explored the potential of HRV analysis for early prediction of in-hospital mortality using ECG signals recorded during the initial moments of ICU admission in COVID-19 patients. Methods: HRV indices were extracted from four ECG leads (I, II, III, and aVF) using sliding windows of 2, 5, and 7 min across observation intervals of 15, 30, and 60 min. The raw data posed significant challenges in terms of structure, synchronization, and signal quality; thus, from an original set of 381 records from 321 patients, after data pre-processing steps, a final dataset of 82 patients was selected for analysis. To manage data complexity and evaluate predictive performance, two feature selection methods, four feature reduction techniques, and five classification models were applied to identify the optimal approach. Results: Among the feature aggregation methods, compiling feature means across patient windows (Method D) yielded the best results, particularly for longer observation intervals (e.g., using LDA, the best AUC of 0.82±0.13 was obtained with Method D versus 0.63±0.09 with Method C using 5 min windows). Linear Discriminant Analysis (LDA) was the most consistent classification algorithm, demonstrating robust performance across various time windows and further improvement with dimensionality reduction. Although Gradient Boosting and Random Forest also achieved high AUCs and F1-scores, their performance outcomes varied across time intervals. Conclusions: These findings support the feasibility and clinical relevance of using short-term HRV as a noninvasive, data-driven tool for early risk stratification in critical care, potentially guiding timely therapeutic decisions in high-risk ICU patients and thereby reducing in-hospital mortality. Full article
(This article belongs to the Section Cardiology)
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18 pages, 4079 KiB  
Article
Enhancing Pediatric Outpatient Medical Services Through the Implementation of the Smart Well Child Center Application
by Naporn Uengarporn, Teerapat Saengthongpitag, Poonyanuch Chongjaroenjai, Atcha Pongpitakdamrong, Wutthipong Sriratthnarak, Phonpimon Rianteerasak, Kanyarat Mongkolkul, Paninun Srinuchasart, Panuwat Srichaisawat, Nicharee Mungklang, Raiwada Sanguantrakul, Pattama Tongdee, Wichulada Kiatmongkol, Boonyanulak Sihaklang, Piraporn Putrakul, Niwatchai Namvichaisirikul and Patrapon Saritshasombat
Healthcare 2025, 13(14), 1676; https://doi.org/10.3390/healthcare13141676 - 11 Jul 2025
Viewed by 387
Abstract
Background: Caregivers of children often encounter barriers when accessing pediatric healthcare services. These challenges highlight the need for digital innovations to improve accessibility and efficiency in pediatric outpatient care. Objectives: This study aimed to design, implement, and pilot evaluate the Smart Well Child [...] Read more.
Background: Caregivers of children often encounter barriers when accessing pediatric healthcare services. These challenges highlight the need for digital innovations to improve accessibility and efficiency in pediatric outpatient care. Objectives: This study aimed to design, implement, and pilot evaluate the Smart Well Child Center application in conjunction with enhancements to the Pediatric Outpatient Department. Methods: This study employs a mixed-methods research approach. The application was developed following the system development life cycle (SDLC) process, and its performance was subsequently evaluated. Additionally, its effectiveness in real-world settings was assessed through a satisfaction survey completed by 85 child caregivers. The results were summarized using the mean and standard deviation, and satisfaction levels were compared using paired t-test and repeated measures ANOVA. Results: The findings reveal that caregivers face significant challenges, including financial burdens related to travel, prolonged wait times, and difficulties accessing healthcare services. In response, the application was designed to incorporate key functionalities. Within the pre-consultation self-assessment module, caregivers can complete evaluations and receive recommendations directly through the application. Furthermore, the service procedure flowchart was restructured to seamlessly integrate these digital innovations, thereby enhancing the overall healthcare experience. The evaluation results indicate that the application achieved high performance ratings across all assessed dimensions (4.06 ± 0.77). Additionally, caregivers reported a substantial increase in satisfaction levels both immediately after implementation (4.58 ± 0.57) and one month afterward (4.59 ± 0.33). Conclusions: Given these findings, it is recommended that the hospital fully adopt the Smart Well Child Center application to improve healthcare accessibility and reduce patient wait times. Future research should assess the long-term impact of the intervention on both caregiver outcomes and healthcare professional workflow, satisfaction, and system usability, to inform broader implementation strategies. Full article
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10 pages, 2451 KiB  
Article
Development and Validation of ELISA for In Vitro Diagnosis of SARS-CoV-2 Infection
by Larissa de Carvalho Medrado Vasconcelos, Leonardo Maia Leony, Ângelo Antônio Oliveira Silva, Aquiles Assunção Camelier, Antônio Carlos Bandeira, Isadora Cristina de Siqueira and Fred Luciano Neves Santos
COVID 2025, 5(7), 108; https://doi.org/10.3390/covid5070108 - 11 Jul 2025
Viewed by 295
Abstract
(1) Background: The ongoing global health threat posed by SARS-CoV-2 requires reliable and accessible diagnostic tools, especially in resource-limited settings where RT-qPCR may be impractical. This study describes the development and validation of two enzyme-linked immunosorbent assays (ELISA) designed to detect anti-SARS-CoV-2 IgG [...] Read more.
(1) Background: The ongoing global health threat posed by SARS-CoV-2 requires reliable and accessible diagnostic tools, especially in resource-limited settings where RT-qPCR may be impractical. This study describes the development and validation of two enzyme-linked immunosorbent assays (ELISA) designed to detect anti-SARS-CoV-2 IgG antibodies employing recombinant S1 and S2 spike protein subunits. (2) Methods: The assays were optimized and validated using serum samples from 354 RT-qPCR-confirmed hospitalized patients and 337 pre-pandemic blood donors. (3) Results: The S1-based ELISA achieved a 52.8% sensitivity and a specificity of 93.5%, with an area under the ROC curve (AUC) of 71.6%. In contrast, the S2-based ELISA demonstrated superior diagnostic performance, with a sensitivity of 63.7%, a specificity of 99.7%, and an AUC of 83.1%. Cross-reactivity analysis using sera from individuals with unrelated infectious diseases confirmed the high specificity of the S2-ELISA. Time-stratified analysis revealed that sensitivity increased with time, peaking between 15 and 21 days post-symptom onset. Compared to commercial serological assays, the S2-ELISA demonstrated comparable or improved performance, particularly in specificity and diagnostic odds ratio. (4) Conclusions: The S2-ELISA offers a robust, highly specific, and operationally simple tool for serological detection of SARS-CoV-2 infection. Its strong diagnostic performance and accessibility make it well-suited for implementation in diverse epidemiological settings, particularly where molecular testing is limited. The development of affordable, validated serological assays such as this is critical for strengthening surveillance, understanding transmission dynamics, and informing public health responses. Full article
(This article belongs to the Section Human or Animal Coronaviruses)
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16 pages, 1148 KiB  
Article
Impact of an Enhanced Disinfection Protocol on the Incidence of Clostridioides difficile Infections and Antibiotic Consumption in a Hospital Setting: A Retrospective Intervention Study
by Patryk Tarka, Wiesław Hreczuch, Arkadiusz Chruściel, Michał Piotrowski, Anna Olczak-Pieńkowska, Karol Warda, Daniel Rabczenko, Krzysztof Kanecki and Aneta Nitsch-Osuch
J. Clin. Med. 2025, 14(14), 4904; https://doi.org/10.3390/jcm14144904 - 10 Jul 2025
Viewed by 647
Abstract
Background: Clostridioides difficile infection (CDI) is a major concern in hospital-acquired infections. C. difficile spores can survive on surfaces for months and require sporicidal disinfection for elimination. The use of disinfectants should be based on laboratory-confirmed sporicidal activity, tested according to current [...] Read more.
Background: Clostridioides difficile infection (CDI) is a major concern in hospital-acquired infections. C. difficile spores can survive on surfaces for months and require sporicidal disinfection for elimination. The use of disinfectants should be based on laboratory-confirmed sporicidal activity, tested according to current standards in suspension and carrier tests. Further evaluation of disinfectant efficacy should occur in clinical settings by analyzing reductions in CDI incidence. This study aims to conduct a retrospective analysis of the impact of a new disinfection protocol and concurrent changes in antibiotic consumption on the incidence of healthcare-acquired CDI (HA-CDI). Methods: This retrospective, single-center study assessed the impact of a chlorine dioxide-based disinfection protocol on HA-CDI across three periods: pre-intervention, intervention, and post-intervention. An interrupted time series analysis (ITS) with a Poisson distribution was used to evaluate the incidence of HA-CDI, while antibiotic consumption data were analyzed to identify any correlation with CDI infection rates. Results: Incidence Rate Ratio (IRR) before the intervention is 1.00, serving as the reference value. During the intervention period, the IRR is 0.79 (95% CI: 0.42–1.36; p = 0.43), indicating a decrease in the incidence of infections compared to the pre-intervention period, although this result is not statistically significant. After the intervention, the IRR is 0.53 (95% CI: 0.26–0.97; p = 0.057), suggesting a further reduction in the incidence of CDI; this result is on the borderline of statistical significance (p = 0.057), indicating a potential effect of the intervention, albeit without full statistical certainty. Conclusions: The absence of a CDI surge despite increased antibiotic consumption highlights the synergistic relationship between antibiotic stewardship and rigorous infection control practices. The combination of the improved disinfection protocol and comprehensive staff training proved remarkably effective in mitigating CDI risk. Cleaning and disinfection in healthcare facilities is crucial for the prevention of healthcare-associated infections. Full article
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39 pages, 1706 KiB  
Systematic Review
Improving Vaccine Coverage Among Older Adults and High-Risk Patients: A Systematic Review and Meta-Analysis of Hospital-Based Strategies
by Flavia Pennisi, Stefania Borlini, Rita Cuciniello, Anna Carole D’Amelio, Rosaria Calabretta, Antonio Pinto and Carlo Signorelli
Healthcare 2025, 13(14), 1667; https://doi.org/10.3390/healthcare13141667 - 10 Jul 2025
Viewed by 586
Abstract
Background/Objectives: Adult vaccination remains suboptimal, particularly among older adults and individuals with chronic conditions. Hospitals represent a strategic setting for improving vaccination coverage among these high-risk populations. This systematic review and meta-analysis evaluated hospital-based interventions aimed at enhancing vaccine uptake in adults aged [...] Read more.
Background/Objectives: Adult vaccination remains suboptimal, particularly among older adults and individuals with chronic conditions. Hospitals represent a strategic setting for improving vaccination coverage among these high-risk populations. This systematic review and meta-analysis evaluated hospital-based interventions aimed at enhancing vaccine uptake in adults aged ≥60 years or 18–64 years with at-risk medical conditions. Methods: We conducted a systematic review and meta-analysis following PRISMA and MOOSE guidelines. Searches in PubMed, EMBASE, and Scopus identified studies published in the last 10 years evaluating hospital-based interventions reporting vaccination uptake. The risk of bias was assessed using validated tools (NOS, RoB 2, ROBINS-I, QI-MQCS). A meta-analysis was conducted for categories with ≥3 eligible studies reporting pre- and post-intervention vaccination coverage in the same population. Results: We included 44 studies. Multi-component strategies (n = 21) showed the most consistent results (e.g., pneumococcal uptake from 2.2% to 43.4%, p < 0.001). Reminder-based interventions (n = 4) achieved influenza coverage increases from 31.0% to 68.0% and a COVID-19 booster uptake boost of +38% after SMS reminders. Educational strategies (n = 11) varied in effectiveness, with one study reporting influenza coverage rising from 1.6% to 12.2% (+662.5%, OR 8.86, p < 0.01). Standing order protocols increased pneumococcal vaccination from 10% to 60% in high-risk adults. Hospital-based catch-up programs improved DTaP-IPV uptake from 56.2% to 80.8% (p < 0.001). For patient education, the pooled OR was 2.11 (95% CI: 1.96–2.27; p < 0.001, I2 = 97.2%) under a fixed-effects model, and 2.47 (95% CI: 1.53–3.98; p < 0.001) under a random-effects model. For multi-component strategies, the OR was 2.39 (95% CI: 2.33–2.44; p < 0.001, I2 = 98.0%) with fixed effects, and 3.12 (95% CI: 2.49–3.92; p < 0.001) with random effects. No publication bias was detected. Conclusions: Hospital-based interventions, particularly those using multi-component approaches, effectively improve vaccine coverage in older and high-risk adults. Embedding vaccination into routine hospital care offers a scalable opportunity to reduce disparities and enhance population-level protection. Future policies should prioritize the institutional integration of such strategies to support healthy aging and vaccine equity. Full article
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11 pages, 811 KiB  
Article
Comparative Analysis of Severe Clinical Outcomes in Hospitalized Patients with RSV, Influenza, and COVID-19 Across Early and Late COVID-19 Pandemic Phases (2021–2024)
by Yuying Xing and Amit Bahl
J. Clin. Med. 2025, 14(14), 4894; https://doi.org/10.3390/jcm14144894 - 10 Jul 2025
Viewed by 471
Abstract
Background: COVID-19, influenza, and respiratory syncytial virus (RSV) are major respiratory infections with overlapping clinical presentations. Comparative data on the severity of these infections in hospitalized adults are limited, particularly across phases of the COVID-19 pandemic. Objectives: The objectives of this study are [...] Read more.
Background: COVID-19, influenza, and respiratory syncytial virus (RSV) are major respiratory infections with overlapping clinical presentations. Comparative data on the severity of these infections in hospitalized adults are limited, particularly across phases of the COVID-19 pandemic. Objectives: The objectives of this study are to compare the risk of severe outcomes among hospitalized patients with COVID-19, influenza, or RSV and to evaluate the role of vaccination and demographic subgroups using recent, real-world data. Design: This is a retrospective cohort study. Setting: Eight hospitals within the Corewell Health system in Michigan, USA, were studied. Participants: The participants included adults aged ≥ 18 years hospitalized between 1 January 2021 and 20 July 2024 with a principal diagnosis of COVID-19, influenza, or RSV. Main Outcomes and Measures: The primary outcome was a composite of ICU admission, mechanical ventilation, or in-hospital death. Multivariable Cox proportional hazard models were used to estimate adjusted hazard ratios (aHRs), with subgroup analyses in terms of vaccination status, age group, and time period. Results: Among 27,885 hospitalized patients (90.5% COVID-19, 7.2% influenza, 2.3% RSV), COVID-19 was associated with a higher risk of severe outcomes compared to influenza (aHR 1.30, 95% CI: 1.11–1.54). RSV showed no significant difference from influenza. Across all infection groups, older age (≥65 years), high comorbidity burden, and immunocompromised status were associated with an increased risk of severe outcomes. Recent COVID-19 vaccination was protective, particularly among older adults. Differences in severity were more pronounced in the pre-March 2022 period. Conclusions: Using one of the most recent large-scale datasets, this study is among the first to directly compare the severity of COVID-19, influenza, and RSV in hospitalized adults. COVID-19 continues to pose a higher risk of severe illness compared to the other viral infections. The findings underscore the importance of up-to-date vaccination and focused clinical strategies for older and high-risk individuals. This study offers timely evidence to guide future respiratory virus response strategies across hospital settings. Full article
(This article belongs to the Section Infectious Diseases)
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18 pages, 618 KiB  
Article
Both, Limited and Often Fatal Systemic Infections Caused by Leuconostoc spp. in Older, Previously Ill Men Are Usually Acquired in the Outpatient Setting
by Johanna Butt, Cristian Arva and Stefan Borgmann
Microorganisms 2025, 13(7), 1626; https://doi.org/10.3390/microorganisms13071626 - 10 Jul 2025
Viewed by 350
Abstract
Leuconostoc spp. are vancomycin-resistant Gram-positive cocci that are used in food production and as pre- and probiotics. However, Leuconostoc spp. can also cause infections. In the present study, the records of patients with Leuconostoc spp. detection between January 2012 and March 2025 were [...] Read more.
Leuconostoc spp. are vancomycin-resistant Gram-positive cocci that are used in food production and as pre- and probiotics. However, Leuconostoc spp. can also cause infections. In the present study, the records of patients with Leuconostoc spp. detection between January 2012 and March 2025 were analyzed, inclusive of the underlying risk factors. Leuconostoc spp. was isolated from 32 patients (21 male, 11 females), including nine patients with blood culture evidence. In the majority of patients, Leuconostoc spp. were obtained on the day of admission to the hospital or in the first few days thereafter, arguing against nosocomial acquisition. The median age of men and women (65.3 and 67.8 years) was similar, but seven of the 14 male patients over the age of 65 had the bacteria in blood culture. The female patients with blood culture evidence had suffered from peripartum thrombophlebitis and from anorexia nervosa (BMI 8.8 kg/m2). In contrast, men with Leuconostoc spp. in the blood culture had severe, limiting underlying diseases. While the two women survived, five of the seven blood-culture-positive men died. Overall, our results show that Leuconostoc spp. is mainly acquired in outpatient settings, but men are at a higher risk of acquisition. Colonized men over the age of 60 with severe underlying diseases have a high risk of systemic infection with a fatal outcome. Full article
(This article belongs to the Special Issue Lactic Acid Bacteria in Food Fermentation and Biotechnology)
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10 pages, 187 KiB  
Article
Correlation of Airway POCUS Measures with Screening and Severity Evaluation Tools in Obstructive Sleep Apnea: An Exploratory Study
by Sapna Ravindranath, Yatish S. Ranganath, Ethan Lemke, Matthew B Behrens, Anil A. Marian, Hari Kalagara, Nada Sadek, Melinda S. Seering, Linder Wendt, Patrick Ten Eyck and Rakesh V. Sondekoppam
J. Clin. Med. 2025, 14(14), 4858; https://doi.org/10.3390/jcm14144858 - 9 Jul 2025
Viewed by 399
Abstract
Background: Obstructive Sleep Apnea (OSA) is a common occurrence in the perioperative patient population but is often undiagnosed. Point-of-Care Ultrasound (POCUS) has emerged as a promising tool for perioperative assessment; however, its effectiveness in detecting the presence or severity of OSA needs to [...] Read more.
Background: Obstructive Sleep Apnea (OSA) is a common occurrence in the perioperative patient population but is often undiagnosed. Point-of-Care Ultrasound (POCUS) has emerged as a promising tool for perioperative assessment; however, its effectiveness in detecting the presence or severity of OSA needs to be evaluated. Objective: We assessed the ability of airway POCUS as a screening and severity evaluation tool for OSA by examining its correlation with STOP-BANG scores and the Apnea–Hypopnea Index (AHI). Design: Cross-sectional observational study. Setting: A single-center study in a tertiary care hospital between June 2020 to May 2021. Patients: Adult patients aged 18–65 with prior Polysomnography (PSG) for OSA workup were screened. Interventions: The participants completed the STOP-BANG questionnaire and subsequently underwent POCUS examinations, either pre- or post-surgery. Ten different POCUS views previously used for evaluating OSA were acquired in a predefined sequence, with subsequent measurements of airway parameters. Outcome measures: Generalized linear modeling was used to explore and assess the relationships between the measured parameters, STOP-BANG, and AHI scores (modeled continuously and categorized into risk levels of STOP-BANG and AHI). Results: A total of 260 patients were screened, of which 142 were enrolled and 127 completed the scanning studies. The median AHI was 16.71, while the STOP-BANG scores were mostly between 5 and 6, indicating a moderate-to-high OSA risk in the study population. Notably, only neck circumference was significantly associated with AHI severity (p = 0.012), whereas none of the other POCUS measures were. Among the POCUS measures, significant associations with STOP-BANG scores were observed for the Tongue Cross-Sectional Area (T-CSA) (p = 0.002), Retro-Palatal Diameter (RPD) (p = 0.034), Distance Between Lingual Arteries (DLA) (p = 0.034), and Geniohyoid Muscle Thickness (GMT) (p = 0.040). Conclusions: Neck circumference is a more reliable predictor of OSA severity (AHI) compared to other POCUS measurements. Many of the POCUS measures had a good correlation with the STOP-BANG scores, highlighting the utility of POCUS as a screening tool for OSA rather than as a severity evaluation tool. Full article
(This article belongs to the Special Issue Innovations in Perioperative Anesthesia and Intensive Care)
21 pages, 1584 KiB  
Article
Evaluating the Feasibility and Acceptability of a Prototype Hospital Digital Antibiotic Review Tracking Toolkit: A Qualitative Study Using the RE-AIM Framework
by Gosha Colquhoun, Nicola Ring, Jamie Smith, Diane Willis, Brian Williams and Kalliopi Kydonaki
Antibiotics 2025, 14(7), 660; https://doi.org/10.3390/antibiotics14070660 - 30 Jun 2025
Viewed by 369
Abstract
Background: Internationally, digital health interventions have increasingly been adopted within hospital settings. Optimising their clinical implementation requires user involvement, but there is a lack of evidence regarding how this should be done. Objectives: This study was carried out to understand the acceptability and [...] Read more.
Background: Internationally, digital health interventions have increasingly been adopted within hospital settings. Optimising their clinical implementation requires user involvement, but there is a lack of evidence regarding how this should be done. Objectives: This study was carried out to understand the acceptability and usability of a prototype Digital Antibiotic Review Tracking Toolkit and identify modifications required to optimise it ahead of a trial. Methods: The optimisation process involved online semi-structured interviews with a purposive sample of fifteen healthcare professionals recruited from Scotland and England, along with three service users, to gather feedback on the prototype’s design, content and delivery. Participants’ negative views were specifically sought to identify adaptations needed to ensure that the intervention’s components aligned optimally with end-user needs. Data were analysed using Framework Analysis guided by the RE-AIM implementation science framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance) to identify key themes. Results: Participants mostly voiced positive views regarding the prototype, finding it acceptable, feasible and engaging. They also identified concerns relating to its adoption, system functionality, accessibility and maintenance that needed to be addressed. Anticipated low adoption rates were linked to issues surrounding computer literacy. This detailed user feedback informed rapid adjustments to the intervention to enhance its acceptability, perceived future credibility and usability in hospitals. Conclusions: This novel study illustrates how to identify, modify and adapt a digital intervention quickly and efficiently using qualitative iterative methods. Findings highlight the critical importance of contextualising end-user experience with health interventions to facilitate future engagement, uptake, and long-term use. This study also demonstrates how core elements of the MRC framework can be operationalised to help refine prototype digital interventions pre-trial. Full article
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14 pages, 2050 KiB  
Article
Barriers to Improving Pain Management in the Emergency Department: Lessons from a Lean-Driven Quality Improvement Initiative
by Jakub Nożewski, Radosław Bondarczuk, Grzegorz Hołody, Meabh Kitt, Natalia Mućka and Urszula Religioni
J. Clin. Med. 2025, 14(13), 4566; https://doi.org/10.3390/jcm14134566 - 27 Jun 2025
Viewed by 534
Abstract
Background/Objectives: Pain remains as a prevailing cause, prompting patients to seek medical attention, comprising approximately 40% of all emergency department (ED) visits annually. Timely and effective pain management is crucial for patient comfort, satisfaction, and optimal recovery. However, there is increasing evidence [...] Read more.
Background/Objectives: Pain remains as a prevailing cause, prompting patients to seek medical attention, comprising approximately 40% of all emergency department (ED) visits annually. Timely and effective pain management is crucial for patient comfort, satisfaction, and optimal recovery. However, there is increasing evidence highlighting the concern that patients often receive inadequate pain management in both emergency departments and prehospital settings. Despite the simplicity and potential for the repetitive use of pain scales throughout a patient’s stay, it appears that a greater emphasis is often placed on monitoring hypotension or low saturation values rather than addressing pain levels above 7 on the numeric rating pain scale. Methods: This article represents an ambitious attempt to implement process improvement methodologies such as Lean Management and SixSigma, both which have been well established in service and industrial fields, within the hospital environment to improve the process of pain management in the emergency department. Results: The implementation of pain management improvement processes in the emergency department led to a statistically significant but clinically modest increase in the administration of analgesics and improved pain reporting practices. The percentage of patients receiving no analgesia decreased from 96.6% to 94.8% (p = 0.008), and the documentation of pain characteristics during triage improved. However, the escalation of pain therapy remained limited, and strong analgesics were still underutilized. Conclusions: Despite partial improvements, the lean management-based interventions did not sufficiently address the problem of oligoanalgesia in the emergency setting. Sustainable change requires enhanced clinical engagement, ongoing staff training, and the broader adoption of structured analgesia protocols across prehospital and hospital care. Full article
(This article belongs to the Section Emergency Medicine)
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22 pages, 1199 KiB  
Article
Assessment of Health Risks Associated with PM10 and PM2.5 Air Pollution in the City of Zvolen and Comparison with Selected Cities in the Slovak Republic
by Patrick Ivan, Marián Schwarz and Miriama Mikušová
Environments 2025, 12(7), 212; https://doi.org/10.3390/environments12070212 - 20 Jun 2025
Viewed by 819
Abstract
Air pollution is one of the most serious environmental threats, with particulate matter PM10 and PM2.5 representing its most harmful components, significantly affecting public health. These particles are primarily generated by transport, industry, residential heating, and agriculture, and are associated with [...] Read more.
Air pollution is one of the most serious environmental threats, with particulate matter PM10 and PM2.5 representing its most harmful components, significantly affecting public health. These particles are primarily generated by transport, industry, residential heating, and agriculture, and are associated with increased incidence of respiratory and cardiovascular diseases, asthma attacks, and heart attacks, as well as chronic illnesses and premature mortality. The most vulnerable groups include children, the elderly, and individuals with pre-existing health conditions. This study focuses on the analysis of health risks associated with PM10 and PM2.5 air pollution in the city of Zvolen, which serves as a representative case due to its urban structure, traffic load, and industrial activity. The aim is to assess the current state of air quality, identify the main sources of pollution, and evaluate the health impacts of particulate matter on the local population. The results will be compared with selected Slovak cities—Banská Bystrica and Ružomberok—to understand regional differences in exposure and its health consequences. The results revealed consistently elevated concentrations of particulate matter (PM) across all analyzed cities, frequently exceeding the guideline values recommended by the World Health Organization (WHO), although remaining below the thresholds set by current national legislation. The lowest average concentrations were recorded in the city of Zvolen (PM10: 20 μg/m3; PM2.5: 15 μg/m3). These lower values may be attributed to the location of the reference monitoring station operated by the Slovak Hydrometeorological Institute (SHMÚ), situated on J. Alexy Street in the southern part of the city—south of Zvolen’s primary industrial emitter, Kronospan. Due to predominantly southerly wind patterns, PM particles are transported northward, potentially leading to higher pollution loads in the northern areas of the city, which are currently not being monitored. We analyzed trends in PM10 and PM2.5 concentrations and their relationship with hospitalization data for respiratory diseases. The results indicate a clear correlation between the concentration of suspended particulate matter and the number of hospital admissions due to respiratory illnesses. Our findings thus confirm the significant adverse effects of particulate air pollution on population health and highlight the urgent need for systematic monitoring and effective measures to reduce emissions, particularly in urban areas. Full article
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