Search Results (1,062)

Background: Moral harassment (mobbing) in healthcare, particularly among nurses, remains a persistent issue with detrimental effects on mental health, resilience, and quality of life. Aim: We examine the relationship between the resilience of nurses working in Emergency Departments (EDs) and how these factors influence experiences of workplace mobbing. Methods: This cross-sectional study included 90 nurses from four public hospitals in Greece’s 5th Health District. Data were collected between October 2023 and March 2024 using the WHOQOL-BREF, Workplace Psychologically Violent Behaviors (WPVB) scale and the Connor–Davidson Resilience Scale (CD-RISC). The sample consisted primarily of full-time nurses (84.3% female; mean age = 43.1 years), with 21.1% reporting chronic conditions. Most participants were married (80.0%) and had children (74.4%), typically two (56.1%). Statistical analyses—conducted using SPSS version 27.0—included descriptive statistics, Pearson and Spearman correlations, multiple linear regression, and mediation analysis, with significance set at p < 0.05. Results: Resilience was moderate (mean = 66.38%; Cronbach’s α = 0.93) and positively correlated with all WHOQOL-BREF domains—physical, psychological, social, and environmental (r = 0.30–0.40)—but not with the overall WHOQOL-BREF. The mean overall WHOQOL-BREF score was 68.4%, with the lowest scores observed in the environmental domain (mean = 53.76%). Workplace mobbing levels were low to moderate (mean WPVB score = 17.87), with subscale reliabilities ranging from α = 0.78 to 0.95. Mobbing was negatively associated with social relationships and the environmental WHOQOL-BREF (ρ = –0.23 to –0.33). Regression analysis showed that cohabitation and higher resilience significantly predicted better WHOQOL-BREF outcomes, whereas mobbing was not a significant predictor. Mediation analysis (bootstrap N = 5000) indicated no significant indirect effect of resilience in the relationship between mobbing and WHOQOL-BREF. Conclusions: Resilience was identified as a key protective factor for nurses’ quality of life in emergency care settings. Although workplace mobbing was present at low-to-moderate levels, it was negatively associated with specific WHOQOL-BREF domains. Enhancing mental resilience among nurses may serve as a valuable strategy to mitigate the psychological effects of moral harassment in healthcare environments. Full article

Background/Objectives: Penetrating intraocular foreign bodies (IOFBs) are ocular emergencies, often leading to preventable vision loss. This case report highlights a unique presentation of a work-related penetrating IOFB that mimicked a golden hypopyon. Methods: A 35-year-old male presented to the emergency department with sudden-onset pain and vision loss in the left eye while he was cutting a tree with metallic scissors. He had a visual acuity of 20/30 in the right eye and counting fingers in the left eye. A dilated slit-lamp examination and CT scan confirmed the presence of a 6–8 mm metallic IOFB in the anterior chamber, with no involvement of the lens or the posterior segment. Surgical removal was performed. Results: The metallic IOFB was removed surgically with IOFB forceps using a single paracentesis. The patient reported resolving pain and regained baseline visual acuity of 20/20 postoperatively, which remained stable at one-month follow-up. Conclusions: This case illustrates the successful surgical management of a penetrating metallic IOFB with a unique presentation mimicking a hypopyon. Emphasis on unique presentations of IOFBs can aid in timely management, ultimately reducing the risk of complications. Full article

Furunculosis caused by Aeromonas salmonicida poses a significant challenge to the sustainable production of maraena whitefish (Coregonus maraena). This case report outlines a multi-year disease management strategy at a European whitefish facility with two production departments, each specialising in different life-cycle stages. Recurrent outbreaks of A. salmonicida necessitated the development of effective vaccination protocols. Herd-specific immersion vaccines failed to confer protection, while injectable formulations with plant-based adjuvants caused severe adverse reactions and mortality rates exceeding 30%. In contrast, the bivalent vaccine Alpha Ject 3000, containing inactivated A. salmonicida and Vibrio anguillarum with a mineral oil adjuvant, yielded high tolerability and durable protection in over one million whitefish. Post-vaccination mortality remained low (3.3%), aligning with industry benchmarks, and furunculosis-related losses were fully prevented in both departments. Transcriptomic profiling of immune-relevant tissues revealed distinct gene expression signatures depending on vaccine type and time post-vaccination. Both the herd-specific vaccine and Alpha Ject 3000 induced the expression of immunoglobulin and inflammatory markers in the spleen, contrasted by reduced immunoglobulin transcript levels in the gills and head kidney together with the downregulated expression of B-cell markers. These results demonstrate that an optimised injectable vaccination strategy can significantly improve health outcomes and disease resilience in maraena whitefish aquaculture. Full article

Background: Midfacial fractures are common outcomes of facial trauma. While younger individuals typically sustain these injuries through high-energy events like assaults and traffic or sports accidents, elderly patients increasingly present with fractures from low-energy mechanisms, primarily falls. Purpose: The aim of this study was to analyze age- and gender-specific patterns in midfacial fractures over a 10-year period, with emphasis on elderly individuals and low-energy trauma. Methods: A retrospective review was performed of proven midfacial fractures between 2013 and 2022 at the Department of Oral and Maxillofacial Surgery (University of Pécs, Hungary). The patients were stratified by age (<65 vs. ≥65 years) and gender. The variables included the injury mechanism, fracture localization, the dental status, hospitalization, and the presence of associated injuries. Bivariate analyses were performed, and the significance level was set to p < 0.05. Results: A total of 957 radiologically confirmed midfacial fracture cases were evaluated, of whom 344 (35.9%) were ≥65 years old. In the elderly group, females had a 19-fold higher risk for midfacial trauma than younger females (OR: 19.1, 95%CI: 9.30–39.21). In the older group, a fall was significantly the most frequent injury mechanism (OR: 14.5; 95%CI: 9.9–21.3), responsible for 89.5% of the cases, while hospitalization (OR: 0.36; 95%CI: 0.23–0.56) was less characteristic. Most of the fractures occurred in the zygomatic bone, in the zygomaticomaxillary complex, or in the anterior wall of the maxilla. Associated injuries in the elderly group included mostly lower limb injuries—particularly pertrochanteric femoral fractures in females—and upper limb injuries, with a slight male dominance. Conclusions: Low-energy falls are the primary cause of midfacial fractures in elderly patients, particularly in women. Tailored prevention and management strategies are essential for improving the outcomes in this growing demographic group. Full article

Background: Intravenous vancomycin remains a key agent in the treatment of complex orthopedic infections, particularly those involving methicillin-resistant Staphylococcus aureus (MRSA). However, its use is associated with significant risks, most notably nephrotoxicity. Despite guideline recommendations, standardized dosing and monitoring protocols are often absent in orthopedic settings, leading to inconsistent therapeutic drug exposure and preventable adverse events. This study evaluated the clinical impact of implementing a structured standard operating procedure (SOP) for intravenous vancomycin therapy in orthopedic inpatients. Methods: We conducted a single-center, pre-post cohort study at a university orthopedic department. The intervention consisted of a standard operating procedure (SOP) for intravenous vancomycin therapy, which mandated weight-based loading doses, renal function-adjusted maintenance dosing, trough level monitoring, and defined dose adjustments. Patients treated before SOP implementation (n = 58) formed the control group; those treated under the SOP (n = 56) were prospectively included. The primary outcome was the incidence of vancomycin-associated acute kidney injury (VA-AKI) defined by KDIGO Stage 1 criteria. Secondary outcomes included therapeutic trough level attainment and infusion-related or ototoxic adverse events. Results: All patients in the post-SOP group received a loading dose (100% vs. 31% pre-SOP, p < 0.001). The range of measured vancomycin trough levels narrowed substantially after SOP implementation (7.1–36.2 mg/L vs. 4.0–80.0 mg/L). The proportion of patients reaching therapeutic trough levels increased, although this was not statistically significant. Most notably, VA-AKI occurred in 17.2% of patients in the control group, but in none of the patients after SOP implementation (0%, p = 0.0013). No cases of ototoxicity were observed in either group. Infusion-related reactions decreased after the implementation of the SOP, though not significantly. Conclusions: The introduction of a structured vancomycin protocol significantly reduced adverse drug events and improved dosing control in orthopedic inpatients. Incorporating such protocols into routine practice represents a feasible and effective strategy to strengthen antibiotic stewardship and clinical quality in surgical disciplines. Full article

Background/Objective: In-hospital cardiac arrest has high incidence and poor survival rates, posing a significant healthcare challenge. It is important to intervene in the hours before the cardiac arrest to prevent poor outcomes. The modified early warning score (MEWS) is a validated tool for identifying a deteriorating patient. It is an aggregate of vital signs and level of consciousness. We retrospectively evaluated MEWS for trends that might predict patient outcomes. Methods: We performed a single-center, one-year, retrospective study. A comprehensive review was conducted for patients aged 18 years and above who experienced a cardiac arrest. Cases that occurred within an intensive care unit, emergency department, during a procedure, or outside the hospital were excluded. A total of 87 cases met our predefined inclusion criteria. We collected data at 12 h, 6 h and 1 h time periods prior to the cardiac arrest. A trend analysis using a linear model with analysis of variance with Bonferroni correction was performed. Results: Out of 87 patients included in the study, 59 (67.8%) had an immediate return of spontaneous circulation (ROSC). Among those who achieved ROSC, 41 (69.5%) died during the admission. Only 20.7% of the patients that sustained a cardiac arrest survived to discharge. A significant increase in the average MEWS was noted from the 12 h period (MEWS = 3.95 ± 2.4) to the 1 h period (MEWS = 5.98 ± 3.5) (p ≤ 0.001) and the 6 h period (4.65 ± 2.6) to the 1 h period (5.98 ± 3.5) (p = 0.023) prior to cardiac arrest. Conclusions: An increase in the MEWS may be a valuable tool in identifying at-risk patients and provides an opportunity to intervene at least 6 h before a cardiac arrest event. Further research is needed to validate the results of our study. Full article

Introduction: Falls are the leading cause of Emergency Department (ED) presentations among residents from residential aged care facilities (RACFs). While most current studies focus on post-fall evaluations and fall prevention, limited research has been conducted on decision-making in post-fall management. Objective: To develop and internally validate a model that can predict the likelihood of RACF residents being discharged from the ED after being presented for a fall. Methods: The study sample was obtained from a previous study conducted in Shepparton, Victoria, Australia. Consecutive samples were selected from January 2023 to November 2023. Participants aged 65 and over were included in this study. Results: A total of 261 fall presentations were initially identified. One patient with Australasian Triage Scale category 1 was excluded to avoid overfitting, leaving 260 presentations for analysis. Two logistic regression models were developed using prehospital and ED variables. The ED predictor model variables included duration of ED stay, injury severity, and the presence of an advance care directive (ACD). It demonstrated excellent discrimination (AUROC = 0.83; 95% CI: 0.79–0.89) compared to the prehospital model (AUROC = 0.77, 95% CI: 0.72–0.83). A simplified four-variable Discharge Eligibility after Fall in Elderly Residents (DEFER) score was derived from the prehospital model. The score achieved an AUROC of 0.76 (95% CI: 0.71–0.82). At a cut-off score of ≥5, the DEFER score exhibited a sensitivity of 79.7%, a specificity of 60.3%, a diagnostic odds ratio of 5.96, and a positive predictive value of 85.0%. Conclusions: The DEFER score is the first validated discharge prediction model for residents of RACFs who present to the ED after a fall. Importantly, the DEFER score advances personalised medicine in emergency care by integrating patient-specific factors, such as ACDs, to guide individualised discharge decisions for post-fall residents from RACFs. Full article

Background: Nemaline myopathy is a rare congenital neuromuscular disease associated with progressive weakness and frequent respiratory complications. In emergency situations, families often serve as the first and only responders. The aim of this study is to explore how parents in Spain care for children with nemaline myopathy during emergency situations, focusing on the clinical responses performed at home and the organizational challenges encountered when interacting with healthcare systems. Methods: A qualitative phenomenological study was conducted with 17 parents from 10 families belonging to the Asociación Yo Nemalínica. Semi-structured interviews were performed via video calls, transcribed verbatim, and analyzed using Giorgi’s descriptive method and ATLAS.ti software (version 24). Methodological rigor was ensured through triangulation, reflexivity, and member validation. Results: Four themes were identified. First, families were described as acting under extreme pressure and in isolation during acute home emergencies, often providing cardiopulmonary resuscitation and respiratory support without professional backup. Second, families managed ambiguous signs of deterioration using clinical judgment and home monitoring tools, often preventing fatal outcomes. Third, parents frequently assumed guiding roles in emergency departments due to a lack of clinician familiarity with the disease, leading to delays or errors. Finally, the transition to the Pediatric Intensive Care Unit was marked by emotional distress and rapid decision-making, with families often participating in critical choices about invasive procedures. These findings underscore the complex, multidisciplinary nature of caregiving. Conclusions: Parents play an active clinical role during emergencies and episodes of deterioration. Their lived experience should be formally integrated into emergency protocols and the continuity of care strategies to improve safety and outcomes. Full article

Background/Objectives: Erysipelas is an acute bacterial skin infection, particularly affecting the lower limbs, with a tendency to recur. Despite its clinical importance, data on demographic and epidemiological risk factors, as well as factors influencing hospitalization, remain limited. This study aimed to analyze the epidemiological and clinical characteristics of patients hospitalized with primary and recurrent erysipelas, focusing on risk factors contributing to disease onset, recurrence, and prolonged hospitalization. Methods: A retrospective single-center analysis was conducted on 239 patients hospitalized for erysipelas at the Department of Dermatology, Pediatric Dermatology, and Oncology at the Medical University of Lodz. Data collected included demographics, lesion location, laboratory markers, comorbidities, and hospitalization outcomes. Statistical analyses were performed to assess associations between risk factors, disease recurrence, and hospitalization duration. Results: The majority of erysipelas cases (85.4%) involved the lower limbs, with a higher prevalence in men. Upper extremities were mostly affected in women, especially those who had undergone breast cancer surgery. Recurrent erysipelas accounted for 75.7% of cases. Most patients (89.1%) had at least one comorbidity, with hypertension, diabetes type 2 (DM2), and obesity being the most common. Higher white blood cell (WBC) count, obesity, atrial fibrillation (AF), and the need for enoxaparin administration were independently associated with prolonged hospitalization. Dyslipidemia was significantly associated with erysipelas recurrence (p < 0.05). Conclusions: Both primary and recurrent erysipelas are associated with specific risk factors. Recurrent erysipelas may be linked to components of metabolic syndrome, particularly obesity and dyslipidemia, which emerged as a significant risk factor in this study. Hospitalization length may be prolonged by inflammation markers (WBC and CRP) and comorbidities such as AF, obesity, or the need for enoxaparin in patients with elevated thrombosis risk. Further multicenter studies with larger cohorts are needed to assess the impact of demographics, biomarkers, metabolic disorders, and treatment strategies on erysipelas recurrence and outcomes. Awareness of these risk factors is essential for effective prevention, management, and recurrence reduction. Full article

Background: This study examined risk factors for syndrome novel coronavirus 2 virus (SARS-CoV-2) infection and self-reported adherence to infection prevention and control (IPC) measures among healthcare workers (HCWs) at a hospital in Thailand near the Myanmar border. Methods: From March to July 2022, HCWs aged ≥ 18 with COVID-19 exposure at Mae Sot General Hospital completed a questionnaire on IPC adherence, training, and COVID-19 knowledge. Nasopharyngeal samples were collected bi-weekly for SARS-CoV-2 testing. A mobile application was used for real-time monitoring of daily symptoms and exposure risks. Chi-square, Fisher’s exact tests, and log-binomial regression were performed to investigate association. Results: Out of 289 (96.3%) participants, 27 (9.9%) tested positive for SARS-CoV-2, with cough reported by 85.2% of cases. Nurse assistants (NAs) had a higher risk of infection (adjusted relative risk [aRR] 3.87; 95% CI: 0.96–15.6). Working in inpatient departments (aRR 2.37; 95% CI: 1.09–5.15) and COVID-19 wards (aRR 5.97; 95% CI: 1.32–26.9) was also associated with increased risk. While 81.7% reported consistent hand hygiene, 37% indicated inadequate IPC knowledge. Conclusions: HCWs, especially NAs and those in high-risk departments, should receive enhanced IPC training. Real-time digital monitoring tools can enhance data collection and HCW safety and are likely to be useful tools for supporting surveillance and data collection efforts. Full article

Background/Objectives: There is a need for randomized clinical trials with higher quality, especially for older people at high risk of falls, with interventions that consider individual needs, comprehensiveness of care, and connection with primary health care. We designed a randomized controlled trial to examine the effects of a case management intervention combined with a physical exercise protocol on risk factors for falls, falls data, adherence, satisfaction, costs, and implementation in community-dwelling older adults with high risk of falls. Methods: A minimum of 60 community-dwelling older people with high falls risk will participate in the randomized controlled assessor-blinded trial (MAGIC—v. 2). The trial will be conducted in a regional health department of São Paulo state (Brazil), which includes 6 cities. Participants will be randomized to the Intervention Group (case management intervention based on all individual risk factors for falls identified by a multidimensional assessment, over 16 weeks, once a week, by telephone calls). Both groups will perform a physical exercise protocol based on falls prevention for 16 weeks (twice a week) in Health Units. The assessment will be performed at baseline, after 16 weeks of intervention, after 6-month follow-up, and after 12-month follow-up. Primary outcome measures include falls data and potentially modifiable risk factors for falls. Discussion: This study has the potential to facilitate the future implementation of the intervention based on case management with a focus on fall prevention in the health sectors. Trial registration: Brazilian Registry of Clinical Trials (ReBEC). Full article

Primary-level social risk prevention and control is a complex, systemic endeavor that requires close cooperation among various local government departments. Within this context, addressing bureaucratic segmentation and strengthening interdepartmental collaboration are critical issues in primary-level social risk governance. This study uses social network analysis and the exponential random graph model to examine the collaborative network structure and driving mechanisms among government departments engaged in risk prevention, with J City as a network study. The findings reveal that (1) while a collaborative governance framework exists, the network has low overall density, strong localized clustering, and a clear core-periphery structure, indicating the need for improved coordination and more refined collaborative mechanisms; (2) the formation of the risk prevention network is influenced by both endogenous structural factors and exogenous actor attributes. Endogenously, reciprocity and transitivity play significant roles in tie formation; exogenously, departments with similar resource mobilization capacities are more likely to collaborate, while those with strong communication, digital technology, and resource mobilization capabilities are more likely to initiate collaborations, and those with high communication capacity are more likely to accept collaborative offers. This study offers insights into the dynamics and formation mechanisms of departmental collaborative networks in primary-level social risk governance. Full article

Equine influenza is a highly contagious disease caused by the equine influenza virus (EIV). The occurrence of EIV outbreaks in America is associated with low levels of vaccination coverage. In Colombia, no seroprevalence evaluation has been carried out to estimate the distribution of the virus within the country. Our aim was to perform a sero-epidemiological survey of equine influenza infections and to identify associated risk factors in horses from four departments of Colombia. Serological testing was carried out by using an ELISA for the detection of IgG antibodies against the influenza A virus. The evaluation of epidemiological variables, clinical manifestations, and vaccination history was carried out through the application of a data collection instrument. Among the 385 horses analyzed, 27% of the samples tested positive, with a higher prevalence in Study 1 from horses with respiratory symptoms (40.4%) than in Study 2 from horses without clinical signs (16.1%). Only horses housed in stables had higher odds of testing positive. The study also revealed that unvaccinated horses were 68% less likely to test positive than vaccinated horses were. This research highlights a significant gap in vaccination coverage and the presence of antibodies even in asymptomatic horses. Management factors such as activity type and housing should be considered when strategies for EIV prevention are developed. Full article

Background/Objectives: Early diagnosis of stroke is crucial for effective treatment with tissue plasminogen activator (tPA) and endovascular thrombectomy. Emergency medical services (EMSs) screening and the early activation of emergency department (ED) stroke protocols reduce treatment times and improve patient outcomes. This study aims to validate ED stroke protocol activation by EMSs in a large stroke center. Methods: This retrospective cross-sectional study was conducted at Magen David Adom and Shamir Medical Center between 1 January 2019 and 31 December 2019. Data were categorized into patients suspected by EMSs of having a stroke and those not suspected by EMSs but diagnosed as having a stroke in the ED. The primary outcome was the accuracy of EMSs in activating ED stroke protocols. Results: In this study, there were 23,061 patients, of which 11,841 (51.9%) were females. The mean age was 61.4 (SD = 22.72) years old. EMSs suspected 743 (3.22%) patients were having a stroke. In 587 (79%), EMSs activated ED stroke protocols. There were 88 cases where strokes were diagnosed in the ED when EMSs did not suspect a stroke. The overall EMSs negative predictive value (NPV) was 100% while the positive predictive value (PPV) was 20%. Conclusions: While Israeli EMSs over-activate the ED stroke protocol, stroke patients are almost never missed, achieving the goal of prehospital stroke screening. To prevent resource waste, all involved teams should be notified, and the actual activation of the stroke protocol should be carried out by an ED physician upon patient arrival. Communication between all levels regarding stroke protocol should also be increased to decrease the time to treatment. Full article

Accurate short-term precipitation forecasting (nowcasting) based on weather radar data is essential for managing weather-related risks, particularly in applications such as airport operations, urban flood prevention, and public safety during outdoor events. This study proposes a computationally efficient nowcasting method based on a Lagrangian advection scheme, estimating both the translation and rotation of radar-observed precipitation fields without relying on machine learning or resource-intensive computation. The method was tested on a two-year dataset (2022–2023) over Tuscany, using data collected from the Italian Civil Protection Department’s radar network. Forecast performance was evaluated using the Critical Success Index (CSI) and Mean Absolute Error (MAE) across varying spatial domains (1° × 1° to 2° × 2°) and precipitation regimes. The results show that, for high-intensity events (average rate > 1 mm/h), the method achieved CSI scores exceeding 0.5 for lead times up to 2 h. In the case of low-intensity rainfall (average rate < 0.3 mm/h), its forecasting skill dropped after 20–30 min. Forecast accuracy was shown to be highly sensitive to the temporal stability of precipitation intensity. The method performed well under quasi-stationary stratiform conditions, whereas its skill declined during rapidly evolving convective events. The method has low computational requirements, with forecasts generated in under one minute on standard hardware, and it is well suited for real-time application in regional meteorological centres. Overall, the findings highlight the method’s effective balance between simplicity and performance, making it a practical and scalable option for operational nowcasting in settings with limited computational capacity. Its deployment is currently being planned at the LaMMA Consortium, the official meteorological service of Tuscany. Full article