Search Results (794)

Background/Objectives: The COVID-19 pandemic had a negative effect on early intervention (EI) delivery to children with developmental delays or disabilities. This study aimed to compare school readiness of children who received, or attempted to receive, EI before, during, and after the COVID-19 pandemic stay-at-home order. Methods: A prospective cohort study was conducted with a single state-funded center that delivers federally mandated EI. School readiness assessments were performed using the Wechsler Preschool and Primary Scale of Intelligence, Fourth Edition (WPPSI-IV). Fisher’s Exact tests, and Kruskal–Wallis ANOVA were performed to compare scores in children who began EI in the three time periods related to the COVID-19 pandemic. Results: A total of 56 children were enrolled in this study, the timing of EI start was available in 43, and 22 were able to complete all assessments. Statistically significant differences were found in WPPSI-IV Verbal Comprehension Index T scores (100 ± 15) across the COVID-19 phases, with the lowest scores arising during the pandemic (76.2 ± 9.3); the highest scores, pre-pandemic (98.0 ± 6.2); and intermediate scores, post-pandemic (81.5 ± 10.1, p < 0.05). Many children exhibited mental health concerns, with 29/56 (52%) being referred to community-based mental health services. Conclusions: In this study, lower scores were reported for markers of school readiness in children who received or attempted to receive EI during the COVID-19 stay-at-home orders compared to those pre- and post-pandemic. High mental health needs were identified, particularly among children with mild–moderate symptoms of autism or those who underwent EI during the COVID-19 stay-at-home orders. Full article

Background: Infective endocarditis (IE) requires 4–6 weeks of intravenous antimicrobial therapy, and timely transition to outpatient parenteral antimicrobial therapy (OPAT) allows clinically stable patients to complete treatment outside the hospital. Because OPAT requires home infusion services or post-acute facility placement that typically depend on coverage, insurance status may strongly influence length of stay (LOS); national data on this association in IE remain limited. Methods: We performed a retrospective cross-sectional analysis of the 2016–2019 National Inpatient Sample (NIS) using ICD-10-CM codes I33 and I38 to identify adult IE hospitalizations. Patients were classified as insured (Medicare, Medicaid, or private insurance) or uninsured (self-pay or no charge). Outcomes included mean and prolonged LOS (>14 and >28 days), in-hospital mortality, discharge against medical advice (AMA), and hospitalization costs. Comparisons used chi-square and Student’s t-tests with appropriate NIS survey weighting. Multivariable Gamma regression (LOS, cost) and logistic regression (binary outcomes) were performed, adjusting for age, sex, race/ethnicity, income quartile, injection drug use (IDU), Elixhauser Comorbidity Index, and hospital characteristics, with an insurance × IDU interaction term. Results: Of 87,211 weighted IE hospitalizations, 81,667 (93.6%) were insured and 5544 (6.4%) were uninsured. Uninsured patients were younger (mean age 40.1 vs. 59.4 years) with lower comorbidity burden but higher injection drug use (IDU) prevalence (38.7% vs. 15.5%). Mean LOS was longer among the uninsured (15.5 vs. 12.4 days, p < 0.001); LOS > 14 days occurred in 35.8% vs. 26.6%, and LOS > 28 days in 18.5% vs. 9.2% (both p < 0.001). AMA discharge was four-fold higher among the uninsured (22.2% vs. 5.5%, p < 0.001), while unadjusted in-hospital mortality was similar (9.0% vs. 9.4%, p = 0.32). LOS and AMA disparities persisted in both IDU and non-IDU subgroups, with a six-fold AMA disparity among non-IDU patients (15.2% vs. 2.5%). Based on multivariable analysis, uninsured status remained independently associated with prolonged LOS > 28 days (adjusted odds ratio [aOR] 1.46, 95% CI 1.30–1.65), AMA discharge (aOR 3.51, 95% CI 3.10–3.97), and—after accounting for age and comorbidity differences—higher in-hospital mortality (aOR 1.25, 95% CI 1.10–1.43). Conclusions: Uninsured adults hospitalized with IE experienced longer stays, markedly higher AMA rates, and—after adjustment for age and comorbidity—higher in-hospital mortality than insured patients. These findings are consistent with nonclinical barriers to discharge—particularly limited OPAT and post-acute care access—and suggest that the younger, less comorbid profile of uninsured patients masks an underlying outcome disparity. The results identify uninsured IE patients as a population that may benefit from alternative care models and policy reforms expanding safe post-acute antimicrobial therapy. Full article

Background/Objectives: Community hospitals can be a valuable and cost-effective resource for elderly people, especially in rural areas. Their aim is to promote self-reliance, prevent unnecessary hospital admissions, and facilitate rapid recovery after acute illness. The widespread adoption of intermediate care facilities helps alleviate hospital overcrowding by preventing clinical deterioration through advanced and continuous nursing care. An intermediate care unit was established in a rural area of central Italy. This study aims to describe the impact of a community hospital on patients’ functional status from admission to discharge, describing a real-life model. Methods: This single-center descriptive study examines trends in the quality of care provided. Data were retrieved from anonymized electronic clinical records. Statistical analyses were performed using descriptive statistics, paired t-tests, and Pearson correlation coefficients. Results: A total of 532 residents (mean age 80.7 ± 13.2 years; 61% female) were admitted to the community hospital between January 2022 and September 2025. The mean length of stay was 15.2 ± 7.6 days, with a mean improvement in Modified Barthel Index score of 5.24 ± 7.95 (p < 0.05). Most patients (81.8%) were discharged home, while 6.0% required hospitalization. No readmissions were recorded in 2025. Clinical risk events occurred only in 1.2% of the total. Nursing specialization increased during the study period, correlating with improved patient outcomes (R = 0.88). Conclusions: This descriptive cross-sectional study in a rural nurse-led intermediate care unit found relatively short lengths of stay, high rates of home discharges and modest, but statistically significant, improvements in functional autonomy. Full article

Shelter organisations take responsibility for the care, assessment and homing of large numbers of domestic cats from diverse backgrounds. However, not all cats that come under shelter care are suited to close human-cohabitation or to certain types of human-domestic lifestyles. Shelter stakeholders may undertake decision-making processes to determine how each cat should be managed and where they should go next. These processes may lead to different cat welfare experiences and long-term outcomes depending on how they occur, yet little is known about current approaches. The aim of this study was to characterise current approaches to cat and adopter assessments, behaviour management and homing decisions across the British Isles shelter sector, considering reported practices against sector minimum standards where applicable. A total of 393 quantitative and qualitative responses from employees and volunteers were received. Responses indicated that overall, stakeholders were consistently undertaking cat and prospective adopter assessments, with subsequent information used to support cat management, decision-making and homing. However, the degree of standardisation and objectivity associated with these processes was unclear, with considerable variation in approaches, including certain practices potentially associated with poor cat welfare outcomes identified. Examples include exposure to stressful handling and behavioural interventions and assessment ‘tests’, prolonged stays for harder-to-home cats and potentially suboptimal homing decisions for cats not suited to domestic ‘pet’ lifestyles. Identified opportunities to support welfare-friendly processes at the individual level include more consistent use of cats’ within-shelter behavioural presentations as grounds for ‘pet’-suitability assessments, and careful and consistent application of cat-labelling and terminology. It is also recommended that care is taken to ensure methods of cat assessments, behavioural interventions and homing decisions are pragmatic and optimised to positive cat welfare outcomes. Full article

Background: Acute drug poisoning is one of the leading causes of admission to pediatric emergency departments and represents a significant public health concern because of its potential severity and associated morbidity and mortality. This study aimed to describe the clinical, epidemiological, and severity characteristics of pediatric patients with acute drug poisoning treated at a tertiary care hospital in western Mexico. Methods: A retrospective, observational, descriptive study was conducted in the pediatric emergency department of Nuevo Hospital Civil de Guadalajara “Dr. Juan I. Menchaca” from January 2016 to December 2024. Results: The mean age of the patients was 77.1 months, with a predominance of females (61.9%). Most poisoning events (97.1%) occurred in the home. Accidental poisoning was the most frequent mechanism (54.5%), followed by suicide attempts (24.4%) and drug overdoses (17.6%). Regarding medical care, 50% of patients arrived at the emergency department within the first four hours after exposure, and 55.1% had a hospital stay of less than 12 h. The most involved drug groups were anxiolytics, mainly benzodiazepines (21.6%), followed by polypharmacy (17.6%) and antiemetic use (13.6%). The most frequent toxidrome was hypnotic–sedative syndrome (42.6% of cases). Multivariate analysis showed that exposure to anticonvulsants was significantly associated with a longer hospital stay (odds ratio [OR] = 7.31, p = 0.003). Most cases were classified as mild according to the Poisoning Severity Score, and no deaths were reported. Conclusions: Although pediatric drug poisoning generally has a favorable prognosis, it remains a significant public health issue. These findings highlight the need for targeted preventive strategies, including caregiver education, safe medication storage at home, and increased awareness and training programs for both families and healthcare professionals. Full article

Meeting the physiological and psychological needs of shelter cats through appropriate care is critical to reducing stress and disease risk, as well as enabling positive homing outcomes. Shelter organisations across the British Isles provide care for many cats; however, little is known about the types of housing and husbandry approaches applied. This study, therefore, aimed to quantify current approaches to cat housing, husbandry, and general care practices, in addition to providing information relevant to local site capacity, considering reported practices against sector minimum standards where applicable. Nine hundred and sixty-one shelter organisations and/or sites caring for cats were identified and invited to complete an online survey including predominantly multiple-choice questions. A total of 393 unique responses were collected from employees and volunteers, and quantitative data were summarised descriptively. In most cases, the results provided evidence of majority alignment with sector standards, although substantial variations in reported practices were also consistently captured. While most responses described approaches supportive of meeting cats’ basic physiological needs (e.g., access to veterinary care and basic resources), psychological needs were addressed less consistently (e.g., general housing and husbandry approaches), potentially leading to poor welfare outcomes. Identified opportunities to better meet cats’ needs include more cat-friendly, low-stress approaches to pen cleaning and cat handling; greater and more consistent provisioning of within-pen resources; and improved approaches to multi-cat housing and associated decision-making. Additional opportunities to enhance both cat and human wellbeing include more structured intake and assessment processes and capacity management to support optimal cat-to-staff ratios, staff working hours, cat lengths of stay and more consistent access to isolation and emergency intake facilities. Full article

Background/Objectives: Frailty has emerged as a relevant marker of biological vulnerability in patients undergoing complex orthopedic procedures, yet its specific prognostic value in revision total hip and knee arthroplasty remains incompletely synthesized. This systematic review evaluated whether validated preoperative frailty assessment tools are associated with adverse postoperative outcomes after revision total joint arthroplasty and whether available studies allow comparison of prediction performance across instruments. Methods: A systematic search of PubMed/MEDLINE, Embase, the Cochrane Library, Web of Science, Scopus, citation lists, and selected gray-literature sources was performed from inception through January 2026. Gray-literature records and conference abstracts were used only for citation tracking; the synthesis included only full-length peer-reviewed original research articles involving adult patients undergoing revision total hip arthroplasty, revision total knee arthroplasty, or both, with quantitative outcomes according to a validated frailty measure. Because of heterogeneity in frailty tools, outcome definitions, revision indications, and adjustment strategies, findings were synthesized narratively and certainty was assessed by outcome domain. Results: Eleven full-length studies were included, with cohorts ranging from 117 patients to 576,920 admissions, and most were retrospective database analyses. Higher frailty burden was consistently associated with worse short-term outcomes, including complications, prolonged hospital stay, readmission, non-home discharge, resource use, and mortality-related risk stratification. Representative findings included 30-day readmission of 23.8% versus 9.9%, surgical complications of 28.6% versus 7.8%, and odds ratios of up to 10.79 for complications across escalating frailty strata. Prediction studies suggested stronger discrimination for revision-specific or broader models, such as CARDE-B, RAI-rev, and machine-learning approaches, than for simpler generic frailty indices. Conclusions: Frailty is a consistent preoperative marker of elevated short-term perioperative risk after revision arthroplasty. The available evidence supports incorporating frailty assessment into preoperative risk stratification and counseling, but it remains insufficient to establish one universally preferred tool or to prove that frailty screening alone improves outcomes without targeted intervention. Full article

Objectives: To present novel strategies in the diagnosis and management of spondylodiscitis in a patient with tetraplegia. Case Presentation: A 44-year-old man presented with increased spasms despite having a SynchroMed II Medtronic for intrathecal infusion of baclofen. The C-reactive protein level was raised. Infection was suspected, but there were no localising signs. Positron Emission Tomography (PET) was performed to identify the focus of infection. PET showed an increased Fluorodeoxyglucose uptake in the L-5 vertebral body and the associated ill-defined soft tissue anteriorly. There was significant erosion and destruction of the S-1 vertebra. Magnetic Resonance Imaging of the lumbo-sacral spine revealed destruction and collapse of the S-1 vertebral body and a 6 cm × 2 cm anterior paravertebral abscess collection. This patient was managed in his home. Intravenous administration of 1 g of Ertapenem daily was provided by community nurses for eight weeks. Blood tests were performed in the community setting, and the patient was monitored by spinal unit doctors. Results: Follow-up CT revealed abnormal soft tissue, expanding and replacing the S-1 vertebral body, with appearances in keeping with an infective process. Using CT guidance and the Madison bone biopsy kit, multiple cores were obtained from the left sacral bone. Four of the five specimens showed no growth after extended incubation. Propionibacterium acnes were isolated after 10 days of incubation from the tissue from the sacral bone biopsy only. A shared decision was made towards active surveillance. Follow-up CT of the abdomen showed a stable appearance of the lumbar and sacral spine. Conclusions: A complex case of spondylodiscitis can be diagnosed and managed while the patient stays mainly in their home, avoiding prolonged admission to the spinal unit, in alignment with the “hospital to community” aspect of the National Health Service’s 10-year Health Plan for England. A diagnostic pathway with PET-CT as the first approach proved useful when the site of infection was unclear. Active surveillance obviated the need for extended periods of antibiotic therapy, which could have led to complications such as antibiotic-induced toxicity and microbial resistance to antibiotics. Full article

Background: Patients with spinal cord injury (SCI) typically have longer lengths of stay (LOS) compared to other rehabilitation patients and show variable therapeutic responses. Identifying reliable predictors of functional outcomes is essential. This study aimed to find prognostic factors to detect patients with high/low functional response, prolonged LOS, and those discharged home. Methods: We retrospectively reviewed charts of SCI patients admitted to our center since 1997, recording neurological status (International Standards for Neurological Classification of SCI), Spinal Cord Independence Measure (SCIM), and Walking Index for SCI (WISCI). Rehabilitation results were measured by treatment effectiveness, reflecting the proportion of potential improvement achieved. Patients with SCIM and WISCI effectiveness above the mean plus one standard deviation (SD) were considered outliers, as were those with LOS exceeding the mean plus one SD. Forward stepwise logistic regression identified variables linked to high effectiveness, LOS, and discharge destination. Results: A total of 1059 patients were included (739 males, mean age 50.8 ± 18; 587 with non-traumatic etiology). There were 132 LOS outliers, 163 high SCIM responders, and 144 high WISCI responders; 913 were discharged home. Regression analysis found that year of admission, older age, and complications at admission and during rehabilitation were independently associated with reduced likelihood of high SCIM response; complications at admission and during rehabilitation were associated with reduced likelihood of high WISCI response; year of admission, older age, longer lesion-to-admission time, and complications during rehabilitation predicted prolonged LOS; and more recent year of admission, traumatic etiology, and lower discharge SCIM were associated with nursing home placement. Conclusions: Our data provide a basis for further research into the problem of SCI prognosis. Subgroups of subjects with poor or excellent rehabilitation prognosis could be recognized at the beginning of treatment based on clinical factors. Full article

Background: Burn injuries remain a major health problem in low- and middle-income countries. Contemporary data from Jordan are scarce, and the last report from Jordan University Hospital (JUH) was published more than four decades ago. This study describes the epidemiology, characteristics, management, and outcomes of burn admissions to JUH during 2016–2020 and compares them with historical and regional data. Methods: We conducted a retrospective cohort study of all consecutive patients admitted to the JUH burn unit with acute burn injury between 1 January 2016 and 31 December 2020. Demographic and clinical variables were abstracted from electronic and paper records using a standardised case-report form. Descriptive statistics summarised injury patterns, while bivariate tests and multivariable linear regression were used to identify factors associated with hospital length of stay (LOS). Results: A total of 575 patients were included (50.3% male; median age 19 years). Children constituted 43.5% of admissions. Median TBSA was 7%, and partial-thickness burns predominated (73.9%). Scalds were the leading aetiology (60.7%), followed by flame burns (19.5%). Most injuries occurred at home (92.5%). The median LOS was 6 days, and 2.1% of patients died. Burn degree, aetiology, TBSA, surgical grafting, and adverse clinical events were independently associated with longer LOS, whereas escharectomy shortened hospitalisation. Conclusions: Domestic scald injuries in children remain the dominant burn pattern in Jordan, although mortality has fallen markedly compared with the 1980 JUH cohort. Prevention efforts should prioritise household safety and child supervision, while continued investment in specialised burn care is likely to further improve outcomes. Full article

Background/Objectives: Patients awaiting total hip arthroplasty (THA) may have a preoperative period for home-based exercise. However, the benefit of prehabilitation may depend on programme completion. This study assessed the association between compliance with home-based prehabilitation and postoperative course after THA, particularly hospital stay and self-assessed health status at discharge, and explored associations between compliance and changes in clinical and functional outcomes. Methods: In this prospective single-centre observational cohort pilot study, 40 adults scheduled for elective THA were included in a planned 60-day home-based prehabilitation programme as standard preoperative care. Assessments were performed before prehabilitation, preoperatively, and at discharge. Compliance was recorded using a daily checklist and expressed as a compliance index. Associations were analysed using non-parametric tests and Spearman correlation. Results: Median compliance index was 32.41%. Higher compliance was observed in participants reporting improvement or marked improvement at discharge than in those reporting slight improvement or no improvement (p = 0.0076). Compliance was inversely correlated with postoperative length of stay, median 6 days (rho = −0.593, p < 0.001). Compliance was lower in participants who reported pain during exercise (p = 0.0127). No significant associations were found between compliance and postoperative symptoms or changes in hip muscle strength, mechanical muscle properties, pain intensity, or functional test performance between baseline and preoperative assessments. Conclusions: Greater compliance with home-based prehabilitation was associated with shorter postoperative hospitalization and more favorable self-assessed health status at discharge. These findings support strategies to improve programme completion and minimize exercise-related pain. Full article

Depression represents one of the most prevalent mental health challenges globally, affecting individuals across diverse populations and settings. Based on the neurogenesis-informed hypothesis that stair use may likely elevate brain-derived neurotrophic factor (BDNF) in humans that in turn may have an antidepressant effect, this study takes residential buildings as a controlled environment to test whether there is a difference in depression symptoms based on single- or multi-storey housing. This study examined associations between staying at home and depression symptoms using the Public Health Questionnaire-8 (PHQ-8) data from 128 adults in England who spend most of their time at home. Residents in single-storey flats in apartment buildings had significantly higher overall depression scores than multi-storey house residents. Among the PHQ-8 items, only Item 8, psychomotor agitation/retardation (moving or speaking too slowly, or restlessly moving around more than usual), approached but did not reach statistical significance after Bonferroni correction (p = 0.056). After adjusting for gender, age, number of residents, activity level, and income, apartment living (vs. multi-storey houses) (β = −0.362, p < 0.001) and loneliness (β = 0.221, p = 0.016) were significant independent predictors of psychomotor agitation/retardation. Future research is needed to explore this relationship using a larger sample size and to explore whether the use of stairs explains this potential relationship through a change in BDNF. Full article

During the winter, school-age children spend much of their time in two indoor environments, homes and classrooms, where ventilation is often restricted to conserve heat, favoring the accumulation of carbon dioxide (CO₂). This study evaluated CO₂ exposure in both environments in Santiago de Chile to characterize real conditions and their daily combinations. Continuous CO₂ monitoring was conducted using sensors in four dwellings with school-age children and four classrooms from different schools during August 2024. Hourly profiles, time over the operating threshold of 1250 ppm, and equivalent hours of exposure, standardized to a daily reference time, were analyzed. In classrooms, levels above the threshold were observed episodically. They were more concentrated during school hours, with marked differences between establishments, ranging from recurrent exposure to high levels to no exposure above the established level. In the bedrooms, the increases were concentrated during the night and early morning hours, consistent with reduced effective ventilation during prolonged stays. Overall, the bedroom-classroom combined exposure showed high variability across cases; together, it allows identifying priority scenarios and the orientation of winter ventilation strategies without neglecting thermal comfort. These results support the incorporation of winter ventilation operational criteria into schools and homes as input for implementing indoor environmental quality policies and standards in urban contexts. Full article

Background and Objectives: Collared, triple-tapered femoral stems have gained increasing popularity in primary total hip arthroplasty (THA) due to their stable metaphyseal fixation and ability to restore native hip biomechanics. This study evaluated the short-term clinical and functional outcomes of a novel collared triple-tapered femoral stem design in primary THA. Materials and Methods: This was a retrospective review of all patients who underwent primary, elective THA using a collared, triple-tapered femoral system at a single, urban, high-volume, academic hospital between September 2024 and February 2025. All procedures were performed by fellowship-trained arthroplasty surgeons. A total of 101 patients (102 hips) with a median follow-up of 1.1 years (range, 1.0 to 1.4 years) were included. Results: Most procedures were performed for primary osteoarthritis (96%). Mean operative time, from skin incision to skin closure, was 93 min, and most femoral stems implanted had a high offset (89%). Most patients were discharged home (96%), with a mean length of stay of 27 h. Within 90 days, three patients were readmitted for surgery-related reasons: one for superficial wound dehiscence, and two for periprosthetic joint infection (PJI). One PJI was treated with irrigation and debridement, antibiotics, and implant retention (DAIR) two months after primary THA. The other required a DAIR three weeks after primary THA, followed by a single-stage revision one week later. No dislocations, periprosthetic fractures, mechanical failures, or aseptic revisions of the femoral stem occurred. All stems were well-fixed at the latest follow-up, with no aseptic loosening observed. Mean Hip disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS, JR) improvement was 15.0 points at six weeks, 25.2 points at three months, and 45.3 points at one year. Conclusions: Our results support encouraging early outcomes with no femoral aseptic complications observed using this novel collared, triple-tapered femoral system. A longer follow-up period is needed to assess mid- and long-term durability. Full article

Introduction: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) volumes continue to rise, yet postoperative functional recovery and physical therapy (PT) utilization remain highly variable. Frailty and sarcopenia capture biological vulnerability beyond chronological age and may better explain heterogeneity in rehabilitation needs and recovery trajectories. Methods: We conducted a qualitative narrative review guided by SANRA recommendations. PubMed, Scopus, Web of Science, CINAHL, and Google Scholar were searched for English-language studies (January 2000–December 2025) involving adults undergoing THA/TKA that assessed preoperative frailty and/or sarcopenia and reported postoperative functional or rehabilitation-related outcomes. Data were extracted and synthesized thematically without quantitative pooling. Results: Thirty-four studies met inclusion criteria. Despite heterogeneous definitions and measures, both frailty and sarcopenia were consistently associated with slower early mobility, poorer functional recovery, longer hospital stays, and higher rates of non-home discharge. Frailty showed stronger links to post-acute care use and healthcare costs, whereas sarcopenia was more closely tied to impaired early function, delayed ambulation, and greater reliance on assistive devices. Frailty may improve after arthroplasty in some patients, while sarcopenia often represents a more persistent, muscle-specific limitation. Direct reporting of PT dose was uncommon, with only a minority of included studies explicitly reporting physical therapy frequency, duration, or intensity, limiting the ability to assess dose–response relationships. Conclusions: Preoperative frailty and sarcopenia are clinically meaningful predictors of functional recovery and rehabilitation utilization after THA/TKA and support vulnerability-informed discharge planning and stratified rehabilitation pathways. Future prospective studies should standardize vulnerability assessment and directly quantify PT dose, setting, and patient-centered outcomes to inform and test vulnerability-guided rehabilitation strategies, including prehabilitation. Full article