Search Results (1,459)

Background and Objectives: The COVID-19 pandemic placed substantial mental and physical burdens on healthcare workers, particularly nurses. In the post-pandemic period, sustained stress, elevated mental workload and disturbed sleep may continue to affect well-being and job performance. This study aimed to assess perceived stress levels, occupational stress, and sleep quality among Hungarian nurses, while identifying key demographic, occupational, and behavioral predictors. Materials and Methods: A cross-sectional, quantitative study was conducted from April to July 2022 among nurses employed in Hungarian general hospitals (N = 418). Data were collected via an online self-administered questionnaire. Stress and sleep quality were measured using the Perceived Stress Scale (PSS-14), Expanded Nursing Stress Scale (ENSS), and Groningen Sleep Quality Scale (GSQS). Statistical analysis included descriptive statistics, ANOVA, post hoc tests, t-tests, and Pearson’s correlation (p < 0.05). Results: The mean PSS-14 score was 27.82 (SD = 7.82), indicating moderate stress. Sleep quality was poor (mean GSQS = 7.29, SD = 4.28), with significant positive correlation with perceived stress (r = 0.442, p < 0.001). Low income, lower education, and high coffee or alcohol consumption, and multiple night shifts were significantly associated with higher stress and poorer sleep quality. Occupational stress and mental workload, as measured by ENSS, was highest in internal medicine (mean = 122.16, SD = 37.09; p = 0.033). The most burdensome ENSS subscale was “workload” (mean = 2.30, SD = 0.92), with “not enough staff to adequately cover the unit” identified as the most stressful item. Additional cognitive and emotional workload components included dealing with violent patients and a lack of emotional preparedness in supporting families. Conclusions: Post-COVID nurses in Hungary experience moderate stress and impaired sleep. Excessive workload, emotional demands, and shift patterns significantly contribute to psychological and cognitive strain. Institutional and policy-level interventions are needed to reduce occupational stress and promote workforce resilience. Full article

Background: Antimicrobial stewardship programs (ASPs) are essential for promoting the rational use of antibiotics and combating resistance. In South Korea, implementation has recently accelerated, but real-world data on short-term program performance remain limited. This study evaluated the early outcomes of a newly launched ASP at a tertiary hospital. Methods: This retrospective, single-center study analyzed ASP activity from January to April 2025. Interventions included prospective audit and feedback for restricted antibiotics and recommendations for prolonged antibiotic prescriptions (≥14 days). The primary outcome was the monthly rejection rate of restricted antibiotics. Secondary outcomes included days of therapy (DOT) for restricted antibiotics and the acceptance rate of interventions for prolonged prescriptions. Results: The monthly rejection rate of restricted antibiotics remained stable between 3.65% and 4.68%. Although the DOT values did not show statistical significance, they demonstrated a moderate inverse correlation with the rejection rate (Pearson’s r = –0.868, p = 0.132). Among 826 prolonged prescriptions, 513 (62.1%) received ASP intervention. Acceptance of recommendations increased over time, from 67.0% in January to 82.5% in April. Interventions were primarily based on insufficient evidence of infection or inappropriate antibiotic selection. Conclusions: The newly implemented ASP demonstrated feasibility and early impact in improving antibiotic oversight. Despite the short observation period, the findings suggest a positive influence on prescribing practices. Longer-term studies are needed to evaluate sustained clinical outcomes and broader applicability in diverse healthcare settings. Full article

Adoption of the use of robots in the foodservice industry has increased, and research in the quality of service provided by robots is required. Our research objective is to determine interrelationships among service quality, perceived value, restaurant image, satisfaction, and revisit intentions among customers at robotic restaurants. Data collection was conducted, with 342 South Korean restaurant consumers considered suitable to offer accurate responses to the survey questions. An online survey was employed to examine hypothesized relationships. Data analysis used descriptive statistics, confirmatory factor analysis, and structural equation modeling. Three dimensions of service quality (atmosphere quality, food quality, and interaction quality) at robotic restaurants were critical for higher perceived value by diners at robotic restaurants. Perceived value increases robotic restaurant image, customer satisfaction, and customer revisit intention. Additionally, findings reveal that robotic restaurant image is a positive predictor of satisfaction, and that satisfaction is a positive predictor of revisit intention. Robotic restaurants have become pervasive in hospitality service environments. Accordingly, theoretical and empirical findings about multiple dimensions of service quality in this context likely will be of interest to marketing researchers and practitioners for sustainable restaurant business. Full article

Background: Sepsis remains a leading cause of mortality in hospitalized patients. We evaluated characteristics and outcomes of patients identified through a comprehensive hospital-wide sepsis protocol over a 16-year period. Methods: This retrospective cohort study analyzed hospital-wide sepsis protocol activations at a tertiary care hospital in Spain from 2006 to 2022. The protocol required at least two SIRS criteria plus evidence of organ dysfunction in patients over 14 years old. We analyzed demographics, activation criteria, hospital location, mortality predictors using univariate and multivariate analyses, including propensity score modeling, and resource utilization trends. Results: A total of 10,919 patients with 14,546 protocol activations were identified. The median age was 69 years (IQR: 56–78), with 60.9% male patients. Protocol activations occurred in the emergency department (54%), ICU (34.2%), and inpatient wards (11.8%). The most common SIRS criteria were tachycardia (75.6%), tachypnea (50.4%), and fever (48.5%). Prevalent organ dysfunctions included hypotension (53%), hypoxemia (50.1%), oliguria (28.9%), and altered mental status (22%). Overall in-hospital mortality showed a significant linear downward trend from 26.5% in the first year to 13.6% in later years (p < 0.01). Propensity score analysis confirmed independent mortality predictors included hyperlactatemia (aOR 2.21), altered consciousness (aOR 2.09), hypotension (aOR 1.87), and leukopenia (aOR 1.79). ICU admission rate decreased from 58% to 24% over the study period. Conclusions: This 16-year analysis shows that comprehensive hospital-wide sepsis protocols achieve sustained mortality reduction with improved resource utilization efficiency. These findings support implementing comprehensive sepsis protocols as an effective strategy for improving sepsis outcomes. Full article

Background: The COVID-19 pandemic prompted concerns about delays in cancer diagnosis and treatment, particularly for lung cancer (LC). We assessed the impact of the pandemic on lung cancer care, diagnostic efficiency, treatment timelines, and short-term survival in a Spanish tertiary hospital. Methods: We performed a retrospective cohort study including 530 patients diagnosed with primary lung cancer from March 2019 to March 2022. Patients were grouped into three cohorts: pre-pandemic (2019), first pandemic year (2020), and second pandemic year (2021). Key intervals—referral-to-diagnosis and diagnosis-to-treatment—along with survival outcomes were compared across cohorts. Multivariate Cox regression identified independent predictors of mortality. Results: LC diagnoses declined by 19% in 2020, rebounding by 42% in 2021. The proportion of patients receiving the first definitive treatment remained stable (~70%). Diagnostic timeliness improved: the median referral-to-diagnosis interval shortened from 19 to 14 days (p < 0.0001), with >80% of patients diagnosed within 30 days throughout all periods. Molecular testing turnaround increased (median 11 to 15 days, p = 0.0226). The diagnosis-to-treatment interval remained unchanged (median 34–35 days). One-year survival improved from 37% (2019) to 43% (2020–2021), and two-year survival from 22% to 30%. In multivariate analysis, only advanced stage and poor ECOG performance status independently predicted mortality; delays in diagnosis or treatment had no significant impact. Conclusions: Despite pandemic-related disruptions, essential LC care and short-term outcomes were largely maintained in our center. Early stage at diagnosis and favorable performance status outweighed the effect of moderate delays. Health system resilience and streamlined care pathways proved critical for sustaining cancer outcomes during the COVID-19 crisis. These findings offer actionable lessons for the Spanish healthcare system and may help guide national preparedness strategies for future oncologic crises. Full article

Background/Objectives: Previous magnetic resonance imaging (MRI) investigations reported brain alterations in anorexia nervosa restricting type (AN-R); however, the number of existing structural neuroimaging studies in the developmental age is limited. Here, we analyzed the volumetric brain differences between adolescent patients with AN-R and control peers, and possible correlations between brain volumes and clinical features. Methods: The sample comprised 47 adolescent females with AN-R (mean age: 15.0 years, SD = 1.4) who underwent structural MRI within one month of admission to a tertiary care university hospital, and 39 typically developing controls matched for sex and age. The patients were clinically characterized by standardized interviews/questionnaires. Using the voxel-based morphometry (VBM) technique, possible significant volumetric brain differences between the two groups were analyzed. Moreover, correlations between altered brain regions and clinical (i.e., body mass index (BMI) and disease duration) or psychopathological variables were investigated. Results: An overall reduction in gray matter (GM) volume with a concomitant increase in cerebrospinal fluid (CSF) is observed in AN-R patients; these alterations correlate with a lower BMI. The reduction in GM volume affects the frontal and parietal regions involved in the cognitive processes that underlie and sustain the AN-R clinical features. Conclusions: These results add to the current knowledge of the AN-R pathophysiology and pave the way for the development of brain imaging biomarkers for AN in the developmental age. Full article

The hospitality sector plays a crucial role in the tourism industry, undergoing a transformation driven by the intersection of service innovation and environmental practices. Competitiveness in this sector requires adaptation to market demands, with a focus on service innovation and environmental sustainability. This research aims to analyze the relationship between service innovation, environmental practices, and sustainable competitive advantage in Brazilian hospitality establishments. A quantitative and descriptive approach was applied to 300 individuals who stayed in Brazil. Data collection was conducted through an online questionnaire, utilizing the Snowball Sampling technique. The data collection was between 15 February and 20 June 2024. Data analysis was performed using Structural Equation Modeling, which enabled the examination of multiple variables and the verification of hypothetical relationships. The research results validated the hypotheses tested, demonstrating that service innovation and environmental practices have a positive influence on sustainable competitive advantage in hospitality establishments. An important finding in the research refers to the correlation between these constructs, which highlights the importance of integrated strategies that consider innovation and environmental sustainability as key elements for organizational success in the hospitality sector. With its theoretical contribution, this research developed a framework for analyzing the relationships between the constructs. Full article

Prior studies have generally confirmed that Environmental, Social, and Governance (ESG) practices have a positive impact on perceived value and sustainability performance. However, empirical research examining the mediating role of employee-perceived value in the relationship between ESG and sustainability performance from the perspective of internal stakeholders remains limited. To address this gap, this study aims to understand the relationship among ESG, employee-perceived value, and sustainable management in green hotels in southern Taiwan. Using a convenience sampling method, 277 valid questionnaires were collected and analyzed through Structural Equation Modeling (SEM). The results show that ESG practices have significant positive effects on both employee-perceived value and sustainability performance, with perceived value partially mediating the relationship between the two, highlighting the critical role employees play in promoting sustainable management. Based on the empirical findings, it is recommended that companies strengthen internal ESG communication and education to ensure that employees understand ESG goals and outcomes and integrate them into daily work. Employee-centered participation programs, such as green innovation contests and community carbon reduction activities, should be designed to enhance emotional value and organizational identification. Companies should internalize ESG principles into corporate culture and management processes, reinforcing sustainable behaviors through performance appraisals, leadership modeling, and continuous dialogue. Finally, ESG should be positioned as a core strategy aligned with long-term corporate objectives, enhancing employee commitment and creating competitive advantages that attract support from customers and stakeholders. Full article

This article examines the adaptive Sufi praxis of Ken‘ān Rifā‘ī (1867–1950) in early 20th-century Istanbul through the lens of practical theology. Navigating the political, social, and legal transformations of the late Ottoman and early Republican periods, Rifā‘ī sustained Sufi practices not by rigid institutional preservation but through a dynamic integration of spiritual tradition into the rhythms of urban modernity. His lodge, the Ümmü Ken‘ān Dergāh, functioned as a “moral commons”—simultaneously a site of devotional practice, social refuge, and ethical formation. Utilizing the frameworks of Don S. Browning’s fundamental practical theology, Elaine L. Graham’s emphasis on lived praxis, and John Swinton’s theology of qualitative reflection, this study explores how Rifā‘ī recontextualized classical Sufi rituals, ethical teachings, and communal hospitality to meet the needs of a rapidly secularizing and urbanizing society. Particular attention is given to his inclusive pedagogies, non-monetary ethos, integration of women as active participants, and the lodge’s role as a “shelter” amid widespread displacement, war, and social dislocation. By reading Rifā‘ī s practices as forms of contextual theology and lived religious adaptation, this article contributes to broader conversations on the resilience of spiritual communities under conditions of modern transformation, offering insights into how religious traditions may remain both rooted and responsive in times of profound societal change. Full article

Background and Objectives: Interpersonal violence (IPV) has overtaken road traffic collisions as a leading cause of facial fractures, yet regional data from Southern Europe are limited. Materials and Methods: We retrospectively reviewed all adults (≥18 y) treated between 1 January 2011 and 31 December 2022 for radiologically confirmed IPV-related facial fractures. Recorded variables were demographics, AO-CMF (Arbeitsgemeinschaft für Osteosynthesefragen—Craniomaxillofacial) fracture site, Facial Injury Severity Score (FISS), presence of facial soft-tissue wounds, treatment modality, and length of stay; associations between variables were explored. Results: A total of 224 victims were identified; 94% were men (median age 26 y, IQR 22–34). The mandible was the most frequently involved bone (42%), followed by the orbit (25%); 14% sustained fractures at multiple sites. Facial soft-tissue wounds occurred in 9% of cases, three-quarters of which were associated with mandibular injury (p = 0.005). The median FISS was 2 and was higher in males, patients > 34 y, those with multiple fractures, and those with wounds (all p < 0.05). FISS showed a weak positive correlation with hospital stay (r = 0.23), which averaged 4.1 ± 1.6 days. Open reduction and internal fixation were required in 78% of patients, most often 24–72 h after admission. Annual IPV-related admissions remained stable throughout the 12-year period. Conclusions: IPV in this region consistently injures young men, with the mandible and orbit most at risk. FISS is a practical bedside indicator of resource use. The unchanging incidence—likely underestimated because isolated nasal fractures and minor injuries are often managed outside maxillofacial services or never reported—highlights the urgency of targeted prevention programs, routine screening, and streamlined multidisciplinary pathways. Full article

Background/Objectives: The incidence of both non-melanoma and melanoma skin cancers has increased significantly in recent years. Understanding their epidemiology is essential for implementing effective community prevention strategies and optimizing healthcare resource planning. This study aimed to (1) quantify the number of skin tumors diagnosed at the Central University Hospital of Asturias (HUCA) from 2014 to 2023; (2) describe temporal trends in the incidence of basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma; and (3) analyze the clinical and histopathological features of melanoma and estimate age-standardized incidence rates. Methods: A retrospective study was conducted using data from the Pathology Registry of HUCA. Diagnosed cases were collected in an Excel database and analyzed with SPSS v.27. Quantitative variables were expressed as mean ± standard deviation; categorical variables as counts and percentages. Incidence rates and 95% confidence intervals were calculated using EPIDAT 4.2, based on the European standard population. Municipal population data were obtained from the SADEI website. Results: A total of 7477 BCC, 2689 SCC, and 585 melanoma cases were identified. Over the study period, BCC cases increased by 50%, SCC by 80%, and melanoma by 159%. Among melanoma cases, 89% were diagnosed by dermatologists, 60% were women, 33.1% were melanoma in situ, and 73.3% were superficial spreading melanomas. Age-standardized melanoma incidence rose from 8.85/100,000 in 2014 to 18.50 in 2023. Conclusions: Skin cancer incidence, especially melanoma, has risen markedly in Asturias, with more in situ cases suggesting improved early detection. The 2020 decline reflects COVID-19′s impact on access to care, underscoring the need for sustained prevention and screening efforts. Full article

Background/Objectives: Occupational well-being and professional quality of life are essential for healthcare sustainability. While clinical staff are presumed to experience higher stress, few studies have compared their experience to that of non-clinical personnel within the same institution. Methods: This observational study involved 63 employees from an Italian research hospital: 36 healthcare workers in critical care and 27 administrative staff. Participants completed the Brief Coping Orientation to Problems Experienced Inventory (Brief COPE), an ad hoc organizational questionnaire, and the ProQoL Version 5 (administered to clinical staff only). Non-parametric tests (Mann–Whitney U and Chi-square) were used to explore group differences. Results: No significant differences emerged between groups in coping styles or strategies. Significant differences were observed only in reports of work-related injuries (42% of healthcare staff vs. 4% of administrative staff; p = 0.002) and perceived disruption caused by vacation requests (64% vs. 26%; p = 0.006). Other organizational indicators such as job dissatisfaction, intention to leave, or perceived managerial support did not differ significantly. ProQoL results showed that 53% of healthcare workers had moderate to high burnout, and 47.2% scored high on compassion fatigue, while only 2.7% showed high levels of secondary traumatic stress. Conclusions: Despite distinct operational contexts, healthcare and administrative staff reported broadly similar experiences in terms of coping and organizational well-being. These findings challenge assumptions of stark differences across professional roles and suggest that workplace well-being strategies should address the needs of both clinical and non-clinical staff. Full article

Long COVID is a persistent post-viral syndrome with the significant involvement of both the cardiovascular and pulmonary systems, often extending well beyond the acute phase of SARS-CoV-2 infection. Emerging evidence has highlighted a spectrum of chronic alterations, including endothelial dysfunction, microvascular inflammation, perivascular fibrosis, and in some cases, the persistence of viral components in the cardiac and pulmonary tissues. At the molecular level, a sustained inflammatory milieu—characterized by elevated pro-inflammatory cytokines such as interleukin 6 (IL-6)—and chronic platelet hyperreactivity contribute to a prothrombotic state. These mechanisms are implicated in microvascular damage, cardiac strain, and impaired gas exchange, correlating with clinical manifestations such as fatigue, dyspnea, chest discomfort, and reduced exercise capacity. In certain patients, especially those who were not hospitalized during the acute phase, cardiac MRI and myocardial biopsy may reveal signs of myocardial inflammation and autonomic dysregulation. These often subclinical cardiovascular alterations underscore the need for improved diagnostic strategies, integrating molecular and histopathological markers during post-COVID evaluations. Recognizing persistent inflammatory and thrombotic activity may inform risk stratification and individualized therapeutic approaches. The interdependence between pulmonary fibrosis and cardiac dysfunction highlights the importance of multidisciplinary care. In this context, molecular and tissue-based diagnostics play a pivotal role in elucidating the long-term cardio-pulmonary sequelae of long COVID and guiding targeted interventions. Early identification and structured follow-up are essential to mitigate the burden of chronic complications in affected individuals. Full article

Invasive yeast infections (IYIs) remain a significant cause of morbidity and mortality in patients with hematologic diseases. We retrospectively analyzed 193 IYI episodes among 179 patients admitted to a tertiary hematology hospital (2012–2023). Candida species accounted for 91.7% (n = 177), while non-Candida yeasts comprised 8.3% (n = 16). Among invasive candidiasis, non-albicans Candida spp. were predominant, representing 76.8% (136/177), with C. tropicalis (36.2%, 64/177) being the most frequently isolated species. Among non-Candida yeasts, Cryptococcus neoformans (n = 10) was the most commonly identified pathogen. The incidence and 42-day mortality rate of IYIs were 0.199 and 0.095 per 1000 patient-days, respectively. The 42-day case-fatality rate remained high at 47.7%. In categorical analysis, age >65 years, corticosteroid use, elevated lactate (>2 mmol/L), neutropenia (<500/mm³), vasopressor use, and mechanical ventilation were more common in non-survivors. Primary bloodstream infections were more frequent in non-survivors, whereas catheter-related and abdominal-origin infections were predominant among survivors. Concomitant bacteremia was observed in 32.6% of IYI cases (n = 63), with Enterococcus faecium being the most frequently isolated co-pathogen. Our findings illustrate the evolving epidemiology of IYIs in hematologic patients, marked by the emergence of C. tropicalis as the predominant species, sustained mortality, and frequent bacterial co-infections, collectively reflecting the substantial clinical burden of IYIs. Full article

Background/Objectives: The calcaneus is the most commonly injured tarsal bone, potentially resulting in long-term functional deficiencies and disability. The type of treatment mainly depends on fracture type and morphology. Treatment of these fractures can be challenging due to a limited soft tissue envelope and is frequently associated with complications. The aim of this study was to classify fracture types and identify factors associated with in-hospital complications. Methods: Patients with calcaneal fractures treated at our level I trauma center between 1997 and 2017 were included. Demographic data, comorbidities, fracture characteristics, type of treatment, complications and revisions, compliance and accompanying injuries were evaluated. Results: A total of 238 patients (m = 163, f = 75) at a mean age of 40 years sustaining either uni- or bilateral calcaneal fracture resulting in a total of 288 calcaneal fractures. Concomitant injuries were present in 103 patients (35.9%). Traumatic spine lesions were present in 21.9%. Complications were recorded in 59 fractures (20.5%). Open fractures were more likely to develop complications (76.0% vs. 15.2%, p < 0.001). Significant complication (33% vs. 14%, p < 0.001) and wound complication rates (29% vs. 10%, p < 0.001) were found in multiple-injured patients. All open fractures were surgically treated on the day of admission. In calcaneal fractures with a Böhler angle below 0 degrees, more complications were seen (33% vs. 17%, p < 0.05). Conclusions: High complication rates following calcaneal fractures were detected, with an increased likelihood in open fractures and in patients with multiple injuries. A negative Böhler angle was associated with worse outcomes. Full article