Search Results (2,128)

Background/Objectives: Post-stroke disability is a prevalent complication in patients who have experienced a stroke. It is imperative that patients suffering from associated disability be hospitalised in rehabilitation wards, with a view to minimising their disability. The primary objective of the present study is to analyse the direct medical costs associated with the rehabilitation of patients with post-stroke disability who are admitted to a rehabilitation clinic for the first time. Methods: This retrospective study was conducted in a public hospital in Romania between January 2021 and December 2024. Patient information was retrieved from the hospital database and included the following: socio-demographic and clinical characteristics; disability score assessed using the modified Rankin scale (mRS); number of days of hospitalisation; and direct medical costs related to hospitalisation. Results: A total of 584 patients were included in this study. The average age was 68.04 years, 82% had suffered an ischaemic stroke, and 18% had suffered a haemorrhagic stroke. The mRS disability scores for ischaemic stroke were 2 (28.54%); 3 (24.79%); 4 (30.41%); and 5 (16.25%). The mRS scores for haemorrhagic stroke were 4 (33.65%); 5 (29.80%); 3 (20.19%); and 2 (16.34%). Hypertension was present in 80% of patients. The average length of hospital stay was 12.44 days. The total cost of hospitalisation per patient averaged RON 5295.33 thousand (approximately EUR 1031). Pearson’s correlation indicates a statistically significant positive association between higher mRS disability scores and higher hospitalisation costs (p < 0.001). Conclusions: The financial burden imposed on healthcare systems in Romania by medical expenses related to the rehabilitation of patients with post-stroke disability is significant. It is imperative to implement measures that will reduce the financial burden associated with hospitalising these patients and minimise the duration of their hospital stay. Full article

Phenology is a key factor influencing the accuracy of regional-scale winter wheat-yield estimation. This study proposes a yield-estimation modeling framework centered on phenological zoning. Based on the remote sensing monitoring results of the heading stage of winter wheat in the Huang-Huai-Hai region from 2016 to 2021, the KNN-Ward spatial constraint clustering method was adopted to divide the Huang-Huai-Hai region into four consecutive wheat phenological zones. The results indicate a consistent spatio-temporal gradient in the phenology of winter wheat across the Huang-Huai-Hai region, characterized by later development in the northern areas and earlier development in the southern areas. The median day of year (DOY) for the heading stage in each zone varies by approximately 4 to 5 days, demonstrating a high degree of interannual stability. Building upon the phenological zoning outcomes, a multi-source data-driven random forest model was developed for wheat-yield estimation by integrating remote sensing data and meteorological variables during the wheat grain filling stage. This model incorporates remote sensing vegetation indices, crop growth parameters, and climatic factors as key input variables. Results show that the phenological zoning strategy significantly improves model prediction performance. Compared with the non-zoning model (R² = 0.46, RRMSE = 13.02%), the phenological zone model shows strong performance under leave-one-year-out cross-validation, with R² ranging from 0.54 to 0.68 and RRMSE below 12.50%. The phenological zoning model also exhibits more uniform residuals and higher prediction stability than models based on non-zoning, traditional agricultural zoning, and provincial administrative zoning. These results confirm the effectiveness of phenology-based zoning for regional yield estimation and provide a reliable framework for fine-scale crop yield monitoring. The phenological zoning model also demonstrates superior residual uniformity and prediction stability compared with models based on non-zoning, traditional agricultural zoning, and provincial administrative zoning. These results confirm the effectiveness of the multi-factor-driven modeling framework based on crop phenological zoning for regional yield estimation, providing a robust methodological foundation for fine-scale yield monitoring at the regional level. Full article

Patient stratification strategies based on digital databases and advanced information technology can predict inpatient rehabilitation outcomes and support safe hospital discharge for patients who underwent joint replacement for hip and knee osteoarthritis. The degree of continuity between surgery and rehabilitation, the perioperative process integration, and the setting where rehabilitation is provided are crucial factors to improve care effectiveness, access, minimize readmissions, and cost increase. The primary aim of this scoping review of the literature is to identify perioperative variables that are predictive of inpatient rehabilitation stay after hip and knee arthroplasty for osteoarthritis. These factors are divided by time of assessment through the perioperative pathway and surgical procedure site. The secondary aim is to explore how different data sources and facilities are linked into a patient-centered perioperative pathway. An electronic search of the literature was performed on PubMed, Embase, and Scopus. No time restrictions were applied. All primary research studies investigating predictive factors of inpatient rehabilitation stay after hip and knee osteoarthritis were included. In total, 25 studies were included in the review. Age, caregiver presence, presence of comorbidities, sex, Body Mass Index, Risk Assessment and Prediction Tool composite score, pre-operative Clinician-Reported Outcome Measures, pre-operative Patient-Reported Outcome Measures, and post-operative Barthel Index of autonomy in the Activities of Daily Living were predictive of some degree of inpatient rehabilitation stay in more than one study. The studies were fairly distributed between retrospective and prospective, with multicentric databases more spread among the latter. Data collection occurred in acute hospitals more than in specialized rehabilitation facilities. Using comprehensive models supported by electronic health records and powerful information technologies, analyzing specific inpatient rehabilitation LOS as distinguished from surgical ward rehabilitation, using institutional registries, and including specific rehabilitation factors in these registries, and promoting vocabulary and federated data sharing can strongly enhance the predictivity of models investigating rehabilitation outcomes and support appropriate discharge from inpatient rehabilitation units. Full article

The Late Holocene flood history of the Cauvery River floodplain in the Poompuhar region was reconstructed using a multiproxy sedimentological approach applied to three trench cores. Lithostratigraphy, loss on ignition (LOI), magnetic susceptibility (MS), sand–silt–clay textural analysis, granulometric statistics (Folk and Ward), Passega CM diagrams, and grain angularity provide complementary evidence to differentiate high-energy flood deposits from background slackwater sediments. Grain-size processing and statistical analyses were carried out in R using the G2Sd package, ensuring reproducible quantification of mean size, sorting, skewness, kurtosis, and transport signatures. We identified 10 discrete high-energy event beds. These layers are characterised by >80% sand content, low LOI (<3.5%), and low frequency-dependent MS (χfd% < 2%), confirming rapid, mineral-dominated deposition. A tentative chronology, projected from the regional aggradation rate, suggests two major flood clusters: a maximum-magnitude event at ~3.2 ka and a synchronous cluster at ~1.6–1.8 ka. These events chronologically align with the documented phases of channel avulsion in the adjacent Palar River Basin, supporting the existence of a synchronised Late Holocene climato-tectonic regime across coastal Tamil Nadu. This hydrological evidence supports the hypothesis that recurrent high-magnitude flooding triggered catastrophic channel avulsion of the Cauvery distributary, leading to the fluvial abandonment and decline of the ancient port city of Poompuhar. Securing an absolute chronology requires advanced K-feldspar post-IR IRSL dating to overcome quartz saturation issues in fluvial deposits. Full article

A coupled CFD-DEM model was adopted to investigate the floating ice accumulation mechanism and its disturbance to the flow field in the pump house of coastal nuclear power plants in cold regions. Based on numerical simulations, the motion, accumulation, and flow interaction characteristics of floating ice under various release positions and heights were analyzed. The results indicate that the release height significantly governs the accumulation morphology and hydraulic response. The release height critically determines ice accumulation patterns and hydraulic responses. For inlet scenarios, lower heights induce a dense, wedge-shaped accumulation at the coarse trash rack, increasing thickness by 57.69% and shifting the accumulation 38.16% inlet-ward compared to higher releases. Conversely, higher releases enhance dispersion, expanding disturbances to the central pump house and intensifying flow heterogeneity. In bottom release cases, lower heights form wall-adhering accumulations, while higher releases cause ice to rise into mid-upper layers, thereby markedly intensifying local vortices (peak intensity 79.68, approximately 300% higher). Spatial release locations induce 2.7–4.8-fold variations in flow disturbance intensity across monitoring points. These findings clarify the combined impact of the release height and location on the ice accumulation and flow field dynamics, offering critical insights for the anti-ice design and flow safety assessment of pump houses. Full article

Background: Mapping anti–HLA class I cross-reactivity from single-antigen bead (SAB) mean fluorescence intensity (MFI) data supports donor selection. However, interpretation is complicated by analytical choices and assay variability. Methods: A total of 4327 SAB assays were analyzed (antigen × test matrix) using an interpretable, distance-based workflow. Antigen profiles were z-scored across tests. Multidimensional scaling (MDS) was used for visualization and hierarchical clustering analysis (HCA) for grouping, and complemented these with a common PCA space for model selection (K-Means via Silhouette; Gaussian Mixture Models via BIC), agglomerative (Ward and average-link on 1–correlation), spectral clustering on correlation-derived affinities, and a graph approach (k-NN ∪ minimum-spanning-tree with modularity-based communities). Non-linear embeddings (t-SNE/UMAP) and density-based HDBSCAN were used only for visual analytics, not for primary inference. Results: The pipeline revealed coherent reactivity neighborhoods that partially overlapped known cross-reactive antigen groups (CREGs) and eplet-based expectations while also highlighting less-documented relationships. Robustness was confirmed through bootstrap resampling, graph modularity, and consensus clustering across methods. Conclusions: This unified, auditable workflow converts descriptive maps into method-robust summaries of antibody reactivity and cross-reactivity. While exploratory and performed on a single dataset without linked outcomes, the approach provides a reproducible structure for comparing cohorts and prioritizing hypotheses that could be prospectively validated for clinical decision support in transplantation. Full article

Background/Objectives: Anxiety can influence dietary choices and habits, but dietary choices and habits can also contribute to the intensification of anxiety symptoms. The study aimed to test the hypothesis that a higher level of anxiety predicts poorer diet quality among adults in Poland. Methods: A cross-sectional survey was conducted among 1841 individuals aged 18 years and older across Poland. A self-developed survey drew upon the KomPAN questionnaire, the Healthy Eating Plate with its accompanying infographic and the Penn State Worry Questionnaire (PSWQ). Multivariable logistic regression analysis was used to assess the relationship between anxiety level and gender, age, nutritional status, and other sociodemographic factors. The same approach was applied to evaluate the relationship between diet quality and the aforementioned variables. In addition, hierarchical clustering of variables was performed using Ward’s method. Results: Nearly half of the respondents presented a high level of anxiety (48.29%), while most reported a low-quality diet (64.58%). Participants aged 18–22 years were significantly more likely to exhibit both high anxiety levels (aOR = 1.614; 95% CI: 1.327–1.964; p < 0.001) and low diet quality (aOR = 1.810; 95% CI: 1.482–2.211; p < 0.001) compared to older groups. The findings support the hypothesis that higher anxiety levels are linked to poorer diet quality, particularly among young adults. Conclusions: Higher levels of anxiety were shown to be significantly associated with poorer diet quality, with the strongest effects observed in the youngest age group. These results highlight the need for integrated psychological and nutritional interventions targeting this group. Further longitudinal studies are warranted to clarify the directionality of the observed associations. Full article

Background/Objectives: Skin disinfection before insulin administration is widely regarded as essential for preventing injection-site infection. However, the World Health Organization advises that while hand hygiene and washing with soap and water are crucial, alcohol-based disinfection before subcutaneous injection is not required. Thus, the necessity for pre-injection (subcutaneous) skin preparation remains controversial. Therefore, this study aimed to clarify the determinants of nurses’ attitudes toward the necessity of skin disinfection before subcutaneous injection. We simultaneously examined the effects of workplace setting, years of professional experience, and social norms to identify the most significant factors influencing clinical judgment. Methods: Nurses employed in wards, outpatient settings, and home care settings were surveyed between October 2021 and January 2022 in this cross-sectional study. A structured questionnaire assessed frequency of skin disinfection and attitudes regarding its necessity before subcutaneous injection. Ordinal logistic regression was performed to identify factors associated with the attitude of nurses. Results: Overall, 992 valid responses were analyzed. Ordinal logistic regression indicated that the attitude of nurses were significantly influenced by years of professional experience (Odds Ratio [OR] = 0.98, 95% Confidence Interval [CI] [0.96, 0.99]), normative expectations (OR = 2.88, 95% CI [2.32, 3.56]), and sanctions (OR = 1.36, 95% CI [1.15, 1.62]) (all p < 0.001). Conclusions: Nurses’ beliefs regarding skin disinfection before subcutaneous injections are primarily influenced by normative expectations and professional experience, rather than workplace environment and experiential expectations. Experienced nurses do not disregard norms: they practice greater critical and situational judgment and show understanding of the purpose of disinfection. Full article

Introduction: Antimicrobial resistance constitutes one of the key challenges to public health. It is a particularly serious problem in the context of hospital-acquired infections (HAIs). By causing infections that are difficult to treat, multiple-drug-resistant bacteria in the hospital environment often require the use of toxic and costly drugs and prolonged hospital stays, and they result in long-term health consequences for patients, including a high risk of death. This study aimed to assess the epidemiological situation of antibiotic-resistant microorganisms in patients hospitalised at the University Teaching Hospital in Bialystok, Poland, between 2020 and 2023. Methods: Data from epidemiological reports covering 15 alert pathogens, including MRSA, VRE, KPC (+), and ESBL (+), were analysed. Their prevalence was assessed in three groups of wards: intensive care, surgical, and non-surgical. Infection and microbiological testing rates were referenced to the number of hospitalisations and patient-days. Results: A total of 6066 cases of infections caused by resistant microorganisms were identified. The most frequently isolated pathogen was Enterococcus faecium VRE, peaking in 2022 (11.43 per 1000 patients). A marked increase in Klebsiella spp. KPC (+) and Enterobacter spp. ESBL (+) was observed, particularly in the 2021–2022 period. Intensive care units showed the highest infection rate (30–36 per 1000 patient-days). In the 2022–2023 period, infections detected within <72 h of admission predominated, which may indicate prior patient colonisation or intensified screening. Conclusions: The rise in infections caused by antibiotic-resistant bacteria requires a high level of microbiological surveillance to be maintained, especially in intensive care units, and preventive measures at hospital admission to be strengthened. Full article

Audits of medication charts conducted by Royal Hobart Hospital Pharmacy revealed that dose omission was the most common medication error experienced by patients. Investigation of these errors also found that nurses spend significant time organising medication for inpatients. To address the issues contributing to these problems, an alternative model of medication management was implemented and tested. This model of bedside medication management involves medication supply managed by ward pharmacy technicians who review charts daily for changes to medicines and obtain the medicines needed for each patient. Outcomes on two intervention wards showed that the model, combined with technician involvement in controlled medicines stock management, resulted in 29.78 h of nursing time released to patient care per 20-bed ward per week, for an investment of 22.28 h of ward pharmacy technician time; a 75% reduction in delayed doses; a 44% reduction in missed doses; and an average decrease of two hours in the turnaround time for supply of inpatient medication. Introducing bedside medication management and controlled medicines stock management activities can release 1.34 h of nursing time to patient care for every hour of ward pharmacy technician time (at a lower hourly salary cost), decrease dose delays and omissions, and improve patient safety. Full article

Background/Objectives: Antimicrobial resistance (AMR) is a critical global health threat, with sub-Saharan Africa disproportionately affected. Antimicrobial stewardship (AMS) programs are essential in combating AMR; however, data on their implementation in resource-limited settings like Zambia remain scarce. This study assessed the post-implementation status of World Health Organization (WHO) AMS core elements in selected public hospitals in Zambia. Methods: A cross-sectional pre- and post-intervention survey was conducted in 11 public hospitals across Zambia’s 10 provinces. Baseline (pre-implementation) and 12-month follow-up (post-implementation) assessments were carried out using the WHO-adapted Periodic National and Healthcare Facility Assessment Tool. The six AMS core elements evaluated included leadership, accountability, AMS actions, education, monitoring, and feedback. Results: The average AMS program score increased from 59% at pre-implementation to 81% at post-implementation. Significant improvements were observed in education and training (+36%) and accountability (+31%). While leadership and monitoring also showed positive trends, gaps persisted in AMS actions (63%) and feedback/reporting mechanisms (68%). Drug and Therapeutics Committee (DTC) functionality improved by 23%, with 90% of facilities now holding regular DTC meetings. Implementation of AMS actions, such as ward rounds, rose from 0% to 73%. Challenges remained in clinical audit feedback, resource mobilization, and prescribing optimization. Variability across facilities highlighted differences in leadership, resources, and technical capacity. Conclusions: AMS implementation in Zambia improved substantially across key domains. However, sustained leadership, adequate financing, and continuous capacity-building are needed to address persistent gaps and ensure long-term success in mitigating AMR. Full article

Background: Clinical pharmacy services (CPS) have been shown to confer significant advantages in patient care. It remains to be clarified how CPS resources are allocated across routine care settings. It remains to be clarified which recommendations are made to resolve the drug-related problems (DRP) identified by CPS and which adverse drug reactions (ADR) actually arise from the identified DRP. Methods: Following positive ethical approval, patient chart analyses, evaluation of pharmacy documentation on CPS and pharmacist interviews were performed to characterize CPS at all medical departments of the Bundeswehr Hospital Hamburg. We developed and pre-tested instruments for standardization: A Standard Operating Procedure (SOP) for the practical exercise and documentation of CPS by the pharmacists performing them, a standardized form (checklist) for retrospective data collection as part of this study, and a standardized questionnaire for conducting the pharmacist interviews including a risk assessment according to the NCC-MERP score. Results: In total, 1000 CPS were documented in 504 patients (mean age: 69.95 years; 229 female) on 16,705 treatment days. A total of 66.87% CPS was initiated when pharmacists participated in ward rounds. In all CPS, “Indications” was the topic addressed most frequently (37.70%). “Agents for obstructive respiratory diseases” was the most frequently involved drug class (11.32%). The most frequent processing time per CPS was 16–30 min (48.61%). The number of CPS ranged from 0.36/100 treatment days in dermatology to 12.47 in oncology. Severity of 358 DRP was classified “very severe” (5.03%), “severe” (42.74%), “moderate” (34.36%), “low” (15.08%), “very low” (1.40%), or “without impact” (1.40%). The probability of DRP occurrence was classified as “high” in 13.13% and “very high” in 3.35%. In 15.36% of the DRP, an ADR actually occurred. In 504 patients, 932 specific recommendations were forwarded to solve the DRP identified during CPS. Of those, 53.97% were implemented. Conclusions: In almost all CPS, a considerable number of DRP with serious clinical consequences were identified. Half of the forwarded recommendations were implemented. Full article

Objectives: This study evaluated changes in serum sodium (S Na) 24 h after the administration of isotonic versus hypotonic intravenous fluids (IVFs) and the incidences of dysnatremia and hyperchloremic metabolic acidosis. Methods: This double-blind, randomized controlled trial involved children aged 3 months to 5 years who were admitted to a general ward between November 2020 and September 2022 and required IVF. We randomly assigned patients (1:1) to receive either an isotonic solution (D₅0.9%NaCl) or hypotonic solution (D₅0.45%NaCl). Serum electrolyte and venous blood gas levels were obtained at the time of IVF administration and 24 and 48 h after IVF administration. During this study, all participants were monitored for vital signs, body weight, fluid intake and output, and clinical symptoms of dysnatremia. Results: Totals of 69 and 68 patients received isotonic and hypotonic solutions, respectively. The mean age was 1.95 ± 1.25 years in the isotonic group and 1.91 ± 1.32 years in the hypotonic group. The initial degrees of dehydration and biochemical indicators were not different. The change in serum sodium level at 24 h was 2.97 (2.32–3.62) mmol/L in the isotonic group and 2.19 (1.54–2.84) mmol/L in the hypotonic group. In both groups, no significant hyponatremia nor hypernatremia occurred. The incidence of hyperchloremic metabolic acidosis was not different between the groups. Neither group showed any complications. Conclusions: Isotonic fluids may be a preferred option for IVFs in pediatric patients under 5 years of age with medical conditions on a general ward, especially within 24 h, due to their potential to better maintain serum sodium levels without increasing the risk of fluid overload or electrolyte complication. Full article

Background: Visual search supports action planning and target selection in daily life. Despite toileting being frequent yet high-risk in rehabilitation, gaze analyses specific to toileting remain limited. This study quantified visual search behavior during the approach phase of toileting. Methods: Twenty inpatients aged 65 years or older in a convalescent rehabilitation ward participated in the study. At the time of hospital admission, their gaze behavior from toilet room entry to arrival at the bowl was recorded using an eye tracker (Tobii Pro Glasses 2). Moreover, we evaluated a toilet-functional independence measure (toilet-FIM), comprising toileting, toilet transfer, and locomotion at discharge. Results: In multiple regression, a longer total gaze time directed towards the toilet seat was associated with a greater toilet-FIM independence (β = 0.446), whereas prolonged gaze to the toilet rim (β = −0.839) and to the right handrail (β = −0.621) were related to lower independence (adjusted R² = 0.715). Conclusions: A toilet seat-oriented gaze implies effective action planning for safe sit-down, whereas toilet rim- or handrail-oriented gazes may reflect responses to visual salience or compensatory visual strategies related to reduced independence. These observations could improve our understanding of older patients’ motor planning and spatial perception in toileting. Full article

Background/Objectives: Older patients with cancer are predisposed to malnutrition, contributing to adverse postoperative outcomes, high complication rates, and poor prognosis, warranting dietary support from nurses. Practices and factors related to such support remain unexplored. We examined factors associated with discharge-oriented dietary support for older patients with cancer. Methods: This cross-sectional study involved registered nurses working in wards and was conducted using a self-report questionnaire between September 2024 and February 2025 at two regional core cancer Japanese hospitals. The survey included the Ward Nurses’ Discharge-Oriented Dietary Support Scale for Older Adult Patients (NDODSS), items assessing nurses’ perceived difficulty with cancer care, patient assessment, interprofessional collaboration, and their interest in, perceived importance of, and difficulty with dietary support. Data were analyzed using t-test, Pearson correlation, and multiple regression analysis. Results: Overall, 134 nurses, with an average of 6.8 years of cancer nursing experience, were included. The total mean scores for NDODSS, assessment of healthy eating behavior, adjustment of the living environment, and continual frailty assessment were 68.6 (11.8), 28.4 (4.9), 18.2 (4.7), and 22.0 (4.2), respectively. Multiple regression analysis showed that NDODSS was significantly associated with difficulty providing dietary support (β = −0.127, p = 0.043), physical assessment of cancer patients (β = 0.282, p < 0.001), social assessment (β = 0.207, p = 0.003), and consultation with other professionals (β = 0.205, p = 0.010). Conclusions: Dietary support for older patients with cancer requires a multidisciplinary approach, including cancer symptom assessment, social factor evaluation and sharing dietary support-related challenges. Full article