Mood and anxiety disorders are leading causes of psychiatric hospitalization. However, data on real-world inpatient psychopharmacologic practices in the Philippines are limited. This study aims to describe the clinical characteristics and psychotropic medication prescribing patterns among inpatients with mood and anxiety disorders at a tertiary private hospital in the Philippines. This retrospective descriptive study reviewed medical records of patients admitted to the Section of Psychiatry at Makati Medical Center from January 1, 2014, to December 31, 2017. Patients with a primary DSM-5 diagnosis of bipolar disorder (BD), major depressive disorder (MDD), or anxiety disorder (AD) were included. Demographic and clinical characteristics, suicidality, and psychotropic prescribing patterns were summarized using descriptive statistics. A total of 705 patients were included: 350 (49.6%) with BD, 301 (42.7%) with MDD, and 54 (7.7%) with AD. Depressed mood was the most common presentation at admission (58.6%), and 72.2% of patients were euthymic at discharge. Suicide attempts were documented in more than half of patients with available data. Valproate, quetiapine, clonazepam, and aripiprazole were the most frequently prescribed medications for BD. In MDD, clonazepam, escitalopram, quetiapine, and aripiprazole predominated, while clonazepam and selective serotonin reuptake inhibitors were most commonly used in AD. Polypharmacy was frequent across diagnostic groups. Psychopharmacologic management of hospitalized patients with mood and anxiety disorders in this Philippine tertiary center largely aligns with international practice. High rates of polypharmacy and suicidality underscore the need for optimized, evidence-based prescribing and longitudinal outcome studies.
Lung cancer remains the leading cause of cancer-related mortality, with early diagnosis critical to prognosis and survival. Histopathological confirmation is achieved through invasive or minimally invasive methods, the effectiveness of which varies according to clinical context. This study aimed to assess the diagnostic sensitivity of procedures commonly used in the evaluation of suspected bronchopulmonary neoplasms. We conducted a retrospective study of 210 patients hospitalised in two specialised centres in southeastern Romania between 2023 and 2024, all presenting with clinical and imaging findings suggestive of bronchopulmonary cancer. We analysed the diagnostic results of endobronchial biopsy, bronchial aspirate cytology, pleural fluid cytology, and surgical biopsy. Sensitivity was calculated against confirmed histopathological diagnoses and compared using the McNemar test. Surgical biopsy demonstrated the highest diagnostic performance (100% sensitivity), particularly in peripheral tumours or when minimally invasive procedures yielded inconclusive results. Endobronchial biopsy had a sensitivity of 80.2%, bronchial aspirate cytology 55.2%, and pleural fluid cytology 24.5% among patients with pleural effusion. While centrally located lesions were often accessible via bronchoscopy, minimally invasive methods were frequently insufficient when used alone. However, combining these approaches enhanced overall sensitivity in selected cases. Surgical biopsy remains the gold standard for the definitive diagnosis of bronchopulmonary cancer. A stepwise diagnostic approach-starting with minimally invasive procedures and progressing to surgical biopsy when necessary-provides an optimal balance between diagnostic accuracy and patient safety. These findings underscore the importance of tailoring diagnostic strategies according to lesion location, resource availability, and individual clinical scenarios.
In the USA, higher forced vital capacity (FVC) is linked with longer survival, and FVC is associated with survival independently of ethnicity. The implications for the low FVC values in parts of Asia and Africa are unknown. We used data from 16 sites of the multinational Burden of Obstructive Lung Disease (BOLD) study that completed follow-up of participants between 2019 and 2021 and reported at least five deaths between baseline and follow-up. We assessed the association of mortality with FVC and Forced Expiratory Volume in 1 second (FEV1)/FVC ratio within each site using Cox proportional hazards models. These models were adjusted for age, smoking, height, and weight. Effect estimates from all sites were combined using meta-analysis. Systematic regional differences were investigated. Of 9927 study participants with follow-up data, 1120 (11.3%) had died [mean follow-up = 8.7 years, standard deviation (SD) = 3.3 years]. Baseline post-bronchodilator FVC and FEV1/FVC were inversely associated with mortality. When both FVC and FEV1/FVC were mutually adjusted for each other, the decreased mortality rates were more pronounced for each SD higher FVC at baseline [44% (95% confidence interval (CI): 25%, 58%) for men and 28% (95% CI: 11%, 41%) for women] than for FEV1/FVC at baseline [14% (95% CI: 8%, 20%) for men and 7% (95% CI: -10%, 21%) for women]. The probability of true regional differences was low. People with a higher FVC adjusted for age, sex, and height have a longer survival. Regional adjustments to lung function standards are inappropriate when assessing prognosis.
Introduction Aggressive acts demonstrated by patients suffering from mood disorders can vary from irritability to homicidal or suicidal behavior. It has been reported that patients with affective disorder, specifically bipolar disorder, most recent episode mixed, have a higher odds of aggressive behavior compared to those with schizophrenia. The investigators were intrigued to explore how suicidality correlated with other factors and determinants of mood disorder by classifying it as an act of aggression toward oneself, giving credence to the psychopathological notion of suicidality. Methods The study was designed as a retrospective cross-sectional analytic investigation that will utilize a database previously gathered. The existing database has 705 data sets and has already been processed to be non-identifiable data. Upon processing, there were 373 data sets gathered and organized through the use of a data collection tool. The data the investigators gathered were the demographics and clinical determinants, as they have been hypothesized to have a relationship. Statistical analysis was done using Student's t-test for continuous variables and chi-square test or Fisher's exact test for categorical variables. Simple logistic regression was done to determine the variables that probably have significant association with aggression. Results The study showed a predominance of patients without aggression (266 from a total of 373). With the P-value noted to be significant if <0.20, only civil status was noted to be significant (p=0.004998) in the demographic variables. In the clinical determinants (p<0.20), the mood state during admission (p=2.798e-10), mood symptoms during admission (p=1.127e-12), the type of aggression (p=2.2e-16), and the total number of mood symptoms, depressed (p=3.462e-10) and manic (p=3.445e-11), were significant. Admitting diagnosis (p=0.004498), discharge diagnosis (p=0.001499), and comorbid psychiatric disorder (p=0.04998) were also noted to be significant in determining the presence or absence of aggression. Individuals in manic, mixed, or anxious states can expect their outcomes to be 5-6 times greater than those who are depressed. These values were also noted to be significant (p<0.20) with manic (p=1.59435e-09), mixed (p=2.60205e-04), and anxious (p=2.880880e-07). Conclusions It can be safely concluded that the factors with significant association to the absence and presence of aggression (civil status, mood state during admission, patients' mood symptoms at the time of admission, the type of aggression, the total number of symptoms for depression and mania, admitting diagnosis, discharge diagnosis, and comorbid psychiatric disorders) are also known considerations for assessing the probability of aggression, either toward others or of suicidal nature. The recent mood state was shown to have a positive association in terms of predicting the probability of aggression, especially manic, anxious, and mixed states. One of the primary purposes of this inquiry was to examine whether there is a change in terms of predictors of aggression if the concept of aggression includes any violence committed toward oneself.
Engineering thinking has become a central goal of undergraduate engineering education, yet the psychological pathways through which it emerges in design-oriented course contexts are not well understood. This study examined how self-efficacy is associated with engineering thinking among engineering undergraduates in China and tested student engagement as a mediator of this link in courses incorporating design-based learning (DBL) activities. A cross-sectional questionnaire survey was completed by 407 students enrolled in 12 engineering-related programs at an applied university in eastern China during the second semester of the 2024-2025 academic year. The questionnaire assessed academic self-efficacy, behavioral, emotional, and cognitive engagement in course design activities, and engineering thinking. Data were analyzed using descriptive statistics, bivariate correlations, and partial least squares structural equation modeling (PLS-SEM) in SmartPLS 4.1.1.2 with 5,000 bootstrap resamples. The measurement model satisfied widely accepted criteria for indicator reliability, internal consistency, and convergent and discriminant validity. In the structural model, self-efficacy predicted higher levels of student engagement and engineering thinking, and engagement was positively related to engineering thinking. Indirect-effect estimates showed that student engagement transmitted part of the effect of self-efficacy on engineering thinking, indicating partial mediation. These findings suggest that students who feel more efficacious are more likely to invest behavioral, emotional, and cognitive resources in design-oriented learning tasks, and that this deeper involvement is linked to more advanced engineering thinking. The study highlights engagement as a key psychological mechanism connecting students' self-beliefs with complex engineering outcomes in DBL-implemented course settings.
This article presents a parallel analysis of Dante Alighieri's Divine Comedy and contemporary literature on moral injury to explore how Dante's journey towards enlightenment can inform the path to healing from moral injury. Described as a soul wound by those affected, moral injury is a severe psychological and spiritual trauma resulting from ethical transgressions such as abuse, betrayal, war and tyranny. Although moral injury is arguably as old as human conflict itself, its scientific study is comparatively new. The Divine Comedy is widely regarded as one of the greatest works in world literature. In this poem, moral suffering appears as a disordering of the soul: the will estranged from responsibility, love misdirected towards evil rather than good and the intellect dimmed of its light, unable to perceive truth. By comparing Dante's allegorical journey through Hell, Purgatory and Paradise with contemporary moral injury discussions and the broader literature, and by tracing connections from individual suffering to wider social and political contexts, this comprehensive narrative review uncovers underexplored dimensions of this multifaceted condition. The analysis addresses key moral injury themes, highlights routes and barriers to healing, identifies gaps in current scholarship and offers practical recommendations relevant in both peacetime and war. Dante's insights provide a symbolic framework for recognising and healing moral injury, potentially offering consolation for the affected and those who care for them, while showing how enduring cycles of violence can be interrupted through an ethic of just peace.
The Epic Sepsis Model version 2 (ESM v2) is a widely implemented proprietary sepsis prediction model, but no multicenter, external validation of its performance has been reported to guide adoption and use. To conduct a multicenter validation of the ESM v2 to compare performance against the original ESM v1, outline differences across heterogenous clinical sites, and compare model performance against clinician recognition of sepsis. This prognostic study included adult inpatient encounters at 4 large US health systems between August 31, 2023, and March 11, 2025. At each site, data were collected for a consecutive period immediately following new model implementation. Data were analyzed from July 23 to August 19, 2025. Sepsis was defined using Sepsis-3 clinical consensus criteria. Model discrimination was assessed using area under the receiver operating characteristic curve (AUROC) at the encounter level and prediction level with 4-hour, 12-hour, and hospitalization-wide time horizons. Performance against clinician recognition of sepsis was measured using antibiotics, lactate, and body culture orders. Of 227 091 inpatient encounters, 7401 (3.3%; median [IQR] age, 65 [54-75] years; 3359 [45.4%] female; 2.7% Asian; 24.6% Black; 64.6% White; 7.1% Hispanic ethnicity) met sepsis criteria and 219 690 (96.7%; median [IQR] age, 48 [33-65] years; 123 563 [56.2%] female; 2.5% Asian; 38.8% Black; 49.6% White; 9.6% Hispanic ethnicity) did not. At the encounter level, the AUROC ranged from 0.82 (95% CI, 0.81-0.83) to 0.92 (95% CI, 0.92-0.93) across study sites. At the prediction level with a 12-hour time horizon, the AUROC ranged from 0.75 (95% CI, 0.74-0.75) to 0.85 (95% CI, 0.85-0.85). Comparison against clinician recognition of sepsis yielded a minor decrease in performance, with the resulting encounter-level AUROC ranging from 0.80 (95% CI, 0.79-0.81) to 0.90 (95% CI, 0.89-0.90) across sites. Positive predictive values remained low, from 0.13 (95% CI, 0.13-0.14) to 0.26 (95% CI, 0.25-0.27), with a high number needed to evaluate and high alert burden. In this prognostic study of a new sepsis prediction model, a multicenter prospective validation performed across 4 major US health systems found improved discrimination for the early prediction of sepsis but noted high institutional variability, low positive predictive value, and high alert burden.
The Enhanced Recovery After Surgery Society published guidelines in 2020 for minimizing physiologic stress in neonatal patients who are undergoing intestinal surgery. This study explores stakeholder perceptions of the acceptability and adoption of a neonatal enhanced recovery protocol as well as barriers and facilitators to implementation. We conducted seven semistructured focus groups, purposively selecting diverse stakeholders (N = 36) from six US hospitals. Transcripts were generated and transferred into MAXQDA for coding and analysis. We used a combined inductive and deductive approach to develop codes, followed by thematic analysis. Implementation of the guidelines was variable, with wide adoption of some components (e.g., breastmilk as preferred nutrition) and limited acceptability of others (e.g., early postoperative enteral feeds). We identified five key barriers/facilitators: (1) the heterogeneity of the neonatal surgical population (e.g., degree of prematurity); (2) competing stakeholder priorities (e.g., caregiver values versus clinician assessment of risks/benefits); (3) aligning care across teams (e.g., clinician-clinician, clinician-caregiver communication); (4) the clarity/specificity of component definitions (e.g., "goal-directed fluid management"); and (5) responsiveness to change (e.g., nursing willingness to learn and trial mucous fistula refeeding). This study provides a preimplementation assessment of an enhanced recovery protocol for neonatal intestinal surgery, highlighting the specific needs of this vulnerable population and identifying actionable refinements to existing guidelines. Broad, effective implementation will require greater consensus on the target population, alignment with stakeholder priorities, clearer care coordination strategies, refined component definitions, and increased openness to practice change.
Antibiotic overuse is harmful to patients and the health care system. Antibiotic prescribing report feedback has been described in outpatient and long-term care settings but is relatively untested in inpatient settings. To assess the association between peer comparative inpatient antibiotic prescribing feedback and changes to antibiotic prescribing rates among hospitalists in a large health care network. This quality improvement study linked data on billing and prescribing of broad-spectrum antibiotics for hospital-onset infections (BS-HO antibiotics) from hospitalists at 5 diverse acute care facilities encompassing both academic and primarily community-based hospitals within the same large health care network. Data were pooled into 12 two-month periods from January 1, 2023, through December 31, 2024, in a quality improvement intervention with a stepped-wedge cluster design. Hospitalists who contributed billed patient days for at least one 2-month period during the study period received the intervention. Observed-to-expected ratios (OERs) for days of therapy (DOT) of prescribed antibiotics were calculated for each hospitalist per period and reported back to hospitalists in a peer comparative report disseminated via email every 2 months. Hospitalists' prescribing rates for BS-HO antibiotics with activity against Pseudomonas aeruginosa were assessed, accounting for time, clustering of hospitalists, and patient characteristics including comorbidities and clinical syndrome. The study included 169 hospitalists (median per hospital, 30 [range, 24-50]) for a total of 1687 bimonthly observation periods. Per 2-month period, hospitalists had a mean (SD) of 126 (48) patient encounters. Among hospitalists at facilities receiving the intervention, the prescribing rate ratio (RR) for DOT was higher among clinicians caring for higher proportions of patients with sepsis (RR, 1.04; 95% CI, 1.00-1.08) and end-stage kidney disease (RR, 1.09; 95% CI, 1.05-1.14) and was lower for each sequential reporting period (RR, 0.99; 95% CI, 0.98-1.00). In multivariable models accounting for these variables and the trend over sequential periods, the intervention was not significantly associated with lower prescribing rates (RR, 0.97; 95% CI, 0.91-1.04). Peer comparative inpatient prescribing reports for hospitalists were not associated with a change in hospitalists' prescribing rates of BS-HO antibiotics. The findings suggest additional efforts to augment the utility of the reports are justified.
BackgroundJob satisfaction influences individuals' motivation to comply with safety regulations and actively participate in safety initiatives.ObjectiveThis research aimed to investigate the influence of safety climate on job satisfaction and determine the relative importance of these variables among employees employed in a tire manufacturing organization.MethodsA descriptive-analytical cross-sectional study was conducted with a sample of 280 randomly selected individuals working in a tire manufacturing company in Tehran province, Iran. Simple random sampling was used for this study. The data collection process involved the utilization of Dante's job satisfaction questionnaire and the NOSACQ Nordic Safety climate questionnaire. Data analysis was performed using SPSS software version 29.0 and R programming language version 4.2.2, employing statistical tests including the Kruskal-Wallis test, post-hoc Dunn test, Mann-Whitney test, Spearman correlation test, and Multiple Quantile Regression.ResultsThe findings revealed that the results of the multiple regression analysis demonstrated a significant relationship between job satisfaction and factors, including the overall safety climate score, history of workplace accidents, and educational status (P < 0.05).ConclusionsThese findings undeniably underscore the crucial role of safety climate in influencing employees' job satisfaction levels within the tire manufacturing industry. Future research should delve deeper into the relationship between safety climate and job satisfaction using longitudinal and qualitative methods.
Background/Objectives: Respiratory dysfunction in Parkinson's disease (PD) is a clinically relevant but frequently underrecognized manifestation associated with functional impairment and increased risk of respiratory complications. This study compared spirometry and impulse oscillometry (IOS) in the assessment of respiratory function in PD, with particular focus on the detection of subtle or peripheral airway abnormalities. Methods: A prospective, single-center, cross-sectional study was conducted, including 108 participants (55 patients with PD and 53 control subjects). Pulmonary function was evaluated using standardized spirometry and IOS protocols. Group comparisons were performed using non-parametric tests, while multivariable regression analyses adjusted for potential confounding factors, including age, body mass index, smoking status, pollutant exposure, and cardiovascular comorbidities. Results: IOS identified a higher frequency of abnormal categorical findings compared with spirometry, including among subjects with normal spirometric values. Although dyspnea was more frequent in patients with PD in unadjusted analyses, multivariable regression demonstrated that PD was not an independent predictor of respiratory dysfunction. Pollutant exposure was significantly associated with abnormal IOS findings (p = 0.011). No significant differences were observed between PD and control groups regarding continuous spirometric or oscillometric parameters. Only a weak association between disease severity and FEV1 (%) was identified, whereas no significant correlations were observed for oscillometric parameters. Conclusions: IOS may provide complementary information regarding subtle or peripheral respiratory abnormalities in patients with PD. The findings suggest that respiratory alterations in this population are likely multifactorial and not independently determined by PD itself. Incorporating oscillometric assessment into respiratory evaluation may contribute to the identification of subtle respiratory mechanical alterations in patients with PD.
Background: Right ventricular (RV) dysfunction is a key contributor to morbidity and mortality in systemic sclerosis (SSc), emerging from the combined effects of microvascular disease, myocardial fibrosis, interstitial lung involvement, and increasing pulmonary vascular load. Conventional echocardiography frequently fails to detect early RV impairment, prompting growing interest in deformation-based parameters such as RV free-wall longitudinal strain (RV-FWS), global longitudinal strain (RV-GLS), and RV-pulmonary artery (PA) coupling indices. Although natriuretic peptides reflect myocardial stress and are widely used in cardiopulmonary diseases, their integration with advanced RV imaging has been inconsistently reported in SSc. This systematic review synthesizes available evidence on RV strain, RV-PA coupling, and their relationship with clinical outcomes and biomarkers in SSc. Methods: A systematic search was conducted to identify clinical studies evaluating RV strain (RV-FWS, RV-GLS), right atrial strain, or RV-PA coupling indices in adult patients with SSc or SSc-associated pulmonary arterial hypertension (SSc-PAH). Eligible studies included those using speckle-tracking echocardiography or cardiac magnetic resonance feature-tracking. Study selection and data extraction were performed in accordance with PRISMA guidelines. Results: Seven studies met the eligibility criteria. Across unselected SSc cohorts, early disease without pulmonary hypertension (PH), and right-heart-catheterization-confirmed SSc-PAH, RV strain consistently detected myocardial impairment even when conventional echocardiographic indices remained normal. RV-FWS and RV-GLS were commonly reduced, and longitudinal data demonstrated progressive deterioration independent of standard measures. Strain-derived RV-PA coupling, particularly RV-FWS/PASP, significantly improved prognostic stratification when added to established PAH risk models. Two studies identified impaired RV deformation as a predictor of mortality, and CMR-derived right atrial strain provided additional prognostic value. Biomarker integration was limited, with only one study reporting an association between natriuretic peptide elevation (NT-proBNP) and impaired RV-PA coupling suggesting that biomarkers may reflect the hemodynamic load, although evidence remains limited captured by strain abnormalities. Conclusions: RV strain and RV-PA coupling indices are more sensitive than conventional echocardiography for detecting early RV dysfunction, monitoring disease progression, and predicting adverse outcomes in SSc. Although biomarker evidence remains limited, available data suggest that natriuretic peptides may provide complementary information to deformation-based assessment, although current evidence remains limited by reflecting combined myocardial and pulmonary vascular load. Standardized prospective studies including both strain imaging and biomarkers are needed to clarify the integrated diagnostic and prognostic value of advanced RV assessment in SSc.
Spontaneous intestinal perforation (SIP) is a morbid condition of low-birth-weight neonates. Peritoneal drainage (PD), as opposed to upfront laparotomy (LP), is favored for SIP. However, PD management is neither standardized nor thoroughly understood. We reviewed our experience of PD in infants with SIP. Neonates treated for SIP between 07/2004 and 03/2023 were reviewed. Patients with NEC or death immediately following PD were excluded. Patients treated with a PD that required LP within 30 days were considered salvage laparotomy (SL). A total of 235 neonates were included. The median gestational age and birth weight were 25.0 weeks (IQR: 24.1, 26.3) and 720 g (IQR: 620, 865). Ninety-three (39.6%) patients required SL at a median of 9 days (IQR: 5, 14) from PD. Indications for failure included recurrent pneumoperitoneum (52%), clinical deterioration (20%), and ongoing feculent drain output (14%). At SL, 8.4% of patients were found to have NEC. SL patients had extended length of stay: 113 days (IQR: 86, 153) vs. 67 days (IQR: 38, 115), p < 0.001. PD is an important tool in the management of SIP, however SL is not uncommon (39%) and has clinical significance. Prospective data to improve PD management is needed.
This study uses a multihospital cohort to evaluate 2 candidate outcome measures being considered for benchmarking by the CDC and CMS for community-onset sepsis hospitalizations: 30-day mortality after admission and composite in-hospital mortality or hospice discharge.
Pediatric choledocholithiasis is traditionally managed with an endoscopy-first approach, where Endoscopic Retrograde Cholangiopancreatography (ERCP) is performed before laparoscopic cholecystectomy (LC). However, ERCP carries risks such as pancreatitis, bleeding, infection, and perforation, and may even be an unnecessary procedure should stones pass spontaneously. An alternative surgery-first approach, utilizing intraoperative cholangiogram (IOC), laparoscopic common bile duct exploration (LCBDE), power flushing, and glucagon, may offer a more efficient treatment pathway. This study aims to evaluate ERCP findings in pediatric patients undergoing an endoscopy-first pathway to characterize the nature and burden of stone disease in the common bile duct. Our ultimate goal is to determine the proportion of cases that could have been successfully managed with a surgery-first approach. This retrospective, multi-center study analyzed 127 pediatric patients (≤18 years) who underwent ERCP prior to LC for suspected choledocholithiasis. Data from seven children's hospitals were reviewed, including imaging studies, ERCP findings, and stone characteristics. ERCP findings were categorized as sludge, small (<4 mm), medium (5-7 mm), large (>8 mm), or absent stones. Cases with sludge, small/medium stones, or negative ERCP findings were considered amenable to a surgery-first approach as they are known to be manageable with intraoperative techniques. 69 % of patients had ERCP findings that were amenable to transcystic surgical maneuvers without preoperative ERCP. Among those, 19 % had only sludge, 46 % had only stones, 24 % had sludge and stones, and 11 % had no evidence of obstruction. Large stones (>8 mm) were found in only 8 % of cases. The findings support a surgery-first has potential for a paradigm shift as standard of care for pediatric choledocholithiasis, with ERCP reserved for select cases where surgical clearance fails or cholangitis is present. Adoption of this approach could reduce hospital stays, procedural risks, and healthcare costs while maintaining high efficacy in duct clearance. Prospective studies are warranted to refine clinical guidelines. IV.
Choledocholithiasis in children is commonly managed with an "endoscopy-first" (EF) strategy (endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC)). Because ERCP availability is often limited at the end of the week (EoW), we hypothesized that a "surgery-first" (SF) approach (LC with intraoperative cholangiogram (IOC) ± transcystic laparoscopic common bile exploration (LCBDE)) would decrease length of stay (LOS) and time to definitive intervention (TTDI). A multicenter, retrospective cohort study was conducted on pediatric patients from 2018 to 2023 with suspected choledocholithiasis. Work week (WW) presentation was defined as admission between Monday to Thursday. TTDI was defined as time to LC or postoperative ERCP (if required). Among seven hospitals, there were 354 pediatric patients; 217 (61%) managed with SF (125 WW, 92 EoW) and 137 (39%) managed with EF (74 WW, 63 EoW). SF groups had a shorter LOS for both WW and EoW presentation (60.2 h and 58.3 h vs 88.5 h and 93.6 h respectively; p < 0.05). TTDI decreased in SF (26.4 h and 28.9 h vs 61.4 h and 72.8 h; p < 0.05). All EF patients underwent at least two anesthetics (preoperative ERCP followed by LC) while the majority (79%) of the SF group had only one procedure (LC + IOC ± LCBDE). Children who present with choledocholithiasis at EoW have a longer LOS and TTDI. These findings are amplified when children enter an EF pathway. A surgery-first approach results in fewer procedures, decreased TTDI, and shorter LOS, regardless of the time of presentation. Level III.
This study aimed to investigate effect of surgeon annual case volume on pediatric inguinal hernia recurrence rates. Surgeons' individual annual case volumes were calculated from a retrospectively collected data set of pediatric inguinal hernia repairs including 21 hospitals from 2017 to 2019. Quartiles were defined based on surgeons' annual case volumes for each year: Lower Volume = Q1-3 and Higher Volume = Q4. Descriptive statistics and bivariate regression were utilized for analysis. For all repair techniques, there were 207 surgeons accounting for 548 surgeon-years with 8519 operations. For all repairs, Higher Volume was defined as > 22 operations per year. On regression analysis, presence of a ventriculoperitoneal shunt, peritoneal dialysis, laparoscopic technique, and surgery performed by a lower volume surgeon were associated with recurrence risk. For open repairs, there were 193 surgeons, 465 surgeon-years, and 5726 operations. Higher Volume was defined as >18 operations per year. On regression analysis, history of an omphalocele, a connective tissue disorder, and tracheostomy dependence contributed to recurrence risk, while surgeon volume did not. For laparoscopic repairs, there were 136 surgeons, 306 surgeon-years, and 2793 operations. High Volume was defined as >14 operations per year. On regression analysis, presence of a ventriculoperitoneal shunt and surgeon laparoscopic volume was associated with recurrence risk. Annual surgical volume is an important determinant of recurrence following laparoscopic inguinal hernia repair. As surgeons integrate both laparoscopic and open techniques in their practice, caution should be taken to maintain adequate volume and proficiency in each technique. This study was IRB reviewed and approved (IRB 22-350). III.
Healthcare-associated infections (HAIs) are a significant public health problem, having a decisive impact on the prognosis of patients hospitalized with COVID-19. In Romania, the absence of a uniform reporting system and the lack of epidemiological data comparable to European standards limit the real assessment of their incidence and consequences. In this context, the present study aimed to conduct an integrated analysis of the clinical, epidemiological, and microbiological factors involved in the mortality of patients with COVID-19 and HAIs in a county located in southeastern Romania. This research was based on a retrospective observational study that included 295 patients with a confirmed diagnosis of COVID-19 and at least one documented HAI between January 2020 and December 2022. Data were extracted from standardized reporting forms, and statistical analyses included tests (Fisher's exact test, Mann-Whitney U), ROC curves, Kaplan-Meier survival analysis, and Cox proportional hazard regression. The analysis revealed a mortality rate of 32.5%, significantly associated with advanced age, gastrointestinal surgery, and respiratory infections. Clostridioides difficile was the predominant pathogen (84.1%), and the threshold of ≥63.5 years demonstrated predictive value for mortality. In multivariate models, age greater than 63 years and gastrointestinal surgery were confirmed as independent predictors of death. The findings highlight the substantial impact of HAIs on the clinical progression of COVID-19 patients, underscoring the need for comprehensive systemic interventions, including enhanced prevention and control strategies, prudent antimicrobial therapy, and standardized epidemiological monitoring. Implementing these measures is crucial to mitigating HAIs' effects and improving patient outcomes in similar situations.
Veno-venous (VV) extracorporeal membrane oxygenation (ECMO) is associated with fewer neurological complications and decreased mortality compared to veno-arterial (VA) ECMO in neonatal respiratory failure. The Crescent right atrial (RA) cannula is the only dual-lumen cannula for neonatal VV ECMO designed to have the tip in the right atrium. The purpose of this study is to describe the experience with early use of the Crescent RA cannula. We performed a retrospective cohort study of 58 neonates and infants cannulated from September 2021 through August 2023 at 15 institutions represented within the Children's Hospital Neonatal Consortium (CHNC) ECMO Focus Group. Members provided information on patient characteristics, ECMO runs, complications, and outcomes. Data were analyzed with descriptive statistics. Imaging was used during cannulation in 79.3% of cases. Survival to discharge was 84.5%. There was one major cannula-related complication resulting in death. The most common complication was cannula malposition in 46.6% of patients, requiring surgical repositioning in 29.3% of the total cohort. Early use experience with the Crescent RA cannula suggests that it is effective and safe in most patients, but the cannula may require repositioning to achieve optimal ECMO support or if malpositioned. Based on these observations, we developed recommendations for cannulation and cannula surveillance.
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