Stigma toward people with substance use disorders (SUD) remains a major barrier to care. There have been multiple calls to action to address SUD stigma in healthcare settings and other reviews have clarified the need for more rigorous effectiveness research. In addition to attention to effectiveness research, there is a need to attend to the implementation strategies used to deliver SUD stigma reduction interventions. Delineating discrete implementation strategies that have been used to address stigma will support future research efforts to arrive at the most optimal interventions to address SUD stigma. We searched three databases and extracted data to identify interventions tested to reduce SUD stigma. We used the adapted Expert Recommendations for Implementing Change (ERIC) taxonomy to characterize the discrete implementation strategies used to support the adoption, implementation, sustainment, and scale-up (or spread) of each intervention. This scoping review synthesized 108 peer-reviewed studies reporting on interventions which to address SUD stigma among healthcare professionals. Most interventions were implemented in training environments, including higher education and continuing education settings, and focused on providing basic education on SUD broadly or opioid use disorder. Within interventions, educational and training implementation strategies were most prominent with 74% of studies using educational meetings and 39% distributing training materials. Far fewer studies used implementation strategies that used experiential approaches such interactive assistance, simulation, case-based learning, or contact with people with lived experience. Most studies (73%) reported reductions in stigmatizing attitudes, most often immediately post-intervention, though the need for higher study quality was notable. Existing stigma-reduction interventions are overwhelmingly education-focused and primarily implemented in academic settings, with limited use of strategies that promote reflective learning, contact-based engagement, or organizational change. Future work should employ more rigorous designs that systematically test implementation strategies to create packaged SUD stigma reduction interventions optimized for effectiveness and implementation.
Previously, young children had limited respiratory support options during interfacility transport. Recently, high-flow nasal cannula (HFNC) and noninvasive ventilation (NIV) have become available for pediatric transport. We hypothesized that the implementation of HFNC and NIV on interfacility transport decreases the rate of intubation in infants and toddlers before and after transport to a tertiary-care pediatric intensive care unit (PICU). We conducted a retrospective chart review of children aged 30 days to < 36 months transported to a tertiary-care PICU from a referring hospital with respiratory distress from 2014 to 2019. Groups were analyzed before (2014-2017) and after the implementation (2017-2019) of HFNC and NIV during transport. NIV was defined as positive pressure ventilation delivered through nasal cannula. The primary outcome was to compare the pre- and postimplementation groups with regard to the rate of intubation before transport and within 48 hours of PICU admission. Secondary outcomes were the association between intubation rate and comorbidities and the comparison of length of respiratory support and hospital length of stay between the pre- and postimplementation groups. A total of 262 patients met criteria, 133 before and 129 after the intervention. The rate of intubation before PICU admission was 44% in the preintervention group versus 36% in patients transported after the implementation of HFNC and NIV, a trend that was not statistically significant (P = .19). The rate of intubation within 48 hours of PICU admission was 8% (before) and 11% (after) with no statistical significance (P = .48). Comorbidities were not associated with an increased rate of intubation before transport (P = .09) or within 48 hours of admission (P = .45). Hospital length of stay and length of respiratory support were not different between pre- and postintervention groups (P = .18 and P = .3, respectively). The availability of HFNC/NIV was associated with a significant decrease in the proportion of patients who received oxygen via nasal cannula or face mask during transport (46% before vs. 13% after the intervention; P < .01). After the introduction of HFNC/NIV during transport to a large tertiary-care hospital in a major metropolitan area, fewer nasal cannula/face masks were used during transport in favor of HFNC/NIV but no significant change in intubation rates was found.
Parents of undiagnosed children (POUC) experience significant psychosocial challenges, including anxiety, uncertainty, and isolation, that stem from parenting medically complex children while facing obstacles throughout the diagnostic journey. Despite these well-described challenges, a mental health intervention designed to meet the unique needs of POUC, which is necessary to promote the psychological and overall wellbeing of this population, does not exist. Acceptance and Commitment Therapy (ACT) has proven effective in a wide range of populations and shows promise for POUC. With the goal of designing and implementing an ACT-based intervention tailored to POUC, this pre-implementation study aimed to understand their psychosocial needs and prior mental health support experiences, explore their reactions towards ACT, and determine their anticipated barriers, facilitators, and preferences for participating in an ACT skills group, guided by the Consolidated Framework for Implementation Research (CFIR). Semi-structured, individual interviews were conducted with 18 POUC, including an experiential portion that exposed participants to key ACT concepts and exercises. Inductive coding based on participant responses and deductive coding based on the CFIR were employed to code interview transcripts. Reflexive thematic analysis was performed to identify key findings. Isolation was a psychosocial challenge for which all participants desired support. Many participants reported inadequacies in their prior mental health support, primarily due to lack of understanding from therapy providers regarding their unique circumstances. Although most participants indicated that ACT could help them manage difficult thoughts and emotions and act in alignment with their values, they also described achievability, collaboration, and accountability as key elements that could support their uptake. The main barriers, facilitators, and preferences that participants highlighted were related to group design (accessibility, flexibility) as well as their own characteristics as recipients (capability, need, and motivation). This pre-implementation study affirmed the potential value of ACT for POUC and identified key opportunities for tailoring an ACT skills group to meet their needs. Future research, including pilot implementation studies, are needed to evaluate the effectiveness of a tailored ACT skills group and further refine both the intervention and its implementation strategy.
Artificial intelligence and machine learning (AI/ML) may strengthen hospital infection prevention and control (IPC) through automated surveillance, early warning, and decision support, but the evidence base is fragmented and often limited to retrospective model development. We conducted a PRISMA 2020 systematic review to synthesize studies of AI/ML in acute-care hospital IPC, distinguishing implemented systems integrated into workflows from non-implemented development/validation studies. On January 17, 2026, we searched PubMed/MEDLINE, Scopus, Web of Science Core Collection, and Cochrane CENTRAL. Two reviewers independently screened records and assessed full texts. Of 7,089 records identified, 2,061 duplicates were removed; 5,028 titles and abstracts were screened; 177 full texts were assessed; and 59 studies were included. Only 9/59 studies reported real-world implementation (6 pilot, 3 routine), whereas 50/59 remained development/validation only. Conventional machine learning predominated (42/59), followed by natural language processing (8/59), deep learning (5/59), and rule-based or expert systems (4/59). Implemented studies more often reported process and operational outcomes than standardized infection outcomes, and rarely quantified unintended consequences such as unnecessary isolation or alert fatigue. Risk of bias and applicability concerns were common, particularly regarding transportability and confounding in uncontrolled pre-post evaluations. AI/ML for hospital IPC shows promise, but translation into routine practice remains limited. Safer adoption requires implementation-focused study designs, standardized IPC-relevant outcomes, and lifecycle governance with continuous monitoring after deployment.
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Digital behavioral health platforms extend clinical capabilities beyond traditional appointment-based care, but implementation challenges limit their routine use. Although validated suicide risk screening instruments exist and evidence suggests individuals provide honest responses in digital contexts, how behavioral health organizations implement asynchronous screening remains poorly understood. This exploratory study examined implementation experiences from nine behavioral health organizations that adopted digital suicide screening. Nine behavioral health organizations that implemented remote, asynchronous Columbia Suicide Severity Rating Scale (C-SSRS) screening completed post-implementation surveys. Using a mixed-methods approach combining Interpretative Phenomenological Analysis and VADER sentiment analysis, we identified implementation patterns, organizational adaptations, and provider attitudes across diverse service settings. Implementation challenges clustered into operational, technical, clinical, and systemic domains. Operational challenges involved workflow integration, staff training, and protocol development, while technical challenges included EHR integration, digital divide concerns, and alert volume management. Clinical challenges centered on screening quality, therapeutic rapport, and risk factor evaluation, while systemic challenges reflected resource constraints, crisis response protocols, and staff capacity. Provider attitudes evolved from initial anxiety and role uncertainty in early-stages to strong support among advanced-stage organizations, where 48% expressed very supportive and 32% expressed moderately supportive sentiments. Sentiment analysis of alert-workflow responses indicated generally positive attitudes across organizations (mean score = 0.24 on a scale of -1 to 1). Two preliminary frameworks emerged from analysis: the Service Delivery Ecosystem Framework describes context-specific adaptation patterns observed in this sample, and the Implementation Stage Framework characterizes common progression from initial rollout to mature implementation. These findings offer preliminary considerations for organizations planning digital suicide screening integration.
The rising prevalence of illicit drug use among Romanian youth underscores the need for effective prevention service delivery systems, particularly in European contexts characterized by high social transition, severe resource constraints, and limited prevention service infrastructure. This study explored international expert and local Romanian stakeholder perspectives regarding factors contributing to the contextual adaptation and potential implementation of the Communities That Care (CTC) prevention system in Romania. Through qualitative interviews with experts in CTC (n = 15) and validation of findings with Romanian community stakeholders (n = 9), this study examined potential challenges in implementing CTC in Romania, such as lack of evidence-based interventions, resource scarcity, cultural differences, and resistance to change. Key factors identified by CTC experts as needed for successful implementation include community improved readiness, continuous adaptation, favorable facilitator and champion characteristics, and community engagement. Romanian stakeholder perspectives further suggested that rural communities may offer particularly favorable conditions for CTC implementation. Stakeholders emphasized the need for partnerships that reflect the needs of local groups and for attention to Romanian values (e.g., including strong family ties, religious traditions, and respect for authority), which should be considered alongside broader societal experiences (e.g., migration, funding limitations, and long-standing institutional distrust). By situating Romania within a broader European context, these findings provide valuable insights for stakeholders seeking to adapt and implement CTC in countries new to the prevention science movement and highlight the relevance of the Romanian case for the Balkan region and similar European settings.
Digital twin technology represents a transformative approach in healthcare, creating virtual replicas of physical entities that enable real-time data integration, predictive modelling, and personalised treatment strategies. In urology, this emerging technology offers unprecedented opportunities to optimise patient care through simulation-based decision-making. This narrative review comprehensively examines current applications of digital twin technology in urology, evaluates its clinical utility across various urological conditions, and identifies key challenges limiting its widespread implementation. A comprehensive search was conducted across PubMed, Web of Science, and Scopus databases for literature published between January 2020 and January 2026. Search terms included digital twin, virtual twin, urology, uro-oncology, prostate cancer, renal surgery, and bladder dysfunction. Studies focusing on the development, validation, and clinical implementation of digital twins in urological practice were included. Digital twin technology demonstrates significant potential in uro-oncology for treatment planning, surgical navigation, and disease progression monitoring. Key applications include patient-specific tumour growth simulation in prostate cancer, three-dimensional anatomical modelling for partial nephrectomy, and bladder function prediction in outlet obstruction. Integration with artificial intelligence enhances predictive accuracy and enables real-time surgical guidance. Digital twin technology represents a paradigm shift towards precision urology, though challenges in data integration, computational requirements, validation, and ethical considerations must be addressed before routine clinical implementation. Future developments should focus on standardisation, regulatory frameworks, and prospective clinical validation studies.
To compare accuracy, precision, recall, F1 and time spent using commercial tools to identify physiotherapy trials based on title and abstract, compared with a human approach. This study compared two approaches for title and abstract screening of 10,793 newly published records. In the reference standard human approach, two reviewers independently screened records using pre-specified rules to assess relevance to physiotherapy. A third person resolved disagreements. We evaluated three LLMs (gpt-4o, gpt-4.5, gpt-4-turbo) within two commercial, web-based tools (ChatGPT and Co-pilot). Outcomes were accuracy (proportion of records that model correctly identified as relevant or irrelevant), precision (proportion of records identified as relevant that were considered as relevant by human approach), recall (the proportion of all actual relevant records that the model successfully identified), F1 (harmonic mean of precision and recall) and time spent. Exploratory analyses compared the performance of the commercial tools with local approaches, including local LLMs implementation, machine learning and natural language processing. Commercial tools showed comparable performance across all metrics (ChatGPT vs Copilot: accuracy: 83% vs 86%; precision: 44% vs 48%; recall: 88% vs 87%; F1: 59% vs 62%). The total time spent using commercial tools with a labelled dataset was equivalent to 37% of the time required for the human-only screening process. Exploratory analysis showed that the API-based implementation has comparable performance (accuracy: 82%; precision: 42%; recall: 93%; F1: 58%). Yet, LLM-based models demonstrated lower performance compared with other local, custom-adapted automation approaches such as machine learning and natural language processing. This proof-of-concept study demonstrates that commercial web-based LLMs may have sufficient accuracy to support title and abstract screening and substantially reduce the time to identify field-specific trials. However, alternative approaches, including machine learning or natural language processing, could achieve screening performance similar to or slightly higher than that of commercial tools, yet they require a series of pre-processing steps for implementation.
Tanzania has adopted artificial intelligence (AI)-assisted chest X-ray screening for tuberculosis (TB), including the use of CAD4TB version 6, which is registered by the Tanzania Medicines and Medical Devices Authority (TMDA). While GeneXpert, practical reference standard used in routine practice, remains the primary bacteriological confirmatory test in routine practice, there is currently no established national threshold for CAD4TB use in either active case finding (ACF) or passive case finding (PCF) settings. This study evaluates the implementation and operational use of CAD4TB version 6 within mobile TB screening units in Tanzania and highlights challenges affecting its effective use. We conducted a retrospective analysis of screening data from 11,923 individuals collected from mobile clinics equipped with digital X-ray, CAD4TB version 6, and GeneXpert systems. Comparisons were made between manual chest X-ray interpretation, CAD4TB scores, and GeneXpert results within the subset of individuals who underwent confirmatory testing. The findings reveal substantial inconsistencies in screening workflows, including non-uniform use of CAD4TB prior to GeneXpert testing, missing radiological records, and deviations from intended protocols across sites. Descriptive analysis showed that CAD4TB scores generally aligned with GeneXpert-positive cases within the tested subset; however, due to selective application of GeneXpert and incomplete data, these observations cannot be interpreted as measures of diagnostic accuracy. This study should be interpreted as an implementation and operational assessment of AI-assisted TB screening rather than a diagnostic accuracy or threshold-setting study. The findings highlight important gaps in protocol adherence, data completeness, and workflow standardization, underscoring the need for prospective, protocol-driven studies to establish validated national thresholds for CAD4TB use in Tanzania.
Recent randomized controlled trials comparing extracorporeal cardiopulmonary resuscitation (ECPR) with conventional cardiopulmonary resuscitation (CCPR) reveal mixed outcomes; however, current data support an association between ECPR and neurologically intact survival, particularly within a meticulously trained and highly functional extracorporeal membrane oxygenation (ECMO) delivery system. Rapid deployment of ECPR is critical to achieving favorable outcomes. We describe the implementation of a single-center ECPR program at Mayo Clinic, incorporating an ECPR emergency backpack, clinical lead ECMO specialists, and an emergency ECPR checklist to enhance deployment efficiency and outcomes. Data were extracted from electronic medical records to assess clinical outcomes, including survival to hospital discharge with favorable neurologic status. A tertiary and quaternary care academic medical center. Fifty-eight adult patients who underwent ECPR between October 3, 2020, and December 31, 2023. Implementation of a structured ECPR program incorporating an emergency ECPR backpack, clinical lead ECMO specialists, and an emergency ECPR checklist to streamline deployment and improve outcomes. Of 58 patients treated with ECPR, the overall rate of neurologically intact survival to hospital discharge was 34.5%, including 41.2% for out-of-hospital cardiac arrest and 31.7% for in-hospital cardiac arrest. This single-center experience demonstrates the feasibility and impact of a streamlined ECPR program emphasizing rapid deployment, standardized processes, and dedicated personnel. Our model provides a reproducible framework for institutions seeking to enhance ECPR timeliness and neurologically intact survival following cardiac arrest.
Albeit rarely recognized as such in existing legislation, violent child discipline is a clear form of domestic violence (DV) with enduring consequences for child well-being. This study merges household survey data from 27 sub-Saharan African countries with World Bank data on law implementation to investigate whether broad DV legislation introduced since the mid-2000s has curbed violent parenting practices. Using a quasi-experimental approach to compare childrearing practices and attitudes between countries with and without anti-DV laws, before and after law implementation, we document a robust increase in violent child discipline-mainly driven by emotional punishment-and a higher endorsement of harsh parenting practices following the introduction of these laws. These adverse effects are attenuated in countries with higher income inequality, where the laws appear to play more of a "protective" role. Our findings underscore the unintended consequences when anti-DV legislation is enacted without a specific target for child protection.
Bullying harms learning and wellbeing, and schools increasingly use digital games as part of their response. This PRISMA-guided systematic review and meta-analysis synthesized 34 studies on educational games for school bullying and cyberbullying intervention. Ten randomized trials passed risk-of-bias screening; nine contributed continuous outcomes to the primary meta-analysis. The pooled effect was small and statistically significant (Hedges' g = 0.14, 95% CI [0.02, 0.26]) and remained stable across sensitivity analyses. Effects were observed at immediate post-intervention assessment and tended to diminish by three to six months without booster components. Among outcome domains, emotional outcomes showed the largest pooled gains, while cognitive and behavioural effects were smaller and did not reach statistical significance. Educational games outperformed usual-care conditions, were comparable to other active programs, and showed higher completion rates than no-intervention controls. Implementation was predominantly classroom-based on PC/web platforms and targeted whole student cohorts rather than role- or risk-defined groups. Common design features included role-based scenarios, branching decisions, immediate feedback, and structured reflection. No tested moderator reached statistical significance. Future trials should pre-specify maintenance strategies, adopt role-sensitive recruitment, use well-matched active comparators, and report design and implementation features with greater precision.
Palliative care improves quality of life and reduces avoidable healthcare utilization for people with heart failure, yet referrals remain inconsistent and delayed. Clinical decision support offers a promising strategy to facilitate timely palliative care, but no tool currently exists to support palliative care decision-making specifically for this population. To identify clinician needs, contextual factors, and design requirements to inform the development of a clinical decision support tool to promote timely palliative care for hospitalized patients with heart failure. Guided by the User-Centered Framework for Implementation of Technology, we conducted a qualitative descriptive study using focus groups and interviews with referring clinicians (hospitalists and cardiologists) and palliative care clinicians across two hospitals in an academic health system. Rapid qualitative and content analysis were used to identify themes related to workflow, decision-making, and tool design. Twenty-five clinicians participated. Clinicians described workflow challenges, goals for earlier palliative care involvement, and barriers such as uncertainty about referral timing. Informational needs included prognostic indicators and healthcare utilization data. Clinicians reported limited experience with palliative-specific decision support and expressed strong dislike for interruptive alerts that disrupt workflow. Preferred features included objective markers of clinical deterioration, tailored recommendations based on clinical acuity, integration into existing workflows, and clear visuals. Clinicians identified critical informational, contextual, and design requirements for a clinical decision support tool to promote timely palliative care in heart failure. These findings directly inform tool design, workflow integration, and implementation strategies, and will guide future pilot testing and clinical evaluation.
Early adolescence is key for adopting healthier lifestyles, yet disadvantaged communities often lack resources to support these changes, perpetuating health inequities. Schools play a crucial role in promoting physical activity and healthy eating. eHealth solutions, like online platforms, offer scalable, cost-effective ways to deliver interventions. These platforms can also enhance adolescent engagement and help bridge health resource gaps. The ePro-Schools project aims to co-design and test an eHealth platform to promote healthy habits among adolescents in socially disadvantaged settings. A randomized controlled trial (RCT) will be carried out with the participation of 6 secondary schools (three controls and three intervention), with a sample size estimated at 1000 students of Central Catalonia (Spain). In the intervention schools, focus groups sessions and meetings with stakeholders have been conducted to co-create the ePro-Schools eHealth platform. Students and school staff are pilot testing the platform to assess the platform's usability, functionality, and layout. Finally, the RCT will be conducted, in which the intervention group will have full access to the ePro-Schools platform (an interactive and informative platform), while the control group will only have access to the informative platform with health literacy content on physical activity, nutrition, and healthy habits. In both groups, adolescents will complete validated questionnaires at baseline, post-intervention, and at the six-month follow-up to assess their physical activity and eating habits, including depressive symptoms, quality of life, social isolation, and mental health. Sociodemographic characteristics will also be collected. Implementation, effectiveness, and cost-effectiveness analysis will be performed. The ePro-Schools project introduces a co-designed eHealth platform that integrates physical activity and healthy eating promotion within schools. The intervention aims to enhance adoption, relevance, and sustainability across diverse settings. ePro-Schools project could reduce health inequalities, improve adolescents' physical and mental well-being, and strengthen daily health habits. The model's scalability and embedded implementation planning may support long-term integration into school systems, informing future policies and contributing to educational engagement, reduced disease risk, and broader population health impact. This trial is registered in ClinicalTrials.gov, with the registration number NCT06792461.
Recent advances in xenotransplantation have gained substantial public and clinical attention as genetically modified porcine organs are now being transplanted into living human recipients. While only case reports have been published to date, the first clinical trials for kidney xenotransplantation are now ongoing. This transition to clinical practice presents multiple implementation challenges for establishing scalable transplant programs while ensuring patient safety. Machine perfusion is expected to play a critical role in addressing these challenges by serving as a central platform for organ preservation, assessment, transport, and therapeutic intervention. Given the limited number of designated pathogen-free (DPF) breeding facilities, regional and international organ transport depends on robust preservation strategies during transit. Additionally, perfusion devices enable essential pre-transplant screening for zoonotic pathogens, a crucial safety measure unique to xenotransplantation. Further, given recent developments that allow for multi-day perfusion of grafts, wild-type grafts could potentially be genetically modified while being perfused ex situ. Beyond these perfusion modalities of isolated whole organs, machine perfusion offers a new therapeutic approach for patients with acute liver failure. Here, cross-circulation between a perfused genetically modified porcine organ and the patient can provide temporary liver replacement therapy. This mini-review summarizes the transformative potential of machine perfusion technology in clinical xenotransplantation with a focus on livers.
Soft skills correspond to intrapersonal and interpersonal abilities related to how individuals interact, make decisions, and manage their activities. In the context of undergraduate nursing education, their development is fundamental to the preparation of professionals capable of acting in an ethical, critical, and relational manner, making it relevant to understand how these competencies are incorporated into the teaching and learning process. In this context, the objective of this study is to understand how faculty members in undergraduate nursing programs incorporate soft skills into their pedagogical approaches and practices, identifying the competencies considered essential and the challenges to their implementation. A qualitative study was conducted with 26 nursing faculty members from four federal public universities in southern Brazil. Data were collected between June and September 2025 through semi-structured interviews, following the criteria of the Consolidated Criteria for Reporting Qualitative Research checklist. The interviews were processed using IRaMuTeQ software and analyzed in light of Discursive Textual Analysis. Three analytical categories emerged: faculty understanding of soft skills in nursing education; pedagogical approaches and strategies for the development of these competencies; and perceived difficulties in their promotion within teaching. The faculty members recognize the relevance of soft skills and report the use of active methodologies and reflective strategies for their development. However, most had not received specific training, and the teaching of these competencies occurs predominantly in an implicit manner. The findings demonstrate that, although soft skills are widely valued in nursing education, their promotion still lacks pedagogical systematization and institutional support. Challenges such as the subjectivity of these competencies, the prioritization of technical skills by students, and distractions associated with the use of technologies limit their intentional development. These results contribute to the international literature in nursing education by highlighting the need for structured institutional strategies for faculty development and for the explicit integration of soft skills into nursing curricula.
Next-generation sequencing (NGS) has revolutionized the field of genomics by providing rapid, high-throughput, and cost-effective platforms for analyzing genomes, transcriptomes, and epigenomes. Its application spans cancer genomics, infectious disease research, rare disease diagnostics, and precision medicine, enabling comprehensive detection of genetic variants and their functional implications. The advent of advanced methods such as single-cell sequencing, long-read technologies, and multi-omics integration has further expanded the scope of NGS, allowing unprecedented insights into cellular heterogeneity, structural variations, and systems-level interactions. These innovations have facilitated the identification of actionable mutations, supported biomarker discovery, and enhanced our understanding of complex biological processes in both research and clinical contexts. Despite these advancements, several challenges remain. The vast volume of sequencing data necessitates robust computational infrastructures for storage, processing, and interpretation. Sequencing error rates, though improving, continue to impact variant detection and clinical reliability. Ethical concerns regarding privacy, data sharing, and equitable access are also critical barriers that must be addressed, particularly in resource-limited settings. Moreover, translating genomic findings into clinically actionable outcomes requires standardized frameworks and interdisciplinary collaboration among clinicians, geneticists, and bioinformaticians. Looking ahead, the integration of artificial intelligence, machine learning, and automation into NGS data pipelines promises to significantly enhance accuracy, scalability, and clinical utility. These emerging innovations, coupled with global efforts to ensure accessibility and ethical implementation, position NGS as a cornerstone of precision medicine, paving the way for individualized treatment strategies and transformative improvements in healthcare delivery.
This study aimed to describe hospital-acquired conditions in older patients hospitalized in an acute care hospital and to examine their associations with clinical patient-related and organizational factors. A secondary analysis of data collected in the electronic health records of a Swiss teaching hospital. The study included 5813 older adults hospitalized in 2019 across 21 medical and surgical units. Hospital-acquired conditions were observed with notable prevalence rates for delirium (3.1%), falls (3.6%), pressure ulcers (5.2%), and weight loss (8.8%). Despite the availability of geriatric assessment scales, their use was inconsistent and limited, with assessment rates for most scales ranging from 1.8% to 28.2%. Only the scales for falls risk (Stratify, 51.0%) and pressure ulcer risk (Braden, 94.8%) were documented routinely. Multivariable analysis revealed that, beyond age and length of stay, the use of benzodiazepines (OR=1.76) and antipsychotics (OR=2.05) during hospitalization were significantly associated with an increased risk of falls. Furthermore, few care units had implemented patient-centered approaches tailored to older adults. Hospital-acquired conditions in older patients remain a major concern in acute care settings. Our findings highlight a significant disconnect between the availability of geriatric assessment tools and their clinical application. This pattern suggests that assessment practices may be driven more by institutional requirements than by patient-centered clinical needs, underscoring the urgent need to improve the implementation and culture of geriatric-focused care.