BackgroundIntegrity is a foundational value in nursing, essential for ethical practice, professional accountability, and maintaining patient trust. Growing evidence of dishonest behaviors in academic and clinical settings highlights the complexity of practice, where boundaries between honesty and dishonesty are not always clear-cut. Despite this, limited research has explored how senior nursing leaders conceptualize integrity and dishonesty across the academic-clinical continuum.AimThis study aimed to explore senior nursing leaders' perceptions of integrity and dishonesty, the underlying factors contributing to unethical behaviors, and potential strategies for addressing these challenges in educational and clinical contexts.DesignA qualitative study was conducted. Data was collected through semi-structured, in-depth interviews and analyzed using thematic analysis to identify patterns and themes.ParticipantsThe study included ten senior nursing leaders from academia, hospitals, and the Ministry of Health. All participants held managerial roles and had experience in nursing education or training, allowing for perspectives across the educational-clinical continuum.Ethical considerationsEthical approval was obtained from the institutional review board. Informed consent was secured from all participants, and principles of confidentiality, anonymity, and voluntary participation were strictly maintained.FindingsThree themes emerged: (1) integrity and dishonesty were perceived as existing along a continuum rather than as dichotomous constructs, with patient safety serving as a key moral boundary; (2) dishonest behaviors were shaped by a combination of individual, cultural, and systemic factors, including organizational pressures and inconsistent enforcement; and (3) leadership practices, particularly education, role modeling, and case-by-case management, were viewed as central to promoting integrity.ConclusionsIntegrity in nursing is not solely an individual attribute but is co-constructed within organizational and educational systems. Promoting ethical practice therefore requires integrated approaches that combine education, supportive organizational cultures, and clear policies, while acknowledging the complexity and ambiguity inherent in real-world clinical practice.
The global population is ageing, and Australia's older population continues to experience the highest growth in emergency department (ED) presentations. Older adults have a higher level of vulnerability and are at greater risk of hospital acquired complications. The Older Persons Emergency Network Acute Outreach Service (OPEN AOS) provides ED substitution and ambulance co-response to older persons in their home to avoid unnecessary transfers to ED. Since establishment, service demand has grown and cost-effective initiatives to increase service capacity and capability are required to sustain service delivery. A quality improvement project was undertaken to trial and assess mixed reality (MR) goggles in conjunction with video calling software over 90 days, to increase service capacity and capability. Usability, acceptability, enablers, and barriers related to MR use was assessed using the System Usability Scale and open-ended questions. Descriptive statistics summarised the data and content analysis further explained the results. The intervention involved Registered Nurses or Advanced Practice Nurses performing solo outreaches wearing the MR goggles to liaise remotely with OPEN AOS senior clinicians (Senior Medical Officers or Nurse Practitioners) for medical governance. Thirty-two clinicians interacted with MR and completed the survey. Most patients were treated in Residential Aged Care Homes (RACHs) (66%, 21/32) for minor injuries or fractures (25%, 9/32), lacerations (25%, 8/32) or wounds (19%, 6/32). Good usability and acceptability were reported. Nurses found MR easy to use and obtained clear advice from senior clinicians. Senior clinicians found the image quality to be the biggest strength of MR. Half of the staff experienced technical issues mainly due to internet connectivity in RACHs causing call disconnections and distorted images. These findings provide valuable insight into MR use in the OPEN AOS, enabling service directors to make informed decisions regarding future investment in MR technology. This was a quality improvement project with a small sample size and caution should be exercised when generalising these findings to other healthcare settings. MR shows great potential to increase capacity and capability within the OPEN AOS, enabling nurses to carry out solo outreaches safely and competently. Further research is necessary to evaluate clinical and cost effectiveness of MR to support broader adoption in other healthcare settings.
 Nursing students face significant academic and clinical stressors that can affect their psychological well-being. These challenges are intensified during extraordinary events, such as the coronavirus disease 2019 (COVID-19) pandemic.  This study investigated psychological distress and resilience among junior (1st year - 2nd year) and senior (3rd year - 4th year) undergraduate nursing students exposed to a major stressor at two universities in the Western Cape, South Africa.  A survey was conducted among 589 nursing students during and after COVID-19. Most respondents were female (77.4%) and junior students (75.2%), with a mean age of 22.5 years (± 4.6). Data collection took place at University A (February 2021-March 2021) and University B (November 2021-February 2022). Measures include psychological distress (Kessler-10), resilience (Response to Stressful Experiences Scale) and fear of COVID-19 (Fear of COVID-19 Scale).  Overall, students reported mild psychological distress and fear of COVID-19, and high levels of resilience. Senior students experienced significantly higher psychological distress than juniors (p  0.001), but lower fear of COVID-19 (p = 0.028). Resilience did not differ significantly between groups, with most students demonstrating high resilience.  Nursing students showed strong resilience despite the added pandemic-related stressors. Elevated distress among seniors, however, highlights the need for targeted psychological support. Strengthening resilience within nursing education may prepare students to manage future crises and contribute to a sustainable, adaptable nursing workforce.Contribution: This study provides evidence on the psychological well-being of nursing students in South Africa during the COVID-19 pandemic. It emphasises the importance of resilience-building interventions within nursing curricula and institutional support systems to safeguard student health and professional readiness.
The Delbet-Colonna (DC) classification guides treatment of pediatric femoral neck fractures (PFNFs) but relies on clinical experience. No deep learning (DL) model has been developed and validated to differentiate between PFNFs and proximal femoral growth plates (PFGPs) and classify PFNFs via DC classification, in order to overcome this limitation. X-ray data including the annotations of 5555 PFGPs, 1306 PFNFs with various DC types, and 257 pediatric subtrochanteric femoral fractures (PSFFs), were prepared to construct a DL model based on the you-only-look-once (YOLO) model with wavelet transform (WT) and attention mechanism (AM) architectures. Two senior-level pediatric orthopedic surgeons (POS) performed the annotations independently by referring to the postoperative X-rays. The annotations were finalized if there were no differences. Otherwise, the two POS discussed and determined the final annotation. Thirty-one POS with different experience assessed the external testing dataset twice, without (first) and with (second) YOLO-WTAM model assistance. The rating performances of the YOLO-WTAM model and POS were evaluated. The kappa value reflecting reliability was obtained using a Fleiss kappa analysis. According to the internal testing dataset, the area under the curve for different annotations ranged from 0.94 to 0.99. According to the external testing dataset, in the second round, the accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were greater than those in the first (P < 0.001): 79.17-87.16%, 83.30-87.47%, 94.68-96.57%, 74.62-79.44%, and 92.97-95.55%, respectively. Senior-level POS exhibited superior accuracy (P = 0.021), sensitivity (P = 0.013), specificity (P = 0.039), PPV (P = 0.004), and NPV (P = 0.025) in the first round but not in the second. The kappa value improved among residents (+27.36%), junior-level (+17.03%), mid-level (+26.66%), and senior-level (+17.07%) POS. The YOLO-WTAM model can accurately differentiate between PFNFs and PFGPs and classify different DC types of PFNFs. This improves POSs' rating performance and reduces the need for experience in classifying PFNFs. Level III.
The Blue Coats program at Penn Medicine is a systemwide initiative designed to amplify the voices of clinical teams to understand and support workforce well-being. Recognizing that traditional system-level strategies often cannot address real-time frontline team needs, the Blue Coats program, launched in August 2022, is a locally embedded group of well-being ambassadors and operational consultants. These trained team members engage directly with clinicians and staff within their local clinical environments - observing, shadowing, and listening to all team members - to identify pain points and bring forth opportunities for improvement for local and senior leadership. The Blue Coats bridge the gap between frontline experience and leadership decision-making by operating within departments and aligning workforce concerns with leadership decision-making. The program utilizes a discovery-to-delivery model: Blue Coats gather actionable insights from clinicians and staff, then collaborate with department leadership to implement customized interventions that enhance workforce well-being and trust, ultimately working to improve retention. Individual solutions informed by Blue Coats' insights are variable by clinical site and have included hiring supply and support staff, redesigning workflows to balance clinical duties, enhancing physical safety infrastructure, and launching local recognition and small division-based reward programs. Early outcome data demonstrated meaningful gains across the domains of hope, trust, and belonging on the part of outpatient clinical staff; the largest improvements, as seen in survey results scored on a five-point Likert scale, include an 11.8% increase in trust (from 3.4 to 3.8) and 7.4% improvement in hope (from 3.4 to 3.65) among nursing staff, and a 24.6% increase in trust among support staff (from 2.85 to 3.55). The Blue Coats initiative has been deployed across diverse clinical units ranging from emergency departments to outpatient clinics. Staff expressed appreciation for being "seen, heard, and supported" - qualities often lost, or difficult to capture, in large health system surveys. Senior clinical leadership recognizes the Blue Coats as a feedback loop and a strategic tool to inform resource allocation, staffing decisions, and cultural investment. Notably, departments engaged with Blue Coats could move quickly from problem discovery to implementation, shortening the traditional lag between insight and action. Perhaps most importantly, the program restored a sense of agency among clinical teams. Many expressed that the presence of Blue Coats signaled a culture shift toward listening, transparency, and shared ownership of workplace challenges. This shift has led to higher trust scores, improvements in self-reported workforce retention, and renewed collaboration and engagement with staff and leadership. The Blue Coats approach offers a scalable, in-house framework for health systems nationally: embed, listen, act, and evolve. As health care continues to confront burnout and operational strain, this model demonstrates how relational, human-centered design can fuel the future of the workforce.
The escalating frequency and severity of disasters and the emergence of global health threats such as the COVID-19 pandemic have exposed vulnerabilities in hospital preparedness and response systems. This study explores leaders' perceptions of the SHEPA tool's application in Saudi hospitals to enhance emergency preparedness. A cross-sectional survey of 21 Health Emergency Operations Center (HEOC) leaders assessed familiarity, usefulness, ease of use, and impact using a Likert scale and open-ended questions. Logistic regression was used to analyze differences by occupation and experience. The study participants primarily consisted of mid-career professionals, with the majority (57.1%) falling within the 25-34 years age group. A significant gender imbalance was observed, with male participants (85.7%) vastly outnumbering their female counterparts (14.3%). Educationally, most participants held a Bachelor's degree (61.9%). Most participants (71-81%) rated the tool highly useful and impactful, though ease of use received mixed reviews. Experienced professionals valued utility more but critiqued impact (OR = 5096 for usefulness; OR = 0.07 for impact). Given the small sample size (N = 21), these logistic regression findings should be interpreted as exploratory and hypothesis-generating rather than confirmatory. However, the consistent patterns suggested that both professional role and experience level meaningfully shaped how the SHEPA tool is perceived, with more senior and experienced staff showing both greater appreciation of its utility and critical assessment of its impacts. This study highlighted the SHEPA tool's potential to strengthen hospital emergency preparedness in Saudi Arabia, with strong endorsement from health emergency operations centers' leaders. The tool's perceived usefulness and ability to identify improvement areas align with national preparedness goals, though its ease of use and impact evaluation require refinement. The logistic regression findings are exploratory due to the limited sample size and require validation in larger, more diverse cohorts.
To compare the agreement and the differences between the modified Thoracolumbar Injury Classification and Severity Score (mTLICS) system and the AO Thoracolumbar Spine Injury Score (TL AOSIS) in guiding surgical decision-making for thoracolumbar fractures. The clinical and imaging data of 100 patients with thoracolumbar fractures admitted to our hospital between January 2021 and December 2023 were retrospectively analyzed. Two orthopedic surgeons, blinded to the patients' clinical outcomes, independently evaluated the cases using both scoring systems and provided treatment recommendations. Disagreements were resolved by a senior attending surgeon. Agreement between the two systems' treatment categories was quantified by weighted Cohen's κ with 95% confidence intervals from paired 3 × 3 cross-tabulations, and interobserver reliability was assessed before consensus adjudication. The two systems assigned the same treatment category in 86 of 100 patients (86.0%; unweighted κ = 0.773, 95% CI 0.666-0.881; linear-weighted κ = 0.820), with no significant asymmetry (McNemar-Bowker P = 0.160). Agreement was substantial in both the 57 neurologically intact patients (κ = 0.696) and the 43 patients with neurological impairment (κ = 0.619). Surgery was recommended by mTLICS versus TL AOSIS in 24.6% versus 19.2% of neurologically intact patients and in 90.7% versus 81.4% of those with neurological impairment. Interobserver reliability before consensus was substantial to high (linear-weighted κ = 0.88 for mTLICS and 0.75 for TL AOSIS). The two scoring systems showed substantial agreement in treatment recommendations. In burst fractures with intervertebral disc injury, mTLICS tended to assign cases to higher treatment categories than TL AOSIS, although these subgroup differences were not statistically significant. mTLICS and TL AOSIS show substantial concordance as decision-support tools for thoracolumbar fractures. For burst fractures with intervertebral disc involvement, mTLICS tends to recommend surgery more often, reflecting a difference in classification behaviour rather than a demonstrated clinical advantage. Because no outcome data were analysed, whether this tendency improves patient outcomes remains to be determined.
Understanding biological and race strategy characteristics of endurance track runners competing at benchmark events provides high-performance athletics programmes and coaches with valuable insight into what is required to succeed. The aim of this systematic review was to identify biological and race strategy characteristics investigated in elite able-bodied endurance track runners (Aim 1) and, where examined, highlight whether these characteristics could differentiate performance success within this elite cohort (Aim 2). For this systematic review, searches across EBSCOhost (Academic Search Complete, CINAHL Complete, MEDLINE Complete and SPORTDiscus), Scopus, PubMed and Web of Science were completed until May 2023. Searches also involved World Athletics Research Centre, New Studies in Athletics, handsearching and scanning of reference lists of included studies. Eligible studies were required to be published in English and have investigated performance-related biological or race strategy characteristics among senior able-bodied endurance track runners (800-10,000 m) capable of competing at benchmark events. Risk of bias of included studies was evaluated based on Sarmento et al.'s 16-item checklist. The review separated middle-distance runners (MDR) and long-distance runners (LDR), to account for the differing performance demands of these event groups. Studies were considered to address Aim 2 if they assessed for statistical associations between athlete characteristics and overall performance (e.g. race time) or compared characteristics between athletes with different competitive results (e.g. medallists and non-medallists). Thirty-nine articles were included in this review, with 23 and 21 of these articles relevant to MDR and LDR, respectively. The most commonly reported characteristics were related to anthropometry (7 studies for MDR and LDR), biomechanics (7 studies for LDR), pacing (9 and 10 studies for MDR and LDR, respectively), qualification pattern (6 studies for MDR) and benchmark performance relative to athlete history (9 and 7 studies for MDR and LDR, respectively). However, the diversity of biological characteristics investigated and the generally small sample sizes makes it difficult to define an optimal biological profile for elite endurance runners. In contrast, race strategy characteristics investigated often included larger sample sizes providing a better understanding, especially in relation to pacing and for middle-distance events qualification patterns. Further, studies investigating whether characteristics differentiate performance among elite endurance track runners indicate that the most successful runners consistently demonstrate superior finishing ability. This is reflected in faster speeds during at least one 100-m segment of the final 400 m of the race and the ability to complete the final segments of the race at a pace close to, or faster than, their season best or 32-month best performance. In long distance events, better performance was associated with faster personal best times across the previous 32 months, indicating that having a high-ranking recent best time may be a prerequisite for succeeding at benchmark events. Faster 10,000-m runners had lower body mass and smaller arm and calf circumferences, suggesting a potential advantage of having lower non-functional mass. In middle distance events, success was associated with achieving superior qualification positions in the heats and semi-final, highlighting the importance of tactical positioning and efficient progression through qualification rounds. Faster male 800-m runners had a technique characterised by longer contact times and more compliant spring mechanics which may allow athletes to maintain or elevate speed during the sprint finish. Biological and race strategy characteristics that profile elite endurance track runners and that, in several studies, showed association with performance success were discussed. These findings may assist high-performance athletics programmes and coaches in informing athlete development and investment. However, further research is required to establish a more holistic understanding of the biological profile of elite endurance track athletes and to determine which biological and race strategy characteristics may differentiate performance reliably among these elite runners.
The health care workforce faces challenges globally, including shortages driven by aging populations and workforce burnout, compounded by rapid technological and care delivery transformations. This article examines international case studies developed by the Future of Health, a global network of senior health leaders, to identify strategies for cultivating a resilient and adaptive health workforce. The authors highlight three key approaches: (1) harnessing technology to streamline clinical workflows and reduce administrative burden, (2) reforming existing roles to optimize skills and expand scope, and (3) introducing new professions to address emerging clinical and operational needs. Case examples include the use of artificial intelligence-powered ambient scribes to improve clinician documentation, the certification of caregivers, and the integration of medical data analysts into clinical teams. This analysis emphasizes the importance of fostering workforce trust, navigating regulatory and payment barriers, and deploying thoughtful change management. These strategies offer actionable guidance for policy makers, health system leaders, and clinicians seeking to create a flexible and efficient workforce able to meet evolving patient needs and technological advances.
Academic coaching in graduate medical education utilizes observation and individualized goal setting to promote self-directed learning and performance improvement. Most academic coaching models are hierarchical (i.e., senior coach and junior coachee). Peer coaching is a unique growth opportunity for academic coaching. However, facilitators and barriers to implementing peer coaching, as well as which clinical and professional domains could be most helpful, remain undefined. We aimed to explore the current attitudes, promoters, and barriers of peer coaching among pediatric residents participating in academic coaching. We conducted a cross-sectional descriptive study of all pediatric and child neurology residents at a freestanding children's hospital in 2025. Residents were anonymously surveyed on their current understanding, use of, and desire for further development of peer coaching. Residents were also allowed to indicate preference for a faculty or peer coach in thematic areas amenable to academic coaching. A total of 23/37 residents (62%) responded and represented all post-graduate years. Most respondents (70%) indicated prior participation in peer coaching, as coach or coachee, in a clinical setting. 73% reported peer coaching as a favorable experience and 86% expressed a desire for additional peer coaching training. Residents preferred peer coaches in thematic areas pertaining to time management (59%) and wellness (45%). Peer coaching may be acceptable to pediatric residents for augmenting faculty-led academic coaching programs and curricula focused on time management and wellness as opposed to clinical skills may be most welcomed. Programs should support the scheduling of coaching activities and ensure time is available to overcome barriers perceived by trainees.
IVR-Warehouse is an immersive virtual reality (IVR) educational game designed to train senior high technical students in warehouse safety, addressing the high incidence of occupational accidents in Taiwan's warehouse environments. The system enables learners to practice hazard identification and safety responses in a realistic, risk-free environment, thereby overcoming the logistical and safety limitations of real-world training. This study examined the relationship between task-specific IVR self-efficacy, extraneous cognitive load (ECL), VR operational cognitive load (OCL), and learning outcome. Structural equation modeling was applied to data collected from 167 participants. The results showed that task-specific IVR self-efficacy was negatively associated with both ECL and OCL, and that both forms of cognitive burden were negatively associated with learning outcome. Notably, OCL showed a stronger predictive effect than ECL, suggesting that operational demands, such as interface access, controller use, attention maintenance, and action sequencing, posed a greater challenge for learners than general system- or environment-related distractions. These findings highlight the importance of reducing operational burden and supporting learners' task-specific confidence to maximize the effectiveness of IVR-based warehouse safety training. These findings underscore the importance of managing content difficulty to maximize the effectiveness of IVR-based safety training.
Type 2 diabetes (T2D) is an increasingly important public health concern in Indonesia and is increasingly affecting adolescents at a growing rate due to lifestyle transitions and limited awareness. Evidence regarding adolescents' knowledge, attitudes, and practices (KAP) toward T2D in rural settings remains limited. This study assessed KAP levels related to T2D, identified sociodemographic factors associated with KAP outcomes, and examined interrelationships among KAP domains among rural Indonesian adolescents. A cross-sectional study was conducted from September 2024 to February 2025 among 1,546 senior high school students in Kampar Regency, Riau Province. Participants were selected using multistage cluster sampling. Data were collected using a validated KAP questionnaire (Cronbach's α = 0.725). Descriptive and inferential statistics, including Mann-Whitney U tests, Kruskal-Wallis tests, Spearman's rank correlations, and multiple linear regression analyses, were used to examine KAP outcomes and associated factors. Participants demonstrated limited knowledge regarding T2D, particularly related to risk factors, symptoms, and complications. Although attitudes toward diabetes prevention were generally positive, preventive practices remained suboptimal, especially regarding physical activity. Female gender, peri-urban school location, higher academic rank, extracurricular participation, and prior exposure to diabetes information were associated with higher KAP scores. Knowledge was moderately associated with attitude but only weakly associated with preventive practices. Rural adolescents demonstrated limited diabetes-related knowledge and suboptimal preventive behaviors despite generally positive attitudes toward T2D prevention. Several sociodemographic and school-related factors were associated with KAP outcomes. However, the weak relationship between knowledge and practice highlights a persistent gap between awareness and preventive behavior. School-based, peer-led, and after-school interventions that integrate education with behavioral reinforcement may strengthen diabetes prevention efforts among rural adolescents.
Introduction Surgical resection of intramedullary spinal cord tumors (IMSCTs) involves direct, albeit controlled, trauma to spinal cord tissue. Postoperative management after resection of IMSCTs can include elevated mean arterial pressure (MAP) to augment blood flow to the injured cord. We measured postoperative spinal cord perfusion pressure (SCPP) in five consecutive IMSCT cases and reviewed postoperative hemodynamic management in a continuous, single-surgeon series. Methods This study was conducted at Rush University Medical Center, Chicago, Illinois. All IMSCT patients who underwent surgical resection by the senior author over a 15-year period were reviewed. We reviewed all practices regarding postoperative MAP goals, vasopressor administration, and intensive care unit (ICU) stay. In five consecutive cases, we transduced intrathecal pressure (ITP) via lumbar drain (LD) to calculate SCPP (SCPP = MAP - ITP). Results Thirty-eight patients were reviewed. Twenty-nine patients were managed with postoperative MAP goals (76.3%) for 3.0 ± 1.4 days, with 2.5 ± 1.7 days in the ICU. Twelve patients required pressor administration (31.6%) for 0.9 ± 1.5 days. All patients with SCPP measurement had elevated MAP goals postoperatively, and 4 of 5 required pressor administration. Daily average ITP was normal for the duration of measurement; the highest ITP was measured postoperative days 0 and 1. All patients maintained normal (and significantly elevated) SCPP. Conclusions SCPP is maintained after resection of IMSCT tumors, primarily due to low ITP. Postoperative elevated MAP goals may be unnecessary, so long as normotension is maintained. Future prospective studies with correlated clinical outcomes are needed to confirm this principle.
Early decision-making in acute pancreatitis (AP) involves diagnostic confirmation, early severity triage, escalation thresholds, and initiation of guideline-concordant management under time pressure and incomplete information. Large language models (LLMs) may support structured bedside reasoning, but their clinical usefulness cannot be inferred from guideline knowledge alone. A cross-sectional, scenario-based comparative evaluation was conducted in January 2026 using 20 AP scenarios: 15 refined hypothetical vignettes and 5 de-identified, privacy-modified real-life case patterns. GPT-4, GPT-5, and Gemini received identical single-turn prompts. Model access was through OpenAI API gpt-4-0613, OpenAI API gpt-5, and Google Vertex AI Gemini 1.0 Pro; temperature was set to 0.0, and each prompt was repeated three times per model. Outputs were scored by two independent clinician-raters using a prespecified 1-5 ordinal rubric across guideline concordance, safety, actionability, and data-synthesis quality. Two senior board-certified surgeons independently generated expert reference pathways for comparison. GPT-5 achieved the highest guideline concordance (4.28 ± 0.38) and safety (4.20 ± 0.45) profiles. GPT-4 provided the clearest stepwise actionability (4.15 ± 0.48), whereas Gemini showed the strongest data-synthesis quality (4.22 ± 0.52). With deterministic settings, internal consistency across three repeated runs was 100%. All models demonstrated clinically relevant failure modes, particularly unwarranted certainty under missing data; this occurred in 12/20 GPT-4, 7/20 GPT-5, and 15/20 Gemini outputs. No model should be used as a stand-alone bedside decision-maker for AP. In this scenario-based early evaluation, GPT-5 was the most safety-aligned model, GPT-4 was the most operationally actionable, and Gemini was strongest for synthesis, but all require clinician oversight, prospective validation, and governance before clinical deployment.
Influenza infection can represent a key factor for functional decline and loss of independence among older adults. In France, over 600,000 seniors live in social institutions, including nursing homes (NH). Yet, real-world data on the place of influenza hospitalization in care pathway before institutionalization are scarce in France. This study described the care pathway of older adults hospitalized for influenza-like illness (ILI) before NH admission. A retrospective observational study based on the French National Health System (SNDS) was conducted. All patients aged ≥ 65 years who were admitted to a NH between the start of the 2018-2019 epidemic season and up to eight months after were identified. Those hospitalized for ILI within six months prior to institutionalization were included and followed for six months prior to and up to three months after NH admission. Demographic and clinical characteristics of patients were described. State sequence analysis (SSA) was used to identify clusters of patients based on healthcare events (e.g. hospitalizations, rehabilitation, and deaths) during follow-up. Among 119,869 NH admissions, 1,239 (1.1%) had prior ILI hospitalization. About 70% of patients had received influenza vaccination. Median age was 88 years; 64.6% were women; over 90% had at least one comorbidity, notably hypertension (75%) and neurodegenerative disorders (31.3%). After ILI-hospitalization, 31.2% of patients were transferred to rehabilitation before NH admission, and 8.4% were admitted directly to NH. SSA identified five patient clusters differing in vaccination rates, comorbidities and healthcare utilization. Cluster 1 and Cluster 2 were generally healthier and admitted to NH immediately after discharge (median 20.5-22.5 days). Cluster 3-5 had more comorbidities and were more frequently transferred to rehabilitation after discharge and before NH admission. The total cost to the French health insurance for these patients exceeded €20 million. Rehabilitation accounted for €9.6 million, ILI hospitalizations €6.0 million, and other hospitalizations (including cardiorespiratory) €4.3 million. This study explored the place of influenza in the care pathway of French older adults admitted to NH after ILI hospitalization. Findings underscore the important place of rehabilitation care following ILI hospitalization, specifically among adults with multiple comorbidities, highlighting the need for improving vaccination coverage among frail older adults to mitigate post‑ILI care burden.
The INHAND Project is a joint initiative of the societies of toxicologic pathology from Europe, the United Kingdom, Japan, and North America to standardize diagnostic nomenclature and criteria used in toxicologic studies. The INHAND initiative includes recommended nomenclature for evaluating histologic specimens from nonclinical studies involving laboratory animals including rodents, non-human primates, dogs, minipigs, rabbits, and fish. Specific terminology and criteria are derived from the consensus opinions of senior toxicologic pathologists and subject matter experts who have expertise in the different species of interest. The standardized nomenclature presented in this document is also available electronically on the internet (http://www.goreni.org/). Sources of material included government databases, including the Registry of Tumors in Lower Animals (RTLA), academia, and industrial laboratories throughout the world. This introduction provides context for 14 chapters, arranged by organ system, that define the INHAND nomenclature and diagnostic criteria for fish used in nonclinical studies. Additionally, the current introductory chapter describes both general features of INHAND methodology as well as elements characteristic of toxicologic fish studies. The latter includes fish study design and conduct; euthanasia, sampling, the histologic processing of fish tissues, and a general approach to evaluating fish studies.
To increase the proportion of preterm infants achieving acceptable positioning [Infant Positioning Assessment Tool (IPAT) Score ≥8] from baseline 6% to ≥75% within 6-9 mo. A quality improvement initiative was conducted in a tertiary teaching hospital's Neonatal Intensive Care Unit (NICU). Preterm infants (<37 wk) cared under radiant warmers/incubators were assessed daily using the validated IPAT Scoring (0-12) across six body domains. IPAT scoring was undertaken across shifts by trained "positioning champions" (senior residents and experienced nurses). Sequential PDSA cycles introduced staff training by Positioning Champions, IPAT cards, thicker nesting, a low-cost "Nest-in-Nest" bedsheet technique, onboard training, and supportive supervision. Of 210 infants [mean (SD) gestational age 32.78 (2.44) wk; mean (SD) birth weight 1.69 (0.55) kg], 1051 IPAT observations were collected. Acceptable positioning improved from 12/201 (6.0%) at baseline [median (IQR) IPAT 4 (2, 5)] to 88/302 (29.1%) after PDSA-1 [median (IQR) 6 (5, 8)], 194/301 (64.5%) after PDSA-2 [median (IQR) 8 (7, 9)], 56/71 (78.9%) after PDSA-3 [median (IQR) 9 (8, 10)], and 156/176 (88.6%) in the sustenance phase [median (IQR) 9 (9, 10)]. A stepwise, team-led package that pairs hands-on training with simple, locally made positioning support and continuous feedback can improve and sustain acceptable positioning in a resource-constrained NICU.
Evidence on neonatal consequences of scheduling elective caesarean section before 39 completed weeks is limited in Palestine. We evaluated neonatal outcomes by delivery mode and gestational timing in two hospitals. This retrospective cohort study used records from Al-Makassed Charitable Hospital, Jerusalem, and Al-Ahli Hospital, Hebron, from January 2021 to December 2024. Liveborn singleton infants delivered at 34 + 0 weeks or later were included and grouped as elective caesarean section late preterm, elective caesarean section early term, non-assisted spontaneous vaginal delivery late preterm, non-assisted spontaneous vaginal delivery early term, or elective caesarean section at 39 + 0 weeks or later. The primary outcome was composite neonatal morbidity. Multivariable logistic regression adjusted for neonatal, maternal, and hospital covariates. Among 8,364 infants, 3,347 were delivered by elective caesarean section; 2,569 (76.8%) occurred before 39 weeks. Composite morbidity was highest after late-preterm elective caesarean section (49.0%), followed by late-preterm vaginal birth (28.2%), early-term elective caesarean section (26.6%), elective caesarean section at 39 weeks or later (15.3%), and early-term vaginal birth (13.9%). Late-preterm elective caesarean section was independently associated with NICU admission, respiratory support, transient tachypnoea, respiratory distress syndrome requiring surfactant, hyperbilirubinaemia requiring treatment, and composite morbidity. Early-term elective caesarean section remained associated with composite morbidity. In this multicentre retrospective cohort, planned prelabour caesarean delivery before 39+0 weeks was associated with higher early neonatal morbidity, especially when performed in the late-preterm period. Because some late-preterm and early-term planned caesarean births may be medically indicated, these findings should be interpreted as support for careful documentation, senior review, and avoidance of non-medically indicated pre-39-week scheduling rather than as evidence that all earlier planned caesarean births should be deferred.
Patients leaving the hospital with severe infections requiring prolonged antibiotic treatment face significant risks without vigilant monitoring, especially where access to infectious disease specialists is limited. At HealthPartners, care after discharge was historically disjointed and often left to primary care providers to coordinate. In 2023, the health system's Antimicrobial Stewardship Program found 13 errors over 6 weeks across 5 hospitals, largely due to fragmented oversight and limited access to specialists. In response, the health system established a centralized complex outpatient antibiotic therapy program in 2024 to support discharged patients. Patients receiving antibiotic therapy for more than 2 weeks after discharge were compared pre intervention and post intervention. The mean duration of therapy was significantly shorter post intervention (50.3 days vs. 34.7 days (-15.6; 95% confidence interval [CI], -23.6 to -7.6). The mean hospital length of stay was 1.2 days shorter (95% CI, -2.4 to 0), with an estimated cost saving of US$575,520. A survey of hospital staff found that 96% reported increased confidence in patient care after the program was implemented. The cost of the necessary investments in structured oversight may be offset through reductions in hospital length of stay.
Irreversible and extensive pulmonary fibrosis caused by paraquat (PQ) poisoning is the main cause of death induced by PQ poisoning in developing countries. Studies have confirmed that epithelial-mesenchymal transition (EMT) contributes to the process of pulmonary interstitial fibrosis caused by PQ poisoning. Many studies have proved that a variety of miRNAs are involved in the occurrence and development of EMT. Through animal and cell experiments, we established the model of EMT on mouse lung and MLE-12 cell. We found that the expression of Regulator of G-protein signaling 2 (RGS2) was decreased in mice lung tissue and MLE-12 induced by PQ, and over-expressed/inhibited miR-9-8974-5p can decrease/increase the level of RGS2. We found that pirfenidone (PFD) can relieve PQ-induced EMT in mice lung tissue and MLE-12 cells. Meanwhile, we found that it had high expression of RGS2 in PFD group. Mimic/inhibited miR-9-8974-5p can aggravate or relieve the EMT with decreasing /increasing the level of RGS2. In conclusion, miR-9-8974-5p can mediate the pulmonary EMT induced by PQ by regulating RGS2. PFD exerts a potential therapeutic effect on PQ-induced pulmonary EMT by regulating miR-9-8974-5p/RGS2 expression.