Patients' admission to different specialty wards (the so-called "outliers") due to a hospital bed shortage may significantly reduce the quality and safety of clinical care. However, data on clinical outcomes are limited, heterogeneous, and mainly retrospective. For this reason, we performed a prospective controlled study, the Survival and Safety Issues for Medical Outliers (SISIFO) study. We conducted the SISIFO study, a prospective, multicenter, controlled study to primarily evaluate clinical and safety outcomes in outliers from October 2018 to March 2020. Thirty-seven Italian Internal Medicine Units enrolled 2056 medically ill patients, 988 outliers, and 1068 controls. Overall, the median length of hospital stay was 10 days [interquartile range (IQR) 7-15]. The median stay in the different specialty wards was 2 days (IQR 2-4). The in-hospital mortality of outliers was significantly higher than that of controls (OR=2.1, 95% CI: 1.3-3.3) at multivariate analysis. Among outliers, modified early warning score (MEWS) >3, reduced mobility, and dysphagia at baseline were significantly associated with a higher risk of in-hospital death. No significant differences between "outliers" and controls were observed for secondary outcomes, including postdischarge 90-day mortality and readmission rate, requests for diagnostic tests, or specialist consultations. In-hospital adverse events presented some noteworthy findings. Our study suggests a significant increase in in-hospital mortality associated with admission to different specialty wards. Future studies should investigate the specific reasons for this finding.

Use of herbal and dietary supplements (HDS) is widespread among patients with chronic liver disease (CLD). Despite the potential for adverse effects (AEs) and drug interactions (ADRs), these products are often perceived as "natural," safe, and not requiring medical prescription. This study aimed to assess HDS, oligo and trace element consumption among patients with CLD, to examine sociodemographic correlates, to determine the extent to which use is overseen by general practitioners or specialists versus self-medication, and to document reasons for use and perceived benefits. Over a 6-month period, patients with CLD attending the outpatient clinic of the Internal Medicine and Hepatology Unit of the University Hospital of Palermo, along with their caregivers, were surveyed regarding their use of supplements. A self-administered questionnaire collected information on demographics, lifestyle habits, supplement use, motivations, perceived benefits, and prescription awareness. A total of 323 participants were enrolled: 220 (68.1%) were CLD patients and 103 (31.9%) were caregivers. Overall, 110 (34%) subjects, 39 patients and 71 caregivers, reported using at least one supplement. Consumption was slightly more frequent among caregivers than patients (37.9% vs 32.3% p = ns). Among users, HDS were the predominant products (87/110; 79.1%), followed by oligo and trace elements (36/110; 33.0%); 21/110 (19.1%) reported combined use. The most common reasons for supplement use were anxiety and sleep disorders (each 15/110; 13.6%), osteoporosis/osteoarthrosis (15/110; 13,6%), dyslipidemia (12/110; 10.9%), and dyspepsia (11/110; 10.0%). Compared with caregivers, patients more frequently used supplements for anemia (7.3%), anxiety (13.6%), and steatotic liver disease (7.3%). Perceived benefit was reported by 70.9% of users, whereas AEs and ADRs were uncommon (3.6%). Supplement consumption for liver steatosis was more common among males than females (14.3% vs 2.9%; p = 0.034). Osteoporosis-related supplement use showed a significant positive correlation with age (p = 0.019). Consumption of HDS, oligo and trace elements is common among CLD patients, and it increases with age. Their use appears driven by perceived health knowledge and a desire for well-being. Further studies are needed to enhance health education and prevent inappropriate or excessive use of these products.

Objective: The aim of this research was to determine the attitudes of nurses working in intensive care units maintaining the privacy of patients. Material and Methods: This research was planned as a descriptive and cross-sectional study. The sample consisted of 100 nurses working in the internal medicine and surgical intensive care units of a university hospital in the Marmara region of Turkey between November 2024 and March 2025, all of whom agreed to participate voluntarily. A Nurses’ Description Form and a Patient Privacy Scale were used to collect research data. Results: It was found that the nurses’ attitudes towards maintaining patient privacy were very positive (4.65±0.35), and that the highest score was obtained from the sub-dimension of bodily privacy (4.76±0.37). Significantly higher mean scores were found in the sub-dimension of sexually-related privacy of female nurses compared to male nurses, as well as in the overall Patient Privacy Scale mean scores and all its sub-dimensions for nurses who had read the patients’ rights management compared to those who had not (p

Delivering bad news to families of end-of-life (EOL) patients is a complex ethical and emotional task for nurses, particularly within culturally specific contexts. This study aimed to explore the lived experiences of Iranian nurses when communicating bad news to families of EOL patients. A qualitative design using conventional content analysis was employed. Semi-structured, in-depth interviews were conducted with 18 purposively selected nurses from intensive care, emergency, oncology, and internal medicine units of teaching hospitals in Tehran, Iran. Data were transcribed verbatim and analyzed through open coding, categorization, and abstraction to identify latent themes. A core process emerged "Navigating the Harsh Reality" comprising three categories: (1) Preparation: assessing family readiness, creating a calm environment, and strategic timing and pacing; (2) Conveying the Bitter Truth: conveying the clinical truth, preserving truthful compassion, and facilitating intra-family communication; and (3) Providing Solace: offering professional reassurance, and communicating with empathetic language. Iranian nurses employ a structured, culturally embedded three-phase approach to bad news delivery that integrates truthfulness with compassionate, family-centered care. These findings offer a foundation for developing culturally appropriate communication guidelines and training programs in EOL care settings in Iran and comparable cultural contexts.

Candida albicans remains the predominant cause of invasive candidiasis worldwide, yet comprehensive global analyses of its antifungal susceptibility trends remain scarce. In this decade-long study, we evaluated 6,342 C. albicans isolates collected between 2015 and 2024 through the Antimicrobial Testing Leadership and Surveillance global surveillance program, representing 41 countries across four continents. Europe accounted for more than half of all isolates, followed by North America, Asia-Western Pacific, and Latin America. The majority of isolates were derived from elderly and critically ill patients, particularly those hospitalized in internal medicine or intensive care units. Echinocandins and amphotericin B demonstrated sustained potency, maintaining low minimum inhibitory concentration (MIC)50/MIC90 values (0.015-0.03 mg/L and 0.5/1 mg/L, respectively) and ≥99% susceptibility throughout the surveillance period. In contrast, fluconazole and voriconazole exhibited broader MIC distributions and a subtle upward shift in MIC90 after 2022. Although global resistance rates remained below 1%, small numbers of resistant isolates were detected in several countries, including Greece (2.1%, n = 1), Belgium (1.1%, n = 4), Ireland (0.7%, n = 2), Turkey (0.5%, n = 2) and the United States (0.3%, n = 10). Temporal analysis further revealed a gradual increase in azole non-wild-type isolates from 2019 to 2024, while echinocandin susceptibility remained stable. These findings confirm that C. albicans remains broadly susceptible to frontline antifungal agents, yet the observed low-magnitude shifts and localized increases underscore the value of continued standardized surveillance and cautious, region-informed stewardship.

International guidelines support the One Health approach and recommend antimicrobial stewardship programmes (ASPs) in veterinary medicine. National data on antimicrobial-resistant bacterial colonisation rates (AMRb CR) in horses remain limited. To evaluate the effectiveness of an ASP in reducing AMRb CR in a Veterinary Teaching Hospital using a clinical audit. Clinical audit. In Autumn 2021 active AMR surveillance in Perinatology/Reproduction and Internal Medicine Units planned; January-July 2022-first audit cycle (A1); Autumn 2022-review and implementation of antimicrobial use and biosecurity policies; January-July 2023-re-audit (A2) after ASP application. In total, 328 hospitalised horses (foals and adults) were included. Nasal and rectal swabs collected at admission/birth and discharge/euthanasia/death were tested for methicillin-resistant Staphylococci (MRS), third-generation cephalosporins-resistant Gram-negative bacteria (3GCR-GNB) and carbapenem-resistant Gram-negative bacteria (CR-GNB). Fisher's exact test and Mann-Whitney U test evaluated differences in AMRb CR, antimicrobial use, and hospitalisation length between A1 and A2. In A2, there was a significant reduction in overall AMRb CR (foals: OR = 0.27, 95% CI 0-0.87, p = 0.03; adults: OR = 0.39, 95% CI 0-0.77, p = 0.01), in MRS CR (foals: OR = 0.30, 95% CI 0-0.57, p < 0.001; adults OR = 0.42, 95% CI 0-0.83, p = 0.01), in 3GCR-GNB CR (adults: OR = 0.47, 95% CI 0-0.89, p = 0.02; total: OR = 0.53, 95% CI 0-0.87, p = 0.01), and in CR-GNB CR (foals: OR = 0.26, 95% CI 0-0.90, p = 0.03; total: OR = 0.24, 95% CI 0-0.78, p = 0.02). Highest priority critically important antimicrobials use decreased (foals: OR = 0.17, 95% CI 0-0.41, p < 0.001; total: OR = 0.20, 95% CI 0-0.43, p < 0.001), as did antibiotic treatment duration (foals: A1 7.75 ± 11.5, A2 3.70 ± 4.63 days, p < 0.001; adults:A1 3.70 ± 4.63, A2 0.74 ± 2.27 days, p = 0.04), and hospitalisation length (foals ≤30 days old: A1 18.1 ± 18.9, A2 9.77 ± 7.01 days, p = 0.05; total: A1 16.0 ± 15.1, A2 12.6 ± 11.4 days, p = 0.03). Lack of genotypic analysis and exclusion of the surgery unit. This clinical audit confirms the effectiveness of the implemented ASP and supports its adoption in comparable veterinary settings.

This study evaluates the efficacy of a post-discharge follow-up program in patients recovering from acute heart failure (AHF) hospitalized in internal medicine (IM) and in cardiology (CA) wards. Patients hospitalized for AHF between October 2020 and November 2022 at a third-level center were retrospectively analyzed according to their hospitalization ward in CA vs IM. Patients deemed eligible for inclusion were ≥ 18years-old and hospitalized for AHF. Only patients discharged alive were included in the post-AHF follow-up program. The primary endpoint was a composite of time to first HF hospitalization or cardiovascular (CV) death at 6months, while secondary endpoints were its individual components, all-cause death and a composite of time to first HF hospitalization or all-cause mortality at 6months. Out of 230 patients, 122 were hospitalized in CA and 108 in IM wards. Patients hospitalized in CA were younger and less frequently affected by extra-cardiac comorbidities compared to patients managed in IM. At 6months, no difference in the primary endpoint was registered in the two groups (IM 16.6% N = 18 vs CA 13.1% N = 16, log-rank p = 0.425; IR 37.5 per 100 p/y CI 23.7-59.6 vs 28.4 per 100 p/y CI 17.4-46.5; p = 0.523). Moreover, the cohorts did not differ for any of the secondary endpoints. A secondary analysis according both to ward of hospitalization and ejection fraction (> 40% vs ≤ 40%) did not show any significant difference in the primary composite outcome between the subgroups. In this single-center retrospective cohort study, no significant differences in the risk of major adverse CV events were observed between patients hospitalized in CA and IM wards during mid-term follow-up after enrollment in a post-AHF follow-up program.

Although growing attention has been drawn to alcohol-related heart damage, several clinical aspects, including prevalence and outcome of alcoholic cardiomyopathy (ACM) and atrial fibrillation (AF) in patients with alcohol use disorder (AUD) remain elusive. This study investigated the clinical impact of ACM and AF on AUD patients in the setting of an internal medicine unit. We retrospectively analyzed 291 consecutive patients admitted for AUD at a single specialized center for AUD diagnosis and treatment, affiliated with an internal medicine unit. We included patients who underwent echocardiographic evaluation following hospital admission. Demographic data, comorbidities, alcohol-related organ damage, and ECG findings were collected to diagnose AF and ACM and to assess their clinical impact. Among 291 patients undergoing echocardiography and ECG, 239 were males (82.1%). They were categorized into patients with (n = 42, Group A) and without ACM (n = 249, Group B). The prevalence of ACM was 14.4%, whereas AF was found in 19.1%. ACM patients were asymptomatic in 28.6% of cases. Among comorbidities, significant differences were observed in the prevalence of type 2 diabetes (7.1% in Group A, 21.2% in Group B, p = 0.0329). Risk of mortality was significantly influenced by AF, but not by ACM. A significant proportion of AUD inpatients were diagnosed with ACM (about 14%, 95% men) and AF (19.1%, 88.9% men), which only affected mortality. Notably, more than a quarter of ACM patients were asymptomatic for heart failure supporting the value of echocardiographic assessment even when overt heart failure was absent. By survival analysis, AF rather than ACM emerged as an adverse prognostic factor. These findings support a structured cardiac evaluation in hospitalized patients with AUD.

This pre-post implementation audit aimed to evaluate adherence to the I-PASS (illness severity, patient summary, action list, situation awareness and contingency planning, and synthesis by receiver) handoff framework before and after an educational intervention in the Internal Medicine Department at Ribat Teaching Hospital. Effective patient handover is critical for continuity and quality of care, and miscommunication during transitions is a major contributor to preventable harm. While structured tools such as I-PASS have improved handoff quality in high‑resource settings, evidence from low‑resource environments, including Sudan, remains limited. Teaching hospitals in Sudan face overcrowding, workforce shortages, and fragmented information systems, which increase the risk of communication errors. This exploratory quasi-experimental pre-post implementation audit was conducted in one Internal Medicine Unit at Ribat Teaching Hospital, Khartoum, Sudan. All handoffs for inpatients requiring close monitoring during the study period were eligible. Two cycles of observation were completed. In each cycle, adherence to the five I‑PASS elements was recorded using a checklist during live verbal handoffs. Between cycles, a structured educational program on I‑PASS was delivered to unit staff. Data were analyzed descriptively, and Fisher's exact test was used to compare adherence proportions between cycles. A total of 105 handoffs were observed (55 in cycle one and 50 in cycle two). In cycle one, adherence varied across I‑PASS elements: illness severity 22/55 (40%), patient summary 37/55 (67%), action plan 55/55 (100%), situational awareness 20/55 (36%), and synthesis by receiver 37/55 (67%). After the educational implementation, adherence improved for most elements: illness severity 43/50 (86%; p<0.001), patient summary 44/50 (88%; p=0.019), action plan 50/50 (100%; p=1.000), situational awareness 42/50 (84%; p<0.001), and synthesis by receiver 48/50 (96%; p<0.001). The I‑PASS framework was feasible to implement in a low‑resource internal medicine unit and was associated with improved short‑term adherence to structured handoff elements after targeted education. The study did not measure adverse events or error rates; therefore, no conclusions can be drawn about the impact of I‑PASS on patient safety. Longer‑term, multi‑unit evaluations incorporating safety outcomes and potential confounders are warranted.

Assessment of decision-making capacity and guardianship in hospitalized patients represents a critical interface between forensic psychiatry, clinical medicine, and law. In Turkiye, such evaluations are frequently requested by courts or notaries; however, empirical data describing their forensic characteristics remain limited. This study examined hospitalized patients referred for forensic psychiatric evaluation of decision-making capacity and guardianship and identified factors influencing medico-legal outcomes. This retrospective study included all inpatient consultations requested for forensic psychiatric evaluation between January 2018 and June 2025 at a university hospital. Sociodemographic characteristics, referring departments, psychiatric diagnoses, Mini-Mental State Examination (MMSE) scores, and forensic psychiatric opinions were extracted from electronic medical records. Eighty forensic psychiatric evaluations were analyzed, including 51 assessments for addressing decision-making capacity for power of attorney and 29 related to guardianship. The mean age was 70.7 ± 14.1 years, and 56.3% of patients were male. Most referrals originated from Internal Medicine and Intensive Care units. Among capacity evaluations, 74.5% of patients possessed decision-making capacity, while 19.6% lacked capacity. Patients assessed as possessing capacity had significantly higher MMSE scores than those assessed as lacking capacity (25.88 ± 2.37 vs. 19.33 ± 2.34; p < 0.001). Guardianship-related evaluations were mainly associated with mental disorders due to acute brain injury. In this acute hospital setting, lack of decision-making capacity was most commonly associated with delirium and dementia, whereas guardianship considerations primarily involved patients with acute brain injury or severe medical illness. These findings underscore the distinct clinical profiles underlying forensic capacity and guardianship evaluations in hospitalized populations.

Few data are available regarding the adherence to treatment guidelines in individuals with type 2 diabetes mellitus (T2DM) admitted to Internal Medicine Wards (IMW) while no information is available concerning the possible efficacy of an educational intervention aimed at improving adherence in this setting. To explore guidelines adherence and the associated impact on glycemic control in subjects with T2DM hospitalized in IMW before and after an educational intervention, we conducted a 3-phase, cluster-randomized, multicenter study. During Phase 1, we retrospectively collected data from patients with T2DM hospitalized for any cause in IMW for ≥5days. In Phase 2, an educational training, based on the method of the educational outreach visits (EOV), was developed in 36 out of the 54 centers involved. In Phase 3, conducted 6months after the training, we replicated the collection of data performed in Phase 1. Overall, we analyzed data from 1909 and 1662 individuals with T2DM during Phase 1 and Phase 3 of the study, respectively. No changes were observed in the difference between mean fasting glycemia levels at discharge vs at admission in Phase 3 comparing EOV vs NO EOV groups. A statistically significant increase in adherence to guidelines was observed from Phase 1 to Phase 3 and a trend toward higher adherence was detected when comparing the EOV and the no EOV groups. A structured educational intervention improves adherence to guidelines for managing T2DM in individuals admitted to IMW but has no effect on short-term glycemic control.

Orthostatic hypotension (OH) is common yet frequently underrecognized in older adults and in patients with arterial hypertension (AH). OH is associated with falls, cardiovascular (CV) events, cognitive decline, and mortality. Despite guideline recommendations, orthostatic blood pressure (BP) measurement is not systematically performed in internal medicine wards. The objective of the study protocol is to estimate the prevalence of OH in hypertensive patients hospitalized in internal medicine units, to identify clinical factors independently associated with OH, and to evaluate the prognostic impact of OH on long-term outcomes. The HYP-OP Study is a national, multicenter, prospective, observational cohort study conducted in approximately 30 internal medicine units in Italy. Overall, 1000 consecutive adult patients with known hypertension or newly diagnosed AH during hospitalization were enrolled. BP and heart rate were measured after at least 5 minutes of rest in the seated position and again after standing for 1 and 3 minutes according to a standardized protocol. During the hospitalization, demographic, clinical, laboratory, cognitive (Mini-Mental State Examination), frailty/physical performance (Short Physical Performance Battery), comorbidity burden (Charlson Comorbidity Index), and pharmacological data were collected. Follow-up was scheduled at 6, 12, 24, and 36 months after discharge to assess falls, major CV events (stroke, transient ischemic attack, myocardial infarction, arrhythmias), and all-cause mortality. The primary endpoint is the prevalence of OH and the identification, through multivariate analysis, of clinical factors independently associated with OH. Secondary analyses will assess the prognostic value of OH for subsequent falls, major CV events, and mortality. The HYP-OP Study will provide contemporary, real-world data on the burden, clinical correlates, and prognostic significance of OH in hypertensive patients hospitalized in internal medicine wards and may support more consistent implementation of orthostatic BP assessment in routine practice.

Digital health technologies such as electronic health records, clinical decision support systems, and reminder mechanisms are increasingly integrated into nursing practice to enhance patient safety and support clinical decision-making. While these systems function as behavioral nudges intended to guide clinical actions, sustained exposure to frequent alerts and reminders may generate unintended cognitive and emotional consequences for nurses. Although alarm fatigue has been widely studied, broader experiences related to continuous digital nudging in nursing practice remain underexplored. This study employed a qualitative descriptive design to explore the experiences of nurses providing direct patient care in surgical and internal medicine units with digital clinical alerts and reminder systems. Semi-structured interviews were conducted with nurses working in medical, surgical, and intensive care units of a university hospital. Data were analyzed using thematic analysis following Braun and Clarke’s framework. Five main themes were identified: (1) perceived clinical value of digital alert systems, (2) alert fatigue and cognitive burden, (3) alarm fatigue and perceived clinical risk, (4) professional experience, autonomy, and job satisfaction, and (5) expectations for system improvement. While participants acknowledged the role of alerts in supporting patient safety and workflow organization, they also reported cognitive overload, emotional exhaustion, desensitization, and concerns about reduced professional autonomy associated with persistent digital prompting. The findings highlight behavioral nudge fatigue as a broader extension of alarm fatigue, capturing the cumulative cognitive, emotional, and professional impact of sustained digital nudging in nursing practice. Addressing behavioral nudge fatigue through human-centered system design and greater involvement of nurses in alert governance may support both nurse well-being and patient safety in increasingly digitalized healthcare environments.

Hospital discharge is a critical moment for patients and their families in the transition between hospital and community care. Early discharge planning is a healthcare strategy aimed at improving coordination between hospital and community services to ensure a safe transition of care, ultimately leading to better health outcomes. The early identification of patients needing Social Work assessment is essential. The absence of clinical screening tools for Social Work compromises equity and access to social healthcare and an integrated, interdisciplinary plan. This study aims to evaluate the suitability of the SWAAT scale in a sample of hospitalized patients within the Portuguese context. The scale comprises six items: mobility, mental state, living situation, active social services at the time of assessment, self-perceived need for additional post-discharge care services, and early identification of social needs. Based on scores, patients are categorized as having low, intermediate, or high need for Social Work assessment. The SWAAT scale was applied to 435 patients admitted to two Internal Medicine Units. With the intervention stratification score for Social Work as the dependent variable, the analysis found a significant positive correlation with hospital readmissions (r = .150, p &lt; .001) and a large positive correlation with social work needs (r = .526, p &lt; .001). However, no significant association was observed between therapeutic intervention and the score (r = .018, p = .353). Integrating the SWAAT scale into clinical practice within the National Health System can enhance effectiveness and equity in health through an interdisciplinary approach with Social Work, promoting integrated care, especially for chronic, complex, and more vulnerable patients. This study confirms the scale's suitability in the Portuguese context and addresses a gap in the objectivity of clinical signaling.

The growing aging trend associated with a higher prevalence of chronic illnesses and increased vulnerability of older adults during hospitalization highlights the need for a person-centered approach in healthcare. This approach emphasizes patient involvement in the healthcare process, fosters shared decision-making and mutual understanding, and honors individual values, preferences, and beliefs. Despite broad consensus on the importance of adopting this clinical practice paradigm, its implementation remains challenging. Person-centeredness understanding of those involved in the therapeutic relationship may significantly impact the development of person-centered practice (PCP) in specific care settings. This study aims to compare and analyze the perceptions of the PCP among a multidisciplinary team and older adults with chronic illnesses hospitalized in a Portuguese internal medicine unit using the Person-Centered Practice Inventory (PCPI). PCPI is an instrument aligned with the theoretical elements of the Person-Centered Practice Framework (PCPF), offering an understanding of its practice, identifying areas of potential improvement, and designing specific interventions to elevate the PCP operationalization. A quantitative, descriptive, cross-sectional approach was followed. A sociodemographic and professional questionnaire and the PCPI-Staff were used for health professionals. For older adults, a sociodemographic and health history questionnaire and the PCPI-Care were applied. Both versions of the PCPI evaluate the person-centered processes domain derived from the PCPF. A descriptive analysis of the effect of different variables on each construct of the person-centered process was performed using an analysis of variance (ANOVA). The independent sample t-test was applied to compare health professionals' and hospitalized older adults' perceptions of care. The results showed that the person-centered process dimension was positively perceived by health professionals (M= 4.08; SD= 0.62) and older adults (M= 3.92; SD= 0.47). For health professionals, the highest-scored construct was working holistically (M= 4.22; SD= 0.62), and the lowest was sharing decision-making (M= 3.91; SD= 0.72). Concerning older adults, the highest-scored construct was working with the person's beliefs and values (M= 4.12; SD= 0.51), and the lowest was working holistically (M= 3.68; SD= 0.70) and sharing decision-making (M= 3.78; SD= 0.60). A significant difference occurs in the perception of working holistically (t(273)= 6.12, p-value= &lt;0.001) and engaging authentically (t(273)= 3.05, p-value= 0.03), showing differences in how care is delivered and experienced through the integration of physiological, psychological, sociocultural, developmental, and spiritual dimensions in a therapeutic relationship that should be dynamic and genuine. No significant effect of the independent variables was found to influence the perceptions of any constructs in the person-centered processes domain in health professionals and hospitalized older adults. These results suggest that each person uniquely experiences person-centered processes through individualized therapeutic relationships rather than as a pattern of care shared by hospitalized older adults. Differences in how working holistically and engaging authentically are perceived should propel health professionals to reassess their understanding of person-centered practice, seek guidance, and actively work to refine their approaches in these areas. This process can help align the perceptions of their work with patients' care experiences, promoting greater consistency between professional intentions and patient outcomes.

To map the extent of advanced practice physiotherapy (APP) integration in Danish hospitals and explore the roles and characteristics of these models of care. Cross-sectional survey. All hospitals in Denmark (secondary care). Representatives from all 36 Danish hospitals were contacted; 31 responded (86 % response rate). Not applicable. Prevalence and duration of APP models, departmental placement, scope of responsibilities, and any required education or competencies. Seventeen of the 31 respondent hospitals (55 %) reported having APP roles. The mean duration of APP integration was 9.7 years. Most APP models were located in orthopaedic departments, although they were also present in rheumatology, internal medicine, and acute medical units. Common APP functions included initial patient examination, triage, ordering diagnostic imaging, establishing medical diagnoses, and, in some settings, performing injections or fracture repositioning. Less frequently reported functions included ultrasound examinations and cast application. All respondents noted continuous access to physician consultation. Considerable regional variation was observed in both the departmental integration of APP and the range of responsibilities undertaken by APP clinicians. Approximately half of Danish hospitals reported established APP roles, indicating broader uptake than previously captured by global surveys. The observed variability across regions and departments underscores the need for standardized guidelines, further research on clinical effectiveness, and clarification of required competencies. Understanding these factors may help optimize APP implementation and improve patient access to timely and effective musculoskeletal and general healthcare.

Antibiotics prescribing patterns and association with system-specific pathologies in equine veterinary practice: Insights from a 12-year study at a veterinary teaching hospital.

Patient safety has been a universal reference in modern hospital practices. In Indonesia, efforts to prevent Patient Safety Incidents—such as Near Misses, Incidents, Adverse Events, and Unsafe Conditions—have been a priority in hospital safety systems. In Nusa Tenggara Barat (NTB), the incidence rate of Patient Safety Incidents is 4.8%. Army Hospital Wira Bhakti Mataram, a military hospital in NTB, plays a significant role in providing healthcare services. The hospital conducts patient safety surveys every six months to monitor and improve safety standards. This study aims to analyze the relationship between patient safety culture and patient safety incidents in the Internal Medicine Unit of Army Hospital Wira Bhakti Mataram. A quantitative analysis method with a cross-sectional approach was used. The study involved a total sample of 82 nurses, collected through in-depth interviews. The results indicate a significant relationship between patient safety culture and patient safety incidents, with a p-value of 0.003. These findings highlight the importance of fostering a strong patient safety culture to reduce incidents and improve overall healthcare quality.

Background: In internal medicine, the management of type 2 diabetes mellitus (T2DM) is challenged by multimorbidity and polypharmacy. The fixed-dose combination of sitagliptin and extended-release metformin (SITA/MET ER) is a valuable option for frail and comorbid patients. Methods: This multicenter, retrospective, observational study involved five Italian Internal Medicine units. Consecutive patients with T2DM who initiated SITA/MET ER were included. Demographic, clinical, and laboratory data were collected at baseline (T0) and at follow-up (T1, 3-4 months). The primary endpoint was change in HbA1c; secondary endpoints included fasting plasma glucose (FPG), treatment adherence, adverse events, and modifications in concomitant antidiabetic therapies. Results: A total of 292 patients (mean age 70.8 ± 10.6 years; 43% female) were analyzed. At baseline, mean HbA1c was 7.4 ± 1.0% and FPG 150.2 ± 42.5 mg/dL, with significant reductions observed at follow-up (HbA1c 7.0 ± 0.8%, FPG 136.8 ± 29.6 mg/dL; both p < 0.05). SITA/MET ER was predominantly prescribed to patients with a complex clinical profile, as reflected by the high prevalence of microvascular (37%) and macrovascular (42%) complications. The use of sulfonylureas decreased from 11% to 3% (p < 0.001), while SGLT2 inhibitor and insulin use remained stable. Treatment adherence to SITA/MET ER was excellent, with full compliance reported and no adverse events recorded. Conclusions: In this real-world internal medicine study, SITA/MET ER improved glycemic control and was well tolerated among patients with complex clinical profiles. These findings support the role of SITA/MET ER as a flexible and practical therapeutic choice in this setting.

Delirium in elderly inpatients needs to be prevented being associated with worse clinical outcome and higher cost burden.Effects of a structured intervention aimed at cognitive stimulation and reorientation to prevent delirium occurrence were tested. A nonrandomized stepped-wedge study was conducted. Patients were consecutively enrolled from 07/05/2024 to 03/10/2024 at an Internal Medicine Unit. Eligibility was verified based on inclusion criteria: age ≥ 65years; hospitalization at the Unit; and exclusion criteria: personal history of dementia or cognitive impairment; delirium at admission. Demographic and clinical data were collected at enrollment. Delirium was assessed daily via the 4AT. Inpatients received a protocol-driven intervention aimed at cognitive stimulation and reorientation (cases) or usual care (controls). The intervention was administered daily from day 1 of hospitalization to discharge. A total of 222 subjects were evaluated (104 received the intervention, 118 had usual care). Males and females were equally distributed (54 males under the intervention, 62 males under usual care). Mean age was 81·54 ± 8·28 yrs among those who received the intervention and 81·24 ± 8·84 yrs among those under usual care. The two groups differed for delirium incidence: 7·69% (n = 8) among those who received the intervention and 22·03% (n = 26) among those who received usual care. The findings of the pilot study should be interpreted as preliminary feasibility results rather than evidence of efficacy. They need replication in larger samples, being promising in terms of implementation of the intervention in real life of Internal Medicine Units.