Candida auris is an emerging yeast that is frequently resistant to antifungal drugs. C. auris can cause invasive infections associated with high mortality and can colonize patients asymptomatically, which facilitates transmission in health care settings. Since it was first reported in the United States in 2016, C. auris has been identified in multiple states, with increasing numbers of cases reported annually. Monitoring national trends in cases identified through clinical testing and screening for colonization is critical to guide infection prevention and control efforts. 2022-2024. State and jurisdictional health departments voluntarily report clinical and screening C. auris cases to CDC using standardized case definitions of the Council of State and Territorial Epidemiologists. Clinical cases are defined as detection of C. auris from specimens collected for diagnostic purposes; screening cases are defined as detection from colonization screening swabs. Cases were reported to CDC through the Research Electronic Data Capture (REDCap) or Data Collation and Integration for Public Health Event Response (DCIPHER) platforms. Data included patient age and sex, case type, specimen type (for clinical cases), health care facility type, Antimicrobial Resistance Laboratory Network geographic region, and specimen collection date. Analyses were descriptive and limited to cases with specimens collected during 2022-2024. During 2022-2024, a total of 13,507 clinical C. auris cases were reported to CDC, increasing from 2,882 in 2022 to 4,428 in 2023 and 6,197 in 2024, with smaller annual percentage increases over time (53.7% from 2022 to 2023 and 39.9% from 2023 to 2024). Most clinical cases occurred among adults aged ≥45 years (87.8%) and among males (61.0%). The most common specimen types among all clinical cases were urine (31.5%) and blood (30.2%); by year, the proportion of blood as the specimen type was 34.4% in 2022, 30.2% in 2023, and 25.6% in 2024. Most clinical cases were identified through specimens collected in acute care hospitals (76.6%) and long-term acute care hospitals (17.8%).During the same period, a total of 27,853 screening cases were reported to CDC, increasing from 6,226 in 2022 to 9,195 in 2023 and 12,432 in 2024. Screening cases most frequently occurred among adults aged ≥45 years (90.0%) and males (57.9%). Among cases with known facility type, the proportion of specimens collected in acute care hospitals increased from 24.7% in 2022 to 50.7% in 2024, whereas the proportion of specimens collected in long-term acute care hospitals decreased from 56.1% to 35.7% during the same period. The number of clinical and screening C. auris cases reported to CDC increased during 2022-2024, indicating ongoing transmission in U.S. health care settings. Although annual percentage increases in clinical cases declined over time, absolute case counts reported to CDC continued to rise. The increasing proportion of screening cases with specimens collected in acute care hospitals might reflect increased use of screening in acute care hospitals, including screening at admission. Because of increases in the number of reported C. auris cases, sustained infection prevention and control efforts in health care facilities, including adherence to transmission-based precautions, environmental disinfection with agents effective against C. auris, and communication of C. auris status during patient transfers remain essential to preventing clinical infections and colonization. Because this pathogen is frequently resistant to antifungal drugs, continued investment in laboratory capacity and surveillance, including antifungal susceptibility testing and screening of patients at high risk for C. auris infection, can support timely detection and guide prevention strategies. Ongoing public health coordination at federal, state, and local levels is critical to limit further spread and to address emerging antifungal drug resistance.

Long-term health care in Greece is covered by a variety of health structures. In contrast to other northern European countries, it is incomplete and fragmented or even absent. The demand for long-term care has been addressed through informal caregiving, provided by family members supporting voluntarily or caregivers getting informal compensation. In recent years, efforts have been made to restructure long-term health care and to introduce services and structures that are conducive to this purpose. In our country there is no corresponding planning or any support for informal care. The provision of informal care has multiple benefits, mainly financial and organizational, for patients, health systems and the state. Compared to Greece, other European countries support informal care through various financial, insurance and social benefits for its providers, thus favoring and facilitating their work. Given that the need for long-term health care and, by extension, the need for informal care will increase continuously and exponentially over time, it is important to recognize and meet the needs of informal caregivers and to formalize this form of care provision. The development of a policy of formal recognition of informal care and the establishment of supportive measures, such as financial assistance, insurance, and education will ensure the sustainability of long-term health care and the health system in general.

The Spanish long-term care system reaches majority of age: A narrative review of evidence and lessons obtained.

Real-world effectiveness and antibody responses of BNT162b2 vaccination in long-term care residents: A retrospective case-control study.

This study examined the main effect of marital status on depressive symptoms and the interactions of marital status with subjective economic status and social support among Japanese family caregivers. A cross-sectional web-based survey was conducted among 1,260 primary family caregivers aged 20 years or older, who provided care to their biological mother or father aged 65 or older and certified as requiring long-term care under Japan's long-term care insurance system. Depressive symptoms were assessed using the Japanese version of the Center for Epidemiological Studies Depression Scale (CES-D). Multivariable linear regression analyses were conducted to assess the association between marital status and depressive symptoms, including interaction terms for subjective economic status and social support. Additionally, stratified analyses were conducted by sex and age group to explore potential heterogeneity. Among the participants, 38.8% were unmarried. Unmarried caregivers initially exhibited significantly higher depressive symptoms; however, after adjusting for covariates, they demonstrated significantly lower depressive symptoms than married caregivers (B: -1.87; 95% CI: -3.44, -0.31). Interaction analyses indicated that depressive symptoms were significantly higher among unmarried caregivers who experienced greater economic hardship or lacked instrumental support (B: 1.28; 95% CI: 0.08, 2.48; B: -5.26; 95% CI: -9.48, -1.03, respectively). Stratified analyses suggested that these interactions were more evident among female caregivers and those aged < 60 years. Although unmarried caregivers experience lower depressive symptoms overall, those experiencing economic hardship and lacking instrumental support exhibited elevated depressive symptoms. These associations may be more pronounced in specific subgroups, particularly by sex and age. These findings highlight the importance of targeted financial and caregiving support for vulnerable caregivers.

The Gaylord Occupational Therapy Cognitive screen (GOT-Cog™) is a novel cognitive screening tool developed to support inpatient occupational therapy treatment planning. It has demonstrated excellent content, construct, and criterion validity, as well as good internal consistency. To assess GOT-Cog rater reliability and responsiveness. Repeated-measures design. GOT-Cog was administered to participants twice at admission and once at discharge. When different investigators collected the first two assessments, interrater reliability was tested; when collected by the same investigator, intrarater reliability was tested. The first and final GOT-Cog scores were used to assess responsiveness. Single long-term acute care hospital (LTACH). 192 participants, recruited from inpatients admitted with an order for occupational therapy services. GOT-Cog total score was the primary outcome measure. Rater reliability was evaluated using interclass correlation coefficients (ICCs); responsiveness was calculated using effect size and score change. Scale-level interrater reliability of GOT-Cog was moderate to good, ICC(2, 1) = .80 (95% confidence interval [CI] [.71, .87], r = .81, n = 87); intrarater reliability was good to excellent, ICC(2, 1) = .84 (95% CI [.76, .90], r = .86, n = 89). Domain-level rater reliability ranged from poor to excellent. A small effect size was demonstrated from admission to discharge (d = .37, n = 149) over a mean length of stay of 24.06 d (95% CI [20.70, 27.41]; n = 192). Previous findings are supported, which indicates that GOT-Cog has the validity and reliability needed to support its use in the LTACH setting with a mixed medically complex inpatient population. Plain-Language Summary: Conducted in the long-term care setting, this study explains how consistent the Gaylord Occupational Therapy Cognitive screen (GOT-Cog™) is when given to the same person, multiple times, and by the same or different people, as well as how sensitive it is to change over time. To test this, GOT-Cog was given to participants twice at inpatient admission and once at discharge. GOT-Cog was found to have moderate to good consistency when delivered by different people and good to excellent consistency when used by the same person. Over an average of 24 days, GOT-Cog showed a small level of change in participants who were tested admission and again at discharge.

Treatment fidelity in nursing education research: Striking a balance between rigor and real-world relevance as a contemporary challenge.

Dementia is a global health issue that affects medical and long-term care systems. The Dementia Support Care Team (DST) was introduced in Japan to support hospitalised patients through multidisciplinary care. Its impact on subsequent admissions remains unclear. This study evaluated associations between prior DST support and clinical characteristics. This retrospective observational study included patients admitted to Fujita Health University Hospital who received DST support. Patients were categorised into two groups based on prior DST support. Multiple regression analysis was performed using the log-transformed length of hospital stay as the dependent variable. Independent variables included age, sex, interval between admissions, laboratory data, and clinical variables. Propensity scores were estimated using logistic regression, with prior DST support as the dependent variable and age, serum albumin levels, 4AT score, interval between admissions, long-term care insurance use, nursing facility use, and history of dementia diagnosis as covariates. Propensity score matching was performed using 1:1 nearest-neighbour matching with a calliper width of 0.2 without replacement. Among 271 patients analysed, those with prior DST support had significantly shorter hospital stays (18.0 days [IQR: 10.0-29.0] vs. 26.0 days [IQR: 15.0-48.3]; p < 0.001). Multiple regression analysis showed that prior DST support (β = -0.34, 95% CI: -0.53 to -0.16), serum albumin levels (β = -0.35, 95% CI: -0.49 to -0.20), physical restraint (β = 0.21, 95% CI: 0.03 to 0.38), and living alone (β = 0.45, 95% CI: 0.14 to 0.77) were significantly associated with log-transformed length of hospital stay. After propensity score matching, hospital stays remained significantly shorter (20 days [IQR: 11-30] vs. 21 days [IQR: 15-42]; p = 0.037). Prior DST support was associated with shorter hospital stays and differences in clinical characteristics during subsequent hospitalisations.

To explore the elements of dignity in interaction and the residents' individual dignity from the viewpoint of staff in long-term care facilities. In-depth interviews were conducted twice with each participant using a hermeneutic phenomenological approach to understand staff experiences and clarify how they understood the meaning of dignity and dignified care. After theme generation, a panel of seven experts reviewed the themes. The previously established framework of the conceptual matrix derived from the residents' perspective was used to verify the applicability of the result. A total of 18 in-depth interviews were conducted with nine staff who worked at long-term care facilities. Mean age of participants was 36.8 years (SD = 5.9; range: 25-43); six were female (66.7%). A total of 944 codes were extracted from the interviews, and four themes were generated: "dignity in relation to family members, friends, society, and other residents"; "dignified direct care"; "dignified care by nursing care facilities and the nursing care system"; and "(residents') dignity developed over the life course." Dignity in interaction and the residents' individual dignity are perceived to be important to care staff. Comparing the elements of dignity extracted from interviews of care staff and those of residents, dignified care is defined by staff with more specific behaviors, responsibilities, and relationships. In long-term care, "dignity developed over the life course" is a subjective and unique dignity that is not easily influenced by others or the environment and is the background of dignity in interaction.

Patients with opioid use disorder (OUD) are frequently hospitalized and often need post-acute care, but face high rates of rejection from post-acute and long-term care (PALTC) facilities. This study aimed to assess the impact of an OUD consult service on referral success. Between 2021 and 2022, 381 hospitalized patients with OUD at a Midwestern academic medical center who were recommended for post-acute care were identified. The primary outcome was referral success (patient's discharge location matching the recommended form of post-acute care). Secondary outcomes included length of stay (LOS), medication for OUD (MOUD) initiation, and naloxone prescription on discharge. Regression analyses were conducted to compare patients who received an OUD consult (n = 207) and those who did not (n = 174). Rates of referral success for the consult and non-consult groups were 49.3% and 55.2%, respectively. When controlled for active OUD, insurance, housing, and prior-to-admission MOUD, receiving a consult did not predict referral success (P = .44). Admission to the hospital from a PALTC facility was a positive predictor of referral success (P < .001). Negative predictors included having active OUD (P < .001), being uninsured (P = .001), or having Medicaid (P = .008) or Medicare (P = .006). LOS was similar between groups (P = .18). Patients in the consult group were more likely to have started MOUD during admission (adjusted odds ratio [aOR] = 2.20, P < .001) and to discharge with naloxone (aOR = 1.48, P < .001). Receipt of an OUD consult did not improve rates of referral success, though this may be due to the non-random nature of the consult population. The low overall referral success rate highlights the need for a multifaceted approach to improve referral success.

Informal caregivers' preferences for self-care support services in caring for community-dwelling older adults with disabilities: A discrete choice experiment.

BackgroundLecanemab is the first approved disease-modified therapy in Japan for patients with mild cognitive impairment (MCI) due to Alzheimer's disease (AD) or mild AD dementia (AD-D).ObjectiveThis study aims to evaluate the social value of lecanemab in Japan.MethodsThe social value was evaluated using a cost-effectiveness model. The intervention was lecanemab added to the standard of care (SOC), and the comparator was SOC alone. The effect of lecanemab was determined based on the phase III trial and subsequent long-term follow-up observation studies. Health outcomes were quantified in life years and quality-adjusted life years (QALYs). Both patient and caregiver utilities were considered by summing the absolute values of utility for both the caregiver and patient. The base-case analysis was conducted from the public healthcare and long-term care payer's perspectives.ResultsLecanemab extended the time spent in early AD, thereby maintaining quality of life (QOL), reducing caregiver burden, and medical and long-term care resource usage. The incremental QALYs were 1.31 QALYs for MCI due to AD and 0.85 QALYs for mild AD-D, and the incremental cost-effectiveness ratios (ICERs) were JPY 8.5 million /QALY and JPY 7.9 million /QALY ($1 = JPY 150), respectively.ConclusionsThe value-based price or the ICER of lecanemab varied greatly depending on the perspectives and the methods of reflecting caregiver QOL. In AD, where the progression of the illness spans a long period and had a significant impact on families and society, narrowly defined value assessments were not sufficient, indicating the need to consider broader social value.

Rheumatoid arthritis (RA) is acommon chronic inflammatory disease and asystemic autoimmune disorder associated with increased morbidity and mortality due to multiorgan involvement. To summarize pathophysiology, clinical presentation, diagnostics and modern treatment strategies of RA, and to highlight its relevance for internal medicine. Narrative review of current literature, guidelines and clinical studies with afocus on clinically relevant aspects regarding diagnosis, treatment, and comorbidities. RA results from acomplex interaction of genetic predisposition and immune dysregulation leading to autoantibody formation and chronic inflammation. Clinically, it typically presents as symmetric polyarthritis, although early and atypical manifestations are common. Diagnosis is primarily clinical and is supported by serology and imaging. Early treatment following atreat-to-target strategy with disease-modifying anti-rheumatic drugs (DMARDs) enables remission in many patients. Comorbidities, particularly cardiovascular disease, significantly contribute to disease burden. RA requires early recognition, timely initiation of therapy, and interdisciplinary management. Internists play akey role in early diagnosis, risk stratification and long-term care.

Lung transplantation is conspicuously resource intensive, yet the carbon footprint of solid organ transplantation, and lung transplantation in particular, remains relatively unmapped. Moreover, there is growing evidence that climate change adversely affects lung transplant recipients, directly and indirectly. This review explores opportunities to integrate sustainable practices across the lung transplantation pathway, with the dual aims of reducing environmental impact and reducing recipient morbidity and mortality. Published literature outlines mitigation strategies to reduce the drivers of climate change, and adaptation strategies to modify the hazardous effects of the climate crisis on healthcare services. Opportunities to create "green chains" of transplant care start with appropriate recipient and donor selection, with both elements optimised to maximise operative success and avoid donor organ discard. The peri-operative phase offers scope for decarbonisation via the reduction of anaesthetic gas emissions, green procurement, and waste reduction. In the post-transplant phase, enhanced recovery after surgery (ERAS) programmes feed into longer term surveillance and care delivery, with increasing opportunities for telemedicine and noninvasive allograft monitoring, to reduce travel-related emissions. The co-ordinated adoption of low-carbon, sustainable practices within lung transplantation offers a meaningful opportunity to reduce environmental harm, enhance healthcare infrastructure and workforce resilience, and improve patient outcomes in a patient cohort vulnerable to climate change. Lessons can be drawn from the global surgery movement; however, it remains the responsibility of transplant practitioners to foster a culture of environmental advocacy and to implement systematic measurement and targets for climate change and health indicators.

Binge eating (BE) and addictive-like eating behaviors, as assessed by the Yale Food Addiction Scale (YFAS) may change following metabolic bariatric surgery (MBS), yet their long-term trajectories and relationship with weight recurrence remain unclear. We examined their prevalence, longitudinal course, and associations with weight outcomes seven years following sleeve gastrectomy (SG). Women who underwent primary SG (n = 62) were evaluated prospectively at baseline and at 3, 6, 12, and 24 months, and 7 years post-surgery. Addictive-like eating behaviors and BE were assessed using the YFAS and Binge Eating Scale (BES), respectively. Longitudinal changes and associations with 7-year weight recurrence from nadir were examined. Thirty women completed the 7-year follow-up. At baseline, addictive-like eating behaviors and BE were identified in 40.0% and 46.0% of participants, respectively. Prevalence declined at 6 months (addictive-like eating behaviors: 8.7%, BE: 10.6%), followed by a gradual increase by 7 years (addictive-like eating behaviors: 21.4%, BE: 26.9%). Baseline behaviors were not associated with weight recurrence at 7 years. In contrast, BE at 7 years was associated with greater weight recurrence from nadir (P = 0.015), whereas addictive-like eating behaviors were not. Although BE and addictive-like eating behaviors decline substantially during the early postoperative period following SG, both may gradually re-emerge over long-term follow-up. BE present at 7 years, but not addictive-like eating behaviors, was associated with significantly greater weight recurrence from nadir, underscoring the importance of sustained behavioral and psychological monitoring during long-term postoperative care.

Infections involving enteric bacteria commonly cause hospitalisation and death in long-term residential aged care (LTC) populations. The risk of such infections has been linked with antibiotic-associated depletion of gut anaerobic commensals and the resulting increase in asymptomatic carriage of gut pathobionts. We sought to determine how antibiotic characteristics, particularly activity against anaerobes, influence pathobiont prevalence in LTC residents. Stool samples from 164 LTC residents (median age: 87.9 years, interquartile range: 81.3-93.0 years) underwent metagenomic analysis. Associations between prior antibiotic exposures (categorised according to anaerobe coverage and type) and gut microbiome characteristics were explored using multivariable models. Of the 164 participants, 138 (84.1%) carried at least one enteric pathobiont. Compared to those with no prior antibiotic exposure, treatment with anaerobe covering (EAC) antibiotics was associated with higher rates of pathobiont carriage (β=1.36, P=0.010) and higher overall pathobiont relative abundance (β=3.53, P=0.013). In contrast, exposure to antibiotics with limited anaerobe coverage (LAC) showed no such associations. Investigation of commonly prescribed EAC and LAC antibiotics (amoxicillin-clavulanate and cefalexin, respectively) were consistent with these findings, with higher detection (β=1.60, P=0.007) and relative abundance (β=3.32, P=0.039) of pathobiont species in amoxicillin-clavulanate recipients. Pathobionts with greater representation included both species with inherent resistance (i.e. Enterococcus faecium) and sensitivity (i.e. Klebsiella pneumoniae) to amoxicillin-clavulanate. Antibiotics that deplete commensal anaerobes are associated with pathobiont prevalence in the gut, even where pathobiont species are sensitive to the administered antibiotic. Off-target disruption of commensal anaerobes should be considered when selecting antibiotic treatments, particularly for LTC individuals.

Nemaline myopathy (NM) is a rare childhood-onset neuromuscular disorder requiring long-term home care. Its progression places a significant emotional and physical burden on parents, especially without formal support. A descriptive phenomenological study was conducted with 17 parents of children diagnosed with nemaline myopathy in Spain. Data were collected through semi-structured interviews, transcribed verbatim and analysed using Giorgi's thematic analysis method. Four central themes emerged: (1) adapting to the unpredictable changes of the disease, in which parents described the need for continuous adaptation to evolving clinical demands; (2) living under continuous caregiving demands, reflecting the temporal, physical and emotional intensity of uninterrupted caregiving; (3) relief and uncertainty in shared care, where formal support services were experienced as essential yet unstable; and (4) when caregiving reorganizes family life, illustrating how caregiving responsibilities progressively reshaped parents' work, social participation and daily routines. Caring for a child with NM profoundly transforms family life. This study highlights the need for coordinated and parent-centered support to ensure sustainable care and protect parents' well-being in their role as caregivers.

Prophylactic Absorbable Antibiotic Beads in Groin Reconstruction Following Vascular Procedures.

Obesity and type 2 diabetes are major global health concerns associated with substantial clinical and economic burdens. Bariatric metabolic surgery (BMS) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) are effective interventions, but their long-term impact on health care utilization costs remains incompletely understood. To compare short- and long-term health care utilization costs among patients with obesity and diabetes treated with GLP-1RAs vs those who underwent BMS. This observational, retrospective cohort study used electronic medical records from Clalit Health Services, the largest health care organization in Israel. Adults (aged ≥24 years) with obesity (body mass index [BMI] ≥30) and diabetes who underwent their first BMS or initiated GLP-1RA therapy between January 1, 2010, and December 31, 2022, were identified. Propensity score matching yielded 2721 matched pairs, who were followed up for up to 12.5 years (mean [SD], 6.5 [3.5] years), through December 31, 2023. Data cleaning and analyses were conducted from June to October 2025. Treatment with GLP-1RAs or BMS. Health care utilization costs incurred by the health system, excluding costs of the index interventions. Attributable costs were estimated using a difference-in-differences approach and modeled with multivariable linear regression. The matched cohort included 5442 adults (mean [SD] age, 51 [10] years; 3243 women [59.6%]; mean [SD] BMI, 40.5 [6.0]). Mean (SD) monthly follow-up costs were higher among patients treated with GLP-1RAs than those who underwent BMS ($415.3 [$746.7] vs $304.9 [$628.5]). The adjusted difference-in-differences method showed $109.0 higher monthly costs per patient for GLP-1RA treatment (SE = $17.0; P < .001), associated primarily with hospitalization costs ($43.9; SE = $13.3; P = .001) and non-GLP-1 medication costs ($52.5; SE = $4.4; P < .001). Most cost differences accrued within the first 4 years. BMS was associated with greater early reductions in BMI and hemoglobin A1c, whereas GLP-1RA treatment showed more modest but sustained effects. This cohort study found that, among adults with obesity and diabetes, health care utilization costs were higher with GLP-1RA treatment than with BMS, excluding intervention costs, largely reflecting differences in early clinical trajectories. These findings suggest that, among patients eligible for both interventions, BMS may confer combined clinical and economic advantages over long-term follow-up.

To review contemporary evidence supporting selective laser trabeculoplasty (SLT) as an initial and longitudinal therapy for glaucoma and to examine its implications for clinical outcomes, functional disease control, and health system sustainability. Randomized clinical trials and extension studies have demonstrated that SLT-first strategies provide intraocular pressure (IOP) control comparable to medication-first therapy while substantially reducing treatment burden. In the Laser in Glaucoma and Ocular Hypertension (LiGHT) Trial, ∼70% of patients initially treated with SLT remained free from topical therapy and incisional surgery at 6 years. Secondary analyses revealed lower rates of moderate or fast visual field progression among eyes treated with SLT-first pathways compared with medication-first pathways (∼17% vs. 26%). Repeat SLT has been shown to produce IOP reductions similar to initial treatment without increased adverse events. Baseline IOP influences treatment response, with greater absolute pressure reductions observed in eyes with higher pretreatment IOP. SLT-first strategies have also been associated with lower cumulative costs and fewer surgical interventions over long-term follow-up. SLT has established itself as a cornerstone of early glaucoma management. By providing durable and repeatable IOP control, SLT-first strategies may reduce reliance on daily medications and improve functional disease stability. Ongoing studies will further elucidate the role and optimal timing of repeat SLT, refining its integration into long-term glaucoma care.