Purpose The Systemic Immune-Inflammation Index (SII) shows promise as a biomarker to assess immune status and inflammation, but its utility in predicting surgical site infections (SSIs) among HIV-infected patients remains underexplored. To evaluate SII’s predictive value for SSI risk in HIV-positive surgical patients in China, suggesting an effective clinical tool for this population. Methods This multicenter retrospective cohort study included HIV-infected patients with fractures from three hospitals. Baseline data on demographics, HIV metrics, comorbidities, and surgical details were collected. Univariate and multivariate logistic regression analyses examined the relationship between preoperative SII and postoperative SSIs, adjusting for potential confounders like age, gender, CD4 count, viral load, and comorbidities. Results Of 338 HIV patients, 36 (10.65%) developed postoperative SSIs. SSI patients had significantly higher SII levels. Bivariate logistic regression analysis showed that HIV viral load, open fracture, albumin, CD4, CD4/CD8 ratio and SII were risk factors for surgical site infection in HIV-positive patients. Multivariate analysis confirmed SII as an independent predictor of SSI (OR = 3.28, 95% CI = 2.07–5.54). SII showed good discriminatory performance (AUC = 0.810) and performed better than the CD4/CD8 ratio (AUC = 0.689), which was included as a representative immune-status marker. Subgroup analyses validated SII’s stability across patient subsets. Further, smooth curve fitting and RCS analysis showed that there was still a linear correlation between SII and surgical site infection in different subgroups of CD4 and HIV viral load (P for nonlinear > 0.05). Conclusions The SII may serve as a clinically accessible and cost-effective biomarker for identifying HIV-infected patients at increased risk of SSI. Incorporating preoperative SII assessment could support perioperative risk stratification and management. This novel approach has implications for optimizing patient care for HIV-positive surgical populations.

This study aimed to analyze patient outcomes in the emergency departments (EDs) during the peak of the pandemic in 2020, focusing on mortality and disposition, utilizing National Emergency Department Sample (NEDS) data. For this study, we included patients aged 18 and older who presented to the ED and were diagnosed with COVID-19, in 2020. Patient records were analyzed using SAS and Python softwares. Chi-squared tests and logistic regression models were utilized, with statistical significance set at p < 0.05. The study examined 2,863,207 COVID-19 patients out of 111,683,248 patient visits to the ED. There was a slight preponderance of females (52.6%) compared with males (47.4%), with the majority of patients being 50-69years old (34%). Females exhibited significantly lower odds of mortality compared with males, with an OR of 0.7 (p < 0.001). Those aged 70 and above (p < 0.001), and Black individuals exhibited significantly higher odds of mortality in the ED (p < 0.001). Our study aims to guide equitable interventions and resource allocation to optimize patient care and mitigate healthcare disparities, particularly by improving access through the ED and better preparing for the future, including other waves of COVID-19 infection with newer variants.

Health care impact of comprehensive genomic profiling of solid tumors in patient management using POWER (Precision Oncology at Western University).

Abstract Background Hip fractures represent a significant global health burden, leading to substantial morbidity, mortality, and healthcare costs. Delays in surgical intervention are consistently linked to poorer patient outcomes. This audit aimed to evaluate and enhance hip fracture management at Southampton General Hospital (SGH) through targeted quality improvement initiatives. Methods An interventional clinical audit was conducted at SGH, a Major Trauma Centre, comparing a pre-intervention period (December 2023—March 2024; n = 272 patients) with a post-intervention period (September 2024—December 2024; n = 291 patients). The methodology adhered to NICE guidelines. Data were collected via consecutive sampling from the National Hip Fracture Database (NHFD), Pathpoint eTrauma, and CHARTS/EDMS. Interventions focused on increasing surgical capacity (e.g. additional theatre allocation, dedicated hip fracture team), implementing comprehensive multidisciplinary medical evaluation, optimising imaging, addressing pre-existing conditions, standardising anticoagulation reversal, and improving overall patient care. Mean operating times, 30-day mortality rates, and length of hospital stay (LOS) were assessed and compared between cycles. Results The overall average patient age was 84 years. In the pre-intervention cycle, the mean operating time was 80 hours, with a 30-day mortality rate of 4.7%. Surgical delays affected 57.4% of patients. Post-intervention, the mean operating time significantly decreased to 55 hours, and the 30-day mortality rate reduced to 3.0%, notably lower than the national average of 5.9% for the same period. Despite these improvements, the proportion of delayed surgeries increased slightly to 63.9%. A key finding was that in the post-intervention cycle, an equal number of patients (n = 6) died in both the non-delayed (5.7%) and delayed (3.2%) groups, suggesting that enhanced medical optimisation during delays contributed to improved outcomes. Delays consistently correlated with prolonged LOS in both cycles. Conclusion Targeted quality improvement initiatives at SGH significantly reduced the average time to hip fracture surgery and improved overall mortality rates. The crucial role of comprehensive medical stabilisation in mitigating mortality risks, even when leading to surgical delays, was evident. Despite systemic challenges inherent to a major trauma centre, these interventions demonstrate a positive impact on patient outcomes. Ongoing efforts should focus on sustainable theatre capacity, streamlined diagnostic pathways, and continuous auditing to optimise patient care.

BackgroundMental disorders are responsible for a significant proportion of global health burden especially in developing countries. In sub-Saharan Africa optimum care for mental health patients is constrained by frequent drug stock-outs. Patients who are victims of drug stock-outs are compelled to seek coping mechanisms to this challenge. These coping mechanisms may either be adaptive or maladaptive. Consequently, persons living with mental illnesses are prone to experiencing undesirable outcomes. This study purposed to explore coping mechanisms to drug stock-outs among patients seeking care at an outpatient department (OPD) of a national mental healthcare facility in Kampala, Uganda.MethodsThis was an observational cross-sectional study. A sample size of 385 was obtained by systematic random sampling. Data was collected using a checklist and a questionnaire. The data was analyzed using SPSS version 29. Numerical variables were presented with means and standard deviations. Categorical variables were presented as frequencies and percentages. The results of the study were presented in tables, pie-charts and graphs.ResultsLess than half of the participants; 164/385(42.60%), had their prescriptions fully filled with an average prescription fulfillment rate of 66.36%. Majority of the patients were victims of drug stock-outs. The most popular coping mechanisms were; out-of-pocket purchase of prescribed drugs from pharmacies, patients returning to hospital on a later date, skipping drug doses and using unprescribed herbal remedies. The commonest undesirable outcomes of coping mechanisms were; worsening of symptoms, insomnia and relapse of signs and symptoms.ConclusionDrug stock-outs could have been responsible for low prescription fulfillment rates. This most likely prompted numerous patients to resort to alternative treatment modalities. These unprescribed treatment modalities could jeopardize patient prognosis and overall safety.

This article addresses the successful wound management case of a male patient in his early 60s with a necrotising parapharyngeal abscess, by a wound care nurse in a home-based care setting with very limited resources. The case study emphasises the necessity for clearly defined legal roles for non-physician wound care clinicians in Indonesia, where resource constraints demand innovative approaches. While not advocating for a direct replacement of physicians, the case study calls for an exploration of a broader scope of practice for wound care nurse practitioners. Further research is required for the establishment of a comprehensive scope of practice for wound care nurses in Indonesia, ensuring optimal patient care while safeguarding professionals from legal complications.

Metabolic and bariatric surgery (MBS) is a highly effective treatment for patients with obesity, with increasing prevalence in France. However, some patients require revisional MBS (RMBS) due to suboptimal initial response, recurrent weight gain, and correction of technique-related complications. Understanding the prevalence and risks associated with RMBS is essential for optimizing patient care. This study aims to assess the rate of RMBS in France and to delineate the associated complications and risk factors. France. Using national discharge data from 2016 to 2022, this observational study compared morbidity and mortality rates between primary and RMBS. Patient demographics, comorbidities, and procedural details were analyzed. Major complications within 90 days post-surgery were assessed using logistic regression models adjusted for potential confounders. Among 284,271 bariatric procedures analyzed, the revision rate was 12.8%. Patients undergoing RMBS were older, predominantly female, and had more comorbidities compared to those undergoing primary procedures. RMBS were associated with significantly higher rates of severe complications (OR 1.58, 95% CI 1.49-1.68, p < 0.001), particularly after gastric bypass (GB) (OR 2.70, 95% CI 2.27-3.20). Subgroup analyses showed increased morbidity following revisional sleeve gastrectomy compared to primary procedures. This study highlights a notable rate of RMBS in France, with evolving trends towards more complex revisions. RMBS are associated with increased morbidity, emphasizing the need for careful patient selection and enhanced postoperative management. Further research into surgical techniques, long-term pharmacological interventions, and surgeon expertise is warranted to optimize outcomes in this population.

Neuroimmune interactions in musculoskeletal conditions. An introduction for clinicians.

Surgical Management and Outcomes of Intradural Spinal Metastases.

An Overview of Nocebo Adverse Events in Clinical Trials.

In sub-Saharan Africa, type 1 diabetes is typically diagnosed clinically, which can be challenging due to atypical diabetes presentations such as ketosis-prone type 2 diabetes or type 2 diabetes in the absence of overweight and obesity. C-peptide, a marker of residual insulin secretion capacity, is crucial for understanding these variations but understudied in the region. Here, we investigated whether C-peptide measurement and concomitant genetic, autoimmune and metabolic characterisation of individuals with clinically diagnosed type 1 diabetes confirm diabetes classification and highlight population-specific features. In this case-control study from Ghana, we recruited 266 individuals with clinically diagnosed and insulin-treated long-term type 1 diabetes and 266 healthy control individuals. We compared clinical features, HLA class II haplotypes, autoantibodies, and inflammatory and metabolic serum profiles across control and patient groups classified by random C-peptide levels: low (<0.2 nmol/l), mid (0.2-0.6 nmol/l) and high (>0.6 nmol/l). Only 28.9% of individuals with clinically diagnosed type 1 diabetes had low C-peptide concentrations. They were the youngest and leanest group, with higher frequencies of HLA class II risk haplotypes and GAD and ZnT8 autoantibodies compared with all other groups. By contrast, 34.6% and 36.5% had mid-range or high C-peptide levels, respectively. These subgroups resembled the control group in terms of low autoantibody titres and one protective HLA class II haplotype. Ketosis at onset was most prevalent in individuals with high C-peptide. Serum proinflammatory biomarkers differed between individuals with diabetes and control participants, but not between C-peptide subgroups. Aromatic and branched-chain amino acids varied between diabetes subgroups and positively correlated with C-peptide levels. Maintained C-peptide levels in two-thirds of individuals with long-term type 1 diabetes in Ghana, combined with the absence of autoantibodies and HLA risk association, highlight the necessity for better differentiation from atypical diabetes presentations to optimise patient care and improve health outcomes in resource-limited settings.

Contemporary structures, processes, and outcomes of critical care nursing education: An integrative review.

SAH is a frequent intracranial finding in patients with trauma and poses significant diagnostic and prognostic challenges. Identifying which patients need closer follow-up because of potential complications of posttraumatic SAH is important because the need for serial imaging is debated. The purpose of this study was to evaluate the rate of posttraumatic subarachnoid hemorrhage enlargement, identify predictors of hemorrhage progression and need for surgical intervention, and propose a risk-stratified approach to follow-up imaging in trauma patients. This retrospective study analyzed 32,401 trauma-related NCCT scans from 2 trauma centers during 6 years, identifying 250 cases of traumatic SAH. Patient demographics, clinical presentation, imaging characteristics, and follow-up data were reviewed. Univariate, bivariate, logistic, and linear regression analyses were performed to determine predictors of SAH enlargement and the need for surgical intervention. Among patients with SAH, 64% were 65 years of age or older, and falls were the most common injury mechanism (66.8%). SAH enlargement occurred in 40/222 (18%) cases that had follow-up CT and was significantly associated with intraparenchymal hemorrhage (IPH), elevated international normalized ratio and prothrombin time, and lower Glasgow Coma Scale scores. Surgical intervention was more commonly required in cases with midline shift or severe traumatic brain injury (Glasgow Coma Scale 3-8). Aneurysms were present in 11/114 patients who underwent CTA, with 9 believed to be the cause of the traumatic episode. Traumatic SAH is often stable in patients without coexistent hemorrhages or coagulopathy. Risk factors such as IPH and elevated international normalized ratio and prothrombin time should guide follow-up imaging and intervention decisions. A tailored imaging protocol based on risk stratification may optimize patient care while reducing unnecessary imaging.

Cancer has become a major public health problem in Cameroon. In 2020, 20,000 new cases and 14,000 deaths were registered. Despite its high burden, access to quality medications for this condition continues to be a persistent challenge in the country. This study assessed the perceptions and practices of key stakeholders on barriers to accessing quality anticancer medicines in Cameroon. The overall goal was to generate data on key challenges related to the quality of anticancer medications and their impact on cancer care and treatment in Cameroon. This is to inform policy and interventions aimed at addressing the problem. In a cross-sectional qualitative study, a document review of key reports and documents, and 57 stakeholders were purposively identified and interviewed. The choice of these respondents was informed by their engagements in one of the areas of the chemotherapy supply chain in Cameroon, including regulation, procurement, quality control, and use. Data from document notes and interviews were analyzed using a thematic approach. Several factors were identified as affecting the quality of chemotherapy medications, including weak regulatory systems, inadequate funding for regulatory activities, and a lack of core competencies among staff responsible for regulatory functions. Other factors included the high cost of anticancer medications, which influenced accessibility to quality products, as well as the quality of care offered to patients who could not afford high-priced products. These weaknesses, coupled with a lack of point-of-care tools, appear to encourage the proliferation of substandard medicines in our setting and the use of substandard therapies or protocols to treat patients. Our study sheds light on the multifaceted problems that plague Cameroon's chemotherapy supply chain and how these impact access to optimal care and treatment for cancer patients. Urgent actions are needed to enhance the regulatory landscape and improve the affordability of quality anticancer medications in Cameroon.

Emergency departments (ED) receive significant scrutiny regarding their function and processes, as the ED is typically the initial hospital entry point for patients. Process improvement initiatives have been shown to improve ED performance metrics. However, these initiatives are often carried out as individual projects rather than comprehensive program redesigns. Therefore, this study aimed to determine if a novel model created with the principles of design-thinking improved patient experience and flow metrics in several EDs within a hospital system. A multi-faceted approach was developed focusing on both culture and performance within 7 EDs. The PEOPLE+model was developed, which comprises 5 key areas of focus: philosophy, economics, operational architecture, providers, and leadership. The PEOPLE+model served as the framework that prioritized all providers, supported staff, optimized patient care, and embraced adaptability and continuous improvement. Left without being seen (LWBS), left against medical advice, emergency medical services volume, diversion hours, visit volume, patient experience, admit volume, length of stay (LOS) discharged, LOS admitted, median door-to-provider time, patient door to provider time <30minutes, total transfers, total boarders, and total boarder hours were compared 22 months before to 24 months post-implementation. Following the partnership, there were statistically significant improvements in LWBS (-80.0%; P < .001), leaving against medical advice (-17.6%; P < .001), diversion hours (-95.6%; P < .001), patient experience (+250.7%; P < .001), LOS discharged (-24.2%; P < .001), LOS admitted (-16.9%; P < .001), median door-to-provider time (-55.2%; P < .001), and patient door to provider <30minutes (+51.5%; P < .001). LWBS (-47.4%; P < .001), diversion hours (≤-84.6%; P ≤ .025), and median door-to-provider time (≤ -31.3%; P < .001) during the second, third, and fourth post-6-month time frames were significantly lower compared to the first 6 months following the partnership, whereas leaving against medical advice (≤-27.8%; P ≤ .013) and LOS discharged (≤ -12.8%; P ≤ .042) during the third and fourth 6-month time frames were significantly lower compared to the first 6 months following the partnership. Conversely, patient experience (≥+36.5%; P ≤ .040) and patient door-to-provider <30minutes (≥+18.1%; P < .001) during the second, third, and fourth 6-month time frames were significantly greater compared to the first 6 months following the partnership. Changes to philosophic, economic, operational, leadership, and staffing models highlighted by provider ownership and direct provider involvement in developing and executing changes allowed ED performance metrics to significantly improve.

Dermatofibrosarcoma protuberans (DFSP) is an uncommon soft tissue tumor that poses significant diagnostic and management challenges. In resource-limited settings such as Libya, insufficient awareness and limited diagnostic facilities may contribute to frequent misdiagnosis and delayed treatment. This study aimed to assess healthcare professionals’ experience, diagnostic approaches, and management strategies for DFSP in Libya. A cross-sectional survey was conducted among 213 healthcare professionals, including dermatologists, surgeons, oncologists, pathologists, radiologists, and general practitioners from various regions of Libya. Data were collected using a standardized questionnaire covering demographic characteristics, experience with DFSP, diagnostic methods, treatment practices, perceived challenges, and recommendations for improvement. Among participants, 65.7% had previously encountered DFSP cases, and 79.8% reported familiarity with the disease. Misdiagnosis was common, with lipoma (39.9%), keloid (23.5%), and dermatofibroma (18.8%) being the most frequent initial incorrect diagnoses. Biopsy with histopathological examination was the primary diagnostic method (61.0%), while 43.2% routinely used immunohistochemistry (IHC), most commonly CD34 (37.6%). The majority of respondents (65.7%) believed that DFSP is often misdiagnosed in Libya. Preferred treatment modalities included wide local excision (56.3%) and Mohs micrographic surgery (23.5%). Major challenges identified were late diagnosis (46.9%), limited diagnostic resources (37.6%), and insufficient clinician awareness (32.9%). The most frequently suggested improvements were organizing training programs and workshops (70.4%) and enhancing diagnostic facilities (56.3%). Specialty and years of professional experience were significantly associated with disease familiarity and use of IHC (p &lt; 0.05). This study highlights substantial diagnostic and management challenges related to DFSP in Libya, primarily due to limited awareness and inadequate diagnostic infrastructure. Targeted training initiatives, improved access to diagnostic tools, and the development of national management guidelines are essential to promote early diagnosis and optimal patient care.

Nursing rounds are one of the important methods to improve the quality of nursing services in hospitals, especially in enhancing communication among nurses and optimizing patient care. However, the implementation of nursing rounds at Bajawa Regional General Hospital has not been carried out optimally, which is suspected to be influenced by low nurse work motivation. This study aims to determine the influence of nurses’ work motivation in inpatient wards on the implementation of nursing rounds at Bajawa Regional General Hospital. This study used a quantitative method with a cross-sectional approach. The population consisted of 108 nurses working in inpatient wards, with a sample of 51 respondents selected using simple random sampling. Data were collected through questionnaires and analyzed using the Chi-Square test. The results showed that most nurses had high work motivation (84.3%) and implemented nursing rounds (94.1%). Statistical analysis showed a significant relationship between work motivation and the implementation of nursing rounds (p = 0.012; OR = 0,071). There is a significant influence between nurses’ work motivation and the implementation of nursing rounds in inpatient wards at Bajawa Regional General Hospital. It is recommended that hospital management enhance nurses’ motivation through continuous support, recognition, and supervision to optimize nursing round implementation.

ABSTRACT Introduction Eustachian tube dilation (ETD) is an increasingly popular and seemingly safe method of treating ETD. We present a rare case of subcutaneous emphysema and pneumomediastinum following ETD. Methods Retrospective chart review. Patient consent was obtained for data collection, analysis, drafting, and publication of information. Results A 33‐year‐old male presented to the emergency department with acute facial swelling 1 day after treatment for bilateral eustachian tube dysfunction with bilateral ETD and pressure equalization tube (PET) insertion by an otolaryngologist at an outside facility. Symptoms began after he tried to pop his ears. He had extensive crepitus throughout his face, neck, and chest bilaterally with intact and patent PETs. Flexible laryngoscopy revealed a patent airway and no evidence of mucosal injury. Computed tomography demonstrated extensive subcutaneous emphysema extending from the chest to the skull base along with pneumomediastinum. The patient was admitted for observation given these findings and ultimately discharged without requiring any surgical intervention. No recurrent symptoms were noted in the subsequent post‐operative period. Discussion This case illustrates a rare but important complication of ETD, where mucosal injury within the Eustachian tube likely facilitated air dissection into deep cervical and mediastinal fascial planes. While subcutaneous emphysema and pneumomediastinum are typically self‐limiting, awareness of anatomical pathways, appropriate imaging, and conservative management strategies are essential for optimal patient care. As ETD gains wider acceptance, further research is needed to characterize risk factors and preventative measures for these complications.

ABSTRACTOvarian sex cord‐stromal tumor with annular tubules (SCTAT) is a rare neoplasm with distinct clinicopathological features in its sporadic and syndromic forms, the latter commonly associated with Peutz‐Jeghers syndrome. Although imaging may suggest a sex cord‐stromal origin, definitive diagnosis relies on histopathological examination. SCTAT primarily affects young women, and fertility‐sparing surgery is typically preferred, often producing favorable outcomes. Nevertheless, the risk of recurrence remains significant, necessitating long‐term follow‐up. We report the case of an asymptomatic 36‐year‐old woman whose routine pelvic ultrasound detected a unilateral, solid, and vascularized right adnexal mass. Further imaging strongly suggested a stromal tumor, which was confirmed as SCTAT by histology after fertility‐sparing laparoscopic salpingo‐oophorectomy. No adjuvant treatment was given, and genetic testing ruled out Peutz‐Jeghers syndrome. At six months postoperatively, there was no evidence of recurrence or tumor marker elevation. This case, the second reported SCTAT in Portugal, highlights the importance of multidisciplinary management and vigilant surveillance for optimal patient care.

Interventional radiology provides effective and minimally invasive means of treating a broad variety of emergency conditions such as bleeding, ischaemia or sepsis. Availability of 24/7 emergency interventional radiology care is an important prerequisite for optimal patient care. It is often lifesaving with generally low complication rates and excellent outcomes; however, safe and sustainable provision of interventional radiology care on a 24/7 basis requires efficient organisation and adequate infrastructure. This document will define the minimum structural and organisational standards required for the safe and sustainable delivery of emergency interventional radiology care on a 24/7 basis, depending on the spectrum of emergencies intended to be treated. CIRSE Standards of Practice documents are not intended to impose a standard of clinical patient care, but recommend a reasonable approach to, and best practices for, the provision of care. The writing group was established by the CIRSE Standards of Practice Committee and consisted of eight clinicians with internationally recognised expertise in emergency interventional radiology. The writing group reviewed the existing literature on emergency interventional radiology, performing a pragmatic evidence search using PubMed to search for publications in English and relating to human subjects preferably published from 2010 to 2025. The final recommendations were formulated through consensus. Interventional radiology has a well-established role in the successful management of a broad variety of emergency conditions. This Standards of Practice document provides up-to-date recommendations for the safe and sustainable delivery of 24/7 emergency interventional radiology care.