Preoperative anxiety is associated with postoperative cardiovascular events, extubation delay, and pain in patients undergoing cardiac surgery: A prospective observational study in Taiwan.

Despite numerous efforts to reduce the elevated mortality rate of patients with stroke admitted to the hospital during weekends or nights, it remains unclear whether the off-hour treatment has been improved. We aim to assess the treatment delay and outcomes of patients with stroke admitted to the hospital during off-hours. Searches were conducted of PubMed, Embase, Medline, and Web of Science from inception to July 2022. Cohort studies reporting the door-to-treatment time, short-term mortality rate, and 90-day function of adult patients with stroke admitted to the hospital on weekends or at night were included. A random-effect meta-analysis model was applied to pool the odds ratio (OR) and mean difference with 95% CI. A total of 84 studies were included. Treatment delay on weekends or nights was significant, with extended door-to-needle time (mean difference, 5.93 [95% CI, 1.88-9.98] minutes) and door-to-groin time (mean difference, 13.54 [95% CI, 5.02-22.06] minutes). Off-hour patients were less likely to receive intravenous thrombolysis within 60 minutes (OR, 0.65 [95% CI, 0.46-0.92]). Off-hour admission was associated with an increased short-term mortality rate for patients with ischemic stroke (OR, 1.07 [95% CI, 1.03-1.11]), intracerebral hemorrhage (OR, 1.10 [95% CI, 1.03-1.18]), and subarachnoid hemorrhage (OR, 1.05 [95% CI, 1.02-1.09]). This review indicates that off-hour admission was associated with treatment delay and increased risk of stroke death. Patients with stroke admitted on weekends and nights may require more attention, especially those with more severe and complex conditions.

This study aimed to determine whether deaf patients experience barriers to orthopedic care compared with hearing patients through evaluating time to appointment, appointment denial rates, and interpreter availability. Researchers called 132 randomly selected US orthopedic offices to request appointments for fictitious patients with distal radius fractures. Each office was called twice on the same weekday over different weeks-once for a hearing patient and once for a deaf patient communicating in American Sign Language (ASL). The primary outcome was time to appointment. Secondary analysis included provider type, ASL interpreter availability, interpreter modality, and requests for family interpretation. Differences in time to appointment with P values were determined using Wilcoxon signed-rank, Mann-Whitney U, and Kruskal-Wallis tests. Data from 132 clinics (63 academic and 69 community/private practices) were analyzed. The time to appointment for patients across all regions, practices, and providers was 3.9 days. Deaf patients experienced significantly longer wait times for physician appointments (4.96 vs 3.32 days, P value: .0031). When considering all providers (physicians, nurse practitioners, and physician associates), deaf patients did not wait significantly longer (4.43 vs 3.38 days, P value: .06). Most offices (81.8%) offered interpreters, with academic institutions more likely to guarantee ASL interpretation (95.5%) than community/private practices (68.2%). Some offices (17.9%) requested family members interpret instead. Distal radius fractures are common, and evidence suggests prompt care results in better outcomes and quicker return-to-work time. This study demonstrates statistically but not necessarily clinically significant delays for deaf patients seeking surgical appointments with MDs and reliance on ad hoc interpreters.

This study aims to determine the delay in treatment of road traffic injuries in the ED during the COVID-19 pandemic. Out of 373 RTI patients, the majority were males (312, 83.6%), and the mean ± SD age was 32.2 ± 17.4. Most injuries were fractures in the upper & lower limbs (236, 63.3%), and 302 (81.0%) underwent surgery. Of 373, 74 (19.8%) RTI patients were positive for COVID-19. The mean ± SD number of hours from ED arrival to treatment start in COVID-19 positive patients was 10.9 ± 6.7, while 6.4 ± 1.6 in negative patients. About 65% of the patients had a delay in treatment (n = 242). After 30 days of follow-up, 21 (5.6%) patients were dead. The adjusted odds of delay in treatment of RTI patients were 1.80 times (95% CI 1.27-2.45) in males compared to females. The adjusted odds of treatment delays in COVID-19 positive patients were 1.47 times (95% CI 1.13-1.92) compared to negative patients.

Pulmonary Tuberculosis (PTB) remains a major public health issue in Nepal and is among the top ten causes of death from a single infectious agent globally. Diagnostic delay refers to the time lag between the onset of symptoms and the confirmation of a correct diagnosis. Delayed diagnosis increases disease severity, prolongs infectivity, and hinders timely treatment. This study aimed to identify factors contributing to diagnostic delays of PTB in Chitwan district, Nepal. A cross-sectional study was conducted among 317 PTB patients receiving Directly-Observed Therapy short-course (DOTS) treatment across all DOTS centers in Chitwan district, using complete enumerative sampling. Data were collected using a semi-structured questionnaire through face-to-face interviews, then analyzed using SPSS version 22 with descriptive and multivariate analysis at a 95% confidence level. Of the 317 PTB patients, 42.6% experienced patient delay, 33.8% health system delay, and 58% total delay. The median delays were 25 days (patient), 5 days (health system), and 30 days (total). Self-medication significantly increased the likelihood of patient delay (AOR = 5.893, 95% CI: 2.133–16.285), as did lack of TB knowledge (AOR = 3.355, 95% CI: 1.603–7.018), poor economic status (AOR = 2.149, 95% CI: 1.109–4.162), and domestic preoccupation (AOR = 2.017, 95% CI: 1.154–3.528). Health system delay was strongly associated with a lack of trained health workers (AOR = 66.202, 95% CI: 27.070–161.906), poor quality services (AOR = 1.102, 95% CI: 1.102–11.078), and distant health facilities (AOR = 4.830, 95% CI: 1.554–15.017). The study identified significant diagnostic delays in Pulmonary Tuberculosis, primarily influenced by self-medication, poor TB knowledge, low socioeconomic status, lack of trained health workers and domestic responsibilities. The findings emphasize the need for community awareness, socioeconomic support, and strengthened primary health services to promote early diagnosis and timely treatment for effective TB control.

Factors of emergency medical services call delay and its impact on prognosis in STEMI patients: Findings from the CCA database-chest pain center registry.

The aim was to investigate reasons for a pre-hospital delay in patients with acute ischemic stroke (AIS) and patients within the thrombolytic window who did not receive thrombolysis. This study was conducted on AIS patients admitted to the stroke center through interviews and questionnaires. Of the 160 consecutive patients included, 67 (41.9%) arrived at the emergency department (ED) within 4.5 h, and 93 (58.1%) were delayed. The early arrival patients had shorter median onset-to-arrival times (P < 0.001). Of the 93 delayed patients, 70 (75.3%) were unaware of the occurrence of a stroke, and 17 (18.3%) had the stroke onset during sleeping. Multivariate logistic regression analysis showed that private car [odds ratio (OR) 4.310, 95% confidence interval (CI) 1.732-10.728] and other traffic tools (OR 6.189, 95%CI 1.843-20.786) were independent of a delayed arrival, whereas symptomatic remission, symptomatic aggravation, education of stroke, and the Oxfordshire Community Stroke Project classification were independently related to early arriving at the hospital after a stroke. Of the 67 patients, 33 (49.3%) who arrived within the window time did not receive thrombolytic therapy. Except for minor stroke (n = 9/27.3%) and contradictions (n = 2/6.1%), the main reasons for pre-hospital delay were patients' refusal (n = 12/36.4%) and misdiagnosis on the part of the physician due to atypical symptoms (n = 4/12.1%). Lack of stroke education, symptom stabilization, and non-emergency medical system utilization were the main reasons for the pre-hospital delay. Patients' refusal and misdiagnosis were the main reasons of patients who were eligible for thrombolytic treatment but did not finally receive thrombolysis.

Why Do Patients with Aneurysmal Subarachnoid Hemorrhage Postpone Treatment?

Impact of Comprehensive STEMI Protocol on Process Metrics and Clinical Outcomes in STEMI Patients With Nonsystem Delay.

Development and Validation of a Machine Learning Model to Predict the Risk of Medical Decision-Making Delay in Acute Myocardial Infarction Patients From Multicenter Tertiary Hospitals in China

Surgical complications after therapeutic lymph node dissection in stage III-IV melanoma: impact of neoadjuvant immunotherapy.

Recently, a nationwide stroke care consisting of stroke care units (SCU) and stroke centers (SC) was established in the Republic of Georgia. A hospital-based prospective registry to evaluate the quality of stroke care and additional nation-wide survey on factors leading to prehospital delay and subsequent low rate of intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT). 5385 consecutive patients with acute stroke (3636 ischemic, 1302 TIA, 447 hemorrhagic) were included in the stroke registry, of whom 2459 (46%) were female, mean age 70.3+/-11.3years. 1538 (28.6%) patients presented < 6 hours (1160 (21.5%) < 4.5 hours). Of 3636 patients with ischemic stroke, 121 (3.3%) patients received IVT, 72 (2.0%) received EVT and 17 (0.5%) received both. Additional 1067 patients with acute ischemic stroke (898) and TIA (169) were interviewed to understand the factors of prehospital delay. Of these, 472 (44.2%) were female, mean age 70.5±11.4 years, and 339 (31.8%) patients arrived < 6 hours (219 (20.5%) <4.5 hours). Forty-two patients (4.7%) received IVT, 37 (4.1%) received EVT and 6 (0,7%) received both. Pre-ictal education level, high socio-economic status, stroke awareness, calling the ambulance, and a knowledgeable ambulance team transferring patients to the stroke-ready hospital predicted timely arrival at the stroke center. The study reveals major problems in the prehospital management of acute stroke. There is a great need for a nation-wide geographic transfer plan for acute stroke service, connecting ambulances, SCUs and SC and for the educational campaigns to increase stroke awareness among the population.

Despite significant decrease in mortality in stroke since 1950, the annual incidence of strokes in thegeneral population remains at 1 or 2 per 1000 each year. There is an estimated of 50 000 new cases ofstroke in Canada annually. There are approximately six to eight survivors of stroke per 1000 each year.Patients live an average of 7 years after stroke.There appears to be low levels of knowledge of both risk factors and stroke warning signs among bothhigh- and low-risk populations. Usually, knowledge about stroke risk factors is por, and as in myocardialinfarction, delays from symptom onset to decision to seek medical attention are the most significantcauses of delay in patients with stroke.The most frequent symptoms are compatible with diagnoses of stroke, transient ischemic attack,intracerebral hemorrhage, or subarachnoid hemorrhage. It is common for the patients don't be unableto respond to questioning due to speech difficulties or an impaired mental status. Non-stroke diagnosesincluded dizziness/ataxia, seizure, dysarthria not otherwise specified (NOS), numbness NOS, syncope,migraine headache, anxiety, subdural hematoma, visual disturbances NOS, hepatic encephalopathy,alcoholic amnesic syndrome, acute poliomyelitis, soft tissue pain NOS, dementia, and other braincondition NOS. The non-stroke patients were like those with a final diagnosis of stroke in terms of age,race, and sex.Supposedly, interventional thrombolytic stroke therapy (recombinant tissue plasminogen activator) isoptimally effective only when administered within 3 hours of the onset of the vascular event.The pharmacological modulation of the unsuspected capacity of eukaryotic cells to generate their ownoxygen, dissociating the water molecules contained inside the cells, as in plants, opens new horizonsregarding the prevention and treatment of one of the most epidemiologically important diseases.

Delays in Radiation Therapy for Head and Neck Cancer: The Role of Pre-Radiation Dental Clearance.

Background: Acute appendicitis is one of the leading causes of acute abdominal pain that requires emergency surgery. Variations in symptoms based on age and delays in patients seeking help often lead to an increase in cases of appendicitis complications. Age and onset of abdominal pain are believed to play an important role in the severity and delay of diagnosis, especially in primary services such as health centers. This study aimed to determine the relationship between age and onset of abdominal pain among patients with acute appendicitis at Puskesmas Jatibaru from May 2024 to September 2025. Methods: This study used an observational analytical design with a cross-sectional approach. The data were obtained from the medical records of patients who came to the Puskesmas Jatibaru with complaints of abdominal pain and were diagnosed with acute appendicitis. The independent variable is age, while the dependent variable is the onset of abdominal pain. The non-normally distributed data were analyzed using the Spearman rho test. Results: A weak positive relationship was found between age and onset of abdominal pain (r = 0.306; p = 0.033). The higher the age of the patient, the longer they tend to experience the onset of abdominal pain before coming to a healthcare facility. Conclusions: There is a significant correlation between age and onset of abdominal pain among patients with acute appendicitis at Puskesmas Jatibaru. Age factors can affect the perception of pain and delay in seeking help. Therefore, there is a need for increased education for extreme age groups to prevent complications of appendicitis.

BackgroundAlthough the policy of screening tuberculosis (TB) in individuals with diabetes mellitus (DM) was suggested, the coexistence of TB and DM is rapidly increasing in China, hindering the country’s TB elimination efforts. The delay in TB consultation and diagnosis poses a challenge for DM-TB patients. However, the impact of DM on TB is not fully understood. Our study aimed to evaluate patient and diagnosis delays in pulmonary tuberculosis (PTB) patients in Ningxia, China, investigate the relationship between DM comorbidity and delays, and provide recommendations for improving the implementation of TB prevention and control strategies.MethodsWe examined all PTB patients with DM registered in the Chinese TB Information Management System (TBIMS) in the Ningxia region from 2016 to 2019. Patient delay was defined as > 20 days from symptom onset to first medical consultation, and diagnosis delay as > 1 day from first consultation to diagnosis, both measured in days. In our study, possible covariates were screened based on relevant literatures, then mediating variables were excluded, and finally covariates were screened by univariate analysis. Propensity score matching (PSM) was conducted (1:1 nearest matching with a caliper of 0.25 standard deviation (SD) of the propensity score (PS), without replacement) using covariates including sex, age, ethnicity, household registration, occupation, type of hospital for initial PTB diagnosis, level of hospital for initial PTB diagnosis, X-ray, the presence of other types of TB, and patient source. Logistic regression was then employed to assess the impact of DM on patient and diagnosis delays. Additionally, we conducted sensitivity analyses, exploring different ratios and caliper sizes, and mahalanobis distance matching. To address the potential for residual confounding by age, we conducted a further sensitivity analysis using age as a continuous variable in the PS model.ResultsOut of 9,625 PTB patients registered in TBIMS, 260 (2.7%) were also diagnosed with DM. In the unadjusted analysis, there was no difference in the median duration of patient delay between NDM-PTB and DM-PTB patients (20 days vs. 22 days, P > 0.05), while the median diagnosis delay was significantly longer in DM-PTB patients (1 day vs. 3 days, P < 0.05). However, after PSM to control for confounders, regression analysis indicated that DM was associated with a higher likelihood of experiencing patient delay [odds ratio (OR) = 1.85; 95% confidence interval (CI) = 1.30–2.64], but not with diagnosis delay (OR = 1.29; 95% CI = 0.89–1.87). In conclusion, after balancing baseline characteristics, DM was a risk factor for patient delay in PTB patients, but not for diagnosis delay.ConclusionsOur study revealed that DM only exacerbated patient delay and ultimately had no significant effect on diagnosis delay. This suggests that screening for TB in DM patients can reduce diagnosis delay. Therefore, emphasizing community TB health education in DM patients is crucial. Additionally, there is a need to promote the integrated model of TB management and enhance the awareness of primary medical institutions’ doctors regarding the comorbidity of DM-PTB, differential diagnosis, and diagnostic capabilities to effectively prevent and control TB.

In this study, we improved MRI room operations by applying Lean Thinking principles with a strong emphasis on leadership and ICT integration. The primary objectives were to enhance MRI appointment slot utilization, reduce patient waiting times, and minimize referrals to external facilities. Lean methodologies such as Kaizen, 5 S, Value Stream Mapping, Standard Work, Spaghetti Chart, and Root Cause Analysis were used to identify inefficiencies and implement structured improvements. A centralized ICT-based management system was introduced to enable real-time tracking and enhance workflow coordination. Leadership played a key role in fostering staff engagement and continuous improvement. MRI workflows were analyzed using Lean tools to identify operational bottlenecks and streamline processes. A structured improvement approach was developed through brainstorming sessions and weekly short meetings to refine management practices. The ICT system facilitated real-time monitoring of patient progress and scheduling adjustments. The 5 S methodology was employed to improve workspace organization, while Kaizen supported incremental daily improvements based on staff input. Following these interventions, MRI appointment reservations increased by 26% and completed examinations grew by 19%, with further daily management refinements contributing additional improvements of 34% and 28%, respectively. Patient waiting times were significantly reduced from an average of 45 days to 5 days, and monthly external referrals for MRI examinations declined from 300 to 50. These outcomes demonstrate that the integrated application of Lean Thinking and ICT not only substantially enhanced operational efficiency, reduced patient delays, and optimized resource utilization but also improved patient access and workflow coordination. Leadership, combined with a supportive and collaborative culture, played a key role in empowering team members to engage in continuous improvement. Open communication, the active valuation of staff input, and the delegation of responsibilities contributed to establishing a sustainable model for process enhancement. Although challenges such as the need for continuous adjustments in daily management and the complexity of coordinating staff schedules while maintaining patient care remained, these results confirm that Lean Thinking originally developed in manufacturing can be effectively adapted to healthcare settings to enhance productivity, service accessibility, and overall operational performance.

The Abbott-Bioline™ malaria antigen Plasmodium falciparum and Plasmodium vivax rapid diagnostic test (Abbott-Bioline™ Malaria Ag P.f/P.v RDT) is used widely in the Greater Mekong Subregion. It is approved by the World Health Organization (WHO) and deployed on a large scale in the regional malaria elimination programmes. Following reports of false-negative test results from field-workers, the Abbott-Bioline™ Malaria Ag P.f/P.v RDT was compared with microscopy in 187 persons with fever during a vivax malaria outbreak in Myanmar. Among them 11 tested positive for P. vivax using the Abbott RDT, while 46 were diagnosed with P. vivax malaria by microscopy. The sensitivity of the Abbott RDTs among febrile patients was 0.24 (95% CI 0.12–0.36) with a specificity of 1.0. Twenty-eight (61%) of the 46 patients had a parasite count of ≥200/µL, the WHO-recommended lower limit of detection for RDTs. Among these 11 were detected by the Abbott malaria RDT, a sensitivity at this threshold of 0.39, (95% CI 0.21–0.57). The colour band denoting positivity on the malaria RDT was often absent. The low intensity of the RDT colour band was confirmed objectively using ImageJ®, an image processing software. The Abbott-Bioline™ Malaria Ag P.f/P.v RDT is insensitive compared to microscopy. In remote areas where there is very limited access to health care and usually only a single source of diagnosis and treatment, as in rural Myanmar, this has resulted in dangerous delays in patients receiving appropriate treatment. The WHO Incidents and Substandard/Falsified Medical Products Team was informed of the problem, but did not respond effectively. Deployment of the underperforming malaria RDT continues.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12936-025-05638-6.

Background: Acute appendicitis is the most common cause of emergency abdominal surgery, yet the optimal timing for appendectomy remains debated. Advances in imaging, antibiotics and perioperative care have led many centers to accept short delays for stable patients, although the safety of delays beyond 24 hours remains uncertain, particularly in low- and middle-income countries. Methods: A retrospective cohort study was conducted at Benha University Hospital from January 2014 to June 2024. Consecutive patients aged 18 years or older with imaging-confirmed acute appendicitis who underwent appendectomy during the index admission were included. Time to surgery was categorized as ≤12 hours, &gt;12–24 hours, &gt;24–48 hours and &gt;48 hours. The primary outcome was a composite of 30-day major postoperative complications. Secondary outcomes included perforation, conversion to open surgery, length of hospital stay and 30-day mortality. Multivariable regression adjusted for demographic, clinical, radiologic and operative factors. Results: A total of 2,784 patients were analyzed. Surgery within 12–24 hours showed no increase in complications compared to ≤12 hours. Delays beyond 24 hours were associated with significantly higher perforation rates, more postoperative complications and longer hospital stays. The adverse effect of delay was more pronounced in patients with complicated appendicitis. Conclusions: Appendectomy performed within 24 hours is safe for stable adults, whereas delays beyond 24 hours increase morbidity, particularly in complicated cases. Early surgical prioritization is recommended to optimize outcomes.

Accurate confirmation of nasogastric (NG) tubes is essential for patient safety, but delays and variability in interpretation remain common in clinical practice. Deep learning (DL) models have shown potential for assisting in this task, but real-world performance, particularly in detecting malpositioned tubes, remains insufficiently characterized. We conducted a pilot evaluation of a previously developed DL model using 135 chest radiographs from Kangwon National University Hospital. Expert physicians established the reference standard. Model performance was assessed and receiver operating characteristic (ROC) curve and precision recall curve (PRC) analyses were performed. Differences between correctly classified and misclassified cases were examined using Wilcoxon rank-sum and Fisher's exact tests to explore potential clinical or radiographic contributors to model failure. The model correctly classified 129 of 135 cases. The sensitivity was 96.1% (95% confidence interval (CI): 92.2-98.9%), specificity was 85.7% (95% CI: 42.2-97.7%), positive predictive value (PPV) was 99.2% (95% CI: 96.1-99.9%), negative predictive value (NPV) was 54.5% (95% CI: 25.4-80.8%), balanced accuracy was 90.8%, and F1-score was 0.976. The area under the ROC curve was 0.970 (95% CI: 0.929-1.000) and that under the PRC was 0.727 (95% CI: 0.289-1.000), reflecting substantial uncertainty related to the very small number of incomplete cases (n = 6). No statistically significant differences in clinical or radiographic characteristics were observed between correctly classified and misclassified cases. The DL model performed well in identifying correctly positioned NG tubes but demonstrated limited and unstable performance for detecting incomplete placements. Given the safety implications of misclassification, the model should be used only as an assistive tool with mandatory physician oversight. Larger, multi-center studies with greater representation of incomplete cases are required to obtain more reliable estimates and support safe clinical implementation.