Effects of implementing universal dysphagia screening at admission in a university hospital.

Clinical characteristics and mortality risk factors in enterococcal bloodstream infections: a 9-year retrospective cohort study in Japan.

ObjectivesThe objectives of this study included assessing the diagnostic performance of HE4 in malignant pleural effusions (MPEs) and identifying the benign etiologies associated with higher HE4 concentrations.MethodsThe study involved patients with pleural effusion (PE) treated at Part Taulí University Hospital. PE and serum samples were collected and analyzed. Diagnosis of MPE was established by the presence of a positive cytology and/or positive pleural biopsy. HE4 concentrations in LP and serum – among other parameters – were measured on an ECLIA-Cobas e801 (Roche Diagnostics) analyzer. Subsequently, pleural fluid to serum HE4 ratio (PF/serum HE4 ratio) was calculated. Patients were assigned to different groups according to final diagnosis, transudate vs. exudate, MPE etiology and estimated glomerular filtration rate (eGFR). An evaluation was performed of the diagnostic performance of HE4 for MPE.ResultsA total of 253 PF and serum samples were included. In patients with benign pleural effusion (BPE), transudates contained higher levels of HE4, as compared to exudates. The highest PF-HE4 concentrations and ratios were observed in MPEs, especially in patients with non-small cell lung cancer + ovarian cancer. The cut-off values established showed a sensitivity of 16.7 % (PF-HE4) and 12.1 % (ratio), with a 100 % specificity, respectively. Following cut-off adjustment, higher sensitivity values were observed in patients with an eGFR ≥ 30 mL/min/1.73 m2.ConclusionsElevated HE4 concentrations may support MPE diagnosis and predict histology. Transudates contain elevated levels of HE4 and lower PF/serum-HE4 ratios. In the investigation of solid neoplasms, different serum HE4 cut-off values should be used for patients with PE, heart failure, cirrhosis or renal insufficiency.

Effective perioperative pain management is essential for patients undergoing total knee replacement. This study assessed professional practices related to perioperative pain evaluation and management at a French university hospital and evaluated the impact of a training program led by nurse anesthetist students. We conducted a prospective, single-center, observational before-after study (convenience sampling) from September 2022 to May 2023 at Clermont-Ferrand university hospital, France. Data were collected from paper medical records and a structured questionnaire administered to paramedical professionals. Pain assessment practices (traceability of numerical rating scale scores) and analgesic management were evaluated across four phases: two practice-assessment phases separated by a two-step training program. Data from 51 to 85 patient medical records before the training (Phase 1) and 85 after the training (Phase 4) were analyzed. A total of 74 % of operating room staff and 58 % of orthopedic-ward staff completed the questionnaire used to develop the training program. Numerical rating scale traceability on orthopedic-ward admission improved from 29.6 % to 48.2 % (P = 0.03). Documentation of pain at post-anesthesia care unit discharge remained stable (78.4 % vs. 82.2 %; P = 0.61). Morphine administration and subsequent pain reassessment in the post-anesthesia care unit increased after training. Patient satisfaction with pain management remained high in both periods (90 % vs. 80 %). The nurse anesthetist student-led training program improved several aspects of perioperative pain evaluation and management in total knee replacement patients, particularly documentation and analgesic practices. These results highlight the value of involving nurse anesthetist students in quality-improvement initiatives and identify remaining gaps for future targeted interventions.

Recurrence patterns in primary urethral carcinoma: Prognostic impact of inguinal and pelvic lymphadenectomy.

Effect of a mobile application-delivered educational video on interest in and uptake of contraception among patients with systemic lupus erythematosus in Thailand: Arandomized controlled trial.

The development of neonatal intensive care has substantially reduced infant mortality, still, infants remain at high risk for adverse outcomes. Safe care relies on adequate nurse staffing and an appropriate skill mix, which is especially important in neonatal intensive care as infants are extremely vulnerable to harm when quality lapses occur. Although international guidelines recommend optimal nurse-to-patient ratios for neonatal care, these standards have not been fully implemented, leaving it unclear whether current staffing levels align with recommendations for safe staffing. To benchmark the acuity-adjusted registered nurse staffing provision ratio in neonatal intensive care and determine the skill mix distribution and variation of nursing staff across shifts. This retrospective cohort study included infant data from a 16-week period in 2022 in three neonatal intensive care units with a common administration at a university hospital. Data were obtained from the hospital's data repository and the Swedish Neonatal Quality Register, including 609 neonatal admissions and 345 nursing staff members working 1008 shifts. Infants' daily acuity levels were assessed using an adapted version of the British Association of Perinatal Medicine's guideline, classifying infants into three levels: intensive care, high dependency care, and special care. Staffing provision was measured as the number of worked hours per shift, staff category, and unit. The registered nurse provision ratio was defined as the number of registered nurse hours provided divided by the recommended hours. A ratio below 1.0 indicates understaffing. The population's total in-hospital days were 4674, and the mean birth weight was 2843 g (SD 1029), with 57.0 % being boys. The proportion of registered nurses relative to nursing assistants ranged from 22.2 % to 85.7 %, with a median of 46.5 %. Registered nurses with specialist education accounted for a median of 73.0 % of total registered nurse hours. Within each unit, the mean acuity-adjusted number of registered nurses recommended by the British Association of Perinatal Medicine's standard was relatively consistent across shift types and between weekdays and weekends. However, the required number of registered nurses between individual shifts showed considerable variation, ranging from 2.5 to 10.3. During the inclusion period, 81.2 % of the shifts had a registered nurse provision ratio below 1.0, suggesting that most shifts did not meet the recommendations for staffing levels. This study highlights a shortfall in registered nurse staffing relative to recommended levels. Ensuring adequate registered nurse staffing levels is crucial for maintaining high-quality neonatal care and improving infant outcomes.

Subjective and objective sleep measurements in ICU Patients: A longitudinal analysis of 706 sleep episode pairs.

Investigation of the impact of image-guided radiotherapy selection on image registration results and non-coding RNAs for cervical cancer patients.

Psychiatrists often perceive their clinical practices as guideline-concordant; however, discrepancies frequently exist between perceived and actual prescribing behaviors. To explore this gap, we examined the association between self-assessed clinical behavior scores (CBs) and prescribing practices objectively evaluated using quality indicators (QIs) within the EGUIDE educational program framework for schizophrenia and major depressive disorder. Identifying such associations is essential for improving care quality and developing interventions fostering evidence-based practice. A prospective observational multicenter study was conducted across Japan involving 820 psychiatrists from university, public, and private hospitals participating in EGUIDE, along with patients diagnosed with schizophrenia (n = 6714) or major depressive disorder (n = 3692) treated at these institutions. The outcome measures were associations between psychiatrists' CB scores and quality indicators (QIs) based on discharge prescriptions; these were analyzed using logistic regression adjusted for age, sex, and institution type. For schizophrenia, CBs were significantly associated with 8 of 11 QIs, including treatment-resistant assessment, antipsychotic monotherapy (with/without other psychotropics), absence of anxiolytics/hypnotics, mood stabilizers, anticholinergics, PRN psychotropics, and clozapine use. For major depressive disorder, 3 of 7 QIs showed significant associations: severity assessment, no anxiolytic/hypnotic prescriptions, and use of modified electroconvulsive therapy. Self-assessed clinical behavior scores partially reflect actual prescribing practices. These findings highlight the value of incorporating subjective evaluations into clinical performance assessment tools to promote guideline adherence. Moreover, our results suggest that collecting self-assessments may offer a feasible and scalable strategy for identifying areas where additional education or system-level support is needed to enhance evidence-based prescribing in diverse clinical settings. University Hospital Medical Information Network registry identifier: UMIN000022645.

To evaluate the impact of a structured tele-education program on hospital hyperglycemia and diabetes, focusing on residents' medical knowledge and inpatient care. This open-label, multicenter, randomized clinical trial enrolled internal medicine residents from four university hospitals in southern Brazil. Teams were block-randomized to an intervention group that received an online lecture plus 30 days of tele-education via WhatsApp, or to a control group with no intervention. The primary outcome was medical knowledge, assessed with a validated 10-item questionnaire. Secondary outcomes included quality of insulin prescriptions, hypoglycemia and hyperglycemia rates, and hospital length of stay (LOS). Analyses were performed using SPSS v29 (5% significance). Fifty residents completed the study. The intervention group achieved higher post-intervention knowledge scores than the control group (median 8 vs. 6 correct answers; p = 0.005) and showed significant improvement from preto post-test (6 to 8; p < 0.001), with consistent gains across centers. Clinical data from 149 hospitalized patients were analyzed (mean age 67.8 years; 55% female); 56% had diabetes, and 44% had hospital-related hyperglycemia. There was a nonsignificant trend toward more appropriate NPH (p = 0.107) and regular insulin (p = 0.203) prescriptions in the intervention group. Median LOS was longer in the intervention group (19 vs. 13 days; p = 0.009). The tele-education program improved residents' knowledge of inpatient hyperglycemia. Larger studies are needed to confirm clinical effects and long-term outcomes of tele-education in hospital glycemic management.

Evolving landscape of targeted therapies in early phase clinical trials.

Thrombin Generation Assay: Ready for Prime Time.

Methylated Septin9 as an auxiliary biomarker for the diagnostic, recurrence monitoring and prognosis of colorectal cancer.

Introduction: Glass Ionomer Cements (GIC) have been valued for their ease of use, fluoride release, and bonding. However, their microleakage can cause sensitivity and secondary caries. Adding Chicken Eggshell Powder (CESP) improves GIC's properties, while Cention N, an alkasite material, enhances wear resistance and sealing with fluoride and calcium release. The present study compares the microleakage of CESP-modified GIC and Cention N. Aim: To evaluate and compare the microleakage of GIC modified with CESP and Cention N. Materials and Methods: This in-vitro study was carried out in the Department of Conservative Dentistry and Endodontics, Bharati Vidyapeeth (Deemed to be) University Dental College and Hospital, Pune, Maharashtra, India and was carried out over three months from August 2024 to October 2024. For the present study, 14 healthy maxillary first premolar teeth that were extracted for orthodontic treatment, intact, had no carious lesions or restorations and were free of pulpal abnormalities were selected. Class V cavities were prepared on the buccal and palatal surfaces of premolars and divided into two groups. Group I where Cavities on the buccal surface were restored using GIC modified with 3% by weight CESP (GIC+CESP), and those on the palatal surface with Cention N being group II. After immersion of the teeth in 0.5% methylene blue dye and buccolingual sectioning, the microleakage assessment was done under a stereomicroscope. Intergroup comparison of microleakage between the two groups was performed using an Independent samples t-test, and the p-value less than 0.05 was considered statistically significant. Results: The comparison showed statistically significant differences (p-value=0.029) between the two groups. Group I (GIC+CESP) and group II (Cention N) showed differences in the microleakage scores, and group I showed the lowest microleakage in comparison to group II. Conclusion: GIC modified with CESP (GIC+CESP) exhibited significantly lower microleakage compared to Cention N in Class V cavities. This suggests that incorporating CESP into GIC enhances its sealing ability, making it a promising alternative for reducing microleakage in restorative dentistry.

Frequency and demographic variability of the corona mortis: Insights from computed tomography angiography.

Cachexia and sarcopenia are prevalent, inflammation-linked syndromes in chronic liver disease that worsen outcomes. To our knowledge, their coexistence in a single chronic liver disease cohort has not been systematically examined. In this study, we evaluated the prevalence, clinical features and prognostic impact of cachexia and sarcopenia-alone and combined-in chronic liver disease. We retrospectively screened 776 patients with liver cirrhosis (LC) and/or hepatocellular carcinoma (HCC) at Hokkaido University Hospital (August 2014-May 2025). The inclusion criteria were grip strength, CT-based muscle mass and complete clinical data, yielding 307 patients; 469 did not meet one of the inclusion criteria. Cachexia was determined following the Asian Working Group for Cachexia criteria, and sarcopenia was determined following Japan Society of Hepatology guidelines. Patients were grouped as no cachexia/sarcopenia, cachexia only, sarcopenia only or cachexia+sarcopenia. The outcomes were overall survival, time to liver-related events and time to readmission (Kaplan-Meier and Cox-proportional models). Among 776 patients, 307 were included in the final-analysis. Of 307 patients, 206 (67.1%) were male, the median age was 70 years (range, 19-90 years), 262 patients (85.3%) had LC and 188 patients (61.2%) had HCC. The patients were grouped as no cachexia/sarcopenia (213; 69.4%), cachexia only (54; 17.6%), sarcopenia only (17; 5.5%) and cachexia+sarcopenia (23; 7.5%). The combined group compared with the others had the lowest body mass index, psoas-muscle-index and grip strength (all p < 0.001). Overall survival (OS), liver-related events, LC progression and readmissions were compared between 246 patients with and without cachexia or sarcopenia, after excluding those who visited the hospital on or after July 2023 and had ≤ 3 months of follow-up. OS was shorter in the cachexia only (median 61.8 [95% CI 40.90-not reached (NR)] months, p = 0.046) and cachexia+sarcopenia (median 59.6 [95% CI 14.26-NR] months, p = 0.027) groups than in the no cachexia/sarcopenia group. Multivariable analysis showed that cachexia+sarcopenia (hazard ratio 2.48, p = 0.010), HCC (hazard ratio 3.40, p < 0.001) and diabetes mellitus (hazard ratio 1.80, p = 0.013) independently predicted mortality. The combined group compared with the other groups had a shorter time to liver-related events and readmission. The coexistence of cachexia and sarcopenia-rather than either alone-can be used as an indicator for identifying patients with chronic liver disease at the highest risk of poor outcomes. Concurrent assessment and early, targeted interventions may improve outcomes in this population.

The burden of patient harm from unsafe care is disproportionately high in low-income countries, particularly in intensive care units (ICUs). Despite this, there is limited empirical evidence explaining the underlying challenges that make patient safety difficult to achieve in resource-limited ICUs. To explore the barriers to patient safety and incident-reporting in ICUs at Ethiopian university hospital. An exploratory qualitative descriptive study was conducted using in-depth interviews guided by a semi-structured protocol and informed by the Theoretical Domains Framework (TDF). Participants were purposively selected, and sample size was determined based on principles of data sufficiency. Reflexive thematic analysis with inductive orientation was employed following Braun and Clarke's approach. Thirty-nine healthcare professionals participated: 23 (59%) nurses, 13 (33%) physicians, and 3 (8%) clinical pharmacists. The mean age of participants was 32±5 years. Three overarching themes captured the barriers to patient safety and incident reporting in ICUs: (i) Fragile systems: Governance failure and resource constraints; (ii) Normalisation of deviance: teaching-hospital dynamics and clinical oversight, normalised communication lapses, and weak teamwork and relational context; and (iii) Silence trap: Fear in punitive and blame-oriented culture and lack of incident-reporting systems. Patient safety in Ethiopian ICUs is undermined by systemic, operational, and clinician-related obstacles. Structural and cultural barriers further hinder incident-reporting creating a vicious cycle where unsafe care remains hidden and opportunities for learning and improvements are lost. Breaking this cycle requires strong governance, coordinated resource investment, enhancing just culture, strengthening teamwork, establishing robust incident-reporting systems, and ongoing professional development focused on patient safety. Identifying barriers to patient safety and incident reporting in ICUs may enables targeted interventions that reduce preventable harm, improve care quality, and promote incident reporting and learning to sustain safe clinical practice.

Impact of introducing nucleic acid amplification testing for diagnosing Clostridioides difficile infection at a Japanese university hospital.

Cardiovascular disease, particularly ischemic heart disease (IHD), is a major cause of morbidity and mortality in patients with type 2 diabetes mellitus (T2DM). Accurate risk prediction is essential, yet the influence of linear versus non-linear feature selection and survival modelling on performance and feature interpretability remains insufficiently explored. We analysed 12,281 patients with T2DM from a university hospital EHR, followed for up to 15years. The outcome was incident IHD, defined by ICD-10 codes. After variance thresholding and multicollinearity filtering, 263 predictors were retained. Features were selected using univariate Cox regression, Random Survival Forest (RSF), and their consensus. Seven survival models (Cox, Ridge Cox, Weibull, RSF, Gradient-Boosted Survival [GBS], Survival SVM, XGBoost) were trained using five-fold cross-validation. Performance was assessed using the concordance index (C-index) and Integrated Brier Score (IBS). Feature importance stability, Spearman rank correlations, and top-20 feature contributions were compared across models. RSF, Weibull, GBS, and SSVM achieved the highest discrimination (C-index up to 0.78) with comparable calibration, whereas XGBoost consistently performed poorest (C-index 0.66-0.68). Linear models produced stable, diffuse feature importance profiles, while non-linear models concentrated importance on a narrower set of dominant predictors. Across all approaches, cardiovascular comorbidities (I10, I50, I15, I11) remained the most influential predictors. Linear models ensured stability and interpretability, whereas non-linear methods enhanced discrimination and calibration but increased variability. Combining linear and non-linear feature selection provided complementary insights for EHR-based risk prediction of IHD in T2DM.