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Perioperative myocardial injury (PMI) is a common complication following non-cardiac, particularly thoracic, surgery and is associated with increased cardiovascular risk. Although guidelines recommend cardiac biomarker monitoring to detect PMI, its implementation in routine clinical practice remains limited.
To evaluate the combined use of high-sensitivity cardiac troponin I (hs-cTnI) and N-terminal pro-brain natriuretic peptide (NT-proBNP) in predicting major adverse cardiovascular events (MACE) following elective thoracic surgery, and to determine whether NT-proBNP provides incremental prognostic value beyond hs-cTnI alone.
Multicentre observational cohort study.
Conducted between February 2021 and November 2023 in three Spanish tertiary hospitals.
Patients aged ≥45 years scheduled for elective thoracic surgery involving lung resection (pneumonectomy, lobectomy, bilobectomy or segmentectomy) under general anaesthesia. Exclusion criteria included urgent or non-thoracic surgery, active infection or sepsis and a history of severe heart failure (ejection fraction
Combined measurement of hs-cTnI and NT-proBNP at baseline (preoperatively) and at 24 and 48 hours postoperatively.
PMI was defined as hs-cTnI ≥45 ng/L at 24 and/or 48 hours or a ≥20% increase from baseline in patients with elevated preoperative concentrations.
Among 475 patients, PMI occurred in 11.8%. PMI had higher rates of prior stroke (12.5% vs 2.9%; p=0.004), smoking history (85.7% vs 64.0%; p=0.001) and severe renal dysfunction (7.1% vs 0.7%; p=0.001), with similar Revised Cardiac Risk Index distribution. Patients with PMI also had greater postoperative elevations of hs-cTnI and NT-proBNP (p
Combined hs-cTnI and NT-proBNP assessment improves perioperative cardiovascular risk stratification beyond ischaemia.
Women constitute the majority of the global healthcare workforce—especially in nursing—yet remain under-represented in formal leadership roles. Understanding how gender disparities intersect with profession, age, and governance models is critical to advancing equity and strengthening nursing leadership within health systems.
Cross-sectional ecological study across publicly funded healthcare entities in Catalonia, Spain.
Data from 124 entities were collected as of 31 December 2023 and analyzed by gender, profession (physician, nurse, or other), age group (≤ 55, > 55), and governance model (direct vs. indirect management) across five hierarchical leadership levels. Descriptive and inferential analyses were conducted to examine gender disparities in leadership distribution.
A total of 8015 leadership positions were identified, of which 62.2% were held by women, despite women representing 75% of the workforce. A clear gender gradient emerged across leadership levels, with women's representation decreasing systematically at each step upward in the hierarchy. Women's representation declined significantly with increasing seniority, whereas men's representation increased at higher organizational levels. Among professions, male physicians were markedly represented at senior levels, while nurses—both women and men—were concentrated in lower and mid-level positions. Gender disparities were also shaped by age and governance model: younger women were clustered in frontline roles, and female leaders in indirectly managed entities were more evenly distributed across leadership levels than those in directly managed organizations.
Persistent gender disparities—particularly affecting nurses and younger professionals—highlight the need for inclusive leadership development, transparent promotion pathways, and robust gender-disaggregated data for workforce planning. Strengthening nursing leadership is not only a matter of equity but a strategic priority for building inclusive and responsive health systems.
(1) To analyse individual and institutional-level factors associated with urinary incontinence in older adults living in nursing homes; (2) to estimate the prevalence of urinary, faecal and double incontinence in nursing home residents.
Cross-sectional study.
Residents aged 65+ living in 22 nursing homes in Catalonia (Spain) were included. Descriptive, bivariate, and multilevel analyses were performed.
The final sample comprised 452 residents (75.9% female, mean age of 87.0 years). The prevalence of urinary, faecal and double incontinence was 77.5%, 46.1% and 45.7%, respectively. Urinary incontinence was statistically significantly associated with neurological conditions, moderate cognitive impairment, moderate dementia, severe cognitive impairment, very severe cognitive impairment and age.
Approximately three out of four nursing home residents suffered from urinary incontinence and almost half of the sample from faecal or double incontinence. Individual-level factors (cognition, neurological conditions and age) played a more important role than institutional-level factors for urinary incontinence.
The findings of this study highlight the importance of individual-level interventions to prevent and manage urinary incontinence in nursing homes.
In Catalonian nursing homes, individual factors such as cognitive impairment and neurological conditions were more strongly associated with urinary incontinence than institutional factors. This has implications for improving care provided to older adults, particularly those with dementia and neurological conditions.
STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines.
Nursing home residents were not involved in this study.
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