Meta-analysis of 3.8 million hospitalizations links each additional patient per nurse to 5.7% higher odds of 30-day adult in-hospital mortality

Ventilator weaning in the intensive care unit is often complicated by severe patient distress, agitation, and escalating sedative requirements that paradoxically lengthen mechanical ventilation. In a parallel-group randomized controlled trial conducted in a general adult ICU, 100 critically ill patients ventilated for at least 48 hours were randomized to standard weaning care alone or standard care with daily individualized music therapy. The intervention consisted of daily sessions averaging 25 minutes delivered by a music therapist, incorporating music-assisted relaxation, guided listening, and clinical improvisation tailored to patient preferences. The primary outcome—ventilator weaning duration—did not differ significantly between groups (p = 0.97). However, patients receiving music therapy exhibited significant reductions in agitation and sedation instability on the Richmond Agitation-Sedation Scale (RASS) on days 1 and 3 (p = 0.048, 0.005, and 0.024). Significantly fewer music therapy patients required propofol infusions during weaning (p = 0.028), and tracheostomy placement was significantly reduced (14% rate reduction, p = 0.025). Perceived pain and vital signs showed no significant differences.

Nasogastric tube (NGT) insertion is one of the most common and distressing bedside nursing procedures, frequently triggering severe nasal pain, pharyngeal trauma, and reflexive gagging. This systematic review (PROSPERO CRD420251177888) searched MEDLINE, Cochrane Central, and CINAHL through October 28, 2025, to assess the efficacy and safety of non-nebulized topical anesthetics or lubricants during adult NGT placement. Five randomized controlled trials evaluating topical lidocaine in formulations including nasal sprays, drops, viscous gels, and atomized solutions versus placebo or routine water-soluble lubricant were included. Methodological quality was independently appraised using the 13-item JBI Critical Appraisal Checklist for RCTs. Despite variation in dosing and administration routes, all five trials reported consistent reductions in procedural pain and discomfort scores. Best-evidence synthesis demonstrated strong evidence supporting lidocaine for procedural pain reduction and moderate evidence for reducing discomfort and insertion-related cough. Topical administration was well tolerated across all trials without serious hemodynamic or local mucosal adverse events.

Severe emergency department overcrowding and prolonged length of stay threaten clinical safety and hospital throughput. The pragmatic, open-label RESHAP-ED randomized controlled trial evaluated an advanced physiotherapist-led model of care across five emergency departments in New South Wales, Australia. Adults presenting with uncomplicated musculoskeletal conditions—including soft-tissue injuries, neck and back pain, and closed fractures or dislocations not requiring surgical admission—were randomized 1:1 to physiotherapist-led care (n=737) or usual physician- or nurse practitioner-led care (n=738). The primary outcome, emergency department length of stay from arrival to departure, was analyzed via an intention-to-treat linear mixed-effects model. Mean length of stay was 2.4 hours in the physiotherapist group versus 3.4 hours in usual care, representing a statistically significant reduction of 1.0 hour (95% CI: -1.2 to -0.8 hours). Adverse events occurred in 6.6% (39/591) of physiotherapy patients versus 5.9% (33/555) of controls (p = 0.72). The intervention delivered mean direct savings of -$35.1 (95% CI: -69.0 to -1.7) per patient with a 98.1% probability of cost-effectiveness.