Hospital Practices and Research

Abstract Care fragmentation is a recognized source of risk in hospitals. During an inpatient stay, responsibility for the patient passes repeatedly between teams and across shifts, and is eventually transferred to outpatient services. Each transfer is more than an administrative step. It is the point at which clinical information and responsibility for the patient must be conveyed without loss or distortion.
Despite decades of patient-safety work, clinical handover has not been established as a reliable process. The World Health Organization (WHO) Global Patient Safety Report 2024 identifies care transitions as a recurring source of risk in hospitals and includes them among the high-priority concerns of the Medication Without Harm initiative. Awareness is no longer the limiting factor, because clinicians and administrators already recognize that poor handovers cause harm. The task that remains is to convert handover from a compliance requirement into reliable bedside practice and to treat it as a measurable indicator of clinical quality.

Abstract Background: Medication errors (MEs) are among the most common preventable causes of patient harm in healthcare. Their frequency and severity are amplified in Intensive Care Units (ICUs) where patients are critically ill, receive complex and high-risk therapies, and are especially vulnerable to iatrogenic harm.
Objectives: This narrative review aims to synthesize the prevalence, unique contributing factors, and consequences of medication errors in ICU settings, with particular attention to India and other developing healthcare systems, and to outline evidence-based strategies for their prevention.
Methods: A narrative literature review was conducted using peer-reviewed articles, systematic reviews, and reports from recognized health authorities (including the World Health Organization) published mainly between 2008 and 2025. Sources addressing medication error prevalence, causes, and consequences in ICU and critical-care settings were prioritized, with supplementary sources on the broader Indian healthcare and economic context.
Results: Reported ICU medication error prevalence ranges widely, from approximately 1.32% to 31.7% of admissions in global reviews,1 and from 8.1 to 2,344 per 1,000 patient-days,2 reflecting differences in error definitions, detection methods, and reporting cultures across studies. Prescribing and transcription errors dominate in Indian ICUs,3 while administration errors involving intravenous and high-alert medications carry the greatest risk of harm. Errors arise from a complex interaction of workload and staffing pressures, incomplete standardization, communication breakdowns, technological limitations, knowledge gaps, and a persistent culture of blame that discourages reporting. Consequences extend beyond the patient to nurses' psychological well-being and to substantial healthcare-system costs, including prolonged ICU stay and increased treatment expenditure.
Conclusion: Medication errors remain a widespread, costly, and largely preventable threat to ICU patient safety, disproportionately underreported in India and other developing settings. A multi-pronged strategy combining standardized protocols, targeted technology, continuous education, non-punitive reporting systems, workforce well-being, and patient and family engagement is required to reduce this burden meaningfully.

Abstract Background: Patients with rheumatoid arthritis (RA) often experience significant psychological distress, including difficulties with emotion regulation and high levels of stress, which can exacerbate disease symptoms.
Objectives: This study aimed to investigate the effectiveness of Emotion-Focused Therapy (EFT) in improving cognitive emotion regulation strategies and reducing perceived stress in patients with RA.
Methods: This was a quasi-experimental study with a pretest-posttest control group design. The study population consisted of patients with RA referred to Shariati Hospital in Tehran, Iran, in 2022. A sample of 40 patients who met the inclusion criteria was selected and randomly assigned to an experimental group (n = 20) and a control group (n = 20). The experimental group participated in eight weekly 90-minute sessions of group EFT. Data were collected using the Cognitive Emotion Regulation Questionnaire (CERQ) and the stress subscale of the Depression Anxiety Stress Scales (DASS-21). The collected data were analyzed using analysis of covariance (ANCOVA).
Results: The results indicated that after the intervention, the experimental group showed a statistically significant increase in the use of adaptive cognitive emotion regulation strategies and a significant decrease in the use of maladaptive strategies compared to the control group (F = 38.72–45.83, P < 0.001, η² = 0.68–0.73). Furthermore, the participants in the EFT group reported a significant reduction in their perceived stress scores compared to the control group.
Conclusion: The findings suggest that EFT is an effective psychological intervention for improving emotion regulation skills and reducing stress levels in patients with RA. Therefore, EFT may serve as a useful adjunct to standard medical care in supporting the psychological well-being of this patient population.

Abstract Background: Helicobacter pylori (H. pylori) is a prevalent chronic bacterial infection of the gastrointestinal tract, especially in developing regions, yet its extra-gastric consequences in chronic diseases remain insufficiently understood.
Objectives: This case control-study evaluated the influence of H. pylori infection on biochemical and hematological parameters in children with type 1 diabetes (T1D).
Methods: This case–control study enrolled 120 children, including 60 patients with T1DM and 60 apparently healthy, non-diabetic controls, age-matched controls. Participants were recruited from diabetes clinics in 2016. Interviews were completed, and blood samples were analyzed for serum H. pylori IgG using competitive ELISA, alongside various biochemical and hematological measurements.
Results: Children with T1D had lower household income, a stronger family history of diabetes, and higher rates of neuropathy and gastritis than healthy controls (P < 0.05). Significant differences were observed in several biochemical and hematological measures. H. pylori seropositivity was notably more prevalent among children with T1D than among non-diabetic participants (40.0% vs. 21.7%, P = 0.030). Within the diabetic group, infected children demonstrated higher levels of glycated hemoglobin, glucose, insulin, total cholesterol, triglycerides, LDL-C, ALT, and white blood cell counts. In contrast, HDL-C, red blood cell counts, and hemoglobin concentrations were lower in seropositive children. Overall, the findings suggest that H. pylori infection may be associated with poorer glycemic control and greater metabolic and hematological abnormalities in pediatric patients with T1D.
Conclusion: H. pylori infection was associated with unfavorable biochemical and hematological changes in children with TID. Further prospective studies should evaluate whether eradication improves metabolic control.

Abstract Background: Personality traits, defined as an organized set of relatively stable and enduring characteristics that distinguish one individual from others, can influence anxiety levels.
Objectives: Given the role and importance of personality traits and anxiety among students, the present study aimed to determine the relationship between personality traits and state-trait anxiety in students at Shahid Sadoughi University of Medical Sciences in Yazd City, Iran.
Methods: This study employed a correlational, cross-sectional design. The study population consisted of 389 students selected through proportional stratified sampling from various faculties. Data were collected using two standard questionnaires. To assess participants' personality profiles, the Bass Questionnaire was utilized, which measures dimensions such as fair-mindedness, bravery, and introversion. Anxiety levels were evaluated using the STAI (State-Trait Anxiety Inventory), encompassing both state and trait anxiety subscales. Data analysis was performed using SPSS26, utilizing descriptive statistics (mean and standard deviation). To examine the relationships between personality dimensions and anxiety levels, Spearman's rank correlation coefficient was employed, as the data did not meet the assumptions of normality.
Results: The mean scores for personality traits and state-trait anxiety were 74.67 ± 11.13 and 113.74 ± 11.61, respectively. A significant correlation was observed only between the overall mean score of personality traits and gender (P = 0.021) and marital status (P = 0.019). Students' personality traits leaned more towards being conscientious, exhibiting fairness, and a tendency to respect the rights of others. Trait anxiety was more evident than state anxiety among students. Regarding state and trait anxiety, the mean scores indicated moderate to high levels of both manifested and hidden anxiety. In general, a significant negative relationship was observed between state-trait anxiety and personality traits (r = −0.158, P = 0.002).
Conclusion: Personality traits can play a significant role in the onset and severity of anxiety in students. Therefore, identifying the personality type of each student using personality typing tests, which can determine the appropriate type of counseling for that individual, followed by organizing specialized counseling sessions for vulnerable personality types, is considered an important step.

Abstract Introduction: Homeopathy can be applied to treat various diseases and conditions such as cancer, allergy, mood disorders, headache and pain. This case showed that homeopathic medicine can be a treatment modality for idiopathic thrombocytopenic purpura (ITP), an autoimmune-mediated hematologic disorder.
Case Presentation: The patient was a 5.5–year-old child with ITP who referred to the homeopathic clinic with extensive petechiae and purpura on her body. Her platelet count was 15000/mcL and her anti-dsDNA and ANA were negative on her first visit. Her disease had first been diagnosed at the age of 2.5 years. She had undergone routine therapy for ITP; however, despite 15 months of corticosteroid therapy and IVIG injections, her platelet count was still low. After treatment with homeopathic remedies, her platelet count increased and signs of ITP disappeared.
Conclusion: Homeopathic remedies can be considered as complementary and alternative medicines for ITP treatment protocols.

Abstract The coronavirus SARS-CoV-2 disease (COVID-19) is the most current life-threating disease that affect health and economic sectors in the world. This pandemic raises weighty and urgent ethical issues that affected patients, health care provider and health care systems. Based on medical ethics textbooks, there are four fundamental ethical principles: The principle of respect for autonomy, the principle of beneficence, the principle of non-maleficence, and the principle of justice. Medical ethics scientists have well explained these principles before with full accuracy and detail. In this review article, we discussed the ethical issues raised during the COVID-19 pandemic. Health inequity and inequality, health care rationing/triage, contact tracing technologies and data privacy, movement restriction and exit strategies, and finally COVID-19 research ethics especially clinical trials and vaccine studies could cause ethical problems during Covid-19 pandemic. In this review article, we discuss about these issues and provide some ethical solutions to these issues

Abstract Background: Motivation is a driver to health worker performance in most Ghanaian hospitals. In view of this, Ghana’s Ministry of Health has rolled out enough motivational policies to accentuate work performance of health workers.
Objective: The focus of this study was to examine the impact of motivation and identify how intrinsic and extrinsic motivating factors affect the work performance of health workers at Korle-Bu Teaching Hospital (KBTH). 
Methods: A qualitative approach was adopted for the study, and purposive sampling was used to select fifteen (15) health workers including both medics and paramedics. An in-depth interview guide and one-on-one interviews were adopted to collect data from the staff at Korle Bu Teaching Hospital. A thematic content analysis was used to analyze the transcribed data.
Results: Key findings from the study revealed that job satisfaction, logistic provision, and an enabling work environment are intrinsic motivating factors that affect the work performance of health workers; extrinsic factors such as financial reward, accommodation, and transportation also impact work performance. Furthermore, motivation is key to the work performance of nurses.
Conclusion: It is recommended that the National Midwifery and Nursing Council (NMC) and the Ministry of Health (MOH) adopt motivational policies based on the intrinsic and extrinsic motivational blocks.

Abstract In this review article, we aim to depict how healthcare facilities may look in the near future from an architectural design point of view. For this purpose, we review newly introduced technology and medical advances in the field of healthcare, such as artificial intelligence (AI), robotic surgery, 3D printing, and information technology (IT), and suggest how those advances may affect the architectural design of future healthcare facilities. In future hospitals, less space will be required; there will be no need for waiting areas. Most care will be given far from the hospital. Every human might have a computer chip attached to his body, with all his medical data ready and monitored by AI. In the future, all processes may be done by robots and AI, from reception to detection (radiology, scans, etc.). Nearly all surgery will be done by robots, so the architectural design of operation departments will need to be changed accordingly. AI is faster and better in disease detection than man; thus, there will be no need for laboratories or detection departments as we know them now. 3D printers are able to print almost everything from medical equipment to parts of the human body; thus, space will be needed for scanning and 3D printing in future hospitals. 3D printers might change the pharmaceutical industries, and drugs will be produced for any human individually.

Abstract Background: Acute appendicitis is one of the most common acute surgery events. Its main treatment is surgery. However medical management before and after the surgery has an important impact on the treatment.
Objective: The aim of study was evaluating the outcomes of single dose and quadruple doses of prophylactic antibiotic therapy in patients with acute non-complicated appendicitis.
Methods: This randomized double blind clinical trial was carried out on 294 patients in single dose (136 patients) and the quadruple doses (158 patients) groups. In single dose group, a dose of 1g Cefazolin + 500mg Metronidazole was prescribed intravenously about half an hour before surgery. The quadruple doses group received three more doses after surgery.  Two groups were followed for fever, erythema, seroma, wound infection, intra-abdominal abscess formation and readmissions within one month after discharge.
Results: The mean age of patients was 31±5.14 years. 203(69%) of patients were men while 91(31%) were women. There were no significant statistical differences between groups in age, sex and body mass index (BMI) variables. No significant statistical differences were observed during surgery and hospitalization period between two groups. In the single dose group, wound infection was 8(5.9%), while it was 6(3.8%) in the quadruple doses group; hence, there were no significant statistical differences in this regard. There was no abdominal abscess in groups. There were significant statistical differences regarding erythema, seroma and antibiotics consumption costs between groups.
Conclusion: A single dose of prophylactic antibiotics is sufficient in patients with acute suppurative non-complicated appendicitis.

Abstract Background: Foodservice is an important issue in hospital settings, and patients’ levels of satisfaction are often indicated by consumption and plate waste.
Objective: The current study compared patient satisfaction in hospital areas and other factors and determined the relationship between patient satisfaction and plate waste.
Methods: This quantitative research was performed in four East Malaysian public hospitals. Patients at these hospitals were asked to complete a questionnaire which had three parts: A) general information, B) patient satisfaction questionnaire (Acute Care Hospital Foodservice Patient Satisfaction Questionnaire), and C) plate waste scale (Comstock 6-point scale).
Results: A total of 189 patients participated. The results indicated that overall, 53.3%, 29.3%, 14.1%, 2.7%, and 0.5% of respondents rated the hospital foodservice as okay, good, poor, very good, and very poor, respectively. Average plate waste was 35% for all hospitals, and only 11% of patients finished all the food served. Satisfaction with hospital food differed according to the catering system (in-house and outsourced). However, the results also indicated that satisfaction with hospital foodservice was not significantly related to food wastage (r=-0.018, n=189, P=0.809).
Conclusion: Various factors in hospital foodservice, especially food quality, should be improved to motivate patients to consume hospital food.

Abstract Background: There is a renewed interest in job satisfaction among healthcare workers including nurses in Africa and the West African sub-region due to the perception that global shifts in the internal structures and employment practices are inducing changes in the ties that bind employees to their job. Therefore, it is necessary to examine various studies in order to establish an empirical base and utility for the theory of knowledge.
Objective: This paper reviewed some of the available literatures on factors affecting job satisfaction among nurses around the world with special focus on the African continent.
Methods: Electronic search of Medline, PubMed, Health Internetwork Access to Research Initiative (HINARI), and Google Scholar databases up to 2014 was carried out for studies which analyzed the factors affecting job satisfaction of nurses around the world, Africa and West Africa.
Results: Although regional variations in levels of job satisfaction exist among nurses globally, there is more general trend of dissatisfaction and these are because of various factors related to the work environment. Nigerian nurses are generally more satisfied (as high as 92%) with their jobs when compared with their colleagues in other African countries. Socio-demographic and socioeconomic variables do not affect job satisfaction as much as leadership styles, promotion and other features related to the work environment.
Conclusion: Strong leadership style is a probable reason why nurses in Nigeria are more satisfied with their jobs when compared with their colleagues in other countries even though they may work for longer hours or earn relatively less salaries.