Hospital Practices and Research

Abstract Despite remarkable advances in reperfusion strategies, antithrombotic therapy, and secondary prevention, myocardial infarction (MI) remains a leading cause of heart failure and cardiovascular mortality worldwide. Among emerging regenerative approaches, exosome engineering has attracted considerable scientific interest. Exosomes are nano-sized extracellular vesicles secreted by nearly all cell types and are now recognized as highly organized mediators of intercellular communication. By transporting microRNAs, proteins, lipids, and signaling molecules, exosomes influence gene expression and cellular behavior in target tissues. We argue that integrating metabolic modulators with engineered exosome delivery platforms represents not merely an incremental innovation but a paradigm shift in post-MI regenerative therapy.

Abstract Neonatal Intensive Care Units (NICUs) face a persistent challenge in controlling healthcare-associated infections (HAIs), with reported rates ranging from 6% to 25% globally. While traditional infection control strategies have focused on symptomatic patients and high-risk groups, a growing body of evidence suggests that “silent spreaders,” asymptomatic carriers of multidrug-resistant organisms (MDROs) among healthcare workers, parents, and neonates themselves may represent a critical blind spot in current surveillance paradigms. If this is the case, then fundamental assumptions underpinning NICU infection control may warrant reexamination. We argue that existing approaches, which rely heavily on active surveillance cultures (ASCs) and hand hygiene compliance, are structurally ill-suited to detect asymptomatic transmission. Emerging genomic, environmental, and data-driven methodologies offer not merely incremental improvements but a necessary reconceptualization of surveillance itself.

Abstract Background: Artificial Intelligence (AI), as a transformative technology, has found widespread applications in the health and hospital sectors.
Objectives: The present study aimed to analyze scientific articles related to AI in hospitals using text mining methods to identify dominant topics and emerging trends.
Methods: In the present study, text mining and topic modeling approaches were used to analyze research trends and identify dominant topics. The research steps included data collection from Scopus, text preprocessing, extraction of frequent words, topic modeling using Latent Dirichlet Allocation (LDA), and visualization. All steps were performed using the Python programming language and open-source libraries, such as NLTK, Gensim, Matplotlib, scikit-learn, and pyLDAvis.
Results: A total of 2238 records related to AI in hospitals were collected from Scopus since 2000. The terms "patient," "model," "machine learning," and "artificial intelligence" were identified as the most frequently used terms. The dominant topic clusters included "patient monitoring," "data-driven systems," "service innovation and emerging technologies," "clinical outcome prediction," "COVID-19 risk prediction," "mortality and hospitalization prediction," "health tourism," "management and implementation," and "hospital death prediction." Most articles were in the clusters "clinical outcome prediction modeling" (663 documents) and "mortality and hospitalization prediction" (335 documents). The publication trend has accelerated significantly since 2018, especially in the clusters "clinical outcome prediction" and "management and implementation."
Conclusion: Conclusion: Artificial intelligence in hospitals has grown rapidly over the last two decades. The shift from limited applications in modeling and prediction to interdisciplinary areas and innovative services indicates the gradual growth of this technology and its role in improving the quality of care, optimizing organizational processes, and developing new services.

Abstract Background: Hospital-acquired infections (HAIs), particularly device-associated infections (DAIs) in ICUs, pose a significant global health burden, especially in low- and middle-income countries.
Objectives: This study aims to estimate the HAI burden by analyzing DAI rates and resistance patterns in ICU settings, contributing to evidence-based infection control strategies.
Methods: We conducted a six-month prospective observational study in the adult ICU of GTBH (July–December 2024), focusing on patients with DAIs. Incidence and device utilization rates were calculated using CDC-standardized metrics based on device and patient days.
Results: Out of 286 patients, 40 developed a total of 62 DAIs, comprising 25 cases of ventilator-associated pneumonia (VAP) (40.3%), 19 cases of catheter-related bloodstream infections (CLABSI) (30.65%), and 18 cases of catheter-associated urinary tract infections (CAUTI) (29.03%). VAP had the highest cumulative infection rate (22.6%), followed by CLABSI (21%) and CAUTI (10.8%). Acinetobacter baumannii was the dominant isolate in VAP cases, Klebsiella pneumoniae and Enterobacter spp. were predominant in CLABSI cases, and non-albicans Candida was the leading pathogen in CAUTI cases. Significant antimicrobial resistance was observed, especially among Acinetobacter and Pseudomonas species. Notably, the case fatality rate among DAI patients reached 57.5%.
Conclusion: In conclusion, our surveillance study highlights a substantial burden of DAIs in the ICU, with VAP being the most prevalent. The dominance of multidrug-resistant pathogens and the striking 57.5% fatality rate emphasize the urgent need for robust infection control, tailored stewardship programs, and continuous local epidemiological monitoring.

Abstract Background: Hospital utilization and financial performance are shaped by payer incentives, managed care participation, and capital investment decisions.
Objectives: This study aims to evaluate the extent to which variations in managed care exposure, capital expenditures, and outpatient revenue are associated with facility-level changes in service volume and net patient revenue over time.
Methods: This study uses a multi-year panel dataset of hospitals observed over 22 quarters from 2020 to 2025. Outcomes include changes in total patient days and net patient revenue, capturing shifts in service volume and realized earnings. Key explanatory variables include capital expenditures, managed care revenue exposure, teaching-related payment adjustments, and outpatient revenue. Hospital fixed-effects models are used to isolate within-hospital variation over time.
Results: Greater managed care revenue exposure and higher capital investment are associated with faster utilization growth but do not consistently produce proportional revenue gains, suggesting margin pressures under certain reimbursement structures. Teaching-related payment adjustments are associated with slower changes in both utilization and revenue.
Conclusion: These findings highlight how payer mix and investment patterns influence provider behavior and operational outcomes. Aligning reimbursement incentives and capital allocation strategies with sustainable utilization and financial stability is important for population health management and delivery system planning.

Abstract Background: Evaluating preparedness in the health sector, particularly within hospitals, is crucial for mitigating the impact of uncontrollable disasters like chemical incidents.
Objectives: This study aims to evaluate the readiness of a military hospital in Tehran to respond effectively to such emergencies.
Methods: In this study, data were collected using a standardized and validated questionnaire, specifically the Hospital Preparedness Tool for Chemical Crises, developed to assess the readiness of the selected military hospital in Tehran.
Results: According to the study's results, the overall level of preparedness at the hospital was assessed as "very good," with a total score of 119. Among the six areas examined in the selected hospital, the highest score was for the planning and guidelines area, with points (73.94%), and in the "very good" category. In contrast, the lowest score was for the risk assessment and early warning area with 7 points (70%), and in the "good" category.
Conclusion: Based on the study findings, the performance of the selected hospital in various dimensions of preparedness and response is assessed at a very favorable level. Also, the hospital has significant capabilities in improving preparedness for various events, including chemical incidents.

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.