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 Background: Corporate universities serve as strategic frameworks for continuous organizational learning and human capital development, especially within complex healthcare and medical education systems.
Objectives: This study aimed to design and psychometrically evaluate the Corporate University Inventory specifically tailored for Universities of Medical Sciences by assessing content validity, construct validity via confirmatory factor analysis, convergent and divergent validity, and internal consistency reliability.
Methods: Conducted in 2025, this exploratory mixed-methods research targeted educational management authorities and medical education experts in Iran. The qualitative sample comprised 15 purposively selected experts, whereas the quantitative phase involved 265 senior specialists chosen via quota-based stratified sampling. Data were gathered utilizing semi-structured interviews and a researcher-developed questionnaire. Analytical procedures encompassed conventional content analysis, Content Validity Ratio (CVR), Content Validity Index (CVI), and Confirmatory Factor Analysis (CFA), utilizing SPSS and AMOS software.
Results: The five core categories (foundational drivers, organizational prerequisites, executive barriers, implementation strategies, and functional achievements) were inductively derived through conventional content analysis until theoretical saturation, refined by expert panel review, and confirmed by CFA. The inventory contains 172 items across 36 components. Content validity was confirmed (CVR ≥ 0.62 for all items per Lawshe's table; I-CVI > 0.80; S-CVI/Ave = 0.91). CFA showed good fit (CFI = 0.94, TLI = 0.93, RMSEA = 0.058, SRMR = 0.047). The five factors explained 71.8% of variance. Convergent validity (AVE = 0.50-0.56) and divergent validity were supported. Composite reliability and Cronbach's alpha both reached 0.92.
Conclusion: The developed inventory is a psychometrically rigorous and highly reliable instrument. It offers healthcare institutions a standardized evaluation framework that may support the implementation of corporate university models, while recognizing that current validation rests on self-reported data and further longitudinal and multi-context studies are needed.

Abstract Background: Muslims are religiously obligated to ensure that the pharmaceutical products they use are Halal. As awareness of Halal healthcare grows, Muslim consumers are increasingly considering the Halal status of medicines in healthcare decisions.
Objectives: This study aims to assess the knowledge, attitudes, and perceptions (KAP) regarding halal pharmaceuticals among Muslim patients at Hospital Besut and to identify influencing factors.
Methods: A cross-sectional study using a validated, self-administered questionnaire was conducted in the outpatient pharmacy. KAP scores were calculated, with higher scores indicating a better understanding. Data were analyzed using descriptive statistics and independent t-tests.
Results: Out of 376 respondents, 58.2% were female, with a mean age of 35.2 years. Mean KAP scores were: knowledge 6.46 ± 2.13 (max 9), attitude 26.93 ± 6.09 (max 35), and perception 30.89 ± 4.78 (max 35). Knowledge scores were significantly associated with age group (P < 0.001), gender (P = 0.003), education level (P < 0.001), occupation (P = 0.027), and health status (P = 0.005). Higher knowledge correlated with purchasing decisions (P = 0.016). Attitudes and perceptions differed significantly across educational levels. A strong positive correlation was found between attitude and perception (r = 0.734, P < 0.001).
Conclusion: Muslim patients in Hospital Besut showed a high KAP regarding halal pharmaceuticals, strongly influenced by education level. Positive attitudes were linked with better perceptions, highlighting the importance of awareness in promoting halal pharmaceutical use.

Abstract Background: Gender differences in sleep disturbances among night shift workers, especially mothers, are influenced by biological and cultural factors, with insomnia and cardiovascular strain heightened during night shifts.
Objectives: The main goals are to evaluate gender-specific differences in sleep disruption and blood pressure, assess correlations between demographic variables (age, education, parenthood) and circadian preferences, and identify the mechanisms linking shift work to autonomic dysfunction.
Methods: A cross-sectional analysis was conducted in 2023 using standardized questionnaires (DRS-15, CTI) and calibrated blood pressure measurements. Non-parametric Spearman correlations were performed using SPSS version 27 for non-normally distributed data, as indicated by the Kolmogorov-Smirnov test (P < 0.05).
Results: Women exhibited a stronger preference for routine stability (r = -0.102, P = 0.037), while higher education was associated with greater openness to change (r = -0.095, P = 0.043). In terms of cardiovascular effects, blood pressure had weak but significant correlations with wake time (r = 0.114, P = 0.014), indicating a circadian-autonomic relationship. Parenthood reduced sleep efficiency by 13%, while marital status and education had minimal effects (R² < 1.3%).
Conclusion: This study highlights the importance of multidimensional interventions addressing the physiological (blood pressure management) and sociocultural (childcare support) aspects of shift-work-related health problems. Future research should combine actigraphy with metabolomic profiling to further understand chronic disease pathways.