Risk Management and Healthcare Policy

Background A culture of patient safety is a significant determinant of healthcare quality and the prevention of patient harm. The objective of this study was to evaluate patient safety culture among healthcare workers at a tertiary-care hospital in India using the Indian-adapted Hospital Survey on Patient Safety Culture (I-HSOPSC 2.0). Method The survey was descriptive and cross-sectional, carried out among 96 healthcare practitioners, comprising 32 doctors, 32 nurses, and 32 allied health professionals. Also, a validated version of the Hospital Survey on Patient Safety Culture (I-HSOPSC 2.0) was used to measure patient safety culture in India. Descriptive statistics, Shapiro-Wilk test, Kruskal-Wallis test, Fishers exact test, and positive response rate analysis were used for the data analysis. Result The overall patient safety culture score was 3.72 {+/-} 0.52, indicating a positive view of patient safety culture. In terms of domains, Communication about Errors, Management Support for Patient Safety, and Teamwork scored highest, while Staffing, Work Pace, and Response to Errors scored lowest. Considerable discrepancies were observed across professions, with allied health professionals giving more favourable answers than nurses. Conclusion Overall, the culture around patient safety was good, but areas such as staffing, pace of work, and error response need targeted attention to sustain patient safety and improve the quality of care in healthcare services.

Background: This research article explores a novel framework for assessing the Quality of Healthcare based on principles of Clinical Risk Management, including the development of a theoretical construct for the quality of healthcare services based on stakeholder needs, and a conceptual model for managing risks at an institutional level. Methodology: The study consisted of a cross-sectional secondary assessment of healthcare service and system-level indicators, guided by a structured decision tree based on face, construct, content, and criterion validity. Established performance measures identified from international benchmarking and institutional quality improvement frameworks were classified and validated for assessment of clinical risks according to indicator type. Results: A total of 233 performance indicators were evaluated, of which 200 (86%) consisted of measures for assessing failures in clinical practice. According to the proposed framework, (30%) and (14%) of indicators met the criteria for assessing risks associated with clinical processes and organizational systems design respectively. Conclusion: More targeted use of indicators is required in order to achieve a greater degree of accuracy and actionability of performance assessment measures in healthcare practice. The proposed framework offers an applied method to enhance the specificity of quality indicators and direct efforts to improve systems design and decision-making capability.

Background Hand hygiene is the most effective and cost-efficient measure for preventing healthcare-associated infections (HAIs). However, adherence among healthcare workers remains suboptimal, particularly in low-resource settings. Purpose/Aim This study assessed the level of adherence to hand hygiene practices and the factors associated with adherence among healthcare workers at Lubaga Hospital, Kampala City. Methods An analytical cross-sectional study was conducted among 216 healthcare workers selected using stratified random sampling. Data were collected through direct observation using the WHO "Five Moments for Hand Hygiene" checklist and a structured, self-administered questionnaire. Data were analyzed using SPSS version 20. Descriptive statistics were used to summarize the data, while inferential analysis included Pearsons Chi-square tests and Modified Poisson regression to estimate crude and adjusted prevalence ratios (cPR and aPR) with 95% confidence intervals at a significance level of p [≤]0.05. Results Overall adherence to hand hygiene practices was 69.9%, while 30.1% of participants were non-adherent. At the individual level, gender, cadre, and attitude toward hand hygiene were significantly associated with adherence. Male healthcare workers were less likely to adhere compared to females (aPR = 0.490, 95% CI: 0.226-0.969), while nurses and midwives were more than twice as likely to adhere compared to other cadres (aPR = 2.213, 95% CI: 1.113-4.398). Participants with a positive attitude toward hand hygiene were also significantly more likely to adhere (aPR = 1.462, 95% CI: 1.227-3.226). Resource-related factors, including the availability of alcohol-based hand rub and timely replenishment of supplies, were not significantly associated with adherence. Organizational factors such as recent training in hand hygiene and infection prevention (aPR = 1.771, 95% CI: 1.673-2.989), presence of reminders (aPR = 1.747, 95% CI: 1.538-5.949), feedback on performance (aPR = 0.339, 95% CI: 0.156-0.738), and teamwork (aPR = 3.006, 95% CI: 1.424-6.348) were significantly associated with improved adherence. Conclusion Adherence to hand hygiene practices among healthcare workers was moderate but remains suboptimal. Behavioral and organizational factors, particularly training, feedback, teamwork, and attitude, play a more significant role in influencing and adherence than resource availability alone.

Perioperative safety checklists standardize critical actions, but reliable completion depends on the surrounding work system and team behavior. We conducted a prospective observational analytic study from April to May 2026 in the central surgical unit of a high-volume public teaching referral hospital in Indonesia to examine whether patient safety culture and teamwork were associated with directly observed perioperative safety compliance and whether teamwork mediated the culture-compliance relationship. Patient safety culture was measured with the Hospital Survey on Patient Safety Culture 2.0, teamwork with a 35-item TeamSTEPPS Teamwork Perceptions Questionnaire research adaptation, and compliance by direct role-based observation using a 45-item checklist derived from the AORN Comprehensive Surgical Checklist. Eighty of 92 recruited professionals contributed 240 person-operation observations across 50 operations. Overall compliance was 74.75%, with sign-out lowest at 70.68%. Patient safety culture was associated with teamwork ({beta} = 0.590; 95% CI 0.510-0.770) and directly with compliance ({beta} = 0.407; 95% CI 0.187-0.712). The teamwork-compliance coefficient was positive ({beta} = 0.285; p = 0.046), but the prespecified percentile 95% CI included zero (-0.045 to 0.517). The indirect effect through teamwork was not supported ({beta} = 0.168; p = 0.079). These findings support a system-level interpretation of perioperative safety and identify learning-oriented responses to error, situation monitoring, and sign-out fidelity as measurable targets for future improvement efforts.

Background: Academic achievement is crucial for university students, but various factors affect their performance. This study explores the impact of anxiety, sleep quality, social media use, and socioeconomic status on academic performance (CGPA) among public university students in Bangladesh. Data and Methods: Data were collected from 225 students using a structured questionnaire that assessed anxiety (GAD-7), sleep quality (PSQI), social media use (SMUQ), and socioeconomic status (income, parental education). Structural Equation Modeling (SEM) was used to analyze the relationships between these variables. Outcomes: The results showed that socioeconomic status had a strong positive effect on academic performance ({beta} = 0.745, p < 0.001), while anxiety negatively impacted academic outcomes ({beta} = -0.675, p < 0.001). Sleep quality was positively related to academic performance ({beta} = 0.113, p < 0.05), but with a weaker effect. Social media usage is found to have a negative significant effect on academic performance ({beta} = -0.137, p < 0.001). Conclusion: These findings highlight the importance of controlling social media usage and anxiety to enhance academic performance among adult students. Sleep quality and socioeconomic background of the students are also found to be meaningfully associated with their educational progress.

Background: Chronic pharmaceutical stock outs hinder Universal Health Coverage in Ethiopia. To address this, the Ministry of Health introduced the electronic Logistics Management Information System for inventory visibility and Auditable Pharmaceutical Transactions and Services for financial management. However, no national study has tested their combined impact. This study evaluated the individual and synergistic effects of electronic Logistics Management Information System and Auditable Pharmaceutical Transactions and Services on essential commodity availability across Ethiopian public healthcare facilities. Methods; We conducted a secondary analysis of the 2024/2025 Ethiopian Service Provision Assessment dataset utilizing 1245 public facilities nested within 125 clusters. The primary outcome was optimal essential commodity availability (zero stock outs and 100% tracer commodity presence). A two-level mixed-effects logistic regression model with an interaction term evaluated synergy, reporting Adjusted Odds Ratios with 95% Confidence Intervals. Results; Overall optimal availability was 54.2% (95% CI; 51.4%-57.0%). Implementation rates were 41.2% for eLMIS, 38.2% for APTS and 26.5% for dual implementation. Facilities using eLMIS alone (AOR = 2.15; 95% CI: 1.52-3.04) and APTS alone (AOR = 1.82; 95% CI; 1.28-2.58) showed higher security. Dual implementation showed a profound synergistic effect (AOR = 4.32; 95% CI; 3.25-5.74, p < 0.001). Positive predictors included functional cold chains (AOR = 2.08), qualified staffing (AOR = 1.68), hub proximity (AOR = 1.58) and urban settings (AOR = 1.95). The model explained 66.2% of regional variance. Conclusion; Dual implementation of electronic Logistics Management Information System and Auditable Pharmaceutical Transactions and Services creates a powerful synergistic impact on pharmaceutical availability. Synchronized national scale-up and cold chain investments are urgently needed to achieve supply chain resilience and Universal Health Coverage in Ethiopia.

High-alert medications are a leading cause of preventable patient harm worldwide, but there was no any high alert medicine list or error prevention strategy for Sri Lankan hospitals. This study addresses that gap by using interviewer administered questionnaire [n=315], five stakeholder consultative meetings [n=62] including multidisciplinary clinicians to reach consensus, followed by interviewer administered questionnaire [n=45], semi-structured three focus group discussions [n=45] to explore implementation barriers. Our findings identified [n=100] medicines as high-alert for acute care settings, and [n=40] medicines for community settings. I believe this article will be of interest and benefit to the readers of your journal. I declare that this manuscript is original, has not been published before and is not currently being considered for publication elsewhere.No conflicts of interest exist. Ethical approval was obtained from the Ethics Review Committee of Faculty of Medicine, University of Colombo (Reference number: 18-008) and approval were renewed annually as required and Ethical Review Committees of National Hospital of Sri Lanka (Reference number: AAj/ETH/COM/2017) and Colombo South Teaching Hospital (Reference number: PL/MO/2018-2019).All approval covered the full data collection period. Permission to photograph hospital pharmacies were obtained from chief pharmacist of participating hospital and no patient-identifiable information is shown.Written informed consent was obtained from all participants. The high alert medicine lists for acute and community settings are provided as S1 and S2 appendices.As corresponding author, I confirm that the manuscript has been read and approved for submission by all the named authors.

A. Rationale: Medication-related incidents are an important patient-safety concern, particularly in critical-care and inpatient settings where polypharmacy, clinical complexity, frequent therapeutic modifications, and transitions of care increase the risk of medication errors. Systematic analysis of reported incidents can help identify predominant error patterns, potential contributing factors, and priority areas for quality improvement. The present study was undertaken to characterize medication-related incidents and identify areas requiring targeted patient-safety interventions. B. Research Question What are the predominant patterns and distribution of medication-related incidents across critical-care and inpatient units, what patient-care, process, communication, documentation, and system-level factors potentially contribute to their occurrence, and how can these findings be systematically translated into prioritized, evidence-based quality-improvement interventions to strengthen medication safety and reduce preventable medication-related harm? C. Study Design and Methods A retrospective descriptive observational study was conducted to assess the pattern of medication-related errors identified through medication audits conducted in inpatient and critical-care settings. A total of 74 medication audit records were retrospectively reviewed. Each record was evaluated for the presence and type of medication-related error, including transcription, administration, documentation, and dispensing errors. The identified medication errors were categorized based on the nature of the error documented in the audit records. As individual records could contain more than one type of medication-related error, the error categories were considered non-mutually exclusive. Consequently, the total number of error occurrences could exceed the number of records reviewed. Descriptive statistical analysis was performed using frequency distributions and percentages to determine the relative occurrence of each medication-error category. Pareto analysis was subsequently performed to identify the predominant error categories and establish priorities for quality-improvement interventions. The Pareto analysis demonstrated that transcription and administration errors constituted the major contributors to the observed medication-related errors. The identified error patterns were further evaluated using a process-based patient-safety approach to determine potential failure points within the medication-use process. Poka-Yoke (error-proofing) principles were applied to identify opportunities for preventing or detecting errors at the point of occurrence. Based on the findings, potential interventions included standardization of medication-ordering and transcription processes, mandatory verification of medication details, strengthening of independent verification for high-alert medications, and incorporation of technology-enabled safeguards such as electronic medication administration records and barcode-based medication administration. The findings were used to identify priority areas for targeted quality-improvement interventions aimed at reducing medication-related errors and strengthening the safety and reliability of the medication-use process. D. Results: A total of 91 medication-related error occurrences were identified across the 74 audit records reviewed. Transcription errors constituted the predominant error category (46; 50.5%), followed by administration-related errors (41; 45.1%). Documentation-related and dispensing-related errors accounted for 3 (3.3%) and 1 (1.1%) occurrences, respectively. Pareto analysis demonstrated that transcription and administration-related errors collectively accounted for 87 of the 91 identified occurrences (95.6%), indicating a substantial concentration of medication-related errors within these two categories. The cumulative frequency increased from 50.5% for transcription errors to 95.6% following inclusion of administration-related errors, while the remaining categories contributed only 4.4% of the total error occurrences. Accordingly, transcription and administration-related errors were identified as the principal priority areas for subsequent root cause analysis and quality-improvement interventions. Interpretation: The findings demonstrate that transcription errors (50.5%) and administration-related errors (45.1%) were the predominant medication-related errors, collectively accounting for 87 of the 91 identified error occurrences (95.6%). Documentation-related errors constituted 3.3%, while dispensing-related errors accounted for 1.1% of the observed occurrences. Pareto analysis revealed a marked concentration of medication-related errors within the transcription and administration domains, indicating that these two categories represented the principal areas requiring focused quality-improvement interventions. Subsequent Root Cause Analysis (RCA) and Poka-Yoke-based error-proofing approaches were therefore directed toward identifying and mitigating process vulnerabilities within these high-frequency error domains. Keywords: Medication-related incidents, Medication errors, Patient safety, Critical care, Inpatient care, Medication transcription errors, Medication omission, Medication administration, Root Cause Analysis, Pareto analysis, Poka-Yoke, Error-proofing, Quality improvement, Medication safety, PDSA.

Objective Nurses' specific medication-administration double-check procedures vary widely; while independent double-checks (IDCs) are considered effective and recommended, they are implemented insufficiently in practice. This study aimed to classify these procedures by their component features and determine which features nurses consider desirable and perceive as implemented in clinical practice. Design Cross-sectional web-based vignette study Setting, participants, and methods Nurses working in Japanese hospitals or clinics participated in this study, for which we created 84 scenarios by combining checking procedures' features, including independence between checkers, across the calculation, preparation, and administration stages. For each scenario, participants self-reported the desirability of the procedure and its perceived implementation frequency in their clinical setting. Linear mixed-effects models assessed associations between checking-procedure features and each rating, and McNemar's test assessed discrepancies between desirability and implementation frequency for IDC. Primary outcome Associations between double-check procedures' features and their desirability and implementation frequency, and the alignment between desirability and implementation frequency for IDC Results Of 534 respondents, 265 were analyzed after prespecified attention-check exclusions. Independent checking was positively associated with desirability (b=0.304, 95% CI [0.255, 0.353], p<0.001), perceived implementation frequency for high-risk medications (b=0.140, 95% CI [0.080, 0.200], p<0.001), and non-high-risk medications (b=0.083, 95% CI [0.022, 0.143], p=0.008). Only 22.5% of nurses perceived IDC as the most frequently implemented procedure during the calculation stage. Moreover, 23.4% rated IDC as the most desirable, but did not report it as the most frequently implemented, whereas 8.1% showed the reverse pattern (OR=2.89, 95% CI [1.69, 4.94], p<0.001). Conclusions Although independence, a key feature of IDC, was reflected in nurses' desirability ratings and perceived implementation frequency, IDC was not the most frequently implemented checking procedure, relative to others. Implementing IDC may require not only promoting understanding of its significance but also establishing work protocols and organizational environments that enable independent checking.

Sepsis and septic shock remain critical medical emergencies that require timely and effective interventions. This study evaluates the knowledge, attitudes, and practices (KAP) of healthcare professionals in Bahrain concerning the management of sepsis and septic shock. A cross-sectional survey was conducted among a sample of 260 healthcare professionals who consented to participate out of 310 approached, yielding a response rate of 83.9%. Data were collected using a structured, self-administered questionnaire designed to ensure anonymity and consistency in responses. Data were analyzed using descriptive and inferential statistics via IBM SPSS version 29. Most participants demonstrated sound general knowledge of sepsis, with 90.7% correctly identifying broad-spectrum antibiotics as the first-line treatment. However, awareness of certain clinical tools was lower--only 44.6% recognized the qSOFA score and 60% understood the use of capillary refill time. Knowledge levels were significantly higher among males (77.4%) than females (70.6%, p = 0.043), and among those with advanced degrees (p < 0.001), especially doctorate holders (84.5%). Physicians had the highest average knowledge scores (91.0%), followed by PharmD holders (82.2%). Positive attitudes toward early sepsis recognition were reported by 82.2% of participants, particularly among those with doctoral education and over 21 years of experience. In practice, 72.7% routinely assessed for organ dysfunction, and 51.9% initiated antibiotic therapy within the first hour of diagnosis. The study identified significant gaps in diagnostic tool familiarity and clinical practice consistency. These findings underscore the importance of initiatives to enhance adherence to sepsis management protocols in Bahrain.

Abstract Background: There is a significant health burden of depression and anxiety in Bangladesh, but there is limited data on depression and anxiety prevalence in the community using multi-site studies that include psychosocial determinants. The independent association of mental health stigma and help-seeking attitudes with risk should be explored. Objectives: To estimate the prevalence of moderate-to-severe depression and anxiety among adults in Bangladesh and examine their associations with sociodemographic characteristics, mental health stigma, and attitudes toward seeking professional psychological help. Methods: A cross-sectional study was conducted from February 1 to June 20, 2026, across three divisions of Bangladesh (urban Dhaka, semi-urban Chattogram, rural Sylhet). Stratified multistage sampling recruited 400 adults aged 18-60 years from government primary care facilities. Depression and anxiety were assessed using the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), respectively . Mental health stigma was measured using the Community Attitudes Toward Mental Illness-Bangla (CAMI-B), and help-seeking attitudes using the Attitudes Toward Seeking Professional Psychological Help-Short Form (ATSPPH-SF). Multivariable binary logistic regression examined independent predictors of depression and anxiety, controlling for sociodemographic variables. Results: Depression prevalence was 39.0% (n = 156; M = 8.13, SD = 5.72) and anxiety prevalence was 29.8% (n = 119; M = 7.21, SD = 5.14). In adjusted models, each additional unit of CAMI-B stigma increased odds of depression (adjusted odds ratio [aOR] = 1.08, 95% confidence interval [CI] [1.03-1.13], p = .001) and anxiety (aOR = 1.07, 95% CI [1.02-1.12], p = .004). Each additional unit of positive help-seeking attitude reduced the odds of depression (aOR = 0.92, 95% CI [0.88-0.97], p = .001) and anxiety (aOR = 0.93, 95% CI [0.89-0.97], p = .001). Age predicted depression (aOR = 1.04 per year, p = .009) but not anxiety (aOR = 1.02, p = .439). Sex, education, and household income were not significant independent predictors in adjusted models. Descriptive analysis showed higher depression prevalence in rural (47.0%) versus urban (33.8%) settings, though rural residence was not significant in adjusted models. Conclusions: Depression and anxiety are highly prevalent among Bangladeshi adults. Mental health stigma and positive help-seeking attitudes emerge as independent psychological determinants, stronger than conventional sociodemographic factors. These modifiable psychosocial factors represent key intervention targets. Comprehensive strategies combining community-level stigma reduction, individual help-seeking enhancement, and healthcare system strengthening are essential to reduce depression and anxiety burden and address Bangladesh's substantial mental health treatment gap.

BACKGROUND: War refugees are prone to psychiatric ailments due to multiple psychosocial stressors. Afghan refugees remain underrepresented in psychiatric studies. Therefore, a study exploring factors contributing to their mental health disorders is essential to guide rehabilitation efforts worldwide. METHODS: This descriptive cross-sectional study evaluates the demographics, psychosocial stressors, psychiatric illnesses, and psychotropic drug use among Afghan refugees visiting the Psychiatry Outpatient Department (OPD) in Islamabad, Pakistan. Convenience sampling was employed on a sample population (n) of 75 participants. Data was collected via a structured questionnaire and analyzed using SPSS v21.0. Qualitative and quantitative variables were analyzed statistically. RESULTS: Nearly 64%(n=48) of the participants were female. About 46.7%(n=35) of participants were uneducated, and 53.3%(n=40) were unemployed. 86.7%(n=65) of participants were married, while 2.7%(n=2) were divorced. 91%(n=61) of the married and divorced participants had an arranged marriage, 46.3%(n=31) had 5-8 children, and 67.2%(n=45) had experienced physical and/or emotional abuse. 74.7%(n=56) of the total participants reported a loss in the family, while 77.3%(n=58) had experienced trauma. 62.7%(n=47) had depression and associated psychotropic use, e.g., SSRIs (42.7%), TCAs (16%), and Benzodiazepines (13.3%). Alarmingly, 37.3%(n=28) reported a previous suicide attempt. CONCLUSION: This study explores the psychosocial stressors faced by Afghan refugees in Pakistan, including displacement, abuse, trauma, and family/income loss. It emphasizes the importance of evidence-based psychiatric care, rehabilitative interventions, and culturally sensitive care to counter psychiatric morbidities and underscores the need for future research to improve the mental health of refugees globally.

This study aims at assessing the rational antibiotic medicine prescribing in public health care facilities in Zanzibar, Tanzania. The study employed a descriptive and cross-sectional study with a quantitative approach in collecting and analyzing data. The study targeted all 30 health care facilities in the western urban region of Zanzibar together with all prescribers and prescriptions prescribed during the study period. Prescriptions were selected by using probability systematic sampling techniques from selected public health facilities. The study found that, 3,455 (99.9%) recorded prescription encounters had a documented diagnosis, indicating comprehensive record-keeping. On average, 1.1 (SD= {+/-}0.3) antibiotics were prescribed per prescription encounter, with 2,277 (65.9%) prescribed generic names. Injectable antibiotics were recorded in 166 (4.8%) of prescriptions, while 2,270 (65.7%) of prescriptions adhered to the Zanzibar Standard Treatment Guidelines (STG). The overall mean knowledge score among prescribers was 6.1 (SD = 0.89). 24.3% of prescribers had low knowledge ([&le;]5 points), 41.4%had medium knowledge (6 points), and 34.3%had high knowledge ([&ge;]7 points). A majority of prescribers (90%) reported that they always adhere to the Zanzibar Standard Treatment Guidelines (ZSTG) and Zanzibar Essential Medicines List (ZEML) when prescribing antibiotics. 1.4% of prescribers acknowledged that they sometimes prescribe antibiotics even when unnecessary. Regarding antibiotic selection, 45.7% of prescribers prescribe only generic antibiotics. The study also found that Beta-Lactam antibiotics were the most prescribed, with 98.6% of prescribers confirming their frequent use. According to the results, most of the prescribing indicators in these health facilities did not meet the WHO's standard requirements, thus being irrational (poor rational prescribing).

Quality healthcare delivery in low- and middle-income countries remains constrained by workforce and resource limitations. This study assessed service provider competence, service provider motivation, and resource availability as determinants of quality healthcare delivery at Makeni Regional Hospital in Northern Sierra Leone, from the service providers' own perspective. A cross-sectional study, descriptive in type, was conducted among 155 service providers, with sample size determined using the Yamane formula. Structured questionnaires were administered and analyzed using STATA to assess the relationship between competence, motivation, resource availability, and quality healthcare delivery. Most service providers (74.8%) reported possessing the required professional skills, and 91.6% perceived that competent staff resulted in improved delivery of quality healthcare; 94.8% associated competent personnel with improved patient outcomes. Motivation levels were markedly lower: only 7.1% of respondents were highly motivated, 16.1% were motivated, and 40.65% were somewhat motivated, while all respondents (100%) agreed that motivation influences quality of care delivery. Resource availability showed the strongest association with quality outcomes, with 99.4% of respondents affirming that adequate resources affect quality healthcare delivery and 95.5% affirming that adequate resources result in improved delivery of quality healthcare; gaps were noted in bed capacity (45.8% reporting inadequacy) and equipment. Service provider competence, motivation, and resource availability were all found to significantly determine the delivery of quality healthcare at Makeni Regional Hospital, with motivation representing the weakest of the three despite high levels of provider competence. Continuous professional development, formal motivation policies, and improved resource allocation are recommended to strengthen quality healthcare delivery.

Objectives: To evaluate the sustainability of Lean Healthcare practices after the implementation phase of a national quality improvement programme and to identify organisational factors associated with maintaining results over time. Design: Multicentre cross-sectional study with a mixed-methods approach. Setting: Twelve public and philanthropic hospitals in Brazil participating in Phase 2 of the Lean in Emergency Departments Project. Participants: Key respondents in managerial or leadership roles from participating hospitals (response rate: 75.0%). Outcome measures: Sustainability of Lean practices and organisational readiness, assessed through a structured survey and triangulated with operational indicators collected across successive implementation cycles at hospital level. Results: During one year of structured follow-up, 66.7% of respondents reported maintenance of Lean practices; this decreased to 33.3% after the end of structured follow-up. Although 66.7% considered professionals capable of maintaining results, only 58.3% positively evaluated institutional structure, indicating a discrepancy between individual capacity and organisational readiness. Operational indicators showed heterogeneous behaviour across hospitals, with no consistent pattern of sustained improvement. Qualitative analysis identified professional and managerial turnover, formal governance structures, and continuous monitoring as key factors associated with sustainability. Conclusions: The sustainability of Lean Healthcare practices is more strongly associated with institutional capacity to embed and sustain changes over time than with isolated individual training. Quality improvement programmes should incorporate structured strategies for the post-implementation phase. Keywords: Lean Healthcare; Sustainability; Quality improvement; Hospital flow; Health systems; Organisational factors

Background Surgical site infections (SSIs) are an alarming threat in the surgical field worldwide. They are among the prevalent Hospital Acquired Infections (HAIs) and contribute to antibiotic resistance in resource-limited countries, including Tanzania, where paucity of data exists. This study aimed to ascertain the five-year trend of SSI in Tanzanian health facilities. Methods A retrospective descriptive cross-sectional study was conducted using SSI data reported in the District Health Information System-2 (DHIS2) between October 2021 and December 2025. Data from 138 health facilities were extracted, cleaned, and analysed in R (version 4.5.0). Trends in SSI rates were assessed using Ordinary Least Squares (OLS) regression, with significant variations measured at [&le;] 0.05. Results The 138 facilities reported 419,412 surgical procedures during the study period. Most facilities were primary-level (96, 69.6%) and government-owned (119, 86.2%). The number of reporting facilities increased from 17 in 2021 to 138 in 2025, with an increase in surgical procedures from 9,616 to 127,039. Overall SSI rates declined from 3.1% in 2021 to 2.4% in 2025. Primary-level facilities had the highest overall SSI rate (5.4%), declining from 4.7% to 4.0%. In contrast, SSI following section increased from 1.8% to 2.0%. Organ/space SSI showed a statistically significant declining trend from 1.2% to 0.3% (slope = -0.23%/year; 95% CI: -0.34 to -0.12; p = 0.006). The trends in overall SSI rates by level of health facility and ownership were not statistically significant Conclusion Between 2021 and 2025, overall SSI rates decreased despite a substantial increase in surgical volume, suggesting improvement in IPC. While an organ/space SSI significantly decreased, SSI rates due to caesarean section persistently increased, with higher rates reported in primary healthcare facilities, highlighting the need for strengthened perioperative IPC measures in obstetric care and SSI surveillance across primary-level facilities.

Background. Regulatory pressure to avoid confusingly similar drug names appears to have pushed manufacturers to coin more distinctive proprietary names, but no one has quantitatively analyzed this trend. Objective. To determine whether proprietary drug names became more orthographically distinctive (unusual in spelling) over time. Methods. We examined 1,321 US Food and Drug Administration (FDA) new molecular entity (NME) names (1985-2024), 2,769 FDA Orange Book trade names (1982-2026), 177,337 US pharmaceutical trademarks (1980-2026), and 1,273 generic names (1982-2025). Compared to prior names (including those already marketed) and ordinary English, we scored each name's character trigram (three-letter sequence) surprisal (statistical unexpectedness) and its edit-distance similarity to the closest existing names. Linear regression tested time trends, controlling for name length. Results. Mean NME trigram surprisal rose in every decade between the 1980s and 2020s, from 7.21 to 8.50 nats (natural-logarithm units, higher meaning less predictable), an 18% increase (b = 0.038, p < .001, R2 = 0.34). Half of 2020s names (7% in the 1980s) contained a letter sequence found in no common English word (e.g., Jesduvroq, Omvoh). Nearest-neighbor similarity fell after the early 1990s. Trademark data showed the same trend (b = 0.016, p < .001). Generic names showed a weaker trend (b = 0.011, R2 = 0.063). Conclusions. Over four decades, drug names became more orthographically distinctive, consistent with namespace crowding, deliberate efforts to avoid confusing names, and branding strategy. Because unfamiliar letter sequences can introduce other error pathways, increased distinctiveness does not necessarily imply improved safety.

The forced displacement of medical students due to armed conflict presents a profound disruption to the global medical education continuum. Existing research predominantly evaluates individual psychological trauma, leaving a critical gap in measuring the structural and institutional friction displaced learners face when transitioning into host medical schools. This study details the development, structural refinement, and psychometric validation of the Displaced Medical Student Scale (DMSS), a novel 38-item instrument theoretically grounded in Pierre Bourdieus Theory of Practice. Utilising an exploratory sequential mixed-methods design adhering to COSMIN guidelines, initial qualitative items generated from a transnational cohort underwent content validation by an expert panel (Scale-Level Content Validity Index Average = 0.96) and pilot face validation (N = 29) to eliminate linguistic barriers. Subsequent psychometric testing with 156 displaced Gazan medical students confirmed a robust six-factor latent structure: Mechanisms of Conflict, Hysteresis and Dislocation, Agential Coping, The Agents Toolkit, The Institutional Field, and Transition Outcomes. Confirmatory factor analysis using diagonally weighted least squares demonstrated excellent model fit (, Comparative Fit Index = 0.925, Tucker-Lewis Index = 0.918, Root Mean Square Error of Approximation = 0.058, Standardised Root Mean Square Residual = 0.064) and exceptional internal consistency (Cronbachs , McDonalds ). Structural equation modelling proved that institutional symbolic violence negatively impacts transposed clinical capital () and that structural hysteresis mathematically mediates the path between symbolic violence and professional attrition fatigue (). Furthermore, agential coping significantly moderates identity crisis outcomes (). The DMSS provides medical faculties with an evidence-based metric to transition from deficit frameworks to targeted structural interventions that preserve displaced clinical capital.

Background: Overuse of antibiotics accelerates antimicrobial resistance (AMR), threatening public health. Poland faces challenges with high antibiotic use; therefore, understanding people's antibiotic-related behaviours and beliefs would help identify targets for interventions. This study aims to identify sociodemographic and psychosocial correlates of antibiotic use among a representative sample of adults in Poland. Methods: The study employed an exploratory survey design. Adults in Poland (N=1,000) were randomly sampled, ensuring the representativeness of the Polish general population. Data were collected using a pretested questionnaire, administered through computer-assisted telephone interviews. Quantitative data were analysed descriptively and using a logistic regression. Free-text data were analysed using content analysis. Results: 31.6% of respondents used oral antibiotics in the preceding year, most commonly for respiratory tract infections (RTIs). Higher age, higher household income level, and education level were identified as predictors of increased antibiotic use, with increasing age being the most prominent factor. The belief that antibiotics accelerate recovery from RTIs and expectations for antibiotic prescriptions were found to be associated with greater antibiotic use. Encouragingly, 92.9% of respondents reported trusting their doctors, 51.5% that doctors explained why antibiotics were unnecessary for particular infections, and 57.1% were willing to engage in such discussions. While 76.5% of respondents reported awareness of antibiotic resistance, descriptions of the concept were often flawed. Conclusions: Key areas of focus for future interventions include addressing attitudes and behaviours of middle-aged (35-65) and older (66+ years old) adults, managing patient expectations regarding recovery and prescriptions, and correcting fundamental misconceptions about AMR.

Health facilities (HFs) routinely administer medicines and are expected to ensure patient safety by detecting, reporting, investigating, and analysing adverse events following exposure to drugs (AEFED). This study aimed to assess the implementation of pharmacovigilance activities in referral and regional health facilities in Cameroon and to identify pharmacovigilance training needs among healthcare personnel (HP). This was a cross-sectional descriptive study targeting referral and regional health facilities and healthcare personnel involved in patient care and pharmacovigilance activities in Cameroon. Health facilities were selected using stratified purposive sampling, while healthcare personnel were selected through exhaustive sampling. Data were collected using semi-structured electronic questionnaires administered face-to-face by trained enumerators. The questionnaires assessed the organization, resources, and implementation of pharmacovigilance activities at health facilities, as well as healthcare personnel knowledge of pharmacovigilance concepts, previous training, and perceived training needs. Of the 14 eligible health facilities, 10 (71.4%) consented to participate in the study. Of the 10 health facilities, 4 (40.0%) had an established pharmacovigilance unit, while 3 (30.0%) reported conducting neither detection nor notification activities. Among the 261 healthcare personnel approached, 214 (81.9%) participated. Only 41.6% had needed knowledge to detect an adverse event, while 72.9% were aware of adverse event notification procedures. Previous exposure to pharmacovigilance training was reported by 37.9% of healthcare personnel, and all participants expressed a need for additional training, particularly on national pharmacovigilance regulations (69.2%), organization of the pharmacovigilance system (67.3%), and adverse event detection (67.3%). The main reported challenges by healthcare personnel in the implementation of pharmacovigilance activities included insufficient budget allocation, limited access to pharmacovigilance training, lack of pharmacovigilance guidelines and insufficient qualified human resources. Pharmacovigilance implementation in referral and regional health facilities in Cameroon remains limited, with gaps in organizational structures, resources, healthcare personnel knowledge, and training. Strengthening pharmacovigilance systems through improved facility capacity, availability of essential tools, and targeted healthcare personnel training is needed to enhance drug safety surveillance.