Risk Management and Healthcare Policy

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.

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.

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

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.

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.

Background: Diabetes mellitus is a global major health concern, with increasing prevalence in Ghana, causing significant mortality and morbidity. Effective management of this chronic condition depends on resilient healthcare systems that adhere to evidence-based guidelines. This study aimed to evaluate the quality-of-care at the diabetic clinic of the Cape Coast Teaching Hospital (CCTH) using the American Diabetes Association (ADA) guidelines as the benchmarks to show the performance of the hospital clearly, reveal gaps in the management algorithm that need to be addressed, and to contribute to the body of knowledge in the health sector of our country. Methods: Retrospective chart review was done from January 2022 to March 2023. 261 patient records were used out of a total study population of 780. Primary process indicators (medical history, physical examination, laboratory check-ups, referrals) and outcome indicators (HbA1c<7%, BP<140/90 mmHg, lipid profile, liver function test, kidney function based on eGFR categories). In analyzing the data, the Statistical Package for Social Sciences (SPSS version 21) software and STATA vs.14 were used to generate frequencies, means, and percentages presented in tables, charts, and graphs to provide answers to the research questions. Results: The overall documented adherence rates were: medical history (17%), physical examination (58.4%), laboratory evaluation (24%), and referrals (5%). These were coupled with low rates of achievement of treatment targets for various clinical outcomes, specifically glycated hemoglobin (HbA1c), blood pressure, lipid profile and estimated glomerular filtration rate (eGFR), with corresponding percentages of 47.2%, 42%, 47.1%, and 48.8%, respectively. Conclusion: The study, therefore, revealed gaps in compliance and documentation, which should be addressed to improve clinical care and patient outcomes.

Background Innovation in pharmaceutical sectors operating under resource and institutional constraints may depend not only on knowledge and attitudes but also on the conditions that enable innovation-related activities to occur. This study examined the relationships among intellectual property (IP) literacy, innovation attitudes, innovation readiness, and reported innovation practice among pharmaceutical professionals in Syria. Methods A cross-sectional survey was conducted among 303 pharmaceutical professionals between March and April 2026. Four composite indices were constructed to assess IP literacy, innovation attitudes, innovation readiness, and innovation practice. Descriptive statistics, correlation analyses, group comparisons, and multivariable regression models were used to characterize patterns of association among study domains. The analysis was designed to identify empirical patterns rather than infer causal relationships. Results Innovation attitudes were comparatively high (73.56/100), whereas innovation readiness (17.00/100) and innovation practice (12.65/100) were substantially lower. IP literacy was positively associated with innovation readiness (r = 0.384, p < 0.001) and innovation practice (r = 0.205, p < 0.001). In contrast, innovation attitudes were not significantly associated with reported innovation practice (p = 0.332). Regression analyses indicated that the inclusion of innovation readiness improved model fit beyond specifications based on knowledge and attitudes alone ({Delta}R{superscript 2} = 0.058, p = 0.028). Significant differences in readiness and practice were observed across professional groups (p < 0.001), whereas knowledge and attitudes showed limited variation. Conclusions High levels of innovation-related knowledge and positive attitudes did not correspond to high levels of reported innovation practice in this setting. The findings suggest that innovation readiness may capture enabling conditions that are not reflected by knowledge or attitudinal measures alone. These results support the value of examining contextual and institutional factors when assessing innovation capacity in resource-constrained pharmaceutical systems. Given the substantial gap observed between innovation attitudes and innovation practice, educational strategies may represent one avenue for strengthening innovation readiness. In the Syrian context, strengthening innovation-oriented education and university-industry engagement may help cultivate innovation competencies and support the translation of research into practical applications.

Background HIV testing is a key entry point for prevention and treatment in Nigeria, yet age-related disparities persist. Adolescent girls and young women (AGYW) are disproportionately affected by HIV but often demonstrate lower uptake of testing services. This study examined differences in HIV self-testing awareness, use, and antenatal HIV testing between AGYW and older women, the distribution of HIV testing service uptake, and identified multilevel factors associated with HIV self-test awareness and testing among AGYW. Methods This study analyzed cross-sectional data from the 2023-2024 Nigeria Demographic and Health Survey (NDHS), including women aged 15-49 years. Descriptive statistics were used to assess differences in HIV self-testing awareness, use, antenatal HIV testing, and place of HIV testing between Adolescent Girls and Young Women (AGYW) (15-24 years) and older women (25-49 years). Among AGYW, bivariate and multivariate logistic regression were conducted to identify socioecological factors associated with HIV self-testing, awareness and use. Results A total of 14,708 AGYW and 24,342 older women were included in the analysis. The median age of AGYW was 19 years (IQR: 17-22), compared to 35 years (IQR: 25-41) among older women. Older women reported significantly higher awareness of HIV self-testing (13.1%) compared to AGYW (8.8%). Use of the HIV self-testing kit was low overall but higher among older women (2.3%) than among AGYW (1.1%). Older women reported greater uptake of antenatal HIV testing (57.9%) than AGYW (48.4%). Education, wealth, and internet use were positively associated with awareness, while AGYW aged 15-19 had significantly lower odds of awareness than AGYW women aged 20- 24. Regional disparities were also observed in the awareness and use of HIV self-test kits. Conclusions Findings support that targeted, AGYW-centred strategies are needed to improve equitable access to HIV testing and achieve national and global HIV prevention goals.

Background A small proportion of hospitalized patients generates a disproportionate share of inpatient admissions, bed-day utilization, and associated health expenditure globally. In Saudi Arabia, where Vision 2030 mandates measurable reductions in preventable hospitalizations and hospitals consume approximately 79% of public health expenditure, population-level evidence on inpatient frequent utilization is absent from the published literature. A key methodological limitation of existing studies is reliance on a single threshold that cannot distinguish acute high-frequency episodes from sustained multi-year hospital dependence. Methods A retrospective cross-sectional study analyzed electronic health records from three public hospitals in Jeddah - East Jeddah Hospital (EJH), King Abdul-Aziz Hospital (KAAH), and Thagher Hospital (TH) - for January 2022 to December 2024. Records from two clinical information systems (Oasis at KAAH and TH; Careware at EJH) were harmonized using an eight-stage data quality protocol applied to 258,391 raw encounters, yielding a final cohort of 82,160 unique patients and 100,685 valid inpatient visits. Three complementary definitions were applied: Frequent Utilizer (FU: >=3 admissions within any rolling 365-day window), Persistent Utilizer (PU: >=3 admissions with >=24 months between first and last), and Yearly Utilizer (YU: >=1 admission in each of 2022, 2023, and 2024). Analyses were conducted in JASP 0.95.4. Results FU prevalence was 2.96% (n=2,434), PU 0.60% (n=494), and YU 0.62% (n=507). Overlap analysis identified 177 compound utilizers (0.22%) satisfying all three criteria simultaneously, with a median of 7 admissions and 33.44 bed days - more than thirteen times the standard patient median. Compound utilizers had the youngest median age of any utilizer group (24 years), while Saudi nationality concentration rose progressively from 75.0% in standard patients to 87.6% in compound utilizers, and female predominance was highest in the persistence-defined groups (PU-only 62.9%, YU-only 63.6%). All three ANOVA models confirmed significant utilizer status x hospital interactions (all p<.001). Logistic regression confirmed age, Saudi nationality, and hospital as independent predictors across all definitions. A gender discrepancy - significant for males in FU Model 1 (OR=1.090, p=.039) but not Model 2 (p=.181) - was attributable to age confounding. Conclusions Approximately one in thirty-four inpatients meets the FU criterion in this Jeddah system, with significant between-hospital variation. The three-definition framework reveals clinically distinct utilization phenotypes invisible to any single threshold, including compound utilizers with extraordinary burden and unexpectedly young age, and persistent users entirely missed by annual-window definitions. Saudi nationality is the strongest and most consistent predictor across all definitions. Integrated clinical pathways connecting primary care and community services to hospital care, with shared accountability for quality across levels, are the recommended system response aligned with Vision 2030.

Introduction: Clinical students are a future health workforce, yet their roles during outbreaks of highly infectious diseases remain uncertain because of safety, training, supervision and welfare concerns. Ugandas 2022 outbreak of Ebola disease caused by Sudan ebolavirus highlighted the need to understand how clinical students perceive outbreak-related care. Aim: This study explored willingness to care for patients with Ebola virus disease among clinical students at a Ugandan medical school and examined how perceived risks, perceived benefits and support needs shaped that willingness. Methods: An exploratory descriptive qualitative study was conducted among clinical students of Makerere University in Kampala, Uganda. Fifteen undergraduate medical and nursing students in the later years of training were purposively selected. Data were collected through in-depth interviews, audio-recorded with consent, transcribed verbatim, de-identified and analysed using latent content analysis. The Health Belief Model sensitised interpretation, and reporting was strengthened using the COREQ guidance. Results: Five interrelated themes emerged, showing that willingness to care was conditional rather than simply present or absent. Students described an initial willingness grounded in professional duty, devotion to patients and the desire to save life. This willingness was restrained by perceived risks of contracting Ebola virus disease, dying, transmitting infection to family members or colleagues, emotional distress, lack of epidemic-readiness in the curriculum, inadequate preparedness and weak welfare support. Perceived benefits, including patient survival, professional learning, outbreak experience and personal fulfilment, strengthened willingness but did not override safety concerns. Students identified reliable personal protective equipment, epidemic-ready curricula, practical infection-prevention and control training, simulation, clear protocols, close supervision, psychosocial support, insurance and fair compensation as cues to action that could convert willingness into safe participation. Conclusions: Clinical students in this Ugandan teaching hospital expressed a strong sense of professional responsibility, but their willingness to participate in Ebola care was conditional upon preparedness, protection, epidemic-ready education and institutional trust. Professional duty and learning opportunities promoted participation, whereas perceived risks and inadequate support limited it. Medical education programmes and outbreak-response systems should develop ethical, supervised, competency-based student roles supported by practical curricula, reliable protective equipment and psychosocial and welfare safeguards.

Bacterial contamination of Surgical sites could lead to Surgical Site infections (SSI) which may prolong hospital stay, increased treatment costs and increased mortality. This study determined the prevalence of bacterial contamination of surgical sites among post-operative wounds and theatre surfaces together with their resistance to commonly prescribed antibiotics. A cross-sectional study design was used where a total of 290 and 74 swabs were collected from patients and theatre surfaces respectively. Swabs were cultured on duplicate plates of Blood Agar, Chocolate Agar and MacConkey Agar. Gram-staining and Biochemical tests were performed to identify the isolates. Resistance to commonly prescribed antibiotics was determined using the Kirby Bauer (KB) method. Data were analyzed using SPSS version 23, and descriptive statistics, Chi square and student T- tests were used to describe the results. The prevalence of bacterial contamination in wounds was 30.7% and was significantly higher in women of child bearing age ({chi}2= 10.79, df=1, P=0.0010). Microbial growth increased with an increase in duration of antibiotic therapy ({chi}2=12.73, df=2, P=0.007). E. coli was responsible for the highest cases of wound contamination (34.9%). All microorganisms isolated from post-operative wounds showed considerable resistance to antimicrobials. All isolates from wounds were resitant to Trimethoprin Sulfamexathone and 76.9% showed resistance to Ciprofloxacin. Other than E.coli and Acinetobacter, the rest of the isolates were susceptible to imipinem. Fourty nine gram positive isolates were grown from theatre surfaces and a significant majority (86%) were from air. There was high resistance to Erythromycin in Coagulase Negative Staphylococcus (CNS) isolates (56.0%). Overall, our study demonstrated that wound contamination at the Hoima Regional Referral Hospital is high but not associated with theatre surface contamination.

Objective: To assess the efficacy of an executive peer coaching program, Charting Champions Program (CCP), in helping physicians manage their administrative workload, thereby improving time management, workflow and well-being. Findings: In this longitudinal survey study, physicians self-reported significant improvements in completing charting and administrative paperwork during their clinical day. Physicians reported significant improvements in mental, cognitive and emotional states after the program. Meaning: The Charting Champions Program is an effective intervention that supports physicians in problem-solving the administrative burden of their clinical day, improving workflow efficiency, completing administrative requirements during clinical hours, and enhancing work-life balance and personal satisfaction. Background: Physicians are subject to high levels of mental, physical, and emotional stress, partly due to increasing administrative burdens. Online coaching is a proven intervention to help physicians improve workflow efficiency, reduce administrative burden and improve job satisfaction. Design: This voluntary longitudinal survey took place between 2020 and 2023. Physicians were asked to complete a survey at program entry and again 30-90 days after program completion. The survey consisted of 14 Likert scale questions, and a final sample of 280 physicians completed both surveys. Intervention: CCP contains modules that teach workflow improvements for clinical days, including timely charting, administrative task workflow, managing patient consultations and reducing interruptions. Interventions include self-paced modules, live coaching, recordings and an online peer community. Results: Post-CCP physicians reported a significant decrease in hours spent charting (P<0.0001) and completing clinical paperwork outside of clinical hours (P<0.006). Physicians also reported a decrease in work-related dread (P<0.001), feelings of burnout (P<0.001), and thoughts of quitting due to administrative burdens (P<0.001). Physicians felt more focused at work (P<0.001), felt more in control of the clinical day (P<0.001), and rated their mental energy at work higher (P<0.001). The program did not affect the number of patients seen in a full clinical day (P > 0.918). Conclusion and Relevance: The CCP reduces the time physicians spend on tasks outside of clinical hours, increasing free time without decreasing the number of patients seen per day.

Effective management of biomedical equipment prevents breakdowns, extends equipment lifespan, ensures perioperative safety and cost-efficiency. There are major challenges in managing biomedical equipment, particularly in low- and middle-income countries. This study aimed to assess the availability, functionality, and adherence to maintenance practices of biomedical equipment in operating rooms (ORs) and post-anaesthesia care units (PACUs) across Rwanda. A cross-sectional observational study was conducted at one Level 2 district hospital in each of Rwanda's five provinces (n=5 sites). Data were collected using three main tools: 1) a medical equipment checklist, 2) a checklist for hospital biomedical management, and 3) direct inspections of selected biomedical equipment. All tools underwent pretesting and face validation with support from biomedical experts prior to data collection in May 2024. Key measures, including the availability and functionality of biomedical equipment, and adherence to maintenance and management practices, were summarised using descriptive statistics. The five hospitals had a total of 16 ORs, 4 PACUs, and 226 pieces of equipment. The overall availability of biomedical equipment was 45%, and the functionality of the available equipment was 96%. The mean adherence rate to national management practices was 66%. The Rwandan government, non-governmental organisations, and hospitals were identified as direct funders of the equipment, accounting for 42%, 12%, and 4%, respectively. However, 42% of the equipment surveyed could not be linked to any of the above sources of acquisition. Among non-functional equipment, 75% was due to a lack of spare parts, while 25% was due to a lack of skills to maintain the equipment. In summary, we found low availability of perioperative biomedical equipment across Rwanda, although the available equipment was highly functional. Adherence to national management practice guidelines was relatively low, threatening the sustainability of functional equipment. We recommend that the government and hospital administrators implement robust, regular auditing systems to ensure proper management of biomedical equipment.

Cancer imposes a rising and largely out-of-pocket-financed burden in Nepal, yet patient-level data on how anticancer drugs are prescribed and what chemotherapy actually costs patients remain limited. This study described the drug utilization pattern and cost of anticancer drug therapy among cancer patients treated at a tertiary cancer hospital in Nepal. A descriptive, cross-sectional, record-based study was conducted at Bhaktapur Cancer Hospital, Bhaktapur, Nepal. Medical records of cancer patients aged above 18 years attending the day-care chemotherapy ward were reviewed using a structured proforma. Sociodemographic characteristics, diagnosis, regimen and cycle data, and WHO/INRUD prescribing indicators were recorded, along with the actual cost, maximum retail price, and Nepal Health Insurance Board reimbursement rate for anticancer drug therapy. Data were analyzed descriptively and, given the skewed distribution of cost, on a log-transformed cost variable using Pearson correlation, independent-samples t tests, and multiple linear regression in SPSS version 16. A total of 151 chemotherapy patients were analyzed (mean age 53.81 {+/-} 12.51 years; 67.5% female). Breast cancer (26.5%) was the most common diagnosis. Patients received a mean of 10.56 {+/-} 2.19 total drugs, of which 1.72 {+/-} 0.67 were anticancer agents; 99.85% of drugs were prescribed generically, and 63.2-67.7% were on the national essential medicines list. Mean actual cost of anticancer therapy per patient was NPR 15,245.28 {+/-} 15,672.33, substantially below the mean maximum retail price (NPR 38,803.22). In bivariate analysis, log-transformed cost was significantly higher among male patients (p =.038) and among patients not fully compliant with the essential medicines list (p =.028), but no patient, disease, or prescribing variable -- including sex -- independently predicted log-transformed cost in a multiple regression model that was not statistically significant overall (R{superscript 2} =.113, p =.323). Anticancer prescribing at this hospital was characterized by near-universal generic use but only partial alignment with the national essential medicines list, and chemotherapy cost varied widely across patients without being reliably explained by the patient or prescribing factors examined. These findings support continued WHO/INRUD-style prescribing surveillance and closer attention to essential-medicines-list adherence and drug pricing in this setting.

Introduction Indigenous peoples in Canada face persistent health inequities rooted in colonialism, systemic racism, discrimination and social exclusion, all of which operate with particular intensity within healthcare institutions. Despite a growing qualitative literature documenting the discrimination and stigmatisation of Indigenous people by healthcare professionals, no validated instrument existed in the Canadian context to measure the stigmatizing attitudes and behaviors of clinicians toward this population. Aim This study aimed to co-develop and validate an instrument using clinical case vignettes designed to capture the affective, cognitive, and behavioral dimensions of stigmatization of indigenous peoples. Method Following Boateng et al.'s three-phase scale development approach, a multidisciplinary team including Indigenous patient partners, researchers, clinicians, and measurement experts generated 244 items across three paired clinical vignettes addressing type 2 diabetes, chronic back pain, and depressive disorder. Each vignette was developed in two versions, one featuring an Indigenous patient (test) and one featuring a non-Indigenous patient (control), distinguished solely by name and origin. Content validity was assessed by an expert committee using a Content Validity Index. The instrument was subsequently administered to a sample of nurses and physicians from two canadian health institutions using a twelve-arm randomization design. Analyses were carried to assess the internal structure of the instrument, convergent and concurrent validity as well as internal consistency. Results Our results show that the instrument developed has good psychometric qualities, particularly in terms of internal consistency, concurrent validity and factor structure, which reflects the theoretical structure assumed. Concurrent validity of the tool with the M-PATAS scale demonstrated weak to moderate significant correlations. Developed through a participatory process centering Indigenous expertise and lived experience, this instrument constitutes a significant methodological advance in the study of racialized stigmatization in Canadian healthcare.

Background: While critical care pharmacists (CCPs) are broadly associated with improvements in outcomes for critically ill patients, operationalizing staffing in the intensive care unit (ICU) requires further study. The purpose of this evaluation was to determine the relationship of a CCP on interprofessional rounds for weekday admissions of ICU patients on patient-centered outcomes. Methods: This post-hoc analysis of the Optimizing Pharmacist-Team Integration for ICU Patient Management (OPTIM) study included adults admitted to an ICU on a weekday in the multicenter observational study. The primary outcome was in-hospital mortality. The primary exposure was level of comprehensive medication management (CMM) during the first 24 hours of ICU stay. A secondary exposure was pharmacist-to-patient ratio. Multivariable generalized estimating equations (GEE) were used to estimate associations between mortality and patient, ICU, and institution variables. Fine-Gray sub-distribution hazards regression estimated hazard of discharge alive (HDA) from the ICU and hospital and hazard of extubation alive. Results: 21,835 patients met inclusion criteria, and 76.1% of patients had CMM delivered on interprofessional rounds. Patients who had no CMM on the first ICU day had an increased risk of mortality of 23% (Odds Ratio (OR) 1.23, 95% Confidence Interval (CI) 1.04-1.46, p=0.02) compared to those who received CMM on interprofessional rounds. Patients with no CMM also had decreased HDA from the ICU and hospital and decreased hazard of extubation alive. No difference was seen in any outcomes when comparing other levels of CMM (CMM delivered outside of interprofessional rounds or abbreviated CMM) compared to CMM delivered on rounds. Conclusions: Absence of pharmacist CMM on the first day of ICU stay for patients with weekday admission was associated with an increased risk of in-hospital mortality, but no difference was seen in other levels of CMM: this signal supports further investigation in prospective analysis.

Background and Objectives: Alkaline Ionized Water (AIW) is considered among the highest quality healthy drinking water worldwide and is widely discussed for its various health benefits. Hydron Alkaline Ionized Water (HAIW) is produced through electrolysis, resulting in a stable pH of approximately 9.5 with a negative Oxidation Reduction Potential (ORP), making it an antioxidant beverage. The objective of this study was to evaluate the safety of HAIW and its effects on digestion, sleep, energy, and overall quality of life in healthy participants compared to Packaged Drinking Water (PDW). Materials and Methods: A randomized, controlled, double blind, prospective clinical study was conducted in which a total of 24 healthy participants between the age group of 21 to 40 years were randomized in a 1:1 ratio to either HAIW Group or Packaged Drinking Water Group with equal gender distribution. Participants were hospitalized for 7 days and asked to consume at least 3 litres of the assigned water daily. Primary outcomes were safety-related laboratory parameters and adverse event monitoring. Secondary outcomes included assessment of digestion (appetite, digestion, bowel habits), urine parameters, sleep quality, freshness after waking, fatigue, energy/stamina/strength, quality of life, and global assessment Results: All 24 participants completed the study with no dropouts. Baseline demographics were comparable between the two groups. Assessment of primary safety-related laboratory parameters including Complete Blood count, liver function tests, renal function tests, blood sugar, Electrocardiogram and serum electrolytes showed non-significant change from baseline to 7 days and remained within normal limits in both groups, with non-significant difference between groups (p>0.05). HAIW showed significantly better improvement in appetite, digestion, and bowel habits from Day 2 onwards compared to Packaged drinking water. Sleep quality and freshness after waking up showed significant improvement from Day 3 and Day 2 respectively in the HAIW and PDW group, with significantly better improvement in HAIW group. Fatigue scores showed significant reduction at Day 6 and 7 in both groups with non-significant difference between groups. A total of 5 adverse events were reported (3 in HAIW, 2 in PDW), all unrelated to study products and were mild in nature. Global assessment showed excellent to good overall safety and tolerability in both groups. Conclusion: HAIW was well tolerated by all participants without any adverse effects. All laboratory safety parameters remained within normal range. HAIW demonstrated significant improvements in digestive function (appetite, digestion, bowel habits), sleep quality, and freshness after waking as compared to PDW. The study concludes that HAIW can be safely consumed. HAIW improves digestive and sleep-related functions.

Abstract Objective. To identify and rank the leadership traits most valued by medical staff in public hospitals, and to compare them with an established generic instrument and a generative artificial intelligence source. Design. Sequential exploratory qualitative-quantitative (QUAL QUAN) mixed-methods study: focus groups followed by an online ranking survey, with cross-comparison against the Northouse Leadership Traits Questionnaire (LTQ) and a ChatGPT derived list (LAIT). Setting. Major public hospital affiliated with Monash University, Melbourne, Australia, in 2023. Participants. Twenty-four senior medical staff (16 men, 8 women; 18 clinicians, 6 administrators) recruited through opportunistic sampling. Main outcome measures. Weighted ranking of the ten most desired leadership traits (Leadership Enabling Traits Survey, LETS); internal consistency (Cronbach s alpha); agreement between LETS and LTQ self-scores; and strong overlap with the AI-derived list. Results. The first most-weighted LETS traits were integrity (1.526), communication (1.435), compelling vision (1.404), emotional intelligence (1.040) and empathy (0.969), the same five identified by the AI source. Integrity was weighted 3.6 times more heavily than rebelliousness (0.424). Both LETS and LTQ achieved Cronbach s alpha > 0.7. Unweighted total self-scores did not differ between LETS (77.4 +/- 7.6) and LTQ (78.4 +/-6.9); weighted emotional intelligence related and other-trait sub-scores diverged significantly (p<0.001). Survey power was 45% at alpha=0.05.