Rising recognition of attention deficit hyperactivity disorder (ADHD) in adults and children is reshaping how Australian health systems organise diagnosis, prescribing and long-term management. This has coincided with sharp increases in ADHD medicine dispensing, high private assessment costs and prolonged waiting times for psychiatrists and paediatricians. Australian states and territories have commenced reforms that expand the role of general practitioners (GPs) in ADHD diagnosis, prescribing and long-term management. This commentary assesses whether these reforms can expand timely and equitable access while maintaining diagnostic accuracy, medication safety and specialist referral. It uses the New South Wales (NSW) model as a detailed exemplar because it has developed a staged pathway: trained continuation prescribers support previously diagnosed patients who are stable on psychostimulant treatment, while endorsed prescribers receive further accredited training or recognition of prior learning to assess, diagnose, initiate and adjust psychostimulant treatment. The commentary distinguishes professional specialty status from ADHD-specific competency: specialist registration in general practice establishes the professional status of qualified Australian GPs, whereas safe extension of ADHD diagnosis and psychostimulant prescribing requires condition-specific education, competency assessment, prescribing authority, monitoring and defined referral pathways. It reviews Australian reforms, explains the NSW training and governance pathway, compares overseas approaches, and identifies safeguards needed to avoid diagnostic compression, overdiagnosis, stimulant diversion and widening inequity. The central argument is that GP involvement should be framed as trained, governed primary-care capacity. If adequately funded, audited and linked to specialist escalation pathways, the model may reduce access barriers while preserving diagnostic rigour.
This paper integrates Adaptive Information Processing (AIP), the Window of Tolerance (WoT), and Hobfoll’s Conservation of Resources (COR) theory into a unified framework for understanding trauma and therapeutic change. We propose that COR, which we conceptualize clinically as a Reservoir of Adaptive Resources (RoAR), predicts and explains whether experiences fall within or outside the WoT, and is therefore a decisive factor determining whether they are processed adaptively or maladaptively. Clinically, this framework reframes resourcing as a core mechanism of change across all phases of treatment, rather than as preparatory work alone, one that operates within and beyond Eye Movement Desensitization and Reprocessing (EMDR). The framework further proposes that resource sufficiency, relational containment, and safe access to maladaptive material may operate as shared contributing mechanisms of change across therapeutic modalities.
Gender role beliefs have been found to play a role in healthcare interactions and outcomes, although research is scarce in contexts where gender-diversity trends increasingly challenge enduring traditions, as is currently the case in Romanian society. This study explored reported gender-role beliefs and behavioural patterns among fifty Romanian participants involved in medical training and practice, representing a heterogeneous socio-professional spectrum rather than a uniform academic group (aged 20–52 with different personal circumstances and clinical employment). Written and oral reflections on gender role axioms widely known in Romania were assessed using an interpretative phenomenological approach. Results indicated strong endorsement of traditional beliefs—such as male authority and female domestic responsibility—while participants also reported behaviours and life situations inconsistent with those beliefs, including women serving as primary earners, engaging in advanced studies, and balancing multiple roles, and men in caregiving professions. This apparent belief–practice gap, not recognised as such by participants, suggests limited prior reflection on gender issues and potential tensions between pressure to conform to inherited sociocultural norms and evolving personal and professional realities. These findings raise questions regarding possible implications for clinical care, as gender-role assumptions may influence communication, rapport, and preparedness for engaging with gender-diverse patients and peers. They suggest a need for gender-diversity education, reflexivity training, and cultural competence development across undergraduate curricula, continuing education, and workplace training. The key insight of the study is that traditional gender representations can persist unexamined alongside changing behavioural realities, warranting further investigation of their relevance for healthcare education and practice.
Background: Psychological inflexibility (PI) is a transdiagnostic risk factor for emotional distress and diminished quality of life (QoL), yet the indirect pathways linking PI to QoL through distress remain largely untested in breast cancer. Methods: This exploratory secondary analysis used a publicly available longitudinal dataset of 40 women with non-metastatic breast cancer assessed at baseline and 2-month follow-up. Bootstrapped mediation (5000 resamples, BCa CIs) tested whether depression, anxiety, and stress (DASS-21) statistically mediated the association between PI (AAQ-II) and QoL (WHOQOL-BREF) across 27 models. Hierarchical regressions, Kruskal–Wallis tests, and extended correlations supplemented the analysis. Results: At follow-up, all nine cross-sectional indirect effects were significant (all 95% BCa CIs excluding zero), with distress accounting for 33–51% of the total association between PI and QoL. The largest indirect effects were observed for depression on psychological QoL (indirect = −0.845, p < 0.001) and anxiety on physical QoL (indirect = −0.739, p < 0.001). No indirect effects were significant at baseline or for change scores (all p > 0.05). Concurrent PI independently predicted psychological QoL (ΔR2 = 0.094, p = 0.002), general QoL (ΔR2 = 0.084, p = 0.015), and anxiety (ΔR2 = 0.122, p = 0.004) in hierarchical regressions. Anxiety severity was associated with impairment across all five QoL domains (all p_adj < 0.05). Conclusions: These preliminary findings suggest that emotional distress may partially account for the association between PI and QoL in breast cancer, consistent with predictions from the ACT model. However, the small sample size and cross-sectional nature of the indirect effects observed at follow-up preclude causal inference. Replication in adequately powered prospective designs is essential.
Pleural Mesothelioma (PM) is a rare, incurable malignancy of the pleura. Lung-sparing surgery, considered investigational, aims to prolong survival and improve quality of life (QOL). Beyond the standard quantitative measures used to determine successful surgical outcomes, an understanding of an individual’s perception of the impact surgery has had on their symptom burden and QOL has not been reported in the literature. The primary aim of this study was to explore the lived experience of dyspnea and QOL before and after lung-sparing surgery. The philosophical approach to this study was grounded in hermeneutical phenomenology. Participants underwent in-depth semi-structured interviews before and 3–4 months post-surgery, analyzed through Interpretive Phenomenological analysis. The analysis identified Group Experiential Themes (GETs) before and after surgery: Psychological (mind supports body), Physiological (body fighting, enduring, and adapting), Social (others sharing and supporting), and Existential (facing an uncertain future). The emotional impact of PM is multidimensional, involving time, internal psychological struggles, and coping with the diagnosis. The physical impact disrupts normal routines and interactions, while social interactions influence the perception of the illness experience. Facing PM disrupts normal bodily routines and interactions with the world. This study provides qualitative evidence that perceptions of dyspnea and QOL significantly impact the patient experience before and after surgery. The enriched understanding of living with mesothelioma and enduring lung-sparing surgery comes from the patients’ voices, highlighting the continuum of dyspnea and QOL influenced by various factors. Healthcare teams must consider patients’ physical, emotional, social, and existential experiences beyond measurable outcomes.
Background: South African university students face escalating levels of psychological distress driven by academic overload, financial precarity, and social challenges. Health professions students are particularly vulnerable due to the demanding nature of clinical training and repeated exposure to human suffering. Aim: This study aims to propose an Integrated Student Well-being and Resilience Model tailored to the South African health professions education context. Methods: This conceptual paper draws on empirical evidence from South African studies on student mental health, global campus well-being frameworks, and socio-ecological theory. Bronfenbrenner’s Socio-Ecological Systems Theory and a tiered public health approach were synthesized to develop a multi-level model aimed at addressing the academic, financial, and social determinants of student mental health. Conceptual synthesis: The study unequivocally identified a syndemic of interconnected factors predisposing students to depression, which included the interplay of academic rigour and cognitive burnout, financial vulnerability as a determinant of mental health, the crisis of social connection and psychological safety, and institutional failure and the resilience fallacy. Conclusions: The Integrated Student Well-being and Resilience (ISWR) Model is a systemic architecture designed to coordinate institutional governance with the complex psychosocial needs of health professions students. The model provides a holistic, scalable framework for strengthening student well-being within health professions education. By shifting from reactive counselling to proactive, system-level interventions, the model offers a strategic blueprint for creating resilient, supportive learning environments capable of improving student mental health and fostering a healthier future healthcare workforce.
Background: Eating disorders are among serious psychiatric conditions and are associated with an increased risk of mortality and significant psychological distress. Mind–body therapies are attracting increasing attention as complementary interventions aimed at improving psychological well-being. The aim of this meta-analysis is to examine the effects of mind–body therapies on psychological outcomes in adults diagnosed with an eating disorder or exhibiting clinically significant symptoms associated with it. Methods: Randomized controlled trials published between 2003 and 2026 were identified through a systematic search of the PubMed, CINAHL, Web of Science, Cochrane, and Scopus databases. Studies were included that involved participants aged 18 years and over who had received a diagnosis of an eating disorder according to standard diagnostic criteria (e.g., DSM-IV, DSM-IV-TR, DSM-5) or who exhibited clinically significant symptoms associated with an eating disorder. Mind–body interventions were compared with control conditions. Methodological quality was assessed using the Joanna Briggs Institute assessment tool. Statistical analyses were performed using Stata 16.0 software. Results: Nine randomized controlled trials involving a total of 688 participants were included in the meta-analysis. It was found that mind–body interventions significantly reduced levels of depression (Hedges’ g = −0.44, 95% CI: −0.67 to −0.20). Similarly, significant reductions were observed in levels of inadequate self (g = −0.51, 95% CI: −0.84 to −0.18) and self-hated (g = −0.56, 95% CI: −0.89 to −0.23). Although an effect in the direction of an increase was observed for self-compassion (g = 0.31, 95% CI: 0.07–0.54), this effect was not found to be statistically significant following the correction applied for multiple comparisons. In contrast, anxiety (g = −0.19, 95% CI: −0.39 to 0.02), stress (g = −0.48, 95% CI: −1.05 to 0.09), and self-esteem (g = 0.29, 95% CI: −0.16 to 0.73). Conclusions: Mind–body therapies are associated with improvements in certain psychological outcomes among adults with a diagnosis of an eating disorder or those exhibiting clinically significant symptoms. However, the current findings should be interpreted with caution, as the included studies largely relied on waiting-list or usual-care control groups.
Background: Cognitive Stimulation Therapy (CST) is one of the most highly recommended non-pharmacological interventions for people living with dementia. In Ireland, over 650 practitioners have been trained to deliver CST; however, the intervention is not routinely available as a post-diagnostic support. The objective of this study was to identify barriers and facilitators to implementation of CST within the healthcare system in Ireland, through interviews with healthcare and policy professionals. Methods: Semi-structured interviews were conducted with 10 key stakeholders involved in the provision of dementia services in Ireland, either in a policy role (n = 5) or as a healthcare professional (n = 5). Participants were responsible for the leadership of a dementia service and/or the direct provision of clinical care. Data collection and analysis was guided by the Consolidated Framework for Implementation Research (CFIR). Framework analysis was used to identify themes that illustrated key barriers and facilitators to the implementation of this intervention in an Irish context. Results: Findings were organised into five themes: Familiarity, Understanding, and Evidence; Partnerships and Connections; Policy; Resources; and Attitudes and Culture. These themes illustrated barriers and facilitators to implementation operating at the Innovation, Outer Setting, and Inner Setting CFIR domains. Conclusion: Identifying and addressing key barriers and facilitators to the implementation of CST within the Irish healthcare system may help to support successful implementation and sustained use of the intervention in future. The CFIR provides a useful framework for conceptualising pre-implementation barriers and facilitators. The findings of this study can be used to develop specific implementation strategies and/or models to increase the availability of CST in Ireland.
Psychological constructs such as anxiety, depression, fatalism subscales—fatalism, divine control, luck, helplessness, and internality—play an important role in shaping mental health outcomes in the United States (US). Although several studies have explored how specific variables correlate with these constructs, less is known about how sociodemographic and experiential factors interact to shape multidimensional fatalism, including the subscales of fatalism, divine control, luck, helplessness and internality. This study addresses the gap by using Conditional Inference Trees (CITs) to explore how interactions among variables are associated with these constructs. Using the Conditional Inference Tree (CIT) analyses, we examined how Adverse Childhood Experience (ACE), age, gender, race, education, and urbanicity are associated with depression, anxiety, and fatalism subscales. Our analyses revealed that ACE and age were the most significant variables associated with depression and anxiety, with higher ACE scores associated with higher levels of both depression and anxiety. For multidimensional fatalism, age, race, gender, and urbanicity were key variables, although their effects varied across subscales. Overall, these findings highlight the importance of considering interaction effects when examining mental health outcomes and fatalistic belief systems. CIT analysis provides a useful explanatory framework for identifying complex patterns of association between early life adversity, sociodemographic factors and psychological constructs.
Worster-Drought syndrome (WDS), also known as congenital suprabulbar paresis, is a rare neurodevelopmental disorder characterized by feeding, swallowing, drooling, and speech disturbances. Currently, it is classified as a subtype of cerebral palsy. However, the limited number of studies and the clinical and radiological overlap with related entities such as congenital bilateral perisylvian syndrome (CBPS) and Foix-Chavany-Marie syndrome (FCMS) have contributed to persistent uncertainty regarding its proper classification. In this review, we summarize the current knowledge on the WDS based on data from published case series. Special emphasis is placed on proposed etiological mechanisms, including recent genetic findings potentially contributing to WDS, as well as on the diagnostic process, ongoing classification dilemmas, and spectrum-based perspective. We point out the need to establish standardized diagnostic criteria and conduct large-scale genetic and neurodevelopmental research. Addressing these gaps may help clarify the underlying pathophysiology, reappraise the classification framework, and ultimately minimize misdiagnosis and time to proper diagnosis to improve outcomes for individuals affected by WDS.
Cognitive impairments are a core feature of psychotic disorders and are strongly associated with long-term functional disability. Although Cognitive Remediation Therapy (CRT) is an evidence-based intervention for improving cognition in psychosis, its feasibility and preliminary effects in acute inpatient settings—particularly using web-based platforms—remain underexplored. This single-arm, pre–post pilot study evaluated the feasibility of delivering a web-based CRT program and examined preliminary cognitive outcomes in a secure psychiatric inpatient facility. Thirteen inpatients with psychotic and non-psychotic diagnoses completed a 15-week intervention comprising twice-weekly sessions that included adaptive computerized CRT exercises (Happy Neuron Pro) and therapist-led bridging discussions focused on metacognitive reflection and functional application. Cognitive performance was assessed pre- and post-intervention using the MATRICS Consensus Cognitive Battery. All participants completed the study with no withdrawals or adverse events, attending a mean of 27.77 of 30 sessions (93.0%). Pre–post improvements were observed in processing speed, verbal learning, and overall composite cognition, with large within-sample effect sizes that remained robust in sensitivity analyses. Exploratory analyses suggested potential associations between sex, history of self-harm, and cognitive change, though these findings require cautious interpretation. Findings support the feasibility of inpatient web-based CRT and provide preliminary cognitive effect-size estimates. Given the single-arm design and absence of systematic medication monitoring, results should be interpreted as exploratory signals warranting controlled validation. Overall, findings support the feasibility of inpatient web-based CRT and provide preliminary signals of cognitive benefit, warranting evaluation in larger controlled studies.
Gender incongruence significantly impacts the family system, yet the subjective experiences of caregivers remain relatively underexplored. This narrative review synthesizes contemporary evidence regarding psychological distress, emotional burden, and quality of life among caregivers of transgender and gender-diverse individuals. A targeted literature search of PubMed, Scopus, PsycInfo, and Google Scholar (2015–2025) was conducted, identifying 16 studies for thematic synthesis. Results indicate that caregivers consistently report elevated emotional distress, characterized by chronic anxiety, hypervigilance, and ambiguous loss. This burden is primarily driven by prolonged exposure to uncertainty, the weight of complex medical decision-making—particularly regarding fertility and hormone therapy—and vicarious minority stress stemming from social stigma and systemic barriers. Notably, distress is often intensified by sociopolitical climates rather than the transition process itself. Conversely, access to peer support networks, healthcare relationships, and engagement in advocacy emerged as vital protective factors facilitating resilience and adaptive meaning-making. We can conclude that caregiver well-being is a multifaceted process deeply embedded in social and institutional contexts. These findings underscore the necessity of integrated, family-centered medical-psychological models that explicitly support caregivers to ensure more equitable and effective gender-affirming care pathways.
A cancer diagnosis has long-term physical and psychological consequences, and patients vary considerably in their mental health outcomes during the disease process. Psychological resilience has been identified as a protective factor, yet the mechanisms through which it influences mental health remain unclear. This study aims to examine the mediating role of psychological flexibility in the relationship between psychological resilience and mental health among individuals diagnosed with cancer. A total of 234 cancer patients participated in this cross-sectional study. Data were collected using the Depression, Anxiety and Stress Scale (DASS-21), the Connor–Davidson Resilience Scale–Short Form, and the Psychological Flexibility Scale. Path analysis was conducted to test the proposed mediation model. The results indicated that psychological resilience was positively associated with psychological flexibility, and psychological flexibility was negatively associated with depression, anxiety, and stress. Psychological flexibility fully mediated the relationship between psychological resilience and mental health. These findings suggest that psychological flexibility plays a key role in explaining how psychological resilience contributes to better mental health outcomes in cancer patients. Interventions aiming to enhance psychological flexibility may therefore be beneficial in psychosocial support programs for individuals coping with cancer.
Background/Objectives: Behaviours that challenge (BtC) are common in people with dementia. International guidelines recommend using non-pharmacological interventions (NPIs) as first-line treatments. A promising training package that provides a framework for delivering NPIs is “Communication and Interaction Training” (CAIT); this programme has received national recognition within the UK. Our study aimed to explore staff’s perceptions of the effect of CAIT on their understanding and responses to the behaviours and emotions of people with dementia. The study also sought to further understand how CAIT worked and the conditions which help implement it. Methods: Reflexive thematic analysis was used to analyse interviews with 11 staff who had been trained in the use of CAIT and then attempted to implement the contents of the training in clinical settings. Results: Six main themes emerged regarding the impact of the training: enhancing understanding, transforming interactions, skills development, accessible and flexible, socio-cultural change enablers, and obstacles in training. CAIT was viewed positively by the participants and was perceived to improve their knowledge, attitudes and skills. Conclusions: The positive findings are consistent with previous studies on CAIT and its current use in guiding training programmes in the UK. Implications for the delivery of CAIT are discussed, as well as suggestions for further trials of the programme.
Background: Medication adherence and persistence in treating chronic diseases present as a continuous challenge for healthcare providers in long-term management. The most frequent reasons that several diseases are poorly controlled in the population include suboptimal drug adherence and discontinuation of therapies. One main issue why physicians cannot detect patients with poor adherence is that they have relatively limited time and tools to do so. Aim: To review the critical role of medication adherence in the management of chronic diseases by addressing the following: what medication adherence is; its critical role; factors and strategies influencing it; challenges and consequences of poor adherence; patients at risk; present and future strategies in place to detect and improve adherence; implications for public health and health value creation for patients; key analytical frameworks for understanding it; determinants; how adherence improves health; the role of healthcare professionals and technological innovations; implications of medication adherence; adherence as a key area for exploring the psychological mechanisms underlying patient behavior; and patient adherence as a major social and public health challenge. Finally, this review considers strengths, limitations, recommendations, and future value. Methodology: The following databases were used to carry out the review: PubMed, Scopus, Google Scholar, and ScienceDirect. The following themes were combined in the search: what adherence is, why it is critical, why adherence occurs, and how to improve adherence. The following search terms were used: what adherence is and critical, why and adherence and occurs, and how and to improve adherence. Results: Under the theme of why adherence is critical, five sub-themes were reviewed; four sub-themes were reviewed under the theme of why adherence occurs; and five sub-themes were reviewed under the theme of how to improve adherence. Conclusions: Strategies to enhance medication adherence involve a comprehensive approach that includes patient education, streamlined treatment plans, digital tools, and effective communication from healthcare professionals.
Training the public health workforce is a critical component of health system strengthening. In Mexico, postgraduate education operates under a national accreditation framework intended to ensure academic quality and social relevance, yet comprehensive information about the scope and distribution of training programs is limited. This study characterizes public health and related academic programs available in 2024, examining the institutional sector, delivery modality, geographic distribution, and accreditation status. A systematic institutional mapping was conducted through structured searches of the official websites of public and private higher education institutions. Eligible programs included bachelor’s degrees, specializations, master’s degrees, and PhDs that were active between March and November 2024. Searches used predefined keyword combinations, repeated at multiple timepoints, and were restricted to official institutional domains. Data were extracted on academic level, institutional sector, delivery format, duration, geographic region, and inclusion in the National Postgraduate System. Descriptive statistics and logistic regression were used to analyze accreditation patterns; geospatial analysis assessed regional distribution. A total of 175 programs were identified across 30 of Mexico’s 32 states. Professional master’s degrees represented the largest category, followed by research-oriented master’s and PhD programs. Public institutions offered nearly two-thirds of all programs. Among postgraduate programs, fewer than half were accredited, with accreditation concentrated in master’s degrees in science (84.6%) and PhDs (55.6%). Only 23.0% of professional master’s degree were accredited. Most programs were delivered fully in person; online offerings were limited and more common in private institutions. Research-oriented programs were geographically concentrated in a small number of states, whereas professional programs exhibited broader but uneven national distribution. Public health education in Mexico shows growth in professionally oriented training but also reveals persistent gaps in accreditation, geographic equity, and flexible delivery modalities. The disproportionate expansion of professional programs without corresponding integration into accreditation frameworks raises concerns for workforce planning and educational equity. Strengthening national information systems, improving institutional reporting standards, and aligning accreditation criteria with workforce needs are essential to ensure that public health training supports progress towards universal health coverage and the Sustainable Development Goals.
Objectives: The present study examined the prevalence of depression, anxiety, and other mental disorders among patients visiting primary healthcare centers (PHCs) in Makkah, Saudi Arabia, and explored demographic, lifestyle, and socioeconomic determinants associated with these conditions. Methods: The study analyzed regional-level data from PHC patients diagnosed with mental health illnesses. The prevalence rates of depression, anxiety, and other mental health disorders were calculated and associated risk factors were assessed using binary variables. Results: The study found that 40% of the population was diagnosed with depression, 25% with anxiety, and 35% with other mental disorders. Depression was most prevalent among patients aged 50–64 years, while anxiety was highest among those aged 19–34 years. The lowest rates were observed in patients aged 65 years or older. Females exhibited higher rates of depression and anxiety than males. Saudi nationals accounted for most cases, with unemployment having the highest prevalence. Single individuals reported the highest prevalence of depression and anxiety. Conclusions: The research indicates a significant prevalence of depression, anxiety, and other mental disorders among primary healthcare patients in Makkah, with females, the unemployed, and younger individuals at elevated risk. Low follow-up rates suggest barriers to ongoing mental health care and highlight the need for targeted interventions.
Contemporary clinical medicine relies on the integration of clinical observation with physiological and pathological mechanisms to improve diagnosis, therapeutic decision-making, and patient outcomes. However, most current biomedical research interprets these mechanisms predominantly through the lens of upward emergence, according to which higher-order biological functions arise from the interaction of simpler lower-level components. Although indispensable for understanding visceral diseases, this perspective provides only partial access to biological complexity. Accumulating evidence from neuroscience, developmental biology, endocrinology, psychiatry, and regenerative medicine shows that higher-level systemic functions can also reorganize, modulate, or generate lower-level structures, a phenomenon known as downward emergence. Together, upward and downward emergence form a bidirectional framework that more accurately reflects the complex organizational pattern of biological systems. This editorial argues that clinical practice and biomedical research must explicitly acknowledge this bidirectional dynamic, as many diseases (including malignancy) cannot be fully understood through upward emergence alone. Downward emergent processes explain phenomena such as morphogenesis, regeneration, matrix remodeling, immunological reprogramming, endocrine-neurovegetative integration, and forms of pathological transformation that are difficult to interpret through classical reductionism. Viewing cancer as the pathological expression of a disturbed supracellular program provides a coherent explanation of its complex biology and highlights the possibility that malignant progression could be responsive to higher-order regulatory instructions. In this context, the Journal of Mind and Medical Sciences is undertaking a conceptual and editorial realignment, positioning itself as a journal of bidirectional emergence in health and disease. Rather than diminishing its clinical mission, this shift strengthens it by providing a more comprehensive framework for understanding physiological and pathological organization, one that integrates structure–function and function–structure relationships. As medicine moves toward increasingly integrative and mechanistic models of disease, adopting a bidirectional perspective becomes not only scientifically justified but also necessary for advancing diagnostic accuracy, therapeutic innovation, and the development of novel supracellular strategies for human health.
Background: Medication errors pose significant health risks and economic burdens globally. In Saudi Arabia, the reported error rates range from 1.6% to 84.8%; yet, the contributing factors remain inadequately understood. This systematic review aims to identify the associated factors and predictors of medication errors across Saudi healthcare settings. Methods: Electronic databases (EMBASE, CINAHL, and PubMed) were searched for peer-reviewed articles published from January 2010 to January 2025. Studies reporting statistically significant factors associated with medication errors or error reporting in Saudi Arabia were included. A quality assessment was conducted using the Appraisal tool for Cross-Sectional Studies (AXIS). Results: Thirteen studies met the inclusion criteria. Healthcare-worker-related factors included age (workers < 35 years are more prone to errors), experience level (4–5 years optimal for reporting), negative attitudes toward errors (AOR = 14.08), and a lack of training (AOR = 7.29). Patient-related factors included advanced age (1.0–2.7-times increased risk), males, polypharmacy (1.1–5.3-times increased risk), and high-risk medications (hypoglycemic drugs, warfarin, and antibiotics). System-related factors included day shift timing (AOR = 1.1), oral medication route (AOR = 0.4), ICU setting (3.3-times increased risk), medical unit setting (1.7-times increased risk), confusing packaging, and look-alike/sound-alike medications. Conclusions: Our findings emphasize that medical errors arise from a complex interplay between healthcare-worker-related factors (age, experience, and attitudes) and hospital-administration-related factors (reporting mechanisms, documentation practices, shift timing, and workload).
Unexpected in-hospital cardiac arrest (IHCA) in the emergency department is defined as an unexpected cardiac arrest during the stay in the emergency department with measured vital signs when entering the emergency department, requiring immediate emergency treatment to save a life. Since IHCA is an urgent medical event, especially in the emergency department, this study explored the risk prediction of IHCA events in the emergency department. IHCA not only has a high mortality rate, but is also likely to cause permanent neurological damage. In the emergency environment, due to the complexity and rapid changes in the patient’s condition, traditional assessment tools often fail to identify high-risk cases in a timely manner. In view of this, this study uses both the Power BI visual analysis platform and the binary decision tree model to construct a data-driven risk prediction tool. Power BI analysis successfully presented the dynamic ranking of influencing factors, and the decision tree prediction model showed excellent performance, with an accuracy of 91%, a recall rate of 89%, an F1-score of 89%, and an overall accuracy of 100%; this prediction system is expected to improve the efficiency of emergency medical care, identify high-risk patients in a timely manner, and assist medical staff in intervening in advance and implementing preventive measures. This study provided two different approaches: Power BI and decision tree. Power BI requires no coding and can be used by medical professionals without a programming background, while decision tree is designed for professionals with a programming background. While the structures of Power BI and decision tree differ slightly, they are generally similar and can both serve as intelligent clinical tools.
