Medication errors (MEs) and their underreporting compromise patient safety in Ghana, but the landscape of error types, reporting systems, and barriers has not been comprehensively synthesized. This systematic review aims to map existing literature on MEs in Ghana and assess the functionality and utilization of reporting systems across healthcare settings. Systematic review conducted in accordance with PRISMA 2020 guidelines. PubMed, PubMed Central, Scopus, ScienceDirect, and Google Scholar were searched for studies published between 1 January 2000 and 30 May 2025, with a final update search performed in August 2025 prior to data analysis. Eligible studies were conducted in Ghana and published in English, addressing MEs or medication-error reporting practices across any study design. Study selection, data extraction, and methodological quality appraisal were performed independently by two reviewers, and findings were synthesized narratively due to heterogeneity in study designs and outcome definitions. Reported medication-error prevalence varied widely across included studies (47%-68.4%), reflecting differences in study designs, populations, clinical settings, and definitions of MEs. Omission errors were frequently identified as the most common type, accounting for up to 77.6% of documented errors in some studies. Contributing factors included inadequate training (91.6%), poor supervision (92.3%), and illegible prescriptions (63.7%), with severe underreporting highly evident. Reporting practices were often informal, with many errors conveyed verbally or not documented. Common barriers included fear of blame or disciplinary action, low confidence in reporting systems, insufficient anonymity, lack of standardized forms, limited training, and minimal mentorship. MEs remain a substantial patient-safety concern in Ghana, compounded by informal reporting systems and persistent organizational and cultural barriers. These findings underscore the urgent need to implement structured, non-punitive reporting systems, enhance staff training, and foster a culture of openness to support medication safety. Medication mistakes in Ghana’s healthcare and how often they are reported: a review of existing studies Medication mistakes during the medication use process are a big problem in Ghana’s healthcare system, yet they often go unreported. We looked at all the research done in Ghana from January 2000 to August 2025 to understand exactly what kind of mistakes happen, how they are reported, and whether they are reported in official systems. We found that almost half to more than two-thirds of patients experience some kind of medication error, with omission errors (when a drug is not given) being the most common. Key reasons behind these errors include lack of training, poor supervision, and hard-to-read prescriptions. On top of that, many errors are never formally documented, as most reports are done verbally or not at all. People often do not report errors because they fear blame, do not trust the systems in place, worry about privacy, or lack proper reporting forms and training. These findings show that Ghana really needs clear, non-punitive reporting systems, better training for healthcare workers, and a system that supports speaking up about mistakes. By improving these areas, there can be a significant strengthening of patients’ safety in the healthcare environment.
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Mechanical ventilation is a life-sustaining therapy, yet in Somali intensive care settings it may be perceived by families as a marker of inevitable death. This commentary examines how refusal of intubation, pressure to discontinue ventilatory support, and self-discharge may emerge from interacting system constraints, belief-based fatalism, out-of-pocket cost anxiety, limited ICU knowledge, and trust and communication gaps related to sedation, prognosis, and goals of care. Using a patient-preference and adherence lens, we argue that some refusal events may represent modifiable non-adherence to a medically indicated plan rather than simple rejection of treatment, while emphasizing that this framing should not blame patients or families facing distress, uncertainty, and financial pressure. We propose pragmatic, culturally responsive steps that are feasible in resource-constrained ICUs, including standardized family orientation to ventilation and sedation, structured daily updates, early cost transparency linked to social support pathways, and documented non-coercive escalation for high-risk refusal. These actions may strengthen informed preference formation, reduce misunderstanding, protect patient rights, and improve alignment between family decisions and appropriate life-sustaining care. Future qualitative, audit, and implementation studies are needed to evaluate these proposed interventions in local critical care settings.
Termination of pregnancy due to fetal anomaly (TOPFA) can be emotionally complex, yet knowledge of parents' grief remains limited. This study examined grief reactions among 677 TOPFA bereaved parents in the Danish Life After Loss cohort at 1, 7, and 13 months post-loss, stratified by gender. Adaptive grief reactions were assessed using the Inventory of Daily Widowed Life, symptoms of prolonged grief disorder (PGD) with the Prolonged Grief Disorder Checklist, and pregnancy loss-specific reactions with the Perinatal Grief Scale. Parents showed high initial grief, followed by a significant decline in grief scores across the three time-points. Heterogeneity was observed, with a subgroup displaying elevated grief. Women reported higher scores than men; however, among parents in the upper quartile of grief scores, women's scores declined between 7 and 13 months, whereas men's remained stable. Single-Items showed emotional pain, longing, and guilt/self-blame in a considerable proportion of parents at 13 months post-loss.
The current crisis confronting psychoanalytic education is described. Essentially, there is little agreement about the definitions of psychoanalysis. Traditionally, the training analyst system has been blamed for all the ills that confront contemporary psychoanalytic education. In contrast, it is suggested that the lack of consensus extends far beyond that one educational standard. The problem involves psychoanalysts' lack of agreement over virtually anything. The main disagreements are seen in debates about curricula, the goals of psychoanalytic education, and even the definition of a competent psychoanalyst. Various solutions to the problem are suggested.
Gastroschisis, a congenital abdominal wall defect, is increasingly reported in sub-Saharan Africa, yet survival remains poor in low-income and middle-income countries, such as Uganda. Barriers to care extend beyond clinical limitations, with societal stigma and cultural beliefs influencing health-seeking behavior. This study explores the sociocultural perspectives surrounding gastroschisis in southwest Uganda using a socioecological model. A qualitative study was conducted with midwives and nurses from public and private facilities across 9 districts in Uganda. Participants underwent in-depth interviews, which were audio-recorded, transcribed, and analyzed using inductive semantic thematic analysis. Twenty-six midwives and nurses participated. Thematic analysis by level of the socio-ecological model revealed multiple factors that influence gastroschisis outcomes in Uganda. At the individual level, parental health literacy, financial constraints, and cultural beliefs were perceived to influence health-seeking behavior. Interpersonal family dynamics play a crucial role in decision-making, with blame and stigma often directed at mothers. Community perceptions, rooted in cultural and religious narratives that perpetuate stigma and misinformation, emerged as deterrents to seeking care. At the organizational level, poor referral systems, inadequate access to essential medical supplies, inadequate pediatric surgical capacity, and hidden financial costs within the health care system were identified as hindrances to gastroschisis management. Improving survival from gastroschisis in Uganda requires coordinated interventions across socioecological levels. Midwives are strategically positioned to influence early care. Strengthening health care infrastructure, reducing financial barriers, implementing early referral strategies, and delivering community education are critical to addressing stigma and improving outcomes.
Bangladeshi students participated in the "July Revolution" that ended on August 5, 2024, after a month-long period. Such protests may negatively impact the mental health of individuals, making effective coping strategies essential in these situations. This study aimed to assess the mental health status and coping strategies of university students after the July Revolution of 2024, and to determine the significant predictors of their mental health status. In this cross-sectional study, data were collected through a web-based self-administered questionnaire from 380 university students enrolled in universities across Bangladesh who voluntarily participated. Psychological distress was assessed using the General Health Questionnaire (GHQ-12) And coping strategies were measured using the Brief-COPE scale. Bivariable and binary logistic regression models were employed to identify the factors influencing the mental health of university students following the July Revolution. Data analysis was conducted using SPSS Version 26. The results showed that 86.3% of students experienced poor mental health. The results from the binary logistic regression model demonstrated that the psychological distress among the university students in Bangladesh after the July Revolution was associated with several factors, including the sex of respondents (OR = 2.7, 95% CI = 1.25-5.81; p = 0.001), students whose close ones suffered an injury or died (OR = 2.22, 95% CI = 1.06-4.64; p = 0.035), those who adopted self-blame (OR = 1.58, 95% CI 1.24-2.03 p < 0.001) and denial coping (OR = 1.39, 95% CI = 1.09-1.76; p = 0.007) strategies, and those who did not adopt active (OR = 0.65, 95% CI = 0.49-0.86; p = 0.003), and religious coping (OR = 0.70, 95% CI = 0.55-0.89; p = 0.004) strategies. Given the significant psychological impact of the July Revolution on university students in Bangladesh, it is imperative for university administrations to implement targeted mental health interventions. This study recommends providing accessible mental health services by qualified professionals to support students coping with any social movement or other emergencies.
Rape trauma syndrome (RTS) is a phenomenon that refers to a recognizable pattern of psychological, physical, cognitive, and relational responses following a sexual assault. To reassess the evidence base for RTS as a valid nursing diagnosis and to offer a conceptual-theoretical-empirical (C-T-E) structure for RTS based on the Roy Adaptation Model (RAM). A scoping review of the literature, following JBI guidelines, was conducted by two reviewers in databases and gray literature. Conflicts were resolved by a third reviewer. Studies published between 1974 and 2024 involving individuals with a nursing diagnosis of "rape trauma syndrome" treated in healthcare settings were included. The analysis of the 34 articles, guided by RAM, revealed that the person who experienced rape needs to be understood as a holistic, dynamic, and complex adaptive system. RTS is a phenomenon of ineffective adaptation to rape trauma that emerges from the person's interaction and contextual environmental stimuli, such as the pressure of secrecy after rape, the circumstances of the rape, and verbal exposure of rape. Nurses can identify RTS through the adaptive modes, focusing on physical trauma, sleep pattern disturbances and nightmares, self-blame, impaired self-image, loss of interest in previous life activities, social interruption, and loneliness. There is a need for more research in different population groups and contexts, as well as for the validation of nursing interventions tailored to the specific needs of people who have experienced rape. Applying RAM broadens the understanding of the rape trauma phenomenon, offering a robust theoretical framework for autonomous assessment, clinical reasoning, and nursing care planning. The RTS nursing diagnosis, guided by RAM, offers a flexible framework for recognizing behaviors resulting from rape trauma, anticipating needs, and identifying recovery points.
This study aims to employ cross-lagged panel network (CLPN) analysis to longitudinally explore the intricate and dynamic relational patterns both within and between the systems of self-stigma and moral disengagement in adolescents who have experienced various forms of bullying. Adopting a two-wave longitudinal design with a four-month interval, the study involved 559 adolescents (39.54% female, 60.46% male; Mage = 13.46, SD = 0.92). The network analysis revealed that, at both T1 and T2, emotional self-stigma, blaming/dehumanizing the victim, and verbal bullying exhibited the highest expected influence (EI), indicating the establishment of a stable and central core within the adolescent psychological pathology network. The CLPN results further highlighted that verbal bullying displayed the strongest out-EI, while cognitive self-stigma demonstrated the strongest in-EI. Additionally, two distinct pathological pathways emerged: relational bullying at T1 significantly predicted cognitive self-stigma at T2 (internalizing pathway), while verbal bullying at T1 predicted cognitive restructuring at T2 (externalizing pathway). The study also illuminated the self-sustaining nature of self-stigma and moral disengagement, revealing a reciprocal feedback loop between these constructs. Notably, minimizing agency at T1 was found to negatively predict cognitive self-stigma at T2, suggesting it serves as a temporary defense mechanism protecting victims from self-depreciation. Overall, the findings underscore that bullying victimization triggers a complex, interconnected psychological system, emphasizing the importance of interventions grounded in psychological mechanisms, sequential strategies, and individualized approaches tailored to the specific types of bullying encountered by victims.
In riverine contexts shaped by seasonal fluctuations, communities cultivate ways of living with water that reflect deep social and ecological entanglements. This study focuses on Bajo Belén, a peri-urban community along the Itaya River in the Peruvian Amazon, where residents live with vaciante (dry season) and creciente (flood season) through practices that sustain their livelihoods. Using a braided approach by weaving living with river rhythmicity, the Capabilities Approach, and Environmental Justice, we analyze 41 storytelling sessions (2022-2024). Our findings show drought and flood processes; and how community capabilities are built through living with the river, yet remain unrecognized in state responses such as forced relocation. This non-recognition leads to non-inclusive procedures and an unequal distribution of blame and responsibility. We argue for governance that respects plural ways of living and supports community-defined aspirations. Situating care, recognition, and capability within river governance offers new pathways for more just, relational, and adaptive responses to environmental uncertainty. The online version contains supplementary material available at 10.1007/s11625-025-01771-y.
Despite scientific evidence on the environmental causes of obesity, policies that target these causes frequently face public opposition. This study investigates the mental model that the public hold about obesity, including perceptions of the causes, consequences and responsibility for obesity, alongside support for different preventive policies. N = 2400 members of the public undertook a cross-sectional online survey across 3 English-speaking countries with high obesity rates: Ireland, the UK and the US. We benchmarked public perceptions against N = 51 experts. We found differences between countries and larger differences between the public and expert samples. The public assigned considerable blame and responsibility to individuals, while the expert sample focused more on societal and environmental causes. Although the public and expert samples concurred on the seriousness of the problem, the latter endorsed more radical policies, such as taxes and restrictions. Public health communications often focus on highlighting obesity as a public health problem, but our findings suggest that this message has been received. Instead, more work may be needed to challenge public beliefs about the causes of, and responsibility for, the obesity epidemic.
Family members of patients with bipolar disorder are at increased risk of stress and other challenges when they assume caregiving responsibilities. However, the lived experiences and resilience strategies of the family caregivers have not received much considerations in research. This study explored the lived experiences and resilience strategies of family caregivers of individuals with bipolar disorder. A phenomenological qualitative study was conducted with 17 family caregivers of bipolar disorder patients who were receiving care at XXX in XXX. Semi-structured interviews were used during data collection. Thematic analysis five major themes were identified representing the lived experiences and resilience measures among the caregivers. These themes were; emotional and psychological impact of caregiving, strain on relationships, coping and resilience strategies, challenges in accessing support and adaptation to caregiving role. Overall, the findings of this study highlights that caregiving of bipolar disorder is associated with various challenges stress, blame, guilt, strain relationships and poor access to resources. However, positive resilience measures such as adapting to caregiving among others are essential to the process.
Omissions in infection prevention and control (IPC) practices may increase the risk of healthcare-associated infections, yet their underlying determinants remain insufficiently understood. This study aimed to examine the extent of IPC omissions among nurses and identify contributing factors using the Consolidated Framework for Implementation Research (CFIR). An explanatory sequential mixed-methods study was conducted at a tertiary hospital in China from October to December 2023. Quantitatively, 397 nurses completed a survey assessing IPC omissions using the Missed Nursing Care in Infection Prevention and Control (MNCIPC) scale. Qualitatively, semi-structured interviews were performed to further explored the causes and mechanisms of IPC omissions, and the data were analyzed using the CFIR framework. IPC omissions were common among nurses and varied substantially across practices, with omission rates ranging from 10.8% to 72.8%. A bipolar pattern in hand hygiene emerged: most nurses reported performing hand hygiene after gown removal or body fluid exposure, whereas omissions were frequently reported before patient contact and after touching patient surroundings. Agreement on the proposed contributing factors was low to moderate. The qualitative findings corroborated most of the quantitative factors and further expanded determinants across CFIR domains, including unequal nurse-physician accountability, risk perception bias, evidence-practice gaps, and limited authority of infection control personnel. IPC omissions among nurses were common and were shaped by interacting individual, contextual, and implementation-related factors, indicating a system-sensitive subtype of missed care. Improving IPC adherence requires shifting from individual blame to systems-based strategies that strengthen leadership, accountability, adaptive implementation, and context-sensitive training.
Autonomic dysfunction, characterized by orthostatic intolerance and presyncope, is understudied in youth. Mental health comorbidities are commonly reported and sometimes blamed for the onset of autonomic dysfunction; however, no studies have yet examined this relationship. This study aimed to establish the prevalence rate of mental health diagnoses in a pediatric sample of patients with autonomic dysfunction, characterize the temporal relationship between autonomic and mental health symptom onset, and understand patients' perspectives on this relationship. Pediatric patients completed surveys at autonomic dysfunction clinic follow-up appointments. Surveys obtained patient self-reported metal health conditions, autonomic symptoms, and patient-perceived timelines. Patients then described their understanding of the relationship between their mental and physical health. Authors analyzed qualitative data using content analysis. Of 142 patients approached, 127 completed surveys (response rate 88.8%; Mean age = 16.1); 70.1% reported a mental health diagnosis, and 4.7% suspected a mental health condition. Anxiety was the most reported concern (72.4%). Patients reported mental health concerns preceding (37.6%), co-occurring (12.2%), or succeeding (38.1%) their autonomic dysfunction symptoms. Qualitative responses revealed patients perceived bidirectional or unidirectional relationships between mental health and autonomic dysfunction, although some patients were uncertain. Patients described varied relationships between mental health symptoms and autonomic dysfunction, emphasizing the individualized nature of these experiences. Although the rate of mental health diagnoses was pointedly high, temporal associations appeared patient-specific rather than consistent across the sample. Providers should consider routine screening and treatment of mental health concerns as part of comprehensive care for youth with autonomic dysfunction.
Between 4% and 17% of hospital inpatients experience a patient safety incident. Many healthcare organisations undertake analysis and investigation of serious incidents to understand them and prevent future occurrences. Tools have been developed to assess investigation quality as a reflection of a health service's learning and improvement process. However, a broad-scale examination of the quality of investigation reports has not been conducted in Australia. This study aimed to assess the quality of a sample of Australian patient safety incident investigation reports. A deductive, directed content analysis was conducted to assess the quality of 300 incident investigation reports from 56 Australian health services. Each report was assessed on the extent to which they met predefined quality criteria using the Dutch Health and Youth Care Inspectorate (IGZ) scoring instrument and the United Kingdom's Learning Response Review and Improvement Tool (LRRT). A detailed and complete description of events was present in just over half of the reports (57%). There was also variable application of systems approaches to incident causation in the reports. Generally, there was evidence that the people affected were engaged with, the avoidance of blame and counterfactual reasoning was well executed, as was overall writing quality. Areas in need of improvement included identifying contributing factors beyond the staff and local hospital, the use of appropriate scientific literature and using observational insights to enhance understanding of work-as-done-in our sample only 4% used observation techniques to examine healthcare processes. This study establishes that stronger foundational, evidence-based approaches to incident investigation are necessary. These approaches include using multiple data sources, like observations of real work, and inclusion of people with skills to apply a systems thinking-driven analytical process to effectively identify contributing factors beyond the individual to drive learning and continuous systemic improvement.
Fraud victimization is an increasingly prevalent global problem that extends beyond financial loss, and encompasses substantial mental health and psychosocial harm. Deception, emotional manipulation, and perceived betrayal have been linked to anxiety, depression, shame, trust erosion, and reduced quality of life. Despite these effects, the psychological consequences of fraud victimization remain under-recognized within healthcare and victim support systems. This systematic review synthesizes empirical evidence of mental health and psychosocial outcomes among adults following fraud or scam victimization. A systematic literature search was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines across four electronic databases (PubMed, OVID, Web of Science, and Embase) from inception to December 31, 2025. Empirical quantitative, qualitative, and mixed-methods studies examining post-victimization mental health or psychosocial outcomes among adult fraud victims were included. Studies exclusively exploring fraud risk, susceptibility, or financial and legal outcomes without assessing the psychological effects of post-victimization were excluded. Owing to heterogeneity in study designs and outcome measures, the findings were synthesized using a narrative approach. Twenty-one studies met the inclusion criteria. Across diverse populations, fraud types, and cultural contexts, fraud victimization was associated with adverse mental health outcomes, including elevated anxiety, depression, psychological distress, shame, self-blame, and diminished quality of life. Psychological harm frequently persisted beyond the resolution of financial losses and was more strongly associated with emotional manipulation, perceived betrayal, and interpersonal trust erosion than with the magnitude of financial loss alone. This systematic review demonstrates that fraud victimization is associated with substantial and enduring mental health and psychosocial sequelae. The findings support reframing fraud victimization as a public mental health concern and underscore the need to integrate trauma-informed and psychosocial care into fraud responses and victim support services. Future research should prioritize longitudinal and intervention studies to elucidate recovery trajectories and inform effective mental health responses for fraud victims.
The Symptom Biography Curriculum proposes a new approach to undergraduate cancer education that teaches medical students to explore how possible cancer symptoms evolve before presentation to healthcare services. Rather than focusing solely on structured symptom checklists, the curriculum encourages students to examine symptom interpretation, changing language, patient attribution, delay, and the social context surrounding help-seeking. The approach introduces competencies including temporal listening, attribution listening, language tracking, and delay without blame. Through simulated consultations, reflective exercises, and patient narratives, students learn to reconstruct the "life story" of symptoms before diagnosis. This curriculum aims to strengthen diagnostic curiosity, communication skills, and patient-centred understanding in early cancer education.
Enzymatic depolymerization of polyethylene terephthalate (PET) is a promising alternative to traditional recycling showing promise in addressing issues with high energy demands and challenges associated with mixed-waste streams. While engineered, thermostable PETase variants exist, achieving high yields under industrially relevant process conditions remains a significant hurdle. Poor thermostability and PET crystallinity are often blamed for low conversions, but these factors do not fully account for the low productivity observed in all cases. This suggests that other poorly understood phenomena may be limiting the catalytic efficiency of PETase warranting further investigation. This work systematically explores the impact of mixing, and in particular, the presence of the air-water and the solid-liquid interfaces, on PETase stability. We found that PET degradation plateaus while soluble PETase activity is lost at increasing mixing rates when an air-water interface is present. It is hypothesized that the enzyme adsorbs to the air-water interface leading to denaturation, aggregation and precipitation. Additional studies demonstrate that the hydrophobic PET film negatively impacts enzyme stability and the rate of enzyme inactivation is also proportional to the PET surface area. Traditional approaches to mitigate enzyme inactivation at interfaces, such as using blocking agents, were effective in preserving enzyme activity, but resulted in significantly reduced PET degradation rates. In contrast, PEGylation of PETase yielded improved stability and enhanced PET degradation during mixing. These findings help explain the significant conversion discrepancies reported in previous studies and demonstrate a robust strategy for improving PETase performance under industrially relevant conditions.
Tanzania has among the highest rates of stillbirth and neonatal death globally, yet little is known about the mental health impact of such loss on mothers. Cultural stigma, silence around grief, and limited access to psychosocial support compound these challenges. This study explores the experiences of bereaved Tanzanian mothers, focusing on mental health symptoms, social support, and preferred forms of post-loss care. We conducted a qualitative descriptive study at Kilimanjaro Christian Medical Center (KCMC) in Moshi, Tanzania. Fifty women (25 with stillbirth, 25 with neonatal death) were enrolled. At 8 weeks post-loss, 40 women completed in-depth interviews. Interviews were transcribed, translated, and thematically coded via a directed content analysis combining deductive and inductive coding. A brief intake questionnaire captured demographic data and perceptions of immediate support. Four organizing themes emerged: (1) identified sources of support included partners, communities, and providers; (2) women experienced negative responses from these loci of support such as blame, gossip, and abandonment; (3) stigma surrounding childlessness disrupted maternal identity; and (4) women expressed a strong desire for structured mental health support, including peer groups and counseling. These organizing themes coalesced into a single ground theme: following perinatal loss, women experienced mental health challenges while expressing needs for greater psychological and psychosocial support. Perinatal loss deeply impacts maternal mental health in Tanzania. Interventions must address cultural stigma and include formal peer support and provider-led bereavement care to support healing and resilience in bereaved mothers.
Intersectionality theory suggests that because stigma arises from the interplay of multiple marginalized identities, Black women with obesity may face stronger negative attitudes than White women when using GLP-1 agonists, a newer class of obesity medications often perceived as an 'easy way out.' This experimental study tested how exposure to different weight loss methods affected stigma toward a Black or White woman with obesity, as well as the influence of participant race on stigma. A sample of 402 Black and White women with overweight or obesity were randomly assigned to read about a Black or White woman named Evette who lost 15% of her total body weight with either diet/exercise or a GLP-1. Participants reported stigmatizing attitudes toward Evette (fat phobia, dislike, desire for social distance, and blame) and beliefs that she took a weight loss shortcut. Stigma was higher when Evette lost weight with a GLP-1 (vs. diet/exercise) and, contrary to hypotheses, when Evette was depicted as White (vs. Black). Moderated mediation analyses demonstrated that GLP-1-assisted weight loss (vs. diet/exercise) led to higher fat phobia, dislike, desire for social distance, and blame via stronger shortcut beliefs and this effect was more pronounced when Evette was portrayed as White. Participant race did not influence how weight loss with a GLP-1 and Evette's race, together, affected stigma through shortcut beliefs. Findings highlight the importance of challenging societal narratives about what constitutes 'acceptable' weight loss strategies for women with obesity to reduce stigma and protect long-term health.