The study, a secondary analysis of data collected with a pretested structured questionnaire, classified participants’ knowledge using ten scored items, with a total score of six or above defined as good knowledge and five or below as poor. The results showed that 271 of the 450 respondents, or 60.2 percent, met the study-defined threshold for good knowledge of medication errors. That figure, while encouraging on its surface, leaves nearly four in ten frontline professionals below the level the researchers considered adequate, a gap with potentially serious consequences in settings where a single prescribing or dispensing mistake can cascade into patient harm.

What makes the findings particularly valuable is the specificity of the perceived contributing factors. Poor handwriting topped the list, cited by 62.9 percent of respondents, followed by inadequate communication at 54.9 percent, workload at 52.0 percent, look-alike or sound-alike medicines at 48.0 percent, and inadequate training at 45.1 percent. These are not abstract system-level abstractions but the daily friction points that clinicians in resource-constrained environments encounter on every shift. A prescription scrawled in haste, a verbal order misheard across a busy ward, a pair of drug names that differ by a single syllable, or a nurse stretched across too many patients each represent a well-documented pathway from system pressure to clinical error.

The organizational and health-system dimensions of the problem emerge clearly from these perceptions. Workload, communication failures, and inadequate training are all factors that reflect how healthcare institutions are structured, staffed, and resourced rather than individual lapses in competence or diligence. This framing aligns with a substantial body of patient-safety research showing that medication errors rarely stem from a single careless actor but instead arise from the interaction of human factors with organizational conditions and health-system constraints. In Kwara State, where the study spanned facilities across urban and rural districts, the consistency of these concerns among different professional groups suggests they are systemic rather than localized.

Perhaps the most striking finding concerns the near-absence of digital safeguards. Only 15.6 percent of respondents reported that their facilities used electronic prescribing, and just 8.7 percent reported barcode medication administration. These technologies, which in high-income countries have been shown to reduce medication errors substantially by eliminating transcription mistakes and verifying drug-patient matches at the bedside, remain rare in the facilities surveyed. The gap between what is known to work and what is actually available represents one of the central challenges for medication safety in low- and middle-income countries, where the infrastructure, funding, and technical support needed to deploy such systems are often lacking.

The researchers went beyond descriptive statistics to examine which characteristics were associated with good knowledge of medication errors. Using multivariable logistic regression, they found that being a physician, being a pharmacy technician, having eleven or more years of professional experience, and reporting the availability of electronic prescribing were each associated with higher odds of good knowledge. These associations are non-causal, as the authors emphasize, but they point to patterns worth investigating. Physicians and pharmacy technicians may encounter medication-error concepts more directly in their training and daily roles, while longer experience may expose clinicians to more error events and safety discussions over time.

Intriguingly, two factors were associated with lower odds of good knowledge: male sex and reported availability of training programmes. The latter finding is counterintuitive at first glance, since one might expect that access to training would improve knowledge. The authors suggest several possible explanations, including the possibility that respondents who perceived training programmes as available may have been in facilities where such programmes existed on paper but were not actually attended or effective, or that those with poor knowledge were less aware of what training was available to them. The association with male sex is harder to interpret without further data but may reflect differences in professional composition, role assignment, or exposure to safety education across gender lines within the Nigerian healthcare workforce.

The study’s methodology deserves attention for its geographic and professional breadth. By selecting nine facilities across Kwara State’s three senatorial districts and including four categories of healthcare professionals, the researchers captured a range of perspectives that narrower studies might miss. The use of a pretested questionnaire strengthens confidence in the consistency of the instrument, and the application of chi-square tests and multivariable logistic regression allowed the team to adjust for potential confounders while examining associations between respondent characteristics and knowledge levels. The authors also reported checking for multicollinearity using the variance inflation factor, a statistical safeguard that helps ensure the reliability of regression estimates.

Medication-error reporting practices emerged as another area of concern in the broader context of the study. While the abstract highlights the perceived contributing factors and the scarcity of digital tools, the research also examined how frequently errors are reported and what improvement strategies professionals would like to see. Underreporting of medication errors is a well-documented phenomenon globally, driven by fear of blame, lack of feedback mechanisms, and cumbersome reporting processes. In settings where electronic reporting systems are absent, the problem is compounded because there is often no structured channel through which errors can be captured, analyzed, and used to drive systemic improvements.

The authors conclude that respondents identified organizational, human, and health-system concerns while digital safeguards were uncommon, and they call for prospective studies to evaluate context-appropriate medication-safety interventions. This is a measured but important recommendation. Rather than simply importing solutions from high-income settings, the emphasis on context-appropriateness acknowledges that interventions must fit the realities of staffing, infrastructure, and resources in places like Kwara State. Whether that means simplified electronic prescribing tools, structured communication protocols, targeted training programmes that address the specific knowledge gaps identified here, or system-level reforms to reduce workload and improve staffing, the path forward will require both political will and sustained investment. What this study provides is a clear, evidence-based map of where the risks lie as seen by the professionals who navigate them every day, and that map is an essential starting point for any effort to make medication use safer for patients across Nigeria and similar settings.

Subject of Research: Healthcare professionals' perspectives on medication-error contributing factors and safeguards in Kwara State, Nigeria

Article Title: Healthcare professionals’ perspectives on organizational, human, and health-system factors relevant to medication errors in Kwara State, Nigeria: a cross-sectional study

Article References: Makinde, I. O., Egwuda, K., Anya-Awa, E. A., & Ehiemere, C. C. (2026). Healthcare professionals’ perspectives on organizational, human, and health-system factors relevant to medication errors in Kwara State, Nigeria: a cross-sectional study. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15726-1

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15726-1

Keywords: medication errors, patient safety, Nigeria, healthcare professionals, electronic prescribing, health systems, medication safety, low- and middle-income countries, cross-sectional study, pharmacovigilance, organizational factors, reporting practices

The review, published in the Journal of Activity, Sedentary and Sleep Behaviors, was led by Denver M. Y. Brown of Kansas State University together with colleagues from institutions across North America. The team searched eight databases from their inception through late 2023, supplemented by forward and backward citation searches, a manual scan of the International Network of Time-Use Epidemiologists’ publication list, and direct consultation with experts. From 7,212 identified records, 102 observational studies met the strict inclusion criteria: each had to use CoDA with log-ratio transformations, capture all three movement behaviors across the full 24-hour day, and test associations with indicators of physical, cognitive, or mental health. The studies, published between 2016 and 2024, drew on samples from 29 countries, with analytic samples ranging from just 28 participants to more than 130,000, and participant ages spanning from infancy to late adulthood.

To make sense of such a heterogeneous literature, the researchers classified reporting practices into seven domains: methodological justification, behavioral measurement and data handling, composition construction, analytic plan, composition-specific descriptive statistics, model results, and auxiliary information. The extraction framework was reviewed by eleven international experts and drew on existing reporting checklists such as STROBE, designed for observational epidemiology, and CREMAS, developed for ecological momentary assessment studies. Each study was also scored with an adaptation of the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-sectional Studies, yielding a sobering baseline: 81 of the 102 studies were rated fair quality, 19 good, and two poor.

The brightest spot was methodological justification. Nearly every study, 100 of 102, mentioned CoDA in the title or abstract, and 94 explained why a compositional approach was appropriate for 24-hour time-use data. This is more than academic housekeeping. Because the 24-hour movement paradigm remains unfamiliar to many journal audiences, clear justification helps readers grasp why the co-dependency of behaviors demands special statistical treatment. It also aids discoverability: when authors flag CoDA prominently, systematic searches can actually find these studies, a prerequisite for any future synthesis of the evidence.

Beyond that strong opening, the picture fragments. In the measurement domain, most studies did describe how accelerometer data were scored and processed for each behavior, where devices were worn, how many minutes constituted a valid day, and how many valid days were required. Yet only 44 of the 90 device-based studies clearly stated which valid days entered the analysis, whether averages across all days, random selections, or weighted combinations of weekdays and weekends. That omission matters: recent work has shown that different data-handling strategies can materially change conclusions about how movement behaviors relate to obesity. Sleep fared worst of all. Only about half the studies clearly conceptualized what sleep they were measuring, whether nocturnal sleep, 24-hour sleep, or daytime naps, and fewer than 40 clearly defined the sleep variable itself. Only 17 studies explicitly included naps in the composition, and in 44 studies it was simply unclear. Without sleep logs, daytime sleep captured by accelerometers risks being misclassified as sedentary time, quietly corrupting the very compositions the analyses depend on.

Composition construction revealed similarly troubling gaps. All 102 studies reported how many parts the day was partitioned into, most commonly four: sleep, sedentary behavior, light physical activity, and moderate-to-vigorous physical activity, with compositions ranging from three parts up to nine. And 101 of 102 reported the log-ratio transformation used. But only six studies specified how a day was defined, midnight-to-midnight versus wake-to-wake, a detail that shapes what the composition actually represents. Most striking, only 27 studies addressed zeros in the behavioral data. Zeros are poison for log-ratio mathematics, since the logarithm of zero is undefined, and how researchers replace them can distort the entire analysis. Encouragingly, of the 19 studies that observed zeros, most used principled methods such as log-ratio expectation maximization imputation or multiplicative replacement, approaches recent methodological work has endorsed over crude substitution.

The analytic plan and results sections showed the deepest inconsistencies, and these are the ones with the greatest consequences for cumulative science. Nearly all studies reported their post-transformation analytic technique and whether covariates were adjusted, but fewer than a third compared their analytic sample to the full sample, and only 15 provided a power analysis, a gap the authors attribute largely to the field’s reliance on secondary data analysis. In the results, only 64 studies reported whether the overall 24-hour composition was significantly associated with the health outcome at all, and just 25 included a standardized effect size such as R-squared. From there, practices diverged into what the authors describe as selective reporting: some studies examined individual behaviors or ran isotemporal substitution models only when the overall model was significant, others ran them regardless, and some never stated whether the overall test was significant. Several studies reported associations for only some components of the composition, omitting exactly the kind of complete, per-behavior estimates that meta-analysis requires.

Isotemporal substitution, the technique that estimates what happens to a health outcome when minutes are swapped between behaviors, was the single most popular analytic approach, appearing in 84 studies. Here, reporting was somewhat better: 83 of the 84 studies clearly stated whether substitutions were one-to-one, such as ten minutes of sitting replaced by ten minutes of brisk walking, or proportional, where reallocated time is spread across all other behaviors. Most reported model statistics with confidence intervals or standard errors. Yet even here, roughly half only examined reallocations for outcomes already found significant, and 15 reported substitutions for only a subset of behaviors. Auxiliary reporting told a similar story of selective diligence: funding sources and conflicts of interest were almost universally disclosed, likely driven by journal requirements, but only 16 studies acknowledged the limitations of CoDA itself, and only 22 discussed whether their effect sizes were clinically meaningful, a crucial question when translating compositional proportions back into actionable minutes of activity.

The stakes of this inconsistency extend well beyond academic tidiness. The 24-hour movement paradigm underpins integrated guidelines now adopted across multiple countries for children, adults, and older adults, and it increasingly informs public health policy about how we should structure our days. If individual studies cannot be compared, and if selective reporting blocks the extraction of complete effect estimates, the field cannot perform the meta-analyses needed to establish robust, population-level conclusions about the optimal distribution of sleep, sitting, and movement. The review’s authors point to a proven path forward: the CREMAS checklist for ecological momentary assessment was born from exactly this kind of systematic characterization of existing practices, and they propose a similar route for CoDA, using Delphi methodology, an iterative consensus process among experts and end-users, to develop a formal reporting checklist for observational compositional studies. They also caution that their conservative approach, counting unmentioned items as unreported, may underestimate actual practice, and that emerging techniques will require the standards to evolve. Still, the message is unambiguous. A field that has grown from two studies in a 2020 systematic review to more than a hundred in under a decade now needs to grow up statistically: consistent, transparent, and complete reporting is the price of turning a promising method into trustworthy evidence about how the whole 24-hour day shapes human health.

Subject of Research: Reporting practices in observational studies using compositional data analysis to examine associations between 24-hour movement behaviors and health indicators

Article Title: A systematic review of research reporting practices in observational studies examining associations between 24-h movement behaviors and indicators of health using compositional data analysis

Article References: Brown, D. M. Y., Burkart, S., Groves, C. I., Balbim, G. M., Pfledderer, C. D., Porter, C. D., Laurent, C. S., Johnson, E. K., & Kracht, C. L. (2024). A systematic review of research reporting practices in observational studies examining associations between 24-h movement behaviors and indicators of health using compositional data analysis. Journal of Activity, Sedentary and Sleep Behaviors, 3(1), Article 23. https://doi.org/10.1186/s44167-024-00062-8

Image Credits: AI Generated

DOI: 10.1186/s44167-024-00062-8

Keywords: compositional data analysis, 24-hour movement behaviors, physical activity, sedentary behavior, sleep, systematic review, reporting practices, time-use epidemiology, isotemporal substitution, accelerometry, research methods, public health

The study, published in BMC Medical Imaging, was led by Seckin Bilgic and colleagues at the Department of Nuclear Medicine of Bursa Uludag University, with additional contributions from Canakkale Onsekiz Mart University and Bursa Yuksek Ihtisas Training and Research Hospital. The team set out to answer a deceptively simple question: when adults undergo fluorine-18 fluorodeoxyglucose positron emission tomography and computed tomography, known as 18F-FDG PET/CT, for cancer evaluation, how often do their kidneys show abnormalities, and how often do those abnormalities actually make it into the written report? The answer, according to their data, is that kidney findings are remarkably common and remarkably under-reported.

The researchers examined 283 consecutive adult patients who underwent oncologic 18F-FDG PET/CT at their institution between March and April 2023. Consecutive enrollment matters here, because it means the cohort was not cherry-picked; these were simply the patients who came through the door during a defined two-month window. The study received ethical approval from the Bursa Uludag University Ethics Research Committee and was conducted in accordance with the 1964 Helsinki Declaration, with informed consent obtained from all subjects. Because the design was retrospective and observational, the investigators could go back and scrutinize the images with a level of systematic attention that busy clinical workflows do not always permit.

What did that scrutiny reveal? The numbers are eye-opening. At least one cortical or pelvicalyceal renal abnormality was identified in 192 of the 283 patients, which works out to 67.8 percent of the cohort, with a 95 percent confidence interval spanning 62.2 to 73.0 percent. In other words, roughly two out of every three cancer patients scanned carried some detectable kidney abnormality on their PET/CT images. The abnormalities fell into two broad morphological categories. Cortical abnormalities, which affect the outer functional tissue of the kidney, were present in 123 patients, or 43.5 percent, and were most commonly large cortical cysts, seen in 22.3 percent of the full cohort. Pelvicalyceal abnormalities, which involve the urine-collecting system deep within the kidney, appeared in 129 patients, or 45.6 percent.

The technical distinction between these two categories is worth unpacking, because it reflects the dual nature of the information contained in a PET/CT scan. The CT component provides high-resolution anatomical detail without contrast enhancement in this setting, allowing reviewers to assess the renal cortex for cysts, masses, and structural changes. The pelvicalyceal system, meanwhile, can be evaluated for dilatation, stones, and other collecting-system pathology. The researchers even developed a stepwise visual grading algorithm, described in their supplementary material, to classify pelvicalyceal dilatation from Grade 0 to Grade 3 based on renal pelvic fullness, calyceal dilatation, and associated thinning of the renal parenchyma. Notably, they used the fused PET/CT images only for anatomical correlation and deliberately ensured that the intense urinary excretion of FDG, which naturally accumulates in the collecting system, did not influence grade assignment. That methodological care matters, because urinary FDG activity is a well-known confounder that can obscure or mimic collecting-system findings.

But prevalence alone was not the heart of the study. The investigators also wanted to know whether the kidney findings they identified on systematic review had ever been documented before. For the 192 patients with at least one renal abnormality, they reviewed available pre-index institutional records, meaning prior imaging and reports already on file at the institution, and classified each patient’s findings as previously documented, mixed, or incidentally identified. The result was stark: only 20 patients, or 10.4 percent, had findings that were entirely previously documented. Another 31 patients, or 16.1 percent, had a mixed picture, with some findings known and some new. The remaining 141 patients, a full 73.4 percent, had kidney abnormalities that were entirely new discoveries, never before captured in the institutional record. Taken together, 172 of the 192 affected patients, or 89.6 percent, had at least one renal abnormality that had never been documented anywhere in their available records.

The most sobering comparison, however, came when the researchers turned to the original clinical PET/CT reports, the documents written by the interpreting physicians at the time of the scan and sent to the treating oncologists. Of the 192 patients whose scans showed renal abnormalities on standardized retrospective review, only 58, or 30.2 percent, had at least one of those abnormalities mentioned in the original report. The other 134 patients, 69.8 percent of those with findings, had no renal abnormality documented at all. The gap between what a systematic review could see and what the clinical report conveyed is the central finding of the paper, and it is difficult to read those numbers without wondering how many clinically meaningful findings slip through the cracks in routine practice.

Why does this happen? The authors point to the inherent structure of oncologic imaging interpretation. A PET/CT study ordered for cancer staging or surveillance generates hundreds of images, and the interpreting physician’s primary obligation is to the clinical question at hand: tumor location, metabolic activity, treatment response, and new metastatic disease. Kidney cysts and mild collecting-system dilatation are, in the vast majority of cases, benign and clinically silent, and flagging every one of them in every report would risk burying the critical oncologic information in a flood of incidental detail. This is the classic tension of incidental findings in modern imaging: as scanners have grown more sensitive and datasets more voluminous, the sheer volume of non-target abnormalities has outpaced any practical reporting strategy. Yet the study’s data suggest the pendulum may have swung too far, with nearly 90 percent of affected patients carrying at least one renal finding absent from all available documentation.

The clinical stakes are not trivial. Some incidental renal abnormalities, particularly complex cysts and solid-appearing cortical lesions, can represent early renal cell carcinoma, a malignancy that is highly curable when caught at a small size but far more dangerous when it grows undetected. Hydronephrosis and collecting-system dilatation can signal obstructing stones or tumors that merit follow-up. Chronic kidney disease, too, often announces itself first through subtle structural changes visible on cross-sectional imaging. Whether the abnormalities catalogued in this study would have changed outcomes for any individual patient is a question the retrospective design cannot answer, and the authors are appropriately measured on this point. They explicitly state that further studies should determine whether more systematic recognition and reporting of these findings influences diagnostic evaluation, clinical decision-making, and patient management.

Still, the study lands at a moment when the imaging community is actively grappling with how to handle the incidentalome, the ever-growing list of unexpected findings generated by modern scans. Structured reporting templates, standardized checklists for organ systems outside the region of interest, and artificial intelligence tools that pre-screen images for non-target abnormalities are all under active investigation as potential solutions. This study provides a concrete baseline for one organ system in one high-volume imaging context, and its message is clear: kidney abnormalities are present in more than two-thirds of oncologic PET/CT patients, yet nearly 70 percent of affected patients leave the encounter with none of those findings on paper. Closing that gap, without drowning the oncologic signal in incidental noise, may be one of the defining reporting challenges of the PET/CT era. The authors received no specific funding for the work and declared no competing interests, and the article is published open access under a Creative Commons license, making the full data and methods available to any research group hoping to replicate or extend the findings.

Subject of Research: Prevalence and under-reporting of incidental renal abnormalities detected on oncologic 18F-FDG PET/CT imaging

Article Title: Incidental renal abnormalities on 18F-FDG PET/CT in oncologic patients: prevalence and reporting practices

Article References: Bilgic, S., Koroglu, I., Akovalı, B., Sahin, H. G., & Alper, E. (2026). Incidental renal abnormalities on 18F-FDG PET/CT in oncologic patients: prevalence and reporting practices. BMC Medical Imaging. https://doi.org/10.1186/s12880-026-02859-2

Image Credits: AI Generated

DOI: 10.1186/s12880-026-02859-2

Keywords: 18F-FDG PET/CT, incidental findings, renal abnormalities, oncologic imaging, kidney cysts, pelvicalyceal dilatation, reporting practices, nuclear medicine, radiology, renal cell carcinoma, patient safety, medical imaging