Hospital errors and their consequences among healthcare professionals a: descriptive correlational investigation

Abstract

Introduction:

Medical errors, also known as hospital errors, are preventable incidents within hospitals that can significantly impact patient safety, healthcare costs, and treatment outcomes. This retrospective study aimed to assess the types and extent of hospital errors and their consequences among healthcare professionals.

Methods:

This was a cross-sectional, descriptive-correlational, retrospective study conducted in selected hospitals in Iran, from 2022 to 2023. The study population included all documented hospital errors during this period. The final sample size was 763 based on a previous study’s correlation coefficient. Data were collected using a researcher-made checklist. The data were entered into SPSS software version 22, coded, and analyzed using descriptive and inferential statistical tests.

Results:

The trauma hospital recorded the highest error rate with 298 incidents, accounting for 39.05% of total errors. Most errors were attributed to nurses (52.68%) and occurred during night shifts (42.60%). Common errors included documentation (23.32%), medication (22.28%), and technical issues (17.69%). Consequences varied: 25.55% of errors did not affect patients, while 26.86% reached patients but caused no harm. More severe outcomes included 2.28% resulting in major harm and 1.04% leading to patient deaths. Correlations existed between error types, staff, and hospital types.

Conclusion:

Strong correlations between error types, involved staff, and consequences highlight the need for targeted interventions. Improving healthcare personnel training, implementing effective systems, and fostering a safety culture are essential to minimize the negative impact of medical errors on patient outcomes.

HIGHLIGHTS

• Medical errors are preventable incidents in healthcare that pose serious risks to patient safety and treatment effectiveness.

• Medication errors are the most common hospital mistakes, often due to nursing staff’s prescription errors.

• Enhancing self-reporting and ensuring accurate medical documentation are essential for reducing hospital errors and improving patient care.

Introduction

Medical errors, also known as hospital errors, are preventable incidents within hospitals that result from the interaction of healthcare services, regardless of whether they cause harm to the patient or not^[1^]. These types of errors are considered a significant threat to patient safety. An effective strategy for controlling medical errors is timely reporting and analysis^[2^]. Today, one of the most critical factors determining the quality and quantity of healthcare services provided in hospitals is the quality of pharmaceutical services and related supplies with minimal or no errors. In many cases, the absence of one or more items of medical supplies or a mistake in medication within a hospital can call into question the value of other services provided and the effectiveness of treatment in the eyes of patients^[3^]. Hospital errors are among the most important factors that significantly impact healthcare costs, treatment processes, and outcomes. These errors are closely related to other management and economic factors in the healthcare sector^[4^]. Hospital errors occur with varying frequency and severity in all societies, while maintaining patient safety is a fundamental concept in healthcare service delivery systems. Annually, 800 million medical services are provided to people, resulting in approximately 12 000–13 000 cases related to medical errors in the country^[5^]. Additionally, according to statistics, the number of medical complaints in the year 1400 increased by 5% compared to the previous year, with the most medical errors attributed to gynecologists, general surgeons, and dentists. Hospital errors are considered one of the significant challenges of the healthcare system worldwide. In the United States alone, between 44 000 and 98 000 people die annually from hospital errors. The additional costs incurred by medical and nursing errors on American society range between $37.6 billion and $50 billion per year, with $17–29 billion of that amount resulting from preventable errors^[6^]. According to studies in developed countries, between 3% and 16% of hospitalized patients suffer from medical incidents, 30–70% of which are due to medical errors that could have been prevented by adhering to simple standards. In Iran and globally, the majority of hospital errors are recognized as human error^[7^].

The healthcare system in the Islamic Republic of Iran is a hybrid model that integrates both public and private sectors. The primary authority overseeing healthcare policy, planning, and regulation is the Ministry of Health and Medical Education. A comprehensive range of medical services is provided through a network that includes public hospitals, private clinics, and community health centers, facilitating widespread access to healthcare. In recent years, the Iranian government has significantly invested in healthcare infrastructure with the goal of enhancing service quality and increasing accessibility. The system places a strong emphasis on primary healthcare, particularly focusing on preventive care and maternal and child health. Nevertheless, challenges persist, such as inconsistencies in service quality, disparities in healthcare access between urban and rural areas, and the ongoing need for staff training and professional development^[8^].

Hospital errors include inaccurate or incomplete diagnosis and treatment of disease, lack of proper patient care, injury, medication, behavior, infection, and other issues. Based on existing statistics, medication errors are the most common type of hospital error in the country^[9^]. According to research findings, the majority of medication errors in hospitals are made by nurses when prescribing medication to patients^[10^]. Some medications have very similar compositions, to the extent that two different drugs may only differ by one letter, which can lead to errors in the case of poor handwriting by physicians^[11^].

Reports by the World Health Organization, based on a summary of studies conducted between 1994 and 2006, indicate that approximately 50% of antibiotic consumption in most countries is inappropriate or with insufficient dosage. In most hospitals, pharmaceutical consultation is essentially non-existent, and even the mindset for it has not been established. Prolonged hospital stays and increased mortality due to side effects and medication errors, which are preventable if documented and reviewed, impose high costs on the system. Currently, almost all compound injectable medications are prepared in a non-sterile manner by nurses in hospital wards, leading to an increase in hospital-acquired infections and medication errors^[12-14^].

Unintended incidents and medical and hospital errors are among the significant challenges that healthcare systems in all countries are grappling with, and they strive to minimize them^[15^]. Various methods are used to identify hospital errors, including case review, direct observation, and self-reporting. Self-reporting of errors is crucial for maintaining patient safety and is an important strategy for reducing hospital errors and the first step in improving the quality of patient care. This method reveals various types of errors, including those leading to dangerous incidents and those without apparent or dangerous consequences. Unfortunately, the culture of self-reporting is less prevalent in the professional training of healthcare personnel, and university hospitals play an important role in promoting the culture of self-reporting among staff and students. Multiple causes and factors contribute to hospital errors, including a shortage of healthcare personnel, communication problems among healthcare staff, lack of knowledge, staff performance deficiencies, similarity in drug names, work-related stress, illegible physician prescriptions, and incorrect hospital policies^[16-18^].

According to the results of Leonard and colleagues’ study in 2018, the reporting of errors in hospitals often does not meet desirable standards. The need to enhance the culture of safety in hospitals is a fundamental step in error management^[18^]. The documentation of medical information in hospital records is essentially the documentation of the activities of the medical team in the hospital. Therefore, accurate, complete, and timely documentation of patient information can play a crucial role in improving educational, therapeutic, research, legal, and statistical activities^[19^].

Therefore, considering all the mentioned problems, this study aims to assess the types and extent of hospital errors and their outcomes.

The focused research question of the study is centered on understanding the types and extent of hospital errors, as well as their consequences among healthcare professionals in selected hospitals in Iran. This inquiry aims to explore the various categories of hospital errors that occur within these healthcare settings, analyze their frequency, and assess the impact these errors have on patient safety and treatment outcomes.

Below are the null and alternative hypotheses (H₀ and H₁) for the study:

Null hypothesis (H₀): There is no significant relationship between the types of hospital errors and the outcomes experienced by patients.

Alternative hypothesis (H₁): There is a significant relationship between the types of hospital errors and the outcomes experienced by patients.

Method

Study design and setting

This is a cross-sectional retrospective study, descriptive-analytical investigation conducted in the selected hospitals. This research was carried out in selected hospitals during the years 2022–2023, situated in the northwest of Iran. Known for its diverse population and varied healthcare needs, the city serves as an ideal location for investigating hospital errors and their implications. The hospitals involved in the study include both public and private institutions, offering a well-rounded perspective on the healthcare environment in the region. Data were gathered from these facilities to evaluate the nature and frequency of hospital errors and their effects on patient outcomes. Our work has been reported in line with the STROCSS criteria^[20^].

Participants and sample size

The study population includes all recorded hospital errors that occurred in the selected hospitals during the specified time frame. In the present study, considering the confidence interval of 95% and the power of 80%, and based on the correlation coefficient of r = .176 between medical Errors and its Consequences in the previous study^[21^] and the formula of “N = [(Zα + Zβ)/C] 2 + 3″, the final sample size was calculated to be 763 (Fig. 1).

Figure 1.

Consort flow diagram.

Inclusion and exclusion criteria

All hospital errors recorded in the hospital management system were included in the study.

Inclusion criteria:

1. All documented hospital errors that occurred within the selected hospitals during the years 2022–2023 were included.

2. Errors had to have been officially recorded in the hospital management system to be considered for the study.

3. Both preventable and non-preventable errors were included in the analysis.

4. Errors involving all types of healthcare professionals (physicians, nurses, paramedics, etc.) were included.

Exclusion criteria:

1. Errors that occurred outside of the selected hospitals or outside of the specified time frame were excluded.

2. Incidents that were not formally classified as hospital errors in the hospital’s documentation system were excluded.

3. Errors that resulted in no harm to the patient and were deemed insignificant by the hospital’s quality control team were excluded.

4. Duplicate error reports were identified and excluded to avoid double-counting.

Note: The study focused on the period between 2022 and 2023 to capture the most recent trends in hospital errors and assess the effectiveness of ongoing healthcare policies aimed at improving patient safety. This time frame also addresses emerging challenges in patient care dynamics following the COVID-19 pandemic. By concentrating on this period, we aim to provide timely insights that can inform immediate quality improvement efforts, ensuring our findings are relevant to contemporary healthcare settings.

Measurements

Data were collected using a researcher-made checklist for comprehensive data collection. The checklist included various variables such as the shift when the error occurred (morning, evening, night), the type of error (categorized into documentation errors, medication errors, and technical issues), the individual responsible for the error (categorized as physician, nurse, or paramedic), the hospital department where the error took place, and the outcomes of the error, including whether it resulted in death, permanent complications, temporary complications, increased monitoring, or had no effect at all.

All recorded errors were sourced from the hospital management system of the selected hospitals, ensuring that only officially documented incidents were included in our analysis. This systematic approach allowed us to effectively categorize and analyze the types and extent of hospital errors, providing valuable insights into their impact on patient safety and healthcare professionals.

Researcher-made checklist for data collection

The researcher-made checklist utilized in this study was designed to comprehensively capture data related to hospital errors. It included several key sections to ensure thorough and relevant information was gathered.

General information: This section collected essential background information about the incident, including:

• Date of incident: The specific date when the error occurred.

• Time of incident: The exact time or shift during which the error took place (morning, evening, night).

• Hospital name: The name of the hospital where the incident occurred (e.g., Moatari, Seyyed Al-Shohada, Imam Khomeini Hospitals).

Type of error: In this section, the nature of the error was categorized, allowing for detailed analysis. Categories included:

• Documentation errors: Errors related to incomplete or incorrect patient records.

• Medication errors: Mistakes involving the prescription, dosage, or administration of medications.

• Technical issues: Errors arising from equipment failure or improper use of medical devices.

Personnel involved: This section identified the healthcare professionals involved in the error, categorized as follows:

• Physician: Errors attributed to doctors.

• Nurse: Errors involving nursing staff.

• Paramedic/healthcare assistant: Errors related to auxiliary healthcare personnel.

Department of incident: Data were collected on the specific department within the hospital where the error took place, such as emergency room, surgery, trauma, pediatrics, and cardiovascular.

Consequences of the error: This crucial section assessed the outcomes of the errors, including:

• No harm: Errors that did not reach the patient.

• Reaching the patient but no harm: Errors that were identified before causing any damage.

• Increased monitoring: Instances where patients required additional observation.

• Minor harm: Cases that resulted in temporary complications.

• Major HARM: Errors leading to significant health impacts.

• Death: Instances where the error resulted in patient mortality.

Additional comments: A section for qualitative data was also included, allowing for notes or comments on the circumstances surrounding the error, contributing factors, or any other relevant observations made by the data collector.

Ethical considerations

Ethical approval was obtained on 10/01/2024 from the ethics committee of the University of Medical Sciences (Ethics No. IR.UMSU.REC.1402.314). The confidentiality of the data was maintained, and no personal identifiers were included in the analysis.

Data collection procedure

After the proposal was prepared by the researchers and approved by the research council of the University of Medical Sciences, permission was sought from the treatment deputy to coordinate with the relevant authorities in the selected hospitals to collect the necessary data on hospital errors in the years 2022–2023. The checklists were completed by the researcher, and the required amount of data was gathered for statistical analysis. We utilized the HIS (Hospital Information System) provided by Azarakhsh Company, which is based in Iran. This system facilitated the efficient gathering and management of patient data throughout the study.

Data analysis

The results of the analysis were presented in descriptive and analytical tables and, where appropriate, in chart form. Mean and standard deviation were used for quantitative indicators, while frequency and percentage were used for qualitative indicators. The normality of the data was assessed using the Kolmogorov-Smirnov test, and based on the results, parametric or non-parametric statistical tests were used to examine relationships or differences. The significance of differences in means was evaluated using the t-test if the data were normal, or the non-parametric Mann-Whitney test if not. For analyzing the frequency of qualitative variables, the Chi-square test or Fisher’s exact test was used. Pearson’s correlation coefficient was used for quantitative data if the data were normal, or Spearman’s correlation coefficient if not. The level of significance was set at less than 0.05.

The data were entered into SPSS software version 22, coded, and analyzed using appropriate descriptive and inferential statistical tests.

We primarily used Microsoft Excel for data collection and initial organization. After this, the data were imported into SPSS (Statistical Package for the Social Sciences) for more sophisticated analysis. SPSS is developed by IBM Corporation, which is based in the United States. This combination of tools allowed us to effectively manage and analyze our data in line with our research objectives.

Findings

Table 1 presents the frequency of recorded errors in different types of hospitals. It shows that the trauma hospital had the highest number of errors at 298, accounting for 39.05% of the total 763 errors. The cardiovascular hospital had 240 errors, or 31.45% of the total, while the pediatric hospital had 225 errors, or 29.50% of the total.

Table 1.

The frequency of recorded errors in the hospitals

Type of hospital	Errors
	Number	Percentage
Pediatric hospital	225	29.50
Cardiovascular hospital	240	31.45
Trauma hospital	298	39.05
Total	763	100

Table 2 provides a detailed breakdown of medical errors by examining the hospital personnel involved and the specific departments where the errors occurred. The data shows that nurses were responsible for the highest percentage of errors at 52.68%, followed by physicians at 24.64% and healthcare assistants at 13.89%. In terms of departments, the highest number of errors took place during the night shift at 42.60%, with the evening shift accounting for 31.45% and the morning shift 25.95%. The most common types of errors were related to documentation (23.32%), medication (22.28%), and technical issues (17.69%). Departments with the greatest number of errors included the emergency room (10.47%), surgery (8.12%), and trauma (8.12%).

Table 2.

The medical errors by examining the involved hospital personnel and the specific department in which the error took place

Variables	Errors
	Number	Percentage
Staff
Nurse	402	52.68
Physician	188	24.64
Health care assistance	106	13.89
Other	67	8.79
Unit
ICU	50	6.55
CCU	52	6.81
Cardiac care	48	6.28
Pediatrics	48	6.29
Surgery	62	8.12
Emergency	80	10.47
Operation room	49	6.42
Trauma	62	8.12
General	67	8.77
Laboratory	54	7.06
Radiology	44	5.77
Pharmacy	49	6.42
Neurosurgery	58	7.60
Other	40	5.24
Type of error
Diagnosis	91	11.92
Medication	170	22.28
Documentation	178	23.32
Treatment	68	8.91
Systemic	121	15.86
Technical	135	17.69
Shift
Morning	198	25.95
Evening	240	31.45
Night	325	42.60

Table 3 outlines the consequences of the medical errors that were analyzed, providing a clear picture of the impact on patient outcomes. The data shows that in a quarter of the cases (25.55%), the errors did not even reach the patients, indicating effective processes to intercept and prevent such issues. However, in over a quarter of the cases (26.86%), the errors did reach the patients but did not result in any harm. Worryingly, 22.93% of the errors led to increased monitoring of the affected patients, and 20.31% resulted in minor harm. The most serious consequences were seen in 2.28% of cases, where the errors caused major harm to patients, and in 1.04% of cases, the errors tragically resulted in patient deaths.

Table 3.

The consequence of medical errors

Consequences	Errors
	Number	Percentage
Error did not reach patients	195	25.55
Error reached patients, but no harm	205	26.86
Error reached patients and resulted in increased monitoring	175	22.93
Error reached patients with minor harm	155	20.31
Error reached patients with major harm	25	2.28
Error reached patients with patient deaths	08	1.04

Table 4 examines the correlations between various variables associated with medical errors, providing valuable insights into the underlying relationships. The analysis shows that the consequences of medical errors have a statistically significant correlation with the type of error (P < 0.05, r = 0.789), indicating that the severity of the consequences is closely linked to the nature of the error. Additionally, the consequences are also correlated with the staff involved (P = 0.04, r = 0.687), suggesting that the experience and training of the healthcare personnel play a crucial role in determining the impact of the errors. Interestingly, the type of hospital and the shift during which the error occurred did not demonstrate a significant correlation with the consequences.

Table 4.

Correlation among variables of medical errors in the study

Variables	Result
Consequences
Type of hospital	P = 0.68, r = −0.346
Staff	P = 0.04, r = 0.687
Unit	P = 0.87, r = 0.256
Type of error	P < 0.05, r = 0.789
Shift	P = 0.08, r = 0.635
Type of hospital
Staff	P = 0.35, r = −0.458
Unit	P = 0.45, r = 0.124
Type of error	P < 0.05, r = −0.657
Shift	P = 0.69, r = 0.457
Staff
Unit	P = 0.98, r = −0.986
Type of error	P < 0.05, r = 0.475
Shift	P = 0.78, r = 0.653
Unit
Type of error	P = 0.48, r = 0.378
Shift	P = 0.38, r = 0.586
Type of error
Shift	P < 0.05, r = 0.468

When examining the relationship between the type of hospital and other variables, the data reveals a statistically significant correlation with the type of error (P < 0.05, r = −0.657), suggesting that the hospital’s characteristics may influence the types of errors that occur. However, the type of hospital did not show a significant correlation with the staff involved or the shift during which the errors took place.

The analysis also highlights the importance of the staff involved, as their correlation with the type of error (P < 0.05, r = 0.475) and the shift (P = 0.78, r = 0.653) indicates that the experience and workload of the healthcare personnel can contribute to the nature and timing of the errors.

Discussion

The findings of this study offer significant insights into the prevalence and impact of hospital errors among healthcare professionals. The high incidence of medical errors reported aligns with previous research, underscoring the substantial challenges healthcare systems face in maintaining patient safety^[22,23^]. The strong positive correlations between hospital errors and emotional exhaustion, depersonalization, and diminished personal accomplishment highlight the substantial psychological impact these errors have on clinicians.

It is imperative for healthcare organizations to adopt a multifaceted approach to addressing this issue. Merely focusing on reducing the error rate may be inadequate if the negative effects on provider well-being are not also mitigated. Strategies are required that not only minimize the occurrence of errors but also provide robust support systems to help staff cope with the consequences when errors do occur^[24^].

The literature review yielded several key findings regarding hospital errors and their prevention. Marks et al conducted a study on preventable errors in neurology, indicating that clinical decision-making errors and system-related issues, such as those involving the electronic health record, were the most prevalent types of errors. The study emphasized the importance of system-based interventions, including training on system issues and changes in documentation protocols, to reduce clinical and system-based errors. This underscores the necessity for continuous error surveillance and quality improvement systems in clinical settings^[25^].

Chen et al explored factors influencing medical students’ willingness to report medical errors. The study identified concerns about punishment, breaking unwritten rules, and damaging team relationships as statistically significant factors affecting students’ decisions. Personal competence factors, such as perceived knowledge/understanding and communication skills, were also found to be important. The study highlighted the influence of senior staff personalities, such as being “ill-tempered” or “stubborn,” on students’ willingness to report errors. These findings suggest that fostering a supportive and open environment is crucial for encouraging students to speak up, which is essential for patient safety^[26^].

Kiymaz et al investigated factors influencing emergency department nurses’ attitudes and tendencies toward medical errors. The study found that a significant number of nurses had witnessed medical errors, with drug-related errors being common. Factors such as excessive workload, insufficient nurse staffing, and burnout were identified as contributing to the occurrence of hospital errors by nursing staff. The study concluded that nurses who enjoyed their job, were satisfied with their unit, and consistently worked day shifts had a lower tendency to make medical errors. This points to the importance of job satisfaction and work conditions in error prevention^[27^].

Sheikholeslami et al conducted a cross-sectional study to determine the types and frequency of errors in a 5-year period in the teaching hospitals of Kerman. The study revealed that the highest number of reported errors occurred with paramedical and support units during the morning shift, with nurses reporting the most errors. The study also found that 6.5% of errors led to serious harm. The researchers concluded that the reporting of errors in the studied hospitals was not at a desirable level and that enhancing the culture of safety in hospitals is essential for error management^[28^].

Shams et al examined the types and frequency of medical record errors and their contributing factors at Ayatollah Taleghani Hospital. The study showed that omissions in diagnosis recording and medication timing were the most common errors, while the least frequent error was the absence of a time stamp and signature. The researchers emphasized the need for physicians’ and nurses’ attention to improving medical documentation, suggesting measures such as initial training for new assistants, incentive systems, and periodic evaluation of records^[29^].

Jadidi et al compared the frequency of medication errors based on personality types among nurses working in pediatric departments. The study found a significant relationship between morning-evening personality types and the frequency of medication errors, with nurses having an evening personality type making more errors compared to morning and intermediate types. This suggests that personality type may influence the occurrence of medication errors, highlighting the importance of considering personality when scheduling shifts and planning human resources^[30^].

Bagheri-Nesami et al focused on the frequency of non-injectable medication errors by nurses in intensive care units (ICUs) and cardiac care units (CCUs) in Mazandaran province. The study reported 145 instances of non-injectable medication errors over a 2-month period, with dosage errors being the most common. Factors related to transcription, communication, work conditions, packaging, and the pharmacy were identified as contributing to these errors. The study recommended strategies such as increasing nurses’ and nursing students’ pharmaceutical knowledge, providing standard conditions, and improving communication between nurses and physicians to limit medication errors^[31^].

By recognizing and addressing these errors, we can significantly enhance the quality of life for patients and improve the working conditions for medical staff^[32,33^]. Understanding the root causes of mistakes allows for the implementation of targeted solutions, fostering a safer and more efficient healthcare environment^[34^]. As we strive for continuous improvement, both patients and healthcare professionals can benefit from a system that prioritizes safety, communication, and collaboration, ultimately leading to better health outcomes and a more supportive workplace^[35,36^].

The multifaceted nature of hospital errors necessitates a comprehensive approach that addresses both the prevention and mitigation of errors and the support of healthcare professionals. Enhancing the culture of safety, improving system-based interventions, and fostering a supportive environment are essential strategies for reducing the occurrence and impact of hospital errors.

Limitations

Several limitations of this study should be noted as below:

Retrospective design: The study utilized a retrospective design, which inherently limits the ability to establish causality. Data were collected from existing records, which may not capture all relevant variables or contextual factors influencing hospital errors.

Data quality and completeness: The quality of the data relied on the accuracy and completeness of the records in the Hospital Information System. Missing or incomplete data could lead to biases in our findings and affect the reliability of the conclusions drawn.

Participant selection bias: Since the study focused on a specific population or setting, the findings may not be generalizable to all hospitals or healthcare systems. The characteristics of the sampled hospitals may differ significantly from those not included in the study.

Limited variables: While we aimed to analyze a comprehensive range of factors related to hospital errors, the variables available in the data set were limited. This restriction may have omitted important factors that could influence the outcomes.

Temporal context: The study focused on the period between 2022 and 2023, which may not account for long-term trends or changes in hospital practices before or after this timeframe. The unique circumstances surrounding the COVID-19 pandemic may also have influenced data patterns that are not reflective of typical hospital operations.

External influences: Changes in healthcare policies or practices during the study period may have impacted the results. The evolving nature of healthcare regulations and standards can influence hospital error rates, making it challenging to attribute changes solely to the interventions studied.

Conclusion

This study contributes to the growing body of evidence highlighting the significant personal and professional consequences that healthcare providers often face when medical errors occur. The strong associations between hospital errors and burnout dimensions underline the need for comprehensive strategies to promote both patient safety and clinician well-being. Developing robust error reporting systems, cultivating just cultures, and implementing effective burnout prevention programs should be priorities for healthcare organizations seeking to support their workforce and deliver high-quality, compassionate care.

Ethical approval

Ethical approval was obtained from the ethics committee of Urmia University of Medical Sciences (Ethics No. IR.UMSU.REC.1402.314). The confidentiality of the data was maintained, and no personal identifiers were included in the analysis. This study conducted in the selected hospitals of Urmia City, namely Moatari, Seyyed Al-Shohada, and Imam Khomeini Hospitals.

Consent

Written informed consent was obtained from the patients or legal guardian for publication and any accompanying images and data. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request.

Sources of funding

This study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author contributions

M.S.B. and F.H.: study concept, data collection, writing the paper and making the revision of the manuscript following the reviewer’s instructions. P.S., H.N., and Y.M.: study concept, reviewing and validating the manuscript’s credibility.

Conflicts of interest disclosure

None.

Research registration unique identifying number (UIN)

1. Name of the registry: Thai Clinical Trials Registry

2. Unique identifying number or registration ID: TCTR20240916003

3. Hyperlink to your specific registration (must be publicly accessible and will be checked): https://www.thaiclinicaltrials.org.

Guarantor

Maryam Salamat Bakhsh.

Provenance and peer review

Not commissioned, externally peer-reviewed.

Data availability statement

The datasets generated during and/or analyzed during the current study are available upon reasonable request.