Background/Objectives: This systematic review explores the evolving landscape of ethical dilemmas and legal responsibilities in hospital-based patient care, with particular attention to how they intersect with institutional safety. Drawing from 40 studies published within the last decade and supplemented by seminal theoretical works, the review examines clinical, technological, legal, and policy-driven challenges that compromise ethical clarity and organisational accountability. Methods: Methods included a structured literature search across major academic databases, guided by inclusion and exclusion criteria aligned with PRISMA guidelines and a quality appraisal ensuring inclusion of only medium- and high-quality studies. Results: Findings reveal that ethical complexity has shifted from individual decision-making to system-level vulnerabilities, particularly in contexts involving artificial intelligence (AI), data governance, consent procedures, and end-of-life care. Moreover, hospitals often lack sufficient protocols for disclosure, cross-border telemedicine accountability, and ethically responsive infrastructure. The results support a growing call for ethics-by-design approaches, where ethical reflexivity is embedded into institutional processes and digital systems. Conclusions: Overall, ethical resilience in hospital care depends not only on clinical training but on proactive organisational structures that support transparency, equity, and patient dignity.

Background and Objectives: Mental health disorders, including major depressive disorder and adjustment disorder with mixed anxiety and depressed mood, present a significant global burden, with early onset and progression leading to substantial individual and social impacts. While pharmacotherapy remains the standard treatment, many patients experience inadequate symptom relief or intolerable side effects. In this context, transcranial magnetic stimulation (TMS) has emerged as a non-invasive, well-tolerated neuromodulation technique offering an alternative treatment option. Although its clinical efficacy is well-documented, limited research exists on patient perceptions, decision-making processes and barriers to TMS utilization in private healthcare settings, particularly in Romania. This study explores patients’ experiences with TMS, factors influencing their treatment choices and comparative views on its acceptability relative to pharmacological interventions. Materials and Methods: A qualitative research design was employed, using semi-structured interviews with 20 patients diagnosed with MDD or AD who had undergone TMS therapy as part of two pilot studies which were non-randomized in Romanian private practices. Data were collected via interviews and analyzed thematically to identify patterns in patient perceptions, decision-making factors and treatment experiences. Results: Participants reported predominantly positive perceptions of TMS, citing improvements in mood, anxiety reduction, and enhanced daily functioning. The most common motivations for seeking TMS included dissatisfaction with pharmacotherapy, recommendations from physicians or peers and information obtained via online sources. TMS was perceived as a safer and more tolerable alternative to medication, particularly due to its lack of systemic side effects. However, barriers such as high treatment costs, limited insurance coverage and logistical challenges in accessing TMS services were noted as significant deterrents. Conclusions: The study highlights the strong preference for TMS among patients who seek alternatives to pharmacotherapy, with key motivators including efficacy, tolerability and non-invasiveness. However, systemic barriers to access remain a critical challenge in private healthcare settings. Future research should focus on expanding accessibility, improving patient education and integrating TMS into broader mental healthcare frameworks to optimize treatment outcomes.

Patient safety emerges where clinical risk governance intersects with ethical duties of non-maleficence, respect for autonomy, and institutional accountability. Safety culture surveys and patient-reported experience measures often evolve on separate analytic tracks, leaving uncertainty about how staff-facing metrics translate into patient-facing ethical practices such as disclosure after harm. We conducted an exploratory cross-sectional multi-informant survey in an acute-care hospital in Romania. Healthcare workers (defined as physicians, nurses, hospital auxiliary staff, and other clinical/non-clinical personnel involved in care delivery or immediate supervision; n = 104) completed the AHRQ Hospital Survey on Patient Safety Culture version 2.0 and the Speaking Up About Patient Safety Questionnaire, capturing safety culture composites, speaking up behaviour, and psychological safety. Inpatients (n = 101) completed a project-specific, not externally validated structured questionnaire covering perceived safety, communication and information, consent and involvement, confidentiality and complaint mechanisms, coordination and organisational reliability, observed safety practices, and experiences of incident communication. We conducted exploratory analyses including composite means, percent positive scores, internal consistency estimates, and examined ward-level associations. Staff composites peaked for teamwork (mean 3.84/5; 74.3% positive) and communication about error (3.74/5; 70.8% positive), while staffing and work pace (2.74/5; 29.3% positive), response to error (31.7% positive), and hospital management support (34.0% positive) showed marked compression. Patients rated coordination and organisation (mean 3.67/5) and consent and involvement (3.60/5) higher than communication and information (3.42/5). Eleven patients (10.9%) perceived a safety incident; among them, ratings for apology, explanation and follow-up clustered at the lower end of the scale (mean 1.73/5). Ward-level overall safety culture scores showed negligible associations with patient global safety, perceived safety and recommendation. Exploratory ward-group analyses suggested that patient-rated coordination aligned more closely with handoffs and information exchange than with global safety culture measures. Other cross-level associations were inconsistent and were interpreted cautiously because of broad clinical-area aggregation and limited between-group variation. Favourable speaking up climate correlated with overall safety culture (r = 0.484, p < 0.001) and management support (r = 0.547, p < 0.001). In this setting, patient-perceived safety aligned more closely with interface processes than with global culture scores, and incident communication surfaced as a salient ethical deficit. Strategies integrating psychological safety, management responsiveness, and structured disclosure practices warrant prospective evaluation as potential ways to advance moral accountability and risk governance. Given the cross-sectional, single-site design and modest sample size, these associations should be interpreted as exploratory and non-causal. Not applicable.

Background and Objectives: Patient safety at hospital interfaces is shaped by organisational fragility, ethical obligations, and anticipated legal exposure. Reporting, disclosure, and speaking up have been studied separately, yet the way these pressures converge in ordinary hospital work remains insufficiently described. Materials and Methods: We conducted a qualitative study in a public hospital in Romania using semi-structured episodic interviews and the critical incident technique. Twelve clinicians participated: six nurses and six physicians working in intensive care, emergency medicine, general surgery, paediatrics, oncology day care, anaesthesia, obstetrics, and internal medicine/cardiology. Interviews were audio-recorded, transcribed verbatim in Romanian, anonymised, and analysed with the framework method from a critical realist perspective. A secondary cross-case coding of all 12 episodes was used for descriptive analytic displays. Results: Four mechanisms organised the material. First, local stop rules and cross-checks created temporary stability at fragile interfaces such as high-alert medication, patient identification, specimen labelling, and transfer documentation. Second, consent and confidentiality were repeatedly compressed by urgency, compromised capacity, public space, and family pressure; legitimacy depended on explicit reasoning rather than documentary completion alone. Third, speaking-up and near-miss reporting were governed by protocol-backed legitimacy, leader response, and the informal cost of interruption. Formal incident reporting was present in one episode, partial in one, and absent in 10. Fourth, documentation and disclosure redistributed accountability. Notes that recorded reasoning supported continuity of care, whereas protective opacity concealed near misses, infrastructural weakness, and interactional pressure. Documentation or disclosure pressure appeared in all 12 episodes. Conclusions: Safety in everyday hospital work was assembled through local barriers, moral triage, and selective visibility. Interface redesign, protected near-miss reporting, psychologically safe escalation, and structured support for urgent consent and post-incident communication would make transparent safety work more sustainable. Trustworthiness was strengthened through reflexive memoing by the physician-interviewer, an audit trail of coding decisions, comparison across professional groups, active attention to negative cases, and iterative assessment of meaning saturation at the level of explanatory mechanisms.

Background/Objectives: Tobacco use is a leading cause of preventable death worldwide and is linked to major health and economic burden. Many smokers attempt to quit, yet long-term success rates with current medicines and counseling are still modest. Long-term nicotine exposure distorts brain systems involved in reward, craving, and self-control. These changes weaken inhibitory control and strengthen responses to smoking cues, which increases the risk of relapse. Transcranial magnetic stimulation (TMS) is a non-invasive technique that delivers magnetic pulses to specific cortical regions, most commonly the dorsolateral prefrontal cortex, to influence neural activity. This narrative review explored how transcranial magnetic stimulation may aid smoking cessation by acting on neural circuits linked to nicotine dependence. Methods: Five major databases were searched for studies published between 2015 and 2026. After removal of duplicates and screening, a total of 34 studies were included in this narrative synthesis. Randomized controlled trials, clinical studies, and neuroimaging investigations involving adults with nicotine dependence were included. A thematic narrative method was employed to synthesize findings due to the differences in study designs, protocols, and outcome measures. Results: TMS has been shown to attenuate cravings, decrease daily cigarette consumption, and decrease nicotine dependence in various studies. Several trials reported higher abstinence rates with active stimulation compared with sham treatment. Meta-analytic findings indicate stronger effects with 10 Hz stimulation and treatment courses of 20 sessions or more. Neuroimaging studies report changes in functional connectivity within reward, executive control, and salience networks, suggesting partial restoration of disrupted circuits. Treatment response varies according to age, educational level, baseline dependence, and stimulation parameters. Conclusions: These findings support transcranial magnetic stimulation as a promising brain-based approach for smoking cessation, while further well-designed trials with longer follow-up are still needed.

Background: Adjustment disorder with mixed anxiety and depressed mood lacks established treatment protocols, despite its clinical significance. Repetitive transcranial magnetic stimulation (rTMS) has demonstrated efficacy in stress-related conditions, yet its application in adjustment disorder remains limited. Study Question: This retrospective chart review examined the safety and clinical benefit of rTMS for this condition in a Romanian health care context. Study Design: Sixty adults with adjustment disorder with mixed anxiety and depressed mood were identified from outpatient clinic records and grouped by treatment received: rTMS alone (n = 20), rTMS with medication (n = 10), or medication only (n = 30). Measures and Outcomes: Low-frequency 1-Hz stimulation at 110% of the motor threshold was applied to the right dorsolateral prefrontal cortex in 10 sessions over 2 weeks. Depressive and anxiety symptoms were measured at baseline and at day 30 using the Hamilton Depression Rating Scale and the Hamilton Anxiety Scale. Logistic regression analysis was used to identify factors associated with treatment outcomes. Results and Discussion: Significant symptom improvements occurred across all groups ( P < 0.001). Complete remission rates varied substantially: rTMS monotherapy achieved 80% remission, medication alone 40%, and combined treatment 20% (χ ² = 13.714, P = 0.008). Sixty percent of participants showed clinical response. Treatment modality predicted response, with rTMS monotherapy increasing odds of improvement 5.7-fold versus medication alone ( P = 0.017). Lower baseline anxiety predicted combined remission (OR = 0.779, P = 0.001), while demographic factors showed no predictive value. Adverse events were mild and transient, with no serious complications or discontinuations. Urban residence significantly influenced rTMS uptake ( P = 0.011). Conclusions: rTMS seems effective and may be considered alongside conventional pharmacotherapy for adjustment disorder with mixed anxiety and depressed mood. The intervention showed good tolerability. Geographic barriers to access warrant attention in service planning. Larger randomized controlled trials with extended follow-up are needed to confirm these findings and establish optimal protocols.