Search Results (119)

Background/Objectives: Antimicrobial stewardship programs (ASPs) optimize antimicrobial use, improving outcomes and reducing resistance. This study assessed the impact of a ward-specific ASP. Methods: A pre/post quasi-experimental study was conducted in an internal medicine ward at a tertiary hospital in Padua, Italy. During the intervention year (September 2023–August 2024), a multidisciplinary team (infectious disease consultants, pharmacists, microbiologists, nurses, and hygienists) held bi-weekly ward-based audits, reviewing antimicrobial prescriptions and performing bedside assessments. Therapy adjustments followed guidelines and local epidemiology. Educational sessions and infection prevention and control (IPC) protocols were also reinforced. Outcomes were compared to the previous year, considering patient characteristics. The primary outcome was antimicrobial consumption (DDD/100 patient days, DDD/100PD); secondary outcomes included cost savings, length of stay (LOS), and mortality. Results: Fifty audits assessed 1074 patients and 1401 antimicrobial treatments. Patient characteristics were similar. Antibiotic suspension or de-escalation occurred in 37.9% and 22% of patients, respectively. AWARE ACCESS class use increased (+17.5%), while carbapenem (−54.4%) and fluoroquinolone (−42.0%) use significantly declined (p < 0.05). IPC and microbiological culture guidance were provided in 12.1% of cases. Antimicrobial consumption dropped from 107.7 to 84.4 DDD/100PD (p < 0.05). No significant changes in LOS or mortality were observed. Antimicrobial costs fell by 48.8% (with EUR 57,100 saved). Conclusions: ASP reduced antimicrobial consumption, improved prescription quality, and cut costs without compromising patient outcomes. Multidisciplinary collaboration, audits, and education proved essential. Future studies should assess long-term resistance trends and integrate rapid diagnostics for enhanced stewardship. Full article

Background/Objectives: Antimicrobial resistance (AMR) poses a critical global health threat, rendering common bacterial infections increasingly difficult to treat and placing considerable strain on healthcare systems. This study assesses public awareness, perceptions, and behaviors related to antibiotic use and AMR in Kosovo, a country with limited existing data on the topic. Methods: Using a cross-sectional survey design, 568 participants from diverse demographic backgrounds provided insights into their knowledge and practices concerning antibiotic use and antibiotic resistance. Results: The results revealed that although 75% of participants had heard of antibiotic resistance, only a limited proportion understood key terms. Knowledge of appropriate antibiotic use varied, with 67% of respondents correctly recognizing the need to complete a prescribed antibiotic course, while 29% believed it was acceptable to stop treatment once they felt better. Gender and educational level emerged as significant factors, with women and more educated individuals demonstrating greater awareness of proper antibiotic use and the risks of misuse. While 71% of respondents considered it unacceptable to use antibiotics prescribed to others, 41% believed it was acceptable to reuse previously effective antibiotics. Most participants (96%) reported obtaining antibiotics through prescriptions. Public awareness of AMR was generally high, but conceptual understanding remained limited, with misconceptions about the origins of resistance, incorrectly attributing it to the human body rather than bacteria. Conclusions: Targeted public health campaigns, guided by the One Health approach, integrating human, animal, and environmental health, are needed. A multifaceted strategy, including education, policy reforms, and international collaboration, is essential to mitigate AMR and preserve the efficacy of antibiotics for future generations. Full article

Background/Objectives: Some ophthalmic antibiotics are publicly subsidised in New Zealand (NZ) for off-label use in the ear, however, this utilisation has not previously been described. This study compared the utilisation of ophthalmic chloramphenicol and ciprofloxacin in the eye and ear, among NZ children. Methods: This study involved clinical record review, and included 11,617 prescriptions of ophthalmic chloramphenicol and ciprofloxacin in 2022, for children aged five years or under in Auckland, NZ. Prescriptions of chloramphenicol and ciprofloxacin for eye and ear use were compared by: patient age, gender, ethnicity and socioeconomic deprivation, indication, community or hospital prescribing and number of repeat prescriptions. Statistical analysis was performed using Chi-squared test and multinomial regression. Results: Most ophthalmic ciprofloxacin was used in the ear (84%). In contrast, almost all chloramphenicol was used in the eye (96%). Post-operative use following tympanostomy tube insertion accounted for half of all hospital-prescribed ophthalmic ciprofloxacin used in the ear. Utilisation of chloramphenicol and ciprofloxacin in the eye and ear was similar, with more prescriptions for children aged one year and males, and most children received only one prescription. Māori and Pacific children generally received fewer prescriptions. Pacific children were more likely than Māori children to receive hospital-prescribed ophthalmic ciprofloxacin for use in the ear (adjusted OR 6.7, p = 0.025). Conclusions: These findings highlight the utilisation of ophthalmic ciprofloxacin in the ear in NZ children. These findings will inform decision-making in the public funding of medications, policy development in equitable medication access, and more collaborative efforts to improve antimicrobial use. Full article

Background: Although forest therapy services in South Korea have demonstrated mental and physical effects, there is no established system for forest therapy prescriptions. To this end, it is necessary to devise a systematic model for the introduction of forest therapy prescriptions by linking the existing forest therapy infrastructure and medical services. Therefore, this study aimed to derive the components and application plans needed to devise a forest therapy prescription model for the spread of medical-linked forest therapy services and to secure a forest therapy prescription infrastructure. Methods: To this end, Korean and foreign cases of prescription models and healthcare service provision systems were analyzed to derive the necessary components for prescription models. Subsequently, a Focus Group Interview (FGI) was conducted with eight experts in the fields of forest therapy and welfare, psychiatry, and health and nursing, and opinions were derived regarding the conception and empirical application of the forest therapy prescription model through content analysis. Results: As a result of the study, five components (clear role-sharing and a collaboration system, a continuous system, customized service provision, various technologies and content, and a database-based prescription system) were derived from cases of prescription models and healthcare service provision systems according to field. Furthermore, the FGI identified three primary topics: stakeholders’ scope and role, procedures and effectiveness, and additional considerations. Each was categorized into eight sub-categories relevant to the design of the forest therapy prescription model. Conclusions: These results can be used as basic data for devising a systematic Korean forest therapy prescription model in which forest therapy and medical services are linked, providing a foundation for personalized forest therapy prescriptions to be implemented. Full article

Background/Objectives: Antimicrobial use (AMU) in livestock drives antimicrobial resistance (AMR). AMR has a significant impact on public health. While several interventions have been used to address this challenge, few have utilized Information and Communication Technology (ICT) approaches. The objective of this study was to pilot and assess an ICT system to monitor the use of veterinary drugs and disseminate information to farmers in peri-urban smallholder poultry systems in Kenya. Methods: The system was developed in collaboration with the stakeholders. It captures drug sales in veterinary pharmacies and disease incidence and treatments reported by farmers. The system was piloted from May 2023 to December 2023. Monthly follow-ups were conducted to monitor progress and address problems. Assessment was performed through focus group discussions with the users (two with farmers and two with veterinary pharmacy staff) and descriptive statistics of the data collected by the system. Results: A total of 15,725 records were obtained from veterinary pharmacies, including antibiotics (57%), dewormers (22%), and vitamins (11%). Requests for a specific product were recorded in 38% of the sales, while 63% were accompanied by some evidence (empty drug containers, old packages, old prescriptions, pictures of sick birds, and actual sick birds). A total of 91 records were obtained from the farmers. The health problems reported were mostly respiratory (40%) and digestive (30%) disorders. The percentage of customers who requested advice on animal health when visiting veterinary pharmacies ranged from 5 to 20%. Conclusions: AMU can be improved in the study area. The piloted system may help policymakers monitor the sales and usage of antibiotics, improve animal health management, and promote responsible AMU. Full article

Regular physical activity plays a critical role in health promotion and athletic performance, necessitating personalized exercise and training prescriptions. While traditional methods rely on expert assessments, artificial intelligence (AI), particularly generative AI models such as ChatGPT and Google Gemini, has emerged as a potential tool for enhancing personalization and scalability in training recommendations. However, the applicability, reliability, and adaptability of AI-generated exercise prescriptions remain underexplored. A comprehensive search was performed using the UnoPerTutto metadatabase, identifying 2891 records. After duplicate removal (1619 records) and screening, 61 full-text reports were assessed for eligibility, resulting in the inclusion of 10 studies. The studies varied in methodology, including qualitative assessments, mixed-methods approaches, quasi-experimental designs, and a randomized controlled trial (RCT). AI models such as ChatGPT-4, ChatGPT-3.5, and Google Gemini were evaluated across different contexts, including strength training, rehabilitation, cardiovascular exercise, and general fitness programs. Findings indicate that generative AI-generated training programs generally adhere to established exercise guidelines but often lack specificity, progression, and adaptability to real-time physiological feedback. AI-generated recommendations were found to emphasize safety and broad applicability, making them useful for general fitness guidance but less effective for high-performance training. GPT-4 demonstrated superior performance in generating structured resistance training programs compared to older AI models, yet limitations in individualization and contextual adaptation persisted. A critical appraisal using the METRICS checklist revealed inconsistencies in study quality, particularly regarding prompt specificity, model transparency, and evaluation frameworks. While generative AI holds promise for democratizing access to structured exercise prescriptions, its role remains complementary rather than substitutive to expert guidance. Future research should prioritize real-time adaptability, integration with physiological monitoring, and improved AI-human collaboration to enhance the precision and effectiveness of AI-driven exercise recommendations. Full article

Background/Objectives: In older patients, falls constitute a significant public health concern and a major cause of hospital admission. Fall-risk-increasing drugs (FRIDs) represent a key risk factor for falls. Therefore, modifying these drugs represents an important strategy for preventing recurrent falls and further patient harm. The objective of this study was to evaluate a structured interprofessional collaboration between physicians and pharmacists on managing FRIDs in older patients who present to the emergency department (ED) after a fall. Methods: This study was performed in the ED of a tertiary care hospital. Patients who were >65 years old and presented to the ED after a fall were included. A routine care group was included between 1 March 2020 and 31 May 2020. A pharmaceutical care group was included between 1 September 2023 and 30 November 2023. In the pharmaceutical care group, a clinical pharmacist supported the physicians in identifying and managing FRIDs. Possible solutions for improving FRID prescription were discussed interprofessionally. The number of FRIDs at ED admission and discharge, as well as the number of FRID modifications, were evaluated. Results: A total of 107 patients were enrolled in each group. There were 85 patients in the routine care group and 89 patients in the pharmaceutical care group, with at least 1 FRID prescribed at ED admission (p = 0.483). At ED discharge, there were 85 patients in the routine care group and 68 patients in the pharmaceutical care group, with at least 1 FRID prescribed at (p = 0.010). There were seven FRID modifications in the routine care group compared to 125 FRID modifications in the pharmaceutical care group. Conclusions: In this study, the interprofessional collaboration between physicians and pharmacists led to a reduced number of FRIDs being prescribed and more FRID modifications in older patients at ED discharge. Further research is required to ascertain the feasibility of integrating this single intervention into a multifactorial fall prevention program. Full article

Background: It is well established by research that large-scale and indiscriminate prescribing, dispensing, and use of antimicrobials drive antimicrobial resistance (AMR) endangering the health and well-being of people, animals, and the environment. In the context of low- and middle-income countries (LMICs), the prescribing of antimicrobials is often not based on biomedical rationality but involves alternative logic driven by social, cultural, and institutional factors. This paper seeks to develop a “biosocial” perspective, reflecting a unified perspective that treats the biomedical and social conditions as two sides of the same coin. Methods: This analysis is based on an empirical investigation of prescription slips that patients carry to buy drugs from the pharmacy following an outpatient department encounter with the clinician. Data collection involves mixed methods, including the quantitative analysis of the antimicrobials prescribed and a qualitative analysis of the underlying reasons for these prescriptions, as described by doctors, pharmacists, and patients. Data analysis involved triangulating quantitative and qualitative data, to develop a “biosocial” perspective, which can provide implications for the development of antimicrobial stewardship policies, particularly relevant for health institutions in low- and middle-income countries. Results: Our analysis of 1175 prescription slips showed that 98% contained antimicrobials, with 74% being broad-spectrum antimicrobials. Only 9% of cases were advised antimicrobial sensitivity testing (AST) before initiating treatment. Qualitative findings indicated that patients had poor awareness of antimicrobials and pharmacists played a crucial role in counseling. Conclusions: This study highlights that antimicrobial prescriptions in public health settings are influenced by both biomedical and social factors, supporting a biosocial perspective. Although AMS interventions are predominantly biomedical, adhering to clinical standards and best practices, this study underscores the necessity of integrating a biosocial viewpoint by incorporating the experiences of pharmacists and patient groups. Strengthening diagnostic support, patient education, and interprofessional collaboration could improve rational antimicrobial uses in low-resource settings. Full article

Prescription digital therapeutics (PDTs) are emerging as a pivotal component of digital healthcare, providing software-based therapies for various diseases. This review aims to analyze the regulatory landscape in the U.S., safety, efficacy, and current challenges of PDTs, focusing on mental health conditions. Relevant articles were searched on PubMed, Google Scholar, ClinicalTrials.gov, and FDA Guidance Documents databases, supplemented by manual searches of reference lists from included studies. Inclusion criteria covered English-language studies on the development and application, therapeutic efficacy, and regulatory guidelines of PDTs in mental health. Data extraction and synthesis were conducted to summarize key findings and trends in the literature. FDA regulatory frameworks for PDTs are evolving through pathways of de novo and 510(k) applications, with patient-centric guidance. Clinical trials and real-world data support PDTs’ safety and efficacy, while highlighting regulatory needs. Challenges include payer coverage, patient accessibility, and data privacy concerns. Mixed patient feedback reveals areas for improvement. Limited healthcare provider engagement and payer coverage contributed to financial challenges for PDT manufacturers. Future trends suggest that PDTs will expand beyond mental health. The evolving landscape underscores the need for continued research, regulatory refinement, and collaborative efforts across stakeholders to ensure the successful integration of PDTs into healthcare. Full article

The only proven method to manage glaucoma is the reduction and stabilization of intraocular pressure (IOP). A wide range of daily activities has been demonstrated to affect the IOP behavior, and eye care specialists should be aware of their effects for the prevention and treatment of glaucoma. Indeed, the impact of physical activity on IOP has gained attention in recent years, considering exercise prescription as a promising adjuvant strategy for controlling IOP in glaucoma patients. To integrate all the available information in this regard, we have conducted a clinical review based on a patient-centered approach. Previous studies have demonstrated that the IOP response to physical exercise is dependent on numerous factors such as the exercise type (e.g., endurance or resistance training), exercise intensity, subjects’ fitness level, body position (e.g., supine vs. standing) and breathing pattern adopted during exercise, underlying medical conditions, concomitant mental effort, or caffeine intake before exercise. This article summarizes the available scientific evidence on the positive and negative effects of physical exercise on IOP and provides practical recommendations for exercise prescription in glaucoma patients or those at risk. An active collaboration between eye care and sports medicine specialists would permit a better management of this ocular condition. Full article

Background/Objectives: Off-label drug use is prevalent in pediatric care, particularly in pediatric palliative care (PPC), due to the scarcity of pediatric-specific formulations and clinical trials. Differences in perception between healthcare professionals regarding off-label prescriptions underscore the complexity of this practice and highlight the need for improved collaboration to optimize therapeutic outcomes. Methods: A cross-sectional observational study was conducted from August to October 2021 at the PPC center of the University Hospital of Padova, Italy. Data were collected from medical records of 169 patients. Off-label prescriptions were independently assessed by two physicians and two clinical pharmacists using respective reference sources. Discrepancies were resolved through consensus. Statistical analyses included the χ²-test for categorical variables and t-tests for continuous data. Results: Among the 993 drug prescriptions analyzed, the pharmacists reported a higher proportion of off-label uses (32.9%) compared to the physicians (18.4%; p < 0.05). After a consensus, 26.5% of the prescriptions were identified as off-label, with 67.9% due to indications, 49.6% due to dosage, and 44.4% due to age discrepancies. Conclusions: This study suggests a high prevalence of off-label prescribing in pediatric palliative care (PPC) and highlights differing professional perspectives, underscoring the potential benefits of exploring standardized protocols and enhanced interdisciplinary collaboration. Enhanced communication between healthcare providers, alongside the development of registries and clinical trials, is essential for improving the safety and efficacy of off-label drug use in pediatric populations. A flexible regulatory framework and customized galenic formulations could further support these goals. Full article

This article offers a concise overview of the best practices for safety in offshore oil and gas operations, focusing on the risks associated with various types of equipment, particularly on the risk of fire. It identifies specific machinery and systems that could pose hazards, assesses their potential impact on safety, and explores conditions that may lead to accidents. Some of the largest accidents were analyzed for their associations with fire hazards and specific equipment. Two primary regulatory approaches to offshore safety are examined: the prescriptive approach in the United States (US) and the goal-oriented approach in Europe. The prescriptive approach mandates strict compliance with specific regulations, while in the goal-oriented approach a failure to adhere to recognized best practices can result in legal accountability for negligence, especially concerning human life and environmental protection. This article also reviews achievements in safety through the efforts of regulatory authorities, industry collaborations, technical standards, and risk assessments, with particular attention given to the status of Mobile Offshore Drilling Units (MODUs). Contrary to common belief, the most frequent types of accidents are not those involving a fire/explosion caused by the failure of the Blowout Preventer (BOP) after a well problem has already started. Following analysis, it can be concluded that the most frequent type of accident typically occurs without fire and is due to material fatigue. This can result in the collapse of the facility, capsizing of the platform, and loss of buoyancy of mobile units, particularly in bad weather or during towing operations. It cannot be concluded that accidents can be more efficiently prevented under a specific type of safety regime, whether prescriptive or goal-oriented. Full article

Background/Objectives: Antimicrobial resistance represents a growing global health crisis, demanding innovative approaches to improve antibiotic stewardship. Artificial intelligence (AI) chatbots based on large language models have shown potential as tools to support clinicians, especially non-specialists, in optimizing antibiotic therapy. This review aims to synthesize current evidence on the capabilities, limitations, and future directions for AI chatbots in enhancing antibiotic selection and patient outcomes. Methods: A narrative review was conducted by analyzing studies published in the last five years across databases such as PubMed, SCOPUS, Web of Science, and Google Scholar. The review focused on research discussing AI-based chatbots, antibiotic stewardship, and clinical decision support systems. Studies were evaluated for methodological soundness and significance, and the findings were synthesized narratively. Results: Current evidence highlights the ability of AI chatbots to assist in guideline-based antibiotic recommendations, improve medical education, and enhance clinical decision-making. Promising results include satisfactory accuracy in preliminary diagnostic and prescriptive tasks. However, challenges such as inconsistent handling of clinical nuances, susceptibility to unsafe advice, algorithmic biases, data privacy concerns, and limited clinical validation underscore the importance of human oversight and refinement. Conclusions: AI chatbots have the potential to complement antibiotic stewardship efforts by promoting appropriate antibiotic use and improving patient outcomes. Realizing this potential will require rigorous clinical trials, interdisciplinary collaboration, regulatory clarity, and tailored algorithmic improvements to ensure their safe and effective integration into clinical practice. Full article

Background: Treatment of CV risk factors, such as cholesterol level, represents one of the main goals to reduce atherosclerotic burden. The aim of this study was to investigate the prescriptive appropriateness of cholesterol-lowering drugs among patients who experienced an atherosclerotic CV disease (ASCVD). Methods: We investigated 155 patients who underwent cardiac rehabilitation in 2020. The European Society of Cardiology (ESC) 2021 guidelines on CV disease prevention and 2019 ESC Guidelines on dyslipidemias were followed to detect the appropriateness of prescription. SCORE2 and SCORE2-OP risk estimations were used to detect patients’ CV risk profiles. Patients were divided into three groups: 1 (n = 118) patients admitted for their first CV event, 2A (n = 18) patients who experienced a previous CV event years before, and 2B (n = 19) patients admitted for a new event with a previous CV event 2 years before. Low-density lipoprotein (LDL) cholesterol level was detected at the time of admission to the hospital, during cardiac rehabilitation, and at the first visit after rehabilitation. Results: The statistics for our study participants, with a mean age of 66.1 years, were: 72.4% overweight/obese, 63.9% diabetic, 72.5% smokers, 93.0% hypertensives, and 91.7% had dyslipidemias. In group 1, only 5.1% had a low/moderate risk, 44.1% presented a high risk, and 50.8% a very high risk according to calculators. The average LDL levels were 115.8 mg/dL (2.99 mol/L) upon admission to the hospital, 66.4 mg/dL (1.72 mmol/L) at the time of cardiac rehabilitation, and 64.8 mg/dL (1.67 mmol/L) at the subsequent medical visit. In the overall group, only 36.0% had LDL < 55 mg/dL (1.42 mmol/L). In group 1, 79.4% were treated with high-intensity statin alone or plus ezetimibe; in group 2A, the percentage increased up to 87.5%, while group 2B 33.4% was treated with high-intensity statin plus ezetimibe and 33.3% were treated with PCSK9 inhibitors. Conclusions: This retrospective study confirms the importance of properly calculating CV risk profiles. The main limitations for the efficacy of lipid-lowering drugs were: patient’s compliance, drugs side effects, lifestyle habits, and collaboration with a general practitioner. Full article

(1) Background: In general, it is known that continuity of care can contribute to an increase in patient satisfaction, reduce health care costs, and improve patient outcomes. A guarantee of continuity in pharmacotherapy is a big challenge facing Japanese health care as a system that encourages cooperation/collaboration for pharmacists with other health care professions is currently lacking. (2) Method: This is a narrative review. (3) Results: The Lund Integrated Medicine Management (LIMM) model describes a systematic approach to individuals and was developed in Sweden to optimize pharmacotherapy among elderly inpatients. The aim of the LIMM model is to provide patients with continuous pharmacotherapy at different levels of care. The LIMM model, in which a clinical pharmacist is the catalyst and leads other health care professions in completing the process, has the potential to reduce potentially inappropriate prescriptions, reduce rehospitalization risk, unscheduled hospital revisits due to problems related to medications, reduce total medical expenditure, and provide a comprehensive understanding of patients’ conditions of taking medicine. (4) Conclusions: Introducing a framework such as Sweden’s LIMM model, anchored by clinical pharmacists, could provide a good opportunity to promote collaborations among different health care professionals and improve continuity in pharmacotherapy. Full article