Search Results (387)

Background: In pediatric dental care, antibiotics are routinely prescribed for both therapeutic and preventive purposes. Their use is primarily indicated for the management of widespread dental or oral infections, in conjunction with appropriate clinical treatment. Additionally, antibiotics are administered to prevent infective endocarditis (IE) in patients identified as being at increased risk. The present study aimed to evaluate the knowledge and prescribing practices of Italian dentists regarding antibiotic use in pediatric patients through an anonymous online questionnaire. Methods: A specifically designed questionnaire was electronically distributed to a group of Italian dentists. The questionnaire included three sections: demographic data, general knowledge on antibiotic prescribing, and IE prophylaxis in pediatric dentistry. Data were analyzed using appropriate statistical methods. Results: The study included 242 Italian dentists. Only a limited number of statistically significant differences were observed between specialists in pediatric dentistry and general dentists or those with other specializations, as well as between practitioners who mainly treat pediatric patients and those who predominantly treat adults. Regarding antibiotic prophylaxis for IE, most respondents identified amoxicillin as the first-line antibiotic for pediatric patients without penicillin allergy, whereas nearly 30% indicated clindamycin for patients with penicillin allergy. The knowledge about the dosage of assumption of the antibiotic of choice and the timing of administration of the antibiotic prophylaxis were considered as not sufficient. Conclusions: Important gaps remain in dentists’ knowledge of current guidelines for IE prophylaxis, particularly regarding drug dosage and administration. Increased awareness of updated recommendations and potential adverse effects of alternative antibiotics, such as clindamycin, is needed. Full article

Major depressive disorder (MDD) affects over 330 million people globally, yet up to 30% of patients fail initial pharmacotherapy due to genetic variability in drug metabolism. This narrative review synthesizes evidence on pharmacogenomic (PGx) guided approaches for MDD, emphasizing their integration with POC diagnostics and engineering solutions. Approximately 40–50% of patients carry actionable variants in CYP2C19 or CYP2D6, which govern the metabolism of selective serotonin reuptake inhibitors. Landmark trials (GUIDED, PRIME Care, GAPP-MDD) and meta-analyses demonstrate that PGx-informed prescribing modestly but significantly improves remission and response rates, particularly in treatment-resistant depression. Established guidelines from CPIC and the Dutch Pharmacogenetics Working Group provide actionable recommendations for CYP2D6 and CYP2C19 phenotypes. Emerging POC platforms, including Genomadix Cube and Genedrive, now deliver CYP2C19 results within one hour, supporting rapid clinical decisions. However, psychiatric-specific implementation data remain limited compared to cardiology; current POC devices lack multi-gene capabilities, and most studies underrepresent diverse populations. Persistent barriers include variable reimbursement, limited clinician education, and fragmented electronic health record integration. Future directions include pre-emptive genotyping, expanded multi-gene panels, and embedded clinical decision support. With continued engineering innovation and rigorous validation, PGx-guided care holds promise for reducing the trial-and-error burden and advancing precision psychiatry. Full article

Background: The IQVIA Disease Analyzer (DA) database is a major outpatient electronic health record dataset in Germany. Over recent years, it has been increasingly used to study neurological diseases, comorbidities, treatment patterns, and long-term sequelae. We narratively summarized neurology-related studies using the German IQVIA Disease Analyzer (DA) database published since 2020 and to highlight methodological considerations relevant for interpreting DA-based neurological research. Methods: We conducted a narrative review of DA-based studies published between January 2020 and December 2025. PubMed was searched using DA-related keywords and major neurological disease terms. Eligible articles included peer-reviewed cohort, case–control, or descriptive studies using DA outpatient data. Results: The review identified studies covering epilepsy, cerebrovascular outcomes, Parkinson’s disease, dementia, multiple sclerosis, migraine, and sensory disorders. Most used retrospective cohort or nested case–control designs with regression or propensity score methods. Follow-up durations ranged from 3 to 10 years. Results consistently reflected routine care outpatient diagnostic and prescribing patterns. Discussion: Strengths of DA studies include large patient populations, long follow-up, and detailed prescription information. Limitations include reliance on outpatient ICD-10 coding, lack of detailed neurological phenotyping, and potential residual confounding and bias. Conclusions: DA-based analyses generate clinically relevant routine care evidence on neurological conditions in the German outpatient setting. Proper methodological safeguards and complementary data sources are required to contextualize findings for clinical and epidemiological use. Full article

Background: Antimicrobial resistance (AMR) is a global health threat arising from inappropriate antibiotic use. Data on the prescription of antibiotics in emergency departments (EDs), critical care points for infection management, are limited. Objective: This study aimed to assess systemic antibiotic use in an Indonesian ED. Methods: This retrospective observational study was conducted in the Cilacap Teaching Hospital ED in 2022. Data, including patient demographics and systemic antibiotic prescription details (World Health Organization Anatomical Therapeutic Chemical (WHO ATC): J01) were extracted from electronic medical records. Antibiotic use was analyzed according to age groups (children [0–14 years], adults [15–64 years], and the elderly [≥65 years]), administration route, and the World Health Organization Access, Watch, and Reserve classification. Results: Among all ED visits during the study period, 52.1% (14,396/27,640) received systemic antibiotics, and adults comprised 68.5% (9861/14,396) of antibiotic-exposed cases. Cephalosporins were the most frequently prescribed antibiotics in all age groups (42.4–50.9%). Penicillins were more frequently prescribed in children (29.9%) than in adults (10.0%) and the elderly (6.6%), whereas fluoroquinolones were more commonly prescribed in the elderly (21.1%) than in adults (16.2%) and children (3.8%). Watch-class antibiotics, comprising 63.9% of all prescriptions, were commonly prescribed in the elderly (71.9%). Oral route was the predominant form (65.8%), particularly in children (76.5%). The most frequently prescribed antibiotics differed across age groups, with amoxicillin followed by cefixime in children, and cefixime followed by ceftriaxone in both adults and the elderly. Conclusions: This study showed high antibiotic exposure and identified age-related differences in antibiotic prescribing, and patterns that warrant further evaluation within antimicrobial stewardship frameworks, to optimize antibiotic use and mitigate AMR. Full article

Background and Objectives: Appropriate antimicrobial dosing according to kidney function is essential to ensure therapeutic efficacy while minimizing toxicity and antimicrobial resistance. Despite established dosing guidelines and electronic prescribing systems, errors in renal dose adjustment of antimicrobials, particularly in the setting of acute kidney injury, remain common among hospitalized patients. Materials and Methods: A point-prevalence study was conducted on 31 October 2024 at a tertiary-care hospital in Greece to evaluate the appropriateness of antimicrobial dosing in relation to renal function. Patient characteristics, renal parameters, and antimicrobial prescriptions were extracted from electronic medical records. Glomerular filtration rate (GFR) was estimated using the MDRD formula. Comparative analyses were performed between correctly and incorrectly dosed cases, and between overdosing and underdosing episodes. Results: A total of 235 hospitalized patients were evaluated (mean age 64.8 ± 18.6 years; 43.4% female). Overall, 15.7% (37/235) received at least one antimicrobial dose inappropriate for their renal function. Among 37 patients where dosing errors were identified, overdosing was noted in 23 (62.2%), underdosing in 16 (43.2%), adding up to 39 prescriptions, while in 2 patients (5.4%), both mistakes were noted in different prescribed antimicrobials. Drug-specific error rates varied considerably: ceftazidime and cefuroxime showed the highest rates of inappropriate dosing (40% each), followed by colistin (33.3%) and acyclovir (33.3%). Piperacillin/tazobactam, the most frequently prescribed agent (n = 50), had a 14% error rate, mainly due to underdosing (10%). Patients with dosing errors were significantly older (71.5 vs. 64.1 years, p = 0.0220) and had worse renal function, including higher serum creatinine (1.68 vs. 1.19 mg/dL, p = 0.0174), lower GFR (58.5 vs. 75.9 mL/min/1.73 m², p = 0.0009), and more frequent dialysis (13.5% vs. 4.3%, p = 0.0422). They also received a higher median number of antimicrobials (2 vs. 1, p = 0.0185). Conclusions: Inappropriate antimicrobial dosing based on kidney function remains common in hospitalized patients, particularly among older individuals and those with impaired renal function or polypharmacy. Targeted antimicrobial stewardship strategies focusing on renal dose adjustment and agents that are more frequently dosed inappropriately, such as colistin, acyclovir, cefuroxime, and ceftazidime, as well as agents that are frequently prescribed despite a relatively lower rate of inappropriate dose, such as piperacillin/tazobactam, are needed to enhance prescribing safety and optimize therapeutic outcomes. Full article

Background/Objectives: Medication errors remain a patient safety concern in neonatal intensive care units (NICU), mainly due to multiple dilution steps, a lack of standardized preparation instructions, and the frequent use of high-alert medications. While standard concentrations (SCs) for intravenous (iv) medication are recommended internationally, a national standard is missing for NICUs in Germany. The aim of this study was to evaluate a proposal for a national list of standardized iv medication concentrations to be used in German NICUs. Methods: In collaboration with the German Society for Neonatology and Pediatric Intensive Care (GNPI) and the Federal Association of German Hospital Pharmacists (ADKA), a multiprofessional expert team, including experts from the medication safety initiatives TELE-KASPER and Kinderformularium.DE and affiliated with seven German university hospitals, evaluated SCs for infusion medication administered to infants weighing 500 g to 5 kg. The evaluation process was based on international SCs lists, clinical practice, stability data, and handling aspects. Medication used in at least four of the seven hospitals was shortlisted. In the first round of the consensus process, an online survey submitted to the German Level-1 NICUs (n = 165) and their affiliated hospital pharmacies identified preferred SCs. In the second round of the consensus process, the expert team further evaluated the results of the survey. Results: The survey response rate was 52%. The consensus process resulted in a list encompassing 50 iv medications and 80 appropriate SCs. Ancillary information on preparation, stability, osmolarity, pH, and practical administration was added. Conclusions: The proposed SCs for infusion medication used in NICUs have the potential to reduce medication errors, simplify electronic prescribing, and improve workflow efficiency. Implementation aligns with international patient safety initiatives to improve medication safety in pediatric patients. Full article

Background: Antimicrobial resistance continues to threaten effective infection management worldwide and is driven largely by inappropriate prescribing practices. In Saudi Arabia, the cities of Makkah and Al-Madinah experience intense seasonal healthcare demand due to the annual pilgrimage, creating additional challenges for rational antibiotic use. This study aimed to evaluate physicians’ knowledge, attitudes, and prescribing behaviors related to antibiotics in these high-demand settings. Methods: A cross-sectional analytic study was conducted between June and August 2024 among physicians practicing in Makkah and Al-Madinah, including those participating in Hajj services. A previously validated, structured electronic questionnaire assessed knowledge of common pathogens, perceptions of antimicrobial resistance, prescribing influences, and counseling practices. The survey was distributed electronically to eligible physicians. Descriptive statistics were generated, and associations were examined using appropriate inferential tests with a 95% confidence level. Results: A total of 487 physicians participated. Most respondents (74%) correctly identified major bacterial causes of upper respiratory tract infections, and 90% acknowledged the association between prior antibiotic exposure and resistance. Nonetheless, misconceptions persisted regarding the benefit of antibiotics in viral conditions. Workload and patient expectations influenced prescribing behavior; 77% reported a greater likelihood of prescribing antibiotics during periods of high clinical pressure. While adherence to guideline-based practice was generally reported, variability existed in counseling practices and perceptions of stewardship policies. Conclusions: Although baseline knowledge was satisfactory, contextual and behavioral factors continue to influence prescribing decisions and may contribute to unnecessary antibiotic exposure, highlighting the need for strengthened antimicrobial stewardship strategies in high-demand healthcare environments. Full article

(1) Background: This follow-up retrospective analysis used electronic medical record (EMR) data from a health system to identify patients and medications prescribed in accordance with Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines. (2) Methods: This analysis included EMR data from a clinical research data warehouse encompassing 928,291 patients seen at an academic medical center between 2020 and 2024. The study evaluated 75 commercially available medications linked to 52 evidence-based CPIC pharmacogenomic (PGx) guidelines. (3) Results: Of the 928,291 patient encounters, 709,673 medication orders were recorded, with 416,621 patients (44.8%) prescribed at least 1 of the 75 CPIC-associated medications. This compares with 845,518 patients who had an encounter in 2015–2019 with 590,526 medication orders, and 335,849 (56.9%) patients had medication orders represented by CPIC-associated medications. One to three CPIC-associated medications accounted for 76.6% of patients in 2020–2024 compared to 75.6% in 2015–2019. (4) Conclusions: The findings demonstrate that the proportion of patients prescribed a CPIC-actionable medication remained just under half of those evaluated within a single institution’s EMR. About three-quarters of patients over the ten-year period had between one to three CPIC-associated medications identified, and the top five classes of medications remained the same in the two periods. This understanding of patient volume may help organizations as they begin to assess the implementation of PGx services. Full article

National legislative frameworks governing prescribing, pricing, reimbursement, and dispensing play a decisive role in shaping access to medicines. This study examines the financial availability of medicines in Bulgaria and North Macedonia through a comparative review of national pharmaceutical legislation, pricing mechanisms, reimbursement models, and digitalisation policies, assessed in relation to European Union standards. The findings indicate that access to medicines in both countries is shaped by the combined effects of multiple regulatory and financial instruments rather than by individual policy measures. Both systems apply strict control of prescribing and dispensing, external reference pricing, and positive reimbursement lists, reflecting alignment with international recommendations. However, significant differences in policy design lead to divergent access outcomes. Bulgaria’s more advanced digitalisation of prescribing and reimbursement, including mandatory electronic prescribing for selected therapeutic groups, enhances regulatory oversight and expenditure control but is associated with higher patient out-of-pocket expenditure, partly due to the application of the standard value-added tax on medicines. In contrast, North Macedonia combines lower taxation with capped patient co-payments, higher regulated pharmacy margins, and fixed pharmacy remuneration per prescription, contributing to improved financial affordability for patients while supporting pharmacy sustainability. Additional instruments, such as the Generics without Co-Payment List, further strengthen patient financial protection. The study provides comparative evidence relevant to pharmaceutical policy reforms and highlights the importance of balanced regulatory approaches that promote affordability, system sustainability, and equitable access to medicines. Full article

Background/Objectives: For patients diagnosed with chronic kidney disease (CKD), it is important to follow guidelines addressing dose-adjustments for renally eliminated drugs to avoid complications related to toxicity and subtherapeutic effects. In Saudi Arabia, limited data are available regarding appropriate medication doses for CKD. In this study, we investigated the prevalence of inappropriately administered drugs in patients with CKD and examined factors associated with unadjusted renal dosing. Methods: A retrospective, cross-sectional, observational analysis (2023–2025) was conducted via a systematic electronic medical record review of hospitalized patients diagnosed with CKD and cardiovascular diseases (CVDs) in the Al-Baha region, Saudi Arabia. Medications were selected and evaluated for appropriate dosing based on creatinine clearance (CrCl). Medications were categorized as appropriately adjusted, inappropriately adjusted, unadjusted, or contraindicated. Results: A total of 440 patients (787 prescriptions) were included. At the patient level, 85% had at least one appropriately adjusted medication, 13% had at least one inappropriately adjusted medication, 30% had at least one medication that was not adjusted despite indication, 34% had at least one medication requiring no adjustment, and 17% had at least one contraindicated medication (categories are not mutually exclusive). At the prescription level, which was the primary analytic unit (N = 787), 48% of prescriptions were appropriately adjusted, 7% were inappropriately adjusted, 17% were not adjusted despite indication, 19% required no adjustment, and 10% were contraindicated. Antibiotics accounted for the largest share of inappropriate adjustments, representing 77% (43/56) of all inappropriate dose-adjustment events. In exploratory bivariate analyses, age was not statistically significantly associated with dosing outcomes (Holm-adjusted p = 0.145). Polypharmacy was highly prevalent (91% of patients) but was not significantly associated with any dosing outcome in these exploratory analyses, likely due to limited statistical power. Conclusions: Our results showed that several regularly prescribed drugs, including metformin, sitagliptin, ceftazidime, ciprofloxacin, and spironolactone, were inappropriately prescribed to patients with CKD. These dosing errors can be avoided by increasing clinicians’ and pharmacists’ awareness of appropriate dosage modifications essential for patients with CKD. Full article

Background: Psychosis is a common neuropsychiatric symptom associated with Parkinson’s disease (PD), with prevalence rates of up to 75% over the course of the disease. Parkinson’s disease psychosis (PDP) is associated with increased morbidity, caregiver burden, depression, poorer quality of life and progression of dementia. It has also been shown to be a strong predictive factor for long-term care placement, and results in up to 71% increase in risk of mortality compared with PD patients free from psychotic symptoms. Use of APs for PDP is common, with up to 35% of PD patients prescribed at least one AP within 7 years of PD diagnosis. Methods: Four electronic databases (Ovid MEDLINE, Embase, PsycINFO, PubMed) were systematically searched for double-blind, randomised, placebo-controlled clinical trials for the use of APs in the treatment of PDP and their effects on PD motor symptoms, according to PRISMA guidelines. Results: Eleven studies from ten publications were identified and included in this review. Four studies investigated quetiapine, three investigated olanzapine, two investigated clozapine and a further two investigated pimavanserin. Quetiapine showed no significant improvement for PDP over placebo in three of the four studies, with both olanzapine studies also showing no improvement. Olanzapine studies also showed significant motor worsening compared to placebo. Clozapine significantly improved psychosis compared with placebo in both studies, with large effect sizes in primary outcome measures; (−0.82, 95% CI −1.37 to −0.26), −0.89 (95% CI −1.42 to −0.36). Pimavanserin also showed significant improvement (−0.48, 95% CI −0.77 to −0.18). Quetiapine, clozapine and pimavanserin showed no significant worsening in motor scores compared with placebo groups. Conclusions: Data from the studies included in this review suggest that the use of quetiapine for the management of PDP may not be evidence based. Clozapine may improve PDP symptoms with low doses however significant side-effects may limit usability. The findings from this review support the use of clozapine as an alternative AP for the management of PDP when clinically appropriate. Full article

Background/Objectives: Antibiotic exposure is highly prevalent in patients hospitalized with COVID-19, yet the relationship between specific prescribing patterns, microbiologically confirmed secondary infections, and clinical outcomes remains incompletely understood, particularly in settings with high antimicrobial resistance. Methods: This single-center retrospective observational cohort included 395 consecutive adults hospitalized with RT-PCR-confirmed COVID-19 in a tertiary infectious diseases hospital. Data on demographics, comorbidities, baseline disease severity, antimicrobial prescribing (timing, WHO AWaRe class, duration, monotherapy/combination, escalation/de-escalation), microbiological results, and outcomes were extracted from electronic records and the microbiology information system. The primary outcome was microbiologically confirmed secondary infection; secondary outcomes were ICU admission, invasive mechanical ventilation, length of stay, and in-hospital mortality. Multivariable logistic regression and survival analyses assessed associations between antibiotic exposure and outcomes. Results: Overall, 88.4% of patients received systemic antibiotics, predominantly initiated within 24 h of admission and mostly empirical; 58.7% received combination regimens, with frequent use of Watch/Reserve agents. Secondary infections occurred in 28.4% of patients, were hospital-acquired in 82.1%, and involved multidrug-resistant organisms in 41.1% of cases. Any antibiotic exposure was independently associated with secondary infection (adjusted odds ratio, aOR 2.15; 95% CI 1.42–3.27), while prolonged therapy (≥7 days), Watch/Reserve use, and early initiation showed additional risk gradients. Antibiotic exposure was also associated with higher odds of ICU admission, invasive mechanical ventilation, prolonged hospitalization, and in-hospital mortality after adjustment. Conclusions: In this real-world COVID-19 cohort, broad and largely empirical antibiotic use was common and strongly associated with hospital-acquired, often multidrug-resistant secondary infections and worse clinical outcomes. These findings highlight the need for reinforced antimicrobial stewardship focusing on restrictive early broad-spectrum use, AWaRe-guided agent selection, systematic 48–72 h reassessment with de-escalation, and minimization of treatment duration. Full article

Background/Objectives: To evaluate whether medical cannabis (MC) use following dysuria diagnosis is associated with increased risk of developing substance use disorder (SUD), given rising cannabis prescriptions for urologic symptoms and concerns about long-term consequences. Methods: We conducted a retrospective cohort study using the TriNetX Research Network, a federated electronic health record database with over 120 million patients. Adult patients newly diagnosed with dysuria between 2003 and 2024 were identified and stratified by subsequent cannabis exposure. MC users were defined by a cannabis-related diagnostic code within 90 days of dysuria diagnosis. Propensity score matching (PSM) was performed 1:1 by age, sex, and race. The primary outcome was a new diagnosis of SUD (cannabis, opioid, or cocaine use disorders) within 12 months. Secondary analysis included Kaplan–Meier (KM) survival estimates over 5 years. Risk ratios (RR), odds ratios (OR), and hazard ratios (HR) were calculated. OR and RR estimated the likelihood of SUD within 12 months, and HR reflected relative hazard over 5 years. Results: After excluding patients with prior SUD, the final sample included 60,544 MC patients and 98,715 general dysuria (GD) patients. The MC group had a significantly higher incidence of new SUD diagnoses (11.13%) than the GD group (2.28%), yielding a risk difference of −8.85% (95% CI: −9.11 to −8.58; p < 0.0001), relative risk 0.205, and OR 0.186. KM analysis showed lower SUD-free survival in MC (80.96%) versus GD (96.35%; log-rank p < 0.0001). MC exposure was associated with nearly fivefold increased odds of SUD within 12 months (OR = 0.186) and sixfold higher hazard over 5 years (HR = 0.163). Conclusions: Medical cannabis use after dysuria is linked to markedly increased risk and earlier onset of SUD. Careful patient selection, counseling, and monitoring are essential when prescribing MC for urologic symptoms. Full article

Background/Objectives: Alopecia areata is an autoimmune disorder affecting approximately 2% of the global population and is associated with a substantial impairment in quality of life. Owing to the limited number of approved therapeutic options, off-label pharmacotherapy is frequently employed in clinical practice when managing this disease. Methods: This retrospective study analyzed electronic medical records of patients treated for alopecia areata at the University Clinical Centre in Gdańsk between 2014 and 2024 to characterize the epidemiological profile and real-world treatment patterns. Results: A total of 334 affected patients were identified, including 199 diagnosed exclusively with alopecia areata and others presenting with immune-mediated comorbidities, most commonly atopic dermatitis and psoriasis. Among patients with isolated disease, women were more frequently affected and were older at diagnosis than men. Most individuals were managed in the outpatient setting, and demographic characteristics remained stable throughout the study period. Off-label pharmacotherapy was used in 77.9% of all patients and in 99.4% of those receiving drug treatment, with no significant associations observed between off-label use and age, sex, place of residence, or calendar year. Glucocorticosteroids, administered both topically and systemically, were the most commonly prescribed off-label agents (65.3%), and monotherapy was the predominant treatment strategy. Conclusions: These findings highlight the extensive reliance on off-label therapies in routine management of alopecia areata in a real-world European clinical setting. Full article

Background: Pharmacology plays a central role in linking biomedical science concepts with their application in clinical practice across medical and healthcare education. Globally, the pharmacological curriculum has evolved, just like other disciplines, through the integration of case-based, problem-based, and hybrid teaching models that led to firm clinical reasoning and long-term learning. Thus, this study aims to evaluate and compare the learning outcomes of pharmacology curricula across the globe by adopting a systematic review and meta-analysis research approach. Methods: This comprehensive review was conducted with transparency and integrity in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines and was registered with PROSPERO (CRD420251207753). Five electronic databases, including MEDLINE (PubMed), EMBASE, CINAHL, PsycINFO, and the Cochrane Library were searched from January 2000 to October 2025. The Cochrane Library tool was used for the risk of bias assessment of randomised controlled trials, while the Joanna Briggs Institute (JBI) checklist was used for mixed-design, quasi-experimental, and cross-sectional cohorts. Review Manager 5.4 was used for statistical analysis. Results: Out of 3300 identified studies, 11 met the inclusion criteria, spanning 11 countries (published between 2007 and 2025). Integrated and case-based curricula significantly improved pharmacology knowledge compared to traditional lecture-based methods (SMD = 0.35; 95% CI: 0.07–0.64; I² = 75%). Student satisfaction also favours integrated learning (OR = 1.53; 95% CI: 1.16–2.02; I² = 46%). Most included studies were of moderate-to-high methodological quality. Conclusion: Globally, active and integrated pharmacology curricula foster greater cognitive understanding and learner satisfaction than conventional models. However, significant variability persists in resource-limited settings, leading to unequal competency in prescribing and therapeutic reasoning. Australian pharmacology programmes align broadly with international standards but require greater standardisation in assessment and experiential learning. Full article