Search Results (45)

Background/objectives: Studies evaluating the longitudinal impact (beyond a decade) of antibiotic stewardship programs (ASPs) on the volume/quality of antibiotic prescriptions, as well as the impact on antibiotic resistance, are lacking. Since 2008, the ASP at Singapore General Hospital has implemented various strategies in the following phases: (1) initiation, (2) expansion, (3) optimisation, and (4) innovation. In this study, we aim to evaluate the volume/quality of antibiotic prescribing and susceptibility trends of clinically significant Gram-negative bacilli (GNBs), along with the evolution of ASP strategies over time. Methods: We conducted a single-centre, retrospective observational study from 2011 to 2024. Antibiotic consumption, appropriateness, and susceptibility trends of six GNBs to seven commonly used antibiotics were analysed using the Kendall tau test to identify potential monotonic trends based on aggregated rather than patient-level data. Results: We demonstrated sustained improvement in appropriateness of seven broad-spectrum IV antibiotics, accompanied by significant reductions in IV ciprofloxacin, cefepime, and ertapenem use (p < 0.05). Hospital-wide susceptibility of six GNBs to all evaluated antibiotics improved significantly (p < 0.05), except for E. coli’s susceptibility to ertapenem and Enterobacterales’s susceptibility to ciprofloxacin. Conclusions: With an evolving, multi-pronged stewardship approach, antibiotic prescribing and GNB susceptibility to most antibiotics have improved. In a rapidly evolving healthcare landscape, ASPs must remain agile, continually refining priorities and employing innovative strategies. Full article

This study investigates the use of digital twin technology, machine learning (ML), and artificial intelligence (AI) to improve energy efficiency. It focuses on the heating, ventilation and air conditioning (HVAC) systems in hotel buildings which rely on central air-conditioning 24/7 throughout the year for ensuring thermal comfort and air ventilation. We develop a three-phase digital twin framework illustrating the progression from monitoring to autonomous control. Using data from real-world deployment in a Hong Kong hotel since 2013, we evaluated the evolution of digital twin applications from the Fixed Mode, to the Energy Optimisation Solution (EOS) Mode, finally to an AI-driven autonomous system. Leveraging 17,520 hourly data points from 1416 Internet of Things sensors, we relate digital twin features to environmental benefits based on energy consumption and Energy Efficiency Ratio (EER). For energy consumption, the AI Mode achieves the lowest daily energy consumption, averaging 841.94 kWh, which was 21.91% lower than Fixed mode and 50.42% lower than EOS mode. Under real-world conditions, the AI-driven autonomous digital twin improved EER by 6.2% over EOS and 2.9% over the Fixed Mode, confirming its superior thermal efficiency. The results demonstrate the benefits of combining digital twins with AI to enable intelligent, scalable, and energy-efficient buildings. Full article

Employee attrition represents a significant burden, yet predictive models often fail to provide actionable retention strategies, creating a critical prediction–prescription gap. This paper introduces the Counterfactual–Dialectical Optimisation (CDO) framework, a novel methodology that bridges this gap by integrating predictive modeling, robust causal inference, and budget-constrained optimization. We first illustrate the framework’s mechanics on the synthetic Human Resources (HR) dataset, then conduct a rigorous proof-of-concept on the empirical ‘Saudi Employee Attrition Dataset’ to test its real-world applicability. In our empirical validation, we employ Propensity Score Matching (PSM) to estimate the causal effects of interventions while controlling for confounding variables. The results on the real-world dataset show that while predicting attrition is challenging Area Under the Curve (AUC ≈ 0.60), the framework successfully identified a deserved promotion as a powerful retention lever, causally reducing attrition probability by an estimated 23.9 percentage points. Acting on this insight, the optimization layer efficiently allocated the entire budget to this single, high-impact strategy for high-priority employees. This work provides a validated blueprint for shifting from passive prediction to active, Return on Investment (ROI)-driven prescription in strategic workforce management, demonstrating how to derive clear, actionable guidance even from complex, real-world data. Full article

Background/Objectives: Understanding prescribing patterns for type 2 diabetes mellitus, a complex condition affecting over 10% of the global adult population, can optimise prescribing practices, guide policymakers in promoting evidence-based medicine, and help tailor first-line treatments to individual characteristics or specific subgroups, improving patient outcomes. This study aimed to identify factors influencing the prescription and non-prescription of metformin, the recommended first-line therapy in Western guidelines, and to evaluate whether these prescribing patterns align with evidence-based recommendations. It also explores factors associated with initial combination therapy, a more recent and controversial approach compared to stepwise therapy. Methods: We conducted a systematic search in PubMed, Scopus, and Web of Science on 25 August 2023, without language or time restrictions, to identify observational analytical studies assessing factors associated with the initiation of metformin or combination therapy in adults with type 2 diabetes mellitus who were naïve to antidiabetic medications. Studies involving pregnant or breastfeeding women were excluded. A narrative synthesis was conducted. Study quality was assessed using the Joanna Briggs Institute critical appraisal checklists (PROSPERO registration number CRD42023438313). Results: Thirty studies were included, evaluating 105 variables, most of which (62%) were assessed in one study. The 25 variables using combination therapy as the outcome were mostly (72%) evaluated also in one study. Initial metformin prescription was strongly and positively associated with younger age, lower glycated haemoglobin levels, higher body mass index, and absence of renal impairment. Initial combination therapy was associated with higher HbA1c levels and a lower burden of comorbidities. Findings also highlighted a discrepancy between clinical practice and evidence-based recommendations. However, concerns were raised regarding both the internal and external validity of the included studies. Conclusions: Our systematic review, which offers insights into real-world clinical practices, indicated that there is a misalignment between clinical practices and evidence-based recommendations, supporting the need for interventions in this field. Full article

Introduction: The increasingly active role of nurses in the management of heart failure (HF) has become important in HF units (HCUs). This study aims to determine the effect of opening a specialised HF nursing (NSHF) consultation in a tertiary hospital on drug titration, and its subsequent impact on cardiac remodelling and prognosis. Methods: A retrospective cohort study was conducted on patients with HF with reduced ejection fraction (HFrEF) who were treated between 2017 and 2020. Patients who were followed by the NSHF were compared with those who underwent conventional clinical follow-up (non-NSHF), focusing on drug optimisation, echocardiographic parameters, biomarkers, and clinical outcomes in terms of mortality and hospital readmissions for HF. Results: A total of 411 patients were analysed, 85 of whom (20.7%) were treated with NSHF. There were hardly any differences in baseline characteristics. At the end of follow-up, the NSHF group had a higher prescription rate of angiotensin receptor–neprilysin inhibitor (+31.7% vs. +23.3%; p < 0.001), beta-blockers (+2.4% vs. −5.8%; p < 0.001), and sodium glucose co-transporter type 2 inhibitors (+24.7% vs. +17.8%; p < 0.001). There was also a higher rate of loop diuretic withdrawal (−16.7% vs. −6.7%; p < 0.001). However, no improvement in reverse remodelling or neurohormonal response was observed. Patients treated with NSHF had a lower probability of dying from HF (88.6% vs. 63.3%; p = 0.006), but this did not reduce hospital admissions for HF. Conclusions: Patients with HFrEF who are cared for through NSHF are more likely to be prescribed drugs that modify the prognosis of the disease. This has an impact on their mortality. Full article

Prescriptive Maintenance (PsM) transforms industrial asset management by enabling autonomous decisions through simultaneous failure anticipation and optimal maintenance recommendations. Yet, despite increasing research interest, the conceptual clarity, technological maturity, and practical deployment of PsM remains fragmented. Here, we conduct a comprehensive and application-oriented Systematic Literature Review of studies published between 2013–2024. We identify key enablers—artificial intelligence and machine learning, horizontal and vertical integration, and deep reinforcement learning—that map the functional space of PsM across industrial sectors. The results from our multivariate meta-synthesis uncover three main thematic research clusters, ranging from decision-automation of technical (multi)component-level systems to strategic and organisational-support strategies. Notably, while predictive models are widely adopted, the translation of these capabilities to PsM remains limited. Primary reasons include semantic interoperability, real-time optimisation, and deployment scalability. As a response, a structured research agenda is proposed to emphasise hybrid architectures, context-aware prescription mechanisms, and alignment with Industry 5.0 principles of human-centricity, resilience, and sustainability. The review establishes a critical foundation for future advances in intelligent, explainable, and action-oriented maintenance systems. Full article

Background: The effective management of psychotic and bipolar disorders in tertiary care can improve patient outcomes, yet the role of clinical pharmacists in optimising psychotropic medication use remains underexplored in South Africa. This study aims to investigate the role and interventions of clinical pharmacists in managing psychotic and bipolar disorders within a tertiary hospital in South Africa. Methods: A quantitative, descriptive study was conducted among 60 adult patients admitted to the psychiatric and internal medicine wards diagnosed with psychotic and/or bipolar disorder. A previously validated, standardised pharmaceutical care form was utilised for a purposive sample of inpatient files. Medication-related problems were identified, and appropriate interventions were suggested. Prescriptions were also assessed for adherence to treatment guidelines, including the South African Standard Treatment Guidelines, the American Psychiatric Association guidelines, and the National Institute for Health and Care Excellence guidelines. Results: The study included 60 patients (37 females) with a mean age of 37 years. Diagnoses included schizophrenia (28.8%), bipolar disorder (27.5%), and stimulant-induced psychosis (19.3%). Sixty-two medication-related problems were identified, leading to 77 proposed interventions, of which 65 were implemented. Among the prescriptions, 75% (n = 45) adhered to the South African Standard Treatment guidelines, 76% (n = 46) adhered to the NICE guidelines, and 71% (n = 43) adhered to the APA guidelines. Conclusions: Clinical pharmacists identified a number of medication-related problems in patients with psychotic and bipolar disorders, and their proposed interventions were largely accepted. The findings highlight the pharmacist’s role in optimising medication therapy and adherence to guidelines, suggesting that improved treatment monitoring is necessary in this setting. Full article

Background: Within 10 years of diagnosis, about 50% of patients with Crohn’s disease (CD) require surgery. Repeated small bowel resections can lead to the development of short bowel syndrome (SBS). It is estimated that 65–75% of CD patients are malnourished. This retrospective observational study was conducted in a Polish reference centre for home parenteral nutrition (HPN). The aim of the study was to investigate the nutritional status and characteristics of patients with CD referred to HPN and to analyse the course of their HPN treatment. Methods: The study group consisted of all adult patients (N = 46) with CD who qualified for HPN between November 2004 and April 2022. Results: The most common indication for HPN was SBS (n = 27; 58.70%), followed by ineffective gastrointestinal nutrition causing progressive malnutrition (N = 9; 19.57%), fistulas (N = 6; 13.04%), and short bowel syndrome and fistulas (N = 4; 8.70%). According to the results of Subjective Global Assessment (SGA), 47.83% (N = 22) of patients were diagnosed with severe malnutrition, followed by 15 patients (32.61%) with moderate malnutrition. Global Leadership Initiative on Malnutrition (GLIM) criteria showed that 71.73% (n = 33) of patients were malnourished on admission to the HPN centre. All patients received parenteral formulas based on individually tailored prescriptions. The results showed that patients with a stoma received statistically significantly higher PN volumes (p = 0.027) and higher amounts of amino acids (p = 0.046) and fat emulsion (p = 0.046). Septic complications were twice as common as mechanical or metabolic complications, although 43.47% of patients had no complications. At the time of data analysis, 19 patients (41.30%) had been successfully weaned from HPN, of whom 12 (26%) achieved nutritional autonomy after 136–1419 days (mean: 560 ± 380.9). Conclusions: Malnutrition is a major problem in CD patients, especially those with SBS. Early nutritional intervention and consideration of artificial nutrition in this study group (HPN) are necessary to prevent the long-term consequences of severe malnutrition. To our knowledge, this was the first study to report on Crohn’s patients referred to long-term HPN. Further studies are needed to assess the impact of HPN on functional, laboratory, and anthropometric outcomes with a view to optimising treatment outcomes. Full article

Introduction: The COVID-19 pandemic has disrupted antibiotic use; easing public health measures may alter infection presentations and antibiotic prescribing in primary care. The study investigated post-pandemic antibiotic utilisation trends in primary care. Methods: A multi-centre, retrospective cohort study was conducted across seven public primary care clinics in Western Singapore, which included all patients prescribed oral antibiotics between 2022 and 2023. Descriptive statistics were used to visualise the prevalence and conditions of the prescribed antibiotics. Antibiotic quality was evaluated using the WHO’s AWaRe (access, watch, reserve) classification. Antibiotic use was quantified using the number of items dispensed per 1000 inhabitants (NTI), defined daily doses (DDD) per 1000 inhabitants per day (DID), and DDD per 100 visits. Segmented regression analysis was applied to monthly prescriptions to assess the utilisation trends. Results: Antibiotic prescription rates increased significantly, from 3.5% in 2022 to 4.0% in 2023 (p = 0.001), with a 9.5% relative increase (38,920 prescriptions for 1,112,574 visits to 42,613 prescriptions for 1,063,646 visits). Respiratory conditions drove the increase in antibiotics use, with a 68.3% rise in prescriptions, with upper respiratory tract infections being the most common diagnosis for antibiotic prescriptions (n = 9296 prescriptions in 2023), with a steady monthly upward trend. Access group antibiotics accounted for >90% of prescriptions. The most antibiotics were prescribed for acne, with 36,304 DDD per 100 visits in 2023. Both NTI and DID significantly increased in 2022, largely contributed by a >100% increase in Watch group antibiotic use. Total antibiotic NTI dipped slightly in 2023, with a stable trend in both NTI and DID for all antibiotics. Conclusions: The post-COVID-19 pandemic surge in the antibiotic prescription rate for respiratory conditions and Watch group antibiotic use highlight the need for targeted stewardship interventions. Optimising acne treatment and diagnosis coding are key strategies to further reduce unnecessary prescriptions. Full article

This systematic review investigated how Higher Education Institutions (HEIs) optimise data analytics in postgraduate programmes to enhance student achievement. Existing research explores the theoretical benefits of data analytics but lacks practical guidance on strategies to effectively implement and utilise data analytics for student success. As such, this review aimed to identify data analytics approaches used by HEIs and explore challenges and best practices in their application. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Five databases were searched. Studies that examined data analytics in HEIs postgraduate programmes and their impact on student learning were included. Studies that were solely theoretical or in non-postgraduate settings were excluded. Twenty-six studies were included. Quality assessment using the Critical Appraisal Skills Programme (CASP) Checklist was employed. The review identified various data analytics approaches including descriptive, predictive, and prescriptive analytics, among others. These approaches can improve foundational skills, create supportive learning environments, and optimise teaching strategies. However, limitations (standardised tests, data integration) and privacy concerns were acknowledged. Recommendations include developing a comprehensive evaluation system, equipping educators with the skills to utilise diverse analytics to enhance student achievement, fostering open communication about data use, and cultivating a data-literate student body. While diverse approaches were explored, the review’s lack of specific contextual details may limit the generalisability of findings. To mitigate this, the review categorised techniques and provided references for further exploration. Full article

Fungal infections are increasingly prevalent; however, antifungal stewardship attracts little funding or attention. Previous studies have shown that knowledge of guidelines and scientific evidence regarding antifungals is poor, leading to prescribing based on personal experiences and the inherent biases this entails. We carried out a retrospective study of inpatient antifungal usage at two major hospitals. We assessed the longitudinal trends in antifungal usage and the effect of COVID-19 on antifungal prescription, alongside levels of empirical and diagnostically targeted antifungal usage. Our results showed that the longitudinal patterns of total systemic antifungal usage within the trusts were similar to national prescribing trends; however, the composition of antifungals varied considerably, even when looking exclusively at the more homogenous group of COVID-19 patients. We showed a high level of empirical antifungal use in COVID-19 patients, with neither trust adhering to international recommendations and instead appearing to follow prior prescribing habits. This study highlights the significant challenges to optimise antifungal use with prescribing behaviour largely dictated by habit, a lack of adherence to guidelines, and high rates of empirical non-diagnostic-based prescribing. Further research and resources are required to understand the impact of antifungal stewardship on improving antifungal prescribing behaviours in this setting and the effects on outcome. Full article

To accurately study human organ function and disease ‘in the dish’, it is necessary to develop reliable cell-based models that closely track human physiology. Our interest lay with the liver, which is the largest solid organ in the body. The liver is a multifunctional and highly regenerative organ; however, severe liver damage can have dire consequences for human health. A common cause of liver damage is adverse reactions to prescription drugs. Therefore, the development of predictive liver models that capture human drug metabolism patterns is required to optimise the drug development process. In our study, we aimed to identify compounds that could improve the metabolic function of stem cell-derived liver tissue. Therefore, we screened a compound library to identify additives that improved the maturity of in vitro-engineered human tissue, with the rationale that by taking such an approach, we would be able to fine-tune neonatal and adult cytochrome P450 metabolic function in stem cell-derived liver tissue. Full article

Maximising the potential benefit of resistance exercise (RE) programs by ensuring optimal recovery is an important aim of exercise prescription. Despite this, research surrounding recovery from RE in older adults is limited and inconsistent. The following randomised controlled trial was designed to investigate the efficacy of milk consumption for improving recovery from RE in older adults. However, the study encountered various challenges that may be applicable to similar studies. These include recruitment issues, a lack of measurable perturbations in muscle function following RE, and potential learning effects amongst participants. Various considerations for exercise research have arisen from the data which could inform the design of future studies in this area. These include (i) recruitment—consider ways in which the study design could be altered to aid recruitment or allow a longer recruitment period; (ii) learning effects and familiarisation—consider potential learning effects of outcome measures and adjust familiarisation accordingly; (iii) identify, validate and optimise protocols for outcome measures that are applicable for the specific population; (iv) adjust the exercise protocol according to the specific aims of the study (e.g., are you replicating a usual exercise bout or is the intent to cause large amounts of muscle damage?). Full article

In phenylketonuria (PKU), natural protein intake is thought to increase with age, particularly during childhood and adolescence. Longitudinal dietary intake data are scarce and lifelong phenylalanine tolerance remains unknown. Nine centres managing PKU in Europe and Turkey participated in a retrospective study. Data were collected from dietetic records between 2012 and 2018 on phenylalanine (Phe), natural protein, and protein substitute intake. A total of 1323 patients (age range: 1–57 y; 51% male) participated. Dietary intake data were available on 1163 (88%) patients. Patient numbers ranged from 59 to 320 in each centre. A total of 625 (47%) had classical PKU (cPKU), n = 357 (27%) had mild PKU (mPKU), n = 325 (25%) had hyperphenylalaninemia (HPA), and n = 16 (1%) were unknown. The mean percentage of blood Phe levels within target ranged from 65 ± 54% to 88 ± 49%. When intake was expressed as g/day, the mean Phe/natural protein and protein equivalent from protein substitute gradually increased during childhood, reaching a peak in adolescence, and then remained consistent during adulthood. When intake was expressed per kg body weight (g/kg/day), there was a decline in Phe/natural protein, protein equivalent from protein substitute, and total protein with increasing age. Overall, the mean daily intake (kg/day) was as follows: Phe, 904 mg ± 761 (22 ± 23 mg/kg/day), natural protein 19 g ± 16 (0.5 g/kg/day ± 0.5), protein equivalent from protein substitute 39 g ± 22 (1.1 g/kg/day ± 0.6), and total protein 59 g ± 21 (1.7 g/kg/day ± 0.6). Natural protein tolerance was similar between males and females. Patients with mPKU tolerated around 50% less Phe/natural protein than HPA, but 50% more than cPKU. Higher intakes of natural protein were observed in Southern Europe, with a higher prevalence of HPA and mPKU compared with patients from Northern European centres. Natural protein intake doubled with sapropterin usage. In sapropterin-responsive patients, 31% no longer used protein substitutes. Close monitoring and optimisation of protein intake prescriptions are needed, along with future guidelines specifically for different age groups and severities. Full article

Background: Anticoagulation therapy plays a crucial role in the management of atrial fibrillation (AF) by significantly reducing the risk of stroke. Direct oral anticoagulants (DOAC) became preferred over warfarin due to their superior safety and efficacy profile. Assessing adherence to anticoagulation therapy is necessary in clinical practice for optimising patient outcomes and treatment efficacy, thus emphasising its significance. Methods: A retrospective study utilised the Latvian National Health Service reimbursement prescriptions database, covering prescriptions for AF and flutter from January 2012 to December 2022. The proportion of days covered method was selected for adherence assessment, categorising it into three groups: (1) below 80%, (2) between 80% and 90%, and (3) above 90%. Results: A total of 1,646,648 prescriptions were analysed. Dabigatran prescriptions started declining after 2020, coinciding with a decrease in warfarin prescriptions since 2018. The total adherence levels to DOAC therapy were 69.4%. Only 44.2% of users achieved an adherence level exceeding 80%. The rate of paper prescriptions decreased from 98.5% in 2017 to 1.3% in 2022. Additionally, the utilisation of international non-proprietary names reached 79.7% in 2022. Specifically, 16.7% of patients selected a single pharmacy, whereas 27.7% visited one or two pharmacies. Meanwhile, other patients obtained medicines from multiple pharmacies. Conclusions: The total adherence level to DOAC therapy is evaluated as low and there was no significant difference in age, gender, or “switcher” status among adherence groups. Physicians’ prescribing habits have changed over a decade. Full article