Guideline Compliance Research Articles

The 20-Year Trend of Obesity and Recreational Screen Time Among Children Receiving Special Education Services

ABSTRACT This study examined obesity and recreational screen time trends in children receiving special education services from 1999 to 2018. We analysed data from 2565 children aged 5–17 years from the United States National Health and Nutrition Examination Surveys (NHANES). Their body mass index (BMI) and recreational screen time were analysed using ordinal and logistic regressions. The obesity prevalence (aOR = 1.043, 95% CI [1.006, 1.082]) and rate of recreational screen time guideline compliance (less than 2 hours [reference]; aOR = 1.082, 95% CI [1.041, 1.124]) in these children showed a small but significantly increasing trend during the two decades, respectively. This group of children also showed disparities in weight status, where growing trends were found in male, non-White, and 12–17 years old children. Children who did not meet the recreational screen time guideline were more likely to be obese compared to be in a healthy weight condition (aOR = 1.353, 95% CI [1.054, 1.736]). The findings point out the substantial need for sustainable and effective actions to reduce obesity and recreational screen time among children receiving special education services.

Perceived Barriers to Leisure-time Physical Activity among Physically Active Individuals with Spinal Cord Injury

ObjectiveTo investigate barriers to leisure-time physical activity (LTPA) for physically active people with spinal cord injury (SCI). DesignProspective cross-sectional. SettingGeneral community. ParticipantsOne hundred and five physically active individuals with SCI. InterventionsSemi-structured interviews and surveys. Main Outcome MeasureParticipants were surveyed and interviewed to determine barriers and determinants of LTPA participation. SCI-specific physical activity (PA) guideline adherence was documented. Barriers were categorised using the Capability, Opportunity, Motivation and Behaviour model, and regression statistics were used to determine relationships between LTPA volume and barriers. ResultsHealth problems, costs of equipment and programs, pain, and a lack of energy were the most common Capability barriers, whilst a lack of accessible facilities, confidence in the knowledge and skill of a health professional, and a lack of time were common Opportunity barriers. Motivation barriers pertained to self-consciousness in a fitness centre and a lack of interest. Believing LTPA to be too difficult, uninteresting, and unable to improve health emerged as significant barriers to SCI-specific PA guideline adherence. ConclusionSCI-specific PA guideline adherence was below 50% in physically active individuals. There are still numerous Capability and Opportunity barriers that physically active people with SCI must overcome when engaging in LTPA. Motivational barriers such as feeling self-conscious in a fitness centre significantly influence PA guideline compliance in this population. Service providers should emphasise the benefit of LTPA to people with SCI while providing LTPA options that facilitate enjoyment, interest, and inclusivity, particularly for those who do not meet PA guideline recommendations.

Evaluating Usability and Accessibility of Visual Programming Tools for Novice Programmers—The Case of App Inventor, Scratch, and StarLogo

The current state of the labor market requires modern engineers to acquire programming skills at different levels of advancement and to apply them in multidisciplinary environments. Not all modern engineers will become fully fledged programmers, but sometimes the possibility to use low-code programming environments like LabView or MIT App Inventor will be sufficient. In order to give good foundations for adulthood, schools use elements of visual programming, e.g., Scratch or StarLogo, to enhance the critical and algorithmic thinking of future engineers. This article attempts to answer the question of whether anyone cares about following general accessibility and usability guidelines in the case of solutions like Scratch, App Inventor, and StarLogo. Another goal is to show a set of tools that is successful in such an assessment. The authors used Nielsen’s heuristics, followed by analyzing WAVE output and Web Content Accessibility Guidelines compliance. Especially, the last one provides insights usually omitted when evaluating low-code environments. It was found that Scratch and App Inventor are leading solutions in terms of look and feel, functionality, documentation, interface navigation, and memorization. The StarLogo interface, on the other hand, is less friendly in terms of aesthetics and functionality.

Evaluation of Covid-19 risk perception and psychological status of transplant patients

Abstract Background Liver transplant patients are in the more at-risk group in terms of COVID-19 infection and mortality due to both immunosuppressive treatment and underlying chronic diseases. The aim of this study was to evaluate the COVID-19 risk perception, compliance with preventive measures, and psychosocial status of liver transplant patients. Methods This descriptive cross-sectional survey study included 311 patients who underwent liver transplantation between 2002 -2021 and presented to the outpatient clinic for routine controls. Data were collected via a questionnaire administered through face-to-face interviews. The questionnaire form used to collect the data of the study included a demographic and clinical characteristics form, the Short Depression-Happiness Scale, the COVID-19 Prevention Guidelines Compliance Scale, and the COVID-19 Risk Perception Scale. The Mann-Whitney U, the Kruskal-Wallis test and Spearman’s Rho correlation analysis were used in statistical analyses. Results The median age of the transplant patients who participated in the study was 56 (18-76) years. Of the transplant patients, 84.9% stated that they had COVID-19 vaccination. There was a statistically significant, very weak relationship between the scores of the Brief Depression-Happiness Scale and the COVID-19 Compliance with Preventive Measures Scale (r = 0.132; p = 0.02), and a weak, significant relationship in the same direction between the scores of the COVID-19 Compliance with Preventive Measures Scale and the COVID-19 Risk Perception Scale (r = 0.344; p = 0.001). Conclusions The vaccination rates of the patients were high. As the depression status of the patients decreases, their compliance with preventive measures increases, and as their compliance with preventive measures increases, their risk perception increases. Key messages • Since transplant patients are a vulnerable group, their vaccination status is important in terms of mortality risk. • Psychological factors such as depression-happiness scores influence adherence to COVID-19 preventive measures among transplant patients.

Relations Between Social-demographic Factors And 24-hour Movement Behavior Guideline Compliance In Preschool Children

Relations Between Social-demographic Factors And 24-hour Movement Behavior Guideline Compliance In Preschool Children

Socio-demographic Modifiers In Relations Between 24-hour Behavior Guideline Compliance And Receptive Vocabulary In Preschool Children

Socio-demographic Modifiers In Relations Between 24-hour Behavior Guideline Compliance And Receptive Vocabulary In Preschool Children

Hip Fracture Management in a Major Trauma Centre: The Impact of 'Smart Phrase' Integration Into Electronic Clerking on Culture and Adherence to Guidelines.

The National Institute for Health and Care Excellence (NICE) introduced guidelines in 2011 for the management of hip fractures in patients over the age of 65. NICE CG124 recommended different procedures depending on the demographics of the patient and fracture pattern. In terms of compliance in 2019, Addenbrooke's Hospital (ADH) was found to be in line with the national average, although room for improvement was noted. The aim of this study was to identify and address areas of substantial non-compliance at ADH. A total of 1636 patients who sustained a hip fracture between 2017 and 2020 and who subsequently underwent surgery at ADH were retrospectively analysed. We collected data from the National Hip Fracture Database (NHFD), digital medical records, and digital imaging systems. We then amended the clerking proforma by adding a 'smart phrase' and re-analysed another 543 patients who attended ADH following hip fracture between 2021 and 2022, using the same data collection methods. From 2017-2020, total adherence to CG124, Section 1.6, was 76.04%. Our results demonstrated that 56.43% of all hip fracture patients indicated for total hip arthroplasty (THA) did not have documented consideration for the procedure. In 2021-22, following the addition of our 'smart phrase,' we made to the clerking proforma, total adherence improved to 87.43%, with only 42.11% of THA-indicated patients lacking documented consideration of the procedure, down from 65.41% in 2020. The use of our smart phrase decreased during the follow-up without a corresponding drop in compliance. In January 2023, NICE CG124 underwent changes, rendering our ADH changes outdated. However, we have demonstrated that we can increase NICE guideline compliance by standardising and encouraging formal documentation of the decision-making process. As electronic patient record (EPR) systems become more widespread, we have shown how 'smart phrases' can be used to generate change and increase compliance, even over a short period of time.

Cost-effectiveness of a novel AI technology to quantify coronary inflammation and cardiovascular risk in patients undergoing routine Coronary Computed Tomography Angiography.

Coronary Computed Tomography Angiography (CCTA) is a first line investigation for chest pain in patients with suspected obstructive coronary artery disease (CAD). However, many acute cardiac events occur in the absence of obstructive CAD. We assessed the lifetime cost-effectiveness of integrating a novel artificial intelligence-enhanced image analysis algorithm (AI-Risk) that stratifies the risk of cardiac events by quantifying coronary inflammation, combined with the extent of coronary artery plaque and clinical risk factors, by analysing images from routine CCTA. A hybrid decision-tree with population cohort Markov model was developed from 3,393 consecutive patients who underwent routine CCTA for suspected obstructive CAD and followed up for major adverse cardiac events over a median(IQR) of 7.7(6.4-9.1) years. In a prospective real-world evaluation survey of 744 consecutive patients undergoing CCTA for chest pain investigation, the availability of AI-Risk assessment led to treatment initiation or intensification in 45% of patients. In a further prospective study of 1,214 consecutive patients with extensive guideline recommended cardiovascular risk profiling, AI-Risk stratification led to treatment initiation or intensification in 39% of patients beyond the current clinical guideline recommendations. Treatment guided by AI-Risk modelled over a lifetime horizon could lead to fewer cardiac events (relative reductions of 4%, 4%, 11%, and 12% for myocardial infarction, ischaemic stroke, heart failure and cardiac death, respectively). Implementing AI-Risk classification in routine interpretation of CCTA is highly likely to be cost-effective (Incremental cost-effectiveness ratio £1,371-3,244), both in scenarios of current guideline compliance or when applied only to patients without obstructive CAD. Compared with standard care, the addition of AI-Risk assessment in routine CCTA interpretation is cost effective, by refining risk guided medical management.

A comparative analysis of 24-hour movement behaviors features using different accelerometer metrics in adults: Implications for guideline compliance and associations with cardiometabolic health.

Movement behavior features such as time use estimates, average acceleration and intensity gradient are crucial in understanding associations with cardiometabolic health. The aim of this study was to 1) compare movement behavior features processed by commonly used accelerometer metrics among adults (i.e. Euclidian Norm Minus One (ENMO), Mean Amplitude Deviation (MAD) and counts per minute (CPM)), 2) investigate the impact of accelerometer metrics on compliance with movement behavior guidelines, and 3) explore potential variations in the association between movement behavior features and cardiometabolic variables depending on the chosen metric. This cross-sectional study collected movement behavior features (Actigraph GT3X+) and cardiometabolic variables. Accelerometer data were analyzed by four metrics, i.e. ENMO, MAD, and CPM vertical axis and CPM vector magnitude (GGIR). Intraclass correlations and Bland‒Altman plots identified metric differences for time use in single movement behaviors (physical activity, sedentary behavior), average acceleration and intensity gradient. Regression models across the four metrics were used to explore differences in 24-hour movement behaviors (24h-MBs; compositional variable) as for exploration of associations with cardiometabolic variables. Movement behavior data from 213 Belgian adults (mean age 45.8±10.8 years, 68.5% female) differed according to the metric used, with ENMO representing the most sedentary movement behavior profile and CPM vector magnitude representing the most active profile. Compliance rates for meeting integrated 24h-MBs guidelines varied from 0-25% depending on the metric used. Furthermore, the strength and direction of associations between movement behavior features and cardiometabolic variables (body mass index, waist circumference, fat% and HbA1c) differed by the choice of metric. The metric used during data processing markedly influenced cut-point dependent time use estimates and cut-point independent average acceleration and intensity gradient, impacting guideline compliance and associations with cardiometabolic variables. Consideration is necessary when comparing findings from accelerometry studies to inform public health guidelines.

Quality Indicators of Antimicrobials Prescribing in Iraq: A Scoping Review

Background: Antimicrobial overconsumption is a global public health concern, particularly in the Middle East, where illnesses and antibiotic use are on the increase. Antimicrobial resistance is associated with excessive usage. As a Middle Eastern country, Iraq provides a suitable baseline for situating it amid its neighbors. We use quality indicators to reliably identify bad practice and recommend updated antibiotic prescribing guidelines for hospitalized patients. Objectives: To compare antimicrobial prescribing quality metrics in Iraqi hospitals to those in Middle Eastern nations. Methods: We conducted a point prevalence survey to assess the inappropriateness of antibiotic usage in the Middle East after evaluating literature from sources such as Scopus, Web of Science, PubMed, and EBSCO. To examine the Iraqi scenario, we used four primary quality indicators: guidelines compliance, stop/review note documentation, parenteral administration, and the selection of specific antibios. According to the study, Iraq's guideline availability ranged from 0% to 7%, which was lower than Jordan's optimum of 95.8%. Results: The rate of stop/review documentation was approximately 0.4%, which was lower than the maximum rate of 72% in the UAE; and only 1.2% of prescriptions were targeted antibiotics, which was higher than Iran's 0%. Regarding parenteral antibiotics, Iraq reported that 89.9% of the antibiotics used were injectable, which is consistent with most comparable nations (74%-100%). Conclusions: In Iraqi hospitals, antimicrobials are used inappropriately. An immediate effort is necessary to update national records, with ongoing follow-up by regular prevalence surveys.

Assessing compliance with national guidelines in diabetes care: A study leveraging data from south Africa's National Health Laboratory Service (NHLS).

Diabetes is a major global health issue. We evaluated compliance to laboratory-based management guidelines for diabetes (type 1 and 2), essential for effective treatment and reducing diabetes-related morbidity and mortality. Our study utilized South Africa's National Health Laboratory Services (NHLS) data, focusing on patients from birth to age 80 years who underwent initial diabetes laboratory testing between January 1, 2012-January 1, 2016. Patients were categorized into type 1 (<30 years) or type 2 (≥30-80 years) diabetes based on age at first diabetes test. National diabetes guidelines recommend blood glucose to be checked every three-six months post laboratory-diagnosis. We employed a sharp regression discontinuity design to estimate the effect of a laboratory-diagnosis of diabetes on the likelihood of having a follow-up laboratory test 24 months post-diagnosis. Among patients with type 2 diabetes, the probability of a diabetes follow-up laboratory test within 24 months was 52.4% for patients presenting above the diabetes diagnosis threshold vs 31.1% for those presenting below. Although the likelihood of repeat testing rose with higher HbA1c and glucose levels, at the diagnostic threshold there was no clinically meaningful difference (risk difference: -2.2%, 95% CI: -3.3%, -1.2%). These results were consistent among patients with type 1 diabetes, those living with and without HIV, and healthcare setting. In a national laboratory cohort, diabetes laboratory-diagnosis did not lead to increased monitoring as recommended in national guidelines. Strategies to improve patient education, healthcare provider communication, and healthcare system support are essential to enhance guideline compliance and overall diabetes management.

The Pattern of Practice in the Management of Early Diabetic Kidney Disease.

Background and objectives Diabetes is a leading cause of kidney failure in various regions worldwide. To detect renal disease in individuals with diabetes, screening typically involves evaluating the glomerular filtration rate and measuring albuminuria. Although there are established guidelines for these screenings, adherence to them varies. This study aims to examine the prevalence of albuminuria screening among adults with diabetes mellitus (DM) and to assess the different practices in managing these patients across primary and tertiary care settings. Methods This cross-sectional observational study involved adult patients with DM attending outpatient clinics in both primary and tertiary care settings. Patient data were gathered using a standardized form, excluding those with established chronic kidney disease (CKD) who were under nephrology care. Results The study included 1,010 patients, with 303 (30%) from primary care clinics and 707 (70%) from tertiary care clinics. The cohort comprised 582 (58%) females, with a median age of 62 years (IQR: 55-70), and approximately 990 (98%) had type 2 DM (T2DM). Annual albumin-to-creatinine ratio (ACR) screening was conducted for 498 out of 1,010 patients (49%) (95% confidence interval {CI}: 46%-52%). Screening compliance was notably higher in primary care settings compared to tertiary care clinics. Older patients (over 60 years) and those with hypertension or cardiac conditions were less likely to undergo screening. Among those screened, 185 of 498 patients (37%) (95% CI: 33%-41%) had abnormal albuminuria (ACR > 3). Conclusion Albuminuria is a significant indicator of progressing renal disease and cardiovascular risk. The annual screening rate for albuminuria in diabetic patients is inadequate. Primary care physicians show better adherence to screening guidelines compared to their tertiary care counterparts. Increasing physician awareness about the importance of screening could improve guideline compliance and mitigate the adverse effects of albuminuria.

Practical estimation and use of natural background concentrations in surface waters for nickel in Europe.

Estimates of ambient background concentrations in surface waters, referred to as natural background concentrations (NBCs) in European guidance documents, may be an important factor in determining whether a monitoring site meets the legally binding Environmental Quality Standard (EQS) when assessing naturally occurring substances. Here, we focus on utilizing routine regulatory surface water monitoring data to provide risk assessors and environmental practitioners with a transparent, implementable, repeatable, and resource-effective approach to estimate NBCs. The methodology does not use additional environmental sampling beyond that which is routine or require advanced statistical methods, or the incorporation of highly specialist, and not always readily accessible, local knowledge. It determines both whether a site is suitable for NBC assessment as well as the identification of suitable surrogate sites and local NBCs using 11 criteria: six for identifying if a site is suitable for NBC correction, and five for identifying suitable surrogate sites for local NBC values. The criteria consider both the extent of any EQS exceedance, after accounting for bioavailability in line with the European guidance and potential anthropogenic impacts at the site, and can be applied in a simple sequential procedure. The method has been applied to derive NBCs for nickel on three case-study countries-Cyprus, France, and Spain-to determine its useability and impact on compliance. The methodology presented addresses a gap in the current guidance regarding the practical and consistent implementation of NBCs and could be applied to other naturally occurring substances in an EQS or Water Quality Guideline compliance assessment process. Integr Environ Assess Manag 2024;00:1-14. © 2024 WCA Environment Ltd and NiPERA Inc. Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

Antibiotic prescribing practices and antibiotic use quality indicators in Luang Prabang, Lao PDR: a point prevalence survey in a tertiary care hospital

ContextThe increase and global dissemination of antibiotic resistance limit the use of antibiotics to prevent and treat infections. Implementing antibiotic stewardship programs guided by local data on prescription profiles is a useful strategy to reduce the burden of antibiotic resistance. The aim was to determine the prevalence of antibiotic use and guideline compliance at Luang Prabang provincial hospital, Lao PDR.MethodsA point prevalence survey of antibiotics was conducted among hospitalized patients admitted to Luang Prabang hospital (204 beds) in Lao PDR on May 25, 2023. All patients presenting at 8:00 AM were eligible. Sociodemographic data, indications for antibiotic use, and antibiotic prescriptions were collected from medical records using a paper-based questionnaire and entered into an electronic platform following WHO methodology. The prevalence of antibiotic use was determined.ResultsOut of the 102 patients included, 60(58.8%) were undergoing antibiotic treatment, of which 33(55.0%) received combination therapy, and 7(10.5%) had two indications for antibiotic use. The highest prevalence was in the surgical ward (14/15, 93%) followed by general paediatrics (18/27, 67%). Out of the 100 antibiotic prescriptions, 47(47%) were for community-acquired infections, 26(26%) for surgical prophylaxis, 13(13%) for hospital-acquired infections and 5(5%) for medical prophylaxis. Twenty(20%) antibiotics were prescribed for obstetrics and gynaecology prophylaxis, 17(17%) for intra-abdominal infections, and 10(10.0%) for pneumonia treatment as well as bone, and joint infections. The main antibiotics prescribed were ceftriaxone 36(34.6%), metronidazole 18(17.3%), ampicillin 8(7.7%), and gentamicin 8(7.7%). Only 2(3%) samples were sent to the laboratory, one of which showed a positive culture for Escherichia coli Extended Spectrum β-Lactamase. According to the WHO Access Watch and Reserve classification, 55(52.9%) molecules belonged to the Access category, 47(49.1%) to the Watch category, and none to the Reserve category. Only 14.9% of antibiotic prescriptions were fully compliant with current guidelines.ConclusionThis study indicated a significant prevalence of antibiotic use and a very low compliance with guidelines at Luang Prabang provincial hospital, Lao PDR. This highlights an urgent need for comprehensive strategies at all levels to optimize antibiotic use in hospitals, emphasizing diagnostic improvements, and continued research to address the factors driving this excessive antibiotic usage and improve adherence to guidelines.

Reducing Failed Extubations in Preterm Infants Via Standardization and Real-Time Decision Support.

Failed extubations are associated with pulmonary morbidity in hospitalized premature newborns. The objective of this study was to use quality improvement methodology to reduce failed extubations through practice standardization and integrating a real-time extubation success calculator into the electronic medical record (EMR). A specific, measurable, achievable, relevant, and time-bound aim was developed to reduce failed extubations (defined as reintubation <5 days from primary extubation) by 50% among infants <32 weeks' gestational age (GA) or <1500 g birth weight by December 31, 2022. Plan-do-study-act cycles were developed to standardize postextubation respiratory support and integrate the EMR-based calculator. Outcome measures included extubation failure rates. Balancing measures included days on mechanical ventilation and number of patients intubated <3 days. Process measures were followed for guideline compliance. Statistical process control charts were used to track time-ordered data and detect special cause variation. We observed a reduction in failed extubations from 10.3% to 2.3%, with special cause variation noted after both plan-do-study-act cycle #1 and #2. Special cause variation was detected in both GA subgroups: <28 weeks' GA (22.0%-8.6%) and ≥28 weeks' GA (4.6%-0.3%). Additionally, the average number of infants intubated <3 days increased (60.2%-73.6%), whereas average ventilator days decreased (10.8-7.0). Finally, the time from infants' extubation score reaching threshold (≥60%) to extubation decreased (14.1-6.4 days) after launching the EMR-integrated calculator. Practice standardization and implementation of an EMR-based real-time clinical decision support tool improved extubation success, promoted earlier extubation, and reduced ventilator days in premature newborns.

Gonorrhoea treatment guideline compliance and influence factors in Guangdong province, China: a cross-sectional survey

BackgroundThe indiscriminate use of antibiotics has accelerated antimicrobial resistance (AMR) in Neisseria gonorrhoeae (NG), emphasising the need to follow treatment guidelines. This study aimed to assess the rate of adherence...

The quality of antimicrobial prescribing in skin and soft tissue management in Australian hospitals: an analysis of the National Antimicrobial Prescribing Survey data

Skin and soft tissue infections (SSTIs) are among the most common indications for antimicrobial prescribing in hospitals. Inappropriate antimicrobial use can lead to increased morbidity, unnecessary hospital re-admission and increased antimicrobial resistance. This study aimed to assess the quality of antimicrobial prescribing practices in SSTI management within Australian hospitals to provide guidance for future practice. A retrospective analysis was conducted with data from the National Antimicrobial Prescribing Survey (NAPS). SSTI prescribing data from Hospital NAPS (2013-2022) and surgical site infection data from Surgical NAPS (2016-2022) datasets were analysed. Variables assessed included guideline compliance, appropriateness as per the structured NAPS algorithm, and reasons for inappropriateness. From the Hospital NAPS dataset, 40,535 antimicrobial prescriptions for SSTIs were analysed. The most common indication was cellulitis (34.1%, N=13,822), and the most prescribed antimicrobial was flucloxacillin (18.8%, N=7,638). SSTI indications had a lower rate of guideline compliance but a higher rate of appropriateness compared with all other indications for antimicrobial prescriptions (guideline compliance 66.3%, N=21,035 vs 67.4%, N=156,285; appropriateness 75.6%, N=30,639 vs 72.7%, N=209,383). The most common reason for inappropriateness was incorrect dose or frequency (29.3%, N=2367). From the Surgical NAPS dataset, 5674 prescriptions for surgical site infections were analysed. Of these, 68.2% (N=3867) were deemed to be appropriate. The most common reason for inappropriateness was incorrect dose or frequency (27.7%, N=350). As SSTIs are a common indication for prescribing an antimicrobial in Australian hospitals, identifying effective antimicrobial stewardship strategies to optimize antimicrobial use for SSTI management is recommended to improve patient outcomes.

Artificial intelligence and clinical guidance in male reproductive health: ChatGPT4.0's AUA/ASRM guideline compliance evaluation.

Male infertility is defined as the inability of a male to achieve a pregnancy in a fertile female by the American Urological Association (AUA) and the American Society for Reproductive Medicine (ASRM). Artificial intelligence, particularly in language processing models like ChatGPT4.0, offers new possibilities for supporting clinical decision-making. This study aims to assess the effectiveness of ChatGPT4.0 in responding to clinical queries regarding male infertility, which is aligned with AUA/ASRM guidelines. This observational study employed a design to evaluate the performance of ChatGPT4.0 across 1073 structured clinical queries categorized into true/false, multiple-choice, and open-ended. Two independent reviewers specializing in reproductive medicine assessed the responses using a six-point Likert scale to evaluate accuracy, relevance, and guideline adherence. In the true/false category, the initial accuracy was 92%, which increased to 94% by the end of the study period. For multiple-choice questions, accuracy improved from 85% to 89%. The most significant gains were seen in open-ended questions, where accuracy rose from 78% to 86%. Initially, some responses did not fully align with the AUA/ASRM guidelines. However, by the end of the 60 days, these responses had become more comprehensive and clinically relevant, indicating an improvement in the model's ability to generate guideline-conformant answers (p<0.05). The depth and accuracy of responses for higher difficulty questions also showed enhancement (p<0.01). ChatGPT4.0 can serve as a valuable support tool in managing male infertility, providing reliable, guideline-based information that enhances the accuracy of clinical decision-making tools and supports patient education.

Appropriateness of antimicrobial prescribing for oral and dental conditions in Australian hospitals: 2013 to 2022

ObjectivesDentists manage a variety of oral infections in clinical practice. Inappropriate antimicrobial prescribing by dentists occurs frequently and antimicrobial stewardship strategies should include dentistry. The aim of this retrospective analysis of the Australian Hospital National Antimicrobial Prescribing Survey (Hospital NAPS) dataset, was to describe the types of oral and dental indications where antimicrobials were prescribed, and assess the guideline compliance and appropriateness of the antimicrobials in Australian hospitals. MethodsData from the Hospital NAPS was extracted for oral and dental indications from 2013 to 2022. The types of oral and dental indications presented, and the corresponding antimicrobials prescribed were assessed for compliance according to national prescribing guidelines, and appropriateness according to the NAPS structured algorithm. ResultsA total of 8,001 prescriptions for 7,477 patients were identified, from 433 hospitals. Antifungal, antibiotic and antiviral agents accounted for 84.5 %, 15.4 % and 0.03 % of prescriptions respectively. A greater proportion of antibiotics were prescribed in regional and rural areas compared to antifungals. The prescriptions assessed as compliant were 80.0 % and 44.7 % of antifungals and antibiotics respectively. Prescriptions assessed as appropriate were 84.4 % of antifungals, and 65.3 % of antibiotic prescriptions. ConclusionsA wide variety of antimicrobials were used with moderate levels of compliance and appropriateness. Future interventions should include targeted education, utilisation of prescribing guidelines, and tools to diagnose and manage oral and dental conditions. Consideration can be given to adjustment of the Hospital NAPS tool to cater for oral conditions and include the provision of dental treatment in the management of these infections. Clinical significanceA wide variety of oral and dental conditions are presented in Australian hospital settings, managed by a range of antibiotics and antifungals, with moderate levels of compliance to guidelines and appropriateness. Antimicrobial stewardship strategies should target and support dentistry in hospital settings.

Intravenous amoxicillin‐clavulanic acid: prescribing practices in Australian hospitals

AbstractBackgroundOral amoxicillin‐clavulanic acid, a broad‐spectrum antimicrobial and one of the most commonly prescribed antimicrobials in Australia, has demonstrated poor prescribing guideline compliance and appropriateness. This may have inadvertent impacts on patient care and safety, from adverse drug reactions to antimicrobial resistance. Intravenous (IV) amoxicillin‐clavulanic acid was first registered in Australia in 2017, reflecting a subsequent and immediate increase in use. There is a need to assess the quality of such prescribing.AimTo describe the quality of IV amoxicillin‐clavulanic acid prescriptions through assessing guideline compliance and appropriateness of use in Australian hospitals.MethodA retrospective data analysis of IV amoxicillin‐clavulanic acid prescriptions from the Hospital National Antimicrobial Prescribing Survey database between 2013 and 2021. The main outcomes measured were guideline compliance and appropriateness. Ethical approval was granted by the Melbourne Health Human Research Ethics Committee (HREC/74195/MH‐2022).ResultsThe proportion of prescriptions for IV amoxicillin‐clavulanic acid, compared to all other antimicrobials, increased from 0.02% (2013) to 2.3% (2021). Guideline compliance and appropriateness have overall decreased (by 18.9% and 16.7%, respectively). Over time, national guidelines predominantly replaced local guidelines as the primary guideline source for prescribing. The most common reason for inappropriateness was unnecessarily broad spectrum of activity (39.5%).ConclusionIntravenous amoxicillin‐clavulanic acid prescribing continues to increase throughout Australian hospitals, with notable reductions in guideline compliance and appropriateness. Since 2019, the increase in these outcomes coincided with updated national prescribing guidelines, evident by prescribers utilising national over local guidelines. These findings reinforce the concept that antimicrobial stewardship initiatives, including auditing, robust national guidelines and education, are crucial to optimise IV amoxicillin‐clavulanic acid prescribing.