Antimicrobial stewardship (AMS) programmes are central to tackling antimicrobial resistance. Comparative evidence on how barriers differ between high-income countries (HICs) and low-/middle-income countries (LMICs) in tertiary care hospitals is limited. The review aims to identify and compare multilevel barriers to implementing AMS programmes in tertiary care hospitals in HICs and LMICs. We conducted a systematic scoping review following PRISMA-ScR and Joanna Briggs Institute guidance. PubMed and Web of Science were searched for English-language primary studies from January 2015 to November 2025. Studies were considered eligible if they examined barriers to implementing AMS in adult inpatient services in tertiary care hospitals. Using a framework-based thematic approach, barriers were grouped into eight themes and mapped to individual, team, organizational, and system levels. Out of 2311 records, 57 studies met inclusion criteria (23 = HICs, 34 = LMICs). Knowledge, education, and confidence gaps were the most frequent barrier theme in both groups, reported in about three-quarters of studies. Staffing and resource constraints and organisational/governance barriers were also highly prevalent, particularly in LMIC hospitals. Workflow and documentation problems and data-system limitations were more prominent in HIC studies, whereas structural health system constraints were more prominent in LMICs. Qualitative and mixed-methods studies identified a broader range of barriers than surveys or observational designs. AMS implementation in tertiary hospitals is constrained by overlapping multilevel barriers that are broadly similar across income groups but differ in emphasis. Tailored strategies that jointly strengthen workforce capacity, infrastructure and governance are needed, with particular attention to system-level constraints in LMICs and workflow and data challenges in HICs.
Introduction This 18-item online closed questionnaire-based study aimed to evaluate and assess the level of knowledge and practices of maxillofacial prosthesis (MFP) among different dental professionals in Saudi Arabia (SA). Methods An Electronic investigation was directed to dental professionals (final-year students, interns, general practitioners, MFP residents, and specialists). Participants were invited to respond to the online forms based on their knowledge and MFP practice. The collected answers were evaluated employing descriptive statistics as values and percentages. The association among participants, knowledge, and practice was analyzed using Chi-square, with a P-value of <= 0.05 indicating statistical significance. Results 336 participants were included, with only 20 patients receiving MFP, those were 12, 3, and 5 patients who received MFP for the mandible, maxilla, and nasal MFPs, respectively. A significant difference was found between dental professional participants and MFP knowledge questions with p < 0.001, except for questions like ''Do you know that there is more than one type of maxillofacial prosthesis?", ''How many maxillofacial specialists or consultants are in the place that you work?" and ''Is there interest to support and develop MFP from the Ministry of Health in the city?" with p-values of 0.104, 0.081, and 0.134, respectively. Also, a significant difference was detected between participants and their answers to most of the practice questions, with p < 0.001, except for the question related to the type of MFP they practice (p = 0.0125). Discussion This study demonstrated that knowledge regarding MFP was good and adequate, while the practice was low and those findings are in parallel with the outcome of other worldwide studies. Thus, a need of a more qualified and professional MFP multidisciplinary team. Conclusion Dental practitioners have good knowledge, but the practice of MFP is still fair. Referrals and multidisciplinary approaches for managing these patients remain poor.
Heart failure (HF) hospitalization is a high-risk transition period with frequent early post-discharge events; we evaluated whether oral metoprolol exposure during the index HF hospitalization is associated with lower all-cause death and/or all-cause readmission at 28-days and 6-months after discharge. An observational cohort analysis was performed using a de-identified Electronic Health Record (EHR) dataset with linked post-discharge outcomes including 2008 HF hospitalizations. The exposure was inpatient oral metoprolol (523; 26.0
INTRODUCTION:Medication management is central to endoscopic safety because comorbidities, polypharmacy, and variable drug responses can substantially influence procedural risk. This review examines how a precision medicine approach can improve peri-endoscopic decision-making and patient outcomes. AREAS COVERED:A structured literature review of PubMed/MEDLINE, Embase, and the Cochrane Library (2000-2025) evaluated evidence on medications and supplements affecting endoscopic safety and efficacy. The review examined drug classes influencing bleeding, sedation, bowel preparation, aspiration, metabolic stability, and diagnostic accuracy, with emphasis on individualized management strategies. EXPERT OPINION:Precision-based medication review should be embedded in routine endoscopy practice through multidisciplinary collaboration, structured reconciliation, and risk stratification. Wider adoption of pharmacogenomic-informed and individualized protocols may reduce preventable complications, improve diagnostic quality, and support safer, more patient-centered care.
