Background: Several national organizations have advocated for inpatient antiretroviral stewardship to prevent the consequences of medication-related errors. This study aimed to evaluate the impact of a stewardship initiative on outcomes in people with HIV (PWH). Methods: A pharmacist-led audit and review of adult patients admitted with an ICD-10 code for HIV was implemented to an existing antimicrobial stewardship program. A quasi-experimental, retrospective cohort study was conducted comparing PWH admitted during pre- and post-intervention periods. Rates of antiretroviral therapy (ART)-related errors and infectious diseases (ID) consultation with linkage to care were evaluated through selection of a random sample of patients receiving ART in each period. Length of stay (LOS) and mortality were assessed by analyzing all admissions in the post-intervention period. Clinical outcomes including LOS, 30-day all-cause hospital readmission, and in-hospital and 30-day mortality in the post-intervention group were stratified by patients not on ART, on ART at admission, and started on ART as a result of the intervention. Results: A total of 100 patients in the pre-intervention period and 103 patients in the post-intervention period were included to assess ART-related errors and linkage to care. A reduction in errors (70.0 versus 25.7%, p < 0.001) and increased linkage to care (19.0 versus 39.6%, p < 0.01) were demonstrated. Of 389 admissions during the post-intervention period, 30-day mortality rates were similar between PWH on ART at admission and those initiated on ART during admission (5% versus 8%, respectively), but less than those not on ART (21%). A longer LOS was observed in the patients started on ART during admission (5 days if ART started during admission versus 3 days if not started during admission, p < 0.01). Conclusions: This interdisciplinary intervention was successful in reducing inpatient ART-related errors and increasing ID consultation with linkage to care among PWH.
There is a growing interest in the internationalization of university education, including through overseas work and study, to enable students across diverse disciplines to develop as global citizens. Legal education traditionally focuses on domestic law, but a major shift is underway to internationalize the law school curriculum with the aim of developing 21st century lawyers as global lawyers. This chapter covers three key topics. First, it identifies important contextual factors influencing Australian law schools to incorporate overseas work and study immersion courses into the curriculum. Second, it presents a case study of internationalization initiatives at the University of Newcastle Law School, New South Wales, focused on overseas work integrated learning and intensive study trips in the Asia-Pacific region. A research project evaluating the impacts of these initiatives for students and staff is summarised. Third, the chapter concludes with reflections on the opportunities and challenges from the perspective of legal educators who must develop their own intercultural competence and navigate new ways of working with overseas service providers and academic institutions. Themes relevant to disciplines other than law are highlighted.
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