Internal Medicine Journal最新文献

{"title":"Acceptability of automatic screening for viral hepatitis in an emergency department setting: patient and healthcare worker perspectives.","authors":"Tahrima Kayes, Julia Di Girolamo, David S Prince, Harry Crane, Joseph Pipicella, Melissa Bagatella, Nathan Jones, Paul M Middleton, Miriam T Levy","doi":"10.1111/imj.70157","DOIUrl":"https://doi.org/10.1111/imj.70157","url":null,"abstract":"<p><strong>Background: </strong>Screening for viral hepatitis by automatically ordering hepatitis B and C serology on blood samples already collected from patients presenting to the emergency department (ED) is a relatively novel concept, with modest costs involved.</p><p><strong>Aim: </strong>The aim of this study was to determine patient and healthcare worker perspectives of automatic hepatitis screening at a large metropolitan hospital in Sydney, Australia.</p><p><strong>Methods: </strong>In this cross-sectional survey study, patients admitted via ED and ED healthcare workers (HCWs) were invited to participate. The primary outcome was the level of patient and HCW acceptability of an automatic hepatitis screening process. Secondary outcomes were patient and HCW knowledge of viral hepatitis, perceptions and barriers to ED hepatitis screening in the absence of an automatic process.</p><p><strong>Results: </strong>Ninety-two percent of 273 patients who participated in the survey wished to know their viral hepatitis status, and 82% found automatic hepatitis B and C testing acceptable as part of their ED blood work. HCWs surveyed (48) believed this strategy would increase testing, as most did not routinely interrogate patients for risk factors or other eligibility criteria for hepatitis testing, as the presenting ED complaint was their priority. Even when indications for testing based on current guidelines were present, few (32%) HCWs initiated testing.</p><p><strong>Conclusion: </strong>Automatic viral hepatitis testing in ED is supported by the majority of patients and HCWs, and the latter believe it would increase testing rates. Increasing identification of patients with hepatitis, if accompanied by effective linkage to care, could facilitate World Health Organization elimination goals.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144690099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinico-pathologic characteristics, updated diagnostic approach and value of positron emission tomography for adults with splenomegaly at a large, university hospital.","authors":"Huw Richards, Adam Gray, Jawad Saeed, Ethan Troy-Barnes, Stefan Voo, Irfan Kayani, Simon Wan, Michael Brown, Christopher McNamara","doi":"10.1111/imj.70155","DOIUrl":"https://doi.org/10.1111/imj.70155","url":null,"abstract":"<p><strong>Background: </strong>Splenomegaly is an important finding in numerous conditions. Most reported cohort studies have not included modern diagnostic methods, such as functional imaging.</p><p><strong>Aim: </strong>We aimed to determine the utility of newer diagnostic methods and provide an updated approach to splenomegaly by examining recent experience at our centre.</p><p><strong>Methods: </strong>We conducted a retrospective review of adult patients with splenomegaly of unknown cause using imaging reports over 12 months. We used an upper limit of 13 cm and applied a validated height- and sex-adjusted formula (SplenoCalc) where possible. Data were analysed using Fisher's exact test on Graphpad Prism software.</p><p><strong>Results: </strong>Liver pathology was identified in 24%, infectious disease in 19%, haematological disease in 18%, inflammatory disease in 8% and no diagnosis in 28%. Patients who had an 18-F-fluorodeoxyglucose positron emission tomography (FDG PET) scan were significantly more likely to undergo a biopsy (25/38 vs. 23/103, P < 0.0001) and reach a diagnosis (34/38 vs. 84/126, P = 0.007). Eight per cent of assessable patients had a spleen size within normal limits when the SplenoCalc formula was applied. Untreated human immundodeficiency virus (HIV) was identified in 8% of tested patients.</p><p><strong>Conclusion: </strong>In our cohort, PET scanning, where appropriate, was valuable in identifying sites for biopsy and establishing a cause for splenomegaly, particularly haematological or inflammatory. Routine recording of height and use of the SplenoCalc formula in imaging departments may avoid unnecessary investigation of people with normal sized spleens. Due to the prevalence of untreated HIV in our cohort, we would also recommend HIV testing in all patients with splenomegaly.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144690100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is semaglutide cost-effective at closing the gap for Aboriginal and Torres Strait Islander Australians with cardiovascular disease and obesity without type 2 diabetes?","authors":"Satyen Hargovan, Nadine Hunt, Hara Kostakis, Clara K Chow","doi":"10.1111/imj.70160","DOIUrl":"https://doi.org/10.1111/imj.70160","url":null,"abstract":"<p><strong>Background: </strong>Aboriginal and Torres Strait Islander Australians experience worse healthcare outcomes due to increased prevalence of cardiovascular disease (CVD). A large proportion of this is preventable if CVD risk factors, such as obesity, are effectively treated. In the SELECT (Semaglutide Effects on Cardiovascular Outcomes in People With Overweight or Obesity) trial, the use of semaglutide for patients with CVD and obesity without type 2 diabetes (T2D) significantly reduced the prevalence of CVD.</p><p><strong>Aim: </strong>To determine the cost-benefit to the Australian healthcare system of funding early-access semaglutide for treating Aboriginal and Torres Strait Islander Australians with CVD and obesity without T2D.</p><p><strong>Methods: </strong>A Markov cohort state-transition model was annually cycled for 25 years. The population was Aboriginal and Torres Strait Islander Australians with CVD and obesity without T2D. They received either semaglutide or standard care. Transition probabilities, utilities, costs and discounting were literature-derived. The incremental cost-effectiveness ratio (ICER) was our primary outcome. Disability-adjusted life-years (DALYs) and fatal and non-fatal CVD events prevented were secondary outcomes. Sensitivity analysis for various scenarios was performed.</p><p><strong>Results: </strong>In the estimated 13 650 Aboriginal and Torres Strait Islander Australians with CVD and obesity without T2D, semaglutide was modelled to prevent an additional 929 fatal CVD events, 13 480 non-fatal CVD events and 8628 DALYs over 25 years at an additional cost to the Australian government of $25 956 522/year (<0.2% of annual CVD expenditure). The ICER was $75 206/DALYs.</p><p><strong>Conclusion: </strong>A strategy of early-access funding and use of semaglutide for Aboriginal and Torres Strait Islander Australians with CVD and obesity without T2D may be cost-effective to the Australian healthcare system while closing the gap in healthcare disparities.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144690101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between Full Moon Day overdose-related intensive care unit admissions and hospital mortality: a medical enigma or mere myth?","authors":"Ashwin Subramaniam, Ryan Ruiyang Ling, Michael Wu, Paul Secombe, David Pilcher","doi":"10.1111/imj.70154","DOIUrl":"https://doi.org/10.1111/imj.70154","url":null,"abstract":"<p><strong>Background: </strong>There is limited evidence on whether Full Moon Day is linked to drug overdoses severe enough to need intensive care unit (ICU) admissions.</p><p><strong>Aims: </strong>To investigate the association between Full Moon Day overdose-related ICU admissions and hospital mortality.</p><p><strong>Methods: </strong>This retrospective multicentre observational study that included data from 172 ICUs across Australia and New Zealand reported to the Australia New Zealand Intensive Care Society Adult Patient Database. We included all adult (≥16 years) patients admitted to an ICU following an overdose between 1 January 2018 and 31 December 2023. The primary outcome was the prevalence of overdose presentations. The secondary outcome was hospital mortality. We used logistic regression models to investigate the association between Full Moon Day overdose and hospital mortality, after adjusting for key confounders. We also analysed this association in a subgroup based on sex.</p><p><strong>Results: </strong>We included 25 577 patients; 4426 (17.3%) were admitted on Full Moon Day. The prevalence of overdose-related ICU admissions for Full Moon Day was similar to those on other lunar days (mean prevalence: 1.4% (standard deviation (SD) 0.6%) vs. 1.4% (SD 0.2%)). The hospital mortality was comparable in both groups of patients (1.3% vs. 1.3%; P = 0.99). There was no association between Full Moon Day overdose-related ICU admission and hospital mortality (adjusted odds ratio = 1.10; 95% confidence interval: 0.77-1.57; P = 0.60). This relationship was consistent in both male and female patients.</p><p><strong>Conclusion: </strong>This large registry-based study found no difference in overdose-related ICU admissions between full moon days and other lunar days, with no association with hospital mortality. This reinforces that the full moon's influence on overdose admissions to the ICU is a myth.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A tale of two echoes: ultraportable versus standard echocardiography in patients with left ventricular dysfunction.","authors":"Joanne Eng-Frost, Rohanti Ravikulan, Jasmine Chan, Kate Kim, Scott Lorensini, Kate George, Emilie Rasheed, Sam Lehman, Majo Joseph, Carmine G De Pasquale","doi":"10.1111/imj.70156","DOIUrl":"https://doi.org/10.1111/imj.70156","url":null,"abstract":"<p><strong>Background: </strong>Handheld echocardiography (HHE) is an emerging tool offering portability and convenience for cardiac imaging. However, its validity in hospitalised patients with left ventricular (LV) dysfunction is unclear.</p><p><strong>Aims: </strong>To determine the concordance of key LV and right ventricular (RV) echocardiographic parameters obtained by HHE and standard echocardiography (SE) in hospitalised patients with LV dysfunction.</p><p><strong>Methods: </strong>This prospective study evaluated hospitalised patients with an echocardiogram during admission demonstrating LV ejection fraction (LVEF) <50%. Key LV and right ventricular (RV) echocardiographic parameters were measured using both standard echocardiography (SE) and HHE. Concordance and differences between both imaging modalities were evaluated using Pearson correlation and paired Student t test, with significance defined as P < 0.05.</p><p><strong>Results: </strong>A total of 156 patients were included. No significant differences were observed between SE and HH for LV end-diastolic diameter (5.23 ± 0.87 vs. 5.28 ± 0.72 cm respectively, P = 0.348), LVEF (33.36 ± 9.2 vs. 33.17 ± 9.09, P = 0.521), LV outflow tract velocity time integral (15.83 ± 4.95 vs. 15.80 ± 5.05, P = 0.856) and inferior vena cava diameter (1.96 ± 0.48 vs. 1.92 ± 0.44, P = 0.122). Significant differences were noted for RV basal diameter (3.87 ± 0.63 cm vs. 3.76 ± 0.68 cm, P < 0.001) and tricuspid annular systolic excursion (1.76 ± 0.46 cm vs. 1.83 ± 0.47 cm, P = 0.025).</p><p><strong>Conclusions: </strong>HHE demonstrates strong concordance with SE for LV parameters. Discrepancies were observed for RV parameters, although the clinical implications of these differences are unclear. These findings highlight the evolving role of HHE as a reliable and accessible tool for experienced users, particularly for monitoring hospitalised patients such as those with acute heart failure, where the use of serial SE may enhance clinical decision-making but is limited by logistical barriers.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes following lung transplantation for interstitial lung diseases in New Zealand: a retrospective review.","authors":"Jeong Suk Oh, James Rance, Eun Ho Choe, Tanya J McWilliams, Mark O'Carroll, Christopher Lewis, Sasiharan Sithamparanathan","doi":"10.1111/imj.70147","DOIUrl":"https://doi.org/10.1111/imj.70147","url":null,"abstract":"<p><strong>Background: </strong>Interstitial lung diseases (ILDs) are a heterogeneous group of diseases that have limited treatment options and can lead to progressive respiratory failures. Lung transplantation offers a therapeutic option for selected patients. There are no New Zealand data published regarding outcomes of those who received lung transplantation for ILDs.</p><p><strong>Aims: </strong>We assessed survival outcomes after lung transplantation for ILDs in New Zealand, comparing bilateral versus single-lung transplants and size-matched versus mismatched lungs.</p><p><strong>Methods: </strong>A retrospective, single-centre study included ILD patients who underwent lung transplantation from December 2006 to March 2023. Baseline characteristics, survival and post-transplant complications were analysed. Size matching was based on predicted total lung capacity ratios.</p><p><strong>Results: </strong>Fourty-four patients underwent lung transplantation for ILDs during this period, with a median recipient age of 54 years old. Median survival was 6.2 years; 30-day and 1-, 3-, 5- and 7-year survival rates were 84%, 80%, 66%, 58% and 49% respectively. Survival did not differ between bilateral and single lung transplants (P = 0.42) or between size matched and mismatched transplants (P = 0.58). Single lung transplants had shorter intensive care unit (ICU) stays and less intra-operative cardiopulmonary bypass use.</p><p><strong>Conclusion: </strong>Lung transplantation for ILDs in New Zealand achieves survival outcomes comparable to international centres. No significant survival differences were found between bilateral and single-lung transplants or between sizes matched and mismatched lungs. Single-lung transplantation may offer advantages such as shorter ICU stays and reduced cardiopulmonary bypass use. Careful patient selection, especially in older patients, may improve outcomes.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144617412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Supremacy of the pulse within the medicine of the enlightenment.","authors":"Bruce Short","doi":"10.1111/imj.70136","DOIUrl":"https://doi.org/10.1111/imj.70136","url":null,"abstract":"<p><p>For the minority of the British sick poor, the healing process was conducted as an in-patient in one of the emerging British voluntary hospitals and infirmaries. But those with fevers and contagious diseases were excluded from admission. During the subsequent truncated physical examination, the character of the pulse received especially close attention. The diagnostic regard paid to the pulse assumed the same pre-eminent consideration as bloodletting was within the therapeutic armamentarium. Fever was not considered a symptom within British medicine during the 18th century; rather, it was regarded as a disease sui generis. Indeed, the pulse was regarded as the most reliable guide to the existence of a febrile illness, and variations in the pulse character directed the physician to adopt certain therapeutic modalities. The rapid bounding pulse was a signal of an inflammatory fever, whilst slow low amplitude pulses inferred a typhus-like aetiology. The importance of the pulse to the 18th century practitioner's understanding of sickness, whereby its pre-eminence was gradually replaced by clinical thermometry adopted fitfully during the mid-19th century.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144600318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is the incidence and burden of cancer increasing among young individuals? An age-related analysis based on Global Burden of Disease Study and Surveillance, Epidemiology and End Results.","authors":"Yijun Cai, Xiaojia Huang, Dong Lin, Dian Gu, Shen Lin, Shaohong Luo, Xiongwei Xu, Xiaoting Huang, Xiuhua Weng","doi":"10.1111/imj.70126","DOIUrl":"https://doi.org/10.1111/imj.70126","url":null,"abstract":"<p><strong>Background: </strong>Cancer incidence patterns are shifting globally. The overall age profile and secular trends in cancer onset remain inadequately understood, and their impact on the global cancer burden unquantified.</p><p><strong>Aims: </strong>This study aimed to analyse long-term trends of cancer onset age and assess their impact on cancer burden.</p><p><strong>Methods: </strong>Using data from GBD 2019 and SEER, trends in onset age of 29 cancer types were analysed in the United States and globally over three decades. Early-onset cancers were defined as cases below the 1990 median age; late-onset cancers exceeded this threshold. Mean and median onset age were analysed globally (Socio-Demographic Index (SDI) stratified). Temporal trends were quantified using average annual percentage change. Age changes related to population structures were evaluated by fixing cancer incidence in 1990. Changes in cancer burden by age were evaluated using disability-adjusted life years for younger and older age groups.</p><p><strong>Results: </strong>In the United States, most cancers showed increasing onset ages. Globally, prostate cancer had a decreasing mean age, while nasopharynx, uterine and prostate cancers displayed declining median ages. The global cancer burden significantly increased for the older age group, surpassing the increase in the younger age group. A similar pattern was observed across SDI, except for low SDI. Notably, early-onset cancers exhibited a trend towards earlier onset in low SDI regions, while the burden remained greater in high SDI areas.</p><p><strong>Conclusions: </strong>Most cancer types showed an increasing onset age in the United States and globally. Despite population aging, certain cancers had a younger onset age. Policymakers and healthcare systems should be aware of these trends and take appropriate action. The young generation should also stay vigilant about cancers with a younger onset age.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144600317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of inpatient blood pressure elevations in Australian hospitalised patients and analysis of associated factors.","authors":"Jin Nuo Joan Tsang, Richard Woodman, Arduino A Mangoni","doi":"10.1111/imj.70145","DOIUrl":"https://doi.org/10.1111/imj.70145","url":null,"abstract":"<p><strong>Background: </strong>Hypertension is a significant cardiovascular risk factor. While community hypertension is well studied, inpatient hypertension remains poorly understood with limited epidemiological data in Australian cohorts. We therefore investigated the prevalence and factors associated with inpatient systolic blood pressure (SBP) elevations, defined as SBP ≥140 mmHg using Australian data.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study on non-cardiac inpatients aged ≥65 admitted to general medical wards at Flinders Medical Centre, Adelaide (January-April in 2022-2024). Blood pressure recordings during hospital stay were extracted from electronic medical records. The primary endpoint was ≥10 SBP readings ≥140 mmHg, with secondary endpoints being at least one, two or three readings ≥140 mmHg.</p><p><strong>Results: </strong>Among 753 eligible patients, 94.2% had at least one, 89.4% two, 85.7% three and 65.2% 10 SBP readings ≥140 mmHg. Independent factors positively associated with ≥10 elevations included age (years) (OR = 1.022, CI 1.00-1.04, P = 0.033), number of comorbidities (OR = 1.203, CI 1.06-1.35, P = 0.0026), length of stay (days) (OR = 1.041, CI 1.02-1.07, P = 0.002), antihypertensive use prior to admission (OR = 1.95, CI 1.26-3.02, P = 0.003) and use of calcium channel blockers (OR = 2.55, 1.53-4.25, P < 0.001). Whereas beta-blocker use (OR 0.593, CI 0.38-0.92, P = 0.020), history of coronary artery disease (OR = 0.59, CI 0.38-0.90, P = 0.015), chronic obstructive lung disease (OR = 0.46, CI 0.39-0.69, P < 0.001) and heart failure (OR = 0.43, CI 0.27-0.7, P < 0.001) were negatively associated.</p><p><strong>Conclusions: </strong>This study provides first evidence of the epidemiology of inpatient SBP elevations in Australian inpatients and the associated factors. Further research should determine the clinical significance of these elevations and the impact of blood-pressure-lowering strategies in hospital settings.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antimicrobial stewardship in regional hospitals: a human factors evaluation of barriers and facilitators and the role of technology.","authors":"Bethany A Van Dort, Jane E Carland, Jonathan Penm, Angus Ritchie, Kate Morton, Nathan Chahoud, Melissa T Baysari","doi":"10.1111/imj.70142","DOIUrl":"https://doi.org/10.1111/imj.70142","url":null,"abstract":"<p><strong>Background: </strong>Antimicrobial stewardship (AMS) programmes aim to optimise antimicrobial prescribing. Regional hospitals have reduced access to resources that are essential for conducting AMS initiatives. Technology has the potential to reduce these challenges if implemented and used effectively.</p><p><strong>Objective: </strong>Identify the barriers and facilitators to successful AMS programmes in two regional hospitals in Australia and explore the role technology played in supporting AMS.</p><p><strong>Methods: </strong>A contextual inquiry methodological approach was used, including observations and semi-structured interviews with AMS team members in two regional hospitals in Australia.</p><p><strong>Results: </strong>Observations were conducted for 27.5 h and interviews were performed with all AMS team members (n = 4). Electronic medication management and an antimicrobial dashboard were reported to make AMS processes efficient and information accessible. The use of multiple computerised systems and poor interoperability hindered AMS work processes. Executive support, resourcing and building rapport through in-person interactions were reported to influence the success of AMS programmes. Passionate and motivated infectious diseases (ID) consultants drove AMS programmes by building rapport with stakeholders and advocating for resources. COVID-19 was viewed as a facilitator of AMS as it increased the visibility of ID consultants, resulting in improved relationships and additional resources.</p><p><strong>Conclusions: </strong>Using a small number of interoperable systems can enhance AMS, with tools such as an antimicrobial dashboard proving beneficial for remotely accessing information and reviewing antimicrobials in peripheral hospitals. Essential components for effective AMS programmes include supportive hospital executives and adequate staff resources. Sustaining AMS in regional settings relies on committed ID doctors and strong interdepartmental relationships.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}