ORCID Profile
0000-0003-4009-5836
Current Organisation
University of Nottingham
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Publisher: Informa UK Limited
Date: 10-02-2021
Publisher: Oxford University Press (OUP)
Date: 13-07-2020
Abstract: Carbapenemase-producing Enterobacterales (CPE) are increasingly seen in Australian hospitals. Antimicrobial stewardship (AMS) interventions have been shown to reduce rates of carbapenem-resistant organisms data on their effect on CPE rates are limited. To explore the effect of a multi-site computer-supported AMS programme on the rates of CPE in an Australian local health district. All laboratory CPE isolates between 2008 and 2018 were identified. Microbiological and demographic data, CPE risk factors and outcomes were collected. Monthly carbapenem use was expressed as DDD per 1000 occupied bed days (OBD). Hand hygiene compliance rates among healthcare workers were analysed. A computer-supported AMS programme was implemented district-wide in 2012. Bivariate relationships were examined using Pearson’s r and predictors of CPE isolates using time series linear regression. We identified 120 isolates from 110 patients. Numbers of CPE isolates and carbapenem use both showed a strong downward trend during the study period the decreases were strongly correlated (r = 0.80, P = 0.006). The positive relationship between carbapenem use and CPE isolation was maintained while adjusting for time (b = 0.05, P & 0.001). Average yearly consumption of carbapenems fell by 20%, from 18.4 to 14.7 DDD/1000 OBD following implementation of the AMS programme. Hand hygiene compliance rates remained high throughout. We demonstrated a reduction of CPE isolates in conjunction with reduced carbapenem use, longitudinally consolidated by a formal AMS programme. Prospective studies are needed to validate the effect of AMS on carbapenem resistance, especially in high-prevalence settings.
Publisher: SAGE Publications
Date: 08-12-2020
Abstract: The study investigated factors associated with frequent (admissions), high (total length of stay) or heavy (frequent and high) hospital use, and with ongoing increased hospital use, for mental health conditions in a regional health district. A retrospective population-based study using longitudinal hospital, emergency department and community service use data for people admitted with a mental health condition between 1 January 2012 and 31 December 2016. Multivariate logistic regression models assessed the association of predisposing, enabling and need factors with increased, and ongoing increased, hospital use. A total of 5,631 people had at least one mental health admission. Frequent admission was associated with not being married (odds ratio = 2.3, 95% confidence interval = [1.5, 3.3]), no private hospital insurance (odds ratio = 2.2, 95% confidence interval = [1.2, 3.8]), previous mental health service use (community, emergency department, lengthy admissions) and a history of a substance use disorder, childhood trauma, self-harm or chronic obstructive pulmonary disease. High and heavy hospital use was associated with marital status, hospital insurance, admission for schizophrenia, previous mental health service use and a history of self-harm. Ongoing frequent use was less likely among those aged 65 and older (odds ratio = 0.2, 95% confidence interval = [0.1, 1.0]) but more likely among those with a history of depression (odds ratio = 2.2, 95% confidence interval = [1.1, 4.4]). Ongoing high use was also associated with admissions for schizophrenia and a history of self-harm. Interventions targeted at younger people hospitalised with schizophrenia, a history of depression or self-harm, particularly with evidence of social and or health disadvantage, should be considered to improve long-term consumer and health system outcomes. These data can support policymakers to better understand the context and need for improvements in stepped or staged care for people frequently using inpatient mental health care.
Publisher: Wiley
Date: 22-01-2022
DOI: 10.1111/AJR.12824
Abstract: To evaluate an integrated care program expanding the physician in the practice model into geriatrics, focussing on dementia assessment and management. Observational descriptive study. The rural section of a local health district in New South Wales, Australia. Patients attending eight general practices, in addition to practice nurses and general practitioners. Self-report questionnaires completed by patients, specialist general practitioners and practice nurses. Responses to open-ended questions were analysed using content analysis. Routinely collected health data of patients who took part in the program were compared with data of patients from the same institution who did not take part in the program. A number of planned reviews, actual reviews and emergency department presentations for participating patients, self-efficacy amongst general practitioners and practice nurses, and patient satisfaction and comfort levels. The GIP program was well received by most patients, GPs and practice nurses. Almost 90% of patients found it easier to see the specialist at their general practice. They were less likely to have planned reviews, actual reviews and emergency department presentations than patients who did not take part in the program. GPs and practice nurses expressed increased confidence in and knowledge of dementia assessment and management. Dementia assessment and management programs based on the physician in the practice model may be well received in similar rural settings. Larger prospective studies are needed to further examine the relationship between programs and patients' health outcomes.
Publisher: Wiley
Date: 05-2022
DOI: 10.1111/IMJ.15773
Abstract: Most clinicians find research ethics and governance difficult and time consuming. This study aimed to develop a better local review process for low‐risk research. We used real‐time processing, leveraged local expertise and streamlined paperwork. As a result, turnaround times decreased from more than 80 days to 10 days, creating an efficient review process for low‐risk projects.
Publisher: Omniscient Pte Ltd
Date: 2023
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Jose Cuenca.