ORCID Profile
0000-0001-5402-6415
Current Organisation
Kyushu University
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Publisher: Mattioli1885
Date: 29-01-2021
DOI: 10.5826/DPC.1101A118
Abstract: Background: Atopic dermatitis (AD) is a common presentation in the general practice (GP) setting. Implementation of appropriate referral pathways is instrumental for best patient care and is an essential skill for Australian GP registrars. Objectives: We aimed to explore the prevalence and associations of GP registrar referrals to specialists for AD management. Methods: A cross-sectional analysis utilizing data from the Registrar Clinical Encounters in Training (ReCEnT) project, an ongoing cohort study that documents in-consultation clinical and educational experience of Australian GP registrars. Registrar, patient, and consultation factors associated with referrals for AD were established using logistic regression. Results: A A total of 3,285 (0.55%) of 595,412 diagnoses managed were AD, of which 222 (6.8%) resulted in referral. Of these referrals, 70% were to dermatologists, 17% to allergists/immunologists, and 10% to pediatricians. Associations of referral included registrar female gender, patient age, longer consultation duration an established (rather than new) AD diagnosis supervisor advice being sought and learning goals being generated. Conclusions: Both registrar and patient factors influence AD referral patterns. Registrars referred established rather than newly diagnosed AD, suggesting a level of comfort in initial management. Referral was associated with longer consultations, seeking supervisor advice, and generation of learning goals—suggesting these are more complex presentations and, possibly, registrar learning opportunities. A significant proportion of referrals were to non-dermatologist specialists. The implication of this for optimal patient care is a subject for further study.
Publisher: Oxford University Press (OUP)
Date: 28-05-2022
Abstract: Most antibiotic prescribing for upper respiratory tract infections (URTIs) and acute bronchitis is inappropriate. Substantive and sustained reductions in prescribing are needed to reduce antibiotic resistance. Prescribing habits develop early in clinicians’ careers. Hence, general practice (GP) trainees are an important group to target. We aimed to establish temporal trends in antibiotic prescribing for URTIs and acute bronchitis/bronchiolitis by Australian GP trainees (registrars). A longitudinal analysis, 2010–2019, of the Registrars Clinical Encounters in Training (ReCEnT) dataset. In ReCEnT, registrars record clinical and educational content of 60 consecutive consultations, on 3 occasions, 6 monthly. Analyses were of new diagnoses of URTI and acute bronchitis/bronchiolitis, with the outcome variable a systemic antibiotic being prescribed. The independent variable of interest was year of prescribing (modelled as a continuous variable). 28,372 diagnoses of URTI and 5,289 diagnoses of acute bronchitis/bronchiolitis were recorded by 2,839 registrars. Antibiotic prescribing for URTI decreased from 24% in 2010 to 12% in 2019. Prescribing for acute bronchitis/bronchiolitis decreased from 84% to 72%. “Year” was significantly, negatively associated with antibiotic prescribing for both URTI (odds ratio [OR] 0.90 95% confidence interval [CI]: 0.88–0.93) and acute bronchitis/bronchiolitis (OR 0.92 95% CI: 0.88–0.96) on multivariable analysis, with estimates representing the mean annual change. GP registrars’ prescribing for URTI and acute bronchitis/bronchiolitis declined over the 10-year period. Prescribing for acute bronchitis/bronchiolitis, however, remains higher than recommended benchmarks. Continued education and programme-level antibiotic stewardship interventions are required to further reduce registrars’ antibiotic prescribing for acute bronchitis/bronchiolitis to appropriate levels.
Publisher: Oxford University Press (OUP)
Date: 25-05-2022
Abstract: Climate change is a rapidly progressing threat to global health and well-being. For general practitioners (GPs) currently in training, the effects of climate change on public health will shape their future professional practice We aimed to establish the prevalence and associations of Australian GP registrars’ (trainees’) perceptions of climate change as it relates to public health, education, and workplaces. A cross-sectional questionnaire-based study of GP registrars of three Australian training organizations. The questionnaire assessed attitudes regarding adverse health effects of climate change (over the next 10–20 years), and agreement with statements on (i) integrating health impacts of climate change into GP vocational training, and (ii) GPs’ role in making general practices environmentally sustainable. Of 879 registrars who participated (response rate 91%), 50.4% (95% CI 46.8%, 54.0%) perceived a large or very large future health effect of climate change on their patients, and 61.8% (95% CI 58.6%, 65.0%) agreed that climate health impacts should be integrated within their education programme. 77.8% (95% CI 74.9%, 80.4%) agreed that GPs should have a leadership role in their practices’ environmental sustainability. Multivariable associations of these attitudes included female gender, training region, and (for the latter two outcomes) perceptions of future impact of climate change on patient health. GP registrars are motivated to receive climate health education and engage in environmentally sustainable practice. This may primarily reflect concern for future practice and patient care.
Publisher: Informa UK Limited
Date: 27-02-2023
Publisher: Wiley
Date: 02-01-2020
DOI: 10.1111/JOCN.15142
Abstract: This study aimed to reduce indwelling urinary catheter (IDC) use and duration through implementation of a multifaceted "bundled" care intervention. Indwelling urinary catheters present a risk for patients through the potential development of catheter-associated urinary tract infection (CAUTI), with duration of IDC a key risk factor. Catheter-associated urinary tract infection is considered preventable yet accounts for over a third of all hospital-acquired infections. The most effective CAUTI reduction strategy is to avoid IDC use where ever possible and to remove the IDC as early as appropriate. A cluster-controlled pre- and poststudy at a facility level with a phased intervention implementation approach. A multifaceted intervention involving a "No CAUTI" catheter care bundle was implemented, in 4 acute-care hospitals, 2 in metropolitan and 2 in rural locations, in New South Wales, Australia. Indwelling urinary catheter point prevalence and duration data were collected at the bedside on 1,630 adult inpatients at preintervention and 1,677 and 1,551 at 4 and 9 months postintervention. This study is presented in line with the StaRI checklist (see Appendix S1). A nonsignificant trend towards reduction in IDC prevalence was identified, from 12% preintervention to 10% of all inpatients at 4 and 9 months. Variability in preintervention IDC prevalence existed across hospitals (8%-16%). Variability in reduction was evident across hospitals at 4 months (between -2% and 4%) and 9 months (between 0%-8%). Hospitals with higher preintervention prevalence showed larger decreases, up to 50% when preintervention prevalence was 16%. Indwelling urinary catheter duration increased as more of the short-term IDC placements were avoided. Implementation of a multifaceted intervention resulted in reduced IDC use in four acute-care hospitals in Australia. This result was not statistically significant but did reflect a positive trend of reduction. There was a significant reduction in short-term IDC use at 9 months postintervention. Clinical nurse leaders can effectively implement change strategies that influence patient outcomes. Implementation of the evidence-based "No CAUTI" bundle increased awareness of appropriate indications and provided nurses with the tools to inform decision-making related to insertion and removal of IDCs in acute inpatient settings. Working in partnership with inpatients and the multidisciplinary team is essential in minimising acute-care IDC use.
Publisher: Hindawi Limited
Date: 16-03-2020
DOI: 10.1155/2020/8712407
Abstract: This work developed a novel ternary composite photoanode of dye-sensitized solar cell (DSSC) composed of (i) N-, S-doped titanium dioxide with exposed {001} facet (N-, S-TiO 2{001} ), (ii) N-, S-doped reduced graphene oxide (N-, S-rGO), and (iii) commercial titanium dioxide (P25). The DSSC device fabricated with the ternary composite photoanode showed the greatest of power conversion efficiency (8.62%) compared to the device fabricated with P25 photoanode (3.20%). This enhancement was attributed to the synergistic effect of the N-, S-TiO 2{001} and the N-, S-rGO, which act as an electron enricher and an electron extractor, respectively.
Publisher: Oxford University Press (OUP)
Date: 07-03-2023
Abstract: Prompted by the COVID-19 pandemic, remuneration was introduced for Australian general practice telehealth consultations. General practitioner (GP) trainees’ telehealth use is of clinical, educational, and policy importance. The aim of this study was to assess the prevalence and associations of telehealth versus face-to-face consultations amongst Australian GP registrars (vocational GP trainees). Cross-sectional analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) study, from 2020 to 2021 (three 6-month terms), including registrars in 3 of Australia’s 9 Regional Training Organisations. In ReCEnT, GP registrars record details of 60 consecutive consultations, 6 monthly. The primary analysis used univariate and multivariable logistic regression, with outcome of whether the consultation was conducted via telehealth (phone and videoconference) or face-to-face. 1,168 registrars recorded details of 102,286 consultations, of which 21.4% (95% confidence interval [CI]: 21.1%–21.6%) were conducted via telehealth. Statistically significant associations of a telehealth consultation included shorter consultation duration (odds ratio [OR] 0.93, 95% CI: 0.93–0.94 and mean 12.9 versus 18.7 min) fewer problems addressed per consultation (OR 0.92, 95% CI: 0.87–0.97) being less likely to seek assistance from a supervisor (OR 0.86, 95% CI: 0.76–0.96) while being more likely to generate learning goals (OR 1.18, 95% CI: 1.02–1.37) and being more likely to arrange a follow-up consultation (OR 1.18, 95% CI: 1.02–1.35). That telehealth consultations were shorter, with higher rates of follow-up, has GP workforce/workload implications. That telehealth consultations were less likely to involve in-consultation supervisor support, but more likely to generate learning goals, has educational implications.
Publisher: Springer Science and Business Media LLC
Date: 23-02-2022
DOI: 10.1186/S12909-022-03178-0
Abstract: General Practice training in Australia is delivered through the apprenticeship model. General Practice supervisors support trainees transitioning from hospital-based work towards competent independent community-based practice. The timing and manner in which support should be provided is still not well understood. This study aimed to establish the variation in clinical and educational experiences and behaviours, and location, of general practice trainees’ consultations by stage of their vocational training. It was hypothesised that change is greater in earlier stages of training. A cross-sectional analysis of data (2010–2018) from the Registrar Clinical Encounters in Training (ReCEnT) study, an ongoing cohort study of Australian GP registrars’ in-consultation clinical and educational experience and behaviours. Multinomial logistic regression assessed the association of demographic, educational, and clinical factors in different stages of training. The outcome factor was the training term. Two thousand four hundred sixteen registrars contributed data for 321,414 patient consultations. For several important variables (seeing patients with chronic disease new patients seeking in-consultation information or assistance ordering pathology and imaging and working in a small or regional practice), odds ratios were considerably greater for comparisons of Term 1 and 3, relative to comparisons of Term 2 and 3. Differences experienced in demographic, clinical and educational factors are significantly more pronounced earlier in registrars’ training. This finding has educational and training implications with respect to resource allocation, trainee supervision and curriculum design. Sociocultural learning theory enables an understanding of the impact of transitions on, and how to support, general practice trainees and supervisors.
Publisher: Wiley
Date: 23-02-2022
DOI: 10.1111/AJR.12850
Abstract: To investigate whether practice rurality and rural training pathway are associated with general practitioner registrars' participation in their practice's after-hours care roster. A cross-sectional analysis of data (2017-2019) from the Registrar Clinical Encounters in Training study, an ongoing inception cohort study of Australian general practitioner registrars. The principal analyses used logistic regression. Three national general practitioner regional training organisations across 3 Australian states. General practitioner registrars in training within regional training organisations. Involvement in practice after-hours care was indicated by a dichotomous response on a 6-monthly Registrar Clinical Encounters in Training study questionnaire item. 1576 registrars provided 3158 observations (response rate 90.3%). Of these, 1574 (48.6% [95% confidence interval: 46.8-50.3]) involved registrars contributing to their practice's after-hours roster. In major cities, 40% of registrar terms involved contribution to their practice's after-hours roster in regional and remote practices, 62% contributed to the after-hours roster. On multivariable analysis, both level of rurality of practice (odds ratio(OR) 1.75, P = .007 and OR 1.74, P = .026 for inner regional and outer regional/remote locations, respectively, versus major city) and rural training pathway of registrar (OR 1.65, P = .008) were significantly associated with more after-hours roster contribution. Other associations were registrars' later training stage, larger practices and practices not routinely bulk billing. Significant regional variability in after-hours care was identified (after adjusting for rurality). These findings suggest that registrars working rurally and those training on the rural pathway are more often participating in practice after-hours rosters. This has workforce implications, and implications for the educational richness of registrars' training environment.
No related grants have been discovered for Jean Ball.