129 results for 2000, Kenealy, Timothy, Journal article

  • Contribution by primary health nurses and general practitioners to the Diabetes Annual Review (Get Checked) programme in Auckland, New Zealand

    Daly, B; Kenealy, Timothy; Arroll, Bruce; Sheridan, Nicolette; Scragg, Robert (2013-08-16)

    Journal article
    The University of Auckland Library

    The 'Get Checked' annual diabetes review programme was successful in engaging practice and community-based specialist nurses in the community management of diabetes and has revealed positive relationships between nurses and doctors, extended roles for nurses and the importance of engaging nurses in the design of health care programmes. Nurses involved in the programme undertake a large proportion of all patient annual reviews at their practice and major nursing roles include measuring blood pressure, weighing patients, undertaking foot examinations and giving health promotional advice. DHBs need to continue to acknowledge the valuable contribution made by the largest health professional workforce and ensure primary health care nurses are involved in developing an effective replacement ‘Get Checked’ programme.

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  • Characteristics of nurses providing diabetes community and outpatient care in Auckland

    Daly, B; Arroll, B; Sheridan, N; Kenealy, Timothy; Scragg, R (2013-03)

    Journal article
    The University of Auckland Library

    INTRODUCTION: There is a worldwide trend for diabetes care to be undertaken in primary care. Nurses are expected to take a leading role in diabetes management, but their roles in primary care are unclear in New Zealand, as are the systems of care they work in as well as their training. AIM: To describe and compare demographic details, education and diabetes experience, practice setting and facilities available for the three main groups of primary health care nurses working in the largest urban area in New Zealand. METHOD: Of the total number of practice nurses, district nurses and specialist nurses working in Auckland (n=1091), 31% were randomly selected to undertake a self-administered questionnaire and telephone interview in 2006-2008. RESULTS: Overall response was 86% (n=284 self-administered questionnaires, n=287 telephone interviews). Almost half (43%) of primary care nurses were aged over 50 years. A greater proportion of specialist nurses (89%) and practice nurses (84%) had post-registration diabetes education compared with district nurses (65%, p=0.005), from a range of educational settings including workshops, workplaces, conferences and tertiary institutions. More district nurses (35%) and practice nurses (32%) had worked in their current workplace for >10 years compared with specialist nurses (14%, p=0.004). Over 20% of practice nurses and district nurses lacked access to the internet, and the latter group had the least administrative facilities and felt least valued. DISCUSSION: These findings highlight an ageing primary health care nursing workforce, lack of a national primary health care post-registration qualification and a lack of internet access.

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  • Characteristics of nurses providing diabetes community and outpatient care in Auckland

    Daly, Barbara; Arroll, Bruce; Sheridan, Nicolette; Kenealy, Timothy; Scragg, Robert (2013)

    Journal article
    The University of Auckland Library

    INTRODUCTION: There is a worldwide trend for diabetes care to be undertaken in primary care. Nurses are expected to take a leading role in diabetes management, but their roles in primary care are unclear in New Zealand, as are the systems of care they work in as well as their training. AIM: To describe and compare demographic details, education and diabetes experience, practice setting and facilities available for the three main groups of primary health care nurses working in the largest urban area in New Zealand. METHOD: Of the total number of practice nurses, district nurses and specialist nurses working in Auckland (n=1091), 31% were randomly selected to undertake a self-administered questionnaire and telephone interview in 2006-2008. RESULTS: Overall response was 86% (n=284 self-administered questionnaires, n=287 telephone interviews). Almost half (43%) of primary care nurses were aged over 50 years. A greater proportion of specialist nurses (89%) and practice nurses (84%) had post-registration diabetes education compared with district nurses (65%, p=0.005), from a range of educational settings including workshops, workplaces, conferences and tertiary institutions. More district nurses (35%) and practice nurses (32%) had worked in their current workplace for >10 years compared with specialist nurses (14%, p=0.004). Over 20% of practice nurses and district nurses lacked access to the internet, and the latter group had the least administrative facilities and felt least valued. DISCUSSION: These findings highlight an ageing primary health care nursing workforce, lack of a national primary health care post-registration qualification and a lack of internet access.

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  • General practice changes in South Auckland from 1990 to 1999: a threat to continuity of care?

    Kenealy, Timothy; Arroll, Bruce; Kenealy, H; Scott, DJ; Scragg, Robert; Simmons, David (2002)

    Journal article
    The University of Auckland Library

    Aims To compare composition and organisation of general practices in South Auckland between 1990 and 1999 and consider implications for continuity of care. Methods Mail questionnaires were sent to all general practitioners in South Auckland in 1990 and in 1999. Results The response rates were 88% in 1990 and 76% in 1999 (p 0.3). The mean practice size increased from 2.8 to 3.7 doctors (p 0.003), the number of GPs in solo practice halved from 31.9% to 16.7% (p 0.009), and the mean number of part-time GPs per practice doubled from 0.7 to 1.3 (p 0.0004). There was no statistically significant difference in the country of origin of the doctors between 1990 and 1999. Women in 1999, compared with the men practitioners, were more likely to work fewer than eight ???tenths??? (53.3% vs 8.1%, p 0.001), were fewer years since graduation (16.1 vs 20.4, p 0.004), had worked fewer years in South Auckland (7.9 vs 12.7, p<0.0001). Conclusion Through the 1990s there have been changes in the organisation of general practice, some of which may help and others hinder provision of continuity of care. Given that patients, practitioners and politicians value continuity of care, it is an important topic that warrants New Zealand research.

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  • Antibiotics not first-line treatment for acute purulent rhinitis

    Arroll, Bruce; Kenealy, Timothy (2009)

    Journal article
    The University of Auckland Library

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  • Antibiotics for the common cold and acute purulent rhinitis

    Arroll, Bruce; Kenealy, Timothy (2002)

    Journal article
    The University of Auckland Library

    Synopsis: Antibiotics are not effective against the common cold, but cause adverse effects The common cold is an infection of the upper respiratory tract (breathing system). It can cause a sore throat, blocked and/or runny nose, and sometimes a cough or fever. Colds are usually caused by viruses, which do not respond to antibiotics. However, antibiotics cause adverse effects, especially diarrhoea, and overuse can increase levels of antibiotic resistance in the community. The review found that trials do not show any benefit from taking antibiotics for the common cold, and adverse gastrointestinal effects are common.

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  • Higher risk of a first CVD event in Maori with diabetes quantified

    Kenealy, Timothy; Elley, C; Robinson, E; Bramley, D; Drury, P; Kerse, Ngaire (2009)

    Journal article
    The University of Auckland Library

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  • Intensive primary care treatment reduced cardiovascular risk factors at 1 year in screen-detected type 2 diabetes.

    Elley, Carolyn; Kenealy, Timothy (2009-05)

    Journal article
    The University of Auckland Library

    The article presents a study which found that an intensive, multifactorial primary care treatment strategy reduces cardiovascular (CV) risk factors more than routine care in patients with screen-detected type 2 diabetes. The study included 498 patients of 50-70 years of age who were newly diagnosed with type 2 diabetes by a 2-stage screening process. The study concluded that in patients with type 2 diabetes, intensive, multifactorial, primary care treatment strategy reduced CV risk factors..

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  • Gems of New Zealand Primary Health Care Research: Including type 2 diabetes in cardiovascular risk equations

    Elley, C; Robinson, E; Kenealy, Timothy; Bramley, D; Drury, L (2010-06)

    Journal article
    The University of Auckland Library

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  • Thiazide diuretics 'justifiable' for hypertension in patients with pre-diabetes

    Arroll, Bruce; Kenealy, Timothy; Elley, Carolyn (2009)

    Journal article
    The University of Auckland Library

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  • Audit of health data captured routinely in primary healthcare for the clinical decision support system PREDICT (PREDICT CVD-4)

    Riddell, Tania; Kenealy, Timothy; Wells, Linda; Jackson, Rodney; Broad, Joanna (2008)

    Journal article
    The University of Auckland Library

    Computerised clinical decision support systems require health data to be captured in an explicit, structured way. However, traditional patient medical records contain data that is recorded in multiple ways using coding systems, free text, medical jargon and idiosyncratic abbreviations. To be meaningful, data transferred either automatically or manually from medical records to a clinical decision support program must accurately reflect data held in the patient medical record. Aims To assess the accuracy of health data captured routinely in primary care practice by PREDICT-CVD, a clinical decision support program for supporting the assessment and management of cardiovascular disease risk. Methods Data saved in the PREDICT clinical decision support system were audited against the same patients??? data held within an electronic patient management system. The audit was conducted in three general practices in Auckland, New Zealand. Within each practice the sample included all Maori patient records and a random sample of non-Maori patient records that made the total up to 100 per practice (n=300). Results We found good agreement between the data stored within PREDICT and that held within the patient management system. For 12 of the 27 variables examined there was perfect agreement. The most common disagreements, in order of frequency, were for smoking, diabetes and ethnicity recordings. Overall, there were 70 observations where data were recorded in PREDICT (but not in the patient management system), compared to 21 occurrences where data were recorded in the patient management system (but not in PREDICT). Conclusions Health data captured routinely in general practice by the clinical decision support system PREDICT were found to be highly consistent with data held in electronic patient records. However, the use of PREDICT-CVD improved the completeness of cardiovascular risk factor documentation.

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  • GPs ??? do we need to change our name?

    Kenealy, Timothy (2006-04)

    Journal article
    The University of Auckland Library

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  • Learning to see in the clinician-patient relationship

    Buetow, Stephen; Kenealy, Timothy (2009-06)

    Journal article
    The University of Auckland Library

    Medical education tends to praise or pay lip-service to the art of observation, while systematically teaching the science of technology. To the extent you were taught observation skills as clinicians, you may have learned how to listen and touch but not usually how to ???see??? your patients and yourself. This paper considers how to see in the clinician???patient relationship, not merely in an optical sense but also to increase your perceptiveness. We suggest 10 strategies to enhance your ability to see.

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  • Analysis of Medication Possession Ratio for Improved Blood Pressure Control - Towards a Semantic Web Technology Enabled Workbench

    Mabotuwana, Thusitha; Warren, James; Gaikwad, RK; Kennelly, John; Kenealy, Timothy (2008)

    Journal article
    The University of Auckland Library

    Using a patient management ontology developed on Semantic Web technologies, we have provided a framework and workbench to identify hypertensive patients with inadequate systolic blood pressure (SBP) control. We have populated our ontology with production electronic medical record data from a general medical practice in New Zealand. Medication Possession Ratio (MPR) is used as a key concept in grouping patients whose SBP control can be improved. We also provide a prescription timeline visualisation scheme to aid a clinician in understanding a patient???s antihypertensive prescribing patterns. Both to validate our workbench and to enable immediate care improvement and research, we have utilised our framework to model the association of prescribing-based MPR to SBP. While the aggregate observed improvement in SBP is 18.55 mmHg from full as compared to nil MPR, there are poorly controlled patients among both high and low MPR groups, indicating distinct cohorts for quality improvement follow-up.

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  • The Challenge of evaluating electronic decision support in the community

    Warren, James; Gaikwad, RK; Mabotuwana, Thusitha; Adnan, Mehnaz; Kenealy, Timothy; Plimmer, Beryl; Wells, Linda; Roseman, P; Cole, K (2008)

    Journal article
    The University of Auckland Library

    There is clear room for improvement in all existing clinical decision support systems (CDSS) to more closely meet the needs of their target users and work processes. Ongoing evaluation serves not just to document benefits, but also to provide feedback to the CDSS engineering process to create more usable and effective tools. This paper discusses the challenges of achieving evaluation data that provides detail on system use at the point of care with a focus on improvement of decision support in a community setting such as a General Practice clinic. After describing some results of CDSS evaluation from the literature, as well as our own recent efforts at laboratory evaluation of the PREDICT CVD/Diabetes tool, we identify specific challenges that arise in CDSS evaluation. We suggest and discuss several approaches that may lead to facilitated and improved data gathering to help CDSS developers understand how their tools are being used and hence how to improve them, including: (a) the challenges and opportunities afforded by automated logging of CDSS usage; and (b) the value of an electronic health record interchange standard for the creation of realistic test cases.

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  • Building Capacity for Research and Audit: Outcomes of a Training Workshop for Pacific Physicians and Nurses

    Ekeroma, Alec; Kenealy, Timothy; Shulruf, B; Nosa, V; Hill, Andrew (2015-07)

    Journal article
    The University of Auckland Library

    Building the research capacity of clinicians in the Pacific Island countries is important in addressing evidence gaps relevant to local policy and clinical practice. This paper aimed to assess the effectiveness of a reproductive health research workshop in increasing research knowledge and intention to perform research amongst a diverse group of clinicians. An online survey of clinicians and stakeholders in the Pacific Islands informed a research workshop curriculum. Physicians and nurses/midwives (n = 28) from six Pacific Island countries were selected as workshop participants as part of a research capacity building program. Questionnaires before after the workshop were used to measure the changes in knowledge, confidence, competence, attitudes and intention to perform research and these were analysed thematically. Sixty-three of 85 (74%) stakeholders and clinicians responded to an online survey, which informed workshop curriculum development. Of the 28 workshop participants, seven were obstetrician-gynaecologists, eight junior physicians and eleven nurses/midwives. The mean pre-test score was 36% (???10) and the post-test was 43% (???6) (p<0.01). By profession, the obstetricians had higher prior research knowledge whereas nurses had a higher knowledge gain after the workshop. Attitude, intention and motivation to perform research was high and the participants learnt that research is important, to start small; to use routinely collected data; to encourage others to do research; and to network regionally. This paper has confirmed that online surveys, in low resource settings, can have an acceptable response rate. It has also shown that a research workshop for a diverse group of clinicians can be effective in increasing knowledge although knowledge gained was more significant amongst nurses/midwives compared to physicians. The other benefits of the research workshop were increased motivation and attitudes for research, which if well supported, should result in an increase in research output in the Pacific Islands. Future evaluation will assess the long-term effectiveness of annual research workshops and mentoring support in improving research performance and evidence utilisation in care.

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  • Educational and Wider Interventions that Increase Research Activity and Capacity of Clinicians in Low to Middle Income Countries: A Systematic Review and Narrative Synthesis

    Ekeroma, Alec; Kenealy, Timothy; Shulruf, B; Hill, Andrew (2015-02)

    Journal article
    The University of Auckland Library

    Research capacity building of clinicians in low to middle income countries may be the most powerful intervention to strengthen health systems, improve clinical standards and address inequities in healthcare. Research training in the form of workshops, postgraduate courses and collaborations are interventions that have been used to increase research activity and capacity. The aim of this literature review is to identify educational and other interventions that worked for clinicians, their characteristics and how they may have worked. Methods: Systematic search of electronic databases was performed for relevant articles from January 2000 to October 2013. Due to the small number of papers, the complex interventions and diverse methods used, a narrative synthesis along themes was used to distil the evidence. The data was collated, reviewed and themed to form four middle-level theories. A theory-driven search of the literature was then performed to identify articles to test the theories. A theoretical framework was then developed to conceptualise how the theories relate in a research capacity building programme. Results: Of 2833 identified articles, only 20 met the inclusion criteria. Most of the articles had multiple interventions, were descriptive accounts and were of variable quality. The interventions were complex and mostly poorly-described although they could be grouped into four broad classes in training workshops, postgraduate training, support and mentoring by collaboration and enhancements in the research environment. Postgraduate research training courses should be for clinicians who have funded and protected time away from clinical work. Clinical research teams can only thrive in a research-enhanced environment and supportive collaborations. Conclusion: Despite limited evidence from low to middle income countries, this review has identified that clinician-led research can be increased by focused development of a team of selected individuals and skills through postgraduate training, supported by collaborative networks and an enhanced research environment.

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  • Health Research Systems in Six Pacific Island Countries and Territories

    Ekeroma, Alec; Biribo, S; Herman, Josephine; Hill, Andrew; Kenealy, Timothy (2016-03)

    Journal article
    The University of Auckland Library

    Background: Evaluating national health research systems (NHRS) in six Paci c Island states - Fiji, Solomon Islands, Vanuatu, Samoa, Tonga and the Cook Islands - is a key step in determining whether their systems, infrastructure and processes are in place to e ectively manage health research resources and facilitate conduct of research and its implementation. Methods The COHRED questionnaire used in a 2007 mapping of the Paci c Islands was utilised to survey informants from the six countries. Results: Fiji had a more developed NHRS followed by the Cook Islands and the Solomon Islands. ere was no correlation between the degree of NHRS development and population size, level of GDP or SCImago ranking for research output. All the six countries had a research structure accompanied by a satisfactory level of coordination. However, there was not always dedicated personnel assigned and there was a lack of research policies and legislation in all jurisdictions. With the exception of Fiji and the Solomon Islands, the countries had weak ethics processes and there were no monitoring and evaluation systems with the exception of Samoa. Conclusions: The NHRS in six Paci c Island states vary from less developed in Vanuatu to more developed in Fiji. e development of the various components of a NHRS in small Island states is sensitive to political, funding and human resource pressures. ere is room for improvement; nevertheless, there is no need in developing all the components of a NHRS in a resource-constrained setting as long as the various countries develop a Paci c solution that includes research collaborations and resource sharing with other Paci c and Paci c-rim countries.

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  • Gems of New Zealand Primary Health Care Research: COPD self-management in New Zealand: patient attitudes and behaviours

    Sheridan, Nicolette; Kenealy, Timothy; Salmon, E; Rea, Harold; Raphael, Deborah; Schmidt-Busby, J (2011)

    Journal article
    The University of Auckland Library

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  • Who are the successful reproductive health clinician-researchers?

    Ekeroma, Alec; Kenealy, Timothy; Latu, R; Hill, Andrew (2016-06)

    Journal article
    The University of Auckland Library

    Health research output from the Pacific Islands is low. Improving clinicians important role in generating and utilizing research evidence to improve patient care has been the aim of research collaborations, governments and funding agencies. Twenty-eight reproductive health clinicians from six Pacific countries participated in a research workshop and were provided mentors to complete identified research projects. Completion of research tasks were assessed 18 months later using a tool co-produced by a panel of research experts. Those with academic and specialist appointments did better than other medical officers and nurses/midwives.

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