125 results for Kenealy, Timothy, Journal article

  • 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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  • Hepatitis B screening, outcomes and management of pregnant women and infants in the Cook Islands. SHORT TITLE Antenatal screening for hepatitis B in the Cook Islands

    Aung, YYM; Sowter, M; Kenealy, Timothy (2015-12-30)

    Journal article
    The University of Auckland Library

    Background To describe current Cook Islands practice for screening and management of Hepatitis B (HB) in pregnant women and their newborns and to consider the implications of an updated screening and management strategy. Methods Retrospective study of pregnant women booked for antenatal care in Cook Islands from January 2010 to December 2014 was conducted. Data were collected on maternal Hepatitis B serology status, timeliness of hepatitis B immune globulin given if indicated and the completion of hepatitis B immunisation for newborns who were due their vaccinations, special service referral and contact tracing from the electronic health information system. Simple descriptive statistics were used to report the data. All women who attended the antenatal clinics accepted Hepatitis B screening in pregnancy. Data from 803 women were analysed. Findings Hepatitis B surface antigen (HBsAg) was detected in 23 of 803 (2.9%) of women of which 21 were Antibody-HBs (Anti-HBs) positive and two were hepatitis B e antigen (HBeAg) positive. Hepatitis B DNA viral load was unable to be tested. Hepatitis B immune globulin was given to 21 of the 23 babies within one day, one was given on day 3 but one was missed. None of the 23 mothers and their babies had any ongoing follow up. The first Hepatitis B vaccine, due within 24 hours of birth, was given within a day to 743 of the 803 (93%) of babies. The second, due at 6 weeks, was given by 8 weeks to 645 of the 778 babies due for their six week vaccination (83%). The third, due at 3 months, was given by 4 months to 648 of the 744 (87%). The fourth, due at 5 months was given by 6 months to 553 of the 712 (78%). Of the 712 babies over 6 months of age, 601 (84%) were recorded as having completed four HB vaccines at any time. Conclusion The hepatitis B screening and immunisation in the Cook Islands appears effective but this study indicates that the follow up of both the mother and their infants needs to be improved.

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  • Removal of a foreign body

    Kenealy, Timothy; Murtagh, J (1996-03-01)

    Journal article
    The University of Auckland Library

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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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  • 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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  • 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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  • Use of antidepressants for depression in primary care

    Arroll, Bruce; Elley, CR; Fishman, Tana; Goodyear-Smith, Felicity; Kenealy, Timothy; Blashki, G; Kerse, Ngaire; MacGillivray, S (2010)

    Journal article
    The University of Auckland Library

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  • 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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  • 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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  • Health Research Systems in Six Pacific Island Countries and Territories

    Ekeroma, Alec; Biribo, S; Herman, Josephine; Hill, A; 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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  • 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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  • 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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  • 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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  • Management of type 2 diabetes

    Tracey, Jocelyn; Kenealy, Timothy; Sinclair, G (2002)

    Journal article
    The University of Auckland Library

    Presents a systematic approach to the monitoring of patients with diabetes. Outlines management guidelines for glycaemic control, retinal screening, diabetic nephropathy, diabetic foot care, hypertension, smoking and cholesterol. Offers a step-by-step guide to starting patients on insulin.

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

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

    Journal article
    The University of Auckland Library

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  • Hunger can be taught: Hunger Recognition regulates eating and improves energy balance

    Ciampolini, Mario; Lovell-Smith, David; Kenealy, Timothy; Bianchi, Riccardo (2013-06-15)

    Journal article
    The University of Auckland Library

    A set of spontaneous hunger sensations, Initial Hunger (IH), has been associated with low blood glucose concentration (BG). These sensations may arise pre-meal or can be elicited by delaying a meal. With self-measurement of BG, subjects can be trained to formally identify and remember these sensations (Hunger Recognition). Subjects can then be trained to ensure that IH is present pre-meal for most meals and that their pre-meal BG is therefore low consistently (IH Meal Pattern). IH includes the epigastric Empty Hollow Sensation (the most frequent and recognizable) as well as less specific sensations such as fatigue or light-headedness which is termed inanition. This report reviews the method for identifying IH and the effect of the IH Meal Pattern on energy balance. In adults, the IH Meal Pattern has been shown to significantly decrease energy intake by one-third, decrease preprandial BG, reduce glycosylated hemoglobin, and reduce insulin resistance and weight in those who are insulin resistant or overweight. Young children as well as adults can be trained in Hunger Recognition, giving them an elegant method for achieving energy balance without the stress of restraint-type dieting. The implications of improving insulin sensitivity through improved energy balance are as wide as improving immune activity.

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  • Childhood immunisations in Northland, New Zealand: declining care and the journey through the immunisation pathway

    Rumball-Smith, J; Kenealy, Timothy (2016-07-15)

    Journal article
    The University of Auckland Library

    In a region with high rates of immunisation refusal, we examine whether refusing an immunisation at 6 weeks (the first scheduled immunisation) predicts the pattern for subsequent scheduled immunisations, and the characteristics of those who declined these immunisations.We used data from the National Immunisation Register to identify 11,972 children born between 1 January 2009 and 31 December 2013 (inclusive), and who had their first immunisation (due at 6 weeks age) in Northland, New Zealand. At each immunisation event, individual vaccines are recorded as being delivered or declined. This cohort was 'followed' to determine which of these children received or declined the scheduled 3-month and 5-month immunisations.Immunisation providers delivered a full immunisation programme to 10,828/11,927 (90%) of the cohort. Caregivers of 897 (7%) of children declined the 6-week vaccination. Of this group, 872 (97%) also declined the 3-month and 850 (95%) declined the 5-month immunisations, constituting 872/962 (91%) and 850/923 (92%) of all declined immunisations, respectively. In the decline group, there was variability with primary care practice, and differences according to ethnic group and deprivation profile.Increasing Northland's immunisation coverage may require primary care providers to more actively engage with declining caregivers prior to the 3-month and 5-month vaccinations. Immunisation information and decision-making programmes targeted at parents and providers in the antenatal and prenatal period may also be of benefit, in addition to considering regulatory and incentive strategies.

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