Evaluating the impact of 2006 Australasian Clinical Practice Guidelines for nutrition in children with cystic fibrosis in Australia

Objectives: To determine the association between the implementation of the 2006 Australasian Clinical Practice Guidelines for Nutrition in Cystic Fibrosis (CF) and the nutritional status of children participating in the Australian Cystic Fibrosis Data Registry (ACFDR). Methods: This research consisted of a quantitative study using ACFDR data and a survey of clinicians and dietitians treating children with CF. Two independent cohorts of children (2–5 years and 6–11 years) were selected from ACFDR between 1998 and 2014 (N = 2304). Generalised estimating equation model was used to assess weight, height and body mass index (BMI) z-scores for each patient before and after the implementation of the nutrition guidelines. A nationwide online survey was sent to 48 clinicians to explore the enablers and barriers to implementation of the guidelines. Results: Data analysis showed significant increase (p < 0.05) in mean weight, height and BMI z-scores ranging from 0.06 to 0.18 after implementation of the guidelines in both cohorts of children. Nineteen (39%) clinicians participated in the survey. The majority of the respondents adopted the recommendations into their practice and used the guidelines as part of their professional development. Structural barriers included a lack of adequate staff resources and clinic space for consultations, inappropriate staff classification, high staff turnover and lack of mentoring support. Conclusion: In children participating in the ACFDR, nutritional status improved after the implementation of the 2006 guidelines. Survey results revealed enablers and barriers to guideline implementation and will inform implementation strategies for the revised Australasian nutrition guidelines for CF, released in 2017

What is the clinical placement experience of prevocational doctors in Victorian health services compared with the defined curriculum, and how may this have been shaped by contemporary healthcare delivery?

© 2015 Dr. Susannah Fleur AhernMedical training in Australia and comparable countries internationally is based on an apprenticeship model of training. However this has been challenged by contemporary healthcare practices as well as the limited training capacity of the acute care settings where medical training is largely undertaken. While this impacts all phases of medical training, it is the prevocational phase in Australia that is most vulnerable as its training outcomes are poorly defined and not routinely measured. Similarly, while a twelve‐month rotation‐based internship has existed in Australia for decades, the effectiveness of this model in providing core training and clinical competencies for prevocational doctors has not been rigorously evaluated, and is currently being questioned. This research seeks to better understand the clinical placement experience of prevocational doctors in Victorian Health Services, and to consider how this may be affected by contemporary healthcare delivery. The research has been designed as a mixed –methods study, where data obtained from a broad‐based survey of exposure to a range of clinical curriculum‐based activities of junior doctors from seven Victorian health services was explored by groups of junior doctor supervisors and managers. These research findings have concurred with limited previous literature, noting that prevocational trainees have limited exposure to a number of curriculum areas, particularly within the curriculum domains of procedures and emergency management, as well as teaching and learning activities, and other more complex patient management and interaction activities. It has identified that particular intern core terms and PGY2 clinical streams may provide better access to curriculum experiences than others, and that there may be particular curriculum strengths and weaknesses of prevocational training in metropolitan versus regional areas. It has also suggested that the current prevocational curriculum framework is variably understood by health service supervisors and managers, and that these findings have potentially significant implications for the trainees themselves, for length of training, and for the confidence and competence of the end practitioner. Essentially a key finding from this research is that acute health services are increasingly performing high‐risk activities within constrained environments, resulting in changes to healthcare teams and individual roles – and the legitimate peripheral participation of junior doctors in clinical care has decreased in proportion to the acuity and specialisation of the activity involved. While local educational initiatives to overcome this challenge are currently being variably utilised by health services, they do not ensure ongoing repeated curriculum exposure and therefore curriculum mastery. Instead, system‐wide issues require to be addressed by a system wide approach. Lave and Wanger’s Situated Learning theory (1991) provided a framework through which the research results were viewed, and provides a lens through which recommendations can be conceptualised. Essentially, this thesis recommends reform of prevocational training ‐ that redefines its role; that addresses curriculum ambiguity; that enhances junior doctor access to legitimate peripheral participation; and that re‐establishes communities of practice. These medical training reforms need to be undertaken within a clear, integrated governance model, and supported by ongoing evaluation and innovation

Academic health science centre models across the developing countries and lessons for implementation in Indonesia: a scoping review

Objective To describe models of academic health science centres (AHSCs) across developing countries, in order to inform AHSC development in Indonesia. Design Scoping review with systematic methods. Data sources Ovid MEDLINE, ProQuest Central, Wiley online library, Scopus and Web of Sciences were searched for relevant publications from 1 January 2015 to 1 December 2020. ‘Grey literature' was hand searched by targeted website searches, Google searches, as well as personal communication held with stakeholders in Indonesia specifically. Relevant articles regarding AHSCs in developing countries are included. The review would be synthesised to focus on the purpose, structure and core activities of AHSCs. Strategies for success were also considered. Results Twenty- six recognised AHSCs in developing countries were identified, located in Asia (n=13), Europe (n=1), South America (n=7) and Africa (n=5). Innovation, health system improvement and enhancement in academic capacity were the common visions. Most centres are functionally integrated and university-led. Most AHSCs include community health services to complement primary stakeholders such as academic institutions and hospitals. Limited information was identified regarding patient and public involvement and workforce capacity building. Five AHSCs have been piloted in Indonesia since 2018, integrating universities, academic hospitals and provincial health offices. However, information regarding their core activities and successes is limited. Conclusions The review suggests that limited published data are available on AHSC models in developing countries, but they still provide important insight into AHSC development in Indonesia. Innovation and health systems strengthening are the common visions. Functional integration with university leadership is the most common model of governance. Other than universities and hospitals, community health centres, research centres and regional health offices are common partners. There is a little description of community engagement and workforce capacity building

Forecasting of Lung Cancer Incident Cases at the Small-Area Level in Victoria, Australia

Predicting lung cancer cases at the small-area level is helpful to quantify the lung cancer burden for health planning purposes at the local geographic level. Using Victorian Cancer Registry (2001–2018) data, this study aims to forecast lung cancer counts at the local government area (LGA) level over the next ten years (2019–2028) in Victoria, Australia. We used the Age-Period-Cohort approach to estimate the annual age-specific incidence and utilised Bayesian spatio-temporal models that account for non-linear temporal trends and area-level risk factors. Compared to 2001, lung cancer incidence increased by 28.82% from 1353 to 1743 cases for men and 78.79% from 759 to 1357 cases for women in 2018. Lung cancer counts are expected to reach 2515 cases for men and 1909 cases for women in 2028, with a corresponding 44% and 41% increase. The majority of LGAs are projected to have an increasing trend for both men and women by 2028. Unexplained area-level spatial variation substantially reduced after adjusting for the elderly population in the model. Male and female lung cancer cases are projected to rise at the state level and in each LGA in the next ten years. Population growth and an ageing population largely contributed to this rise

Victorian junior doctors' perception of their competency and training needs in healthcare management

Introduction. Australian medical speciality colleges have adapted and integrated the CanMEDS Physician Competency Framework into their training programs. The role as manager is one of the competencies and is presently thought to receive little attention during training. The objective of our study was to investigate the perceptions of Australian junior doctors regarding their management skills and their perceived need for management education. Methods. In November and December 2011, 1376 junior doctors from eight Victorian metropolitan health services were invited via email to participate in this study. Participating junior doctors received a questionnaire regarding their self-perceived management skills and knowledge and a medical management training needs assessment. Results. The response rate of one of the health centres was too low (6%) and therefore insufficient for credible conclusions to be drawn. Of the other health services, 194 (16%) out of 1213 junior doctors responded to the survey. Overall, the junior doctors rated their perceived competency on a 1-5 Likert scale as moderate (mean 3.45; s.d. 0.42). Of the 194 residents who responded, 71.3% (n = 139) reported a need for management training. Discussion. The junior doctors of Victoria, Australia perceived their knowledge on medical management as moderate. The results of this study showed that there is a perceived need among junior doctors for more management training. This need seems to confirm that management skills are thought to be valuable in medical practice. Our study also suggests that before the development of specific interventions, there is a need for a gap analysis between the perceived and actual management skills desired in medical residents. The attention paid to the role 'as manager' should therefore be embedded in training of all junior doctors

The global impact of SARS-CoV-2 in 181 people with cystic fibrosis

With the growing SARS-CoV-2 pandemic, we need to better understand its impact in specific patient groups like those with Cystic Fibrosis (CF). We report on 181 people with CF (32 post-transplant) from 19 countries diagnosed with SARS-CoV-2 prior to 13 June 2020. Infection with SARS-CoV-2 appears to exhibit a similar spectrum of outcomes to that seen in the general population, with 11 people admitted to intensive care (7 post-transplant), and 7 deaths (3 post-transplant). A more severe clinical course may be associated with older age, CF-related diabetes, lower lung function in the year prior to infection, and having received an organ transplant. Whilst outcomes in this large cohort are better than initially feared overall, possibly due to a protective effect of the relatively younger age of the CF population compared to other chronic conditions, SARS-CoV-2 is not a benign disease for all people in this patient group