Alexandria Turner

Fellowship examinations in Australian vocational general practice training assess competency for unsupervised practice. Early identification of trainees at risk of failing these summative examinations facilitates pro-active remediation. This study aimed to explore the utility of formative pre-general practice assessments (PGAs), undertaken at the commencement of training, for predicting final summative examination performance. This was a retrospective cohort study. The PGAs included a written, short-answer, five-case Key Feature Problems test ('PGA-KFP') and an Objective Structured Clinical Examination ('PGA-OSCE'). Multivariable regression was used to examine the relationship between these PGAs and standardized scores on first-attempts at three summative fellowship examinations (an Applied Knowledge Test ('Fellowship-AKT'), a KFP ('Fellowship-KFP') and an OSCE ('Fellowship-OSCE'); and passing all three (versus failing at least one) examination on first attempt. Registrar demographics and training-related factors were included as covariates. Higher PGA-KFP and PGA-OSCE scores were univariably associated with higher Fellowship-AKT, Fellowship-KFP, and Fellowship-OSCE scores (all p-values ≤ 0.002) and with passing all three examinations on first attempt (p < 0.006). On multivariable analyses, higher PGA-KFP and PGA-OSCE scores were significantly associated with higher Fellowship-AKT, Fellowship-KFP (p values ≤ 0.016) but not Fellowship-OSCE scores. Higher PGA-KFP scores were also predictive of passing all three Fellowship exams on first attempt (p < 0.001). This study found intensive formative assessments conducted at the commencement of training to be predictive of final fellowship examination performance in an apprenticeship-based model of general practice training. This suggests utility of these assessments for early-identification of trainees in need of proactive remediation both in Australia and internationally. Further research is required to explore predictive utility of less resource-intensive PGAs.

Background: Cellulitis is a common bacterial skin infection usually requiring antibiotic treatment. Accurate diagnosis and management are crucial for patient prognosis and antibiotic stewardship. Phenoxymethylpenicillin is usually the recommended first‐line antibiotic for suspected streptococcal nonpurulent cellulitis. This study investigated antibiotic prescribing patterns and temporal trends for new diagnoses of cellulitis by Australian general practice registrars (speciality trainees in general practice [family medicine]). Methods: Analyses of the Registrar Clinical Encounters in Training (ReCEnT) study utilised registrars’ 2010–2021 consultation data involving new diagnoses of cellulitis. The proportion of consultations involving the prescription of antibiotics was calculated. Univariable and multivariable logistic regression examined longitudinal changes in the prescription of the two most prescribed antibiotics (cefalexin vs. flucloxacillin/dicloxacillin), adjusted for patient, registrar, practice and consultation factors. Results: A total of 3852 registrars provided data. Of 2708 new diagnoses of cellulitis, flucloxacillin/dicloxacillin was most commonly prescribed ( n = 1209; 43.6% [95% CI: 41.8, 45.5), followed by cefalexin ( n = 1191; 43.0% [95% CI: 41.1, 44.9]). Phenoxymethylpenicillin was prescribed in 0.6% of cases [95% CI: 0.3, 0.9]. Cephalexin prescription relative to flucloxacillin/dicloxacillin did not change over the 12‐year period (OR 0.99 per year [95% CI: 0.96, 1.03]). Prescription of cefalexin, compared to flucloxacillin/dicloxacillin, was associated with (compared to the age group 25–44 years) ages less than 5 years (OR 2.75 [95% CI: 1.70, 4.43], 5–14 (OR 2.51 [95% CI: 1.63, 3.89]) and 65 years and older (OR 1.51 [95% CI: 1.15, 1.99]). Cefalexin prescription was less likely when registrars sought in‐consultation information from ‘Therapeutic Guidelines (Antibiotic)’ guidelines (OR 0.58 [95% CI: 0.43, 0.80]), supervisors (OR 0.69 [95% CI: 0.51, 0.94]) or other sources (OR 0.64 [95% CI: 0.43, 0.96]). Conclusions: Phenoxymethylpenicillin was prescribed in only 0.6% of presentations, whereas cefalexin and flucloxacillin/dicloxacillin accounted for over 86% of prescriptions. This may reflect a lack of guideline specificity regarding first‐line treatment options and/or registrars’ aetiological diagnostic uncertainty. Prescribing patterns remained relatively stable over time.

Objectives Frequency of general practitioners’ (GPs’) antibiotic prescribing for acute, self-limiting respiratory tract infections (aRTIs) is high. The practice environment and culture influence the clinical behaviour, including prescribing behaviour, of GP specialist vocational trainees (registrars). We aimed to assess inter-practice variability in registrars’ antibiotic prescribing. Design This was a cross-sectional analysis from the Registrar Clinical Encounters in Training (ReCEnT) cohort study, from 2010 to 2020. Setting ReCEnT documents registrars’ clinical experiences and behaviours. Before 2016, 5 of 17 Australian training regions participated in ReCEnT. From 2016, three of nine regions (~40% of Australian registrars) participated. Participants 3210 registrars (response rate 91.8%) from 1286 training practices contributed to the analysis. Outcome measures The outcomes were prescription of an antibiotic for new diagnoses of (1) all aRTIs and (2) acute bronchitis diagnoses specifically. Prescribing percentages were calculated at the training practice level. Intraclass correlation coefficients (ICCs) were used to measure the ratio of interpractice variation to total variance. Median ORs (MORs) were also estimated to quantify interpractice variability. Results Practice-level antibiotic prescribing percentages ranged from 0% to 100% for both aRTIs and acute bronchitis diagnoses in the primary analysis. ICCs for aRTI prescribing were 0.08 (unadjusted) and 0.02 (adjusted). For acute bronchitis, ICCs were 0.10 (unadjusted) and 0.05 (adjusted). MORs were 1.66 (unadjusted) and 1.32 (adjusted) for aRTIs. MORs for acute bronchitis were 1.80 (unadjusted) and 1.53 (adjusted). This indicates a marked variation in the odds of a patient receiving antibiotics for an aRTI if randomly attending different practices. Conclusions There was considerable interpractice variation in registrars’ antibiotic prescribing frequencies. Further research is required to examine the factors accounting for this variation and to develop practice-level interventions to reduce antibiotic prescribing in high-prescribing practices.

Background: Antimicrobial resistance is a global threat. Australia has high antibiotic prescribing rates with the majority of antibiotics prescribed by general practitioners (GPs) for self-limiting acute respiratory tract infection (ARTIs). Australian GP trainees’ (registrars’) prescribing for ARTIs may have been affected by the introduction of remunerated telehealth consultations in 2020. Understanding of the impact of telehealth on antibiotic stewardship may inform registrar educational programs. Objective: This study aimed to compare the prevalence of antibiotic prescribing by GP registrars in telehealth versus face-to-face (F2F) consultations for common cold (upper respiratory tract infection [URTI]), bronchitis, sore throat, acute otitis media, and sinusitis. Methods: A cross-sectional analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) study, a multicenter inception cohort study of registrars’ in-consultation clinical and educational experiences. Analysis used univariable and multivariable logistic regression using 2020-2023 ReCEnT data. The outcome variable was “antibiotic prescribed” for new presentations of URTI, acute sore throat, acute bronchitis, acute sinusitis, and acute otitis media. The study factor was consultation type (telehealth or F2F). Results: A total of 2392 registrars participated (response rate=93.4%). The proportions of diagnoses that were managed via telehealth were 25% (5283/21384) overall, 19% (641/3327) for acute sore throat, 29% (3733/12773) for URTI, 21% (364/1772), for acute bronchitis, 4.1% (72/1758) for acute otitis media, and 27% (473/1754) for acute sinusitis. Antibiotics were prescribed for 51% (1685/3327) of sore throat diagnoses, 6.9% (880/12773) of URTI diagnoses, 64% (1140/1772) of bronchitis diagnoses, 61% (1067/1754) of sinusitis diagnoses, and 73% (1278/1758) of otitis media diagnoses. On multivariable analysis, antibiotics were less often prescribed in telehealth than F2F consultations for sore throat (adjusted odds ratio [OR] 0.69, 95% CI 0.55-0.86; P=.001), URTI (adjusted OR 0.64, 95% CI 0.51-0.81; P<.001), and otitis media (adjusted OR 0.47, 95% CI 0.26-0.84; P=.01). There were no significant differences for acute bronchitis (adjusted OR 1.07, 95% CI 0.79-1.45; P=.66) or acute sinusitis (adjusted OR 1, 95% CI 0.76-1.32; P=.99). Conclusions: GP registrars are less likely to prescribe antibiotics for sore throat, URTI, and otitis media when seeing patients by telehealth versus F2F. Understanding the reason for this difference is essential to help guide educational efforts aimed at decreasing antibiotic prescribing by GPs for conditions such as ARTIs where they are of little to no benefit. There was no evidence in this study that telehealth consultations were associated with greater registrar antibiotic prescribing for ARTIs. Therefore, there is no deleterious effect on antibiotic stewardship.

Background: Inappropriate antibiotic prescription for self-limiting respiratory tract infections (RTIs) by general practitioner (GP) registrars (trainees) is less common than by established GPs but still exceeds evidence-based benchmarks. A 2014 face-to-face educational intervention for registrars and supervisors reduced registrars’ acute bronchitis antibiotic prescription by 16% (absolute reduction). We aimed to establish the efficacy of an updated registrar/supervisor RTI-management intervention (delivered at distance) on antibiotic prescribing. Methods: A non-randomized trial using a non-equivalent control-group nested within the ReCEnT cohort study. The intervention included online educational modules, registrar and supervisor webinars, and materials for registrar-supervisor in-practice educational sessions, and focussed on acute bronchitis as an exemplar RTI. The theoretical underpinning was the ‘capability, opportunity, and motivation’ (COM-B) framework. The intervention was delivered to registrars and supervisors of one large educational/training organization annually from mid-2021, with pre-intervention period from 2017, and with postintervention period ending 2023. Two other educational/training organizations served as controls. The primary outcome was antibiotics prescribed for acute bronchitis. Analyses used multivariable logistic regression with predictors of interest: time (before/after intervention), treatment group, and an interaction term for time-by-treatment group, adjusted for potential confounders. The interaction term P-value was used to infer statistical significance of the intervention effect. Results: Of 4612 acute bronchitis presentations, 70% were prescribed antibiotics. There was a 6.9% absolute reduction (adjusted) of prescribing in the intervention-group compared with the control-group. This was not statistically significant (Pinteraction = .22). Conclusions: Failure to find a significant effect on prescribing suggests difficulties with scalability of this (and similar educational) innovations.

BACKGROUND Antimicrobial resistance is a global threat. Australia has high antibiotic prescribing rates with the majority of antibiotics prescribed by general practitioners (GPs) for self-limiting acute respiratory tract infection (ARTIs). Australian GP trainees’ (registrars’) prescribing for ARTIs may have been affected by the introduction of remunerated telehealth consultations in 2020. Understanding of the impact of telehealth on antibiotic stewardship may inform registrar educational programs. OBJECTIVE This study aimed to compare the prevalence of antibiotic prescribing by GP registrars in telehealth versus face-to-face (F2F) consultations for common cold (upper respiratory tract infection [URTI]), bronchitis, sore throat, acute otitis media, and sinusitis. METHODS A cross-sectional analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) study, a multicenter inception cohort study of registrars’ in-consultation clinical and educational experiences. Analysis used univariable and multivariable logistic regression using 2020-2023 ReCEnT data. The outcome variable was “antibiotic prescribed” for new presentations of URTI, acute sore throat, acute bronchitis, acute sinusitis, and acute otitis media. The study factor was consultation type (telehealth or F2F). RESULTS A total of 2392 registrars participated (response rate=93.4%). The proportions of diagnoses that were managed via telehealth were 25% (5283/21384) overall, 19% (641/3327) for acute sore throat, 29% (3733/12773) for URTI, 21% (364/1772), for acute bronchitis, 4.1% (72/1758) for acute otitis media, and 27% (473/1754) for acute sinusitis. Antibiotics were prescribed for 51% (1685/3327) of sore throat diagnoses, 6.9% (880/12773) of URTI diagnoses, 64% (1140/1772) of bronchitis diagnoses, 61% (1067/1754) of sinusitis diagnoses, and 73% (1278/1758) of otitis media diagnoses. On multivariable analysis, antibiotics were less often prescribed in telehealth than F2F consultations for sore throat (adjusted odds ratio [OR] 0.69, 95% CI 0.55-0.86; P=.001), URTI (adjusted OR 0.64, 95% CI 0.51-0.81; P<.001), and otitis media (adjusted OR 0.47, 95% CI 0.26-0.84; P=.01). There were no significant differences for acute bronchitis (adjusted OR 1.07, 95% CI 0.79-1.45; P=.66) or acute sinusitis (adjusted OR 1, 95% CI 0.76-1.32; P=.99). CONCLUSIONS GP registrars are less likely to prescribe antibiotics for sore throat, URTI, and otitis media when seeing patients by telehealth versus F2F. Understanding the reason for this difference is essential to help guide educational efforts aimed at decreasing antibiotic prescribing by GPs for conditions such as ARTIs where they are of little to no benefit. There was no evidence in this study that telehealth consultations were associated with greater registrar antibiotic prescribing for ARTIs. Therefore, there is no deleterious effect on antibiotic stewardship. CLINICALTRIAL

Antibiotics provide minimal benefit for sore throat, otitis media, and sinusitis. Antibiotic stewardship, with reduced prescribing, is required to address antibiotic resistance. As most antibiotic prescribing occurs in general practice and prescribing habits develop early, general practitioner (GP) trainees (registrars) are important for effective antibiotic stewardship. To establish temporal trends in Australian registrars’ antibiotic prescribing for acute sore throat, acute otitis media, and acute sinusitis. A longitudinal analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) study from 2010 to 2019. ReCEnT is an ongoing cohort study of registrars’ in-consultation experiences and clinical behaviours. Pre-2016, 5 of 17 Australian training regions participated. From 2016, 3 of 9 regions (42% of Australian registrars) participate. The outcome was prescription of an antibiotic for a new acute problem/diagnosis of sore throat, otitis media, or sinusitis. The study factor was year (2010–2019). Antibiotics were prescribed in 66% of sore throat diagnoses, 81% of otitis media, and in 72% of sinusitis. Prescribing frequencies decreased between 2010 and 2019 by 16% for sore throat (from 76% to 60%) by 11% for otitis media (from 88% to 77%) and by 18% for sinusitis (from 84% to 66%). In multivariable analyses, “Year” was associated with reduced prescribing for sore throat (OR 0.89; 95%CI 0.86–0.92; p < 0.001), otitis media (OR 0.90; 95%CI 0.86–0.94; p < 0.001), and sinusitis (OR 0.90; 95%CI 0.86, 0.94; p < 0.001). Registrars’ prescribing rates for sore throat, otitis media, and sinusitis significantly decreased during the period 2010–2019. However, educational (and other) interventions to further reduce prescribing are warranted.

Background: 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. Methods: 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. Results: 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. Conclusions: 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.

(1) Background: The aetiology of oral disease is multifactorial, involving genetic and environmental factors, including dietary ones. Bitter taste genetics may be related to oral health through dietary modulation or non-gustatory roles, including modulation of inflammation. Investigations of bitter taste and oral health associations to date have been restricted to specific polymorphisms, limited outcomes (caries), and age-groups (children), and links to inflammation remain to be elucidated. (2) Methods: A cross-sectional study (n = 65) investigated the correlations between bitter taste genotypes, oral health outcomes, and oral inflammation markers. Oral examinations were conducted, including saliva testing with evaluation of flow rate, pH, and buffering and antioxidant capacity (FRAP) and IL-1β, TNF-α, IL-6 levels. DNA was collected via buccal swabs and used to evaluate the presence of multiple bitter-taste receptor gene polymorphisms. (3) Results: The major allele for TAS2R4-rs2233998, TAS2R5-rs2227264, TAS2R50-rs1376251, and TAS2R9-rs3741845 was associated with a higher mean of unstimulated salivary flow rate, FRAP, TNF-α, IL-1β, and likelihood of filled teeth. Presence of the major allele for TAS2R4-rs2234001 and TAS2R9-rs3741845 was associated with lower means FRAP, TNF-α, IL-1β, DMFT index, and likelihood of missing teeth. (4) Conclusions: These findings suggest relationships between bitter-taste genotypes, oral health outcomes, and inflammatory markers. These findings justify the need for further studies that could help identify risk groups and develop novel agents for maintaining oral health.

Differences in sour-taste thresholds have been identified in cognition-related diseases. Diet is a modulator of cognitive health, and taste perception influences dietary preferences and habits. Heritable genetics and polymorphisms in the KCNJ2 gene involved in the transduction of sour taste have been linked to variations in sour taste and non-gustatory functions. However, relationships between sour taste genetics, mild cognitive impairment, and diet quality are yet to be elucidated. This study investigated the associations between the presence of the KCNJ2-rs236514 variant (A) allele, diet quality indices, and mild cognitive impairment evaluated by the Mini-Mental State Examination (MMSE), in a secondary cross-sectional analysis of data from the Retirement Health & Lifestyle Study. Data from 524 elderly Australians (≥65y) were analyzed, using standard least squares regression and nominal logistic regression modeling, with demographic adjustments applied. Results showed that the presence of the KCNJ2-A allele is associated with increased proportions of participants scoring in the range indicative of mild or more severe cognitive impairment (MMSE score of ≤26) in the total cohort, and males. These associations remained statistically significant after adjusting for age, sex, and diet quality indices. The absence of association between the KCNJ2-A allele and cognitive impairment in women may be related to their higher diet quality scores in all indices. The potential link between sour taste genotype and cognitive impairment scores may be due to both oral and extra-oral functions of sour taste receptors. Further studies are required on the role and relationship of neurotransmitters, sour taste genotypes and sour taste receptors in the brain, and dietary implications, to identify potential risk groups or avenues for therapeutic or prophylactic interventions.