Journal of the New Zealand Medical Association, 26-August-2005, Vol 118 No 1221
This Issue in the Journal
Breast cancer screening for women aged 40 to 49 years—what does the evidence mean for New Zealand?
S Baker, M Wall, A Bloomfield
The National Screening Unit uses an evidence-based policy approach, examining the relative benefits and harms of breast cancer screening at different ages, to advise on the most appropriate age range for BreastScreen Aotearoa (BSA). A review of the evidence demonstrates that as younger and younger women are screened, the benefits become less and the potential harms become greater. The most recent reports of the United Kingdom Age Trial suggest a smaller reduction in predicted deaths than observed in many other studies that included women below the age of 50. Any further lowering of the age range of BSA should be informed by the results of this trial as well as other high quality studies that examine both the benefits and harms of breast screening for women aged 40 to 44.
Musculoskeletal pain in the adult New Zealand population: prevalence and impact
Although overseas surveys have shown that musculoskeletal disorders are very common in the general population, there are few relevant New Zealand studies to confirm this. This postal survey of randomly selected electoral-roll registrants showed that about half the adult population experience musculoskeletal pain lasting more than 7 days in the previous month and that people with musculoskletal pain have a significantly impaired health-related quality of life. Back and shoulder pain are the most commonly affected sites. Musculoskeletal disorders should receive a higher public health priority in New Zealand.
Informed consent for vascular intervention
L Temple-Doig, M Gordon, T Buckenham, J Roake, D Lewis
The process of informed consent for an operation or medical intervention is complex and spans many interactions between patients and medical staff during “the patient journey”. The aim is to provide adequate and appropriate information to patients to help them understand and choose between treatment (or indeed no treatment) options. Gaining a patient signature on a consent form does not equate to obtaining informed consent, and some forward-thinking institutions have done away with generic consent forms. Divulgence of information to patients and patient understanding of this information is extremely difficult to assess. Documentation of the consent process, provision of patient information sheets, and use of procedure-specific consent forms may simplify as well as improve the consent process. Endorsement of these “aids to consent” by surgical institutions and national legislative bodies is desirable, if not essential.
Clinical trials in New Zealand—treading water in the knowledge wave?
A Jull, M Wills, B Scoggins, A Rodgers
Clinical trials are the most reliable means of determining whether a treatment works. Ethical approval was sought for 665 trials between 1998 and 2003. The majority of trials were drug trials for cancer, cardiovascular, and respiratory diseases. Only 1 in every 3 trials were registered on publicly available trials databases. The number of trials per year does not seem to be increasing. Few trials are focused on modifiable risk factors or fields causing significant health burden in New Zealand—e.g. smoking cessation or mental health.
Local recurrence in patients with synchronous or metachronous colorectal liver metastases—is there a difference?
M Alwan, R Stubbs
A retrospective study of several operative and pathological variables, undertaken in two groups of patients, showed no evidence that the higher recurrence rate developed in 65 patients who had liver metastases at time of bowel cancer surgery, compared with 42 patients who developed liver metastases at a later stage after the bowel cancer surgery, relates to the surgical excision or to the biological aggressiveness of the tumour. Deficiencies in, and considerable variation in the quality of, pathology reporting was noted.
Prospects for cancer control: colorectal cancer
B Cox , M Sneyd
Actions that may reduce the burden of colorectal cancer in New Zealand were reviewed, and estimates made of the number of deaths and cancers prevented. Improving surgical and other treatment services, increasing consumption of fruit and vegetables, and introducing screening would have the greatest impact on colorectal-cancer incidence and mortality.
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