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Issue

Vol 123 No 1315: 28 May 2010

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Issue Summary

SUMMARY

Is the prevalence of CYP2C19 genetic variants different in Pacific people than in New Zealand Europeans?

Nuala Helsby, Michael Goldthorpe, Peter Gow, Janak de Zoysa

There are large differences in how people respond to therapy: some people respond well, others have little or no benefit and some will have side effects. This inter-individual variability may be due to differences in how the body degrades drugs. Drugs are degraded in the body by liver enzymes such as cytochrome P450 (CYP). Many of the CYP enzymes display variability which can be predicted from a persons genotype (pharmacogenetics). For example, CYP2C19, an enzyme involved in the metabolism of more than 10% of the top 200 prescribed drugs, has genetic variants (CYP2C19*2 & CYP2C19*3) which result in a poor metabolism in certain people. Another variant (CYP2C19*17) has been associated with ultrarapid metabolism. These variants and their consequences have been extensively studied in European populations, but little is known about their presence in Pacific peoples. This study suggests that further work in this area is warranted.

SUMMARY

Rural general practitioner perspectives of the needs of Māori patients requiring palliative care

Ross Lawrenson, Dot Smyth, Erena Kara, Rachel Thomson.

This paper discusses rural general practitioners perspectives on the palliative care needs of M ori. Whilst some rural doctors rarely encounter M ori patients, for others caring for M ori who are in need of palliative care is an important part of their practice. Key themes that appeared were the need for better communication when dealing with M ori, the need for more M ori nurses, and increased information about hospice/palliative care services for M ori. Further research in this area from a patient perspective would be valuable.

SUMMARY

An audit of patients treated for syphilis at Auckland Sexual Health Service

Sunita Azariah

This paper is a retrospective review of the clinical management of 109 patients who were recently treated for syphilis at Auckland Sexual Health Service. Syphilis was rare in NZ until the last 5 years and most cases were acquired overseas. However syphilis is becoming increasingly common in NZ and the main people at risk are men who have sex with men. This is a trend that has happened in other developed countries such as the USA, UK, Europe and Australia. Correct treatment and follow-up is important to ensure that the infection resolves as syphilis can have serious complications. Syphilis can be transmitted sexually or from a pregnant woman to her unborn baby. This paper discusses the results of treatment and follow-up of 109 cases and concludes that management at Auckland Sexual Health Service compared well with UK audits of syphilis management.

SUMMARY

A multi-setting audit of the management of genital Chlamydia trachomatis infection

Jane Morgan, Andre Donnell, Anita Bell

In 2008, the New Zealand Ministry of Health drafted guidelines for chlamydia management that emphasised targeted testing of those with known risk factors, along with prompt identification of cases and treatment of their sexual contacts. This paper reports an audit of case management of genital chlamydia infection in a range of clinical settings in the Waikato District Health Board, using the proposed new guidelines as the recommended standard. Identified potential gaps include documentation of advice given as part of case management and, more importantly, lack of effective partner management. This baseline audit has helped shape the development of education and training resources for all local providers as part of implementation of the new management guidelines. Further, it is hoped that participation in the audit may in turn contribute to improved case management.

SUMMARY

Increasing medical student interest in general practice in New Zealand: where to from here?

Phillippa Poole, David Bourke, Boaz Shulruf

This discussion paper looks at the level of interests of University of Auckland medical students in general practice within the wider context of NZs future health needs and the current GP workforce. NZ students have levels of interest in general practice comparable with international data. With the limitation that this study measures intentions only and not who eventually worked in general practice, the level of interest is insufficient. Ways to increase interest in general practice are discussed. This might involve medical schools enrolling more students from groups with higher interest levels (rural, M ori and Pacific, NZ-born), a greater emphasis on the positive aspects of general practice, and on GPs as equals to other specialists.

SUMMARY

Rural hospitals in New Zealand: results from a survey

Martyn Williamson, Andrew Gormley, Susan Dovey, Patrick Farry

We conducted a survey of all New Zealand rural hospitals (both DHB-governed and community governed) to describe the variety and range of work that they perform, and to examine the factors that might influence either of these. We found that their catchment populations range from 750 to 45,000. They are staffed by either Medical Officers of Special Scale or General Practitioners, they do not all have laboratory services and radiology services available on-site and they care for a wide range of patients and manage health conditions covering many different vocational areas of practice. We conclude that rural hospitals play an important and unique role in New Zealands healthcare system which is currently unrecognised.

ALL ARTICLES
SUMMARY

Is the prevalence of CYP2C19 genetic variants different in Pacific people than in New Zealand Europeans?

Nuala Helsby, Michael Goldthorpe, Peter Gow, Janak de Zoysa

Australian recruitment advertising in the NZMJ—with response by Don Simmers

Greg Judkins

George Condor Hitchcock

Rural general practitioner perspectives of the needs of Māori patients requiring palliative care

Ross Lawrenson, Dot Smyth, Erena Kara, Rachel Thomson.

Marketing tobacco to New Zealand women: 8 ways to reflect on “World No Tobacco Day”

Nick Wilson, Janet Hoek, Jo Peace, Heather Gifford, George Thomson, Richard Edwards

Practising without an Annual Practising Certificate – Professional Misconduct (Med09/129P)

An audit of patients treated for syphilis at Auckland Sexual Health Service

Sunita Azariah

Sexual Relationship with a Patient – Professional Misconduct (Med09/120P)

The New Zealand World Health Organization Quality of Life (WHOQOL) Group

Rex Billington, Jason Landon, Christian U Kr 00e4geloh, Daniel Shepherd

31st World Medical & Health Games: Poreč, Croatia 3–10 July 2010

Anticoagulant-induced intramural haematoma of the caecum mimicking a colonic tumour

Jesse Fischer, Paul Samson, Greg Robertson

Medical image. A complication of H1N1 influenza A swine" flu"

Alexander E T Finlayson, Jamie M Strachan

Postgraduate medical education in New Zealand: at the crossroads

Don Simmers

Urban rickettsiosis in the Waikato region of New Zealand

Anurag Sekra, James Irwin, Paul Reeve

The future disposition of the New Zealand medical workforce

Des Gorman

Medical Benevolent Fund

A multi-setting audit of the management of genital Chlamydia trachomatis infection

Jane Morgan, Andre Donnell, Anita Bell

Increasing medical student interest in general practice in New Zealand: where to from here?

Phillippa Poole, David Bourke, Boaz Shulruf

Murray James Overington

Codes, codes, and more codes

F Allan Cockburn

Paratyphoid fever

Rural hospitals in New Zealand: results from a survey

Martyn Williamson, Andrew Gormley, Susan Dovey, Patrick Farry

Examination Medicine: a guide to physician training (6th edition; Nicholas J Talley, Simon O'Connor)

Christina McLachlan, Lutz Beckert

University of Otago Faculty of Medicine Freemasons Postgraduate Fellowships in Paediatrics and Child Health for 2011

SUMMARY

Is the prevalence of CYP2C19 genetic variants different in Pacific people than in New Zealand Europeans?

Nuala Helsby, Michael Goldthorpe, Peter Gow, Janak de Zoysa

There are large differences in how people respond to therapy: some people respond well, others have little or no benefit and some will have side effects. This inter-individual variability may be due to differences in how the body degrades drugs. Drugs are degraded in the body by liver enzymes such as cytochrome P450 (CYP). Many of the CYP enzymes display variability which can be predicted from a persons genotype (pharmacogenetics). For example, CYP2C19, an enzyme involved in the metabolism of more than 10% of the top 200 prescribed drugs, has genetic variants (CYP2C19*2 & CYP2C19*3) which result in a poor metabolism in certain people. Another variant (CYP2C19*17) has been associated with ultrarapid metabolism. These variants and their consequences have been extensively studied in European populations, but little is known about their presence in Pacific peoples. This study suggests that further work in this area is warranted.

SUMMARY

Rural general practitioner perspectives of the needs of Māori patients requiring palliative care

Ross Lawrenson, Dot Smyth, Erena Kara, Rachel Thomson.

This paper discusses rural general practitioners perspectives on the palliative care needs of M ori. Whilst some rural doctors rarely encounter M ori patients, for others caring for M ori who are in need of palliative care is an important part of their practice. Key themes that appeared were the need for better communication when dealing with M ori, the need for more M ori nurses, and increased information about hospice/palliative care services for M ori. Further research in this area from a patient perspective would be valuable.

SUMMARY

An audit of patients treated for syphilis at Auckland Sexual Health Service

Sunita Azariah

This paper is a retrospective review of the clinical management of 109 patients who were recently treated for syphilis at Auckland Sexual Health Service. Syphilis was rare in NZ until the last 5 years and most cases were acquired overseas. However syphilis is becoming increasingly common in NZ and the main people at risk are men who have sex with men. This is a trend that has happened in other developed countries such as the USA, UK, Europe and Australia. Correct treatment and follow-up is important to ensure that the infection resolves as syphilis can have serious complications. Syphilis can be transmitted sexually or from a pregnant woman to her unborn baby. This paper discusses the results of treatment and follow-up of 109 cases and concludes that management at Auckland Sexual Health Service compared well with UK audits of syphilis management.

SUMMARY

A multi-setting audit of the management of genital Chlamydia trachomatis infection

Jane Morgan, Andre Donnell, Anita Bell

In 2008, the New Zealand Ministry of Health drafted guidelines for chlamydia management that emphasised targeted testing of those with known risk factors, along with prompt identification of cases and treatment of their sexual contacts. This paper reports an audit of case management of genital chlamydia infection in a range of clinical settings in the Waikato District Health Board, using the proposed new guidelines as the recommended standard. Identified potential gaps include documentation of advice given as part of case management and, more importantly, lack of effective partner management. This baseline audit has helped shape the development of education and training resources for all local providers as part of implementation of the new management guidelines. Further, it is hoped that participation in the audit may in turn contribute to improved case management.

SUMMARY

Increasing medical student interest in general practice in New Zealand: where to from here?

Phillippa Poole, David Bourke, Boaz Shulruf

This discussion paper looks at the level of interests of University of Auckland medical students in general practice within the wider context of NZs future health needs and the current GP workforce. NZ students have levels of interest in general practice comparable with international data. With the limitation that this study measures intentions only and not who eventually worked in general practice, the level of interest is insufficient. Ways to increase interest in general practice are discussed. This might involve medical schools enrolling more students from groups with higher interest levels (rural, M ori and Pacific, NZ-born), a greater emphasis on the positive aspects of general practice, and on GPs as equals to other specialists.

SUMMARY

Rural hospitals in New Zealand: results from a survey

Martyn Williamson, Andrew Gormley, Susan Dovey, Patrick Farry

We conducted a survey of all New Zealand rural hospitals (both DHB-governed and community governed) to describe the variety and range of work that they perform, and to examine the factors that might influence either of these. We found that their catchment populations range from 750 to 45,000. They are staffed by either Medical Officers of Special Scale or General Practitioners, they do not all have laboratory services and radiology services available on-site and they care for a wide range of patients and manage health conditions covering many different vocational areas of practice. We conclude that rural hospitals play an important and unique role in New Zealands healthcare system which is currently unrecognised.

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