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Issue

Vol 125 No 1364: 26 October 2012

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Issue Summary

SUMMARY

Improved stroke care processes and outcomes following the institution of an acute stroke unit at a New Zealand district general hospital

Nicholas G Burgess, Ritva Vyas, Jennifer Hudson, Olivia Browne, Yun Lee, Sisira Jayathissa, Tom Thomson

A Stroke Unit is another way of saying: highly organised care for Stroke. It is proven to reduce mortality and dependency after stroke. In this paper we describe how we re-organise care for Stroke in our DHB showing marked improvements in process of care ( number of patients who got aspirin within 48hours, number of patients who got a swallow test , reduction in delay in transfer to the rehabilitation ward) and some reduction in complications such as urinary infections. We show a trend towards a reduction in length of stay and reduction in mortality. Other similar size hospitals in Australasia could reorganise their services similarly without great expense and achieve substantial benefit for their patients

SUMMARY

Young ischaemic stroke in South Auckland: a hospital-based study

Teddy Y Wu, Ajay Kumar, Edward H Wong

We performed an audit looking at the risk factors and outcome of young strokes patients (age 15-45 years) admitted to Middlemore Hospital between June 2004 and December 2009. We found a relatively high proportion of patients to have hypertension (42.7%), high cholesterol (45.8%), obesity (36.6%) and were current tobacco smokers (42.7%) at the time of the stroke. There is an over representation of Pacific Island (41.2%) and Maori (30.5%) in this group of patients studied. We believe further research into ethnic appropriate healthy initiative is required.

SUMMARY

Health-enhancing physical activity programme (HEPAP) for transient ischaemic attack and non-disabling stroke: recruitment and compliance

James Faulkner, Danielle Lambrick, Brandon Woolley, Lee Stoner, Lai-kin Wong, Gerard McGonigal

Sixty individuals who experienced a transient ischaemic attack (TIA; mini stroke) were successfully recruited and retained into a research trial. Participants were typically of European descent and lived within 20km of the study site. Distance to travel was largely reported as the primary reason for non-participation. A different approach is required to study interventions in M ori, Pacific Islanders, Asian and Indian populations. If the exercise intervention improves vascular risk factors and reduces recurrent vascular events, it could be applied to a large number of people who suffer a TIA or non-disabling stroke.

SUMMARY

A Pacific population’s access to and use of health services in Dunedin

Faafetai Sopoaga, Lianne Parkin, Andrew Gray

There are Pacific people who do not have a regular GP/health service. It was surprising that many students were in this category, as there are heavily subsidised services for tertiary students. Pacific organisations can work together with primary care providers to encourage access to services. A walk in health service provides for the needs of those whose GPs are not able to see them at short notice.

SUMMARY

General practitioner attitudes to direct-to-consumer genetic testing in New Zealand

Sanyogita Ram, Bruce Russell, Mary Gubb, Rebekah Taylor, Cassandra Butler, Imran Khan, Andrew Shelling

The aim of the study was to explore the attitudes of general practitioners (GPs) towards Direct to Consumer (DTC) Genetic Testing and elicit their perceptions of the risks and benefits associated with DTC genetic testing. Misunderstanding of results and inadequate provision of information were perceived to be the greatest risks associated. Clinical validity of tests and counselling were thought to be the most important aspects to be regulated. Respondents considered convenience to be the greatest benefit for the individual requesting DTC genetic testing. The involvement of health professionals in the DTC genetic testing process will aid patients in making informed health decisions, and ensure increased benefit from recent advances in genetic information.

SUMMARY

Carotid endarterectomy in octogenarians

Shaw-Hua Kueh, Vicki Livingstone, Ian A Thomson

Corrective surgery for carotid artery narrowing (carotid endarterectomy) to prevent stroke has previously been thought to be associated with increased perioperative complication rate amongst patients older than 80 years old (octogenarians). In our retrospective study over 9 year period, older age did not appear to be associated with significantly increased overall perioperative complication at 14% compared to 17% amongst younger patients.

SUMMARY

Investigating the pathways in primary practice leading to the diagnosis of central hypothyroidism

Veronique Gibbons, Ross Lawrenson, Phillipa Sleigh, Tania Yarndley, John V Conaglen

Clinical diagnosis of central hypothyroidism is not always obvious. Endocrinologists and biochemists have suggested that the recommended first-line strategy of TSH alone rather than requesting additional thyroid hormone samples will lead to avoidable delays in diagnosis and treatment of patients with central hypothyroidism. Central hypothyroidism is rare and is associated with a varied and prolonged course of somewhat vague symptoms. Enquiring about symptoms related to other pituitary hormone deficiencies may be helpful in establishing a diagnosis.

SUMMARY

An assessment of the Hua Oranga outcome instrument and comparison to other outcome measures in an intervention study with Māori and Pacific people following stroke

Matire Harwood, Mark Weatherall, Api Talemaitoga, P Alan Barber, John Gommans, William Taylor, Kathryn McPherson, Harry McNaughton

The Hua Oranga instrument, developed for Maori people with mental illness, showed good responsiveness and adequate psychometric properties in Maori and Pacific people after stroke. Its simplicity, relative brevity, minimal cost and adequate psychometric properties should favour its use in future studies with both Maori and Pacific people. Suggestions are made for refinements to the measure. These should be tested in a new population before Hua Oranga is recommended for general use in a clinical setting.

ALL ARTICLES
SUMMARY

Admission to Medicine at the University of Auckland

Brigid Loughnan

Direct-to-consumer genetic testing: letting the genie out of the bottle?

Dee Mangin, Ben Hudson, Les Toop

Multiple nutrient insufficiencies—hypovitaminosis D and C in young adult New Zealand males

Anitra C Carr, Margreet C M Vissers, John Lewis, Peter Elder

Proceedings of the 213th Scientific Meeting of the Otago Medical School Research Society, Wednesday 26 September 2012

Medical image. Another stroke with chest infection?

Philip M C Choi, Danielle H J Oh

The health of Pacific peoples in New Zealand

Jim Reid

Tarantula hair keratitis

Simran Singh Mangat, Bill Newman

Improved stroke care processes and outcomes following the institution of an acute stroke unit at a New Zealand district general hospital

Nicholas G Burgess, Ritva Vyas, Jennifer Hudson, Olivia Browne, Yun Lee, Sisira Jayathissa, Tom Thomson

Thigh pain—an unusual presentation of ruptured appendicitis

John English, Jean-Claude Theis

Young ischaemic stroke in South Auckland: a hospital-based study

Teddy Y Wu, Ajay Kumar, Edward H Wong

Major David Eilenberg

Smoking cessation is a prolonged journey rather than a single trip

K Marie Ditchburn, Brent Caldwell, Julian Crane

Health-enhancing physical activity programme (HEPAP) for transient ischaemic attack and non-disabling stroke: recruitment and compliance

James Faulkner, Danielle Lambrick, Brandon Woolley, Lee Stoner, Lai-kin Wong, Gerard McGonigal

Proceedings of the Waikato Clinical School Biannual Research Seminar, September 2012

A Pacific population’s access to and use of health services in Dunedin

Faafetai Sopoaga, Lianne Parkin, Andrew Gray

New Zealand’s first two-pair kidney transplant chain

Karina Voitov, Ian Dittmer, Jo Burton, Carl Muthu

General practitioner attitudes to direct-to-consumer genetic testing in New Zealand

Sanyogita Ram, Bruce Russell, Mary Gubb, Rebekah Taylor, Cassandra Butler, Imran Khan, Andrew Shelling

Cholesterol levels have negligible correlations with cardiovascular incidents

Reginald Marsh

Presidential Address: ‘A State service will eventually evolve’

Carotid endarterectomy in octogenarians

Shaw-Hua Kueh, Vicki Livingstone, Ian A Thomson

Synthetic cannabinoid use in New Zealand: a recent rebound

Leo J Schep, Robin J Slaughter, Wayne A Temple, Bruce S Lambie, Paul Gee, Martin Watts, Chip Gresham

Investigating the pathways in primary practice leading to the diagnosis of central hypothyroidism

Veronique Gibbons, Ross Lawrenson, Phillipa Sleigh, Tania Yarndley, John V Conaglen

Take it from me

Roger M Ridley-Smith

Raj Kumar Gupta

Professional Misconduct (Med10/151P)

An assessment of the Hua Oranga outcome instrument and comparison to other outcome measures in an intervention study with Māori and Pacific people following stroke

Matire Harwood, Mark Weatherall, Api Talemaitoga, P Alan Barber, John Gommans, William Taylor, Kathryn McPherson, Harry McNaughton

SUMMARY

Improved stroke care processes and outcomes following the institution of an acute stroke unit at a New Zealand district general hospital

Nicholas G Burgess, Ritva Vyas, Jennifer Hudson, Olivia Browne, Yun Lee, Sisira Jayathissa, Tom Thomson

A Stroke Unit is another way of saying: highly organised care for Stroke. It is proven to reduce mortality and dependency after stroke. In this paper we describe how we re-organise care for Stroke in our DHB showing marked improvements in process of care ( number of patients who got aspirin within 48hours, number of patients who got a swallow test , reduction in delay in transfer to the rehabilitation ward) and some reduction in complications such as urinary infections. We show a trend towards a reduction in length of stay and reduction in mortality. Other similar size hospitals in Australasia could reorganise their services similarly without great expense and achieve substantial benefit for their patients

SUMMARY

Young ischaemic stroke in South Auckland: a hospital-based study

Teddy Y Wu, Ajay Kumar, Edward H Wong

We performed an audit looking at the risk factors and outcome of young strokes patients (age 15-45 years) admitted to Middlemore Hospital between June 2004 and December 2009. We found a relatively high proportion of patients to have hypertension (42.7%), high cholesterol (45.8%), obesity (36.6%) and were current tobacco smokers (42.7%) at the time of the stroke. There is an over representation of Pacific Island (41.2%) and Maori (30.5%) in this group of patients studied. We believe further research into ethnic appropriate healthy initiative is required.

SUMMARY

Health-enhancing physical activity programme (HEPAP) for transient ischaemic attack and non-disabling stroke: recruitment and compliance

James Faulkner, Danielle Lambrick, Brandon Woolley, Lee Stoner, Lai-kin Wong, Gerard McGonigal

Sixty individuals who experienced a transient ischaemic attack (TIA; mini stroke) were successfully recruited and retained into a research trial. Participants were typically of European descent and lived within 20km of the study site. Distance to travel was largely reported as the primary reason for non-participation. A different approach is required to study interventions in M ori, Pacific Islanders, Asian and Indian populations. If the exercise intervention improves vascular risk factors and reduces recurrent vascular events, it could be applied to a large number of people who suffer a TIA or non-disabling stroke.

SUMMARY

A Pacific population’s access to and use of health services in Dunedin

Faafetai Sopoaga, Lianne Parkin, Andrew Gray

There are Pacific people who do not have a regular GP/health service. It was surprising that many students were in this category, as there are heavily subsidised services for tertiary students. Pacific organisations can work together with primary care providers to encourage access to services. A walk in health service provides for the needs of those whose GPs are not able to see them at short notice.

SUMMARY

General practitioner attitudes to direct-to-consumer genetic testing in New Zealand

Sanyogita Ram, Bruce Russell, Mary Gubb, Rebekah Taylor, Cassandra Butler, Imran Khan, Andrew Shelling

The aim of the study was to explore the attitudes of general practitioners (GPs) towards Direct to Consumer (DTC) Genetic Testing and elicit their perceptions of the risks and benefits associated with DTC genetic testing. Misunderstanding of results and inadequate provision of information were perceived to be the greatest risks associated. Clinical validity of tests and counselling were thought to be the most important aspects to be regulated. Respondents considered convenience to be the greatest benefit for the individual requesting DTC genetic testing. The involvement of health professionals in the DTC genetic testing process will aid patients in making informed health decisions, and ensure increased benefit from recent advances in genetic information.

SUMMARY

Carotid endarterectomy in octogenarians

Shaw-Hua Kueh, Vicki Livingstone, Ian A Thomson

Corrective surgery for carotid artery narrowing (carotid endarterectomy) to prevent stroke has previously been thought to be associated with increased perioperative complication rate amongst patients older than 80 years old (octogenarians). In our retrospective study over 9 year period, older age did not appear to be associated with significantly increased overall perioperative complication at 14% compared to 17% amongst younger patients.

SUMMARY

Investigating the pathways in primary practice leading to the diagnosis of central hypothyroidism

Veronique Gibbons, Ross Lawrenson, Phillipa Sleigh, Tania Yarndley, John V Conaglen

Clinical diagnosis of central hypothyroidism is not always obvious. Endocrinologists and biochemists have suggested that the recommended first-line strategy of TSH alone rather than requesting additional thyroid hormone samples will lead to avoidable delays in diagnosis and treatment of patients with central hypothyroidism. Central hypothyroidism is rare and is associated with a varied and prolonged course of somewhat vague symptoms. Enquiring about symptoms related to other pituitary hormone deficiencies may be helpful in establishing a diagnosis.

SUMMARY

An assessment of the Hua Oranga outcome instrument and comparison to other outcome measures in an intervention study with Māori and Pacific people following stroke

Matire Harwood, Mark Weatherall, Api Talemaitoga, P Alan Barber, John Gommans, William Taylor, Kathryn McPherson, Harry McNaughton

The Hua Oranga instrument, developed for Maori people with mental illness, showed good responsiveness and adequate psychometric properties in Maori and Pacific people after stroke. Its simplicity, relative brevity, minimal cost and adequate psychometric properties should favour its use in future studies with both Maori and Pacific people. Suggestions are made for refinements to the measure. These should be tested in a new population before Hua Oranga is recommended for general use in a clinical setting.

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