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Issue

Vol 126 No 1372: 05 April 2013

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Issue Summary

SUMMARY

Ambulance triage and treatment zones at major rugby events in Wellington, New Zealand: a sobering experience

Andrew H Swain, Amanda Weaver, Alasdair J Gray, Mark Bailey, Stephen G Palmer

In 2011 and 2012, Wellington hosted the quarter finals of the Rugby World Cup as well as the New Zealand rounds of the International Rugby Boards Sevens tournament. These events attracted large numbers of fans and revellers and many required medical attention for minor injuries and illness which were most frequently associated with excessive consumption of alcohol. In preparation for these events, on-site treatment facilities staffed by paramedics were established at the stadium and in the CBD in an attempt to ease the strain on the Wellington Free Ambulance Service and the citys Emergency Department. The paramedics worked to pre-prepared guidelines and succeeded in producing a secure environment in which dehydration, vomiting, hypothermia, minor injuries and other conditions could be treated. This reduced unnecessary ambulance transport to the Emergency Department and allowed hospital staff to focus on more serious clinical emergencies. Significant healthcare savings were generated by using this model.

SUMMARY

Progression of diabetic maculopathy in patients on the Wellington Diabetic Screening Programme initially graded M3

Neil Avery, Kenneth Chan, Keith Maslin

Patients with moderate diabetic maculopathy in Wellington are currently monitored under a primary screening service. To ensure this is appropriate and no patient safety is not compromised we reviewed this screening protocol. Screening photographs were obtained, and graded for initial and subsequent screening sessions. The number of patients who had progression of maculopathy, loss of vision and the duration between screening visits were reviewed. A significant number of patients had worsening of their maculopathy between visits, however none had worsening visual acuity due to diabetic eye disease. This suggests patients with moderate maculopathy can be maintained under an optometrist based screening programme, as is the case in the United Kingdom.

SUMMARY

A standardised and validated patient survey in primary care: introducing the New Zealand General Practice Assessment Questionnaire (NZGPAQ)

Gerard Zwier

To improve the quality of care in GP practices it is important that a survey questionnaire is used which has been shown to be valid and reliable. Questionnaires which have low validity may not measure what they purport to measure and questionnaires that have little reliability will show different results each time they are used. This article documents how a very good questionnaire used by the National Health Service in the UK has been adapted to the New Zealand environment. Since 2005, some 50,000 patients have returned completed questionnaires. Subsequent analyses have shown that it is a valid and reliable survey tool. It is argued that instead of trying to understand the complex relationship between socio-demographic factors, patient expectations and situational effects, it is more productive to identify and monitor patient satisfaction with a particular GP or specific practice in an ongoing fashion and with the same questionnaire. This will enable health professionals to recognise and appreciate high scoring GPs and practices which will enable them to better understand how they can improve the quality of care.

SUMMARY

Blood pressure and hypertension in New Zealand: results from the 2008/09 Adult Nutrition Survey

Rachael M McLean, Sheila Williams, Jim I Mann, Jody C Miller, Winsome R Parnell

This study reports blood pressure results from the 2008/09 Adult Nutrition Survey - the first nationally representative measured blood pressure levels in New Zealanders aged 15 years and above. Results show that although use of medication to lower blood pressure has increased since 1997, blood pressure levels may be increasing among younger New Zealanders of New Zealand European and Other (NZEO), and Mori ethnicity; particularly those aged 35 to 54 years of age. Elevated blood pressure is an important risk factor for cardiovascular disease (heart disease and stroke). Public health interventions to improve nutrition, increase physical activity and reduce overweight and obesity are warranted.

SUMMARY

Who should manage transient ischemic attacks? A comparison between stroke experts, generalists, and electronic decision support

Annemarei Ranta, Pietro Cariga

Stroke and mini-strokes (TIAs) are medical emergencies and rapid intervention can reduce the risk of long term disability and death. This study confirms that stroke experts are highly consistent and guideline adherent when managing potential strokes and mini-strokes, while generalist management is frequently incomplete, at times inappropriate, and often non-guideline adherent. This study also indicates that the use of the bpac TIA/Stroke electronic decision support tool can closely mimic expert care and therefore offering access of this tool to generalists has the potential to significantly improve TIA/stroke management in situations were rapid access to experts cannot be guaranteed. The effect of this tool on stroke outcomes is currently being assessed in the form of a large multi-centre New Zealand wide clinical trial with results anticipated late 2013.

SUMMARY

The future of the New Zealand plastic surgery workforce

Brandon M Adams, Michael F Klaassen, Swee T Tan

The New Zealand (NZ) plastic and reconstructive surgery (PRS) workforce provides reconstructive plastic surgery (RPS) public services from six centres throughout NZ. This study analysed the current workforce, its distribution and future requirements. The NZ PRS workforce is compared with international benchmarks. NZ has a lower number of plastic surgeons per capita than comparable countries and is maldistributed with some areas notably lacking in workforce numbers. The current workforce maldistribution will worsen with future population growth and distribution. Up to 60% of the NZ population will be at risk of inadequate access to PRS services by 2027. Development of PRS services must be coordinated to ensure that equitable and sustainable services are available throughout NZ.

ALL ARTICLES
SUMMARY

Ambulance triage and treatment zones at major rugby events in Wellington, New Zealand: a sobering experience

Andrew H Swain, Amanda Weaver, Alasdair J Gray, Mark Bailey, Stephen G Palmer

Chiropractic manipulation of the neck

Andrew Gilbey, Shaun Holt, Edzard Ernst

The uptake rates of influenza vaccine in pregnant women in the Nelson region of New Zealand

Sylvia Ross, Judy Ormandy, Bia Jungji Kim

Proceedings of the Annual Meeting of the Waikato Clinical School, March 2013

Organisation

Drinking up rugby

Brad Peckler, Mai Nguyen

A rare cause of nasal septal abscess

David Waterhouse, Jeremy Hornibrook

What does ‘undiagnosed’ diabetes really mean?

Wing Cheuk Chan, Doone Winnard, Campbell Brebner, Brandon Orr-Walker

Progression of diabetic maculopathy in patients on the Wellington Diabetic Screening Programme initially graded M3

Neil Avery, Kenneth Chan, Keith Maslin

A standardised and validated patient survey in primary care: introducing the New Zealand General Practice Assessment Questionnaire (NZGPAQ)

Gerard Zwier

Blood pressure and hypertension in New Zealand: results from the 2008/09 Adult Nutrition Survey

Rachael M McLean, Sheila Williams, Jim I Mann, Jody C Miller, Winsome R Parnell

Medical image. Liver parenchyma visible during gastroscopy

Nadim El Majzoub, Assaad Soweid

Who should manage transient ischemic attacks? A comparison between stroke experts, generalists, and electronic decision support

Annemarei Ranta, Pietro Cariga

Hemifacial spasm leading to diagnosis of Moyamoya disease

Teddy Y Wu, Andrew Smith, Dean Kilfoyle

The future of the New Zealand plastic surgery workforce

Brandon M Adams, Michael F Klaassen, Swee T Tan

The cost of non-funded vaccinations in New Zealand

Jose D Perezgonzalez

Palliative care patients’ use of emergency departments

Ross Lawrenson, James Waetford, Veronique Gibbons, Peter Kirk; Sandra Haggar, Rangimahora Reddy

Transient ischaemic attacks: “mini-strokes” with major but preventable consequences

John Gommans, P Alan Barber

SUMMARY

Ambulance triage and treatment zones at major rugby events in Wellington, New Zealand: a sobering experience

Andrew H Swain, Amanda Weaver, Alasdair J Gray, Mark Bailey, Stephen G Palmer

In 2011 and 2012, Wellington hosted the quarter finals of the Rugby World Cup as well as the New Zealand rounds of the International Rugby Boards Sevens tournament. These events attracted large numbers of fans and revellers and many required medical attention for minor injuries and illness which were most frequently associated with excessive consumption of alcohol. In preparation for these events, on-site treatment facilities staffed by paramedics were established at the stadium and in the CBD in an attempt to ease the strain on the Wellington Free Ambulance Service and the citys Emergency Department. The paramedics worked to pre-prepared guidelines and succeeded in producing a secure environment in which dehydration, vomiting, hypothermia, minor injuries and other conditions could be treated. This reduced unnecessary ambulance transport to the Emergency Department and allowed hospital staff to focus on more serious clinical emergencies. Significant healthcare savings were generated by using this model.

SUMMARY

Progression of diabetic maculopathy in patients on the Wellington Diabetic Screening Programme initially graded M3

Neil Avery, Kenneth Chan, Keith Maslin

Patients with moderate diabetic maculopathy in Wellington are currently monitored under a primary screening service. To ensure this is appropriate and no patient safety is not compromised we reviewed this screening protocol. Screening photographs were obtained, and graded for initial and subsequent screening sessions. The number of patients who had progression of maculopathy, loss of vision and the duration between screening visits were reviewed. A significant number of patients had worsening of their maculopathy between visits, however none had worsening visual acuity due to diabetic eye disease. This suggests patients with moderate maculopathy can be maintained under an optometrist based screening programme, as is the case in the United Kingdom.

SUMMARY

A standardised and validated patient survey in primary care: introducing the New Zealand General Practice Assessment Questionnaire (NZGPAQ)

Gerard Zwier

To improve the quality of care in GP practices it is important that a survey questionnaire is used which has been shown to be valid and reliable. Questionnaires which have low validity may not measure what they purport to measure and questionnaires that have little reliability will show different results each time they are used. This article documents how a very good questionnaire used by the National Health Service in the UK has been adapted to the New Zealand environment. Since 2005, some 50,000 patients have returned completed questionnaires. Subsequent analyses have shown that it is a valid and reliable survey tool. It is argued that instead of trying to understand the complex relationship between socio-demographic factors, patient expectations and situational effects, it is more productive to identify and monitor patient satisfaction with a particular GP or specific practice in an ongoing fashion and with the same questionnaire. This will enable health professionals to recognise and appreciate high scoring GPs and practices which will enable them to better understand how they can improve the quality of care.

SUMMARY

Blood pressure and hypertension in New Zealand: results from the 2008/09 Adult Nutrition Survey

Rachael M McLean, Sheila Williams, Jim I Mann, Jody C Miller, Winsome R Parnell

This study reports blood pressure results from the 2008/09 Adult Nutrition Survey - the first nationally representative measured blood pressure levels in New Zealanders aged 15 years and above. Results show that although use of medication to lower blood pressure has increased since 1997, blood pressure levels may be increasing among younger New Zealanders of New Zealand European and Other (NZEO), and Mori ethnicity; particularly those aged 35 to 54 years of age. Elevated blood pressure is an important risk factor for cardiovascular disease (heart disease and stroke). Public health interventions to improve nutrition, increase physical activity and reduce overweight and obesity are warranted.

SUMMARY

Who should manage transient ischemic attacks? A comparison between stroke experts, generalists, and electronic decision support

Annemarei Ranta, Pietro Cariga

Stroke and mini-strokes (TIAs) are medical emergencies and rapid intervention can reduce the risk of long term disability and death. This study confirms that stroke experts are highly consistent and guideline adherent when managing potential strokes and mini-strokes, while generalist management is frequently incomplete, at times inappropriate, and often non-guideline adherent. This study also indicates that the use of the bpac TIA/Stroke electronic decision support tool can closely mimic expert care and therefore offering access of this tool to generalists has the potential to significantly improve TIA/stroke management in situations were rapid access to experts cannot be guaranteed. The effect of this tool on stroke outcomes is currently being assessed in the form of a large multi-centre New Zealand wide clinical trial with results anticipated late 2013.

SUMMARY

The future of the New Zealand plastic surgery workforce

Brandon M Adams, Michael F Klaassen, Swee T Tan

The New Zealand (NZ) plastic and reconstructive surgery (PRS) workforce provides reconstructive plastic surgery (RPS) public services from six centres throughout NZ. This study analysed the current workforce, its distribution and future requirements. The NZ PRS workforce is compared with international benchmarks. NZ has a lower number of plastic surgeons per capita than comparable countries and is maldistributed with some areas notably lacking in workforce numbers. The current workforce maldistribution will worsen with future population growth and distribution. Up to 60% of the NZ population will be at risk of inadequate access to PRS services by 2027. Development of PRS services must be coordinated to ensure that equitable and sustainable services are available throughout NZ.

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