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Issue

Vol 129 No 1431: 11 March 2016

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Issue Summary

SUMMARY

Stroke care delivery at North Shore Hospital, Waitemata District Health Board 2014

Jennifer Yeo, Lifeng Zhou, Yogini Ratnasabapathy

This paper provides a snapshot of stroke care at North Shore Hospital (NSH) over a 2 month period. It shows significant gains being made around rates of admission to the stroke unit and brain scanning. Overall, therapy intensity received by patients at NSH is similar to UK patients, however longer delays are seen from time of admission to the first assessment of therapy for NSH patients. It is encouraging to see that prescription rates for secondary prevention (blood pressure and cholesterol) medication are similar to our Australian counterparts. For stroke survivors who are discharged from hospital, delays in access to community physiotherapy and occupational therapy are seen.

SUMMARY

Accuracy of frozen sections for breast cancer sentinel lymph node biopsies within a peripheral New Zealand hospital

James PL Tan, Lesley Joblin, Emily Davenport

Afrozen section is a test performed to give a rapid (within 30 mins) result for testing if cancer has spread to lymph nodes. It is commonly used during breast cancer surgery. The rapid result has a down-side of being less accurate than traditional testing. This study confirmed thatfrozen sections performed in Hawkes Bay meet internationally accepted standards for accuracy.

SUMMARY

Current management of acute diverticulitis: a survey of Australasian surgeons

Rebekah Jaung, Jason Robertson, David Rowbotham, Ian Bissett

Diverticular disease (DD) is a condition caused by the formation of pouch-like diverticula in the wall of the large bowel. Even though it is a relatively common condition, there is little agreement about the best way to manage DD. This survey of surgeons working in New Zealand and Australia was conducted in order to study how acute diverticulitis (AD), a common acute manifestation of DD, is routinely being managed. The results of this survey show that there is a wide range of clinical practice amongst surgeons, particularly when managing the less severe form of AD. These findings support the idea that more high quality research into this field is warranted in order to provide consistent and evidence-based care to patients with DD.

SUMMARY

Management of gestational trophoblastic disease: a survey of New Zealand O&G practice

Maria Kladnitski, Diane Kenwright

In very rare cases an early pregnancy tissue can undergo pre-cancerous or cancerous transformation. The definite diagnosis can only be made by examining the tissue under the microscope. The treatment may range from a simple observation to a full chemotherapy treatment .It has been proven that a prompt diagnosis and centralised management of the condition greatly improves treatment outcomes. The aim of our study was to obtain some information on the current practices in diagnosis and management of this condition, and explore the view of O&G Specialists on some form of centralisation of care.

SUMMARY

An exploratory study of the health harms and utilisation of health services of frequent legal high users under the interim regulated legal high market in central Auckland

Chris Wilkins, Jitesh Prasad, KC Wong, Thomas Graydon-Guy, Marta Rychert

We recruited 105 frequent legal high users from outside of licensed legal high stores in central Auckland in early 2014. Eighty percent used synthetic cannabinoids (SC) and 20% party pills . Fifty-four percent of SC users were classified as SC dependent. The most common problems reported from SC use were insomnia (29%), vomiting/nausea (25%), short temper/agitation (21%), anxiety (21%), strange thoughts (16%) and heart palpitations (14%). The health services most commonly accessed by SC users were a doctor/GP (9%), counsellor (9%), DrugHelp/MethHelp websites (7%), Alcohol & Drug Helpline (4%), ambulance (3%), A&E (3%) and hospitalisation (3%). Frequent use of SC products was associated with health problems, including drug dependency. Further research is required to determine the health risks of these products.

SUMMARY

Decision-making in an era of cancer prevention via aspirin: New Zealand needs updated guidelines and risk calculators

Nick Wilson, Vanessa Selak, Tony Blakely, Josh Knight, Nhung Nghiem, William Leung, Philip Clarke, Rod Jackson

Based on new systematic reviews of the evidence, a key US Task Force has drafted updated guidelines on the use of low-dose aspirin for the primary prevention of both cardiovascular disease (CVD) and cancer. This Task Force generally recommends consideration of aspirin in adults aged 50-69 years with 10-year CVD risk of at least 10%, in whom absolute health gain (from reduction of CVD and cancer) is estimated to exceed absolute health loss (increase in bleeds with aspirin). With the ongoing decline in CVD, current risk calculators for New Zealand are probably outdated. Nevertheless, we suspect that most smokers aged 50-69 years and some non-smokers in New Zealand would probably meet the new threshold for taking low-dose aspirin. New Zealand therefore needs updated guidelines and risk calculators that are ideally informed by estimates of absolute net health gain (in quality-adjusted life-years or QALYs per person) and cost-effectiveness.

ALL ARTICLES
SUMMARY

Stroke care delivery at North Shore Hospital, Waitemata District Health Board 2014

Jennifer Yeo, Lifeng Zhou, Yogini Ratnasabapathy

Accuracy of frozen sections for breast cancer sentinel lymph node biopsies within a peripheral New Zealand hospital

James PL Tan, Lesley Joblin, Emily Davenport

Colon cancer screening: the devil is in the details

James Church

Time to establish a New Zealand/Aotearoa Twin Registry?

Frank Houghton, Jeremy Toms, Bruce Duncan

Current management of acute diverticulitis: a survey of Australasian surgeons

Rebekah Jaung, Jason Robertson, David Rowbotham, Ian Bissett

Management of gestational trophoblastic disease: a survey of New Zealand O&G practice

Maria Kladnitski, Diane Kenwright

An exploratory study of the health harms and utilisation of health services of frequent legal high users under the interim regulated legal high market in central Auckland

Chris Wilkins, Jitesh Prasad, KC Wong, Thomas Graydon-Guy, Marta Rychert

Trouble in an hospital: honorary staff resigns

Decision-making in an era of cancer prevention via aspirin: New Zealand needs updated guidelines and risk calculators

Nick Wilson, Vanessa Selak, Tony Blakely, Josh Knight, Nhung Nghiem, William Leung, Philip Clarke, Rod Jackson

Medication review and deprescribing method for hospitalised older patients receiving multiple medications

The proposed change to primary HPV screening in New Zealand: reasons for caution

Peter Fitzgerald, Brian Cox, Andrew Miller, Sandy Hall, Jim Reid

SUMMARY

Stroke care delivery at North Shore Hospital, Waitemata District Health Board 2014

Jennifer Yeo, Lifeng Zhou, Yogini Ratnasabapathy

This paper provides a snapshot of stroke care at North Shore Hospital (NSH) over a 2 month period. It shows significant gains being made around rates of admission to the stroke unit and brain scanning. Overall, therapy intensity received by patients at NSH is similar to UK patients, however longer delays are seen from time of admission to the first assessment of therapy for NSH patients. It is encouraging to see that prescription rates for secondary prevention (blood pressure and cholesterol) medication are similar to our Australian counterparts. For stroke survivors who are discharged from hospital, delays in access to community physiotherapy and occupational therapy are seen.

SUMMARY

Accuracy of frozen sections for breast cancer sentinel lymph node biopsies within a peripheral New Zealand hospital

James PL Tan, Lesley Joblin, Emily Davenport

Afrozen section is a test performed to give a rapid (within 30 mins) result for testing if cancer has spread to lymph nodes. It is commonly used during breast cancer surgery. The rapid result has a down-side of being less accurate than traditional testing. This study confirmed thatfrozen sections performed in Hawkes Bay meet internationally accepted standards for accuracy.

SUMMARY

Current management of acute diverticulitis: a survey of Australasian surgeons

Rebekah Jaung, Jason Robertson, David Rowbotham, Ian Bissett

Diverticular disease (DD) is a condition caused by the formation of pouch-like diverticula in the wall of the large bowel. Even though it is a relatively common condition, there is little agreement about the best way to manage DD. This survey of surgeons working in New Zealand and Australia was conducted in order to study how acute diverticulitis (AD), a common acute manifestation of DD, is routinely being managed. The results of this survey show that there is a wide range of clinical practice amongst surgeons, particularly when managing the less severe form of AD. These findings support the idea that more high quality research into this field is warranted in order to provide consistent and evidence-based care to patients with DD.

SUMMARY

Management of gestational trophoblastic disease: a survey of New Zealand O&G practice

Maria Kladnitski, Diane Kenwright

In very rare cases an early pregnancy tissue can undergo pre-cancerous or cancerous transformation. The definite diagnosis can only be made by examining the tissue under the microscope. The treatment may range from a simple observation to a full chemotherapy treatment .It has been proven that a prompt diagnosis and centralised management of the condition greatly improves treatment outcomes. The aim of our study was to obtain some information on the current practices in diagnosis and management of this condition, and explore the view of O&G Specialists on some form of centralisation of care.

SUMMARY

An exploratory study of the health harms and utilisation of health services of frequent legal high users under the interim regulated legal high market in central Auckland

Chris Wilkins, Jitesh Prasad, KC Wong, Thomas Graydon-Guy, Marta Rychert

We recruited 105 frequent legal high users from outside of licensed legal high stores in central Auckland in early 2014. Eighty percent used synthetic cannabinoids (SC) and 20% party pills . Fifty-four percent of SC users were classified as SC dependent. The most common problems reported from SC use were insomnia (29%), vomiting/nausea (25%), short temper/agitation (21%), anxiety (21%), strange thoughts (16%) and heart palpitations (14%). The health services most commonly accessed by SC users were a doctor/GP (9%), counsellor (9%), DrugHelp/MethHelp websites (7%), Alcohol & Drug Helpline (4%), ambulance (3%), A&E (3%) and hospitalisation (3%). Frequent use of SC products was associated with health problems, including drug dependency. Further research is required to determine the health risks of these products.

SUMMARY

Decision-making in an era of cancer prevention via aspirin: New Zealand needs updated guidelines and risk calculators

Nick Wilson, Vanessa Selak, Tony Blakely, Josh Knight, Nhung Nghiem, William Leung, Philip Clarke, Rod Jackson

Based on new systematic reviews of the evidence, a key US Task Force has drafted updated guidelines on the use of low-dose aspirin for the primary prevention of both cardiovascular disease (CVD) and cancer. This Task Force generally recommends consideration of aspirin in adults aged 50-69 years with 10-year CVD risk of at least 10%, in whom absolute health gain (from reduction of CVD and cancer) is estimated to exceed absolute health loss (increase in bleeds with aspirin). With the ongoing decline in CVD, current risk calculators for New Zealand are probably outdated. Nevertheless, we suspect that most smokers aged 50-69 years and some non-smokers in New Zealand would probably meet the new threshold for taking low-dose aspirin. New Zealand therefore needs updated guidelines and risk calculators that are ideally informed by estimates of absolute net health gain (in quality-adjusted life-years or QALYs per person) and cost-effectiveness.

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