Issue

Vol 129 No 1437: 1 July 2016

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Issue Summary

SUMMARY

New Zealand needs guidelines for the safe and responsible inclusion of pregnant women in medical research

Angela Ballantyne

Pregnant women continued to be excluded from nearly all clinical research, without justification, for their own safety. But this is dangerous for pregnant women and foetuses because it means there is a lack of evidence to guide their clinical care. When pregnant women get sick they end up taking medicines off label. This is not good medical practice and it is not fair. One barrier to including pregnant women in medical research in New Zealand is the lack of research ethics guidance. New Zealand needs specific ethical advice to guide researchers and research ethics committees in ensuring that pregnant women are safely and responsibly included in medical research.

SUMMARY

Incidence and type of bleeding complications early and late after acute coronary syndrome admission in a New Zealand cohort (ANZACS-QI-7)

WB Voss, M Lee, G Devlin, AJ Kerr on behalf of the All New Zealand Acute Coronary Syndromes Quality Improvement (ANZACS-QI) Investigators

Cancer of the upper gastrointestinal system (oesophagus, stomach, pancreas and bile duct system) is associated with poor prognosis and curative treatments for their diseases are generally not offered if the cancer is advanced and has spread to other areas of body as the treatments come with significant risks. PET-CT scan is a technology that utilises chemical activity of cancer and can detect cancers elsewhere in the body that can be missed on the traditional CT scan. Our study showed that PET-CT scan showed that cancer has already spread in more than 20% of patients when a CT scan has shown that there was no spread of disease. These patients would have traditionally proceeded to have an invasive surgery with poor prognosis.

SUMMARY

Auckland City Hospital’s Ortho-Geriatric Service: an audit of patients aged over 65 with fractured neck of femur

Bodhi Wimalasena, Roger Harris

This is an audit looking at hip fracture care for patients aged over 65 at Auckland City Hospital in 2013. We collected the Minimum Data Set outlined by the Australia New Zealand Hip Fracture Registry which has recently been launched. We have looked at how our data compares to Auckland City Hospital audit data from 2007, as well as established international guidelines for hip fracture care. Emergency department waiting time and the rate of provision of timely surgery have improved since 2007. Deep vein thrombosis prophylaxis coverage and osteoporosis management are areas in need of improvement.

SUMMARY

Are ethnic inequalities in 30-day ischaemic stroke survival emerging as treatment becomes more effective?

Peter Sandiford, Vanessa Selak, Mazin Ghafel

We report data showing that the chance of surviving a stroke caused by a blood clot is lower for M1ori, Pacific and Asian patients compared with Europeans and that the difference for Pacific and Asian has emerged only in the last 10 years. These inequalities have not been noted in previous studies, perhaps because they have not taken into account the differences in age at which different ethnic groups develop stroke. We do not fully understand the reason for these differences but it may be because of changes in the type and severity of the stroke, or alternatively because Europeans are getting better access to the increasing effective urgent treatments for stroke.

SUMMARY

Development and initial outcomes of an upper gastrointestinal multi-disciplinary clinic

Anna Brown, Neil Wylie, Michael Rodgers, Jonathan Casement, Neil McIlree, Lindsay Gray, Glenn Mulholland, Vicki Volkova, Erna van der Watt, Michael Booth, Jonathan B Koea

Historically patients needing input from multiple medical services prior to complex upper gastrointestinal surgery (eg removal of the stomach or pancreas) were required to attend multiple different individual outpatient appointments. This slowed their treatment progression and relied on prompt interservice communication. In 2014 Waitemata District Health Board started a single clinic to see complex upper gastrointestinal surgery patients. This clinic includes surgeons, anaesthetists, intensive care specialists, dietitians, social workers, psychologists, nurse specialists and physiotherapists. The results of the clinics first year of function show a high degree of patient and staff satisfaction, improved functioning of the multidisciplinary team looking after patients and a sense that care is more comprehensive. There is improved compliance with Ministry of Health Faster Cancer Treatment targets.

SUMMARY

Treatment of uncomplicated cystitis: analysis of prescribing in New Zealand

Natalie J Gauld, Irene SL Zeng, Rosemary B Ikram, Mark G Thomas, Stephen A Buetow

Antibiotic prescribing should follow national guidelines to help limit resistance. We analysed prescribing for women with suspected urinary tract infections in New Zealand. While most prescribers used first-line antibiotics for suspected cystitis without complicating features, the dose or duration prescribed often differed from the BPAC Antibiotics Guide. This provides a useful snapshot of antibiotic use and potential areas for improvement.

SUMMARY

Auckland City Hospital s Ortho-Geriatric Service: an audit of patients aged over 65 with fractured neck of femur

Bodhi Wimalasena, Roger Harris

This is an audit looking at hip fracture care for patients aged over 65 at Auckland City Hospital in 2013. We collected the Minimum Data Set outlined by the Australia New Zealand Hip Fracture Registry which has recently been launched. We have looked at how our data compares to Auckland City Hospital audit data from 2007, as well as established international guidelines for hip fracture care. Emergency department waiting time and the rate of provision of timely surgery have improved since 2007. Deep vein thrombosis prophylaxis coverage and osteoporosis management are areas in need of improvement.

ALL ARTICLES
SUMMARY

New Zealand needs guidelines for the safe and responsible inclusion of pregnant women in medical research

Angela Ballantyne

Adult idiopathic hypertrophic pyloric stenosis

Simon Richards, Glenn Farrant, Gerard McCarthy

Doris Gordon: the foundation of a legacy

Ronald W Jones

Incidence and type of bleeding complications early and late after acute coronary syndrome admission in a New Zealand cohort (ANZACS-QI-7)

WB Voss, M Lee, G Devlin, AJ Kerr on behalf of the All New Zealand Acute Coronary Syndromes Quality Improvement (ANZACS-QI) Investigators

Health Practitioners Disciplinary Tribunal Notices

Blood-pressure and cholesterol lowering in persons without cardiovascular disease

Auckland City Hospital’s Ortho-Geriatric Service: an audit of patients aged over 65 with fractured neck of femur

Bodhi Wimalasena, Roger Harris

Impact of PET-CT scan on management in upper gastrointestinal malignancy

Aditya Sharma, Michael Young

Are ethnic inequalities in 30-day ischaemic stroke survival emerging as treatment becomes more effective?

Peter Sandiford, Vanessa Selak, Mazin Ghafel

Development and initial outcomes of an upper gastrointestinal multi-disciplinary clinic

Anna Brown, Neil Wylie, Michael Rodgers, Jonathan Casement, Neil McIlree, Lindsay Gray, Glenn Mulholland, Vicki Volkova, Erna van der Watt, Michael Booth, Jonathan B Koea

Treatment of uncomplicated cystitis: analysis of prescribing in New Zealand

Natalie J Gauld, Irene SL Zeng, Rosemary B Ikram, Mark G Thomas, Stephen A Buetow

Ethnic inequalities in stroke: improvements not fast enough for everyone

John Fink

Douglas Paviour Short

Jill Dawson

Lodges and Doctors

Auckland City Hospital s Ortho-Geriatric Service: an audit of patients aged over 65 with fractured neck of femur

Bodhi Wimalasena, Roger Harris

Intercalated degrees in New Zealand: a call for more undergraduate medical research training opportunities

Ibrahim S Al-Busaidi

SUMMARY

New Zealand needs guidelines for the safe and responsible inclusion of pregnant women in medical research

Angela Ballantyne

Pregnant women continued to be excluded from nearly all clinical research, without justification, for their own safety. But this is dangerous for pregnant women and foetuses because it means there is a lack of evidence to guide their clinical care. When pregnant women get sick they end up taking medicines off label. This is not good medical practice and it is not fair. One barrier to including pregnant women in medical research in New Zealand is the lack of research ethics guidance. New Zealand needs specific ethical advice to guide researchers and research ethics committees in ensuring that pregnant women are safely and responsibly included in medical research.

SUMMARY

Incidence and type of bleeding complications early and late after acute coronary syndrome admission in a New Zealand cohort (ANZACS-QI-7)

WB Voss, M Lee, G Devlin, AJ Kerr on behalf of the All New Zealand Acute Coronary Syndromes Quality Improvement (ANZACS-QI) Investigators

Cancer of the upper gastrointestinal system (oesophagus, stomach, pancreas and bile duct system) is associated with poor prognosis and curative treatments for their diseases are generally not offered if the cancer is advanced and has spread to other areas of body as the treatments come with significant risks. PET-CT scan is a technology that utilises chemical activity of cancer and can detect cancers elsewhere in the body that can be missed on the traditional CT scan. Our study showed that PET-CT scan showed that cancer has already spread in more than 20% of patients when a CT scan has shown that there was no spread of disease. These patients would have traditionally proceeded to have an invasive surgery with poor prognosis.

SUMMARY

Auckland City Hospital’s Ortho-Geriatric Service: an audit of patients aged over 65 with fractured neck of femur

Bodhi Wimalasena, Roger Harris

This is an audit looking at hip fracture care for patients aged over 65 at Auckland City Hospital in 2013. We collected the Minimum Data Set outlined by the Australia New Zealand Hip Fracture Registry which has recently been launched. We have looked at how our data compares to Auckland City Hospital audit data from 2007, as well as established international guidelines for hip fracture care. Emergency department waiting time and the rate of provision of timely surgery have improved since 2007. Deep vein thrombosis prophylaxis coverage and osteoporosis management are areas in need of improvement.

SUMMARY

Are ethnic inequalities in 30-day ischaemic stroke survival emerging as treatment becomes more effective?

Peter Sandiford, Vanessa Selak, Mazin Ghafel

We report data showing that the chance of surviving a stroke caused by a blood clot is lower for M1ori, Pacific and Asian patients compared with Europeans and that the difference for Pacific and Asian has emerged only in the last 10 years. These inequalities have not been noted in previous studies, perhaps because they have not taken into account the differences in age at which different ethnic groups develop stroke. We do not fully understand the reason for these differences but it may be because of changes in the type and severity of the stroke, or alternatively because Europeans are getting better access to the increasing effective urgent treatments for stroke.

SUMMARY

Development and initial outcomes of an upper gastrointestinal multi-disciplinary clinic

Anna Brown, Neil Wylie, Michael Rodgers, Jonathan Casement, Neil McIlree, Lindsay Gray, Glenn Mulholland, Vicki Volkova, Erna van der Watt, Michael Booth, Jonathan B Koea

Historically patients needing input from multiple medical services prior to complex upper gastrointestinal surgery (eg removal of the stomach or pancreas) were required to attend multiple different individual outpatient appointments. This slowed their treatment progression and relied on prompt interservice communication. In 2014 Waitemata District Health Board started a single clinic to see complex upper gastrointestinal surgery patients. This clinic includes surgeons, anaesthetists, intensive care specialists, dietitians, social workers, psychologists, nurse specialists and physiotherapists. The results of the clinics first year of function show a high degree of patient and staff satisfaction, improved functioning of the multidisciplinary team looking after patients and a sense that care is more comprehensive. There is improved compliance with Ministry of Health Faster Cancer Treatment targets.

SUMMARY

Treatment of uncomplicated cystitis: analysis of prescribing in New Zealand

Natalie J Gauld, Irene SL Zeng, Rosemary B Ikram, Mark G Thomas, Stephen A Buetow

Antibiotic prescribing should follow national guidelines to help limit resistance. We analysed prescribing for women with suspected urinary tract infections in New Zealand. While most prescribers used first-line antibiotics for suspected cystitis without complicating features, the dose or duration prescribed often differed from the BPAC Antibiotics Guide. This provides a useful snapshot of antibiotic use and potential areas for improvement.

SUMMARY

Auckland City Hospital s Ortho-Geriatric Service: an audit of patients aged over 65 with fractured neck of femur

Bodhi Wimalasena, Roger Harris

This is an audit looking at hip fracture care for patients aged over 65 at Auckland City Hospital in 2013. We collected the Minimum Data Set outlined by the Australia New Zealand Hip Fracture Registry which has recently been launched. We have looked at how our data compares to Auckland City Hospital audit data from 2007, as well as established international guidelines for hip fracture care. Emergency department waiting time and the rate of provision of timely surgery have improved since 2007. Deep vein thrombosis prophylaxis coverage and osteoporosis management are areas in need of improvement.

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