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Issue

Vol 129 No 1439: 5 August 2016

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Issue Summary

SUMMARY

The All New Zealand Acute Coronary Syndrome Quality Improvement Programme: Implementation, Methodology and Cohorts (ANZACS-QI 9)

AJ Kerr, MJA Williams, S Harding , H White, RN Doughty, C Nunn, G Devlin, C Grey, M Lee, C Flynn, M Rhodes, K Sutherland, S Wells, RT Jackson, RAH Stewart, on behalf of the ANZACS-QI investigators

There is a formidable evidence base supporting the use of a range of lifestyle, pharmaceutical and interventional treatments to improve outcomes in patients with heart attacks. However, in practice, there is often a substantial gap between ideal treatment based on clinical trials and what is achieved in practice. The identification of these evidence-practice gaps, and the implementation of programmes to close them, represent an important opportunity to improve the outcomes of patients with CVD in New Zealand. The All New Zealand Acute Coronary Syndrome Quality Improvement programme (ANZACS-QI) has recently been implemented in 41 NZ public hospitals to support appropriate, evidence based management of ACS and subsequently of other cardiac patients regardless of age, sex, ethnicity, socioeconomic status, or rural or city dwelling. In this report we describe the development and national implementation of ANZACS-QI, its governance, the data collection processes and the current ANZACS-QI cohorts and available results.

SUMMARY

Pregnant women lack accurate knowledge of their BMI and recommended gestational weight gain

Emma Jeffs, Jillian J Haszard, Benjamin Sharp, Joanna Gullam, Helen Paterson

This study indicates that New Zealand women, particularly those who are overweight and obese, are unaware of of their own body size, and this may lead to an under or over-estimation of the right amount of weight they should gain in their pregnancy, which may in turn lead to increased risk of poor health outcomes for both mother and baby. Public Health campaigns, related to healthy weight gain in pregnancy, similar to those aimed at giving up smoking in pregnancy, are urgently required.

SUMMARY

Key design features of a new smokefree law to help achieve the Smokefree Aotearoa

Louise Delany, George Thomson, Nick Wilson, Richard Edwards

University of Otago researchers propose a comprehensive new law to help New Zealand reach the governments Smokefree 2025 goal. The law would require all those dealing with tobacco to be licensed, and the makeup of tobacco products (for instance, flavours and sugar) would be controlled. If smoking prevalence targets relevant to the 2025 goal are not reached, tobacco sales would be moved to non-commercial agencies.

SUMMARY

TABLE - ‘Poorly defined’: unknown unknowns in New Zealand rural health

David Fearnley, Ross Lawrenson, Garry Nixon

Ensuring equity of access to health services and outcomes for rural people in NZ is compromised by the Statistics NZ definition of rurality which is not suitable for the purposes of health research. The geographic definition does not take available health services into account and so the population defined as rural differs from that which actually receives rural health care. Around 40% of the people who actually access rural health services are currently classified as urban, and 20% of those defined as rural actually receive urban health care. The extent of this mismatch masks any inequality in health care access or outcomes that may exist and hampers all current and future research. Rural versus urban disparities in both access to health services and in health outcomes are well recognised in other similar countries. It is quite likely these same disparities exist in NZ but we don t have the tools to uncover and describe them. Until we can identify these disparities we won t see rural healthcare policy to address them. We are proposing a fit for purpose definition of rurality for rural research, and to use this definition to analyse current health data to better understand rural health in NZ. Rural healthcare research in NZ is a very undeveloped field.

SUMMARY

Smoking in cars: knowledge, behaviours and support for smokefree cars legislation among New Zealand smokers and recent quitters

Judy Li, Sarah Nelson, Rhiannon Newcombe, Darren Walton

This study fills the information gap around smoking in cars, by providing a more complete picture of the attitudes and behaviours of smokers and recent quitters. The findings noted that smoking in cars is still a problem in New Zealand. This problem could possibly be addressed through new health promotion messages to improve understanding of the health risks caused by smoking in cars, or through legislation. In fact, a large majority of respondents in this study supported banning smoking in cars while children are in them.

SUMMARY

Smoking prevalence in New Zealand from 1996 2015: a critical review of national data sources to inform progress toward the Smokefree 2025 goal

Jude Ball, James Stanley, Nick Wilson, Tony Blakely, Richard Edwards

The New Zealand Government has committed to a goal of becoming a smokefree nation by 2025. This study analysed findings from the Census, the New Zealand Health Survey and the Health and Lifestyles Survey to assess progress towards the smokefree goal. The findings show that recent declines in smoking are modest, and are clearly inadequate for achieving the Smokefree 2025 and interim 2018 goals, particularly for Mori and Pacific peoples. Mori and Pacific smoking rates remain unacceptably high, and urgent action is needed to reduce the health burden of tobacco on these communities.

SUMMARY

Improved scores for observed teamwork in the clinical environment following a multidisciplinary operating room simulation intervention

Jennifer Weller, David Cumin, Ian Civil, Jane Torrie, Alexander Garden, Andrew MacCormick, Nishanthi Gurusinghe, Matthew Boyd, Christopher Frampton, Ludvig Selander, Martina Cokorilo, Magnus Tranvik, Lisa Carlsson, Tracey Lee, Wai Leap Ng, Michael Crossan, Alan Merry

Failures in teamwork and communication are a contributing factor in the majority of unintended events causing patient harm. To address this, we provided team training for 20 complete general surgical teams from two large metropolitan hospitals in the Multidisciplinary Operating Room Simulation (MORSim) course. To evaluate if this team training was effective, we observed operating room teams in over 200 cases before and after the training, and scored teamwork performance. We found a significant improvement in teamwork scores following MORSim. Previous research suggests this would translate to a clinically important reduction in patient harm for surgical patients. On the basis of these findings, ACC has provided funding for the national roll out of MORSim in every public hospital in New Zealand.

ALL ARTICLES
SUMMARY

Inappropriate vasopressin secretion due to limbic encephalitis secondary to LGI1 antibodies

Sonakshi Sharma, Ian Holdaway

The All New Zealand Acute Coronary Syndrome Quality Improvement Programme: Implementation, Methodology and Cohorts (ANZACS-QI 9)

AJ Kerr, MJA Williams, S Harding , H White, RN Doughty, C Nunn, G Devlin, C Grey, M Lee, C Flynn, M Rhodes, K Sutherland, S Wells, RT Jackson, RAH Stewart, on behalf of the ANZACS-QI investigators

Alcohol intake and risk of breast cancer and coronary heart disease among postmenopausal women

Pregnant women lack accurate knowledge of their BMI and recommended gestational weight gain

Emma Jeffs, Jillian J Haszard, Benjamin Sharp, Joanna Gullam, Helen Paterson

Key design features of a new smokefree law to help achieve the Smokefree Aotearoa

Louise Delany, George Thomson, Nick Wilson, Richard Edwards

Military eyesight and compensation

Making the next steps the right ones: progress towards the Smokefree Aotearoa 2025 Goal

Judith McCool, Chris Bullen

TABLE - ‘Poorly defined’: unknown unknowns in New Zealand rural health

David Fearnley, Ross Lawrenson, Garry Nixon

Smoking in cars: knowledge, behaviours and support for smokefree cars legislation among New Zealand smokers and recent quitters

Judy Li, Sarah Nelson, Rhiannon Newcombe, Darren Walton

Smoking prevalence in New Zealand from 1996 2015: a critical review of national data sources to inform progress toward the Smokefree 2025 goal

Jude Ball, James Stanley, Nick Wilson, Tony Blakely, Richard Edwards

Improved scores for observed teamwork in the clinical environment following a multidisciplinary operating room simulation intervention

Jennifer Weller, David Cumin, Ian Civil, Jane Torrie, Alexander Garden, Andrew MacCormick, Nishanthi Gurusinghe, Matthew Boyd, Christopher Frampton, Ludvig Selander, Martina Cokorilo, Magnus Tranvik, Lisa Carlsson, Tracey Lee, Wai Leap Ng, Michael Crossan, Alan Merry

SUMMARY

The All New Zealand Acute Coronary Syndrome Quality Improvement Programme: Implementation, Methodology and Cohorts (ANZACS-QI 9)

AJ Kerr, MJA Williams, S Harding , H White, RN Doughty, C Nunn, G Devlin, C Grey, M Lee, C Flynn, M Rhodes, K Sutherland, S Wells, RT Jackson, RAH Stewart, on behalf of the ANZACS-QI investigators

There is a formidable evidence base supporting the use of a range of lifestyle, pharmaceutical and interventional treatments to improve outcomes in patients with heart attacks. However, in practice, there is often a substantial gap between ideal treatment based on clinical trials and what is achieved in practice. The identification of these evidence-practice gaps, and the implementation of programmes to close them, represent an important opportunity to improve the outcomes of patients with CVD in New Zealand. The All New Zealand Acute Coronary Syndrome Quality Improvement programme (ANZACS-QI) has recently been implemented in 41 NZ public hospitals to support appropriate, evidence based management of ACS and subsequently of other cardiac patients regardless of age, sex, ethnicity, socioeconomic status, or rural or city dwelling. In this report we describe the development and national implementation of ANZACS-QI, its governance, the data collection processes and the current ANZACS-QI cohorts and available results.

SUMMARY

Pregnant women lack accurate knowledge of their BMI and recommended gestational weight gain

Emma Jeffs, Jillian J Haszard, Benjamin Sharp, Joanna Gullam, Helen Paterson

This study indicates that New Zealand women, particularly those who are overweight and obese, are unaware of of their own body size, and this may lead to an under or over-estimation of the right amount of weight they should gain in their pregnancy, which may in turn lead to increased risk of poor health outcomes for both mother and baby. Public Health campaigns, related to healthy weight gain in pregnancy, similar to those aimed at giving up smoking in pregnancy, are urgently required.

SUMMARY

Key design features of a new smokefree law to help achieve the Smokefree Aotearoa

Louise Delany, George Thomson, Nick Wilson, Richard Edwards

University of Otago researchers propose a comprehensive new law to help New Zealand reach the governments Smokefree 2025 goal. The law would require all those dealing with tobacco to be licensed, and the makeup of tobacco products (for instance, flavours and sugar) would be controlled. If smoking prevalence targets relevant to the 2025 goal are not reached, tobacco sales would be moved to non-commercial agencies.

SUMMARY

TABLE - ‘Poorly defined’: unknown unknowns in New Zealand rural health

David Fearnley, Ross Lawrenson, Garry Nixon

Ensuring equity of access to health services and outcomes for rural people in NZ is compromised by the Statistics NZ definition of rurality which is not suitable for the purposes of health research. The geographic definition does not take available health services into account and so the population defined as rural differs from that which actually receives rural health care. Around 40% of the people who actually access rural health services are currently classified as urban, and 20% of those defined as rural actually receive urban health care. The extent of this mismatch masks any inequality in health care access or outcomes that may exist and hampers all current and future research. Rural versus urban disparities in both access to health services and in health outcomes are well recognised in other similar countries. It is quite likely these same disparities exist in NZ but we don t have the tools to uncover and describe them. Until we can identify these disparities we won t see rural healthcare policy to address them. We are proposing a fit for purpose definition of rurality for rural research, and to use this definition to analyse current health data to better understand rural health in NZ. Rural healthcare research in NZ is a very undeveloped field.

SUMMARY

Smoking in cars: knowledge, behaviours and support for smokefree cars legislation among New Zealand smokers and recent quitters

Judy Li, Sarah Nelson, Rhiannon Newcombe, Darren Walton

This study fills the information gap around smoking in cars, by providing a more complete picture of the attitudes and behaviours of smokers and recent quitters. The findings noted that smoking in cars is still a problem in New Zealand. This problem could possibly be addressed through new health promotion messages to improve understanding of the health risks caused by smoking in cars, or through legislation. In fact, a large majority of respondents in this study supported banning smoking in cars while children are in them.

SUMMARY

Smoking prevalence in New Zealand from 1996 2015: a critical review of national data sources to inform progress toward the Smokefree 2025 goal

Jude Ball, James Stanley, Nick Wilson, Tony Blakely, Richard Edwards

The New Zealand Government has committed to a goal of becoming a smokefree nation by 2025. This study analysed findings from the Census, the New Zealand Health Survey and the Health and Lifestyles Survey to assess progress towards the smokefree goal. The findings show that recent declines in smoking are modest, and are clearly inadequate for achieving the Smokefree 2025 and interim 2018 goals, particularly for Mori and Pacific peoples. Mori and Pacific smoking rates remain unacceptably high, and urgent action is needed to reduce the health burden of tobacco on these communities.

SUMMARY

Improved scores for observed teamwork in the clinical environment following a multidisciplinary operating room simulation intervention

Jennifer Weller, David Cumin, Ian Civil, Jane Torrie, Alexander Garden, Andrew MacCormick, Nishanthi Gurusinghe, Matthew Boyd, Christopher Frampton, Ludvig Selander, Martina Cokorilo, Magnus Tranvik, Lisa Carlsson, Tracey Lee, Wai Leap Ng, Michael Crossan, Alan Merry

Failures in teamwork and communication are a contributing factor in the majority of unintended events causing patient harm. To address this, we provided team training for 20 complete general surgical teams from two large metropolitan hospitals in the Multidisciplinary Operating Room Simulation (MORSim) course. To evaluate if this team training was effective, we observed operating room teams in over 200 cases before and after the training, and scored teamwork performance. We found a significant improvement in teamwork scores following MORSim. Previous research suggests this would translate to a clinically important reduction in patient harm for surgical patients. On the basis of these findings, ACC has provided funding for the national roll out of MORSim in every public hospital in New Zealand.

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