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Issue

Vol 129 No 1443: 14 October 2016

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Issue Summary

SUMMARY

Can team training make surgery safer? Lessons for national implementation of a simulation-based programme

Jennifer Weller, Ian Civil, Jane Torrie, David Cumin, Alexander Garden, Arden Corter, Alan Merry

Operations dont always go as intended, and patients can occasionally suffer preventable harm. Good communication between the staff looking after patients has been identified as one factor that may reduce this harm and improve outcomes for patients. We ran a team training program for all members of the surgical team using a simulated patient and operating theatre. Analysis of follow-up interviews identified very positive changes in communication practices for many participants, and those factors that will need to be addressed in our national implementation of this program in 2017.

SUMMARY

Pilot study of feasibility of a randomised controlled trial of asthma risk with paracetamol versus ibuprofen use in infancy

Judith Riley, Anna Hunt, Alice McDouall, Steve Waqanivavalagi, Irene Braithwaite, Mark Weatherall, Thorsten Stanley, Richard Beasley, Edwin A Mitchell, Stuart R Dalziel

This pilot study assessed the likelihood of recruiting infants into a study that would randomly allocate infants to use only paracetamol or ibuprofen for fevers and pain from birth until the age of one year, and to then compare the rates of asthma between the two groups when the children turned six years old.

SUMMARY

Where to from here? The treatment of impetigo in children as resistance to fusidic acid emerges

Alison Vogel, Diana Lennon, Emma Best, Alison Leversha

Impetigo (school sores) are a very common problem especially in children. Fusidic acid is the funded topical antibiotic treatment for impetigo in New Zealand but there is substantial concern about increasing use and increasing resistance to this antibiotic. Our paper reviewed the evidence about the effectiveness of alternative treatments, especially antiseptic creams and found very little high-quality evidence. A randomised controlled trial comparing treatment with fusidic acid, treatment with hydrogen peroxide antiseptic cream and simple wound care is about to commence in Auckland and will help to provide quality new evidence to guide practice.

SUMMARY

Emergency EVAR for ruptured abdominal aortic aneurysms: New Zealand experience

Sam Taylor, Ian Thomson, Jo Krysa

An endovascular aortic repair (EVAR) is a minimally invasive combined radiology/surgical procedure that has been recently introduced in New Zealand and is an alternative to the open surgical repair of a ruptured abdominal aortic aneurysm (rAAA) a life-threatening emergency. This paper reviews the current New Zealand approach to rAAAs and shows that our rates of emergency EVARs are lower than those internationally. The length of hospital stay and combined in-hospital mortality/post-operative complication rate was significantly reduced in the New Zealand emergency EVAR group compared to the New Zealand open repair group. The recent introduction of emergency EVARs in New Zealand may represent the beginning of a shift in the management of ruptured AAAs here, although it is currently unlikely to be an option available 24/7 outside the few New Zealand centres with well-established EVAR capabilities.

SUMMARY

Rapid access carotid endarterectomy: winning the RACE following a natural disaster

Manar Khashram, Rachel Falconer, Afif Mahmud, Adib Khanafer, Peter Laws, Tim Beresford, Justin Roake

Carotid endarterectomy needs to be performed within two weeks to provide the greatest benefit in stroke prevention. In Christchurch Hospital, after several audits conducted, a rapid access pathway was established. This was challenged during the 2011 earthquakes. However, we noted that the service remained efficient and the majority of patients underwent surgery within two to four weeks. This highlights the importance of developing pathways for common and critical conditions.

SUMMARY

Costs of bariatric surgery in a randomised control trial (RCT) comparing Roux en Y gastric bypass vs sleeve gastrectomy in morbidly obese diabetic patients

Siva T Gounder, Delendra Wijayanayaka, Rinki Murphy, Delwyn Armstrong, Richard Cutfield, David D Kim, Michael G Clarke, Nicholas J Evennett, Martin L Humphreys, Steven J Robinson, Michael WC Booth

This study looks at role of bariatric surgery in obese patients with diabetes. Two types of surgery (sleeve gastrectomy and gastric bypass) were compared. Cost of provision of surgery and medication usage and cost were also examined.

SUMMARY

The impact of the Hand Hygiene New Zealand programme on hand hygiene practices in New Zealand s public hospitals

Joshua T Freeman, Louise Dawson, Deborah M Jowitt, Margo White, Hayley Callard, Christine Sieczkowski, Ron Kuriyan, Sally A Roberts

Performing hand hygiene is one of the most effective measures to reduce healthcare-associated infections. Every time a healthcare worker delivers care, they are at risk of transiently contaminating their hands with bacteria from the skin of the patient or from the surface of medical equipment or devices, or surfaces in the patient s bed space. When the healthcare worker provides care to another patient, they can transfer the bacteria to the patient. In vulnerable patients these bacteria can cause infection. The use of alcohol-based hand rubs between patient-care activities and following contact with the patient environment reduces the risk of this occurring. Improving hand hygiene is linked to reduced rates of healthcare-associated infections and it is an essential activity that will protect our patients.

ALL ARTICLES
SUMMARY

Can team training make surgery safer? Lessons for national implementation of a simulation-based programme

Jennifer Weller, Ian Civil, Jane Torrie, David Cumin, Alexander Garden, Arden Corter, Alan Merry

Pilot study of feasibility of a randomised controlled trial of asthma risk with paracetamol versus ibuprofen use in infancy

Judith Riley, Anna Hunt, Alice McDouall, Steve Waqanivavalagi, Irene Braithwaite, Mark Weatherall, Thorsten Stanley, Richard Beasley, Edwin A Mitchell, Stuart R Dalziel

Acetaminophen (paracetamol) versus ibuprofen in young children with mild persistent asthma

Erythematous gingival lesion

Pallav Patni, Mona J Patni

Where to from here? The treatment of impetigo in children as resistance to fusidic acid emerges

Alison Vogel, Diana Lennon, Emma Best, Alison Leversha

Emergency EVAR for ruptured abdominal aortic aneurysms: New Zealand experience

Sam Taylor, Ian Thomson, Jo Krysa

An interesting gynaecological case

By LESLIE J. THOMPSON, M.B. (N.Z.), F.R.C.S. (Ed.), Auckland.

Rapid access carotid endarterectomy: winning the RACE following a natural disaster

Manar Khashram, Rachel Falconer, Afif Mahmud, Adib Khanafer, Peter Laws, Tim Beresford, Justin Roake

How much can we achieve with simulation?

Ian Bissett

Costs of bariatric surgery in a randomised control trial (RCT) comparing Roux en Y gastric bypass vs sleeve gastrectomy in morbidly obese diabetic patients

Siva T Gounder, Delendra Wijayanayaka, Rinki Murphy, Delwyn Armstrong, Richard Cutfield, David D Kim, Michael G Clarke, Nicholas J Evennett, Martin L Humphreys, Steven J Robinson, Michael WC Booth

The impact of the Hand Hygiene New Zealand programme on hand hygiene practices in New Zealand s public hospitals

Joshua T Freeman, Louise Dawson, Deborah M Jowitt, Margo White, Hayley Callard, Christine Sieczkowski, Ron Kuriyan, Sally A Roberts

SUMMARY

Can team training make surgery safer? Lessons for national implementation of a simulation-based programme

Jennifer Weller, Ian Civil, Jane Torrie, David Cumin, Alexander Garden, Arden Corter, Alan Merry

Operations dont always go as intended, and patients can occasionally suffer preventable harm. Good communication between the staff looking after patients has been identified as one factor that may reduce this harm and improve outcomes for patients. We ran a team training program for all members of the surgical team using a simulated patient and operating theatre. Analysis of follow-up interviews identified very positive changes in communication practices for many participants, and those factors that will need to be addressed in our national implementation of this program in 2017.

SUMMARY

Pilot study of feasibility of a randomised controlled trial of asthma risk with paracetamol versus ibuprofen use in infancy

Judith Riley, Anna Hunt, Alice McDouall, Steve Waqanivavalagi, Irene Braithwaite, Mark Weatherall, Thorsten Stanley, Richard Beasley, Edwin A Mitchell, Stuart R Dalziel

This pilot study assessed the likelihood of recruiting infants into a study that would randomly allocate infants to use only paracetamol or ibuprofen for fevers and pain from birth until the age of one year, and to then compare the rates of asthma between the two groups when the children turned six years old.

SUMMARY

Where to from here? The treatment of impetigo in children as resistance to fusidic acid emerges

Alison Vogel, Diana Lennon, Emma Best, Alison Leversha

Impetigo (school sores) are a very common problem especially in children. Fusidic acid is the funded topical antibiotic treatment for impetigo in New Zealand but there is substantial concern about increasing use and increasing resistance to this antibiotic. Our paper reviewed the evidence about the effectiveness of alternative treatments, especially antiseptic creams and found very little high-quality evidence. A randomised controlled trial comparing treatment with fusidic acid, treatment with hydrogen peroxide antiseptic cream and simple wound care is about to commence in Auckland and will help to provide quality new evidence to guide practice.

SUMMARY

Emergency EVAR for ruptured abdominal aortic aneurysms: New Zealand experience

Sam Taylor, Ian Thomson, Jo Krysa

An endovascular aortic repair (EVAR) is a minimally invasive combined radiology/surgical procedure that has been recently introduced in New Zealand and is an alternative to the open surgical repair of a ruptured abdominal aortic aneurysm (rAAA) a life-threatening emergency. This paper reviews the current New Zealand approach to rAAAs and shows that our rates of emergency EVARs are lower than those internationally. The length of hospital stay and combined in-hospital mortality/post-operative complication rate was significantly reduced in the New Zealand emergency EVAR group compared to the New Zealand open repair group. The recent introduction of emergency EVARs in New Zealand may represent the beginning of a shift in the management of ruptured AAAs here, although it is currently unlikely to be an option available 24/7 outside the few New Zealand centres with well-established EVAR capabilities.

SUMMARY

Rapid access carotid endarterectomy: winning the RACE following a natural disaster

Manar Khashram, Rachel Falconer, Afif Mahmud, Adib Khanafer, Peter Laws, Tim Beresford, Justin Roake

Carotid endarterectomy needs to be performed within two weeks to provide the greatest benefit in stroke prevention. In Christchurch Hospital, after several audits conducted, a rapid access pathway was established. This was challenged during the 2011 earthquakes. However, we noted that the service remained efficient and the majority of patients underwent surgery within two to four weeks. This highlights the importance of developing pathways for common and critical conditions.

SUMMARY

Costs of bariatric surgery in a randomised control trial (RCT) comparing Roux en Y gastric bypass vs sleeve gastrectomy in morbidly obese diabetic patients

Siva T Gounder, Delendra Wijayanayaka, Rinki Murphy, Delwyn Armstrong, Richard Cutfield, David D Kim, Michael G Clarke, Nicholas J Evennett, Martin L Humphreys, Steven J Robinson, Michael WC Booth

This study looks at role of bariatric surgery in obese patients with diabetes. Two types of surgery (sleeve gastrectomy and gastric bypass) were compared. Cost of provision of surgery and medication usage and cost were also examined.

SUMMARY

The impact of the Hand Hygiene New Zealand programme on hand hygiene practices in New Zealand s public hospitals

Joshua T Freeman, Louise Dawson, Deborah M Jowitt, Margo White, Hayley Callard, Christine Sieczkowski, Ron Kuriyan, Sally A Roberts

Performing hand hygiene is one of the most effective measures to reduce healthcare-associated infections. Every time a healthcare worker delivers care, they are at risk of transiently contaminating their hands with bacteria from the skin of the patient or from the surface of medical equipment or devices, or surfaces in the patient s bed space. When the healthcare worker provides care to another patient, they can transfer the bacteria to the patient. In vulnerable patients these bacteria can cause infection. The use of alcohol-based hand rubs between patient-care activities and following contact with the patient environment reduces the risk of this occurring. Improving hand hygiene is linked to reduced rates of healthcare-associated infections and it is an essential activity that will protect our patients.

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