Issue

Vol 130 No 1453: 7 April 2017

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Issue Summary

SUMMARY

Trends in New Zealand stroke thrombolysis treatment rates

Qiliang Liu, Annemarei Ranta, Ginny Abernethy, P Alan Barber

Stroke affects 9,000 New Zealanders every year. Stroke can be devastating, leaving half of survivors dependent on others for care. Most strokes are due to a clot blocking an artery supplying blood flow to part of the brain. Dissolving these clots by injecting a drug called alteplase into a vein can improve a person s chance of going home independently. Alteplase treatment rates in New Zealand have been low compared to other countries. The National Stroke Network established a database to monitor all people treated with alteplase in an effort to increase treatment rates. This study reports that over the 18 months of the study, 623 New Zealanders were treated with alteplase. By mid-2016, 8.4% of people with stroke were receiving this therapy up from 3% in 2009. The efficiency and speed with which alteplase is being given has also improved. This is important because time is brain, with more brain cells saved from dying the earlier that treatment is given. These results are encouraging but there is still room for improvement.

SUMMARY

A retrospective observational study of mortality rates in elderly patients with shock in a New Zealand district hospital ICU

Owen Keet, Stephanie Chisholm, Jennifer Goodson, Troy Browne

The decision whether to admit and treat the very elderly patient with septic shock in ICU is a complex decision. Although age in itself is not a reason to deny a patient ICU admission, it is taken into account in context of the burden of chronic and acute disease. The patient selection and subsequent treatment at Tauranga Hospital, a secondary level New Zealand hospital, produced results that saw most of the patients during a five-year period, including those >85 years, being discharged alive from hospital. This study suggests that with carefully considered selection, elderly patients greater than 85 years may have an acceptable long-term outcome following an episode of septic shock.

SUMMARY

A decade of improvement in the management of New Zealand ST-elevation myocardial infarction (STEMI) patients: results from the New Zealand Acute Coronary Syndrome (ACS) Audit Group national audits of 2002, 2007 and 2012

John Elliott, Tom Kai Ming Wang, Greg Gamble, Michael Williams, Philip Matsis, Richard Troughton, Andrew Hamer, Gerry Devlin, Stewart Mann, Mark Richards, John French, Harvey White, Chris Ellis

The presentation with a STEMI heart attack is a dangerous medical event. Even by 2012, approximately 7% of those who reach hospital die. The 2002 National heart attack and unstable angina audit was run by cardiologists and specialist physicians who wanted to record the low levels of service available. This audit shocked the Health Ministry into action, with subsequent audits from 2007 and 2012 demonstrating ongoing improvements in services available to manage patients, which the paper describes. However, the paper also describes the need for ongoing improvements from 2012, especially in the rapid access to a cardiac angiogram, with a stent or cardiac surgery for those who need this treatment. This should occur within 24 hours.

SUMMARY

Effect of house officer clerking on short-term outcomes in paediatric orthopaedic patients

Yassar Alamri

This study examined any outcome differences between children seen and examined by junior doctors prior to their orthopaedic operations with those who were not. Children seen and examined by junior doctors had better documentation of their physical examination findings and allergies. However, no difference in clinical outcomes (eg, complication rates) was detected.

SUMMARY

Provision of stroke thrombolysis services in New Zealand: changes between 2011 and 2016

Qiliang Liu, P Alan Barber, Ginny Abernethy, Annemarei Ranta

Stroke affects 9,000 New Zealanders every year. Stroke can be devastating, leaving just over half of survivors dependent on others for care. Most strokes are due to a clot blocking an artery supplying blood flow to part of the brain. Dissolving these clots by injecting a drug called alteplase into a vein can improve a person s chance of going home independently. This study shows that the way in which alteplase is provided across the country has improved over the last five years. However, regional variations still exist with treatment, with alteplase limited to working hours in four of the 20 DHBs. This is because there aren t enough senior doctors who can supervise this treatment.

ALL ARTICLES
SUMMARY

A History of New Zealand Women

Charlotte Paul

Trends in New Zealand stroke thrombolysis treatment rates

Qiliang Liu, Annemarei Ranta, Ginny Abernethy, P Alan Barber

A retrospective observational study of mortality rates in elderly patients with shock in a New Zealand district hospital ICU

Owen Keet, Stephanie Chisholm, Jennifer Goodson, Troy Browne

A decade of improvement in the management of New Zealand ST-elevation myocardial infarction (STEMI) patients: results from the New Zealand Acute Coronary Syndrome (ACS) Audit Group national audits of 2002, 2007 and 2012

John Elliott, Tom Kai Ming Wang, Greg Gamble, Michael Williams, Philip Matsis, Richard Troughton, Andrew Hamer, Gerry Devlin, Stewart Mann, Mark Richards, John French, Harvey White, Chris Ellis

Improvements in acute stroke treatments in New Zealand no one should be left behind

John Fink

Treatment strategies for women with WHO group II anovulation

Obituaries

David Russell Hay

Norman Sharpe

Dr Judith (Judi) Dawn Donnell

Rebecca Burton

Effect of house officer clerking on short-term outcomes in paediatric orthopaedic patients

Yassar Alamri

Admitting elderly patients to ICU: is it just about survival?

Jay Ritzema, Paul Young

Does New Zealand need a third medical school?

Peter Crampton

Provision of stroke thrombolysis services in New Zealand: changes between 2011 and 2016

Qiliang Liu, P Alan Barber, Ginny Abernethy, Annemarei Ranta

SUMMARY

Trends in New Zealand stroke thrombolysis treatment rates

Qiliang Liu, Annemarei Ranta, Ginny Abernethy, P Alan Barber

Stroke affects 9,000 New Zealanders every year. Stroke can be devastating, leaving half of survivors dependent on others for care. Most strokes are due to a clot blocking an artery supplying blood flow to part of the brain. Dissolving these clots by injecting a drug called alteplase into a vein can improve a person s chance of going home independently. Alteplase treatment rates in New Zealand have been low compared to other countries. The National Stroke Network established a database to monitor all people treated with alteplase in an effort to increase treatment rates. This study reports that over the 18 months of the study, 623 New Zealanders were treated with alteplase. By mid-2016, 8.4% of people with stroke were receiving this therapy up from 3% in 2009. The efficiency and speed with which alteplase is being given has also improved. This is important because time is brain, with more brain cells saved from dying the earlier that treatment is given. These results are encouraging but there is still room for improvement.

SUMMARY

A retrospective observational study of mortality rates in elderly patients with shock in a New Zealand district hospital ICU

Owen Keet, Stephanie Chisholm, Jennifer Goodson, Troy Browne

The decision whether to admit and treat the very elderly patient with septic shock in ICU is a complex decision. Although age in itself is not a reason to deny a patient ICU admission, it is taken into account in context of the burden of chronic and acute disease. The patient selection and subsequent treatment at Tauranga Hospital, a secondary level New Zealand hospital, produced results that saw most of the patients during a five-year period, including those >85 years, being discharged alive from hospital. This study suggests that with carefully considered selection, elderly patients greater than 85 years may have an acceptable long-term outcome following an episode of septic shock.

SUMMARY

A decade of improvement in the management of New Zealand ST-elevation myocardial infarction (STEMI) patients: results from the New Zealand Acute Coronary Syndrome (ACS) Audit Group national audits of 2002, 2007 and 2012

John Elliott, Tom Kai Ming Wang, Greg Gamble, Michael Williams, Philip Matsis, Richard Troughton, Andrew Hamer, Gerry Devlin, Stewart Mann, Mark Richards, John French, Harvey White, Chris Ellis

The presentation with a STEMI heart attack is a dangerous medical event. Even by 2012, approximately 7% of those who reach hospital die. The 2002 National heart attack and unstable angina audit was run by cardiologists and specialist physicians who wanted to record the low levels of service available. This audit shocked the Health Ministry into action, with subsequent audits from 2007 and 2012 demonstrating ongoing improvements in services available to manage patients, which the paper describes. However, the paper also describes the need for ongoing improvements from 2012, especially in the rapid access to a cardiac angiogram, with a stent or cardiac surgery for those who need this treatment. This should occur within 24 hours.

SUMMARY

Effect of house officer clerking on short-term outcomes in paediatric orthopaedic patients

Yassar Alamri

This study examined any outcome differences between children seen and examined by junior doctors prior to their orthopaedic operations with those who were not. Children seen and examined by junior doctors had better documentation of their physical examination findings and allergies. However, no difference in clinical outcomes (eg, complication rates) was detected.

SUMMARY

Provision of stroke thrombolysis services in New Zealand: changes between 2011 and 2016

Qiliang Liu, P Alan Barber, Ginny Abernethy, Annemarei Ranta

Stroke affects 9,000 New Zealanders every year. Stroke can be devastating, leaving just over half of survivors dependent on others for care. Most strokes are due to a clot blocking an artery supplying blood flow to part of the brain. Dissolving these clots by injecting a drug called alteplase into a vein can improve a person s chance of going home independently. This study shows that the way in which alteplase is provided across the country has improved over the last five years. However, regional variations still exist with treatment, with alteplase limited to working hours in four of the 20 DHBs. This is because there aren t enough senior doctors who can supervise this treatment.

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