Issue

Vol 130 No 1455: 12 May 2017

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Issue Summary

SUMMARY

Survival of Legionella in earthquake-induced soil disturbance (liquefaction) in residential areas, Christchurch, New Zealand: implications for disease

Frances Graham, David Harte

Legionella bacteria is ubiquitous in the environment. This study set out to expand our understanding of the environmental exposure risks to Legionella and whether seemingly unrelated environmental factors, such as aerosolised liquefaction-affected soil resulting from the Christchurch earthquakes had the potential to impact on disease prevalence. Liquefaction-affected soil could not contribute directly to the observed increase in legionellosis cases after the earthquakes due to its inability to support growth and survival of the Legionella bacteria. Chemical and size analysis of the liquefaction-affected soil showed it consisted of >65%. Silica. The authors propose that inhalation of earthquake associated airborne liquefaction-affected soil can damage lung tissue and cause inflammation. Inflammation and damage could allow opportunistic pathogens, such as Legionella bacteria, to more successfully infect the human host.

SUMMARY

Enhanced hip fracture management: use of statistical methods and dataset to evaluate a fractured neck of femur fast track pathway—pilot study

Nigel Gilchrist, Kristian Dalzell, Scott Pearson, Gary Hooper, Kit Hoeben, Jeremy Hickling, John McKie, Ma Yi, Sandra Chamberlain, Caroline McCullough, Marc Gutenstein

This paper demonstrates how integration of service components that are involved in frac-tured neck of femur can be achieved. It also shows how the use of electronic data capture and analysis can give a very quick and easily interpretable data trend that will enable change in practise. Cooperation between health professionals and practitioners can signifi-cantly improve the length of stay and the time in which patients can be returned home. Full interdisciplinary involvement was the key to this approach. The use of electronic data capture and analysis can be used in many other health pathways within the health system.

SUMMARY

Rotorua, hydrogen sulphide and Parkinson’s disease—A possible beneficial link?

Yusuf Ozgur Cakmak

Rotorua city (New Zealand) is known for its rotten egg smell, due to high levels of hydrogen sulphide (H2S) concentrations emitted from local geothermal vents. Studies have shown H2S as potentially toxic if too high in concentration. However, research on H2S on health postulates whether ambient air inhalation levels of H2S in Rotorua might have a therapeutic role in the management of motor symptoms in Parkinsons disease (PD). An observed beneficial link between chronic H2S inhalation in PD animal models and improved finger tapping scores in a sample of the Rotorua population, linked to dopaminergic nerve function, is worth investigating further.

SUMMARY

Effect of the Shorter Stays in Emergency Departments time target policy on key indicators of quality of care

Peter Jones, James Le Fevre, Alana Harper, Susan Wells, Joanna Stewart, Elana Curtis, Papaarangi Reid, Shanthi Ameratunga

This study explored the association between the introduction of a mandatory national target for emergency department (ED) length of stay, which was introduced in New Zealand in 2009, and five key indicators of quality of care. We did this study as there is some evidence from overseas that focusing on a process target for the time spent in the ED may divert attention away from other aspects of quality of care. Our study found that more people left the ED within six hours after introduction of the shorter stays in ED target. There was no difference in the quality of care for patients in pain, with severe infections, with heart attacks, with appendicitis and with fractured hips when comparing the outcomes for these conditions before and after the introduction of the target.

SUMMARY

New Zealand plastic surgeons life-time contribution to peer-reviewed literature

Tess Brian, Brandon Adams

The New Zealand Medical Association commits the New Zealand doctor to evidence-based medicine, scholarship, teaching, collaboration and communication. To assess this commitment, one measure, contribution to the peer-reviewed literature, was examined for one group of New Zealand doctors: plastic surgeons. Based on this metric, as a group, but with exceptions and less so in later practice, New Zealand plastic surgeons would seem to demonstrate this commitment.

SUMMARY

Increased use of police and health-related services among those with heavy drinkers in their lives in New Zealand

Taisia Huckle, Khoon Ching Wong, Karl Parker, Sally Casswell

The findings of this study are the first to show the extent of service use because of others drinking among the general population in New Zealand. There are considerable numbers of New Zealanders requiring intervention from police or health-related services due to the effects of someone elses drinking. Heavy drinkers place increased burden on police and health-related services, not only because of directly attributable effects but because they impact others.

SUMMARY

Is high-quality trauma care “business as usual” in New Zealand?

Ian Civil, Siobhan Isles

New Zealand is on the cusp of establishing a world-class trauma system. Many of the building blocks are in place with national and regional guidelines in both the pre-hospital and hospital phases of care established. A dedicated clinical workforce is available in all DHBs and national data is available through the Major Trauma Registry. The greatest threat to achieving high-quality trauma care in New Zealand at this point is governance stability rather than clinical variability. Now is the time to lock the trauma system into a framework not subject to political or bureaucratic whims.

SUMMARY

A walking stick in one hand and a chainsaw in the other: patients perspectives of living with multimorbidity

Louise Signal, Kelly Semper, Jeannine Stairmand, Cheryl Davies, Elinor Millar, Tony Dowell, Ross Lawrenson, Dee Mangin, Diana Sarfati

Living with multimorbidity (two or more long-term health conditions) is becoming more common in both young and older New Zealanders. It disrupts people s 'normal' lives, posing challenges for many, yet people learn to cope by making changes to much of what they do (eg, eating, activity and employment). Dealing with the health care system for those with multimorbidity can be challenging and people value simple things like good communication and receiving care that is effective and respectful even when they are from a different cultural background to that of their health care provider. Health care system support is needed to help people with multimorbidity manage the challenge of dealing with multiple medications using simple aids such as blister packs. Improvements to the health care system are needed to better serve those people living with multimorbidity, their support people and health care providers, eg, longer consultation times with GP/primary care providers to discuss multiple health issues and medications.

ALL ARTICLES
SUMMARY

Survival of Legionella in earthquake-induced soil disturbance (liquefaction) in residential areas, Christchurch, New Zealand: implications for disease

Frances Graham, David Harte

Enhanced hip fracture management: use of statistical methods and dataset to evaluate a fractured neck of femur fast track pathway—pilot study

Nigel Gilchrist, Kristian Dalzell, Scott Pearson, Gary Hooper, Kit Hoeben, Jeremy Hickling, John McKie, Ma Yi, Sandra Chamberlain, Caroline McCullough, Marc Gutenstein

A case of confirmed primary hyperaldosteronism diagnosed despite normal screening investigations

Richard Carroll, Alana Gould, Joe Feltham, Simon Harper

Rotorua, hydrogen sulphide and Parkinson’s disease—A possible beneficial link?

Yusuf Ozgur Cakmak

Effect of the Shorter Stays in Emergency Departments time target policy on key indicators of quality of care

Peter Jones, James Le Fevre, Alana Harper, Susan Wells, Joanna Stewart, Elana Curtis, Papaarangi Reid, Shanthi Ameratunga

Implementation and effects of Enhanced Recovery After Surgery for hip and knee replacements and fractured neck of femur in New Zealand orthopaedic services

Suzanne Proudfoot, Brandon Bennett, Simon Duff, Julie Palmer

Coeliac disease and fertility in New Zealand women

Catherine Rees

Heather Thomson

Dr Rosy Fenwicke

Unmet need and antenatal care

Ben Gray

Acute calcific tendinitis of the longus colli muscle

Michael Plunkett, Hugh De Lautour, Adam Worthington

Improving outcomes in orthopaedic care

Gary Hooper

The ‘six hour target’ in New Zealand is associated with reduced mortality and greater efficiency

Mike Ardagh

New Zealand plastic surgeons life-time contribution to peer-reviewed literature

Tess Brian, Brandon Adams

Increased use of police and health-related services among those with heavy drinkers in their lives in New Zealand

Taisia Huckle, Khoon Ching Wong, Karl Parker, Sally Casswell

Is high-quality trauma care “business as usual” in New Zealand?

Ian Civil, Siobhan Isles

Early death after discharge from emergency departments

A tale of two islands trauma care in New Zealand

Dominic Fleischer, Christopher Wakeman

War Medical Research

A walking stick in one hand and a chainsaw in the other: patients perspectives of living with multimorbidity

Louise Signal, Kelly Semper, Jeannine Stairmand, Cheryl Davies, Elinor Millar, Tony Dowell, Ross Lawrenson, Dee Mangin, Diana Sarfati

SUMMARY

Survival of Legionella in earthquake-induced soil disturbance (liquefaction) in residential areas, Christchurch, New Zealand: implications for disease

Frances Graham, David Harte

Legionella bacteria is ubiquitous in the environment. This study set out to expand our understanding of the environmental exposure risks to Legionella and whether seemingly unrelated environmental factors, such as aerosolised liquefaction-affected soil resulting from the Christchurch earthquakes had the potential to impact on disease prevalence. Liquefaction-affected soil could not contribute directly to the observed increase in legionellosis cases after the earthquakes due to its inability to support growth and survival of the Legionella bacteria. Chemical and size analysis of the liquefaction-affected soil showed it consisted of >65%. Silica. The authors propose that inhalation of earthquake associated airborne liquefaction-affected soil can damage lung tissue and cause inflammation. Inflammation and damage could allow opportunistic pathogens, such as Legionella bacteria, to more successfully infect the human host.

SUMMARY

Enhanced hip fracture management: use of statistical methods and dataset to evaluate a fractured neck of femur fast track pathway—pilot study

Nigel Gilchrist, Kristian Dalzell, Scott Pearson, Gary Hooper, Kit Hoeben, Jeremy Hickling, John McKie, Ma Yi, Sandra Chamberlain, Caroline McCullough, Marc Gutenstein

This paper demonstrates how integration of service components that are involved in frac-tured neck of femur can be achieved. It also shows how the use of electronic data capture and analysis can give a very quick and easily interpretable data trend that will enable change in practise. Cooperation between health professionals and practitioners can signifi-cantly improve the length of stay and the time in which patients can be returned home. Full interdisciplinary involvement was the key to this approach. The use of electronic data capture and analysis can be used in many other health pathways within the health system.

SUMMARY

Rotorua, hydrogen sulphide and Parkinson’s disease—A possible beneficial link?

Yusuf Ozgur Cakmak

Rotorua city (New Zealand) is known for its rotten egg smell, due to high levels of hydrogen sulphide (H2S) concentrations emitted from local geothermal vents. Studies have shown H2S as potentially toxic if too high in concentration. However, research on H2S on health postulates whether ambient air inhalation levels of H2S in Rotorua might have a therapeutic role in the management of motor symptoms in Parkinsons disease (PD). An observed beneficial link between chronic H2S inhalation in PD animal models and improved finger tapping scores in a sample of the Rotorua population, linked to dopaminergic nerve function, is worth investigating further.

SUMMARY

Effect of the Shorter Stays in Emergency Departments time target policy on key indicators of quality of care

Peter Jones, James Le Fevre, Alana Harper, Susan Wells, Joanna Stewart, Elana Curtis, Papaarangi Reid, Shanthi Ameratunga

This study explored the association between the introduction of a mandatory national target for emergency department (ED) length of stay, which was introduced in New Zealand in 2009, and five key indicators of quality of care. We did this study as there is some evidence from overseas that focusing on a process target for the time spent in the ED may divert attention away from other aspects of quality of care. Our study found that more people left the ED within six hours after introduction of the shorter stays in ED target. There was no difference in the quality of care for patients in pain, with severe infections, with heart attacks, with appendicitis and with fractured hips when comparing the outcomes for these conditions before and after the introduction of the target.

SUMMARY

New Zealand plastic surgeons life-time contribution to peer-reviewed literature

Tess Brian, Brandon Adams

The New Zealand Medical Association commits the New Zealand doctor to evidence-based medicine, scholarship, teaching, collaboration and communication. To assess this commitment, one measure, contribution to the peer-reviewed literature, was examined for one group of New Zealand doctors: plastic surgeons. Based on this metric, as a group, but with exceptions and less so in later practice, New Zealand plastic surgeons would seem to demonstrate this commitment.

SUMMARY

Increased use of police and health-related services among those with heavy drinkers in their lives in New Zealand

Taisia Huckle, Khoon Ching Wong, Karl Parker, Sally Casswell

The findings of this study are the first to show the extent of service use because of others drinking among the general population in New Zealand. There are considerable numbers of New Zealanders requiring intervention from police or health-related services due to the effects of someone elses drinking. Heavy drinkers place increased burden on police and health-related services, not only because of directly attributable effects but because they impact others.

SUMMARY

Is high-quality trauma care “business as usual” in New Zealand?

Ian Civil, Siobhan Isles

New Zealand is on the cusp of establishing a world-class trauma system. Many of the building blocks are in place with national and regional guidelines in both the pre-hospital and hospital phases of care established. A dedicated clinical workforce is available in all DHBs and national data is available through the Major Trauma Registry. The greatest threat to achieving high-quality trauma care in New Zealand at this point is governance stability rather than clinical variability. Now is the time to lock the trauma system into a framework not subject to political or bureaucratic whims.

SUMMARY

A walking stick in one hand and a chainsaw in the other: patients perspectives of living with multimorbidity

Louise Signal, Kelly Semper, Jeannine Stairmand, Cheryl Davies, Elinor Millar, Tony Dowell, Ross Lawrenson, Dee Mangin, Diana Sarfati

Living with multimorbidity (two or more long-term health conditions) is becoming more common in both young and older New Zealanders. It disrupts people s 'normal' lives, posing challenges for many, yet people learn to cope by making changes to much of what they do (eg, eating, activity and employment). Dealing with the health care system for those with multimorbidity can be challenging and people value simple things like good communication and receiving care that is effective and respectful even when they are from a different cultural background to that of their health care provider. Health care system support is needed to help people with multimorbidity manage the challenge of dealing with multiple medications using simple aids such as blister packs. Improvements to the health care system are needed to better serve those people living with multimorbidity, their support people and health care providers, eg, longer consultation times with GP/primary care providers to discuss multiple health issues and medications.

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