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Issue

Vol 130 No 1464: 27 October 2017

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Issue Summary

SUMMARY

The outcomes of patients returned to general practitioner after being declined hip and knee replacement

Toni Anitelea, Ella Iosua, Ayaaz Ebramjee, David Gwynne-Jones

Three hundred and seventy-four (31%) of patients listed for total hip or knee replacement in Dunedin were returned to their GP over the two-year period 2013-15 due to lack of capacity to meet the four-month target for surgery. At a minimum follow-up of 12 months, 122 (33%) remain in the community without further contact. One hundred and ninety-four (52%) had qualified for public surgery and 22 (6%) had gone privately. Thirty-six (10%) had been rereferred and failed to qualify a second time. The average wait for surgery was 14.6 months from their initial clinic appointment. The delay results in waste, added costs to the patient, healthcare system and society, and may reduce the benefit of surgery.

SUMMARY

Health data research in New Zealand: updating the ethical governance framework

Angela Ballantyne, Rochelle Style

Demand for health data for secondary research is increasing, both in New Zealand and worldwide. To support the ethical governance of patients data, we argue in favour of the establishment of: (1) a specialist Health and Disability Ethics Committee (HDEC) to review applications for secondary-use data research; (2) a public registry of approved secondary-use research projects (similar to a clinical trials registry); and (3) detailed guidelines for the review and approval of secondary-use data research. We present an ethical framework based on the values of public interest, trust and transparency to justify these innovations.

SUMMARY

Gene expression profiling of breast tumours from New Zealand patients

Anita Muthukaruppan, Annette Lasham, Cherie Blenkiron, Kathryn J Woad, Michael A Black, Nicholas Knowlton, Nicole McCarthy, Michael P Findlay, Cristin G Print, Andrew N Shelling

Genomic profiles, which are reflective of tumour biology, showed no clear difference between breast tumours from New Zealand patients and those from an international breast cancer cohort. This suggests that other factors may contribute to the high and increasing breast cancer incidence in New Zealand compared to international populations. Our findings also suggest that as breast tumours from New Zealand women exhibit similar features to international cohorts, and were found to share multiple clinical associations, genomic tests should have the same relevance to clinical practice in New Zealand as they do overseas.

SUMMARY

The state of quality improvement and patient safety teaching in health professional education in New Zealand

Gillian Robb, Susan Wells, Iwona Stolarek, Gillian Bohm

This study investigated the teaching of healthcare quality and safety in all institutions providing training for medicine, nursing, midwifery, dentistry, pharmacy, physiotherapy, dietetics and 11 other allied health professions in New Zealand. Interviews were undertaken with 43 people who led the teaching programmes. Evidence-based practice, patient-centred care and teamwork and communication were well embedded in programmes, while leadership, systems thinking and the role of IT were less explicitly included. Patient safety teaching was focused mainly around incident reporting, and to a lesser extent learning from adverse events. Except for two institutions, specific application of improvement science was absent from pre-registration curricula. Improvement science is relatively new for healthcare, but as an applied science, it offers a robust approach to addressing real life problems in real life situations. Healthcare training needs to address the identified gaps so that new graduates will be able to improve the quality and safety of healthcare.

SUMMARY

Deceased donor kidney transplantation in New Zealand: use and audit of a survival prediction tool

Frances Dowen, Nicholas Cross, Philip Clayton, Helen Pilmore

Diabetes is a major health issue in New Zealand. In New Zealand, we have clear guidelines on how to treat diabetes. These guidelines state that if medication is to be started, metformin should be started first, followed by sulfonylureas. This research shows that these guidelines are being well followed in New Zealand, particularly when compared with other countries.

SUMMARY

Is cardiomegaly on chest radiograph representative of true cardiomegaly: a cross-sectional observational study comparing cardiac size on chest radiograph to that on echocardiography

Jane McKee, Katherine Ferrier

A chest x-ray (CXR) is a common tool used in medicine. When a chest x-ray is interpreted, comment is often made of the heart size, the term cardiomegaly being used to indicate the person has an enlarged heart. This study looked at the heart size on CXR in patients who had suffered a heart attack compared to echocardiography, which is often considered to be the gold standard in measuring a person s heart. The study showed that cardiomegaly on CXR was indicative of true cardiomegaly only 56% of the time, thereby concluding that, in our sample population, a diagnosis of cardiomegaly cannot be made purely based on CXR findings.

ALL ARTICLES
SUMMARY

The outcomes of patients returned to general practitioner after being declined hip and knee replacement

Toni Anitelea, Ella Iosua, Ayaaz Ebramjee, David Gwynne-Jones

Health data research in New Zealand: updating the ethical governance framework

Angela Ballantyne, Rochelle Style

New Zealand gastroenterologists perceptions, knowledge and experience of exclusive enteral nutrition to treat Crohn s disease

Catherine L Wall, Richard B Gearry, Andrew S Day

Gene expression profiling of breast tumours from New Zealand patients

Anita Muthukaruppan, Annette Lasham, Cherie Blenkiron, Kathryn J Woad, Michael A Black, Nicholas Knowlton, Nicole McCarthy, Michael P Findlay, Cristin G Print, Andrew N Shelling

Waikato District Health Board: a trustworthy custodian of New Zealand s future doctors?

Caleb Armstrong

Risk of major congenital malformations in relation to maternal overweight and obesity severity

Intestinal Obstruction by a Band in an Infant Nineteen Days Old End-to-End Union Recovery

By W. M. THOMSON, M.A., M.B.

Smokefree signage at New Zealand racecourses and sports facilities with outdoor stands

George Thomson, Nick Wilson

Iron-pill inhalation

Matlawene J Mpe, William Diprose

The state of quality improvement and patient safety teaching in health professional education in New Zealand

Gillian Robb, Susan Wells, Iwona Stolarek, Gillian Bohm

Deceased donor kidney transplantation in New Zealand: use and audit of a survival prediction tool

Frances Dowen, Nicholas Cross, Philip Clayton, Helen Pilmore

Time for healthy investment

Scott Metcalfe, Sanji Gunasekara, Kate Baddock, Lesley Clarke, for the New Zealand Medical Association

Rationing access to deceased donor kidney transplantation: New Zealand charts her own course

Stephen Munn

Is cardiomegaly on chest radiograph representative of true cardiomegaly: a cross-sectional observational study comparing cardiac size on chest radiograph to that on echocardiography

Jane McKee, Katherine Ferrier

SUMMARY

The outcomes of patients returned to general practitioner after being declined hip and knee replacement

Toni Anitelea, Ella Iosua, Ayaaz Ebramjee, David Gwynne-Jones

Three hundred and seventy-four (31%) of patients listed for total hip or knee replacement in Dunedin were returned to their GP over the two-year period 2013-15 due to lack of capacity to meet the four-month target for surgery. At a minimum follow-up of 12 months, 122 (33%) remain in the community without further contact. One hundred and ninety-four (52%) had qualified for public surgery and 22 (6%) had gone privately. Thirty-six (10%) had been rereferred and failed to qualify a second time. The average wait for surgery was 14.6 months from their initial clinic appointment. The delay results in waste, added costs to the patient, healthcare system and society, and may reduce the benefit of surgery.

SUMMARY

Health data research in New Zealand: updating the ethical governance framework

Angela Ballantyne, Rochelle Style

Demand for health data for secondary research is increasing, both in New Zealand and worldwide. To support the ethical governance of patients data, we argue in favour of the establishment of: (1) a specialist Health and Disability Ethics Committee (HDEC) to review applications for secondary-use data research; (2) a public registry of approved secondary-use research projects (similar to a clinical trials registry); and (3) detailed guidelines for the review and approval of secondary-use data research. We present an ethical framework based on the values of public interest, trust and transparency to justify these innovations.

SUMMARY

Gene expression profiling of breast tumours from New Zealand patients

Anita Muthukaruppan, Annette Lasham, Cherie Blenkiron, Kathryn J Woad, Michael A Black, Nicholas Knowlton, Nicole McCarthy, Michael P Findlay, Cristin G Print, Andrew N Shelling

Genomic profiles, which are reflective of tumour biology, showed no clear difference between breast tumours from New Zealand patients and those from an international breast cancer cohort. This suggests that other factors may contribute to the high and increasing breast cancer incidence in New Zealand compared to international populations. Our findings also suggest that as breast tumours from New Zealand women exhibit similar features to international cohorts, and were found to share multiple clinical associations, genomic tests should have the same relevance to clinical practice in New Zealand as they do overseas.

SUMMARY

The state of quality improvement and patient safety teaching in health professional education in New Zealand

Gillian Robb, Susan Wells, Iwona Stolarek, Gillian Bohm

This study investigated the teaching of healthcare quality and safety in all institutions providing training for medicine, nursing, midwifery, dentistry, pharmacy, physiotherapy, dietetics and 11 other allied health professions in New Zealand. Interviews were undertaken with 43 people who led the teaching programmes. Evidence-based practice, patient-centred care and teamwork and communication were well embedded in programmes, while leadership, systems thinking and the role of IT were less explicitly included. Patient safety teaching was focused mainly around incident reporting, and to a lesser extent learning from adverse events. Except for two institutions, specific application of improvement science was absent from pre-registration curricula. Improvement science is relatively new for healthcare, but as an applied science, it offers a robust approach to addressing real life problems in real life situations. Healthcare training needs to address the identified gaps so that new graduates will be able to improve the quality and safety of healthcare.

SUMMARY

Deceased donor kidney transplantation in New Zealand: use and audit of a survival prediction tool

Frances Dowen, Nicholas Cross, Philip Clayton, Helen Pilmore

Diabetes is a major health issue in New Zealand. In New Zealand, we have clear guidelines on how to treat diabetes. These guidelines state that if medication is to be started, metformin should be started first, followed by sulfonylureas. This research shows that these guidelines are being well followed in New Zealand, particularly when compared with other countries.

SUMMARY

Is cardiomegaly on chest radiograph representative of true cardiomegaly: a cross-sectional observational study comparing cardiac size on chest radiograph to that on echocardiography

Jane McKee, Katherine Ferrier

A chest x-ray (CXR) is a common tool used in medicine. When a chest x-ray is interpreted, comment is often made of the heart size, the term cardiomegaly being used to indicate the person has an enlarged heart. This study looked at the heart size on CXR in patients who had suffered a heart attack compared to echocardiography, which is often considered to be the gold standard in measuring a person s heart. The study showed that cardiomegaly on CXR was indicative of true cardiomegaly only 56% of the time, thereby concluding that, in our sample population, a diagnosis of cardiomegaly cannot be made purely based on CXR findings.

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