Issue

Vol 130 No 1466: 1 December 2017

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Issue Summary

SUMMARY

Teaching quality improvement to medical students: over a decade of experience

Michelle R Wise, Bridget Kool, Lynn Sadler, Roshini Peiris-John, Gillian Robb, Susan Wells

Final year medical students at University of Auckland perform a clinical audit project within the constraints and context of a busy women s health service. Students work with a clinical supervisor to identify an area for potential improvement, set a standard of care, measure current practice, investigate reasons for not achieving the standard and make real-world suggestions to close the gap between research and observed practice. Since 2004, over 1,250 student projects have been completed, many of which have resulted in actual improvements to clinical care. Such experiential learning during medical school is important in preparing future doctors to incorporate quality improvement knowledge and skills into their daily practice.

SUMMARY

A New Zealand platform to enable genetic investigation of adverse drug reactions

Simran DS Maggo, Eng Wee Chua, Paul Chin, Simone Cree, John Pearson, Matt Doogue, Martin A Kennedy

Pharmacogenomics is the study of how genes influence a patient's responses to drugs. This research area is helping to clarify how genetic differences contribute to the risk of side effects (ADRs) or failure of drug treatment, and how we might better tailor treatment to each patient, leading to improved safety and effectiveness. This study describes a Christchurch initiative to collect and study the genetic basis of ADRs.

SUMMARY

Physician advocacy in Western medicine: a 21st century challenge

Philip Bagshaw, Pauline Barnett

Some doctors believe it is a professional responsibility to speak out publicly in defence of the health of patients and communities. Others think they should only give their views privately when asked by health authorities. With many healthcare systems in Western countries under increasing stress, with underfunding and growing unmet need for care, it is important that these divergent views on such professional responsibilities are quickly resolved. In the UK, where the National Health Service is in serious trouble, medical representative organisations are increasingly speaking openly about the problems. Will such organisations in other Western countries do the same, as-and-when their healthcare systems are similarly threatened?

SUMMARY

Asthma and Respiratory Foundation NZ child and adolescent asthma guidelines: a quick reference guide

Innes Asher, David McNamara, Cheryl Davies, Teresa Demetriou, Theresa Fleming, Matire Harwood, Lorraine Hetaraka-Stevens, Tristram Ingham, John Kristiansen, Jim Reid, Debbie Rickard, Debbie Ryan

The New Zealand child and adolescent asthma guidelines provide health professionals who deliver asthma care with simple, practical and evidence-based guidance for the diagnosis and treatment of asthma in children of 15 years of age and below. Prior to this project, New Zealand s child and adolescent asthma guidelines had not been updated since 2005. While medications essentially have remained the same, the way they should be utilised has subtly changed in the last 12 years. The new guidelines align the latest research with specific information for the New Zealand context, including available medications and relevant content for treating Mori and Pacific adults with asthma. The aim of the guidelines is to improve outcomes and reduce inequalities, and discusses factors such as unhealthy indoor environments and inadequate income for the basics needed for wellbeing.

SUMMARY

Breastfeeding indicators among a nationally representative multi-ethnic sample of New Zealand children

Teresa Castro, Cameron Grant, Clare Wall, Michaela Welch, Emma Marks, Courtney Fleming, Juliana Teixeira, Dinusha Bandara, Sarah Berry, Susan Morton

Although 97 percent of New Zealand children are breastfed initially, a large number are not being breastfed for as long as international guidelines recommend. New evidence from the Growing Up in New Zealand longitudinal study of more than 6,000 children and families (generalisable to the New Zealand national birth cohort) showed only one in six children achieved the World Health Organization-recommended six months of exclusive breastfeeding. One in eight achieved the recommendation of receiving some breast milk for two or more years. Duration of breastfeeding was also shown in the study to be associated with mothers age, ethnicity, education, number of children and whether the pregnancy was planned.

SUMMARY

Exposure to respirable crystalline silica in the construction industry do we have a problem?

David McLean, Bill Glass, Andrea t Mannetje, Jeroen Douwes

Heavy exposure to dust containing very fine particles of silica has long been known to cause silicosis or a scarring of the lung. From many studies conducted overseas, it has been found that even low levels of exposure also increase the risk of lung cancer and kidney disease. We measured the levels of exposure of construction workers, mainly when cutting or grinding concrete. We found that a sizeable proportion of construction workers did have exposure that was hazardous, and recommend that dust levels need to be reduced to prevent disease.

SUMMARY

Asbestos worker exposure, family disease

William Ivan Glass, Helen Clayson

Mesothelioma is a fatal disease resulting from asbestos exposure; such exposure usually occurs at work, however if the asbestos fibres are carried to the home from the workplace on the hair, clothes or boots of the worker, then family members in close contact with the worker can be exposed and may develop the disease. Because the link between work and home is not clear, the family member usually a female develops mesothelioma unexpectedly. As the family member did not develop the disease at work, ACC compensation is not available.

SUMMARY

Acupuncture, ACC and the Medicines Act

Daniel J Ryan

This study looked at acupuncture websites to see if they were breaching Section 58 of the Medicines Act, which prohibits claiming the ability to prevent, mitigate or cure a range of serious diseases. Seventy-three percent of the websites claimed they could treat/prevent mental illness, infertility and arthritis, 11% said they could treat/prevent cancer, 23% for diabetes, 19% for thrombosis and 14% for heart disease. This is the case despite a clear lack of evidence for the efficacy of acupuncture.

SUMMARY

Deaf New Zealand sign language users access to healthcare

Joanne Witko, Pauline Boyles, Kirsten Smiler, Rachel McKee

Part of the District Health Boards Sub-Regional Disability Strategy is to develop a comprehensive New Zealand Sign Language (NZSL) policy for the Wairarapa, Hutt Valley and Capital and Coast District Health Boards. To support this, research was carried out to investigate the quality of access to health services for deaf NZSL users. A co-design approach was used to collect qualitative data. Results suggest deaf NZSL users face multiple barriers within the health system mainly stemming from language barriers and a lack of information accessible in NZSL.

ALL ARTICLES
SUMMARY

New Zealand asthma guidelines updated

Richard Beasley, Robert J Hancox

Teaching quality improvement to medical students: over a decade of experience

Michelle R Wise, Bridget Kool, Lynn Sadler, Roshini Peiris-John, Gillian Robb, Susan Wells

A New Zealand platform to enable genetic investigation of adverse drug reactions

Simran DS Maggo, Eng Wee Chua, Paul Chin, Simone Cree, John Pearson, Matt Doogue, Martin A Kennedy

Aggressive prostate cancer incidence in New Zealand œunited we fall, divided we stand 

Venkatesh Vaidyanathan, Nishi Karunasinghe, Vetrivhel Krishnamurthy, Chi Hsiu-Juei Kao, Vijay Naidu, Radha Pallati, Alice Wang, Khanh Tran, Prasanna Kallingappa, Anower Jabed, Syed M Shahid, Jonathan Masters, Clare Wall, Ajit Narayanan, Lynnette R Ferguson

Physician advocacy in Western medicine: a 21st century challenge

Philip Bagshaw, Pauline Barnett

Asthma and Respiratory Foundation NZ child and adolescent asthma guidelines: a quick reference guide

Innes Asher, David McNamara, Cheryl Davies, Teresa Demetriou, Theresa Fleming, Matire Harwood, Lorraine Hetaraka-Stevens, Tristram Ingham, John Kristiansen, Jim Reid, Debbie Rickard, Debbie Ryan

Breastfeeding indicators among a nationally representative multi-ethnic sample of New Zealand children

Teresa Castro, Cameron Grant, Clare Wall, Michaela Welch, Emma Marks, Courtney Fleming, Juliana Teixeira, Dinusha Bandara, Sarah Berry, Susan Morton

Proceedings of the Waikato Clinical Campus Biannual Research Seminar

Tiotropium in early-stage chronic obstructive pulmonary disease

Examination of the Heart, and Life Insurance

Exposure to respirable crystalline silica in the construction industry do we have a problem?

David McLean, Bill Glass, Andrea t Mannetje, Jeroen Douwes

Asbestos worker exposure, family disease

William Ivan Glass, Helen Clayson

Acupuncture, ACC and the Medicines Act

Daniel J Ryan

Fanconi anaemia and oral squamous cell carcinoma: management considerations

Thasvir Singh, Kavin Andi

Deaf New Zealand sign language users access to healthcare

Joanne Witko, Pauline Boyles, Kirsten Smiler, Rachel McKee

SUMMARY

Teaching quality improvement to medical students: over a decade of experience

Michelle R Wise, Bridget Kool, Lynn Sadler, Roshini Peiris-John, Gillian Robb, Susan Wells

Final year medical students at University of Auckland perform a clinical audit project within the constraints and context of a busy women s health service. Students work with a clinical supervisor to identify an area for potential improvement, set a standard of care, measure current practice, investigate reasons for not achieving the standard and make real-world suggestions to close the gap between research and observed practice. Since 2004, over 1,250 student projects have been completed, many of which have resulted in actual improvements to clinical care. Such experiential learning during medical school is important in preparing future doctors to incorporate quality improvement knowledge and skills into their daily practice.

SUMMARY

A New Zealand platform to enable genetic investigation of adverse drug reactions

Simran DS Maggo, Eng Wee Chua, Paul Chin, Simone Cree, John Pearson, Matt Doogue, Martin A Kennedy

Pharmacogenomics is the study of how genes influence a patient's responses to drugs. This research area is helping to clarify how genetic differences contribute to the risk of side effects (ADRs) or failure of drug treatment, and how we might better tailor treatment to each patient, leading to improved safety and effectiveness. This study describes a Christchurch initiative to collect and study the genetic basis of ADRs.

SUMMARY

Physician advocacy in Western medicine: a 21st century challenge

Philip Bagshaw, Pauline Barnett

Some doctors believe it is a professional responsibility to speak out publicly in defence of the health of patients and communities. Others think they should only give their views privately when asked by health authorities. With many healthcare systems in Western countries under increasing stress, with underfunding and growing unmet need for care, it is important that these divergent views on such professional responsibilities are quickly resolved. In the UK, where the National Health Service is in serious trouble, medical representative organisations are increasingly speaking openly about the problems. Will such organisations in other Western countries do the same, as-and-when their healthcare systems are similarly threatened?

SUMMARY

Asthma and Respiratory Foundation NZ child and adolescent asthma guidelines: a quick reference guide

Innes Asher, David McNamara, Cheryl Davies, Teresa Demetriou, Theresa Fleming, Matire Harwood, Lorraine Hetaraka-Stevens, Tristram Ingham, John Kristiansen, Jim Reid, Debbie Rickard, Debbie Ryan

The New Zealand child and adolescent asthma guidelines provide health professionals who deliver asthma care with simple, practical and evidence-based guidance for the diagnosis and treatment of asthma in children of 15 years of age and below. Prior to this project, New Zealand s child and adolescent asthma guidelines had not been updated since 2005. While medications essentially have remained the same, the way they should be utilised has subtly changed in the last 12 years. The new guidelines align the latest research with specific information for the New Zealand context, including available medications and relevant content for treating Mori and Pacific adults with asthma. The aim of the guidelines is to improve outcomes and reduce inequalities, and discusses factors such as unhealthy indoor environments and inadequate income for the basics needed for wellbeing.

SUMMARY

Breastfeeding indicators among a nationally representative multi-ethnic sample of New Zealand children

Teresa Castro, Cameron Grant, Clare Wall, Michaela Welch, Emma Marks, Courtney Fleming, Juliana Teixeira, Dinusha Bandara, Sarah Berry, Susan Morton

Although 97 percent of New Zealand children are breastfed initially, a large number are not being breastfed for as long as international guidelines recommend. New evidence from the Growing Up in New Zealand longitudinal study of more than 6,000 children and families (generalisable to the New Zealand national birth cohort) showed only one in six children achieved the World Health Organization-recommended six months of exclusive breastfeeding. One in eight achieved the recommendation of receiving some breast milk for two or more years. Duration of breastfeeding was also shown in the study to be associated with mothers age, ethnicity, education, number of children and whether the pregnancy was planned.

SUMMARY

Exposure to respirable crystalline silica in the construction industry do we have a problem?

David McLean, Bill Glass, Andrea t Mannetje, Jeroen Douwes

Heavy exposure to dust containing very fine particles of silica has long been known to cause silicosis or a scarring of the lung. From many studies conducted overseas, it has been found that even low levels of exposure also increase the risk of lung cancer and kidney disease. We measured the levels of exposure of construction workers, mainly when cutting or grinding concrete. We found that a sizeable proportion of construction workers did have exposure that was hazardous, and recommend that dust levels need to be reduced to prevent disease.

SUMMARY

Asbestos worker exposure, family disease

William Ivan Glass, Helen Clayson

Mesothelioma is a fatal disease resulting from asbestos exposure; such exposure usually occurs at work, however if the asbestos fibres are carried to the home from the workplace on the hair, clothes or boots of the worker, then family members in close contact with the worker can be exposed and may develop the disease. Because the link between work and home is not clear, the family member usually a female develops mesothelioma unexpectedly. As the family member did not develop the disease at work, ACC compensation is not available.

SUMMARY

Acupuncture, ACC and the Medicines Act

Daniel J Ryan

This study looked at acupuncture websites to see if they were breaching Section 58 of the Medicines Act, which prohibits claiming the ability to prevent, mitigate or cure a range of serious diseases. Seventy-three percent of the websites claimed they could treat/prevent mental illness, infertility and arthritis, 11% said they could treat/prevent cancer, 23% for diabetes, 19% for thrombosis and 14% for heart disease. This is the case despite a clear lack of evidence for the efficacy of acupuncture.

SUMMARY

Deaf New Zealand sign language users access to healthcare

Joanne Witko, Pauline Boyles, Kirsten Smiler, Rachel McKee

Part of the District Health Boards Sub-Regional Disability Strategy is to develop a comprehensive New Zealand Sign Language (NZSL) policy for the Wairarapa, Hutt Valley and Capital and Coast District Health Boards. To support this, research was carried out to investigate the quality of access to health services for deaf NZSL users. A co-design approach was used to collect qualitative data. Results suggest deaf NZSL users face multiple barriers within the health system mainly stemming from language barriers and a lack of information accessible in NZSL.

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