Issue

Vol 131 No 1471: 9 March 2018

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Issue Summary

SUMMARY

What do doctors know about assessing decision-making capacity?

Greg Young, Alison Douglass, Lorraine Davison

All doctors need to know how to assess a patient s capacity to make decisions so that they can get informed consent for medical procedures, but also to support a patient who may have a condition that impairs their cognition and who needs to make an important decision, but may not be able to do so. Such patients are vulnerable and need support. We did a survey of hospital doctors of all grades and of GPs to assess what they knew about capacity assessment, whether they wanted to learn more, and what format of teaching they preferred. The majority of respondents could recall seeing a patient with suspected problems with capacity in the previous year, mostly due to cognitive disorders like dementia. There were significant gaps in the respondents knowledge about capacity assessment, and the respondents described a range of difficulties they perceived with doing capacity assessment. Tutorials, internet-based learning and workshops were equally popular educational methods.

SUMMARY

Mahi a Atua: a pathway forward for Māori mental health?

Diana Rangihuna, Mark Kopua, David Tipene-Leach

Mori demand on New Zealand mental health services is out of proportion to the size of the Mori population, and the psychiatric service response is limited by lack of capacity. But there is also an inherent lack of capability, that is, the ability of a Western paradigm psychiatric service to meet the needs of an indigenous community. The Mahi a Atua narratives-based programme established in the primary mental healthcare services of the Tairwhiti/Gisborne area has created a new approach to psychiatric assessment, diagnosis and therapy that is appropriate, but not confined, to the Mori community. This pilot project will be of interest nationwide and will have implications for those dealing with mental health problems and other forms of social distress.

SUMMARY

New atrial fibrillation diagnosed perioperatively anticoagulation practices in a secondary hospital

Alyssa Kirby, Sisira Jayathissa

Atrial fibrillation is an abnormal heart rhythm which can occur around the time of surgery. Atrial fibrillation can lead to serious complications, which include an increased risk of having a stroke in the future. It is not clear whether or not atrial fibrillation before or after surgery should be managed in the same way that patients without surgery are treated. This paper shows current practice at this hospital varies from patient to patient, due to a lack of strong evidence to guide treatment.

SUMMARY

Management of suspected acute coronary syndrome patients admitted to cardiology or non-cardiology services at Auckland City Hospital: implications for future national data collection

Tom Kai Ming Wang, Kok-Lam Chow, Aaron Lin, Alexei Chataline, Harvey White, Matthew Dawes, Greg Gamble, Chris Ellis

The study used comprehensive data from the previous 2012 National ACS (heart attack and unstable angina) audit to consider differences in patient management between those patients cared for by the cardiology and non-cardiology services. The current Ministry of Health-funded National database: the All New Zealand ACS Quality Improvement (ANZACS-QI) database, does not enrol non-cardiology ACS patients (at Auckland Hospital and potentially also at other large-centre hospitals), which will lead to inaccuracies with the data, and limitations to the quality improvement programme. There is a need to ensure complete capture of ACS patients on the National ANZACS-QI database, to allow appropriate assessment of available ACS services.

SUMMARY

Smoking prevalence among doctors and nurses 2013 New Zealand census data

Richard Edwards, Danny Tu, James Stanley, Greg Martin, Heather Gifford, Rhiannon Newcombe

We examined recent smoking trends among doctors and nurses in New Zealand using recent census data. We found that smoking had declined steadily and by 2013 only 2% of male and female doctors and 9% of male and 8% of female nurses were regular cigarette smokers. Smoking was more common among Mori doctors (7%) and nurses (19%), and also among psychiatric nurses. The findings suggest that New Zealand doctors had achieved the Smokefree 2025 goal of minimal (

SUMMARY

Paediatric pelvic fractures: Starship Hospital experience

Mohit Bajaj, Giorgio Stefanutti, Haemish Crawford, Vipul Upadhyay

We examined recent smoking trends among doctors and nurses in New Zealand using recent census data. We found that smoking had declined steadily and by 2013 only 2% of male and female doctors and 9% of male and 8% of female nurses were regular cigarette smokers. Smoking was more common among Mori doctors (7%) and nurses (19%), and also among psychiatric nurses. The findings suggest that New Zealand doctors had achieved the Smokefree 2025 goal of minimal (

SUMMARY

Renal function monitoring in patients prescribed dabigatran in the Compass Health Primary Health Organisation: a quality improvement audit

Lynn McBain, Anna Kyle

The Compass Health Primary Health Organisation checked every patient prescribed the anticoagulant (blood thinner) dabigatran twice during 2014 and 2016. There was a big increase in patients prescribed dabigatran during this time. Kidney function needs to be monitored if dabigatran is being taken. Ninety-six (96%) percent of patients prescribed dabigatran were taking it for approved reasons and 90% of patients had their kidney function checked each year, which is recommended by treatment guidelines.

SUMMARY

Seasonal variation in Takotsubo syndrome compared with myocardial infarction: ANZACS-QI 16

Jen-Li Looi, Mildred Lee, MSc, Corina Grey, Mark Webster, Andrew To, Andrew J Kerr

Takotsubo syndrome, TS (also known as broken heart syndrome) mimics the presentation of a heart attack. Heart attack shows well-defined temporal patterns in its occurrence throughout the year, which is characterised by a peak in winter and a trough in summer. Our study is the first study to date investigating the seasonal patterns of presentation of TS and heart attack in the Southern Hemisphere. We have demonstrated that the onset of TS differed as a function of season, with the events most frequent in summer and least so in winter. In contrast, incidence of heart attack was highest in winter and lowest in summer. The reasons underlying this seasonal variation observed in TS are still unclear and further studies are needed to investigate the potential link between season variation in TS onset and its underlying cause.

ALL ARTICLES
SUMMARY

What do doctors know about assessing decision-making capacity?

Greg Young, Alison Douglass, Lorraine Davison

Mahi a Atua: a pathway forward for Māori mental health?

Diana Rangihuna, Mark Kopua, David Tipene-Leach

New atrial fibrillation diagnosed perioperatively anticoagulation practices in a secondary hospital

Alyssa Kirby, Sisira Jayathissa

Management of suspected acute coronary syndrome patients admitted to cardiology or non-cardiology services at Auckland City Hospital: implications for future national data collection

Tom Kai Ming Wang, Kok-Lam Chow, Aaron Lin, Alexei Chataline, Harvey White, Matthew Dawes, Greg Gamble, Chris Ellis

Aspirin versus placebo in pregnancies at high risk for preterm preeclampsia

Smoking prevalence among doctors and nurses 2013 New Zealand census data

Richard Edwards, Danny Tu, James Stanley, Greg Martin, Heather Gifford, Rhiannon Newcombe

Status of Dentists in New Zealand

Cannabis don t smoke it! Four cannabis-related pathologies in one radiograph

Kate Grant, Vivienne Campbell, Lutz Beckert

Children cycling on footpaths

Edward Randal, Romane Baland, Michael Keall

Paediatric pelvic fractures: Starship Hospital experience

Mohit Bajaj, Giorgio Stefanutti, Haemish Crawford, Vipul Upadhyay

Renal function monitoring in patients prescribed dabigatran in the Compass Health Primary Health Organisation: a quality improvement audit

Lynn McBain, Anna Kyle

Climate change, human health and the CPTPP

Oliver Hailes, Rhys Jones, David Menkes, Joshua Freeman, Erik Monasterio

Seasonal variation in Takotsubo syndrome compared with myocardial infarction: ANZACS-QI 16

Jen-Li Looi, Mildred Lee, MSc, Corina Grey, Mark Webster, Andrew To, Andrew J Kerr

SUMMARY

What do doctors know about assessing decision-making capacity?

Greg Young, Alison Douglass, Lorraine Davison

All doctors need to know how to assess a patient s capacity to make decisions so that they can get informed consent for medical procedures, but also to support a patient who may have a condition that impairs their cognition and who needs to make an important decision, but may not be able to do so. Such patients are vulnerable and need support. We did a survey of hospital doctors of all grades and of GPs to assess what they knew about capacity assessment, whether they wanted to learn more, and what format of teaching they preferred. The majority of respondents could recall seeing a patient with suspected problems with capacity in the previous year, mostly due to cognitive disorders like dementia. There were significant gaps in the respondents knowledge about capacity assessment, and the respondents described a range of difficulties they perceived with doing capacity assessment. Tutorials, internet-based learning and workshops were equally popular educational methods.

SUMMARY

Mahi a Atua: a pathway forward for Māori mental health?

Diana Rangihuna, Mark Kopua, David Tipene-Leach

Mori demand on New Zealand mental health services is out of proportion to the size of the Mori population, and the psychiatric service response is limited by lack of capacity. But there is also an inherent lack of capability, that is, the ability of a Western paradigm psychiatric service to meet the needs of an indigenous community. The Mahi a Atua narratives-based programme established in the primary mental healthcare services of the Tairwhiti/Gisborne area has created a new approach to psychiatric assessment, diagnosis and therapy that is appropriate, but not confined, to the Mori community. This pilot project will be of interest nationwide and will have implications for those dealing with mental health problems and other forms of social distress.

SUMMARY

New atrial fibrillation diagnosed perioperatively anticoagulation practices in a secondary hospital

Alyssa Kirby, Sisira Jayathissa

Atrial fibrillation is an abnormal heart rhythm which can occur around the time of surgery. Atrial fibrillation can lead to serious complications, which include an increased risk of having a stroke in the future. It is not clear whether or not atrial fibrillation before or after surgery should be managed in the same way that patients without surgery are treated. This paper shows current practice at this hospital varies from patient to patient, due to a lack of strong evidence to guide treatment.

SUMMARY

Management of suspected acute coronary syndrome patients admitted to cardiology or non-cardiology services at Auckland City Hospital: implications for future national data collection

Tom Kai Ming Wang, Kok-Lam Chow, Aaron Lin, Alexei Chataline, Harvey White, Matthew Dawes, Greg Gamble, Chris Ellis

The study used comprehensive data from the previous 2012 National ACS (heart attack and unstable angina) audit to consider differences in patient management between those patients cared for by the cardiology and non-cardiology services. The current Ministry of Health-funded National database: the All New Zealand ACS Quality Improvement (ANZACS-QI) database, does not enrol non-cardiology ACS patients (at Auckland Hospital and potentially also at other large-centre hospitals), which will lead to inaccuracies with the data, and limitations to the quality improvement programme. There is a need to ensure complete capture of ACS patients on the National ANZACS-QI database, to allow appropriate assessment of available ACS services.

SUMMARY

Smoking prevalence among doctors and nurses 2013 New Zealand census data

Richard Edwards, Danny Tu, James Stanley, Greg Martin, Heather Gifford, Rhiannon Newcombe

We examined recent smoking trends among doctors and nurses in New Zealand using recent census data. We found that smoking had declined steadily and by 2013 only 2% of male and female doctors and 9% of male and 8% of female nurses were regular cigarette smokers. Smoking was more common among Mori doctors (7%) and nurses (19%), and also among psychiatric nurses. The findings suggest that New Zealand doctors had achieved the Smokefree 2025 goal of minimal (

SUMMARY

Paediatric pelvic fractures: Starship Hospital experience

Mohit Bajaj, Giorgio Stefanutti, Haemish Crawford, Vipul Upadhyay

We examined recent smoking trends among doctors and nurses in New Zealand using recent census data. We found that smoking had declined steadily and by 2013 only 2% of male and female doctors and 9% of male and 8% of female nurses were regular cigarette smokers. Smoking was more common among Mori doctors (7%) and nurses (19%), and also among psychiatric nurses. The findings suggest that New Zealand doctors had achieved the Smokefree 2025 goal of minimal (

SUMMARY

Renal function monitoring in patients prescribed dabigatran in the Compass Health Primary Health Organisation: a quality improvement audit

Lynn McBain, Anna Kyle

The Compass Health Primary Health Organisation checked every patient prescribed the anticoagulant (blood thinner) dabigatran twice during 2014 and 2016. There was a big increase in patients prescribed dabigatran during this time. Kidney function needs to be monitored if dabigatran is being taken. Ninety-six (96%) percent of patients prescribed dabigatran were taking it for approved reasons and 90% of patients had their kidney function checked each year, which is recommended by treatment guidelines.

SUMMARY

Seasonal variation in Takotsubo syndrome compared with myocardial infarction: ANZACS-QI 16

Jen-Li Looi, Mildred Lee, MSc, Corina Grey, Mark Webster, Andrew To, Andrew J Kerr

Takotsubo syndrome, TS (also known as broken heart syndrome) mimics the presentation of a heart attack. Heart attack shows well-defined temporal patterns in its occurrence throughout the year, which is characterised by a peak in winter and a trough in summer. Our study is the first study to date investigating the seasonal patterns of presentation of TS and heart attack in the Southern Hemisphere. We have demonstrated that the onset of TS differed as a function of season, with the events most frequent in summer and least so in winter. In contrast, incidence of heart attack was highest in winter and lowest in summer. The reasons underlying this seasonal variation observed in TS are still unclear and further studies are needed to investigate the potential link between season variation in TS onset and its underlying cause.

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