Issue

Vol 131 No 1476: 8 June 2018

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Issue Summary

SUMMARY

Violence and aggression in the emergency department is under-reported and under-appreciated

Sandra K Richardson, Paula C Grainger, Michael W Ardagh, Russell Morrison

Staff working in emergency departments are exposed to a constant level of violence and aggression. This includes verbal threats and harassment that have become seen as a normal part of the work environment, and in many cases there is a failure to report the full extent of aggression that occurs. When reporting is not provided, there is the potential for management and DHBs to misinterpret the level of violence in the workplace, and be unaware of the need to respond appropriately.

SUMMARY

The New Zealand PIPER Project: colorectal cancer survival according to rurality, ethnicity and socioeconomic deprivation results from a retrospective cohort study

Katrina Sharples, Melissa Firth, Victoria Hinder, Andrew Hill, Mark Jeffery, Diana Sarfati, Charis Brown, Carol Atmore, Ross Lawrenson, Papaarangi Reid, Sarah Derrett, Jerome Macapagel, John Keating, Adrian Secker, Charles De Groot, Christopher Jackson, Michael Findlay

Colorectal cancer (bowel cancer) is one of New Zealand s most common and deadly cancers, and we have poorer survival than Australia. The PIPER project is the largest and most detailed study of bowel cancer undertaken in New Zealand. In the second of many publications from this project, we report differences in outcome between Mori, Pacific and non-Mori non-Pacific. We found Mori and Pacific people were more likely to die from bowel cancer than non-Mori mostly because their cancers were detected later, and they were much more likely to be diagnosed as an emergency than non-Mori. This suggests that earlier diagnosis for Mori and Pacific needs to be a focus to improve outcomes for these groups.

SUMMARY

Paediatric team handover: a time to learn?

Stephen Bradley, John P Egan, Marcus Henning

We interviewed 29 doctors and medical students who were involved in team handovers in New Zealand hospitals. At these handovers, children who were under the team s care were discussed, with the aim of ensuring that critical information was passed on from one team member to others. Team handover was described as an important time for learning to occur, and much of the learning was reported to occur opportunistically as patients diagnoses and treatment were considered. In addition, participants also reported that discussion about patients allowed them to consider how they would manage future patients with similar problems. This study draws attention to the way that this important hospital meeting can also provide a time for learning.

SUMMARY

Changes in New Zealand s alcohol environment following implementation of the Sale and Supply of Alcohol Act (2012)

Stephen Randerson, Sally Casswell, Taisia Huckle

The Sale and Supply of Alcohol Act was implemented during 2013, with the new aim of minimising harm from excessive consumption of alcohol. We assessed the impact of the Act on the drinking environment by reviewing public datasets and reports and interviewing alcohol regulatory staff. We found little evidence that the Act had affected the alcohol environment between 2013 and 2015, other than a small reduction in on-licence trading hours in New Zealand s main cities. The process of establishing local alcohol policies to protect health has been subverted by the appeals by the alcohol suppliers whose resources are greater than those of local authorities and health agencies.

SUMMARY

The Matthew effect in New Zealand rural hospital trauma and emergency care: why rural simulation-based education matters

Marc Gutenstein, Sampsa Kiuru

Rural hospitals treat patients with trauma and health emergencies, as these problems occur all around New Zealand, and are sometimes more common in rural areas. Rural hospital teams are at a disadvantage when compared with the large urban university hospitals, as they are less experienced, less specialised, have less backup help on hand and get less training for these emergencies. High fidelity simulation using mannequins and real patient scenarios can help train teams to perform better in emergency situations. Simulation is used all around the world in many different occupations, and in many countries has been funded specifically for emergency medical training. Until recently in New Zealand, simulation training has only been available at main university hospitals (this is the Matthew Effect where the already successful urban teams become more successful, and the disadvantaged rural teams become more disadvantaged). To remedy the situation we should offer high fidelity simulation to rural medical services in New Zealand.

SUMMARY

Crisis resolution: consumer, family and referrer perspectives on care

Frances A Carter, M Joan Taylor, Madeline J Weston, Teresa A Quigley, John H Beveridge, Robert AJ Green, Steve Duffy, Joseph M Boden

Almost by definition, needing help from a crisis resolution service is a highly stressful time for consumers, their families and potentially referrers. Overall, consumers, families and referrers reported high levels of satisfaction with crisis resolution. However, if consumers were dissatisfied with their care, they were more likely to be aged between 25-34 years. The present study was not able to explore the reasons why this might be the case. This study highlighted what matters to people when accessing help from crisis resolution. Not surprisingly, people emphasised the importance of effective treatment of sufficient duration, and staff manner (eg, being warm, understanding, reassuring and respectful). Some challenges for staff in delivering effective care in a crisis resolution context are discussed.

SUMMARY

Holding a mirror to society? Progression towards achieving better sociodemographic representation among the University of Otago’s health professional students

Peter Crampton, Naomi Weaver, Andrea Howard

This paper describes the sociodemographic characteristics of students accepted into eight health professional programmes at the University of Otago in 2016 and compares them with a similar 2012 paper to illustrate progress towards increasing diversity among health professional students. Between 2010 and 2016 there was: a marked increase in the proportion of M1ori (124% increase) and Pacific students (121% increase) in health professional programmes, more pronounced in medicine and dentistry (increases of 179% and 133% respectively); an increase in the proportion of students from rural areas from 19.2% to 22.5%; an increase in the proportion of female students from 59.6% to 61.3%; and little overall change in the overall socioeconomic profile. The recent introduction of new affirmative categories will hopefully result in the future in an increase in socioeconomic diversity and in the number of refugee students.

ALL ARTICLES
SUMMARY

Violence and aggression in the emergency department is under-reported and under-appreciated

Sandra K Richardson, Paula C Grainger, Michael W Ardagh, Russell Morrison

The New Zealand PIPER Project: colorectal cancer survival according to rurality, ethnicity and socioeconomic deprivation results from a retrospective cohort study

Katrina Sharples, Melissa Firth, Victoria Hinder, Andrew Hill, Mark Jeffery, Diana Sarfati, Charis Brown, Carol Atmore, Ross Lawrenson, Papaarangi Reid, Sarah Derrett, Jerome Macapagel, John Keating, Adrian Secker, Charles De Groot, Christopher Jackson, Michael Findlay

New Zealand Soldiers’ Medical Club

Lipid-lowering therapy use and achievement of cholesterol targets in an Australian diabetes clinic

Acupuncture and ACC: therapeutic regulation and funding in New Zealand

Dylan A Mordaunt

Acupuncture and the Medicines Act: a reply

Ben Gray

Paediatric team handover: a time to learn?

Stephen Bradley, John P Egan, Marcus Henning

Rarely a triple whammy in general medicine

Amy Okamura-Kho, QianYi Chuah, Paul Chin, Matthew Doogue

The importance of medical assessment prior to high-intensity interval training

Melyssa Claire Roy, Kimberley Anne Meredith-Jones, Hamish Robert Osborne, Sheila Mary Williams, Rachel Clare Brown, Michelle Rose Jospe, Rachael Waring Taylor

Acute appendicitis in an incarcerated femoral hernia

Simon Richards, Joel D Souza

Changes in New Zealand s alcohol environment following implementation of the Sale and Supply of Alcohol Act (2012)

Stephen Randerson, Sally Casswell, Taisia Huckle

Diagnosing pre-clinical dementia: the NZ Genetic Frontotemporal Dementia Study (FTDGeNZ)

Brigid Ryan, Ashleigh Baker, Christina Ilse, Kiri L Brickell, Hannah M Kersten, Helen V Danesh-Meyer, Joanna M Williams, Donna Rose Addis, Lynette Tippett, Maurice A Curtis

Lynch syndrome: much progress but many questions remain

John Keating

Professor Diana Lennon

Innes Asher

The Matthew effect in New Zealand rural hospital trauma and emergency care: why rural simulation-based education matters

Marc Gutenstein, Sampsa Kiuru

Crisis resolution: consumer, family and referrer perspectives on care

Frances A Carter, M Joan Taylor, Madeline J Weston, Teresa A Quigley, John H Beveridge, Robert AJ Green, Steve Duffy, Joseph M Boden

Holding a mirror to society? Progression towards achieving better sociodemographic representation among the University of Otago’s health professional students

Peter Crampton, Naomi Weaver, Andrea Howard

Is it time for New Zealand to adopt alcohol policy that will reduce the harm from alcohol?

Jennie Connor

SUMMARY

Violence and aggression in the emergency department is under-reported and under-appreciated

Sandra K Richardson, Paula C Grainger, Michael W Ardagh, Russell Morrison

Staff working in emergency departments are exposed to a constant level of violence and aggression. This includes verbal threats and harassment that have become seen as a normal part of the work environment, and in many cases there is a failure to report the full extent of aggression that occurs. When reporting is not provided, there is the potential for management and DHBs to misinterpret the level of violence in the workplace, and be unaware of the need to respond appropriately.

SUMMARY

The New Zealand PIPER Project: colorectal cancer survival according to rurality, ethnicity and socioeconomic deprivation results from a retrospective cohort study

Katrina Sharples, Melissa Firth, Victoria Hinder, Andrew Hill, Mark Jeffery, Diana Sarfati, Charis Brown, Carol Atmore, Ross Lawrenson, Papaarangi Reid, Sarah Derrett, Jerome Macapagel, John Keating, Adrian Secker, Charles De Groot, Christopher Jackson, Michael Findlay

Colorectal cancer (bowel cancer) is one of New Zealand s most common and deadly cancers, and we have poorer survival than Australia. The PIPER project is the largest and most detailed study of bowel cancer undertaken in New Zealand. In the second of many publications from this project, we report differences in outcome between Mori, Pacific and non-Mori non-Pacific. We found Mori and Pacific people were more likely to die from bowel cancer than non-Mori mostly because their cancers were detected later, and they were much more likely to be diagnosed as an emergency than non-Mori. This suggests that earlier diagnosis for Mori and Pacific needs to be a focus to improve outcomes for these groups.

SUMMARY

Paediatric team handover: a time to learn?

Stephen Bradley, John P Egan, Marcus Henning

We interviewed 29 doctors and medical students who were involved in team handovers in New Zealand hospitals. At these handovers, children who were under the team s care were discussed, with the aim of ensuring that critical information was passed on from one team member to others. Team handover was described as an important time for learning to occur, and much of the learning was reported to occur opportunistically as patients diagnoses and treatment were considered. In addition, participants also reported that discussion about patients allowed them to consider how they would manage future patients with similar problems. This study draws attention to the way that this important hospital meeting can also provide a time for learning.

SUMMARY

Changes in New Zealand s alcohol environment following implementation of the Sale and Supply of Alcohol Act (2012)

Stephen Randerson, Sally Casswell, Taisia Huckle

The Sale and Supply of Alcohol Act was implemented during 2013, with the new aim of minimising harm from excessive consumption of alcohol. We assessed the impact of the Act on the drinking environment by reviewing public datasets and reports and interviewing alcohol regulatory staff. We found little evidence that the Act had affected the alcohol environment between 2013 and 2015, other than a small reduction in on-licence trading hours in New Zealand s main cities. The process of establishing local alcohol policies to protect health has been subverted by the appeals by the alcohol suppliers whose resources are greater than those of local authorities and health agencies.

SUMMARY

The Matthew effect in New Zealand rural hospital trauma and emergency care: why rural simulation-based education matters

Marc Gutenstein, Sampsa Kiuru

Rural hospitals treat patients with trauma and health emergencies, as these problems occur all around New Zealand, and are sometimes more common in rural areas. Rural hospital teams are at a disadvantage when compared with the large urban university hospitals, as they are less experienced, less specialised, have less backup help on hand and get less training for these emergencies. High fidelity simulation using mannequins and real patient scenarios can help train teams to perform better in emergency situations. Simulation is used all around the world in many different occupations, and in many countries has been funded specifically for emergency medical training. Until recently in New Zealand, simulation training has only been available at main university hospitals (this is the Matthew Effect where the already successful urban teams become more successful, and the disadvantaged rural teams become more disadvantaged). To remedy the situation we should offer high fidelity simulation to rural medical services in New Zealand.

SUMMARY

Crisis resolution: consumer, family and referrer perspectives on care

Frances A Carter, M Joan Taylor, Madeline J Weston, Teresa A Quigley, John H Beveridge, Robert AJ Green, Steve Duffy, Joseph M Boden

Almost by definition, needing help from a crisis resolution service is a highly stressful time for consumers, their families and potentially referrers. Overall, consumers, families and referrers reported high levels of satisfaction with crisis resolution. However, if consumers were dissatisfied with their care, they were more likely to be aged between 25-34 years. The present study was not able to explore the reasons why this might be the case. This study highlighted what matters to people when accessing help from crisis resolution. Not surprisingly, people emphasised the importance of effective treatment of sufficient duration, and staff manner (eg, being warm, understanding, reassuring and respectful). Some challenges for staff in delivering effective care in a crisis resolution context are discussed.

SUMMARY

Holding a mirror to society? Progression towards achieving better sociodemographic representation among the University of Otago’s health professional students

Peter Crampton, Naomi Weaver, Andrea Howard

This paper describes the sociodemographic characteristics of students accepted into eight health professional programmes at the University of Otago in 2016 and compares them with a similar 2012 paper to illustrate progress towards increasing diversity among health professional students. Between 2010 and 2016 there was: a marked increase in the proportion of M1ori (124% increase) and Pacific students (121% increase) in health professional programmes, more pronounced in medicine and dentistry (increases of 179% and 133% respectively); an increase in the proportion of students from rural areas from 19.2% to 22.5%; an increase in the proportion of female students from 59.6% to 61.3%; and little overall change in the overall socioeconomic profile. The recent introduction of new affirmative categories will hopefully result in the future in an increase in socioeconomic diversity and in the number of refugee students.

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