Issue

Vol 131 No 1477: 22 June 2018

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Issue Summary

SUMMARY

The impact of multimorbidity on people s lives: a cross-sectional survey

Jeannine Stairmand, Jason Gurney, James Stanley, Elinor Millar, Cheryl Davies, Kelly Semper, Anthony Dowell, Dee Mangin, Ross Lawrenson, Diana Sarfati

Multimorbidity is the coexistence of more than one chronic disease. Multimorbidity is increasingly common particularly among those over 65 years, Mori and Pacific people and those living in socioeconomic deprivation. Multimorbidity results in high health service use, competing demands on patients and healthcare professionals, and reduces quality and quantity of life. Multimorbidity research is growing internationally and scarce in New Zealand. This research surveyed a sample of New Zealand primary care patients and describes the prevalence and impact of multimorbidity on their lives.

SUMMARY

Projected stroke volumes to provide a 10-year direction for New Zealand stroke services

Annemarei Ranta

While stroke incidence and mortality are declining due to better management strategies, the overall number of stroke sufferers will rise by 40% over the next 10 years to around 12,000 stroke per annum. This is attributable to projected population growth and more importantly ageing of the population. It is imperative that the health sector implements effective stroke prevention and post-stroke intervention strategies to minimise the impact on human suffering and healthcare expenditure.

SUMMARY

Sexuality and gender identity teaching within preclinical medical training in New Zealand: content, attitudes and barriers

Oscar Taylor, Charlene M Rapsey, Gareth J Treharne

Negative healthcare experiences are common for people with diverse sexual and gender identities. A survey was distributed to staff responsible for curriculum in the pre-clinical years of New Zealand s medical schools, inquiring about the sexuality and gender content they teach, and their perceived attitudes around this content. Results showed that LGBTQI-specific content is covered minimally and some staff are aware of a gap in teaching content. The staff felt this content would be easy to teach, but finding the time to include it was difficult. Experience with sexuality and gender in a healthcare setting and further faculty support could potentially help with providing the opportunity to facilitate the sensitive inclusion of sexuality and gender content in the medical school curriculum.

SUMMARY

Keeping track of antimicrobial resistance for Neisseria gonorrhoeae in Auckland, New Zealand: past, present and future considerations

Gary N McAuliffe, Marian Smith, Mike Brokenshire, Rose Forster, Murray Reid, Sally A Roberts

We looked at how likely gonorrhoea was to respond to available treatments in Auckland over an eight year period. We found that only the currently recommended antibiotic combination was suitable, and that this may also be at risk. We have changed the way we detect resistant gonorrhoea to pick up on potential problems at an earlier stage.

SUMMARY

New Zealand s health workforce planning should embrace complexity and uncertainty

Gareth H Rees, Peter Crampton, Robin Gauld, Stephen MacDonell

New Zealand has recurring shortages of medical professionals, yet many of the solutions implemented have failed to sustainably address the problem. The article suggests that by broadening the range of methods, future workforces could be configured and skilled to meet future expected health needs. By embracing these methods, policy makers can be better equipped to develop options which are more likely to represent future workforce conditions and needs. Including this approach within planning will contribute to the design of more sustainable workforce policies.

SUMMARY

The futility of fertility research? Barriers to embryo research in New Zealand

Lucy Goodman, Lynsey Cree, Gareth Jones, Michael Legge, Andrew Shelling, Cindy Farquhar

Research that uses viable human embryos cannot currently be conducted in New Zealand. This includes research that uses identical methods to clinical treatments for infertility. This survey reveals that New Zealand researchers feel dissatisfied with the lack of guidance from the Ministry of Health about human embryo research, and that this is a barrier to progressing scientific research in this country. The Minister of Health should direct its ethics committees to develop guidelines on this issue.

SUMMARY

Faster Cancer Treatment pathway in gynaecological malignancy: a repeat clinical audit

Minah Ha, Anand Gangji

Faster Cancer Treatment Pathway is a Ministry of Health-led initiative to ensure all cancer patients have their treatment in a timely manner to achieve optimal health outcome, with 31-day target between treatment decision and treatment and 62-day target between specialist referral and treatment. Our study shows 85% of women with gynaecological cancer in Northland are meeting the 31-day target and 45% meeting the 62-day target. This shows an overall improvement in cancer care provision from previous study in 2014-2015, however it still falls short of government targets. Shortage of radiological and theatre resources were the main contributing factors for the delay in commencement of cancer treatment in our women with gynaecological cancer in Northland.

SUMMARY

Audit to investigate junior doctors knowledge of how to administer and score the Montreal Cognitive Assessment (MoCA)

Chani Tromop-van Dalen, Katie Thorne, Krystina Common, Garrick Edge, Lisa Woods

The Montreal Cognitive Assessment (MoCA) is a standardised test commonly used by medical professionals to assess cognition. Junior doctors often conduct the MoCA in hospital on patients at risk of cognitive problems, however many have never received formal teaching on how to do so. This audit looked at the ability of junior doctors to administer and score the MoCA before and after a brief teaching session. The results show that a brief teaching session improved junior doctors ability to conduct the MoCA, which may have significance for patient outcomes.

SUMMARY

Antimicrobial resistance among Shigella in New Zealand

Helen Heffernan, Rosemary Woodhouse, Chris Hewison, Jillian Sherwood

Shigellosis is a gastrointestinal infection that does not usually require treatment with antibiotics. However, antibiotics are recommended when the patient is severely ill or for patient groups at increased risk of spreading the infection, for example, young children. A recent New Zealand survey found that a high proportion of Shigella, the bacterium that causes shigellosis, are resistant to the antibiotics recommended when cases of shigellosis require treatment. Therefore, it is important that laboratories processing specimens from shigellosis cases include testing to determine which antibiotics will be effective should treatment be required.

SUMMARY

Impact of discontinuation of telestroke: the Nelson experience

Annemarei Ranta, Suzanne Busch

Telestroke helps to improve out-of-hour patient access to IV thrombolysis in provincial hospitals through remote expert support using videconference equipment. Telestroke may also help upskill local clinicians. To test the benefit of upskilling local teams, telestroke was discontinued at Nelson Hospital. Following discontinuation the treatment rates dropped to pre-telestroke rates. This shows that telestroke does not result in sufficient local staff upskilling to retain improved treatment rates once remote expert support is withdrawn.

ALL ARTICLES
SUMMARY

The impact of multimorbidity on people s lives: a cross-sectional survey

Jeannine Stairmand, Jason Gurney, James Stanley, Elinor Millar, Cheryl Davies, Kelly Semper, Anthony Dowell, Dee Mangin, Ross Lawrenson, Diana Sarfati

Twenty-one years of saving lives: The New Zealand Resuscitation Council

Lachlan McKenzie, Jonathon Webber, Richard Aickin, Julie Considine, Anna Lawson, Lindsay Mildenhall, Kevin Nation, Tonia Nicholson, Gabrielle Nuthall, Tony Scott, Malcolm Stuart

Projected stroke volumes to provide a 10-year direction for New Zealand stroke services

Annemarei Ranta

Book Review
Vol 131 No 1477: 22 June 2018

Black Flu 1918; The story of New Zealand s worst public health disaster

Frank Frizelle

This is the account of the 1918 influenza pandemic.

Sexuality and gender identity teaching within preclinical medical training in New Zealand: content, attitudes and barriers

Oscar Taylor, Charlene M Rapsey, Gareth J Treharne

Is New Zealand immigration policy a barrier to TB elimination?

Emmanuel Badu, Charles Mpofu, Pante00e1 Farvid

Keeping track of antimicrobial resistance for Neisseria gonorrhoeae in Auckland, New Zealand: past, present and future considerations

Gary N McAuliffe, Marian Smith, Mike Brokenshire, Rose Forster, Murray Reid, Sally A Roberts

New Zealand s health workforce planning should embrace complexity and uncertainty

Gareth H Rees, Peter Crampton, Robin Gauld, Stephen MacDonell

The Smokefree 2025 goal: an opportunity for the new government

Martin Witt, Richard Edwards, Janet Hoek, George Thomson

The futility of fertility research? Barriers to embryo research in New Zealand

Lucy Goodman, Lynsey Cree, Gareth Jones, Michael Legge, Andrew Shelling, Cindy Farquhar

Faster Cancer Treatment pathway in gynaecological malignancy: a repeat clinical audit

Minah Ha, Anand Gangji

A Case of Congenital Hypertrophic Stenosis of the Pylorus

By J. P. S. Jamieson, Nelson Hospital

Book Review
Vol 131 No 1477: 22 June 2018

The Older Traveller: A guide for the health professional

Frank Frizelle

When I found this book was returned from the initial reviewer without a review from the person who had “volunteered” to review it

Audit to investigate junior doctors knowledge of how to administer and score the Montreal Cognitive Assessment (MoCA)

Chani Tromop-van Dalen, Katie Thorne, Krystina Common, Garrick Edge, Lisa Woods

Professor Derek Nigel John Hart

Peter Pryor, Georgina Clark

Primary care-led weight management for remission of type 2 diabetes

Antimicrobial resistance among Shigella in New Zealand

Helen Heffernan, Rosemary Woodhouse, Chris Hewison, Jillian Sherwood

Organised stroke care to improve survival and independence: New Zealand perspectives

Mark Weatherall

Impact of discontinuation of telestroke: the Nelson experience

Annemarei Ranta, Suzanne Busch

SUMMARY

The impact of multimorbidity on people s lives: a cross-sectional survey

Jeannine Stairmand, Jason Gurney, James Stanley, Elinor Millar, Cheryl Davies, Kelly Semper, Anthony Dowell, Dee Mangin, Ross Lawrenson, Diana Sarfati

Multimorbidity is the coexistence of more than one chronic disease. Multimorbidity is increasingly common particularly among those over 65 years, Mori and Pacific people and those living in socioeconomic deprivation. Multimorbidity results in high health service use, competing demands on patients and healthcare professionals, and reduces quality and quantity of life. Multimorbidity research is growing internationally and scarce in New Zealand. This research surveyed a sample of New Zealand primary care patients and describes the prevalence and impact of multimorbidity on their lives.

SUMMARY

Projected stroke volumes to provide a 10-year direction for New Zealand stroke services

Annemarei Ranta

While stroke incidence and mortality are declining due to better management strategies, the overall number of stroke sufferers will rise by 40% over the next 10 years to around 12,000 stroke per annum. This is attributable to projected population growth and more importantly ageing of the population. It is imperative that the health sector implements effective stroke prevention and post-stroke intervention strategies to minimise the impact on human suffering and healthcare expenditure.

SUMMARY

Sexuality and gender identity teaching within preclinical medical training in New Zealand: content, attitudes and barriers

Oscar Taylor, Charlene M Rapsey, Gareth J Treharne

Negative healthcare experiences are common for people with diverse sexual and gender identities. A survey was distributed to staff responsible for curriculum in the pre-clinical years of New Zealand s medical schools, inquiring about the sexuality and gender content they teach, and their perceived attitudes around this content. Results showed that LGBTQI-specific content is covered minimally and some staff are aware of a gap in teaching content. The staff felt this content would be easy to teach, but finding the time to include it was difficult. Experience with sexuality and gender in a healthcare setting and further faculty support could potentially help with providing the opportunity to facilitate the sensitive inclusion of sexuality and gender content in the medical school curriculum.

SUMMARY

Keeping track of antimicrobial resistance for Neisseria gonorrhoeae in Auckland, New Zealand: past, present and future considerations

Gary N McAuliffe, Marian Smith, Mike Brokenshire, Rose Forster, Murray Reid, Sally A Roberts

We looked at how likely gonorrhoea was to respond to available treatments in Auckland over an eight year period. We found that only the currently recommended antibiotic combination was suitable, and that this may also be at risk. We have changed the way we detect resistant gonorrhoea to pick up on potential problems at an earlier stage.

SUMMARY

New Zealand s health workforce planning should embrace complexity and uncertainty

Gareth H Rees, Peter Crampton, Robin Gauld, Stephen MacDonell

New Zealand has recurring shortages of medical professionals, yet many of the solutions implemented have failed to sustainably address the problem. The article suggests that by broadening the range of methods, future workforces could be configured and skilled to meet future expected health needs. By embracing these methods, policy makers can be better equipped to develop options which are more likely to represent future workforce conditions and needs. Including this approach within planning will contribute to the design of more sustainable workforce policies.

SUMMARY

The futility of fertility research? Barriers to embryo research in New Zealand

Lucy Goodman, Lynsey Cree, Gareth Jones, Michael Legge, Andrew Shelling, Cindy Farquhar

Research that uses viable human embryos cannot currently be conducted in New Zealand. This includes research that uses identical methods to clinical treatments for infertility. This survey reveals that New Zealand researchers feel dissatisfied with the lack of guidance from the Ministry of Health about human embryo research, and that this is a barrier to progressing scientific research in this country. The Minister of Health should direct its ethics committees to develop guidelines on this issue.

SUMMARY

Faster Cancer Treatment pathway in gynaecological malignancy: a repeat clinical audit

Minah Ha, Anand Gangji

Faster Cancer Treatment Pathway is a Ministry of Health-led initiative to ensure all cancer patients have their treatment in a timely manner to achieve optimal health outcome, with 31-day target between treatment decision and treatment and 62-day target between specialist referral and treatment. Our study shows 85% of women with gynaecological cancer in Northland are meeting the 31-day target and 45% meeting the 62-day target. This shows an overall improvement in cancer care provision from previous study in 2014-2015, however it still falls short of government targets. Shortage of radiological and theatre resources were the main contributing factors for the delay in commencement of cancer treatment in our women with gynaecological cancer in Northland.

SUMMARY

Audit to investigate junior doctors knowledge of how to administer and score the Montreal Cognitive Assessment (MoCA)

Chani Tromop-van Dalen, Katie Thorne, Krystina Common, Garrick Edge, Lisa Woods

The Montreal Cognitive Assessment (MoCA) is a standardised test commonly used by medical professionals to assess cognition. Junior doctors often conduct the MoCA in hospital on patients at risk of cognitive problems, however many have never received formal teaching on how to do so. This audit looked at the ability of junior doctors to administer and score the MoCA before and after a brief teaching session. The results show that a brief teaching session improved junior doctors ability to conduct the MoCA, which may have significance for patient outcomes.

SUMMARY

Antimicrobial resistance among Shigella in New Zealand

Helen Heffernan, Rosemary Woodhouse, Chris Hewison, Jillian Sherwood

Shigellosis is a gastrointestinal infection that does not usually require treatment with antibiotics. However, antibiotics are recommended when the patient is severely ill or for patient groups at increased risk of spreading the infection, for example, young children. A recent New Zealand survey found that a high proportion of Shigella, the bacterium that causes shigellosis, are resistant to the antibiotics recommended when cases of shigellosis require treatment. Therefore, it is important that laboratories processing specimens from shigellosis cases include testing to determine which antibiotics will be effective should treatment be required.

SUMMARY

Impact of discontinuation of telestroke: the Nelson experience

Annemarei Ranta, Suzanne Busch

Telestroke helps to improve out-of-hour patient access to IV thrombolysis in provincial hospitals through remote expert support using videconference equipment. Telestroke may also help upskill local clinicians. To test the benefit of upskilling local teams, telestroke was discontinued at Nelson Hospital. Following discontinuation the treatment rates dropped to pre-telestroke rates. This shows that telestroke does not result in sufficient local staff upskilling to retain improved treatment rates once remote expert support is withdrawn.

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