Issue

Vol 131 No 1484: 26 October 2018

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Issue Summary

SUMMARY

Preventing cardiovascular disease in New Zealand: making better use of statins but also tobacco control, changing the food supply and other strategies

Nick Wilson, Amanda C Jones, Nhung Nghiem, Tony Blakely

Given that it is very well proven that statins reduce the risk of premature death, in this article we examine how the use of these medicines may be improved for primary prevention of cardiovascular disease (CVD) in New Zealand. We suggest the need to explore such options as fixed-dose combination pills containing statins, three-drug polypills, behind-the-counter dispensing and six-month prescriptions. But in addition to pharmacological prevention of CVD, there is a need for improved population-wide changes to the environment. These include adopting policies to improve tobacco control, the nutrition environment (eg, particularly around sodium), alcohol control, and making walking and cycling easier options.

SUMMARY

Can colonoscopy at peripheral day hospitals meet internationally accepted quality and safety standards?

Mehul Lamba, Steven Ding

This is an independently conducted audit of safety and quality of colonoscopy service offered at Charity hospital, Christchurch, and the quality indicators were compared against the current international standards. Complying with quality indicators is important, as it has been shown to improve diagnosis of polyps (precancerous lesions) at colonoscopy. This study showed that colonoscopies performed during one year at the charity hospital were of high quality and met internationally accepted quality indicators. It also provides confidence that it is possible to provide colonoscopy service of high standard in smaller peripheral centres like the Charity hospital, instead of the public hospitals, supporting a trend that has been seen in the North American countries over the last several years.

SUMMARY

Endovascular clot retrieval for acute ischaemic stroke in New Zealand

Adam Langton Burnell, Anna Ranta, Teddy Wu, John Fink, Ben McGuiness, James Caldwell, Wayne Collecutt, Stefan Brew, P Alan Barber

This study has shown that by early 2018, 312 patients from 11 of the 20 New Zealand DHBs had been treated with endovascular clot retrieval. This is up from 50 patients treated at four DHBs in 2015. Patients receiving this cutting edge treatment are doing at least as well as seen internationally. However, 3/4 of the patients are treated in one centre and there are still nine DHBs where patients have yet to be treated. Ongoing regional collaboration is essential to achieve equitable access to this life-saving and life-changing therapy.

SUMMARY

Sun protection and shade availability in New Zealand s outdoor recreation spaces

Ryan Gage, Michelle Barr, James Stanley, Anthony Reeder, Christina Mackay, Moira Smith, Tim Chambers, William Leung, Louise Signal

Our study used wearable cameras to explore sun protection and shade availability in New Zealand s outdoor recreation spaces at times when sun protection was warranted. Children wore the devices, which captured images of 2,635 people in 16 outdoor recreation spaces (beaches, playgrounds and pools). We assessed the clothing worn and shade used by each person, as well as the amount of shade available in each setting. Only 4.3% of the people observed wore sun-protective hats and only 10.7% were under shade. New Zealand has the highest rate of skin cancer in the world. Our findings highlight the need to encourage sun safety behaviours and increase opportunities for shade in outdoor recreation settings.

SUMMARY

Are the benefits of aspirin likely to exceed the risk of major bleeds among people in whom aspirin is recommended for the primary prevention of cardiovascular disease?

Vanessa Selak, Rod Jackson, Katrina Poppe, Andrew Kerr, Sue Wells

There is a lot of uncertainty about whether aspirin should be used to prevent someone having a first heart attack or stroke (cardiovascular disease, or CVD). This is because while aspirin reduces the risk of having a CVD event, it also increases the risk of bleeding, particularly from the gut. The latest New Zealand recommendations are to consider the use of aspirin in people aged less than 70 years and with a high (15% or greater) risk of having a first CVD event within the next five years. In this study we found that for most of these people that are recommended to take aspirin, the benefits (preventing a heart attack or stroke) do outweigh harms (having a major bleed). However, caution is needed in people aged 60-69 years as other factors are important to consider (other medications, diabetes, smoking).

SUMMARY

Feasibility and reliability of clinical coding surveillance for the routine monitoring of adverse drug events in New Zealand hospitals

Jerome Ng, Penny Andrew, Paul Muir, Monique Greene, Sabitha Mohan, Jacqui Knight, Phil Hider, Peter Davis, Mary Seddon, Shane Scahill, Jeff Harrison, Lifeng Zhou, Vanessa Selak, Carlene Lawes, Geetha Galgali, Joanna Broad, Marilyn Crawley, Wynn Pevreal, Neil Houston, Tamzin Brott, David Ryan, Jocelyn Peach, Andrew Brant, Dale Bramley

The routine measurement of adverse drug events (ADE) is important for monitoring and informing improvement, but current detection tools are manual and too resource intensive. Our research, for the first time, shows ADEs can be reliably and sustainably measured using clinical coding surveillance (CCS). Using CCS, almost 12,000 ADEs over two years were detected in hospitalised patients. Most ADEs originated from the community setting.

SUMMARY

Readmissions to hospital in a frail older cohort receiving a community-based transitional care service

Claire Heppenstall, Anne Chiang, Carl Hanger

Readmissions to hospital are generally regarded as a poor outcome and often considered a failure of support care services. We performed this study to look in more detail in reasons for readmission in a group of frail older people who had been recently discharged with a community-based support and rehabilitation service. They experienced high rates of readmission, however we found that the majority of these were with new acute medical conditions, not a failure of support services. Most people who were readmitted were able to return to their own homes after a period of inpatient treatment.

ALL ARTICLES
SUMMARY

Oral steroids for resolution of otitis media with effusion in children

​Māori positive ageing

Will Edwards, Reremoana Theodore, Mihi Ratima, Rangimahora Reddy

Stroke reperfusion treatment in regional New Zealand

Bhavesh Dayal Lallu, Alexander Campbell Brebner, Bronwen Pepperell, Roger Blume, Jeanette Langridge, Sarah Caswell, Heather Webb

How common is off-label prescription of quetiapine?

Andrew McKean, Erik Monasterio, Tom Elliott

Preventing cardiovascular disease in New Zealand: making better use of statins but also tobacco control, changing the food supply and other strategies

Nick Wilson, Amanda C Jones, Nhung Nghiem, Tony Blakely

Can colonoscopy at peripheral day hospitals meet internationally accepted quality and safety standards?

Mehul Lamba, Steven Ding

Endovascular clot retrieval for acute ischaemic stroke in New Zealand

Adam Langton Burnell, Anna Ranta, Teddy Wu, John Fink, Ben McGuiness, James Caldwell, Wayne Collecutt, Stefan Brew, P Alan Barber

Lower-limb amputation in New Zealand: temporal changes and the role of diabetes mellitus

Jason K Gurney, James Stanley, Steve York, Diana Sarfati

A New Zealand case of nasal myiasis involving Lucilia cuprina (Diptera: Calliphoridae)

Dallas Bishop, Depak Patel, Allen Heath, David Hammer

George John Alexander Wilson

Sun protection and shade availability in New Zealand s outdoor recreation spaces

Ryan Gage, Michelle Barr, James Stanley, Anthony Reeder, Christina Mackay, Moira Smith, Tim Chambers, William Leung, Louise Signal

Are the benefits of aspirin likely to exceed the risk of major bleeds among people in whom aspirin is recommended for the primary prevention of cardiovascular disease?

Vanessa Selak, Rod Jackson, Katrina Poppe, Andrew Kerr, Sue Wells

Unplanned readmissions in frail individuals

Joel Dsouza, Simon Richards

An Apparatus for Administering Warm Ether

By E. H. Williams, M.R.C.S.

Feasibility and reliability of clinical coding surveillance for the routine monitoring of adverse drug events in New Zealand hospitals

Jerome Ng, Penny Andrew, Paul Muir, Monique Greene, Sabitha Mohan, Jacqui Knight, Phil Hider, Peter Davis, Mary Seddon, Shane Scahill, Jeff Harrison, Lifeng Zhou, Vanessa Selak, Carlene Lawes, Geetha Galgali, Joanna Broad, Marilyn Crawley, Wynn Pevreal, Neil Houston, Tamzin Brott, David Ryan, Jocelyn Peach, Andrew Brant, Dale Bramley

Readmissions to hospital in a frail older cohort receiving a community-based transitional care service

Claire Heppenstall, Anne Chiang, Carl Hanger

SUMMARY

Preventing cardiovascular disease in New Zealand: making better use of statins but also tobacco control, changing the food supply and other strategies

Nick Wilson, Amanda C Jones, Nhung Nghiem, Tony Blakely

Given that it is very well proven that statins reduce the risk of premature death, in this article we examine how the use of these medicines may be improved for primary prevention of cardiovascular disease (CVD) in New Zealand. We suggest the need to explore such options as fixed-dose combination pills containing statins, three-drug polypills, behind-the-counter dispensing and six-month prescriptions. But in addition to pharmacological prevention of CVD, there is a need for improved population-wide changes to the environment. These include adopting policies to improve tobacco control, the nutrition environment (eg, particularly around sodium), alcohol control, and making walking and cycling easier options.

SUMMARY

Can colonoscopy at peripheral day hospitals meet internationally accepted quality and safety standards?

Mehul Lamba, Steven Ding

This is an independently conducted audit of safety and quality of colonoscopy service offered at Charity hospital, Christchurch, and the quality indicators were compared against the current international standards. Complying with quality indicators is important, as it has been shown to improve diagnosis of polyps (precancerous lesions) at colonoscopy. This study showed that colonoscopies performed during one year at the charity hospital were of high quality and met internationally accepted quality indicators. It also provides confidence that it is possible to provide colonoscopy service of high standard in smaller peripheral centres like the Charity hospital, instead of the public hospitals, supporting a trend that has been seen in the North American countries over the last several years.

SUMMARY

Endovascular clot retrieval for acute ischaemic stroke in New Zealand

Adam Langton Burnell, Anna Ranta, Teddy Wu, John Fink, Ben McGuiness, James Caldwell, Wayne Collecutt, Stefan Brew, P Alan Barber

This study has shown that by early 2018, 312 patients from 11 of the 20 New Zealand DHBs had been treated with endovascular clot retrieval. This is up from 50 patients treated at four DHBs in 2015. Patients receiving this cutting edge treatment are doing at least as well as seen internationally. However, 3/4 of the patients are treated in one centre and there are still nine DHBs where patients have yet to be treated. Ongoing regional collaboration is essential to achieve equitable access to this life-saving and life-changing therapy.

SUMMARY

Sun protection and shade availability in New Zealand s outdoor recreation spaces

Ryan Gage, Michelle Barr, James Stanley, Anthony Reeder, Christina Mackay, Moira Smith, Tim Chambers, William Leung, Louise Signal

Our study used wearable cameras to explore sun protection and shade availability in New Zealand s outdoor recreation spaces at times when sun protection was warranted. Children wore the devices, which captured images of 2,635 people in 16 outdoor recreation spaces (beaches, playgrounds and pools). We assessed the clothing worn and shade used by each person, as well as the amount of shade available in each setting. Only 4.3% of the people observed wore sun-protective hats and only 10.7% were under shade. New Zealand has the highest rate of skin cancer in the world. Our findings highlight the need to encourage sun safety behaviours and increase opportunities for shade in outdoor recreation settings.

SUMMARY

Are the benefits of aspirin likely to exceed the risk of major bleeds among people in whom aspirin is recommended for the primary prevention of cardiovascular disease?

Vanessa Selak, Rod Jackson, Katrina Poppe, Andrew Kerr, Sue Wells

There is a lot of uncertainty about whether aspirin should be used to prevent someone having a first heart attack or stroke (cardiovascular disease, or CVD). This is because while aspirin reduces the risk of having a CVD event, it also increases the risk of bleeding, particularly from the gut. The latest New Zealand recommendations are to consider the use of aspirin in people aged less than 70 years and with a high (15% or greater) risk of having a first CVD event within the next five years. In this study we found that for most of these people that are recommended to take aspirin, the benefits (preventing a heart attack or stroke) do outweigh harms (having a major bleed). However, caution is needed in people aged 60-69 years as other factors are important to consider (other medications, diabetes, smoking).

SUMMARY

Feasibility and reliability of clinical coding surveillance for the routine monitoring of adverse drug events in New Zealand hospitals

Jerome Ng, Penny Andrew, Paul Muir, Monique Greene, Sabitha Mohan, Jacqui Knight, Phil Hider, Peter Davis, Mary Seddon, Shane Scahill, Jeff Harrison, Lifeng Zhou, Vanessa Selak, Carlene Lawes, Geetha Galgali, Joanna Broad, Marilyn Crawley, Wynn Pevreal, Neil Houston, Tamzin Brott, David Ryan, Jocelyn Peach, Andrew Brant, Dale Bramley

The routine measurement of adverse drug events (ADE) is important for monitoring and informing improvement, but current detection tools are manual and too resource intensive. Our research, for the first time, shows ADEs can be reliably and sustainably measured using clinical coding surveillance (CCS). Using CCS, almost 12,000 ADEs over two years were detected in hospitalised patients. Most ADEs originated from the community setting.

SUMMARY

Readmissions to hospital in a frail older cohort receiving a community-based transitional care service

Claire Heppenstall, Anne Chiang, Carl Hanger

Readmissions to hospital are generally regarded as a poor outcome and often considered a failure of support care services. We performed this study to look in more detail in reasons for readmission in a group of frail older people who had been recently discharged with a community-based support and rehabilitation service. They experienced high rates of readmission, however we found that the majority of these were with new acute medical conditions, not a failure of support services. Most people who were readmitted were able to return to their own homes after a period of inpatient treatment.

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