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Issue

Vol 132 No 1488: 18 January 2019

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Issue Summary

SUMMARY

Quality of electronic records documenting adverse drug reactions within a hospital setting: identification of discrepancies and information completeness

Rhiannon Braund, Courtney K Lawrence, Lindsay Baum, Brittany Kessler, Madison Vassart, Carolyn Coulter

Electronic patient records are useful as they can hold all historical information, which can be accessed by prescribers each time a patient presents. However, if the information entered is not accurate and complete, then it is difficult for prescribers to use this information to make informed choices. Where multiple systems, information duplication and a lack of information completeness mean that the prescriber does not have ready access to this information, it is challenging for prescribers to use these records optimally.

SUMMARY

Doctors, drugs of dependence and discipline: a retrospective review of disciplinary decisions in New Zealand, 1997 2016

Katharine A Wallis, Susie Middleton

We reviewed disciplinary decisions in New Zealand 1997-2016 to describe cases involving doctors and the inappropriate prescribing of drugs of dependence. Drug dependence is recognised as a disease, not a crime. We identified 25 disciplinary cases involving 24 doctors. Most doctors were male, older and working in general practice. Few cases came to light through reporting by colleagues. The penalties were severe, often spelling the end of a doctor s career.

SUMMARY

A qualitative analysis of adolescents opinions of proactive long-acting reversible contraceptive (LARC) provision

Rebecca Duncan, Helen Paterson, Lynley Anderson, Neil Pickering

Some New Zealand adolescents are sexually active, and of those adolescents who are having sex, some are using contraceptive methods with high typical use failure rates, and some are using no contraception at all. Long-acting reversible contraceptives (LARCs) are intrauterine devices (IUDs) and implants, a group of contraceptive methods that are 22 times as effective as the pill. We suggested a provision model where adolescents would be offered LARCs proactively, and consulted with four focus groups of female adolescents to assess whether they found this model to be acceptable. The adolescents were positive about this concept, and described a range of barriers that currently prevent them from accessing effective contraception.

SUMMARY

Urinalysis orders and yield among General Medicine patients: a single-centre s experience in New Zealand

Khurram Shahid, Yassar Alamri, Hannah Scowcroft, Liane Dixon, Julie Creighton, Heather Isenman, Sarah Metcalf, Steve Chambers

We found a large number of urine tests is being ordered unnecessarily in patients without symptoms. A more useful approach is testing symptomatic patients only following careful clinical evaluation. Performing routine tests in patients presenting a wide variety of symptoms may lead to unnecessary costs and treatment of asymptomatic patients.

SUMMARY

Reducing inappropriate urine testing at Hutt Valley District Health Board using Choosing Wisely principles

Aidan D Wilson, Matthew J Kelly, Emma Henderson, Lynn McBain, Sisira Jayathissa, Belinda Loring

Urinary tract infections (UTI), which should be treated promptly with antibiotics to avoid complications, involve bacteria present in the urine along with common signs and symptoms, such as painful urination, blood in the urine, frequent urination, fever and pain. However, if there are bacteria present in the urine without the signs and symptoms of a UTI which is called asymptomatic bacteriuria (ASB) it should not be treated as it provides no benefit to the patient and may contribute to antibiotic resistance and cause drug side effects. In order to stop unnecessary treatment of ASB, urine culture tests should only be ordered in those patients who present with likely UTIs. Hutt Valley District Health Board sought to reduce clinically inappropriate urine culture requests through removal of urine dipsticks from wards and education of staff using Choosing Wisely principles. This intervention caused a 28% reduction in monthly urine culture requests for inpatients as well as annual savings of at least $41,760.

SUMMARY

The time has come for New Zealand to improve outcomes after emergency laparotomy

Katherine Broughton, Era Soukhin, Andrew R Moot, Ben Griffiths

Emergency laparotomies are a common operation undertaken for a patient who has a serious abdominal condition such as a perforated colon or ulcer and include procedures such as colectomy (removal of a section of colon). These patients are often elderly, very unwell on arrival to the hospital and have a high risk of dying as a result of their surgical condition. The risk of a patient dying within 30 days (30-day mortality) after such an operation in the UK is approximately 10%. We do not have similar data in New Zealand or Australia and need to collect such data. By data collection and subsequent changes in how we treat and manage such patients we are likely to be able to improve how our patients do after this risky operation. This project will involve surgeons, intensivists (doctors who manage patients in the intensive care unit (ICU)) and anaesthetists (doctor who anaesthetise patients for operations).

ALL ARTICLES
SUMMARY

Hot tub lung: take a bathing history from the breathless

Dave A Duggan, Andrew G Stanley, Phil Shoemack

Doctors, drugs of dependence and discipline: a retrospective review of disciplinary decisions in New Zealand, 1997 2016

Katharine A Wallis, Susie Middleton

Quality of electronic records documenting adverse drug reactions within a hospital setting: identification of discrepancies and information completeness

Rhiannon Braund, Courtney K Lawrence, Lindsay Baum, Brittany Kessler, Madison Vassart, Carolyn Coulter

A qualitative analysis of adolescents opinions of proactive long-acting reversible contraceptive (LARC) provision

Rebecca Duncan, Helen Paterson, Lynley Anderson, Neil Pickering

Urinalysis orders and yield among General Medicine patients: a single-centre s experience in New Zealand

Khurram Shahid, Yassar Alamri, Hannah Scowcroft, Liane Dixon, Julie Creighton, Heather Isenman, Sarah Metcalf, Steve Chambers

Harold Bourne

Brian Barraclough

Cannabis law and cannabis-related harm

Joseph M Boden, David M Fergusson

Reducing inappropriate urine testing at Hutt Valley District Health Board using Choosing Wisely principles

Aidan D Wilson, Matthew J Kelly, Emma Henderson, Lynn McBain, Sisira Jayathissa, Belinda Loring

Over and under? Ethnic inequities in community antibacterial prescribing

Scott Metcalfe, Sandhaya (Sandy) Bhawan, Meena Vallabh, Peter Murray, Catherine Proffitt, Greg Williams

The time has come for New Zealand to improve outcomes after emergency laparotomy

Katherine Broughton, Era Soukhin, Andrew R Moot, Ben Griffiths

Effects of aspirin on risks of vascular events and cancer according to bodyweight and dose

Book Review
Vol 132 No 1488: 18 January 2019

The Art of Recovery: six personal journeys

Frank Frizelle

As an editor you receive books for review, which are sent to suitable people following an email agreement to review.

John Gwyther Richards

Felicity Goodyear-Smith, John Werry, David Richards

Book Review
Vol 132 No 1488: 18 January 2019

Fat Off; the Right Way A clever and sustainable eating guide for weight loss and healthy living

Frank Frizelle

Paul Anderson is a New Zealander who trained in general surgery and works part-time in Australia and part-time in New Zealand.

The Intolerance of Quinine in Influenza-Pneumonia Patients

By G. Metcalfe Sharpe, M.B.

SUMMARY

Doctors, drugs of dependence and discipline: a retrospective review of disciplinary decisions in New Zealand, 1997 2016

Katharine A Wallis, Susie Middleton

We reviewed disciplinary decisions in New Zealand 1997-2016 to describe cases involving doctors and the inappropriate prescribing of drugs of dependence. Drug dependence is recognised as a disease, not a crime. We identified 25 disciplinary cases involving 24 doctors. Most doctors were male, older and working in general practice. Few cases came to light through reporting by colleagues. The penalties were severe, often spelling the end of a doctor s career.

SUMMARY

Quality of electronic records documenting adverse drug reactions within a hospital setting: identification of discrepancies and information completeness

Rhiannon Braund, Courtney K Lawrence, Lindsay Baum, Brittany Kessler, Madison Vassart, Carolyn Coulter

Electronic patient records are useful as they can hold all historical information, which can be accessed by prescribers each time a patient presents. However, if the information entered is not accurate and complete, then it is difficult for prescribers to use this information to make informed choices. Where multiple systems, information duplication and a lack of information completeness mean that the prescriber does not have ready access to this information, it is challenging for prescribers to use these records optimally.

SUMMARY

A qualitative analysis of adolescents opinions of proactive long-acting reversible contraceptive (LARC) provision

Rebecca Duncan, Helen Paterson, Lynley Anderson, Neil Pickering

Some New Zealand adolescents are sexually active, and of those adolescents who are having sex, some are using contraceptive methods with high typical use failure rates, and some are using no contraception at all. Long-acting reversible contraceptives (LARCs) are intrauterine devices (IUDs) and implants, a group of contraceptive methods that are 22 times as effective as the pill. We suggested a provision model where adolescents would be offered LARCs proactively, and consulted with four focus groups of female adolescents to assess whether they found this model to be acceptable. The adolescents were positive about this concept, and described a range of barriers that currently prevent them from accessing effective contraception.

SUMMARY

Urinalysis orders and yield among General Medicine patients: a single-centre s experience in New Zealand

Khurram Shahid, Yassar Alamri, Hannah Scowcroft, Liane Dixon, Julie Creighton, Heather Isenman, Sarah Metcalf, Steve Chambers

We found a large number of urine tests is being ordered unnecessarily in patients without symptoms. A more useful approach is testing symptomatic patients only following careful clinical evaluation. Performing routine tests in patients presenting a wide variety of symptoms may lead to unnecessary costs and treatment of asymptomatic patients.

SUMMARY

Reducing inappropriate urine testing at Hutt Valley District Health Board using Choosing Wisely principles

Aidan D Wilson, Matthew J Kelly, Emma Henderson, Lynn McBain, Sisira Jayathissa, Belinda Loring

Urinary tract infections (UTI), which should be treated promptly with antibiotics to avoid complications, involve bacteria present in the urine along with common signs and symptoms, such as painful urination, blood in the urine, frequent urination, fever and pain. However, if there are bacteria present in the urine without the signs and symptoms of a UTI which is called asymptomatic bacteriuria (ASB) it should not be treated as it provides no benefit to the patient and may contribute to antibiotic resistance and cause drug side effects. In order to stop unnecessary treatment of ASB, urine culture tests should only be ordered in those patients who present with likely UTIs. Hutt Valley District Health Board sought to reduce clinically inappropriate urine culture requests through removal of urine dipsticks from wards and education of staff using Choosing Wisely principles. This intervention caused a 28% reduction in monthly urine culture requests for inpatients as well as annual savings of at least $41,760.

SUMMARY

The time has come for New Zealand to improve outcomes after emergency laparotomy

Katherine Broughton, Era Soukhin, Andrew R Moot, Ben Griffiths

Emergency laparotomies are a common operation undertaken for a patient who has a serious abdominal condition such as a perforated colon or ulcer and include procedures such as colectomy (removal of a section of colon). These patients are often elderly, very unwell on arrival to the hospital and have a high risk of dying as a result of their surgical condition. The risk of a patient dying within 30 days (30-day mortality) after such an operation in the UK is approximately 10%. We do not have similar data in New Zealand or Australia and need to collect such data. By data collection and subsequent changes in how we treat and manage such patients we are likely to be able to improve how our patients do after this risky operation. This project will involve surgeons, intensivists (doctors who manage patients in the intensive care unit (ICU)) and anaesthetists (doctor who anaesthetise patients for operations).

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