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Issue

Vol 132 No 1489: 1 February 2019

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Issue Summary

SUMMARY

Addition of explicit guidance to acute pancreatitis guidelines increases compliance with amylase measurement recommendations

Serin Cooper Maidlow, Michael Ardagh, Rosie Callender, Oliver Thomas

Clinical guidelines provide a source of evidence-based recommendations for healthcare professionals, allowing them to deliver the best care for their patients in accordance with local procedure and up-to-date research. A bullet point, called a Practice Point , was added to a hospital s guidelines which provided advice on managing acute pancreatitis (inflammation of the pancreas), to clarify and highlight when a particular blood test should be done and when it should be avoided. This led to a significant increase in compliance with this recommendation. This shows that clarity of recommendations affects compliance with clinical guidelines, and this is important because small changes like this can actually make big improvements in patient care.

SUMMARY

Self-harm in adults: a comparison between the middle-aged and the elderly

Yu Mwee Tan, Gary Cheung

This study compared self-harm in two age groups (45-64 years versus 65 years and above). Self-harm is defined as the direct, deliberate act of hurting or injuring the body, but without necessarily wanting to die as in suicide attempt. We found some key differences between the two age groups. Older people are more likely to report physical illness as a stressor, have a history of depression and be diagnosed with depression. Their intent is stronger and they have a higher risk of dying of all causes in the 12 months after their self-harm attempt. Suicide prevention in older people should address the emotional sequelae (including depression) of physical illness.

SUMMARY

Examining the accuracy of the New Zealand B4 School Check universal health service anthropometric measurements of children

Burt Hatch, Andrew R Gray, Rachael W Taylor, Maha Hanna, Anne-Louise Heath, Julie Lawrence, Rachel Sayers, Barry Taylor

Child weight data from the New Zealand B4 School Check assessment service was compared to data collected as part of a study that followed the World Health Organization protocol for weight measurement. This indicated that the New Zealand B4 School Check assessment service tends to overestimate child weight. This overestimation is greater when New Zealand B4 School Check assessments occur on colder days, suggesting that it is due to excess clothing. The New Zealand B4 School Check service monitoring child growth could be improved by including standardised procedures to account for non-removal of clothing.

SUMMARY

Minimal risk of PFOS residues in eel to Māori consumers

Ian C Shaw, Te-Rina King-Hudson

PFOS was used extensively in fire retardants used to fight fires. It is banned in most parts of the world because of its toxicity some studies have shown that it causes cancer. Taranaki Regional Council have shown that it is present in eels from a stream near to a place that firefighting foam has been used. Since eels are a Mori traditional kai (food), we have estimated eel consumption by Mori from two whanau and used this to estimate PFOS intake. We found that PFOS residues in eel are unlikely to be of concern from a cancer perspective, but are just below the highly conservative tolerable daily intake set by Food Standards Australia New Zealand (FSANZ).

SUMMARY

SF-12 indicators of health following the 22 February 2011 Christchurch earthquake

Megan J Pledger, Janet McDonald, Jacqueline Cumming

On average, people experiencing the 22 February, 2011 Christchurch earthquake had changes in their health status over time. On average, their physical and mental health initially improved (2011/12), then declined and reached a low point in 2013/14 and then improved. This is consistent with theories about people s health status and recovery following a disaster, although it usually happens over a shorter time frame.

SUMMARY

The 'elephants in the room' for New Zealand's health system in its 80th anniversary year: general practice charges and ownership models

Robin Gauld, Carol Atmore, Jo Baxter, Peter Crampton, Tim Stokes

The 2018 year signalled the 80th anniversary of the Social Security Act 1938. In order to implement this legislation, a historic compromise between the government and the medical profession created institutional arrangements for the New Zealand health system that endure to this day. The 2018 year also marked commencement of a Ministerial review of the New Zealand health system. This article considers two intertwined arrangements which stem from the post-1938 compromise that the Ministerial review will need to address if goals of equity and, indeed, the original intent of the 1938 legislation are to be delivered upon: general practice patient charges; and ownership models. It describes the problems patient charges create, and options for ownership that the Ministerial review might contemplate.

SUMMARY

Video or verbal? A randomised trial of the informed consent process prior to endoscopy

Cameron Schauer, Tiffany Floyd, Jerry Chin, Alain C Vandal, Alex Lampen-Smith

Discussion prior to gastroscopy and colonoscopy, including risks and benefits is poorly done and usually varies widely between clinicians and hospitals. We attempted to use a video to improve this, but found that it did not change outcomes. Despite very poor recollection of what was discussed, patients in both the video and verbal explanation groups reported understanding of the procedure and satisfaction. Further work needs to be completed to improve this important process.

SUMMARY

Specialist mental health care for older adults in New Zealand an exploration of service models and routine data

Ruth Cunningham, Debbie Peterson, Adam Sims

This paper used a survey of DHBs and information reported to the Ministry of Health for the Northern part of New Zealand to investigate what mental health services are provided to older adults (from the age of 65). Two in every 100 older adults access mental health services each year. Many have already been in contact with mental health services before turning 65. Better and more consistent data collection and reporting is needed to understand the mental health needs of older adults.

SUMMARY

The development and first six years of a nurse-led chest pain clinic

Andrew McLachlan, Chris Aldridge, Mildred Lee, Courtney Harper, Andrew Kerr

People who experience chest pain in the community that isn t considered life-threatening can wait a long time to be reviewed by specialist services. Most patients with narrowed arteries can be identified with a simple history and treadmill test that can be carried out by suitable trained and qualified nurses. In our health board we developed and have audited a nurse-led chest pain clinic for over six years and found the clinic was safe and effective and sees patients much quicker than the traditional model.

SUMMARY

Lifetime risk of primary total knee replacement surgery in New Zealand from 2000 to 2015

Isobella S Henzell, Lifeng Zhou, Chris Frampton, Gary Hooper, Ilana Ackerman, Simon W Young

This study found that a person s lifetime risk of requiring a total knee replacement has increased significantly from 2000 to 2015. Currently the lifetime risk of total knee replacement for males and females is approximately one in six.

ALL ARTICLES
SUMMARY

Addition of explicit guidance to acute pancreatitis guidelines increases compliance with amylase measurement recommendations

Serin Cooper Maidlow, Michael Ardagh, Rosie Callender, Oliver Thomas

Self-harm in adults: a comparison between the middle-aged and the elderly

Yu Mwee Tan, Gary Cheung

Examining the accuracy of the New Zealand B4 School Check universal health service anthropometric measurements of children

Burt Hatch, Andrew R Gray, Rachael W Taylor, Maha Hanna, Anne-Louise Heath, Julie Lawrence, Rachel Sayers, Barry Taylor

Minimal risk of PFOS residues in eel to Māori consumers

Ian C Shaw, Te-Rina King-Hudson

SF-12 indicators of health following the 22 February 2011 Christchurch earthquake

Megan J Pledger, Janet McDonald, Jacqueline Cumming

Rivaroxaban in patients with heart failure, sinus rhythm and coronary disease

Shirley Joan Chapple

Alan Kerr, Raven Chapple

The 'elephants in the room' for New Zealand's health system in its 80th anniversary year: general practice charges and ownership models

Robin Gauld, Carol Atmore, Jo Baxter, Peter Crampton, Tim Stokes

Herbert Dick Rawson

Mary Rawson, John Rawson, Harvey Morgan

Video or verbal? A randomised trial of the informed consent process prior to endoscopy

Cameron Schauer, Tiffany Floyd, Jerry Chin, Alain C Vandal, Alex Lampen-Smith

Specialist mental health care for older adults in New Zealand an exploration of service models and routine data

Ruth Cunningham, Debbie Peterson, Adam Sims

Local experience with methamphetamine associated stroke at a small district health board

Karim M Mahawish, Andrew Bowers, Susan DeCaigney

The development and first six years of a nurse-led chest pain clinic

Andrew McLachlan, Chris Aldridge, Mildred Lee, Courtney Harper, Andrew Kerr

Lifetime risk of primary total knee replacement surgery in New Zealand from 2000 to 2015

Isobella S Henzell, Lifeng Zhou, Chris Frampton, Gary Hooper, Ilana Ackerman, Simon W Young

Book Review
Vol 132 No 1489: 1 February 2019

Mind That Child; A Medical Memoir

Frank Frizelle

This a book that recounts the experience of the Auckland Starship’s paediatrician Dr Simon Rowley over his professional lifetime.

How Coromandel kept the Influenza Epidemic at Bay

By Major J. Lovell Gregg. N.Z.M.C.

SUMMARY

Addition of explicit guidance to acute pancreatitis guidelines increases compliance with amylase measurement recommendations

Serin Cooper Maidlow, Michael Ardagh, Rosie Callender, Oliver Thomas

Clinical guidelines provide a source of evidence-based recommendations for healthcare professionals, allowing them to deliver the best care for their patients in accordance with local procedure and up-to-date research. A bullet point, called a Practice Point , was added to a hospital s guidelines which provided advice on managing acute pancreatitis (inflammation of the pancreas), to clarify and highlight when a particular blood test should be done and when it should be avoided. This led to a significant increase in compliance with this recommendation. This shows that clarity of recommendations affects compliance with clinical guidelines, and this is important because small changes like this can actually make big improvements in patient care.

SUMMARY

Self-harm in adults: a comparison between the middle-aged and the elderly

Yu Mwee Tan, Gary Cheung

This study compared self-harm in two age groups (45-64 years versus 65 years and above). Self-harm is defined as the direct, deliberate act of hurting or injuring the body, but without necessarily wanting to die as in suicide attempt. We found some key differences between the two age groups. Older people are more likely to report physical illness as a stressor, have a history of depression and be diagnosed with depression. Their intent is stronger and they have a higher risk of dying of all causes in the 12 months after their self-harm attempt. Suicide prevention in older people should address the emotional sequelae (including depression) of physical illness.

SUMMARY

Examining the accuracy of the New Zealand B4 School Check universal health service anthropometric measurements of children

Burt Hatch, Andrew R Gray, Rachael W Taylor, Maha Hanna, Anne-Louise Heath, Julie Lawrence, Rachel Sayers, Barry Taylor

Child weight data from the New Zealand B4 School Check assessment service was compared to data collected as part of a study that followed the World Health Organization protocol for weight measurement. This indicated that the New Zealand B4 School Check assessment service tends to overestimate child weight. This overestimation is greater when New Zealand B4 School Check assessments occur on colder days, suggesting that it is due to excess clothing. The New Zealand B4 School Check service monitoring child growth could be improved by including standardised procedures to account for non-removal of clothing.

SUMMARY

Minimal risk of PFOS residues in eel to Māori consumers

Ian C Shaw, Te-Rina King-Hudson

PFOS was used extensively in fire retardants used to fight fires. It is banned in most parts of the world because of its toxicity some studies have shown that it causes cancer. Taranaki Regional Council have shown that it is present in eels from a stream near to a place that firefighting foam has been used. Since eels are a Mori traditional kai (food), we have estimated eel consumption by Mori from two whanau and used this to estimate PFOS intake. We found that PFOS residues in eel are unlikely to be of concern from a cancer perspective, but are just below the highly conservative tolerable daily intake set by Food Standards Australia New Zealand (FSANZ).

SUMMARY

SF-12 indicators of health following the 22 February 2011 Christchurch earthquake

Megan J Pledger, Janet McDonald, Jacqueline Cumming

On average, people experiencing the 22 February, 2011 Christchurch earthquake had changes in their health status over time. On average, their physical and mental health initially improved (2011/12), then declined and reached a low point in 2013/14 and then improved. This is consistent with theories about people s health status and recovery following a disaster, although it usually happens over a shorter time frame.

SUMMARY

The 'elephants in the room' for New Zealand's health system in its 80th anniversary year: general practice charges and ownership models

Robin Gauld, Carol Atmore, Jo Baxter, Peter Crampton, Tim Stokes

The 2018 year signalled the 80th anniversary of the Social Security Act 1938. In order to implement this legislation, a historic compromise between the government and the medical profession created institutional arrangements for the New Zealand health system that endure to this day. The 2018 year also marked commencement of a Ministerial review of the New Zealand health system. This article considers two intertwined arrangements which stem from the post-1938 compromise that the Ministerial review will need to address if goals of equity and, indeed, the original intent of the 1938 legislation are to be delivered upon: general practice patient charges; and ownership models. It describes the problems patient charges create, and options for ownership that the Ministerial review might contemplate.

SUMMARY

Video or verbal? A randomised trial of the informed consent process prior to endoscopy

Cameron Schauer, Tiffany Floyd, Jerry Chin, Alain C Vandal, Alex Lampen-Smith

Discussion prior to gastroscopy and colonoscopy, including risks and benefits is poorly done and usually varies widely between clinicians and hospitals. We attempted to use a video to improve this, but found that it did not change outcomes. Despite very poor recollection of what was discussed, patients in both the video and verbal explanation groups reported understanding of the procedure and satisfaction. Further work needs to be completed to improve this important process.

SUMMARY

Specialist mental health care for older adults in New Zealand an exploration of service models and routine data

Ruth Cunningham, Debbie Peterson, Adam Sims

This paper used a survey of DHBs and information reported to the Ministry of Health for the Northern part of New Zealand to investigate what mental health services are provided to older adults (from the age of 65). Two in every 100 older adults access mental health services each year. Many have already been in contact with mental health services before turning 65. Better and more consistent data collection and reporting is needed to understand the mental health needs of older adults.

SUMMARY

The development and first six years of a nurse-led chest pain clinic

Andrew McLachlan, Chris Aldridge, Mildred Lee, Courtney Harper, Andrew Kerr

People who experience chest pain in the community that isn t considered life-threatening can wait a long time to be reviewed by specialist services. Most patients with narrowed arteries can be identified with a simple history and treadmill test that can be carried out by suitable trained and qualified nurses. In our health board we developed and have audited a nurse-led chest pain clinic for over six years and found the clinic was safe and effective and sees patients much quicker than the traditional model.

SUMMARY

Lifetime risk of primary total knee replacement surgery in New Zealand from 2000 to 2015

Isobella S Henzell, Lifeng Zhou, Chris Frampton, Gary Hooper, Ilana Ackerman, Simon W Young

This study found that a person s lifetime risk of requiring a total knee replacement has increased significantly from 2000 to 2015. Currently the lifetime risk of total knee replacement for males and females is approximately one in six.

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