Issue

Vol 132 No 1490: 22 February 2019

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Issue Summary

SUMMARY

Patterns of referral and uptake of BReast CAncer (BRCA) gene testing of eligible women with ovarian cancer in New Zealand

Katherine Fraser, Ai Ling Tan, Carrie Innes, Rosalie Stephens, Amanda Tristram, Simone Petrich, Caroline Lintott, Peter H Sykes, Kimberley Gamet, Alice Christian, Bryony Simcock

Women with specific variants of the BRCA (BReast CAncer) gene are at higher risk of developing a specific type cancer of the ovaries known as high-grade serous cancer (HGSC). Knowing whether a woman with HGSC has one of these mutations allows us to improve decisions around treatment and test family members, as it may mean they are at higher risk. Our study determined that 70% of New Zealand women diagnosed with HGSC between 2015-2016 were referred for genetic testing for these BRCA variants, this is higher than rates shown in other international studies. This data allows for further research into methods to improve the number of women being referred and thus able to access the benefits of the knowledge gained for themselves and their families.

SUMMARY

Post-operative mortality rates for neck of femur fracture at Waitemata District Health Board

Reuben J Kirk, Carlene MM Lawes, William Farrington, Peter Misur, Matthew L Walker, Michal Kluger, Min Yee Seow, Penny Andrew

Our study investigated patient death rates following surgery for hip fracture at Waitemata DHB between 2009 and 2016. We found that 23.8% of patients died within one year of surgery; however death rates have gradually reduced in recent years. We also found that decreased time from hospital presentation to surgery was linked to improved survival in patients with hip fracture.

SUMMARY

The cost of teriflunomide in the treatment of relapsing-remitting multiple sclerosis

J Alasdair Millar

Teriflunomide is a new drug funded for the treatment of multiple sclerosis (MS). It is a derivative of an older and cheaper drug, leflunomide. The standard dose of leflunamide will produce the same dose of teriflunomide in the body and hence it is likely that identical benefits in MS would be obtained with leflunomide at lower cost. I scrutinised the minutes of eight drug regulatory bodies, including those of New Zealand and Australia, to determine whether the above possibility was minuted during consideration of teriflunomide subsidy. Three bodies (European Union, Canada and the US) discussed the relationship between the two drugs, especially with regard to toxicity, but no body minuted the possible use of leflunomide or the pricing implications. The majority dealt with the applications in a routine manner. It is possible that an opportunity to decrease the cost of treating MS has been missed, though a new clinical trial comparing the two drugs would be required.

SUMMARY

Electronic whiteboards improve the acute surgical patient admission process

Yi Hai Li, Eve Fitzgerald, Ross Roberts

This study is a survey of registrars (junior surgical staff) working in the Department of Surgery at Christchurch Hospital before and after introduction of an electronic whiteboard for managing the admission of acute (emergency) patients. The study has shown increased efficiency of the process following introduction of the electronic whiteboard. Significantly, the registrars report increased satisfaction with the process and furthermore they reported that they were more aware of incoming patients. Other important outcomes of the study were that there did not seem to be any increased concern about patient or data security when this information was conveyed electronically versus telephonically. The electronic whiteboards are now being used in more areas as other services realise their benefits.

SUMMARY

Multimorbidity and multiple social disadvantage in a New Zealand high-needs free primary healthcare clinic population: a cross-sectional study

Sharmaine Sreedhar, Lauralie Richard, Tim Stokes

It is now common for patients to need care for several chronic medical conditions they may have. This is called multimorbidity. Multimorbidity increases with age, is more common and occurs earlier in those living in poorer areas and disproportionately affects Mori and Pacific people. Patients living in poorer areas will have difficulty accessing traditional GP clinics, often because of the cost of GP appointments, and may use third sector (non-government, non-profit) GP clinics, which may provide care at lower cost or be free. This study found that patients attending one such free GP clinic in Dunedin had very high levels of multimorbidity and half had both physical and mental health problems. The needs of such patients cannot at present be met by the traditional model of New Zealand general practice.

ALL ARTICLES
SUMMARY

Smoke in our eyes: the Sense Partners evaluation of the legalisation of cannabis in New Zealand

Chris Wilkins, Marta Rychert, Jose S Romeo, Steve Randerson

Patterns of referral and uptake of BReast CAncer (BRCA) gene testing of eligible women with ovarian cancer in New Zealand

Katherine Fraser, Ai Ling Tan, Carrie Innes, Rosalie Stephens, Amanda Tristram, Simone Petrich, Caroline Lintott, Peter H Sykes, Kimberley Gamet, Alice Christian, Bryony Simcock

Etiology and Treatment of Influenza

Getting surgical antibiotic prophylaxis right, lessons from the National Orthopaedic Surgical Site Infection Improvement Programme: a call for action!

Arthur J Morris, Sally A Roberts, Nikki Grae, Deborah Jowitt

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

Kate Baddock, Jan White, Lesley Clarke

Post-operative mortality rates for neck of femur fracture at Waitemata District Health Board

Reuben J Kirk, Carlene MM Lawes, William Farrington, Peter Misur, Matthew L Walker, Michal Kluger, Min Yee Seow, Penny Andrew

The cost of teriflunomide in the treatment of relapsing-remitting multiple sclerosis

J Alasdair Millar

Electronic whiteboards improve the acute surgical patient admission process

Yi Hai Li, Eve Fitzgerald, Ross Roberts

Multimorbidity and multiple social disadvantage in a New Zealand high-needs free primary healthcare clinic population: a cross-sectional study

Sharmaine Sreedhar, Lauralie Richard, Tim Stokes

Smokefree signage at railway stations: a survey of 54 stations in 11 local government areas

Nick Wilson, George Thomson

Effect of aspirin on cardiovascular events and bleeding in the healthy elderly

SUMMARY

Patterns of referral and uptake of BReast CAncer (BRCA) gene testing of eligible women with ovarian cancer in New Zealand

Katherine Fraser, Ai Ling Tan, Carrie Innes, Rosalie Stephens, Amanda Tristram, Simone Petrich, Caroline Lintott, Peter H Sykes, Kimberley Gamet, Alice Christian, Bryony Simcock

Women with specific variants of the BRCA (BReast CAncer) gene are at higher risk of developing a specific type cancer of the ovaries known as high-grade serous cancer (HGSC). Knowing whether a woman with HGSC has one of these mutations allows us to improve decisions around treatment and test family members, as it may mean they are at higher risk. Our study determined that 70% of New Zealand women diagnosed with HGSC between 2015-2016 were referred for genetic testing for these BRCA variants, this is higher than rates shown in other international studies. This data allows for further research into methods to improve the number of women being referred and thus able to access the benefits of the knowledge gained for themselves and their families.

SUMMARY

Post-operative mortality rates for neck of femur fracture at Waitemata District Health Board

Reuben J Kirk, Carlene MM Lawes, William Farrington, Peter Misur, Matthew L Walker, Michal Kluger, Min Yee Seow, Penny Andrew

Our study investigated patient death rates following surgery for hip fracture at Waitemata DHB between 2009 and 2016. We found that 23.8% of patients died within one year of surgery; however death rates have gradually reduced in recent years. We also found that decreased time from hospital presentation to surgery was linked to improved survival in patients with hip fracture.

SUMMARY

The cost of teriflunomide in the treatment of relapsing-remitting multiple sclerosis

J Alasdair Millar

Teriflunomide is a new drug funded for the treatment of multiple sclerosis (MS). It is a derivative of an older and cheaper drug, leflunomide. The standard dose of leflunamide will produce the same dose of teriflunomide in the body and hence it is likely that identical benefits in MS would be obtained with leflunomide at lower cost. I scrutinised the minutes of eight drug regulatory bodies, including those of New Zealand and Australia, to determine whether the above possibility was minuted during consideration of teriflunomide subsidy. Three bodies (European Union, Canada and the US) discussed the relationship between the two drugs, especially with regard to toxicity, but no body minuted the possible use of leflunomide or the pricing implications. The majority dealt with the applications in a routine manner. It is possible that an opportunity to decrease the cost of treating MS has been missed, though a new clinical trial comparing the two drugs would be required.

SUMMARY

Electronic whiteboards improve the acute surgical patient admission process

Yi Hai Li, Eve Fitzgerald, Ross Roberts

This study is a survey of registrars (junior surgical staff) working in the Department of Surgery at Christchurch Hospital before and after introduction of an electronic whiteboard for managing the admission of acute (emergency) patients. The study has shown increased efficiency of the process following introduction of the electronic whiteboard. Significantly, the registrars report increased satisfaction with the process and furthermore they reported that they were more aware of incoming patients. Other important outcomes of the study were that there did not seem to be any increased concern about patient or data security when this information was conveyed electronically versus telephonically. The electronic whiteboards are now being used in more areas as other services realise their benefits.

SUMMARY

Multimorbidity and multiple social disadvantage in a New Zealand high-needs free primary healthcare clinic population: a cross-sectional study

Sharmaine Sreedhar, Lauralie Richard, Tim Stokes

It is now common for patients to need care for several chronic medical conditions they may have. This is called multimorbidity. Multimorbidity increases with age, is more common and occurs earlier in those living in poorer areas and disproportionately affects Mori and Pacific people. Patients living in poorer areas will have difficulty accessing traditional GP clinics, often because of the cost of GP appointments, and may use third sector (non-government, non-profit) GP clinics, which may provide care at lower cost or be free. This study found that patients attending one such free GP clinic in Dunedin had very high levels of multimorbidity and half had both physical and mental health problems. The needs of such patients cannot at present be met by the traditional model of New Zealand general practice.

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