Issue

Vol 132 No 1498: 12 July 2019

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Issue Summary

SUMMARY

The epidemiology of acute rheumatic fever in Northland, 2012-2017

Kate Wauchop, Anil Shetty, Catherine Bremner

This audit demonstrated that rates of acute rheumatic fever (a preventable disease) remain among the highest in the world for Northland Mori aged 5-14 years. Ninety-three percent of all cases were Mori. Pacific Islanders were also over-represented. Adults may be at risk of delayed diagnosis and developing rheumatic heart disease. The data from this audit differs from data reported by the Ministry of Health. Accurate national data is required to assess the true burden of disease and inform future directions.

SUMMARY

Imaging of midface fractures a retrospective study

Nika Korduke, Thasvir Singh

Currently there is an inconsistency in the scans that patients with midface (eye socket, nose and cheekbone) fractures are receiving when they present to the emergency department of hospitals in the Midlands Region. We have found that many patients (70%) are having multiple and unnecessary plain films (two dimensional x-rays) which are of little value, creating delays in their surgery and wasting hospital time and resources. Computed tomography (3D scans) are far more accurate at detecting these fractures, as well as allowing the surgeon to plan for a predictable surgery. We wish to propose a system in the Midlands Emergency Departments which will allow the assessing doctor to make a decision on which patients should proceed straight to computed tomography (three dimensional) scans and avoid 2D x-rays. This system can be generalised to hospitals across New Zealand to improve resource allocation, prevent delays in treatment and reduce radiation to patients.

SUMMARY

Primary care doctor and nurse utilisation rates for billed consultations across the Comprehensive Care Primary Health Organisation

Jennifer N Baldwin, Nick Garrett, Peter J Larmer, Craig Murray, Rachael Evans, Rosey Buchan, Stephen Neville

The aim of our study was to examine socio-demographic trends in doctor and nurse utilisation rates for invoiced consultations in the Comprehensive Care Primary Health Organisation. We found that women, older adults and people living in socially deprived areas utilise primary care more frequently when compared to other population groups. Nurse utilisation rates were highest for Mori and Pacific patients.

SUMMARY

The ongoing evolution of capitation funding for primary care: the December 2018 PHO capitation funding changes for Community Services Card holders

Peter Crampton

The December 2018 PHO capitation funding policy changes represent a further step towards universal low-cost primary healthcare. This paper aimed to examine the possible impact on equity of the recent policy to support people on low incomes to access primary care using the Community Services Card (CSC), and to identify questions that will need to be answered in order for the policy and funding changes to be evaluated. The study found that CSC possession is an important new determinant of eligibility to low-cost access to primary care for many people. As the funding changes are complex, the equity effects cannot be fully understood until further detailed modelling is carried out, and specific questions are answered. It is the responsibility of the Ministry of Health to ensure that an evaluation of the changes takes place.

SUMMARY

Acute reperfusion for ST-elevation myocardial infarction in New Zealand (2015 2017): patient and system delay (ANZACS-QI 29)

Andrew J Kerr, Mildred Lee, Corina Grey, Tammy J Pegg, Nick G Fisher, Harvey H White, Chris M Nunn, Michael JA Williams, David Smyth, Tony Scott, Rachel X Chen, Jinfeng Zhao, Thu Rein Tun, Matire Harwood, Gerry P Devlin, on behalf of the ANZACS-QI investigators

Prompt access to cardiac defibrillation and reperfusion therapy improves outcomes in patients with ST-segment elevation myocardial infarction (STEMI), which is the most serious type of acute heart attack. We have documented preventable delays in patients both calling for help and receiving timely treatment once they have made contact with the ambulance or hospital. Nationwide implementation of the NZ STEMI pathway is needed to reduce system delays in delivery of primary PCI, fibrinolysis and rescue PCI. Ongoing initiatives are required to reduce barriers to calling the ambulance early after symptom onset.

SUMMARY

Investigating strategies to improve clinical trial opportunities for patients with cancer in New Zealand INSIGHT

Yeojeong Jane So, Michael Jameson, Vincent Newton, Anne O Donnell, Mark Jeffery, Christopher Jackson, Alexander Tuck, Kate Gregory, Richard North, Malcolm Anderson, Katrina Sharples, Michael Findlay, Michelle K Wilson

Clinical trials often provide access to unfunded or investigational treatments and trial participation has improved cancer outcome around the world. To better understand why New Zealand has low clinical trials participation rates, we conducted a qualitative survey of cancer patients around New Zealand to determine what barriers are present at patient level. Our patients reported strong enthusiasm in clinical trials across age, tumour group, demographics and location. Majority wanted to participate in clinical trials/research to help others but few patients felt that fear of randomisation held them back from participating in clinical trials.

SUMMARY

Probiotics and health: understanding probiotic trials

Gemma A Laws, Roslyn A Kemp

Probiotics available in New Zealand have a range of reported health benefits, and it can be difficult for consumers and healthcare professionals to compare efficacy of different products. Probiotic products contain a variety of bacterial species and strains that interact with our bodies in unique ways and provide different health benefits, and it is important to acknowledge that these strains cannot be compared unless tested in standardised way. Development of an online resource that collates and translates the scientific literature on probiotics into easy-to-understand clinically relevant information would help consumers and healthcare professionals compare probiotic products and make informed decisions.

ALL ARTICLES
SUMMARY

Another government ignores a recommendation to strengthen alcohol regulations

Doug Sellman, Simon Adamson, James Foulds, Ben Beaglehole, Roger Mulder

Few New Zealand medical students intend to work in rural areas

Garry Nixon, Katharina Blattner, Rory Miller, Fiona Bolden, Grahame Jelley, Jennifer Keys

Randomised trial of verubecestat for prodromal Alzheimer s disease

The epidemiology of acute rheumatic fever in Northland, 2012-2017

Kate Wauchop, Anil Shetty, Catherine Bremner

Imaging of midface fractures a retrospective study

Nika Korduke, Thasvir Singh

Contemporary audit of antiplatelet therapy prescribing patterns following coronary artery bypass grafting

Danting Wei, Tom Kai Ming Wang

Primary care doctor and nurse utilisation rates for billed consultations across the Comprehensive Care Primary Health Organisation

Jennifer N Baldwin, Nick Garrett, Peter J Larmer, Craig Murray, Rachael Evans, Rosey Buchan, Stephen Neville

The ongoing evolution of capitation funding for primary care: the December 2018 PHO capitation funding changes for Community Services Card holders

Peter Crampton

Enamelware and Appendicitis

Dishonest and unethical behaviour

Acute reperfusion for ST-elevation myocardial infarction in New Zealand (2015 2017): patient and system delay (ANZACS-QI 29)

Andrew J Kerr, Mildred Lee, Corina Grey, Tammy J Pegg, Nick G Fisher, Harvey H White, Chris M Nunn, Michael JA Williams, David Smyth, Tony Scott, Rachel X Chen, Jinfeng Zhao, Thu Rein Tun, Matire Harwood, Gerry P Devlin, on behalf of the ANZACS-QI investigators

Investigating strategies to improve clinical trial opportunities for patients with cancer in New Zealand INSIGHT

Yeojeong Jane So, Michael Jameson, Vincent Newton, Anne O Donnell, Mark Jeffery, Christopher Jackson, Alexander Tuck, Kate Gregory, Richard North, Malcolm Anderson, Katrina Sharples, Michael Findlay, Michelle K Wilson

Inappropriate prescribing

Removal of medication and medical equipment for personal use

Probiotics and health: understanding probiotic trials

Gemma A Laws, Roslyn A Kemp

Inaugural University of Auckland and Waitematā DHB Research Symposium

Persistent postural daily headaches

Samantha Lang, Stephen Wong, Richard Cutfield

SUMMARY

The epidemiology of acute rheumatic fever in Northland, 2012-2017

Kate Wauchop, Anil Shetty, Catherine Bremner

This audit demonstrated that rates of acute rheumatic fever (a preventable disease) remain among the highest in the world for Northland Mori aged 5-14 years. Ninety-three percent of all cases were Mori. Pacific Islanders were also over-represented. Adults may be at risk of delayed diagnosis and developing rheumatic heart disease. The data from this audit differs from data reported by the Ministry of Health. Accurate national data is required to assess the true burden of disease and inform future directions.

SUMMARY

Imaging of midface fractures a retrospective study

Nika Korduke, Thasvir Singh

Currently there is an inconsistency in the scans that patients with midface (eye socket, nose and cheekbone) fractures are receiving when they present to the emergency department of hospitals in the Midlands Region. We have found that many patients (70%) are having multiple and unnecessary plain films (two dimensional x-rays) which are of little value, creating delays in their surgery and wasting hospital time and resources. Computed tomography (3D scans) are far more accurate at detecting these fractures, as well as allowing the surgeon to plan for a predictable surgery. We wish to propose a system in the Midlands Emergency Departments which will allow the assessing doctor to make a decision on which patients should proceed straight to computed tomography (three dimensional) scans and avoid 2D x-rays. This system can be generalised to hospitals across New Zealand to improve resource allocation, prevent delays in treatment and reduce radiation to patients.

SUMMARY

Primary care doctor and nurse utilisation rates for billed consultations across the Comprehensive Care Primary Health Organisation

Jennifer N Baldwin, Nick Garrett, Peter J Larmer, Craig Murray, Rachael Evans, Rosey Buchan, Stephen Neville

The aim of our study was to examine socio-demographic trends in doctor and nurse utilisation rates for invoiced consultations in the Comprehensive Care Primary Health Organisation. We found that women, older adults and people living in socially deprived areas utilise primary care more frequently when compared to other population groups. Nurse utilisation rates were highest for Mori and Pacific patients.

SUMMARY

The ongoing evolution of capitation funding for primary care: the December 2018 PHO capitation funding changes for Community Services Card holders

Peter Crampton

The December 2018 PHO capitation funding policy changes represent a further step towards universal low-cost primary healthcare. This paper aimed to examine the possible impact on equity of the recent policy to support people on low incomes to access primary care using the Community Services Card (CSC), and to identify questions that will need to be answered in order for the policy and funding changes to be evaluated. The study found that CSC possession is an important new determinant of eligibility to low-cost access to primary care for many people. As the funding changes are complex, the equity effects cannot be fully understood until further detailed modelling is carried out, and specific questions are answered. It is the responsibility of the Ministry of Health to ensure that an evaluation of the changes takes place.

SUMMARY

Acute reperfusion for ST-elevation myocardial infarction in New Zealand (2015 2017): patient and system delay (ANZACS-QI 29)

Andrew J Kerr, Mildred Lee, Corina Grey, Tammy J Pegg, Nick G Fisher, Harvey H White, Chris M Nunn, Michael JA Williams, David Smyth, Tony Scott, Rachel X Chen, Jinfeng Zhao, Thu Rein Tun, Matire Harwood, Gerry P Devlin, on behalf of the ANZACS-QI investigators

Prompt access to cardiac defibrillation and reperfusion therapy improves outcomes in patients with ST-segment elevation myocardial infarction (STEMI), which is the most serious type of acute heart attack. We have documented preventable delays in patients both calling for help and receiving timely treatment once they have made contact with the ambulance or hospital. Nationwide implementation of the NZ STEMI pathway is needed to reduce system delays in delivery of primary PCI, fibrinolysis and rescue PCI. Ongoing initiatives are required to reduce barriers to calling the ambulance early after symptom onset.

SUMMARY

Investigating strategies to improve clinical trial opportunities for patients with cancer in New Zealand INSIGHT

Yeojeong Jane So, Michael Jameson, Vincent Newton, Anne O Donnell, Mark Jeffery, Christopher Jackson, Alexander Tuck, Kate Gregory, Richard North, Malcolm Anderson, Katrina Sharples, Michael Findlay, Michelle K Wilson

Clinical trials often provide access to unfunded or investigational treatments and trial participation has improved cancer outcome around the world. To better understand why New Zealand has low clinical trials participation rates, we conducted a qualitative survey of cancer patients around New Zealand to determine what barriers are present at patient level. Our patients reported strong enthusiasm in clinical trials across age, tumour group, demographics and location. Majority wanted to participate in clinical trials/research to help others but few patients felt that fear of randomisation held them back from participating in clinical trials.

SUMMARY

Probiotics and health: understanding probiotic trials

Gemma A Laws, Roslyn A Kemp

Probiotics available in New Zealand have a range of reported health benefits, and it can be difficult for consumers and healthcare professionals to compare efficacy of different products. Probiotic products contain a variety of bacterial species and strains that interact with our bodies in unique ways and provide different health benefits, and it is important to acknowledge that these strains cannot be compared unless tested in standardised way. Development of an online resource that collates and translates the scientific literature on probiotics into easy-to-understand clinically relevant information would help consumers and healthcare professionals compare probiotic products and make informed decisions.

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