The New Zealand medical journal最新文献

{"title":"Sirenomelia.","authors":"G. Santra, N. Pandit, P. K. Sinha, M. K. Das","doi":"10.32388/47rfl1","DOIUrl":"https://doi.org/10.32388/47rfl1","url":null,"abstract":"Sirenomelia is a rare malformation of caudal part of embryo. It is characterised by complete or partial fusion of the legs into a single lower limb. Abnormalities of the kidneys, large intestines and genitalia are common. Sirenomelia cases have only one umbilical artery and one vein. Upper body birth defects are rare and include abnormalities of heart, lungs, arms, spine and brain. Here we report a case of sirenomelia with uncommon upper body birth defects involving right forearm and hand, and the rib cage. Vascular steal phenomenon cannot explain the upper body birth defects.","PeriodicalId":160836,"journal":{"name":"The New Zealand medical journal","volume":"80 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126717662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Smoking cessation.","authors":"G. Taylor, M. J. Graham","doi":"10.32388/icxhzo","DOIUrl":"https://doi.org/10.32388/icxhzo","url":null,"abstract":"","PeriodicalId":160836,"journal":{"name":"The New Zealand medical journal","volume":"105 930 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128783691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hepatitis C.","authors":"J. Miller, M. Tobias, D. Woodfield","doi":"10.3949/ccjm.67.s1.9","DOIUrl":"https://doi.org/10.3949/ccjm.67.s1.9","url":null,"abstract":"","PeriodicalId":160836,"journal":{"name":"The New Zealand medical journal","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126319283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving patient experience and outcomes following serious injury.","authors":"A. Beaton, K. O'leary, J. Thorburn, Alaina Campbell, G. Christey","doi":"10.5334/IJIC.S3079","DOIUrl":"https://doi.org/10.5334/IJIC.S3079","url":null,"abstract":"AIM\u0000To explore injured patients' experiences of care to identify areas for improvement in routine service delivery from surgical teams in the transition from inpatient to community-based care.\u0000\u0000\u0000METHODS\u0000Qualitative study drawing on 17 in-depth, semi-structured interviews, conducted from 1 October 2017 to 31 November 2017, with trauma patients (and patient-nominated key support people and health or social care professionals) registered by the Midland Trauma System Registry (New Zealand).\u0000\u0000\u0000RESULTS\u0000All patient respondents had been under the primary care of surgical sub-specialty teams at Waikato Hospital rather than the specialised trauma service that primarily cares for patients with major multi-system trauma. Patients perceived their pre-hospital and emergency care as high quality and highly valued the compassion of staff during their inpatient phase of care. Exceptions were the perception of communication gaps across the spectrum of care from admission to discharge and beyond, limited access to psychosocial services to manage ongoing psychological trauma and a lack of preparedness for discharge. Following discharge, respondents reported the high level of reliance on key support people, inadequate information provision about what to expect in relation to the journey through the health system after discharge, and a lack of coordination of post-discharge care.\u0000\u0000\u0000CONCLUSION\u0000This study highlights perceived issues in the patient care pathway in the transition from inpatient to community-based care, especially communication and discharge information provided by surgical clinical teams and Accident Compensation Corporation (ACC). Comprehensive inpatient care and clinical handover to primary care (rather than discharge planning processes) by dedicated clinical trauma services may provide more holistic models for surgical services to improve their influence on the transition of trauma patients into the community, assisted by organisation changes and support to enable effective service delivery. Specifically, trauma patients and their carers perceived the need for better screening and treatment for psychological trauma in the inpatient and outpatient setting; better information exchange prior to the transition from inpatient to primary care; more convenient and accessible follow-up services including a single point of contact for coordination of post-discharge care; and acknowledgement and practical support to relieve the significant and pervasive carer burden identified in this study. These findings provide the opportunity to implement focused system changes to provide more equitable and effective support in the transition to community care and beyond. The end result will be better experiences for patients and whānau, and improved health and vocational outcomes following serious injury.","PeriodicalId":160836,"journal":{"name":"The New Zealand medical journal","volume":"121 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125362877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antenatal education.","authors":"J. Clarkson","doi":"10.1017/9781108684729.166","DOIUrl":"https://doi.org/10.1017/9781108684729.166","url":null,"abstract":"","PeriodicalId":160836,"journal":{"name":"The New Zealand medical journal","volume":"112 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132768393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility and reliability of clinical coding surveillance for the routine monitoring of adverse drug events in New Zealand hospitals.","authors":"Jerome Ng,&nbsp;Penny Andrew,&nbsp;Paul Muir,&nbsp;Monique Greene,&nbsp;Sabitha Mohan,&nbsp;Jacqui Knight,&nbsp;Phil Hider,&nbsp;Peter Davis,&nbsp;Mary Seddon,&nbsp;Shane Scahill,&nbsp;Jeff Harrison,&nbsp;Lifeng Zhou,&nbsp;Vanessa Selak,&nbsp;Carlene Lawes,&nbsp;Geetha Galgali,&nbsp;Joanna Broad,&nbsp;Marilyn Crawley,&nbsp;Wynn Pevreal,&nbsp;Neil Houston,&nbsp;Tamzin Brott,&nbsp;David Ryan,&nbsp;Jocelyn Peach,&nbsp;Andrew Brant,&nbsp;Dale Bramley","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Aim: </strong>To explore the feasibility and reliability of Clinical Coding Surveillance (CCS) for the routine monitoring of Adverse Drug Events (ADE) and describe the characteristics of harm identified through this approach in a large district health board (DHB).</p><p><strong>Method: </strong>All hospital admissions at Waitemata DHB from 2015 to 2016 with an ADE-related ICD10-AM code of Y40-Y59, X40-X49 or T36-T50 were extracted from clinical coded data. The data was analysed using descriptive statistics, statistical process control and Pareto charts. Two clinicians assessed a random sample of 140 ADEs for their accuracy against what was clinically documented in medical records.</p><p><strong>Results: </strong>A total of 11,999 ADEs were identified in 244,992 admissions (4.9 ADEs per 100 admissions). ADEs were more prevalent in older adults and associated with longer average length of stays and medicines such as analgesics, antibiotics, anticoagulants and diuretics. Only 2,164 (18%) of ADEs were classified as originating within hospital. Of ADEs originating outside of the hospital, the main causes were poisoning by psychotropics, anti-epileptics and anti-parkinsonism agents and non-opioid analgesics. Clinicians agreed that 91% of ADE positive admissions were accurately classified as per clinical documentation.</p><p><strong>Conclusion: </strong>CCS is a feasible and reliable approach for the routine monitoring of ADEs in hospitals.</p>","PeriodicalId":160836,"journal":{"name":"The New Zealand medical journal","volume":" ","pages":"46-60"},"PeriodicalIF":1.7,"publicationDate":"2018-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36660068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A New Zealand case of nasal myiasis involving Lucilia cuprina (Diptera: Calliphoridae).","authors":"Dallas Bishop,&nbsp;Depak Patel,&nbsp;Allen Heath","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>A case of nasal myiasis that occurred in February 2017 in the Northland region was the first involving L. cuprina naturally-acquired in New Zealand.</p>","PeriodicalId":160836,"journal":{"name":"The New Zealand medical journal","volume":" ","pages":"68-70"},"PeriodicalIF":1.7,"publicationDate":"2018-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36660070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"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?","authors":"Vanessa Selak,&nbsp;Rod Jackson,&nbsp;Katrina Poppe,&nbsp;Andrew Kerr,&nbsp;Sue Wells","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Aim: </strong>The 2018 New Zealand Consensus Statement on cardiovascular disease (CVD) risk assessment and management recommends the use of aspirin in people aged less than 70 years with a five-year CVD risk >15% but without prior CVD. We determined whether the estimated number of CVD events avoided by taking aspirin is likely to exceed the number of additional major bleeds caused by aspirin in this patient population.</p><p><strong>Method: </strong>Major bleeding rates were obtained from the PREDICT primary care study, a large New Zealand cohort of people eligible for CVD risk assessment, after excluding those with no other indications for (eg, established CVD) or contraindications/cautions (eg, prior major bleed) to aspirin use. We modelled the benefits (CVD events avoided) and harms (additional major bleeds) of aspirin for primary prevention of CVD over five years using hypothetical populations aged 40 to 79 years, stratified by sex, age-group and estimated five-year CVD risk. Two clinical scenarios were modelled, according to whether or not optimisation of lipid- and blood pressure-lowering therapy was required prior to aspirin initiation.</p><p><strong>Results: </strong>In both clinical scenarios the number of CVD events prevented by aspirin over five years was estimated to be, on average, more than the number of bleeds caused by aspirin among people aged less than 70 years with estimated five-year CVD risk of >15%. However, the magnitude of the net benefit of aspirin was modest among people aged 60-69 years, particularly if lipid- and blood pressure-lowering therapy had not already been optimised.</p><p><strong>Conclusion: </strong>The benefits of aspirin are likely to exceed the risk of major bleeds among people in whom aspirin is recommended for the primary prevention of CVD. A more cautious approach to the use of aspirin is appropriate for people aged 60-69 years who are likely to have a smaller net benefit from aspirin, particularly those in whom lipid- and blood pressure-lowering therapy has not already been optimised or who have other bleeding risk factors, such as diabetes or smoking. More specific recommendations will be possible when bleeding risk equations are developed to complement the recently developed New Zealand CVD risk equations.</p>","PeriodicalId":160836,"journal":{"name":"The New Zealand medical journal","volume":" ","pages":"19-25"},"PeriodicalIF":1.7,"publicationDate":"2018-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36616069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Readmissions to hospital in a frail older cohort receiving a community-based transitional care service.","authors":"Claire P Heppenstall,&nbsp;Anne Chiang,&nbsp;H Carl Hanger","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Aims: </strong>To investigate frequency of and reasons for hospital readmission in a frail older cohort receiving a community-based, multidisciplinary, transitional care service.</p><p><strong>Methods: </strong>A prospective cohort study with descriptive analysis of reasons for readmission in a cohort of frail older people discharged from hospital with the service. Measures of frailty, comorbidity, cognition, quality of life and function were recorded at discharge. Readmissions were recorded within three months after index discharge. Discharge summaries were reviewed and reasons for readmission categorised. Outcomes following readmission were recorded.</p><p><strong>Results: </strong>Readmission rates were high (42%) in our cohort, despite the intervention. People readmitted had worse functional ability and a greater burden of comorbidities. Half of the readmissions were classified as being new, acute medical problems requiring inpatient treatment, and a quarter as exacerbations of chronic medical problems. Eighty-six percent of those readmitted were able to return home following their readmission.</p><p><strong>Conclusions: </strong>Our study showed high readmission rates despite the community supports. This high readmission rate does not imply failure of the intervention as the majority of these were with new or acute medical problems requiring inpatient treatment which were not preventable. Most were able to recover and return to their own homes.</p>","PeriodicalId":160836,"journal":{"name":"The New Zealand medical journal","volume":" ","pages":"38-45"},"PeriodicalIF":1.7,"publicationDate":"2018-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36616072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lower-limb amputation in New Zealand: temporal changes and the role of diabetes mellitus.","authors":"Jason K Gurney,&nbsp;James Stanley,&nbsp;Juliet Rumball-Smith,&nbsp;Steve York,&nbsp;Diana Sarfati","doi":"","DOIUrl":"","url":null,"abstract":"<p><p></p>","PeriodicalId":160836,"journal":{"name":"The New Zealand medical journal","volume":" ","pages":"71-73"},"PeriodicalIF":1.7,"publicationDate":"2018-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36660071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}