The Ministry hosted the national ‘Performing better and measuring better performance’ emergency department forum on Monday 23 March 2015 in Wellington.

• New Zealanders live longer, healthier and more independent lives.
• The health system is cost-effective and supports a productive economy.

The Ministry has three high-level outcomes that support the achievement of the above health system outcomes:

• New Zealanders are healthier and more independent.
• High-quality health and disability services are delivered in a timely and accessible manner.
• The future sustainability of the health and disability system is assured.

The Statement of Intent outlines the strategic direction for the Ministry, work that will be undertaken to deliver priorities and how success will be measured.

To read the Statement of Intent, go to:  http://www.health.govt.nz/publication/statement-intent-2015-2019

In the latest issue (attached below):

Ten reviews covering chronic patients (eg, diabetes and hypertension) and primary care patients, as well as health care providers were found but eight were included for the analysis of outcome measures.

The authors found mixed outcomes across both patient and health care providers groups, with approximately half of the reviews showing positive changes with record access. Patients believe that record access increases their perception of control; however, outcome measures thought to create psychological concerns (such as patient anxiety as a result of seeing their medical record) are still unanswered. Nurses are more likely than physicians to gain time efficiencies by using a patient accessible electronic health records (PAEHRs) system with the main concern from physicians being the security of the PAEHRs.

The authors conclude that there is a lack of rigorous empirical testing that separates the effect of record access from other existing disease management programs. Current research is too targeted within certain clinical groups’ needs, and although there are positive signs for the adoption of PAEHRs, there is currently insufficient evidence about the effect of PAEHRs on health outcomes for patients or health care providers.

This is an open access article and can be read in free full text at:  http://dx.doi.org/10.2196/jmir.4446

Jilka, S.R., et al. (2015). “Nothing about me without me”: An interpretative review of patient accessible electronic health records. Journal of Medical Internet Research, 17(6), e161.

This Atlas raises interesting questions as to whether rates of antibiotic use following surgery are a possible area for quality improvement".

To read the full story and to access the new domain, go to:  http://www.hqsc.govt.nz/our-programmes/health-quality-evaluation/news-and-events/news-2/news/2214/

MidCentral District Health Board’s Clinical Leadership Council has had a busy year with multiple projects and provision of clinical governance for the health services of its district.

The council, formed in 2012, meets bi-monthly “with the purpose of providing leadership, direction and influence to enhance clinical quality, effectiveness and sustainability of health services for the people/populations of the district”.

In the past year Chairman Dr Kenneth Clark says among a busy work programme the council has:

• Endorsed a palliative care quality framework that provides a district-wide, measurable and achievable framework aimed at enhancing access to palliative care and end of life care.
• Endorsed a work plan to roll out an electronic patient information system in 2016 that will be available to all health professionals across the district.
• Reviewed last year’s Quality Account and is supporting the development of this year’s account with a stronger focus on the quality improvement framework and patient outcomes.
• Supported MDHB and CentralPHO joining the New Zealand Business Excellence Foundation. This will see work against criteria for performance excellence and replaces the former EQUIP4 accreditation that MDHB undertook for many years.
• Supports and oversees the continued development and implementation of collaborative clinical pathways in MDHB and, in collaboration with Whanganui and Hawke’s Bay districts, across the region. In the past year 15 pathways have been developed and implemented and subsidised ECG machines have been provided within general practice.
• Provides ongoing clinical governance of the Maternity Clinical Information System (MCIS), and Neonatal Clinical Information System (NCIS) which went live last October.

In the next year the council’s focus will be on the Master Health Services Planning work involving the redevelopment of Palmerston North Hospital; regional and sub-regional projects; increased analysis of the activities of the clinical networks across the district; and on activities of MDHB’s contracted non-government organisations.

A number of government policies that come into effect tomorrow will deliver real benefits to families, Prime Minister John Key says.

From tomorrow all children under 13 will have access to free GP visits and prescriptions.  

It is estimated that over 400,000 children will benefit from the scheme, taking the total number of children who are benefitting from free GP visits and prescriptions to over 750,000.

“We’re committed to giving kids the best start in life and that means ensuring they are able to go to the doctor any time of the day or night without their parents worrying about the cost,” says Mr Key.

“Doctor’s visits and prescriptions are already free for children under the age of six and thanks to our careful management of the government’s books we have been able to extend this policy to all children under 13.”

Other changes that come into effect tomorrow include:

• The average ACC motor vehicle levy, including the annual licence levy and petrol levy, will fall from around $330 to $195 per year.
• Paid parental leave payments will increase with the maximum weekly rate for eligible employees and self-employed parents going from $504.10 to $516.85 gross.
• More assistance for solo parents who are studying
• Additional checks for people working with young New Zealanders
• More funding will also be made available to hospices to help them expand their community palliative services to better support terminally ill people at home and in aged-care facilities.

“These changes show how a growing and vibrant economy is delivering New Zealanders more money in their back pockets.”

To read the full story, go to:  http://www.hqsc.govt.nz/our-programmes/health-quality-evaluation/news-and-events/news/2212/

• Upfront: Time to reduce antibiotic prescribing – NOW
• Debate: Do you prescribe antibiotics for respiratory tract infections? An everyday conundrum in general practice
• Is it ok to stop antibiotics when symptoms resolve?
• Delayed antibiotic prescriptions for respiratory tract infections: does the strategy work?
• Should I prescribe a topical antiseptic cream instead of a topical antibiotic for minor skin infections?
• Is point-of-care CRP testing useful in guiding antibiotic prescribing in patients with respiratory tract infections?
• Do probiotics provide effective and safe protection against antibiotic-associated adverse effects?
• When is an allergy to an antibiotic really an allergy?
• The role of prophylactic antibiotics for preventing infective endocarditis in people undergoing dental or other minor procedures
• Cellulitis: skin deep and spreading across New Zealand

To read the issue in full text, go to:  http://www.bpac.org.nz/BPJ/2015/June/contents.aspx

Limited published studies on community representation in hospital governance in Australia were identified. The author does note that: "1) quality subcommittees set up to assist Hospital Boards are a key structure for involving community representation in decision making around quality of care, and 2) there are a number of challenges to effectively developing the process of community representation in hospital governance: ambiguity and the potential for escalated indecision; inadequate value and consideration given to it by decision makers resulting in a lack of time and resources needed to support the community engagement strategy (time, facilitation, budgets); poor support and attitude amongst staff; and consumer issues, such as feeling isolated and intimidated by expert opinion".

Now available to read in free full text at: http://dx.doi.org/10.1071/AH14016 

Murray, Z. (2015). Community representation in hospital decision making: A literature review. Australian Health Review, 39(3), 323-328.

They provide two case studies explaining how this approach could be applied, in Australian and Canadian settings. It is argued that this framework type of approach to evaluation offers better potential for incorporating the learnings from resultant evaluations into business decisions by “learning organisations”, through alignment with organisational performance considerations.

This is an open access article and can downloaded in free full text at:  http://dx.doi.org/10.3233/978-1-61499-505-0-84

Maeder, A., et al. (2015). Achieving greater consistency in telehealth project evaluations to improve organisational learning. Studies in Health Technology and Informatics, 209, 84 - 94.

In this narrative reviw, the authors provide an "... overview of the major evidence base on nutrition therapy in critically ill patients and provide practical suggestions".

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1016/j.clnu.2014.12.008 or contact your DHB library, or organisational or local library for assistance.

Ridley, E., et al. (2015). Nutrition therapy in critically ill patients - a review of current evidence for clinicians. Clinical Nutrition, 34(4), 565-571.

Studies reported in this issue (attached below):

Studies in this issue (attached below):

Health Minister Jonathan Coleman today officially opened a new maternal mental health respite and support service in Te Atatu South, Auckland.

“Pregnancy and childbirth can be vulnerable times for women - at least 15 per cent will develop depression, anxiety or other mental health issues. It is important mothers get the support they need,” says Dr Coleman.

“The Government is committed to providing high quality mental health services. In Budget 2013 we invested an extra $18.2 million in maternal mental healthcare for the North Island.

“This funding has resulted in a range of new and enhanced services including the maternal mental health respite and support service in Te Atatu South, He Kakano Ora, as well as a new mother and baby unit at Starship Hospital.

“The new community based service He Kakano Ora will provide crucial support to mums, babies and the whole family. He Kakano Ora will initially provide a four bed residential option, and it will also have the flexibility to support mothers in their own homes.”

Waitemata and Auckland DHB selected the WALSH Trust as the maternal mental health respite and support service provider. The WALSH Trust has been supporting people with mental health issues in Auckland for 27 years.

He Kakano Ora will be delivered from an interim site in Te Atatu South while a specially designed six bedroom facility is built. The new facility is expected to open later in 2016.

The three core outcomes for the medicines system as set out in the Strategy are:

• access
• optimal use
• quality, safety and efficacy.

Implementing Medicines New Zealand is about the changes required to deliver on Medicines New Zealand. This action plan supports the achievement of the Strategy’s outcomes by:

• making the most of every point of care
• enabling shared care through an integrated health care team
• optimal use of antimicrobials
• empowering individuals and families/whānau to manage their own medicines and health
• optimal medicines use in older people and those with long-term conditions
• competent and responsive prescribers
• removing barriers to access.

This will be done by harnessing the collective efforts of all health professionals, including those working in community organisations, primary health care, pharmacies, hospitals, rest homes and end-of-life care.

Implementing Medicines New Zealand 2015 to 2020 can be downloaded at:  http://www.health.govt.nz/publication/implementing-medicines-new-zealand-2015-2020

Ministry of Health (2015). Implementing Medicines New Zealand 2015 to 2020. Wellington: Miistry of Health

The article is available to read in free full text at:  http://dx.doi.org/10.5888/pcd12.150187

Soumerai SB, Starr D, Majumdar SR. (2015). How Do You Know Which Health Care Effectiveness Research You Can Trust? A Guide to Study Design for the Perplexed. Preventing Chronic Disease, 12:150187.

To read the full media release from the Midwifery Council of New Zealand, go to:  http://www.scoop.co.nz/stories/GE1506/S00155/slight-increase-in-qualified-midwives-in-the-workforce.htm

In this issue:

They included six trials (483 participants), with interventions delivered on the ward (2 studies); both on the ward and in the community (1 study); and in the community (3 studies).

The authors were "... unable to determine an overall result for the effects of exercise-based interventions. Three studies reported improvement in functional exercise capacity following completion of the exercise programme, and the other three found no effects of treatment.

Only two studies measured patient-reported health-related quality of life, and both of these studies showed no effects related to treatment. Again, we were unable to reach an overall conclusion".

This article is available to read in free full text at:  http://dx.doi.org/10.1002/14651858.CD008632.pub2

Connolly B, Salisbury L, O'Neill B, Geneen L, Douiri A, Grocott MPW, Hart N, Walsh TS, Blackwood B,for the ERACIP Group. Exercise rehabilitation following intensive care unit discharge for recovery from critical illness. Cochrane Database of Systematic Reviews, 6, CD008632. 

Sixteen randomised and quasi-randomised trials "... compared day hospitals with comprehensive care (five trials), domiciliary care (seven trials) or no comprehensive care (four trials)". 

The authors conclude from their analysis that "there is low quality evidence that medical day hospitals appear effective compared to no comprehensive care for the combined outcome of death or poor outcome, and for deterioration in [activities of daily living ]. There is no clear evidence for other outcomes, or an advantage over other medical care provision".

This article can be read in free full text at:  http://dx.doi.org/10.1002/14651858.CD001730.pub3

Brown L, Forster A, Young J, Crocker T, Benham A, Langhorne P, Day Hospital Group. (2015). Medical day hospital care for older people versus alternative forms of care. Cochrane Database of Systematic Reviews, 6, CD001730. 

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.12968/ijpn.2015.21.5.225 or contact your DHB library, or organisational or local library for assistance.

Langemo, D., et al. (2015). Evidence-based guidelines for pressure ulcer management at the end of life. International Journal of Palliative Nursing, 21 (5).

Two up-and-coming University of Otago researchers are the latest recipients of the Carl Smith Medal and Rowheath Trust Award.

Associate Professor Jessica Palmer (Faculty of Law) and Associate Professor Suetonia Palmer (Department of Medicine, Christchurch) are co-recipients of the Award and Medal which recognise outstanding research performance of early-career staff at Otago and are accompanied by a $5000 grant for personal scholarly development.

Announcing the honours, Deputy Vice-Chancellor Professor Richard Blaikie warmly congratulated both researchers saying the pair had already made important international contributions to their respective disciplines.

“Both Jessica and Suetonia have outstanding records of scholarly achievement and are richly deserving of this recognition. Their research accomplishments, academic and professional contributions are seen as truly world class.

“The international referees highlighted the impacts that the research findings of Jessica and Suetonia have made on the practice of Law and Medicine respectively, and the assessment committee was compelled to make a joint award. They are outstanding examples of the calibre of translational research being undertaken at Otago.”

Jessica Palmer’s research primarily focuses on the areas of trusts and restitution. Trusts being very popular in New Zealand, her innovative work has been influential on the development of trust law in this country and is regularly cited by the courts.

While Jessica is as yet unsure how she will allocate the award money, the former recipient of the Law Foundation’s Ethel Benjamin Scholarship, says she feels “very lucky to be acknowledged in this way”.

“This award is a strong vote of encouragement from the University that the work I am doing is worthwhile and that I am doing it well. Otago is a wonderful place to teach and research and I know that I have benefitted from many discussions with colleagues, students and visitors that have helped to develop my thinking and direct my research enquiries.

“I am also grateful for the support I have had to develop relationships with academics from other universities in New Zealand and internationally which has been crucial to progressing my research.”

Suetonia Palmer is a kidney specialist and Rutherford Discovery Fellow, who is interested in evaluating whether medicines are effective. Her particular research focus is in applying meta-analysis (the mathematics of combining research studies together) to study the evidence behind treatments used for people with kidney disease, which has previously awarded her a L’Oréal UNESCO For Women in Science Fellowship.

Of receiving the award, she says: “I feel much honoured, particularly given the high standard of research done by many outstanding researchers at the University. It is also gratifying to see recognition for the usefulness of meta-analysis in clinical medicine.

“This award will allow me to spend more time with my international collaborators to generate more research ideas and strengthen connections.”

The two researchers will each give public lectures later this year, at which they will be presented with the Medal.

The Rowheath Trust was established in 1964 by Carl Smith – whose family lived in the Rowheath area of England – to support the University. Mr Smith received an honorary doctorate from Otago in 1968.

Associate Professor Jessica Palmer

Jessica Palmer is an Associate Professor in the Law Faculty and teaches courses in contract, equity and commercial law. She is a graduate of Auckland and Cambridge. She was a Judges’ clerk in the High Court in Auckland and worked in a national corporate law firm before coming to Otago.

Much of Jessica's recent research has been in trust law. She was a member of the New Zealand Law Commission’s reference panel for its recent review of the law of trusts. This is a major review undertaken at the request of the Government to reform trust law and respond to the general discontent of many New Zealanders with the apparent widespread abuse of trust structures.

Trusts are very popular in New Zealand and are widely used by people to protect their home and other assets from claims by creditors, spouses or partners, and from the State’s means test for state subsidies. Trusts are normally discretionary in nature, which allows the settlors who created the trusts to hold themselves out as not having any beneficial interest in the trust assets. Yet, at the same time they give themselves significant powers to control the trust for their own benefit.

Not surprisingly, these trusts are coming under increasing scrutiny. Any avenues used by the courts or Parliament to set aside or look through trusts demand close attention because of the potentially far reaching consequences they have for the traditional understanding of the trust. Jessica has written on the rights of beneficiaries and on the avenues available to creditors, spouses and partners to access the property held in these trusts.

Her work is cited regularly by courts and has been influential on the development of the law in relation to sham trusts and the control of express trusts. For example, her writing was relied on by the New Zealand Court of Appeal in cases that have attracted much attention for trust and matrimonial property lawyers (Clayton v Clayton [2015] NZCA 30; Official Assignee v Wilson [2008] NZLR 45). A Court of Appeal judge has cited her work as an example of the important contribution that academic lawyers can make to the development of law (G Hammond, “Judges and Academics in New Zealand” (2013) 25 NZ Universities Law Review 681 at 690).

Jessica is an author in two leading textbooks in New Zealand on the law of trusts and on civil remedies (A Butler (ed) Equity and Trusts in New Zealand (2nd ed) Wellington, Thomson Reuters (2009; P Blanchard (ed) Civil Remedies in New Zealand (2nd ed) Wellington, Thomson Reuters (2011)). She is also a contributing editor to the New Zealand Law Review on equity and restitution.

Associate Professor Suetonia Palmer

Suetonia Palmer is an Associate Professor and kidney specialist who is based in the Department of Medicine at the University of Otago, Christchurch. After qualifying as a doctor and specialist in 2005, she completed a PhD before attending Harvard Medical School as a post-doctoral fellow. Since returning to New Zealand and joining the University of Otago in 2011, she has conducted research within a large international collaboration.

Her significant contribution includes applying complex meta-analysis techniques to medical treatments to discover whether drugs are effective. The combining of hundreds of drug trials together to provide greater power to detect side-effects and even evaluate treatments against placebo when these trials have not been extensively available, have led to definitive summaries of the evidence for doctors and policy-makers.

The research has identified that many widely prescribed treatments have little evidence to support their use and some are not demonstrably better than receiving no treatment. These findings have been published in the world’s leading medical journals including the Lancet, JAMA, PLoS Medicine, and the Annals of Internal Medicine and informed global policy and clinical guidelines for medical practice. Suetonia also works as a clinical kidney specialist at Christchurch Hospital.

In 2012 she was the first New Zealand woman to receive a L’Oréal Australia and New Zealand For Women in Science Fellowship and is currently a Rutherford Discovery Fellow (2014-2019) awarded by the Royal Society. She was a 2013 recipient of the University’s Early Career Award for Distinction in Research. She attributes her research achievements to the dedicated and talented colleagues who she works with around the world.

The 2015 update is now available, showing progress across 19 key indicators and nearly 30 contextual measures, including international comparisons and a focus on equity. The measures are accompanied by commentary.

To access this information, go to:  http://www.hqsc.govt.nz/our-programmes/health-quality-evaluation/news-and-events/news/2211/

To find out more about this event, go to:  http://www.wcaa2016.com.au/

Eligible studies required the use of a quantitative method to identify high performing hospitals, and qualitative methods or tools to identify factors associated with high performing hospitals or hospital departments. Practical strategies for achieving high performance were then mapped against the identified themes.

A total of 19 studies from a possible 11,428 were included in the review. A range of process, output, outcome and other indicators were used to identify high performing hospitals. Seven themes representing factors associated with high performance (and 25 sub-themes) emerged from the thematic syntheses: positive organisational culture, senior management support, effective performance monitoring, building and maintaining a proficient workforce, effective leaders across the organisation, expertise-driven practice, and interdisciplinary teamwork. Fifty six practical strategies for achieving high performance were catalogued.

The authors conclude that this review provides insights into methods used to identify high performing hospitals, and yields ideas about the factors important for success. It highlights the need to advance approaches for understanding what constitutes high performance and how to harness factors associated with high performance.

This is an open access article and can be read in free full text at:  http://dx.doi.org/10.1186/s12913-015-0879-z

Taylor, N., et al. (2015). High performing hospitals: A qualitative systematic review of associated factors and practical strategies for improvement. BMC Health Services Research, 15:244.

People with disabilities will benefit from a new Palmerston North Hospital campus map soon to be available showing as many disability-friendly features as possible, making access to health services simpler.

The map – a one-stop map – showing the location of  40 mobility car parks; ramp and lift access to buildings, disability toilets; low counters for people in wheelchairs; hearing loops; Braille on lifts; 19 taxi cab spots for easy pick-up, and many more.

Until now the hospital has had a number of maps with some disability features on each. This has meant people with disabilities have had to check all of the maps to see things like where are the closest mobility car parks; does the building have steps or ramp or lift access; where can a taxi drop them off and pick them up from; and does the building they go to have wheelchair access to counters and disability toilets.

Soon, it will be made easier for all our patients, including those with a disability, to check out/copy the map to make sure they will be more easily able to attend appointments.

Director Patient Safety and Clinical Effectiveness Muriel Hancock welcomes the initiative. “For people with disabilities this new map should make accessing all our services much easier. We hope our efforts in producing one map with all disability-friendly features will be welcomed. We are also keen to hear about other disability-friendly features we could consider adding to the map in future.”

If anyone has any other ideas to make it simpler for people with disabilities that we could include in the map can you please telephone (06) 350 8945, or email

Advanced biomedical engineering that restores mobility for those with failed orthopaedic implants has earned a Christchurch man a national award.

Seamus Tredinnick, a PhD candidate at the University of Canterbury and Assistant Research Fellow at the University of Otago, Christchurch, has been working on a project that allows 3D printed titanium implants to become integrated with bone.

Integration allows the bone to heal and remodel, providing new mobility for those at the end of traditional medicine methods with failed implants that would otherwise relegate them to a wheelchair or bed.

Seamus was the winner of the inaugural Healthtech Award for Best Translational Research Project at the recent Healthtech Week, hosted by the MedTech Centre of Research Excellence, MTANZ, NZHITC and Callaghan Innovation.

Seamus started work in this area of biomedical engineering while completing his Bachelor of Engineering at the University of Canterbury. His work for Ossis Ltd, as a Foundation for Research, Science and Technology Intern, was the basis of his PhD study.

“Ossis had been working for some time in the area of 3D printing of patient specific implants, but we wanted to get smarter about how the implants integrated with the patient. That led to the idea of using scaffolds to allow the bone to grow directly into the implants. That needed substantial research, so I embarked on my PhD.”

Seamus’ primary supervisor, Distinguished Professor Geoff Chase, of the University of Canterbury’s Mechanical Engineering Department, says: “Seamus has pursued an aggressive and, ultimately, very successful PhD going from a single idea or concept to a complete, clinically validated outcome with huge potential.

“This is very rare given normal research timeframes in this field, as well as the difficulty often encountered in translating across engineering and clinical science boundaries.”

Today, Seamus is working with the University of Otago to research and develop the next generation of the scaffold technology, alongside Dr Tim Woodfield and Ossis Ltd, with the assistance of an MBIE grant.

Dr Woodfield says: “This is a great example of leading New Zealand companies working alongside researchers and clinicians to translate cutting edge biomaterials and 3D printing technologies into new medical devices.”

“Seamus and his work are an exemplar of a new breed of bio engineers that need to work across disciplines to grow this exciting technology and New Zealand’s Med Tech industry. This award recognises his major contribution to improving the clinical use of additive manufacturing technology that is leading to better outcomes for patients.”

Seamus’ award will take him to Dusseldorf in Germany, to attend the MEDICA trade fair, the largest medical marketplace internationally, in November this year.

Health and Social Care Information Centre media release, 23 June 2015

Community pharmacists across England will be given the opportunity to access the Summary Care Record (SCR), in new plans announced today.

Mixtures of common chemicals used in our environment may act in concert with each other in the human body to cause the development of cancer. This is the overall finding of ground-breaking new research by an international task force that included New Zealand.

Dr Linda Gulliver, from the University of Otago’s Faculty of Medicine, was the only New Zealand scientist selected to join an ‘Environmental Mixtures’ task force, one of two task forces assembled by an NGO called “Getting to Know Cancer” in Halifax Nova Scotia in July 2013.

Amid worldwide concern on high rates of cancer, the task force brought together 174 scientists from prominent institutions in 28 countries to tackle longstanding concerns that there are linkages between mixtures of commonly encountered chemicals and the development of cancer.

From the thousands of chemicals to which the population is now routinely exposed, the scientists selected 85 prototypic chemicals that were not considered to be carcinogenic to humans, and they reviewed their effects against a long list of mechanisms that are important for cancer development.

Working in teams that focused on various hallmarks (shared characteristics) of cancer, the group found that 50 of those chemicals examined supported key cancer-related mechanisms at environmentally relevant levels of exposure (i.e. levels at which humans are routinely exposed).

This supports the idea that chemicals may be capable of acting in concert with one another to cause cancer, even though low-level exposures to these chemicals individually might not be carcinogenic. 

“Since so many chemicals that are unavoidable in the environment can produce low-dose effects that are directly related to carcinogenesis, the way we've been testing chemicals (one at a time) is really quite out of date. Every day we are exposed to an environmental 'chemical soup', so we need testing that evaluates the effects of our ongoing exposure to these chemical mixtures,” says William Goodson III, a senior scientist at the California Pacific Medical Center in San Francisco.

Goodson is the lead author of this synthesis of the findings, which is today published (along with a seminal series of supporting reviews authored by each of the teams) in a special issue of the top-tier journal Carcinogenesis.

Their published report says: “Cumulative risk assessment methods that are based on ‘common mechanisms of toxicity’ or common ‘modes of action’ may be underestimating cancer-related risks….

“And current regulations in many countries (that consider only the cumulative effects of exposures to individual carcinogens that act via a common sequence of key events and processes on a common target/tissue to produce cancer) should be revisited.”

In light of this evidence, the task force is calling for an increased emphasis and support for research on low-dose exposures to mixtures of environmental chemicals.

This was the first time this large-scale problem has ever been considered by interdisciplinary teams that could fully interpret the full spectrum of cancer biology and incorporate what is now known about low-dose chemical effects.

Dr Linda Gulliver is a senior lecturer and reproductive biologist with an interest in oestrogen-related cancer causation. She was recruited into the “The Halifax Project” initiative in late December 2012.

Dr Gulliver was a member of the ‘Sustained Proliferative Signalling’ team, which looked at one of the ten established hallmarks of cancer cells; their ability to grow and multiply in an uncontrolled manner that is prevented in normally functioning cells.

She says her own team found that chemicals that act as environmental oestrogens and androgens play important roles in the activation of the cancer hallmark of “Sustained Proliferative Signalling,” as well as the cross-activation of several of the other cancer hallmarks.

And Dr Gulliver agrees with her colleague Dr David Carpenter, project contributor and Director of the Institute for Health and the Environment of the University at Albany in New York, that research into the area of how low-dose mixtures of environmental chemicals may facilitate cancer causation “merits considerable attention where interdisciplinary and international collaboration is needed.”

Dr. Carpenter adds: “The science in this field is changing rapidly. Although we know a lot about the individual effects of chemicals, we know very little about the combined and additive effects of the many chemicals that we encounter every day in the air, in our water and in our food.”

Current estimates suggest that as many as one in five cancers may be due to chemical exposures in the environment that are not related to personal lifestyle choices. So the effects of exposures to mixtures of commonly encountered chemicals needs to be better understood to try and reduce the incidence of cancer.

"This year’s IAP2 Australasia community engagement symposium in New Zealand will consider how we work in partnership to develop plans, make decisions and improve services while considering new ways of understanding and connecting with our communities. It’s about breaking down the traditional barriers between decision-makers and community members or service users, to allow for the co-creation of outcomes."

To find out more, go to:  http://www.iap2.org.au/events/event/2015-Engagement-Symposium

Among the main topics addressed at the conference were: active and ambient assisted living (AAL); eHealth education; electronic patient and health records; ethical legal and economic aspects of eHealth; ICT for integrated treatment, research and personalized medicine; patient portals and personal health records; semantic interoperability of information systems; and visualization of clinical or epidemiological data".

http://ebooks.iospress.nl/volume/ehealth2015-health-informatics-meets-ehealth-innovative-health-perspectives-personalized-health

Hayn, D., et al. (Eds.). eHealth2015 – Health Informatics Meets eHealth. Studies in Health Technology and Informatics, 212.

Telehealth is at the forefront of hospital services in Thames. All four types of the technology are been used throughout the hospital to link patients with specialists throughout the Waikato.

When Health Minister Jonathan Coleman and Minister for Coromandel Scott Simpson visited the rural hospital last week Thames clinical director Dr Ruth Large explained how telehealth (or video conferencing) is been used to improve access and equity for patients living remotely.  “Tele-acute support, tele-ambulatory care, tele-ward support and tele-workplace support are been used to allow patients services closer to their home and whanau,” she said.

“Tele-acute support, tele-ambulatory care, tele-ward support and tele-workplace support are been used to allow patients services closer to their home and whanau,” she said.

Dr Large demonstrated how complex trauma cases are now beamed to specialists all over New Zealand when the Emergency Department in Thames needs a more specialist opinion.

“The tool also helps to improve professional collaboration by allowing us to video conference with other specialists in our field – where we used to have to take a day off clinical duties we can now just sit in on the conference for an hour and then get back to see patients,” said Dr Large.

In addition to some outpatients clinic being run via telehealth,  Thames has trialled a mobile cart unit which is hoped to be used increasingly for virtual ward rounds and the development of a virtual stroke unit.

In the future, Telehealth may be able to facilitate the management of acute patients and potentially be used to augment specialist services in the community both by tele-monitoring and increased primary care support.

There is also a videoconference set up for education days and general meetings.

After the demonstration Dr Coleman met with staff and toured other parts of the hospital.

The rate of babies dying from 20 weeks of pregnancy to 28 days old (perinatal mortality rate) has fallen to the lowest number since reporting began in New Zealand.

The Perinatal and Maternal Mortality Review Committee’s (PMMRC’s) ninth annual report, released today, shows there was one death for every 100 babies born in New Zealand in 2013.

“Although the overall reduction in perinatal mortality is not statistically significant, any reduction is encouraging,” says PMMRC chair Dr Sue Belgrave.

The overall reduction in perinatal mortality included a significant reduction in stillbirths at term (after 37 weeks of pregnancy) from 117 in 2007 to 69 in 2013.

The report has issued several recommendations which align with work to improve maternity services at Waikato DHB.

Over the past two years Waikato DHB has already begun implementing several of these recommendations as part of the organisation’s maternity quality and safety programme.

Several changes to the way staff screen for foetal development and environmental risks to both mother and foetus are aimed to reduce the number of maternal and neonatal deaths in the region.

The 7^th PMMRC report (2013) identified that Waikato DHB had an apparent higher neonatal encephalopathy rate (disturbed neurological function in term infants occurring in the first seven days after delivery). An initial review identified three commonalities – the scope in reporting cases, geographical issues and sick mothers or acute perinatal events.

The review led to a multidisciplinary team being established between midwifery, obstetrics and neonatology, all of whom now work together to review the information collected on infants from Waikato Hospital Newborn Intensive Care Unit (NICU) with neonatal encephalopathy.

Today the team will present their key learnings at the PMMRC conference in Wellington.

In addition to the multidisciplinary team Waikato DHB has trained 555 current staff in family violence intervention across emergency, maternity and children services.

Several new clinical guidelines have also become standardised practice to ensure any risks to pregnant women or their foetus are identified earlier in their pregnancy.

The appointment of a perinatal loss specialist midwife has led to a closer relationship between the Waikato District Health Board and Sands – a national not-for-profit family support organisation – to better support families and whanau who lose their baby soon after birth or deliver a still born.

This has led to increased training for midwives on how to better care for families in their time of grief and several changes are to be considered for Waikato DHB’s Women’s Assessment Unit.

Midwives are also helping reduce the risk of perinatal and maternal loss by increasing awareness of smoking while pregnant and the impact of influenza. Two campaigns led by the Waikato DHB have increased accessibility to quit smoking services and to free influenza vaccines for pregnant women.

To find out more about this event, go to:  http://www.nzno.org.nz/groups/sections/nzno_nurse_managers_new_zealand/conferences_events

The rate of babies dying from 20 weeks of pregnancy to 28 days old (perinatal mortality rate) has fallen to the lowest number since reporting began in New Zealand in 2007.

The Perinatal and Maternal Mortality Review Committee’s (PMMRC’s) ninth annual report shows there was one death for every 100 babies born in New Zealand in 2013.

“Although the overall reduction in perinatal mortality is not statistically significant, any reduction is encouraging,” says PMMRC chair Dr Sue Belgrave.

The overall reduction in perinatal mortality included a significant reduction in stillbirths at term (after 37 weeks of pregnancy) from 117 in 2007 to 69 in 2013.

The greatest reduction in stillbirths came from fewer babies dying due to a lack of oxygen at birth (hypoxic peripartum deaths), with an 80 percent fall compared to the 2007-2009 period. There was also a 30 percent reduction in unexplained antepartum deaths (babies dying before birth without a known cause).

Dr Belgrave says spontaneous preterm births are the second highest cause of perinatal death in New Zealand and a special focus of this year’s report.

“These deaths are more common among smokers, mothers living with socioeconomic deprivation, young mothers, Māori and Pacific mothers and in multiple pregnancies,” she says.

“It may be possible to reduce the risk of preterm birth for some women. For example, 34 percent of mothers whose babies died after a spontaneous preterm birth were smokers. This is higher than the rate of smoking for New Zealand mothers overall (15.3 percent). These mothers need to receive as much help and support as possible to stop smoking.”

The PMMRC has recommended all maternity care providers identify women with modifiable risk factors for perinatal-related death and work with them to address these.

This includes taking folic acid prior to and during early pregnancy and appropriate care pre-pregnancy for known medical diseases such as diabetes.

“Early access to antenatal care is important so women get appropriate pregnancy care including advice on smoking cessation, ideal weight gain and awareness of risk factors such as bleeding and decreased fetal movements,” says Dr Belgrave.

The PMMRC has consistently found the leading cause of maternal death directly related to pregnancy is as a result of amniotic fluid embolism. The rate in New Zealand is 5.6 times higher than the rate reported in the United Kingdom.

“This finding is of concern and the committee plans to further review all cases of amniotic fluid embolism reported to the PMMRC – both deaths and women who survived – with a particular focus on identifying areas for improvement in care,” says Dr Belgrave.

Some DHBs have undertaken work recommended by the committee in previous reports, and future reductions in their mortality rates may be a reflection of this.

Two Auckland-based DHBs – Counties Manukau and Auckland DHB – have instituted measures within the past year aimed at helping mothers and babies.

“The PMMRC is encouraged to see implementation of previous recommendations within several DHBs,” says Dr Belgrave.

“Auckland DHB has commissioned a mother baby unit and Counties is implementing recommendations from its external review.”

The PMMRC’s ninth annual report is available to download below.

The report recommendations include:

• As a matter of urgency, the Ministry of Health update the National Maternity Collection, including the ethnicity data as identified by the parents in the birth registration process.
• That all maternity care providers identify women with modifiable risk factors for perinatal related death and work individually and collectively to address these.
• Offer education to all clinicians so they are proficient at screening women, and are aware of local services and pathways to care, for the following:
• family violence
• smoking
• alcohol and other substance use.
• That multi-disciplinary fetal surveillance training be mandatory for all clinicians involved in intrapartum care.
• There is observational evidence that improved detection of fetal growth restriction, accompanied by timely delivery, reduces perinatal morbidity and mortality. The PMMRC recommends that assessment of fetal growth should incorporate a range of strategies.
• Seasonal or pandemic influenza vaccination is recommended for all pregnant women any time in pregnancy and for women planning to be pregnant during the influenza season.
• All pregnant women with epilepsy on medication should be referred to a physician.
• Widespread multidisciplinary education is required on the recognition of neonatal encephalopathy with a particular emphasis on babies with evidence of intrapartum asphyxia (eg, babies who required resuscitation) for all providers of care for babies in the immediate postpartum period.
• That all DHBs review local cases of neonatal encephalopathy.

Background

Each year, the Perinatal and Maternal Mortality Review Committee (PMMRC) releases a report on maternal and perinatal deaths. It advises the Health Quality & Safety Commission on how to reduce these deaths.

• A perinatal death is the death of a baby from 20 weeks gestation (pregnancy) up to 28 days after birth, or weighing a least 400g if gestation is unknown.
• A neonatal death is the death of a baby from live birth to 27 days of age.
• A stillbirth is a baby who dies in the womb and is born from 20 weeks of pregnancy without any signs of life.
• An antepartum death is a baby dying at any time before birth, without a known cause.
• A death associated with a spontaneous preterm birth is a baby born too early to survive.
• A maternal death is the death of a woman while pregnant or within 42 days of the end of pregnancy.

Download the Ninth PMMRC report questions & answers.

This report considers perinatal and maternal mortality and morbidity from 1 January to 31 December 2013; perinatal mortality from 2007 to 2013; maternal mortality from 2006 to 2013; severe and rare maternal disorders of pregnancy from 2010 to 2013; and babies with neonatal encephalopathy from 2010 to 2013.

Access to the full text of the report is free online at: http://www.hqsc.govt.nz/our-programmes/mrc/pmmrc/publications-and-resources/publication/2123/

Jonathan Coleman media release, 22 June 2015

Health Minister Jonathan Coleman has announced that Cancer Core, a group of students from the University of Otago, is the overall winner of the 2015 Minister of Health Volunteer Awards. 

“The health volunteer awards celebrate and recognise the thousands of dedicated health sector volunteers who give many hours of their time to help other New Zealanders,” says Dr Coleman.

“The judges were particularly impressed by the quality of this year’s entries. Well done to all those who were nominated and congratulations to those recognised as outstanding achievers.

“I would like to congratulate the overall winners Cancer Core. Their inaugural Relay for Life attracted more than 1,000 students and raised over $60,000 for the Cancer Society.”

Marking National Volunteer Week, Dr Coleman presented the Minister of Health Volunteer Awards in Parliament today.

Outstanding achievers were recognised across five categories – healthcare service provider, community or NGO, youth health, Māori and Pacific health, and long service.

A full list of recipients and categories can be found at: www.volunteerawards.health.govt.nz.

Dr Michael Gardam is physician director of Infection Prevention and Control Canada and the national lead of infection prevention and control collaboratives for Safer Healthcare Now! He is a pioneer of behavioural change approaches, including ‘positive deviance’ and ‘frontline ownership’ to improve patient safety.

This workshop precedes the Infection Prevention & Control Nurses College conference in Napier, 2–4 September 2015.

To find out more about this event, go to:  http://www.hqsc.govt.nz/our-programmes/infection-prevention-and-control/news-and-events/event/2205/

The project was associated with "... a 17% improvement in [National Emergency Access Target (NEAT)] performance with no evidence of an increase in clinical deterioration on inpatient wards and evidence for an improvement in hospital mortality".

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1111/1742-6723.12424 or contact your DHB library, or organisational or local library for assistance.

Dinh, M. M., Green, T. C., Bein, K. J., Lo, S., Jones, A. and Johnson, T. (2015). Emergency department clinical redesign, team-based care and improvements in hospital performance: A time series analysis. Emergency Medicine Australasia, 14 June [Epub before print]

To read the full story, go to:  http://www.hqsc.govt.nz/our-programmes/infection-prevention-and-control/news-and-events/news/2197/

They conclude that "... no single strategy is likely to improve the negative effect of interruptions without focus on patient safety. Practice education to improve team building interactions is required that equips nurses with the skills in managing interruptions and delegating high priority secondary tasks".

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1111/nicc.12185 or contact your DHB library, or organisational or local library for assistance.

Bower, R., Jackson, C. and Manning, J. C. (2015). Interruptions and medication administration in critical care. Nursing in Critical Care, 20: 183–195. 

A UK pharmaceutical company is using Auckland University of Technology (AUT) bioengineering research for a potential break-through therapy for cancer.  

Agalimmune, which develops anti-cancer therapies for the treatment of solid tumours, has licensed engineered-molecule technology developed by AUT’s Centre for KODE Technology Innovation. It will use the KODE molecules (the synthetic glycolipid variations), which can attract the immune system to destroy cancer cells, in its new cancer immunotherapy product. AUT Professor of Biotech Innovation Stephen Henry, within the Centre for KODE Technology Innovation in the School of Engineering, described the technology to the New Zealand Herald as a “biological paint” that could add virtually any biological or non-biological material to almost any living or synthetic surface in just a few minutes. This includes cells, viruses, bugs and tumour cellss and solid surfaces such as glass, plastic, metals etc. 

Agalimmune has exclusive rights to use KODE’s molecules in the field of injection of tumours for cancer treatment. The KODE molecules will be used to label or modify the outside of cancerous tumours making them a target of the body’s immune system. In the process of destroying the tumour, the immune system will be educated to recognise and destroy other unmodified primary and secondary tumours. (see www.youtube.com/watch?v=pIiWgQRa66o for a video explanation). Working together, the two technologies have been shown to be effective for treatment of both primary and secondary tumours in animal models. 

Under the licence, KODE Biotech (an AUT spin out which has commercialised the technology) will receive up to $44 million in development and sales milestone payments, plus potentially 10’s of millions in annual royalties. 

Agalimmune director Graham Griffiths says, “We believe that this technology has great value in immunotherapy, and we are very pleased to be collaborating with a world-leader in the development of synthetic glycolipids. This licensing agreement also represents a significant step forward in Agalimmune’s progress towards the development of pioneering targeted cancer vaccines and immunotherapies for the benefit of patients.”

Professor Henry says, “We are delighted that Agalimmune has identified the potential of KODE™ Technology for this application, and we look forward to seeing the results of the next phase of development of the therapeutic.” 

 Also see http://www.nzherald.co.nz/science/news/article.cfm?c_id=82&objectid=11466262 for an interview by Jamie Morton from the New Zealand Herald.  

Medsafe says New Zealanders who choose to buy medicines online from overseas are continuing to run risks from substandard, illegal, or counterfeit medicines.

The authority has again been part of a joint local and international operation with Customs on such items crossing the border.

Medsafe Manager of Compliance Management, Derek Fitzgerald, says medicines purchased online are risky because quality, safety and effectiveness can’t be guaranteed.

Medsafe and Customs participated in the week-long Operation PANGEA VIII International Internet Week of Action led by INTERPOL (June 9-16) which feeds data from the ongoing New Zealand border control programme into the worldwide effort aimed at detecting illegal trade in medicines.  Operation PANGEA seeks to disrupt criminal networks trading in illicit, counterfeit and poor quality medicines through working with international and national enforcement bodies and with internet and payment system providers. This is the eighth time New Zealand authorities have participated.

Customs targets all incoming international mail suspected to contain medicines, and thousands of interceptions are referred to Medsafe each year.  

As a result of Operation PANGEA VIII, 181 packages were held requiring further investigation, 67 less than the number investigated last year 248.

These parcels originated from 29 different countries around the world (32 last year) and were stopped because they contained prescription medicines, weren’t labelled or were known to contain undeclared or hidden ingredients.  The most common sources of these products were India (103), United States (24) and China (20).

Mr Fitzgerald says medicines for the treatment of erectile dysfunction were the most prevalent products examined by Medsafe (amounting to 3412 individual tablets). Medicines for insomnia, treatment of infections, mental health and pain were the next most prevalent. Only four parcels contained a counterfeit or fake product (medicines for the treatment of erectile dysfunction) – two more than last year.

Medsafe strongly encourages anyone intending to buy prescription medicines via the internet to consult their doctor who can advise on potential side effects, interactions with other medicines and appropriate dosage.

“Prescription medicines are potent substances and as such should only be used following a consultation with a doctor.”

“Consumers considering buying any type of medicine over the internet should be aware that, even though a website may appear to be legitimate, appear to be established in a well-regulated country and appears to be offering well-known medicines, these impressions may not be true.” according to Mr Fitzgerald.

Prescription medicines are referred to Medsafe by Customs to ensure compliance with New Zealand law.  Most prescription medicines Medsafe detains are held until the person importing them provides a valid doctor’s prescription - if this does not occur they are destroyed.  

Three Dennis Pickup Clinical Educator Awards and five Butland Teaching Excellence awards were presented at a ceremony in the Faculty of Medical and Health Sciences this week.

The Dennis Pickup Clinical Educator Awards are made to clinical teachers who are judged by staff and students to have made an outstanding contribution to medical, nursing, optometry or pharmacy education.

“This is by virtue of their qualities as role models in clinical practice and their contribution to the relationship between the health professions and the Faculty of Medical and Health Sciences,” said Deputy Dean, Distinguished Professor, Ian Reid.

“These awards recognise clinicians and practitioners who give their time to assist in the education of health professionals,” he said.

Dennis Pickup is a previous CEO of Auckland City Hospital, and in that role he played a crucial part in establishing the enduring partnership between the University of Auckland and the hospital.  These awards were presented by Dennis Pickup.

Professional Teaching Fellow and GP, Dr Chris Wong from the Department of General Practice and Primary Healthcare at the School of Population Health was awarded the Dennis Pickup Award for his contribution to general practice in the medical programme.

“Dr Chris Wong is a GP in West Auckland and is employed to teach medical students one day a week,” said Director of the Teaching Programme, Associate Professor Warwick Bagg. “The contribution he makes to general practice in the medical programme is immense.”

Dr Wong co-ordinates and teaches in the Year 4 General Practice Observed Patient Simulations for a full week, six times a year, and in 2014 redesigned the week and arranged for it to be delivered in Hamilton .

He is actively involved in all aspects of the general practice teaching, including facilitating Year 5 and Year 6 symposium days, marking written assignments from them as well as Year 2 assignments. He attends team meetings; contributes to protocols and visits practices to accredit them as community-based teaching sites.

He has also contributed to the medical programme by assessing clinical scenarios and progress test questions for general practice relevance, interviewing candidates for medical school admission and assisting with the inaugural Year 5 Clinical Skills Assessment examination.

“Chris is an excellent clinician who serves as a wonderful role model to inspire students to consider general practice as a career option,” said Dr Bagg.  “As a GP working four days in clinical practice, he brings a grassroots general practice perspective to his teaching and serves as a great bridge between clinical practice and academia.”

“He is an extremely innovative teacher,” he said. “His involvement in so many aspects of the curriculum means his input has a huge impact on student learning. The passion and time he gives to so many components of general practice teaching far exceeds the expectations for someone employed on this basis and is very deserving of a clinical educator award.”

Clinical Director of the Paediatric Service in Rotorua for Lakes DHB, Dr Stephen Bradley, also received a Dennis Pickup award that acknowledged his sustained and wide ranging contribution to the medical programme.

“Dr Bradley is an Honorary Clinical Senior Lecturer in the Department of Paediatrics: Child and Youth Health and has demonstrated his commitment to undergraduate and postgraduate education throughout his career as a consultant paediatrician at Lakes DHB,” said Dr Bagg.

Dr Bradley now holds a Postgraduate Diploma in Clinical Education and is currently undertaking his Masters in Clinical Education. He is an instructor for the Advanced Paediatric Life Support.

“Steve has, for many years, played a key role in the ongoing development of Rotorua as a teaching site for undergraduate students,” said Dr Bagg.  “He is held in high esteem by his colleagues in New Zealand, but carries that prestige with great humility.   He is a very hard worker and has actively engaged in reinvigoration of our curriculum.”

Dr Bradley’s active participation in the changes within the paediatrics discipline was highly valued, he said.

“He draws on a wealth of experience and understanding of educational principles in his teaching and is a highly regarded teacher, said Dr Bagg.

In 2012 his team received two teaching awards; 'The Lakes DHB Clinical Teaching Award, and Rotorua Paediatrics the 'Most Supportive Clinical Team'   (voted by students of MBChB 5 class).

“That year Steve himself received a 'Distinguished Clinical Teacher Award' from the School of Medicine.  In 2014 he volunteered to be filmed for the crucial Mini CEX calibration videos, a role few other academics would put their hands up for. This is a further illustration of how Steve is a wonderful role model to other academics, clinical teachers and students,” he said.

The final Dennis Pickup Award recipient for 2015 was the Director of Nursing at Waikato District Health Board, Sue Hayward for her extraordinary leadership in nursing education and she was introduced by the acting Head of the School of Nursing, Associate Professor Nici Sheridan.

“Sue is a Registered Nurse with a Postgraduate Diploma in Health Management and Masters in Health Sciences who has, since 2008, been the Director of Nursing and Midwifery at the Waikato District Health Board.  She is also the executive sponsor of the Bachelor of Nursing Honours programme within the DHB.”

In 2013, Waikato DHB, recognising the need to focus on investing in our future nursing leaders, started working with the University of Auckland on a programme that would allow newly graduated nurses to not only complete an Honours degree, but also participate in a high level supervision and mentoring programme.  

“This programme has, from day one benefitted from Sue’s exceptional oversight,” said Dr Sheridan. “There is no doubt that the programme would not have been possible without her guidance, commitment and sponsorship.”

“To redirect education funds away from experienced nurses to new graduates was a brave call and one which she undertook willingly. Sue continues to provide one-on-one and group sessions with the students and is heavily involved in the development and selection of their research topics.”

“For many years Sue has been very active in nursing education across the DHB particularly in relation to leadership and clinical nursing practice,” she said.  “Sue’s interaction with the University and this programme in particular, has led to the programme being seen as a Waikato DHB initiative.”

Professor Reid introduced the Butland Awards with some background to the history of the award.

In 1964, four years before our first medical class started at the University of Auckland, the University received an endowment of 40,000 pounds from food manufacturer and philanthropist, Sir Jack Richard Butland.

The aim of this endowment was to establish a Medical Foundation to advance medicine on a broad spectrum within New Zealand and in a specific sense to ensure the planned medical school had the best teaching talent it could attract.

Jack Butland was a self-made millionaire who developed the iconic Chesdale brand and pioneered the small packaging and retailing of dairy products in New Zealand.  Jack Butland was a leading public benefactor of his day and in today’s terms his endowment would be the equivalent of many millions of dollars.

“This evening we acknowledge those who have been identified as providing exemplary teaching and support to their students within the Faculty of Medical and Health Sciences with the Butland Teaching Excellence Awards, said Professor Reid.

The 2015 Butland Award for Early Career Excellence in Teaching was made to Dr Max Petrov from the School of Medicine and recognized his teaching excellence and innovation in the Faculty.  These awards were attended by Debbie and Grant Cathrow from the Butland Family and made by Trustee Dr Jock Carnachan.

“Max joined the Department of Surgery in 2011 as a Senior Lecturer and since his appointment he has been an enthusiastic and willing participant in a wide range of activities within the Department,” said Professor Reid.

“Despite a relatively short period of teaching, Max has achieved record of excellence in teaching, research supervision, and leadership.  His innovative approaches to inducting PhD students caught the attention of the awards committee.”

“Soon after his appointment, he proposed the introduction of a research induction seminar for new PhD and Masters Students in the Department of Surgery,” he said. “Max was given responsibility for developing and introducing this course and it has grown over the last three years, rapidly becoming a whole School of Medicine programme that continues to grow in numbers and in the maturity of content.  The programme has received excellent reviews from attendees.”

This year Dr Petrov brought in further innovation with the introduction of the Science Café, where postgraduate students can develop relationships with more senior researchers in the Faculty. More than 40 students attend not only from the School of Medicine, but also from Liggins and the Schools of Medical Sciences, Population Health, and Nursing. The initiative has been an outstanding success.

“Max is deeply committed to postgraduate and undergraduate supervision,” said Professor Reid. “In just over three years since he was appointed he has supervised or is supervising more than 10 PhD, Masters, and Honours students.”

“ His skill in this endeavour is already evident with several high quality publications from his students and many winning awards for their endeavours. Four out of the five of his Masters and Honours students have graduated with First Class Honours,” he said.  “ Max has shown that he teaches to an excellent standard and he has shown huge promise as an emerging leader within the School of Medicine.  He is a worthy recipient of this 2015 award.”

The Butland Award for Excellence in Teaching Innovation was awarded to Senior Lecturer, Dr Phillipa Malpas from the School of Medicine.

“Phillipa has made an outstanding contribution to the innovative teaching of ethics to our medical students following her appointment to the Department of Psychological Medicine,” said Professor Reid.  “Phillipa has innovated through curriculum and assessment development to achieve truly novel teaching and course design in the areas of ethics and medical humanities.”

“Her approach to teaching ethics engages medical student's right from the early years, capturing their curiosity and excitement about the ethical dimension of medicine,” he said.  “Content draws on clinicians' experiences and knowledge, case studies, student's own experiences, and topical issues within society.”  “Recognising that ethical thinking can be confounding for many students, she has developed an innovative ethical 'toolkit' to help students reason their way through ethical and medico-legal challenges.”

Building on the early teaching in the medical programme Phillipa turned her attention to the year five curriculum and developed an "Ethics Report” that is completed by senior students.  In the report students are encouraged to reflect critically on ethical aspects arising from their clinical experiences.  

“The feedback from students demonstrates how profoundly doing this work affects many of them,” said Dr Reid. “Phillipa has taken students’ work in these reports an important step further.  She recognized a number of common themes emerging in student writing, in particular in the broad area of consent.”

“This led Phillipa to work with a range of stakeholders including chief medical officers, the Health and Disability commissioner, medical student groups and her colleagues in Auckland and Otago to develop a national consensus document on medical students and informed consent – the first such document in the world.”

“The novelty and reach of Phillipa’s innovations make her a very worthy recipient of this award,” said Professor Reid.

The Butland Award for Excellence in Research Supervision recognises and rewards a long-term, consistent or broad contribution to research supervision at the Faculty, and this year went to Professor Paul Donaldson from the School of Medical Sciences.

“Through his excellent supervisory practices Paul has played a significant and influential role in shaping the careers of many emerging scientists,” said Professor Reid.  “Paul has directed a large, successful research group based at FMHS since 1996 when he was appointed to the Department of Physiology.”

“Over the 19 years since then he has enjoyed many successes, attributable to his forward-thinking approach to research, and his ability to build and maintain a strong research group,” he said.  “He has been able to maintain this research group in part due to the excellence of his supervision and mentorship. It is a hallmark of Paul’s research group that several of his students have worked with him over extended periods of time.”

The awards panel was impressed by the ‘joined up’ strategic thinking that underpins Paul’s recruitment and development of future research students.  From his earliest interactions with undergraduates, summer students and the like Professor Donaldson fosters strong, positive relationships, welcoming and encouraging new members of the group to become ‘part of the team’, recognising and celebrating their achievements and successes.

“Paul learns about his students and tailors his supervision to get the best out of each of them,” said Professor Reid.  “Like winners of this award in the past, Paul always has the student’s career development at the forefront of his supervision style and provides networking and conference opportunities to all his lab members, including students.”

“Paul’s approach ensures that research students work in an inclusive lab environment of fun, friendship and research excellence,” he said.  “He is an inspirational teacher to his students, a role model to younger scientists and a natural leader. The positive impact he has had on many students over the years, both personally and professionally make him a worthy recipient of this award,”

Associate Professor Mark Barrow, said the Butland Award for Sustained Teaching Excellence recognizes and rewards a long term, consistent or broad contribution to teaching excellence in the Faculty.

“This year two nominations exemplified the excellence we seek,” said Associate Professor Peter Barrow.  “After a lot of deliberation the panel approached the Dean who agreed that two awards be made and I’m sure you will agree that both are well deserved.”

The first Butland Award for Sustained Teaching Excellence went to Peter Riordan from the School of Medical Sciences.

“Peter was appointed in 2000 to help support the growth in Biomedical Science teaching,” said Dr Barrow. “He arrived with an outstanding command of IT technologies and this expertise (alongside a broad portfolio of skills) has been a major contributor to the success of the very large classes that are a feature of Medical Science teaching.”

“Managing student numbers in the thousands is a real art as one needs to make sure that the students not only have all the information they need, but that they still feel important as individuals and can approach their lecturers. Peter achieves this with ease.”

“In 2005 Peter stepped up and took on additional teaching for both MEDSCI 201 students and Year II MBChB student”, he said. “It was in this role that Peter really stood out as a superb teacher - it was as if ‘he had found his true calling’”

“Since that time Peter has expanded and advanced his teaching and involvement in gross anatomy and when the opportunity arose, he took on the role of Laboratory Manager of the Human Anatomy Laboratory and has overseen the entire refurbishment of this unique and highly specialised facility.”

“The panel was impressed by Peter’s humble approach, deriving satisfaction from working alongside students to enhance their learning, providing additional assistance and opportunities for further learning wherever he can.  His students value Peter highly, and this shone through in the nomination,” said Dr Barrow.

The second Sustained Teaching Excellence Award was made to Associate Professor Warwick Bagg.

“Since his appointment in 2000 Warwick has been a leader in the development and delivery of the medical programme; his contribution to teaching has been sustained, consistent and broad,” said Dr Barrow. “Warwick stepped up quickly from the core teaching role to lead the Year six Medicine attachment, then Phase three as a whole.”

“During this time Warwick led the development of the Year Five Pūkawakawa programme,” he said. “Despite time-pressured development, this programme has run like clockwork from the start and has become an exemplar for immersion programmes in Australasia, with tangible workforce benefits.”

“We all know Warwick as the Head of the Medical Programme.  His exemplary leadership of the programme, through a recent period of redevelopment is recognised here.  Of Warwick’s multiple roles in the reinvigoration of the MBChB, perhaps the most outstanding example of his leadership was the introduction of Progress Testing.”

“This was a radical idea for Auckland and Auckland is the first programme in Australasia to use it,” said Dr Barrow. “Warwick steered the introduction with considerable patience and persistence working to gain acceptance by staff and students drawing on the experience of other institutions and the evidence in the literature to assist him.”

“Despite his role as Head of the Medical Programme Warwick continues to lecture the fourth and fifth year medical students, supervises senior medical students, and does ‘beside tutorials’ with medical students completing clinical attachments at Auckland City Hospital,” he said.  “He shows a genuine interest and curiosity in his students’ approach to learning and in the development of every individual medical student.”

“Warwick is seen by his students as excellent and empathetic teacher, communicator, mediator, and by the staff in the programme as an inspirational leader of change,” said Dr Barrow.

They conclude from their analysis that "in the USA, patients who are readmitted to hospital after various major operations consistently achieve improved survival if they return to the hospital where their surgery took place. These findings might have important implications for cost-effectiveness-driven regional centralisation of surgical care".

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1016/S0140-6736(15)60087-3 or contact your DHB library, or organisational or local library for assistance.

Brooke, B.S., et al. (2015). Readmission destination and risk of mortality after major surgery: An observational cohort study. The Lancet, 17 June [Epub before print]

Studies in this issue (attached below):

Healing Our Spirit Worldwide, the Seventh Gathering will provide the forum to:

• Share initiatives, programmes and solutions
• Connect and learn from other each other as indigenous people
• Share strengths, hope and wisdom
• Celebrate and express cultural practices, keeping alive the cultural and spiritual foundation of indigenous people.

To find out more about this event, go to:  http://hosw.com/

Reaching the community in new ways with comprehensive health and wellness advice, support and information.

Homecare Medical – a leading New Zealand tele-triage organisation - has been announced as the Ministry of Health’s partner to develop and deliver a new, enhanced, integrated, national telehealth service for New Zealand. The national telehealth service will see clinical and non-clinical staff provide phone and online advice, support, assessment of symptoms, triage, treatment advice, and preventative and educational aspects for a range of health, wellbeing and counselling services. Initial services available will be a health advice and triage service, quit smoking services, poisons advice, alcohol and drug advice, immunisation and vaccination advice, depression advice and services, and gambling advice and services.

Homecare Medical Board Chair Dr Martin Seers said today “People expect to get help and advice through a variety of channels, they expect to be able to talk to a ‘real’ person and they expect a joined up system that ‘knows’ them.” 

Dr Seers explained “We will work to deliver a service that can be accessed through multiple channels 24 x 7 – phone, websites, email, txt message, chat, and in the future, video calling and mobile applications. This will be a service where every door is the right door – where users’ needs are met directly, or by linking them to the appropriate service - their GP, nurse,   pharmacist, a midwife, paramedics, a counsellor or therapist.”

The service aims to provide accessible, people-centred, flexible and adaptable quality health and counselling services, where the individual who takes the call is responsible for ensuring the caller gets the help or advice they need. Key to this is that the service is integrated with local and regional services and that users get a consistent service no matter where or how they make contact, and where each caller should only have to tell their story once.

The benefits will be better care outcomes for New Zealanders, a reduction in acute and unplanned care - reducing emergency department admissions and pressure on ambulance services - improved health and wellness support for users, improved health literacy, more care delivered close to home, more self-management, and getting the right advice from well trained staff.

“While the current health and wellness phone advice lines work well and we’re starting from a strong base, there is an opportunity for them to be more connected and to significantly enhance the services currently offered. We will integrate with them and collaborate with other service providers over time. We are thrilled to have this once in a generation opportunity to fundamentally change the health services and agencies approach to health and wellness in New Zealand to meet growing demand, consumer expectations and the need for sustainable healthcare.”

From 1 November 2015 the following services will make up the 24 x 7, free national telehealth service:- 

Health triage and advice

• Homecare Medical will deliver the Healthline service, with experienced registered nurses providing high quality health advice. 

Poisons advice

• The National Poisons Centre will continue to provide a service to clinicians and the public; Homecare Medical will integrate and partner with the Poisons Centre to give the national telehealth service triage nurses access to elements of their extensive database. 
• The University of Otago have been involved in designing our approach. 

Quit smoking services

• Using suitably qualified and experienced staff, Homecare Medical will be responsible for delivering virtual smoking cessation support. We are delighted that throughout the procurement process we have built a constructive relationship with the Quit Group Trust who have agreed to support us during the transition period to 1 November. 

Alcohol and drug advice

• Homecare Medical, using highly experienced staff will deliver the Alcohol Drug Helpline services. We will continue to work very closely with Alcohol Drug Association New Zealand (ADANZ) who currently deliver this service. 

Immunisation and vaccination advice

• The Immunisation Advisory Centre (IMAC) team will train Homecare Medical nurses to provide advice to the public; IMAC will continue to provide clinical advice to GPs and hospital staff and support our nurses when required. 

Depression advice and services

• This will be provided by a well-resourced team with a thorough and deep understanding of mental health and depression.

Gambling advice and services

•  We will have leading New Zealand mental health and addiction specialists providing this service. 

No phone numbers or contact details that users access will change at this stage. 

The current services manage around 2 million calls per year.

In addition, Homecare Medical is working with Plunket to jointly manage calls to PlunketLine that are currently referred to Healthline, and with St John on extending the advice for non-urgent, not life threatening 111 calls for ambulance currently provided in Auckland by Homecare Medical nurses. 

Dr Seers explained “Our commitment has always been to innovate, create and deliver services that are focussed on giving all New Zealanders the best possible chance to live well. In developing our telehealth vision and designing the national telehealth service we worked closely with current service providers, with consumer organisations, nurses, pharmacists, doctors, counsellors and others to inform our proposal and our idea of the best ‘design’ for a national telehealth service. We kept focussed on developing better, easier ways of getting health and wellness support for the mum with an asthmatic child, for the middle aged overweight man who is depressed and struggling to monitor his diabetes, for the gen x smoker who needs help quitting. We named them and we built our models with them at the centre.”

“For them, the benefits of a new national telehealth service will be a pathway to the right information, care or service they need, whenever and wherever they need it.  And for their general practice team, the national telehealth service means additional, integrated support for their patients and better continuity of care. For DHBs it will mean fewer emergency department admissions.”

“This isn’t an exercise driven by costs – this is an initiative focussed on reaching the community in new ways with comprehensive health and wellness advice, support and information.”

Homecare Medical (formerly HML) is a New Zealand-owned healthcare organisation currently providing 24 x 7 telehealth services, including nurse-based teleconsults, care coordination, telephone-based screening and in and out of hours general practice support.

Health Minister Jonathan Coleman has announced that Homecare Medical is the preferred provider for the new national telehealth service.

New Zealand currently has multiple individual telehealth services that handle around two million calls a year. Some of these services are not available 24/7.

“In 2011 we committed to roll out a comprehensive telehealth advice service with access to nurses, GPs and pharmacists,” says Dr Coleman.

“The free national telehealth service will be available 24 hours a day, seven days a week. It will provide the public with better access to high quality consistent health advice across the country.

“The public can still contact services using current phone numbers. Behind the scenes, the new national service will be more seamless and ensure people access the right advice, at the right time, no matter where they live.

“The national telehealth service will also help encourage patients to use community based services and to self-care. This will help reduce the pressure on after-hours primary care and hospital emergency departments.”

Final contract negotiations are underway with Homecare Medical which is a partnership between Pegasus Health and ProCare Health. The service will go live on 1 November 2015. It will be delivered within current Ministry of Health funding.

It will integrate Healthline, Poisonline, Quitline, Gambing Helpline, Alcohol and Drug Helpline, the National Depression Initiative, and immunisation advice for the public. 111 calls and PlunketLine will not be affected.

The Ministry of Health will work closely with providers to ensure a smooth transition.

In 2007 Te Omanga Hospice in conjunction with several Hutt Valley aged-care providers created the ‘Changing Minds’ biannual seminar to disseminate the principles of positive end-of-life care. The seminars aim to stimulate discussion around challenges faced by those working in the field of gerontology and palliative care to bring about significant and positive change.

To find out more about this event, go to:  http://www.teomanga.org.nz/Article.aspx?ID=445  

Mobile phone calls to 111 will be quicker and safer in future with the development of a new app, Communications Minister Amy Adams has announced.

“Creating this new app will allow Emergency Services to better respond to New Zealanders in need of urgent help. The app, to be developed by mid-2016, will automatically provide caller location information to emergency services. This will help save lives and reduce damage and theft of property,” says Ms Adams.

Each year, there are more than 1.3 million genuine calls to 111 emergency services. In 2014, 73 per cent of all calls to 111 were made from a mobile phone. 

“Emergency services sometimes have difficulty pinpointing the caller’s exact location. People can’t always give an accurate address in an emergency – they may not know exactly where they are or are somehow prevented from providing details,” says Ms Adams.

The ability for Emergency Services to receive more accurate locations of callers was recommended by Coroner Ian Smith in response to the death of Jason Roach, who died in December 2010 after calling Police, who could not locate him.

“Mobile callers who download the app and use it to dial 111 can also connect directly to the emergency service they require, rather than going through an initial transfer process to fire, police or ambulance,” says Ms Adams.

“Emergency Services will be able to respond more quickly to these calls, plus they will have accurate information about the caller’s location.

“Industry and software developers are being invited to respond to the RFP and help us develop technical solutions for the new emergency response system.

“I have decided to adopt a new procurement approach under which two entities will be chosen to work with Government through a competitive proof of concept stage to show how their version of the ERS would work.

“This process is supported by the IT industry and is expected to allow for suppliers to be more innovative in designing a solution that meets the needs of emergency service providers,” Ms Adams says.

The new app will also have the ability to distribute information to the public, based on their geographical location, such as in the wake of natural disasters. This public alert information will be available to those who choose it on an opt-in basis.

The new app will be free for users to download.  The overall cost of the new emergency response system will be met through the Telecommunications Development Levy, which is paid by telecommunications service providers. 

The project to develop the new system will be jointly led by the Ministry of Business, Innovation and Employment and Police, and procurement is expected to get underway by the end of the month.

The Sorting things out: Preventing or resolving problems, and making complaints leaflet is available to download in full text at: http://www.hdc.org.nz/publications/other-publications-from-hdc/disability-resources/sorting-things-out-preventing-or-resolving-problems,-and-making-complaints

The Know Your Rights resources have been produced by the Health and Disability Commissioner and Enabling Good Lives Christchurch for people who manage their own disability support funding and who receive support from personal assistants or support workers in their own home.

The Personal Space: Support workers in your home leaflet is available to download in full text at: http://www.hdc.org.nz/publications/other-publications-from-hdc/disability-resources/personal-space-support-workers-in-your-home

The Starting off right: Setting up a good relationship with your support workers leaflet is available to download in full text at: http://www.hdc.org.nz/publications/other-publications-from-hdc/disability-resources/starting-off-right-setting-up-a-good-relationship-with-your-support-workers

Fifty-eight studies were included, which addressed a wide array of health outcomes and risk behaviors. The review examined the effects of four types of strategies or interventions: community system-level change strategies; broad health and social care system-level strategies; interventions using lay community health outreach workers or group-based health education led by professional staff; and group-based health education.

The authors found that "... interventions led by community coalitions may connect health and human service providers with ethnic and racial minority communities in ways that benefit individual health outcomes and behaviors, as well as care delivery systems". However, they go on to say that "... because information on characteristics of the coalitions themselves is insufficient, evidence does not provide an explanation for the underlying mechanisms of beneficial effects".

This article is available to read in free full text at:  http://dx.doi.org/10.1002/14651858.CD009905.pub2

Anderson LM, Adeney KL, Shinn C, Safranek S, Buckner-Brown J, Krause LK. (2015). Community coalition-driven interventions to reduce health disparities among racial and ethnic minority populations. Cochrane Database of Systematic Reviews, 6, CD009905.

A new set of online resources will help carers look after their own needs, make time for themselves and stay connected, Senior Citizens Minister Maggie Barry says.

Around one in ten New Zealanders helps a family member or friend with everyday life, and many find it hard to balance that important role with work or their other commitments.

“Being a carer can be immensely rewarding, but it can also take a heavy physical, mental and financial toll,” Ms Barry says. “It is vital they are able to get the free time they need to look after their own health and happiness.”

The new resources, including three online programmes, have been developed by the Ministry of Social Development and Carers New Zealand.

“Time Out is a guide to help carers have breaks, encouraging them to plan ahead so they get the essential time they need to focus on their own wellbeing,” Ms Barry says.

Work and Care, developed with help from Business New Zealand and the New Zealand Council of Trade Unions, gives workers and employers information about how to balance jobs with care.

“Carers should also be able to work if they want to – and employers can learn more about how they can help through Work and Care.”

Other resources being launched today include a Facebook page for young carers, a series of online seminars and MeetUps, a toolkit which helps people set up get-togethers and social opportunities.

The launch of the resources coincides with the 10th anniversary of the Carer’s Alliance, a consortium of 45 not for profit organisations that supports and advocates for carers.

All the resources are available now on the new carers’ website: www.carers.net.nz.

The Commission invites patients and interested health professionals to give feedback on the draft survey by 24 June 2015. All feedback is anonymous.

To find out more, go to:  http://www.hqsc.govt.nz/news-and-events/news/2196/

With support from Genesis Oncology Trust, Hospice NZ are presenting a Palliative Care lecture series in 2015. This education opportunity is designed for healthcare professionals with an interest in palliative care.

To find out more about this event, go to:  http://arganzmeeting.com/

To find out more about this event, go to:  http://www.legalmedicine.com.au/wp-content/uploads/2014/09/2015-ASM-Flyer1.pdf

To find out more about this event, go to:  http://www.cosa2015.org/

A ‘one size fits all’ approach to healthcare is being called into question by a researcher at Victoria University of Wellington, who says the immune systems of Māori and Pasifika people are very different from those with European ancestry.

Molecular geneticist Dr Geoff Chambers, who is an alumnus researcher at Victoria’s School of Biological Sciences, says the findings are the latest to come out of a research project that has so far spanned 25 years.

Dr Chambers’ earlier investigations identified genetic markers that traced the origin of Austronesian people (Polynesian, Māori, Melanesian, Micronesian and people from parts of South East Asia) back to Taiwan. His work also used molecular methods for forensic identification and as indicators for a range of diseases, including alcoholism and diabetes.

New data from his ongoing research shows that Māori and Pasifika people are genetically distinct from Europeans. “It goes some way to explaining why some autoimmune diseases that are relatively common in people of European descent—such as multiple sclerosis—are virtually unheard of among Māori and Pasifika,” says Dr Chambers. “It also partly explains why diseases such as type-2 diabetes are more common in Māori or Pasifika people.”

Dr Chambers says the findings highlight an existing inequity in medical treatment. “Medicine today is an increasingly genetic field of knowledge,” he says. “Many new drugs have been developed by Europeans for Europeans, but if we are to deliver these advances effectively to Māori and Pasifika people then we need new information, which we must uncover ourselves. This requires knowing something about their genetic make-up.”

Dr Chambers says the research has implications for the public health system. “It’s really important for organisations like the bone marrow registry to know that the immune system markers are different, in order to increase the number of matched donors and help improve the outcome of transplants.

“The important underlying message is that the research demonstrates very clearly that genes which are important in medical genetics have a whole different repertoire in Māori and Pasifika people than they do in Europeans—we need to take account of that to ensure we have equity in medicine.”

Dr Chambers has recently been reporting back on his findings directly to Māori and Pasifika groups so that the information can be shared throughout the communities, and as a gesture of gratitude towards the original volunteer participants.

Women with near-fatal illnesses during pregnancy have been leaving New Zealand hospitals without the contraception that could prevent future serious harm to their health, a study by University of Otago, Wellington, has found.

Study author Dr Jane MacDonald, a senior research fellow with Women’s Health Research Centre, Department of Primary Care, says a retrospective audit of the medical notes of 98 women who had experienced severe acute maternal morbidity (SAMM) showed that a high number, nearly 86% (84), were discharged from hospital without a prescription for contraception. Failure to ensure these women had contraception before they left hospital was termed “substandard care.”

Of the 14 women who did have contraception documented on discharge from hospital, seven had received procedures that meant they could not become pregnant again, one had been given a contraceptive implant, one woman’s partner had a vasectomy booked, and another five had condom prescriptions.

The study, just published in Contraception, an international peer reviewed journal, focused on women with SAMM that were admitted to four New Zealand District Health Boards during a 17-month period between 2011 and 2012.

Medical emergencies that affected these women included severe haemorrhage, toxemia of pregnancy, heart disease, ectopic pregnancy, and severe infection. They all needed one to one nursing, and were admitted to high-dependency units or intensive care.

“The cases I looked at had experienced severe illness and needed time to recover from illness/operations as well as the pregnancy itself, and also had a new baby who might also be unwell, or premature – or they had a stillbirth to come to terms with,” she says.

“Any unplanned pregnancy can be stressful, but presumably more so if you are recovering from major illness, an operation, serious infection, or anaemia. In these circumstances, having another unplanned pregnancy means the woman may be more likely to suffer illness again, such as in post-partum haemorrhage cases, or she faces having to choose a termination, and if proceeding with the pregnancy, may die. In certain circumstances where women have pre-existing severe medical conditions, long-acting appropriate contraception could be life-saving,” she says.

Often hospital clinicians believed that the midwife or GP should deal with contraception in the six weeks after delivery. However, the researchers recommend that women should have the option of contraception before they are discharged from hospital.

“Mothers will frequently put their own priorities such as contraception to the bottom of the list and just do not manage to get to their GP.

“It is not adequate medical care to tell these women as they leave hospital that they should not get pregnant. You have to be able to give them the advice and the actual contraception – make it easy for them - and if you don't know what they need you should refer quickly to someone who can,” says Dr MacDonald.

She warns that in developing countries, previous research has found that women are more likely to die if they have a SAMM event and then conceive again too quickly.

“There appears to be a perception that women will not have sex again for a time after pregnancy. For some that is true but for many they want to get back to normal sexual activity,” she says. 

Dr MacDonald adds that all women who have had a pregnancy should at least be offered contraceptive advice. The WHO state that all women should have at least 18 months between babies to ensure best health for them and their babies.

She adds that there is some evidence that in fact a large percentage of women do not get contraception post-partum. One study in New Zealand showed that only 25% of young women who presented for a termination within 6 months of having a baby had contraception prescribed for them in the 6 weeks after having their baby.

“Of course it is their choice - they don’t have to have contraception. But these women should have the choice and at the moment they often don’t seem to have that.”

The outstanding contributions of five up-and-coming University of Otago academics have been recognised through Early Career Awards for Distinction in Research.

Dr Anitra Carr (Pathology, Christchurch), Dr Jörg Hennig (Mathematics & Statistics), Dr Karl Iremonger (Physiology), Dr Sheri Johnson (Zoology) and Dr Logan Walker (Pathology, Christchurch) have been selected for the award on the basis of their outstanding research achievements.

Their research spans diverse topics including the role of micronutrients in human health and disease, the field of general relativity, the effect of chronic stress on the brain, genetic and environmental effects on behaviour and reproduction, and genetic factors underlying breast cancer.

Announcing this year’s recipients, University of Otago Deputy Vice-Chancellor (Research & Enterprise) Professor Richard Blaikie warmly congratulated the five researchers, saying their impressive records are a reflection of the calibre of research being undertaken at Otago.

“Even at this early stage in their careers, these accomplished researchers are making remarkable contributions in their respective fields and within the University. Such achievements mean they are well positioned to be among Otago’s future research leaders,” Professor Blaikie says.

The Early Career Awards for Distinction in Research were introduced in 2004 to recognise and nurture the University’s most promising early career researchers. Each recipient will receive $5000 to support their research and scholarly development.

Recipients also become members of the University’s O-Zone Group of early-to-mid-career researchers. O-Zone undertakes activities to promote interdisciplinary thinking and collaborations and to present a positive, clear, innovative, and independent voice for research within the University and beyond.

About the recipients:

Dr Anitra Carr

Dr Anitra Carr

Dr Anitra Carr is a Senior Research Fellow and Centre Co-ordinator for the Centre for Free Radical Research, Department of Pathology, University of Otago, Christchurch. After completing her PhD at the Christchurch School of Medicine, Dr Carr obtained an American Heart Association Postdoctoral Fellowship which she undertook at the Linus Pauling Institute, Oregon State University, USA. Her research focused on oxidative stress, antioxidants and cardiovascular disease, and resulted in a number of high-impact publications in the field. Dr Carr’s work in the USA contributed to the recommended daily intake for vitamin C being increased and thus has had an impact on public health policy.

Since returning to the University of Otago, Christchurch, Dr Carr has managed a number of human intervention studies investigating the bioavailability and potential health effects of vitamin C. Dr Carr is currently researching the role of vitamin C in acute and chronic disease, such as cancer, and recently obtained a Freemasons Carrell-Espiner Research Fellowship to begin research into the role of vitamin C in severe infection and sepsis, the major cause of mortality in critically ill patients. Dr Carr hopes that her research will have a direct impact on people’s health and lives.

Dr Jörg Hennig

Dr Jörg Hennig

Dr Jörg Hennig is a lecturer at the Department of Mathematics and Statistics where his research in applied mathematics and mathematical physics focuses on general relativity, i.e. Albert Einstein's theory of gravitation. Dr Hennig was appointed in 2011 after completing a post-doctoral fellowship at the Albert Einstein Institute in Potsdam and, before that, a PhD in theoretical physics at the University of Jena, Germany.

Dr Hennig's research is concerned with cosmological models, properties of black holes and the application of highly-accurate numerical methods to problems in general relativity. Currently, his main goal is a deeper understanding of unusual cosmologies. In these models, causality breaks down and the present state does not determine all of the future. Moreover, an observer could travel along a closed curve that brings one back to the same point in space and time from where one started, which would be genuine time travel. While such models are compatible with the equations of general relativity, they are believed to be unphysical. Dr Hennig's research aims to find out whether such solutions could be realised in our real universe, which would require them to have certain stability properties. This is also the topic of his current Marsden Fast-Start Grant “Causality and Cosmological Models”.

Dr Karl Iremonger

Dr Karl Iremonger

Dr Karl Iremonger initially completed a BSc (Physiology) and a Bachelor of Physical Education (Hons) at the University of Otago. He then moved to the University of Calgary, Canada, where he completed a MSc and PhD in Neuroscience. In 2010 he returned to Otago to undertake postdoctoral research investigating the structure and function of brain cells which control fertility. Dr Iremonger took up an appointment as a Lecturer in the Department of Physiology at Otago in 2014.

Last year, he was awarded the Prime Minister’s MacDiarmid Emerging Scientist Prize as well as a Sir Charles Hercus Health Research Fellowship.

Dr Iremonger is a Principle Investigator in the Centre for Neuroendocrinology and the Brain Health Research Centre. He currently runs an independent research programme focused on understanding how brain cells control the body’s response to stress.

Dr Sheri Johnson

Dr Sheri Johnson

Dr Sheri Johnson is a Lecturer in the Department of Zoology. She moved to New Zealand to take up a postdoctoral position in the Department of Anatomy in 2010 and rapidly established a strong line of independent research at Otago, notably on the effects of age on fertility traits in zebrafish and humans. She was subsequently appointed a Research Fellow (Anatomy) and fixed-term Lecturer (Zoology), before commencing her current role.

Dr Johnson has broad interests in ecology, evolution and behaviour and her ability to initiate, manage and lead multiple projects is one of her key strengths. In just over a year at Otago she obtained a Marsden Fast-Start grant, and was successful in obtaining competitive grants from the National Geographic Society and the University of Otago. She has actively been developing collaborations within Otago, the wider NZ science community, and overseas. Her work has also attracted the interest of the media around the world and locally.

Dr Johnson’s goal is to lead a happy, productive, and internationally renowned research group at the cutting edge of behavioural ecology, behavioural genetics and behavioural epigenetics, and to help grow the rapidly developing field of behavioural epigenetics at the Otago and beyond.

Dr Logan Walker

Dr Logan Walker

Dr Logan Walker is a Senior Research Fellow in the Department of Pathology at the University of Otago, Christchurch. He joined the University as a Research Fellow in 2011 after four years post-doctoral training at the QIMR Berghofer Medical Research Institute in Brisbane, Australia. In 2012, he was awarded the Sir Charles Hercus Fellowship from the Health Research Council. He has been the Principal Investigator on multiple research grants from agencies, such as the Cancer Society of New Zealand and Lottery Health Research.

Dr Walker’s research aims to evaluate the clinical significance of genetic variants associated with cancer risk and development. He leads multiple projects within two international consortia to advance diagnostic tools used for screening individuals at high-risk of cancer. He established the first New Zealand node for these consortia to assess genetic factors in New Zealand women in relation to breast and ovarian cancer risk and to support a multidisciplinary approach to informed decision-making in health practice. His published research has contributed to the clinical categorisation of BRCA1 and BRCA2 sequence variants for breast/ovarian cancer families worldwide, leading directly to an improvement in the clinical management of patients and their family members.

This article is available to read in free full text at: http://dx.doi.org/10.5694/mja14.00208

Doran, E., et al. (2015). Part of the fabric and mostly right: An ethnography of ethics in clinical practice. Medical Journal of Australia, 202(11), 587-590.

Research into cutting edge cell reprogramming that will help develop drugs in the fight against Huntington disease, has just had a boost of one million dollars.

The grant of $1.19 million over three years from the Health Research Council to University of Auckland neuroscientist Associate Professor Bronwen Connor will, if successful, enable new drug targets to be identified for trial development.

This funding will enable DrConnor and her team to understand Huntington’s disease better and investigate differences in genes and proteins, and brain cell development and function between normal and Huntington’s disease patients using live human brain cells.

“By doing this, we hope to identify cell targets that may lead to new drug development,” says Dr Connor who is based in the University’s Centre for Brain Research.  “The last step of the project is collaboration with Griffith University in Brisbane at the Eskitis Institute that has a natural drug compound library of more than 200,000 compounds.

“If we can identify some targets in the live human Huntington disease brain cells, we are going to use these cells to screen drugs, potentially to identify new compounds that we could then take further forward into drug development,” she says.  “The beauty of that are these targets and compounds will be tested on human cells, not on animal cells or on engineered human cells lines.  That will mean a much more precise result and hopefully faster and more successful translation to clinical use.”

In 2007 Shinya Yamanaka working at the University of Kyoto, developed a unique cell technology that takes human skin cells (or fibroblasts), and ’reprogrammes‘ them back to an embryonic-like stem cell state (induced pluripotent stem cells).  (Yamanaka was awarded the Nobel Prize for this work in 2013).

That was an advance on using embryonic stem cells, but that approach has the same issues as working with pluripotent stem cells.  Both embryonic stem cells and pluripotent stem cells are innately unstable - they can turn into all different types of cells including the potential to turn into cancer cells and cause tumours.

“On the one hand it's unique and exciting work because the pluripotent skin cells can turn into all different cell and tissue types, but we are looking for a clinical application,” says Dr Connor  “If you wanted to use those cells for cell or tissue replacement, the pluripotency is an issue.  We need to make sure that for clinical application, the cells are at the mature stage where they lose that pluripotency.”

"This is the issue that embryonic stem cell technology is facing and the reason why it has not gone into the clinic as fast as everyone thought," she says.  “It's because nobody has yet managed to completely purify these - the pluripotent cells of either the reprogrammed skin cells or the embryonic stem cells.

“We want to work with brain stem cells that are multi-potent, so that they will only turn into brain cells and so we are using a technology called direct cell reprogramming.”

The first technology that was developed in direct reprogramming for neuroscience was taking skin cells and directly turning them into mature neurons.

"It's pretty incredible to go from one mature cell type to another,” says Dr Connor.  “The issue around that is of course that a mature cell can’t proliferate at all.  If you only get ten percent of your cells turning into a mature neuron, then that’s all you have got to work with, so it’s not very efficient and there are issues around how much research you can do."

Dr Connor wanted something in between the two techniques and so she and her team identified two genes which are involved in brain development - one known as Pax6  (the first gene to come up during development when the neural tube forms), and the other called Sox2 (which is also involved in forming brain cells and involved in stem cell function as well).

 "We have generated this technology now where we can put Sox2 and Pax6 into adult human skin cells and generate brain stem cells which we call neural precursor cells.  From those cells we can generate different types of mature brain cells.  That’s taken us about three years to get up and going.

“There are two areas where this research can be used.  One is for cell replacement therapy - replacing brain cells that have been lost through disease-  in this case brain diseases where there is a specific population of cells lost, (such as Huntington’s and Parkinson’s disease) and we can target that population of cells.”

The second area is to study neurological diseases to further understand what causes them and potentially to identify new drug targets.

“We can use skin cells from patients with genetic disorders such as Huntington’s disease, because that genetic mutation is in all the cells of that patient, but only shows up as a functional deficit in the brain cells,” says Dr Connor.

“We can take those cells from a simple skin biopsy and we can reprogramme them using Sox2 and Pax6 to become a brain stem cell,” she says.  “Our preliminary data already shows that we can compare brain stem cells from a patient with Huntington’s disease to a patient who is neurologically normal and detect differences.

“We have seen right from the start of brain stem cell development, that there are already genetic defects,” says Dr Connor.  “Some cells are already altered, even at that early stage of development.

 “Although Huntington’s disease is a genetic disorder, you tend not to see the onset until patients are about 40-50 years old, so it’s a disease we see later in life,” says Dr Connor.  “However the genetic changes are there and the cells are impaired, right from the word go.

“This reprogramming process starts to give us an idea about what the mutation is doing in the developing cell,” she says.  “We also see how the cell matures and how it functions.  These live human brain cells give us the capability of observing this development, and also to observe the function and vulnerability of live human GABAergic medium spiny neurons which are the ones that are lost in Huntington’s disease.”

“In our preliminary work using reprogrammed brain stem cells generated from Huntington’s disease patients, we showed that there are some genes in Huntington’s disease that were hugely over-expressed compared to neurologically-normal subjects”, says Dr Connor.  “They are genes that are also involved in forming a mature GABAergic neuron, suggesting the development process in Huntington’s disease was altered and the cells may be maturing too fast.

She says this technology enables her team to look at the disease pathogenesis – something they can’t do specifically in humans until now.At present, the only technology researchers can do that with is transgenic animals or zebrafish.  The only human material they could use is post mortem human tissue which is usually at an end-stage usually.

The authors conclude that the findings "... indicate that the use of a simple, low-cost communication strategy for patient care is associated with improvements in clinician and carer experience with potential implications for patient safety. Minimally, TOP 5 represents ‘good practice’ with a low risk of harm for patients".

Now available to read in free full text at: http://dx.doi.org/10.1093/intqhc/mzv026 

Luxford, K., et al. (2015). Improving clinician–carer communication for safer hospital care: A study of the ‘TOP 5’ strategy in patients with dementia. International Journal for Quality in Health Care, 27(3), 175 - 182

A tiny, life-saving heart monitor that makes a significant difference to a patient’s quality of life has won the inaugural Medical Technology Association of New Zealand (MTANZ) Innovation Award for 2015.

Medtronic Australasia received the award for its Reveal LINQTM Insertable Cardiac Monitor at last night’s Healthcare Congress Dinner event in Auckland in front of healthcare sector leaders.

The Reveal LINQTM Insertable Cardiac Monitor identifies (or excludes) fainting due to heart rhythm disease by continuously monitoring, recording and storing a patient’s electrocardiogram and other health measurements for up to three years. Its wireless capabilities mean doctors can be notified remotely and quickly if a patient needs medical attention between regular appointments.

The implanted monitor is tiny, about the size of a paperclip or AAA battery. The device offers significant benefits over existing devices for the high numbers of New Zealanders living with potentially fatal heart rhythm disorders. The technology is designed to cause minimal disruption during implant and is especially suitable for children.

“Our organisation has initiated these awards to highlight the exciting levels of innovation that are available from our local medical device industry and to encourage further creativity. We believe such innovation enables the healthcare sector to deliver significant benefits to patients and clinicians while balancing healthcare budgets and increasing efficiencies,” explains MTANZ chief executive Faye Sumner.

The award judges were: Dr Diana Siew, National MedTech Sector Manager, Callaghan Innovation; Professor Peter Hunter, director of Auckland Bioengineering Institute, University of Auckland and Professor John Windsor, Professor of Surgery at the University of Auckland.

The MTANZ awards were judged on the basis of the product’s significant contribution to improving patient outcomes by enhancing quality of life; as well as evidence of technical excellence and innovation.

MTANZ says the awards will be an annual event.

www.mtanz.org.nz

The response rate was 42%, with 1457 acute care hospitals completing the survey. Responses regarding key practices fell into three broad categories: (1) organisational practices, (2) bedside practices and (3) access to information and shared decision-making. The authors found a wide range of scores across hospitals.

Selected findings include: 86% of hospitals had a policy for unrestricted visitor access in at least some units; 68% encouraged patients/families to participate in shift-change reports; 67% had formal policies for disclosing and apologising for errors; and 38% had a patient and family advisory council. The most commonly reported barrier to increased PFE was ‘competing organisational priorities’.

The authors conclude that there is a large variation in hospital implementation of PFE practices, with competing organisational priorities being the most commonly identified barrier to adoption.

This is an open access article and can be read in free full text at:  http://qualitysafety.bmj.com/content/early/2015/06/16/bmjqs-2015-004006.full

Herrin, J., et al. (2015). Patient and family engagement: A survey of US hospital practices. BMJ Quality & Safety, 16 June [Epub before print]

Its aim is to serve as an educational resource for practitioners from a wide array of disciplines engaged in the delivery of care to those with life threatening illnesses along the entire continuum of care from diagnosis to the end of life. The journal's scope is broad and relates to all aspects of palliative medicine that do not directly or exclusively deal with the administration of palliative care or hospice services, or with the primary management of pain and physical symptoms in palliative care.

 was a big night for the Whanganui District Health Board’s (WDHB) Māori Health Services team who took home the Supreme Award at last week’s Whanganui Health & Disability Awards.
 
They won with their entry for the Te Hau Ranga Ora Haumoana Services introduced to Whanganui Hospital last year.
 
Māori Health Services director Rowena Kui says she and her team are “absolutely delighted” and feeling very humbled and grateful for the recognition received for the work they do. “For us, it’s been about supporting the kaupapa of quality improvement,” Mrs Kui says.

Awards organiser and WDHB patient, safety and quality manager Lucy Dunlop says the awards received 31 entries across seven categories - one of the highest number of nominations received to date.
 
Awards were presented in the following four categories:

• Excellence in Integration and Collaboration: Multi Interventional Approach to Polypharmacy
• Excellence in Quality Improvement: First Equal – Acute Stroke Unit Development and Te Hau Ranga Ora Haumoana Services
• Excellence in Innovation and Development: Red folder, Red Bin Project
• Excellence in Service Delivery Award: Piki Te Ora

 
In addition, the judging panel presented a special award to Stanford House for three projects they said deserved special recognition. And the WDHB Communications Department received the inaugural Chief Executive’s Award established by chief executive Julie Patterson for the department that has made an outstanding contribution to the DHB’s image and reputation.
 
Master of Ceremonies for the night was MediaWorks Radio breakfast announcer and programme director Craig Hanford, with Wanganui Enterprises manager Andy Lynn the keynote speaker. Health Quality & Safety Commission chief executive Janice Wilson presented the Supreme Award.
 
WDHB board chair Dot McKinnon says the awards are a wonderful way to recognise quality and excellence in the Whanganui district health and disability sector where she knows a lot of exciting, innovative work is taking place.
 
“Our communities can take comfort in knowing that their health sector is in good heart and that Te Oranganui, the Whanganui Regional Health Network and the WDHB are all working well together.”
 
Mrs McKinnon thanked the organising committee, the sponsors, photographer Chris Hollenback and the Wanganui Floral Society for the valuable contribution they had made to the awards evening.

Disability Issues Minister Nicky Wagner says the release of the Government response to the United Nations Committee on the Rights of Persons with Disabilities reaffirms New Zealand’s position as a world leader on disability issues.

As part of the Government response, Ms Wagner also announced the formation of a new interagency Disability Data and Evidence Working Group.

“New Zealand first reported to the UN Convention on the Rights of Persons with Disabilities in 2011 and I am pleased that our record on disability issues puts us in a good position to respond to the Committee’s recommendations,” Ms Wagner says.

“New Zealand’s world-leading reputation on disability issues means we are held to a high standard. I believe we are meeting that standard, but there is always more we can do to improve lives of disabled people.”

The Government has responded to recommendations from the UN Committee along with similar recommendations from the Independent Monitoring Mechanism, the body set up to monitor New Zealand’s progress against the UN Convention.

“Particular areas where New Zealand is doing well include development of the Disability Action Plan, involving disabled people in decision making and taking steps to increase employment for disabled people.

“Last week, I represented New Zealand on disability issues at the United Nations. One of the big issues raised is how to increase, and make better use of, data on disabled people.

“This is why part of the Government response includes the establishment of the Disability Data and Evidence Working Group.

“The Working Group will focus on the type of data and evidence required to ensure services and supports best meet the needs of disabled people in New Zealand,” Ms Wagner says.

In the latest issue (attached below):