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

• Total cancer
• Ischaemic heart disease
• Cerebrovascular disease
• Chronic lower respiratory diseases
• Other forms of heart disease
• Pneumonia and influenza
• Diabetes
• Motor vehicle accidents
• Intentional self-harm
• Assault
• Total deaths

To view the tables in an Excel spreadsheet, go to: http://www.health.govt.nz/publication/mortality-historical-summary-1948-2012

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.

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

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1111/add.12998 or contact your DHB library, or organisational or local library for assistance.

West, R., et al. (2015). Healthcare interventions to promote and assist tobacco cessation: a review of efficacy, effectiveness and affordability for use in national guideline development. Addiction, 29 May [Epub before print].

A systematic review was undertaken of observational studies that investigated men’s health literacy and its components related to ischaemic heart disease or type 2 diabetes mellitus, and their associated risk factors. Nine studies were included: only one study examined health literacy (nutrition literacy). The majority of included studies focused on only one component of health literacy, namely knowledge (n = 7) and personal skills (confidence) (n = 1). Twenty correlates were identified, primarily relating to the knowledge component, with the strength of the evidence for only one correlate, education, graded as being of moderate quality. The evidence for all other correlates was graded as being of low quality.

The authors conclude that the limited body of research identified may have resulted from a lack of consensus about the definition of health literacy, and a concordant set of validated health literacy measures. Despite these limitations, broadening the search to include components of health literacy has identified that several factors are associated with men’s knowledge and awareness of ischaemic heart disease and type 2 diabetes mellitus that will assist in the development of men’s health promotion strategies. However, addressing the broader knowledge gaps and controversy in the health literacy field will deliver policy and programme benefits to address these major contributors to the burden of disease among men.

This is an open access article and is available to read in free full text at:  http://dx.doi.org/10.1186/s12889-015-1900-5

Davey, J., et al. (2015). The correlates of chronic disease-related health literacy and its components among men: A systematic review. BMC Public Health, 15:589.

Studies in this issue (attached below):

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

To find out more about this event as information becomes available, go to:  http://www.esmo.org/Conferences/ESMO-2016-Congress

WorkSafe New Zealand with support from ACC and the Canterbury Rebuild Safety Charter will be rolling out its occupational health van in the CBD and on residential sites from 29 June until 8 July.

To read the full story, go to:  http://www.voxy.co.nz/health/rebuild-workers-receive-free-mini-health-checks-site/5/224979

The authors analysed US and European data and and conclude that "these population-level results reject the hypothesis of hardening as smoking prevalence drops, instead supporting softening of the smoking population as prevalence declines".

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1136/tobaccocontrol-2015-052329 or contact your DHB library, or organisational or local library for assistance.

Kulik, M.C. & Glantz, S. (2015). The smoking population in the USA and EU is softening not hardening. Tobacco Control, 24 June [Epub before print]

In the latest issue (attached below): 

Health Minister Jonathan Coleman says since the pneumococcal vaccine was introduced in 2008 there have been approximately 600 fewer cases of invasive pneumococcal disease in children under five.

“Pneumococcal bacteria can cause severe ear infections, meningitis, pneumonia, and blood infection. Invasive pneumococcal disease can be fatal in around four per cent of cases,” says Dr Coleman.

“Pneumococcal vaccines have proven to be very effective. Most of the strains covered by the 2008 vaccine have now been almost completely eliminated in young children.

“In 2007 prior to the introduction of the vaccine, there were 156 cases of invasive pneumococcal disease among children under five. In the last five years, this has dropped to 40 to 65 cases a year thanks to the protection offered by the vaccine.”

Based on data from the Institute of Environmental Science and Research (ESR), the rate of pneumococcal disease in children under five decreased by 62 per cent between 2007 and 2014. The rate decreased by 66 per cent for children under two.

Young children and the elderly are most affected by pneumococcal disease.

The pneumococcal vaccine is free to babies and children at age six weeks, three months and five months, with a booster at 15 months of age. It is also funded for adults with certain high risk health conditions.

The Government has made immunisation a top priority, lifting the national target from 90 to 95 per cent of eight month olds immunised. More babies than ever before are being protected against whooping cough and other serious preventable diseases.

Studies in this issue (attached below):

Customs Minister Nicky Wagner says Customs has destroyed over 2.5 tonnes of abandoned tobacco and collected $1.35 million in additional duty and taxes since the drop in tobacco duty free limits last November.

“People seem to be learning about the change. The amount of tobacco abandoned at airports by those not wanting to pay duty is dropping from the 100 kilograms Customs was initially collecting every week,” Ms Wagner says.

“The change was well signalled in advance and advertising to highlight the change continues. Customs’ passenger surveys show most people are aware of and accept the change in regulations.

“Customs recorded over 7,600 individual transactions for people choosing to pay duty, with the total collected in the six months adding to over $1.35 million.

“Nonetheless, 2.5 tonnes of cigarettes and tobacco left at airports is an incredible amount, and I’m pleased Customs is actively supporting the aim of making New Zealand smoke-free by 2025,” Ms Wagner says.

Associate Health Minister Peseta Sam Lotu-Iiga welcomed the reduction in the amount of tobacco being brought into New Zealand through airports.

“The amount, 2.5 tonnes, is staggering. Every time a traveller abandons their tobacco at Customs or decides not to bring it in at all, is a victory for our health system.

“The fact that people appear to be aware of the changes to our duty-free tobacco limits and accept them is confirmation that our Government’s policies are making a real difference.

“We are determined to reduce the harm tobacco causes and the cost to our health system. The new duty-free tobacco limits, together with tax increases on tobacco sold in New Zealand, are pricing tobacco out of reach of many users. This is reflected in the numbers of smokers giving up tobacco,” Mr Lotu-Iiga says.

All articles are available to read in free full text at:  http://tobaccocontrol.bmj.com/content/24/Suppl_3.toc

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.

In the latest issue (attached below):

The latest edition of the Tobacco Control Update has just been published by the Smokefree Coalition. The issue includes:

In a change to its 2005 predecessor, the updated guideline uses a new approach – focusing on the symptoms that a patient might experience and go to their doctor with - to make its recommendations easier for GPs to use. It sets out clear tables linking signs and symptoms to possible cancers and includes simple recommendations about which tests to perform and the type of referral to specialist services that should be made".

To read the full story on the NICE website, go to:  http://www.nice.org.uk/news/article/nice%E2%80%99s-new-symptom%E2%80%93based-approach-will-help-to-save-thousands-of-lives-from-cancer

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.

To find out more about this event, go to:  http://www.esmo.org/Conferences/EMUC-2015-Urological-Cancers

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 find out more about this event, go to:  http://www.esmo.org/Conferences/Immuno-Oncology-2015

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.  

Now available to read in free full text at: http://dx.doi.org/10.1093/ntr/ntv099 

Thompson, T.P., et al. (2015). An exploratory analysis of the smoking and physical activity outcomes from a pilot randomised controlled trial of an exercise assisted reduction to stop (EARS) smoking intervention in disadvantaged groups. Nicotine & Tobacco Research, 11 May [Epub before print]

Main topics in scientific programme:

• 3-4 D Echocardiography
• Strain and Strain Rate Echocardiography
• Stress Echocardiography
• Transoesophageal Echocardiography
• Ischeamic Heart Disease
• Valvular Heart disease
• Heart Failure
• Congenital Heart Disease
• Aortic Valve Disease
• Pulmonary Hypertension
• Atrial Fibrillation
• Cardiomyopathies
• Pericardial Disease
• Cardioembolic Stroke
• Heart and Brain Interactions

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

The European Lung Cancer Conference is a collaborative effort of multidisciplinary societies representing thoracic oncology specialists, all working towards a shared goal: to advance science, disseminate education and improve the practice of lung cancer specialists worldwide. 

To find out more about this event, go to:  http://www.esmo.org/Conferences/ELCC-2016-Lung-Cancer

To find out more about this event, go to:  http://www.esmo.org/Conferences/IMPAKT-2016-Breast-Cancer

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

In the latest issue (attached below):

This report examines how OECD countries deliver the programmes and services related to CVD and diabetes. It considers how countries have used available health care resources to reduce the overall burden of CVD and diabetes, and it focuses on the variation in OECD health systems’ ability to convert health care inputs (such as expenditure) into health gains.

For information on how to access the report and for links to some content, go to: http://www.oecd.org/health/cardiovascular-disease-and-diabetes-policies-for-better-health-and-quality-of-care-9789264233010-en.htm or contact your DHB library, or organisational or local library for assistance.

You can read a media release about the report at:  http://www.oecd.org/newsroom/rising-diabetes-and-obesity-threaten-progress-in-tackling-cardiovascular-diseases.htm

OECD (2015), Cardiovascular Disease and Diabetes: Policies for Better Health and Quality of Care, OECD Health Policy Studies, OECD Publishing, Paris.

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.

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

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.

"These pilots are an integral part of Project SWIFT which is all about embracing new technology and tools that let patients better manage their health at home and in the community".

To read the full blogpost, go to:  http://countiesmanukau.health.nz/blog/swift-helping-patients-help-themselves/

Seventeen randomised controlled trials were included. The authors conclude form their analysis that "nicotine replacement therapy, behavioural support and combination approaches appear to increase smoking abstinence in those treated for substance use disorders. Higher quality studies are required to strengthen the evidence base".

This is an open access article and is available to read in free full text at:  http://ntr.oxfordjournals.org/content/early/2015/06/10/ntr.ntv127.full.pdf+html

Thurgood, S.L., et al. (2015). A systematic review of smoking cessation interventions for adults in substance abuse treatment or recovery. Nicotine & Tobacco Research, 11 June [Epub before print]

In this systematic review and meta-analysis, the authors investigated the effect of reducing saturated fat intake and replacing it with carbohydrate, polyunsaturated or monounsaturated fat and/or protein on mortality and cardiovascular morbidity.

To read the paper, Vaccines on the frontline, go to:  http://www.chiefscientist.gov.au/2015/06/paper-vaccines-on-the-frontline/

Topics covered:

• Improving Hospital Food and Beverage Environments
• Improving Hospital Physical Activity Environments 
• Improving Support for Breastfeeding Employees 
• Improving Support for Tobacco-Free Hospital Environments
• Hospitals Partner with Public Health to Improve Food Environments:
• Addressing Community Health in Schools, Early Care and Education, and the Clinic 
• Community Benefit: Encouraging Healthy Habits Early
• Children’s Hospitals Working Together to Improve their Food Environments 

To read the issues in this series, go to:  http://www.cdc.gov/nccdphp/dnpao/hwi/resources/hospital_p2p.htm

The recommendations have been developed by an editorial board in consultation with an advisory board of academics and experts, and following feedback from four regional events with local and national tobacco control professionals.

To read the report and associated reports, go to:  http://www.ash.org.uk/current-policy-issues/smoking-still-kills

Smoking Still Kills: Protecting children, reducing inequalities. London, ASH, 2015

Health Minister Jonathan Coleman says Waikato DHB is focused on delivering faster access to improve cancer services.

Dr Coleman visited Waikato Hospital’s chemotherapy day stay unit and met with staff and patients as well as representatives from the Cancer Society and Hospice Waikato.

The unit has up to seven registered nurses who treat 30 to 40 outpatients every day from Waikato, Tairawhiti and Lakes DHBs.

“Waikato DHB has a plan in place to provide faster access to cancer services to patients,” says Dr Coleman.

“As a regional cancer centre, Waikato DHB plays a significant role in the Midland region helping to treat patients as well as improving the delivery of cancer services.

“They are working towards achieving the Government’s new 62-day faster cancer treatment health target which puts the lens right across the cancer pathway.

“The DHB is also reviewing their systems against the national tumour standards for 11 of the most common tumour types which will help to improve the quality of care.”

Dr Coleman met with one of the DHB’s cancer nurse coordinators. They fill an important role, acting as a single point of contact for patients and families.

Cancer nurse coordinators also work closely with Hospice Waikato and Waikato-Bay of Plenty Cancer Society.

Budget 2015 invested an extra $4.6 million into Hospice Waikato over the next four years to expand community palliative care services.

Nineteen papers were identified as relevant for this review (3 randomised control trials; 4 cross-sectional, 5 cohort and 3 qualitative studies, and 3 systematic reviews). "The reviewed studies indicated that providing general practitioner-led supportive interventions for post-treatment care of cancer patients is feasible and acceptable to patients. General practitioner involvement resulted in improved physical and psychosocial well-being of patients and continuity of care, especially for patients with concomitant health conditions".

The authors discuss the implications of these findings.

This article is available to read in free full text at:  http://www.ijic.org/index.php/ijic/article/view/1987/2983

Ngune, I., et al. (2015). Do patients with long-term side effects of cancer treatment benefit from general practitioner support? A literature review. International Journal of Integrated Care, 8 June.

Nationally 33% of people with a mental health problem smoke compared to 18.7% in the population as a whole. A PHE and NHS England survey found that smoking rates among service users in mental health units is even higher at 64%. 

PHE and NHS England have published new guidance to help medium and low secure mental health units best implement the NICE recommendation that all NHS funded sites should provide access to on-site stop smoking services and deliver care in an environment free of smoke.

The guidance highlights case studies which show the benefits of completely smokefree mental health units, where service users are provided support to stop smoking. This has resulted in:

• better patient health
• freeing up staff time
• improved ward atmosphere

Alongside the physical health improvements, an increasing body of research is finding that mental health can be improved by stopping smoking. Contrary to the myth, evidence shows that stopping smoking is associated with reduced depression, anxiety, stress and improved positive mood and quality of life.

Evidence also shows that people who smoke often require higher doses of psychotropic medication as smoking increases the metabolism of these drugs.

They hypothesised that prior exposure to opinions rejecting the safety or value of HPV vaccines would be associated with an increased risk of posting similar opinions and tested this hypothesis by analysing temporal sequences of messages posted on Twitter (tweets).

The study design was a retrospective analysis of tweets related to HPV vaccines and the social connections between users. Between October 2013 and April 2014, they collected 83,551 English-language tweets that included terms related to HPV vaccines and the 957,865 social connections among 30,621 users posting or reposting the tweets. Tweets were classified as expressing negative or neutral/positive opinions using a machine learning classifier previously trained on a manually labeled sample.

The authors conclude from their analysis that the heterogeneous community structure on Twitter appears to skew the information to which users are exposed in relation to HPV vaccines. They found that among users that tweeted about HPV vaccines, those who were more often exposed to negative opinions were more likely to subsequently post negative opinions. They go on to say that, although this research may be useful for identifying individuals and groups currently at risk of disproportionate exposure to misinformation about HPV vaccines, there is a clear need for studies capable of determining the factors that affect the formation and adoption of beliefs about public health interventions.

This is an open access article and can be read in free full text at:  http://doi.org/10.2196/jmir.4343

Dunn AG, Leask J, Zhou X, Mandl KD, Coiera E (2015). Associations between exposure to and expression of negative opinions about human papillomavirus vaccines on social media: An observational study. Journal of Medical Internet Research, 17(6), e144.

The latest edition of the Tobacco Control Update has just been published by the Smokefree Coalition. The issue includes:

Topics covered in this conference and workshops include: paediatric eczema management; gastroenterology; fertility; ophthalmology; ECG interpretation; diabetes management; musculoskeletal examinations;  and joint injections.

To find out more, including registration details, go to:  http://acma.org.nz/acma-conference-2015/

Fetuses of smoking mothers showed a significantly higher rate of mouth-movements compared to fetuses of non-smoking mothers and these differences widened as pregnancy progressed. There were also differences in the rate of fetal facial self-touch that were borderline significant.

The authors  discuss the implication of these findings and note that a "... larger study is needed to confirm these results and to investigate specific effects, including the interaction of maternal stress and smoking". 

This article is now available to read in free full text at: http://dx.doi.org/10.1111/apa.13001 

To read a UK Independent article about this study, go to:  http://www.independent.co.uk/life-style/health-and-families/4d-ultrasound-study-shows-harmful-effects-of-smoking-on-unborn-babies-10128345.html

Reissland, N., et al. (2015). Ultrasound observations of subtle movements: A pilot study comparing fetuses of smoking and non-smoking mothers. Acta Paediatrica, 104(6), 596–603

He will also draw upon some evidence from goal setting in sport psychology and business settings including a look at the darker side of this practice. He will argue that goal setting is more complex and nuanced than we have acknowledged and that a more sophisticated approach is required. 

To find out more about this event, go to:  http://www.aut.ac.nz/__data/assets/pdf_file/0010/558991/Richard-Siegert-professorial-address_July-2015.pdf

Two trials were included this review. One (involving 213 women and 213 neonates) evaluated the impact of Hib vaccination during pregnancy and was assessed as having a 'high risk of bias'. The other study (involving 2116 women and 2049 neonates) evaluated the impact of viral influenza vaccination during pregnancy, and was assessed as being at 'low risk of bias'.

The authors describe the findings from these studies and conclude that "further trials for both Hib and viral influenza vaccines with appropriate study designs and suitable comparison groups are required".

This article is available to read in free full text at:  http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009982.pub2/full

Salam R.A., Das J.K., Dojo Soeandy C., Lassi Z.S., Bhutta Z.A. (2015). Impact of Haemophilus influenzae type B (Hib) and viral influenza vaccinations in pregnancy for improving maternal, neonatal and infant health outcomes. Cochrane Database of Systematic Reviews, 6, CD009982. 

Clinical psychologist and PhD researcher Sarah Malthus works with people who have serious complications of diabetes, such as amputations, kidney failure, and blindness.

She says it can be “heart-breaking” work, but it prompted her interest in developing and evaluating interventions for people at the pre-diabetes stage, so they can avoid these complications in the future.

“Diabetes is a potentially debilitating long-term health condition that comes with substantial physical and psycho-social cost, and unless more is done at a prevention level the impact on the health system is likely to be substantial,” she says.

Ms Malthus, who is based at Massey University’s Psychology Clinic in Palmerston North, is seeking 150 people with prediabetes who live in the MidCentral district to take part in her intervention study.

In the study, funded by the MidCentral District Health Board, participants will receive information about their condition, along with practical changes they can make to their lifestyle to reduce their risk of progressing to diabetes. Involvement requires approximately three to seven hours over six months.

People interested in the study will need to meet criteria for pre-diabetes, which is based on a blood test result. They can be referred into the study by their GP or practice nurse, or contact her directly to discuss a referral. Haemoglobin A1c (HbA1c) is the recommended screening test for Type 2 diabetes and prediabetes. Those with HbA1c levels in the range 41–49 mmol/mol are considered to have prediabetes, otherwise known as ‘intermediate hyperglycaemia’.

Study participants will be randomly assigned to research groups, which will be provided with different types of lifestyle interventions relating to diet and physical activity. The interventions have been informed by international approaches in line with prediabetes advice provided by the Ministry of Health They have been developed in collaboration with the Diabetes Trust along with input from nurse practitioners, dieticians and other health professionals with extensive experience in diabetes prevention and research.

Ms Malthus said Type 2 diabetes is referred to as a ‘silent killer’, because in the early stages people may not have any symptoms or symptoms are very subtle. Symptoms that can indicate a shift from prediabetes to Type 2 diabetes include; feeling tired, increased thirst, increased urination, blurred vision and frequent infections.

Currently, about 25 per cent of New Zealanders meet the criteria for pre-diabetes, which means they are at high risk of developing Type 2 diabetes.

“These rising rates are partly related to changes in lifestyle, such as what we eat, our weight and how physically active we are,” she says.

Rising rates of both prediabetes and diabetes within New Zealand and globally has made diabetes prevention a central focus of health research. International research has demonstrated that the risk of developing Type 2 diabetes can be substantially reduced by almost 60 per cent by providing lifestyle interventions for people with prediabetes.

Ms Malthus was motivated to pursue her doctoral research as a result of her work as a psychologist for the Massey Health Conditions Psychology Service. Her role with this service involves helping people to cope with emotional distress related to living with diabetes, and supporting them to make changes to their lifestyle to manage their diabetes.

She hopes her study will ultimately help those who are at high risk of developing diabetes take steps towards a healthier future, and prevent them from developing serious health problems down the track. She is optimistic that diabetes prevention approaches, such as these, will reduce pressure on the health system that is already overwhelmed with managing diabetes and its complications.

To find out more about the study, or register to take part, contact Sarah Malthus on (06) 350 5180.

It draws on the experiences of groups who have already undertaken successful smokefree car promotional and advocacy activities.

In the Tool Kit you will find information, templates, a project plan and evaluation to assist you and your communities to promote the smokefree cars message with your local community within your region.

To download the toolkit from the ASPIRE2025 website, go to:  http://aspire2025.org.nz/smokefree-cars-tool-kit/

• Module 1: Collecting Patient Data
• Module 2: Working with Patient Data

To find out more, go to:  http://learnonline.health.nz/course/category.php?id=23

Farmers attending NZ National Agricultural Fieldays this week are being encouraged to head down to the Heart Foundation stand and get their blood pressure checked.

Fieldays kicks off on Wednesday and runs for four days, with around 120,000 visitors expected to flock to Mystery Creek near Hamilton.

As one of the charities on-site, the Heart Foundation will be offering free blood pressure checks, talking about the effects of heart disease, and demonstrating a new online tool for people who have had a heart attack. 

Gerry Devlin, Heart Foundation Medical Director, urged farmers to head over to the stand in the Pavilion for a free blood pressure test with one of the Heart Foundation nurses.

“High blood pressure is the single most common risk factor in heart disease. It is often called the ‘silent killer’, because for most people there are no symptoms. The only way to find out if your blood pressure is high is to have it checked.”

Devlin said New Zealand’s rural community is a key audience for the Heart Foundation because farmers are notoriously slow to get help when they experience heart trouble. 

“Farmers need to take their heart health seriously. There are too many examples of farmers who ignore the symptoms of a heart attack because they feel it’s more important to finish milking the cows or shifting stock,” Devlin said. 

Delaying treatment can be fatal or result in severe long-term damage to the heart. When a farmer has a heart event, the impact is not limited to that individual but to their livelihood, their staff and their financial future.

“That’s why it’s so important to get help at the first sign that something could be wrong with your heart. Don’t put it off and wait till end of the day – those extra minutes and hours matter,” Devlin said.

People living in isolated rural communities face greater difficulties accessing healthcare or medical advice but the Heart Foundation encourages farmers to see their health professional for heart checks because small preventative acts can have significant long-term benefits.

He added that the uncertain economic outlook for dairy farmers right now won’t help with levels of stress and depression, which can contribute to heart disease.

The Heart Foundation stand is located at site PD47 in the Mystery Creek Pavilion.

The note that the findings of their analysis "... suggest an immediate impact of display bans on youth’s exposure to tobacco pack displays, and likely impacts on smoking-related outcomes. These results suggest that removing tobacco displays from retail environments can positively contribute to the denormalization of smoking among youth".

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1093/ntr/ntu180 or contact your DHB library, or organisational or local library for assistance.

Dunlop, S., et al. (2015). Out of sight and out of mind? Evaluating the impact of point-of-sale tobacco display bans on smoking-related beliefs and behaviors in a sample of Australian adolescents and young adults. Nicotine & Tobacco Research, 17(7), 761-768.

Health Minister Jonathan Coleman says good progress is being made towards accurately measuring patient flow from GPs to hospital based specialists and the outcome of those referrals.

“The Government is focused on delivering better and faster access to health services, including more elective surgeries,” says Dr Coleman.

“We’ve backed that up in Budget 2015 with a further $98 million for increased access to elective surgery. This comes on top of the $110 million committed in Budget 2014.

“The number of patients receiving surgical first specialist assessments has significantly increased over the last six years, from around 260,000 patients a year, to over 315,000 patients assessed each year.

“However there have always been an uncounted percentage of patients who are returned to the care of their GPs.”

The previous Government in 2006 estimated around 25 percent of all GP referrals to specialists were returned to GP care. This would mean that of the 260,000 patients seen each year under Labour, at least 65,000 patients were being referred back to their GPs for care.

“Generally we know that patients can be referred back to their GP for a variety of reasons in addition to not meeting the threshold,” says Dr Coleman. 

“These may be cases where management in primary care is more appropriate such as if the patient has been referred for tests that primary care can access. Patients may also have been referred with incomplete information or to the wrong DHB.

“We are keen to better understand the exact outcomes of GP referrals.

“It is a significant undertaking to standardise the way this data is recorded by different DHBs and to understand referral outcomes. New Zealand will be one of a few countries to be collecting information of this kind at a national level.

“The Ministry of Health is working with DHBs to collect data in a comparable way.

“Ultimately this data will provide more comprehensive information for primary care on their patients.”

The project is on track to release the first set of reliable information in early to mid-2016.

Notes:

The National Patient Flow project has a three year implementation plan, with preliminary data expected to be available in early to mid-2016

The first phase being the collection of information on referrals received by DHBs for first surgical assessments. This has been underway since July 2014.

The second phase will commence in October 2015 and will include information on referrals for elective surgery, and some other procedures, including colonoscopy.

The third phase of the collection will commence in July 2016, and will include the full scope of the collection.  This will encompass a wider range of services, including diagnostics, and will allow linking of related referrals, and capture of a clinical classification of referral reason. This will allow more defined understanding of outcomes for patients

The initial phase of the application process will be hosted by the Ministry of Business, Innovation & Employment (MBIE). Interested applicants will be required to register an Expression of Interest via the MBIE application portal.

To find out more, go to:  http://www.hrc.govt.nz/news-and-media/news/nz-china-non-communicable-diseases-collaborations

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1093/ntr/ntv117 or contact your DHB library, or organisational or local library for assistance.

Hoeppner, B., et al. (2015). How smart are smartphone apps for smoking cessation? A content analysis. Nicotine & Tobacco Research, 4 June [Epub before print]

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1093/ntr/ntv122 or contact your DHB library, or organisational or local library for assistance.

McRobbie, H., et al. (2015). Complementing the standard multicomponent treatment for smokers with de-nicotinised cigarettes: A randomised trial. Nicotine & Tobacco Research, 4 June [Epub before print].