• 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.

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

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

Studies in this issue (attached below):

In the latest issue (attached below):

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

"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/

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.

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.

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 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

Twenty-seven studies were included in the review. "The prevalence of adherence ranged from 38.5 to 93.1%. Only six out of 27 studies (22.2%) reported prevalence of adherence of ≥80% among their study population. Depression and medication cost were found to be consistent and potentially modifiable predictors for diabetes medication-taking behaviour. The associations between adherence and other factors were inconsistent among the reviewed studies". The authors discuss the implications of these findings.

Now available to read in free full text at: http://dx.doi.org/10.1111/dme.12651 

Krass, I., et al. (2015). Adherence to diabetes medication: A systematic review. Diabetic Medicine, 32(6), 725-737.

University of Otago researchers have been awarded more than $30M in new health research funding to support their world-class studies aimed at improving New Zealanders’ health and well-being.

The Health Research Council of New Zealand’s latest annual funding round results were announced today. Otago researchers gained 18 contracts, including three major multi-million, five-year programmes and 15 projects.

Otago’s recipients span the University’s campuses in Dunedin, Christchurch and Wellington and each campus hosts one of the major new programmes.

Programmes focus on cancer genetics, key immune cells, and healthy housing

The new Dunedin campus-based programme, led by Pathology’s Professor Antony Braithwaite, will investigate the complex role that the p53 tumour suppressor genepathway plays in many cancers. Defects in this pathway are commonplace in cancers, making them an attractive target for improved therapies. The researchers will also examine links between cancer and inflammation. 

Professor Anthony Kettle of the University’s Christchurch campus will lead a programme studying the oxidative action of a common type of white blood cell known as neutrophils. These cells are a key line of defence against harmful bacteria, but when unrestrained during inflammation they damage healthy tissue. This aberrant activity occurs in many diseases, including pneumonia, arthritis, and heart disease. The long-term goal is to advance the diagnosis and treatment of inflammatory diseases dominated by neutrophils.

At the University’s Wellington campus Professor Philippa Howden-Chapman, head of the award-winning He Kainga Oranga: Housing and Health Research Programme, will lead an HRC programme that will translate their housing research to practice for children’s health. The researchers will examine health issues arising from children’s exposure to poor housing and trial several interventions, including one to insulate and warm newborn babies’ homes and provide them with feather duvets, and another to study air quality and possible health effects on children living in housing located beside arterial roads.

The three programmes are funded at nearly $5M each over five years.

15 new Otago projects to tackle a wide range of pressing health issues

Otago’s 15 new HRC projects range from studying a newly discovered neuronal pathway implicated in polycystic ovarian syndrome to testing how effectively modifications to front door steps can reduce falls and injuries around the home.

Several projects focus on child and young people’s health and include studies on the genetic causes of epilepsy, improving asthma outcomes in Maori children, and whether airway inflammation and infection can be reduced in cystic fibrosis by inhibiting white blood cells’ bleaching activity.

Three studies focus on the health of older New Zealanders. One will calculate osteoarthritis’s growing burden on the country’s ageing population and compare the promise and feasibility of potential strategies in cost-effectively managing this issue. 

Another study will trace people’s oral health from childhood into mid-life and examine its links with cardiovascular, and other, aspects of health. A third aims to help develop evidence-based policy and programmes to balance mobility and safety issues amongst older drivers. 

New cancer genetics-related projects include studies into breast cancer, acute myeloid leukaemia, and stomach cancer. The first project involves investigating the signalling pathways relating to Trib1, a protein that is often over-expressed in breast cancer. 

The second project will use zebrafish to study a newly discovered genetic pathway that may cause acute myeloid leukaemia and screen for drugs that selectively target this pathway.

Another study involves growing stomach tissue buds to test several drugs identified as preferentially killing cells that carry a specific mutation causing deadly diffuse stomach cancer. 

Other Otago projects focus on areas such as tobacco control in New Zealand, discrimination in healthcare, testing a seaweed extract nasal spray to treat adult asthma attacks caused by viral infections, and investigating potential therapies for preventing and treating heart disease in patients with diabetes.

Latest HRC funding successes reflect excellence of Otago researchers

Deputy Vice-Chancellor (Research and Enterprise) Professor Richard Blaikie warmly congratulated all the HRC programme and project recipients on their “dazzling success” in the funding round. 

“It is very pleasing to see that the excellent and innovative research proposals developed by our staff can now be pursued to continue to contribute to improved health and well-being of New Zealanders. Health Research Council funding has for the past 25 years underpinned important advances in health diagnostics, treatment, prevention and policies and this year will be no exception,” Professor Blaikie says.

The latest funding follows the announcement of the HRC Emerging Researcher First Grants and Feasibility Study recipients last month. Eight of the nine Emerging Researcher grants went to Otago staff, as did five of the nine Feasibility grants.

This brings Otago’s funding in the 2014 annual HRC round to a total of $31.98M.

A bone disease research programme is one of 11 successful University of Auckland applications for health research funding with this round’s grants totalling about $14.65 million.

A research programme that will progress prevention and management of several bone-related conditions has received funding of nearly $5 million over the next five years.
The Health Research Council (NZ) has today announced funding for the ‘Mechanisms and management of musculoskeletal disease’ led by Distinguished Professor Ian Reid from the University of Auckland.

Professor Reid is an endocrinologist specialising in bone disease who will lead the teams involved in the five projects that make up this research programme.
“These studies involve a broad group of researchers including clinicians, scientists, statisticians, nurses and surgeons,” says Professor Reid.  “Some will involve volunteers from the public, some will involve patients with these conditions, and some will be carried out in the laboratory.

“These projects have the capacity to provide a new convenient way of preventing fractures in older women at intermediate fracture risk, re-assess the importance of dietary calcium and calcium supplements in bone health, improve management for severe gout, and develop artificial bone substitutes for use in managing fractures and some bone cancers where there is a need to fill local bone defects,” he says.

The five projects are;

• A random controlled trial (RCT) of zoledronate infusions every 18 months for fracture prevention in women at intermediate fracture risk
• A systematic review of all studies relating calcium intake to fracture risk, to provide a sound basis for advice to practitioners and the public for recommendations in this area
• An RCT of intensive drug treatment of gout, to determine whether this reduces joint damage
• A comparison of bone cell function between people in their 50s and those aged >75 years, to define what changes occur in cell function with age that might contribute to the development of osteoporosis
• Development of bone substitutes that can be used to promote healing of severe fractures or large areas of damaged bone

 
“These studies will increase understanding of why osteoporosis develops in old age and advance its treatment and that of gout, both common musculoskeletal problems in older New Zealanders,” says Professor Reid.
 
A study that follows up on a successful trial of a cheap oral gel for treating low blood sugar levels in newborn babies has also received HRC funding for five years.
Distinguished Professor Jane Harding, a neonatal paediatrician and Vice-chancellor of Research at the University of Auckland, has received more than $1 million for this project.

Professor Harding and her team have provided the first evidence-based strategy to treat low blood sugar levels that affects up to 15 per cent of otherwise healthy babies.
They will follow-up babies treated with an oral glucose gel as newborns at two-years of age to ensure the safety and efficacy of the treatment before it’s introduced into clinical practice.

 “The importance of this work cannot be overstated,” says HRC Chief Executive Professor Kath McPherson. “Such an intervention could prevent brain damage in babies, improve breastfeeding rates and long-term health, prevent major distress for affected families, and save our health system significant costs, potentially revolutionising the management of neonatal hypoglycaemia around the world.”
“Two dollars is all it costs to produce the oral gel which has been shown to prevent brain damage in a newborn. This is a small price to pay, given that treating the 2,100 babies severely affected by low blood sugar levels in the neonatal intensive care unit each year costs the nation $9.4 million,” she says.

The following is a summary of other University of Auckland health research projects that received funding from the HRC in this latest round.
 

• Professor Larry Chamley (Obstetrics and Gynaecology). ‘A healthy life starts with a bio-energetically healthy placenta’, 36 months, $ 1,193,142
• Associate Professor Alan Davidson (Molecular Medicine and Pathology). ‘The role of the Pax-Notch pathway in kidney disease’, 36 months, $1,067,513
• Associate Professor Bronwen Connor (Pharmacology/CBR). ‘Cellular reprogramming: A unique approach to understanding Huntington's disease’, 36 months, $1,190,497
• Dr Bridget Kool (Epidemiology and Biostatistics). ‘Prehospital injury deaths: preventability, service accessibility and equity’, 24 months, $598,181
• Dr Fiona McBryde (Physiology). ‘Hypertension after stroke – therapeutic or pathological?’, 36 months, $1,055,738
• Professor Mark McKeage, (Pharmacology). ‘Lung cancer genetic testing in New Zealand’, 36 months, $1,182,641
• Dr Thomas Proft (Molecular Medicine). ‘TeeVax - a novel vaccine against group A streptococcus?’, 36 months, $1,122,354
• Dr Vanessa Selak (Epidemiology and Biostatistics).  Aspirin harm benefit calculator to guide cardiovascular primary prevention, 24 months, $632,382
• Dr Natalie Walker (National Institute of Health Innovation). ‘The combined use of nicotine replacement therapy and e-cigarettes’, 36 months, $1,199,916

Studies in this issue (attached below):

In the latest issue (attached below): 

Whanganui Hospital Acute Stroke Unit and rehabilitation staff are focusing their attention on really understanding what it is their patients experience while in hospital.
 
And clinical nurse manager Amanda Van Elswijk says a key part of this effort involves recording day-to-day events in the Life after stroke diary given to patients. Until recently the diaries were filled in by patients only but now, family members and staff are making entries to create a more comprehensive record of a patient’s progress.
 
“We know many patients have difficulty recognising their progress and that this can lead to them feeling frustrated and disillusioned,” Mrs Van Elswijk says. “So, we’re using the stroke diary to record their therapy, goals, feelings and events to provide a reassuring record for them and their families.
 
“We are also providing discharge information in the stroke diary for patients to refer to when they go home. We recognise that receiving a lot of information at the time of discharge can be very overwhelming.”
 
Mrs Van Elswijk says there’s no doubt that how well stroke patients process what has happened to them and what the future holds, is very dependent on the support they and their family members receive.
 
“Having a stroke is life-changing for everyone concerned. Patients come to us grappling with a huge sense of loss and change and it’s particularly difficult for those who are permanently disabled. Knowing you will no longer be able to work or take care of yourself is devastating.
 
“In addition to the Life after stroke diary we give to patients, our staff take photos during a person’s rehabilitation process to give them a visual record of their progress and a feeling of hope that things will keep improving. Having a psychologist who works closely with our patients and families to help them come to terms with grief, loss and change brought about by strokes is also proving invaluable.
 
“Research has shown us that stroke patients who have access to acute stroke units attached to rehabilitation wards, do have better long-term outcomes. We hope by constantly looking at how we can improve our care we will improve those outcomes even further,” Mrs Van Elswijk says.

Facts about stroke

• Stroke is the third largest killer in New Zealand (about 2500 people every year).
• Around 10 percent of stroke deaths occur in people under 65.
• Every day, about 24 New Zealanders have a stroke. A quarter occur in people under 65.
• Stroke is the major cause of serious adult disability in New Zealand.
• Stroke is largely preventable, yet about 9000 New Zealanders every year have a stroke.
• There are an estimated 60,000 stroke survivors in New Zealand.
• Many are disabled and need significant daily support but stroke recovery can continue throughout life.
• Most people can’t recognise the signs of a stroke occurring. Know the signs to look for.
• High blood pressure is a major cause of strokes. One in five New Zealanders has high blood pressure.

For information on how to recognise the signs of, and how to prevent stroke, visit www.stroke.org.nz.

Studies in this issue (attached below):

A New Zealand neuroscience team from AUT University is launching what could become the world’s largest ever health study. The research, which tackles the mounting toll of non-communicable diseases (NCDs), is tapping into the power of mobile technology to gain vast amounts of international data and vital epidemiological insights.

Entitled Reducing the International Burden of Stroke Using Mobile Technology (RIBURST), the study will be conducted through the mobile app, Stroke Riskometer^TM. Researchers hope that the findings will significantly reduce the devastating impact of conditions such as stroke, diabetes, dementia and heart disease.

“This study has the potential to save countless lives and billions of dollars worldwide,” says AUT University’s Professor Valery Feigin, who is leading the programme. “By delivering population-specific predictive algorithms plus preventative strategies tailored to different cultural and ethnic groups, we hope to dramatically reduce the burden these diseases place on people, families and health systems around the world,” says the Professor of Epidemiology and Neurology.

The Stroke Riskometer^TM app, which enables users to assess their individual stroke risk on a smartphone or tablet, was launched in October 2013. However the newly updated version will be available in multiple languages, and allows users to participate in the cross-sectional study and a subsequent longitudinal study from the comfort of their homes.

With an estimated 1.75 billion smart-phone users around the world, the potential scale of the research is immense and could eclipse that of the largest medical experiment in history, a polio study conducted in the 1950s. Field trials for the Salk vaccine involved 1-2 million participants and led to near eradication of the disease, an inspiring outcome for AUT’s RIBURST Study team.

“Non-communicable diseases account for 66 percent of deaths worldwide and cause serious disability for millions of people. Current primary prevention strategies are simply not effective enough,” says Professor Feigin. “We need a step-change in the care and prevention of major non-communicable diseases, but at present we lack the data that’s critical to attaining that.”

The data collected through the RIBURST study will enable the development of a predictive algorithm based on modern risk factors. It will also allow for the generation of population-specific predictive algorithms. “In the case of stroke, 80 percent of people classified as low or medium risk will have a stroke in their lifetime. One in three Māori under 60 will suffer a stroke, compared to one in six European, and in Pacific people the incidence is even worse.”

“The big question is why, and how do we halt it? There’s a huge need for more accurate prediction, more effective prevention, and culturally and ethnically unique preventative strategies,” says Professor Feigin. “This study gives us a chance to achieve that.”

To read the full story in the UK Guardian, go to:  http://www.theguardian.com/healthcare-network/2015/may/21/obesity-diabetes-governments-top-priorities-says-jeremy-hunt

The authors conclude from the results that "in type 2 diabetes, smoking cessation is associated with deterioration in glycaemic control that lasts for 3 years and is unrelated to weight gain. At a population level, this temporary rise could increase microvascular complications".

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1016/S2213-8587(15)00082-0 or contact your DHB library, or organisational or local library for assistance.

Lycett, D., et al. (2015). The association between smoking cessation and glycaemic control in patients with type 2 diabetes: A THIN database cohort study. The Lancet Diabetes & Endocrinology, 3(6), 423-430.

Primary health workers throughout the Whanganui District Health Board (WDHB) area have reason to celebrate as the Minister of Health’s national health targets results show primary care achieving the Better help for smokers to quit target for the first time with a 91 percent result. 
 
The results released today report the performance of DHBs against the six national health targets over the 2014/15 Quarter Three period of January to March 2015. Whanganui GP and national primary care tobacco target champion John McMenamin says he’s delighted to see the primary care Better help for smokers to quittarget reached in Whanganui.
 
“Whanganui health workers have every reason to celebrate. This result reflects the determination of primary health workers to encourage people to quit smoking,” Dr McMenamin says. “It’s a result that is very deserving as well as timely, with World Smokefree Day coming up on 31 May.”
 
While the WDHB narrowly missed out by one percent on achieving the 95 percent smoking target set for hospitals, the consistent results achieved for this target each quarter are a credit to the hospital staff offering advice and support for patients to quit smoking, says WDHB chief executive Julie Patterson.

Emergency Department clinical director Athol Steward is delighted that the WDHB’s hospital-wide efforts to admit, discharge or transfer 95 percent of patients from ED within the six-hour target, have been sustained. Dr Steward says it’s interesting to see the WDHB once again achieving 96 percent. “It shows consistency by the Whanganui Hospital’s entire clinical team and management.”
 
The 2014/15 Quarter Three national health target results show Whanganui district residents continue to enjoy a high access rate to elective surgical procedures with the DHB achieving 103 percent for the 100 percentImproved access to elective surgery.
 
But disappointingly, Whanganui’s result for the 95 percent Increased immunisation target has dropped to 86 percent. Whanganui Regional Health Network chief executive Judith McDonald says in addition to the 181 children who were immunised in this quarter, there were a further 19 children who did not receive their immunisation on time. “And given that the target performance includes families who have made an informed decision to decline immunisations, and, families who despite being offered support have not met the target timeline, the result is not surprising,” Mrs McDonald says.

Meanwhile, Mrs McDonald is delighted that for a third quarter in a row, Whanganui exceeded the 90 percent national target for More heart and diabetes checks by one percent. She says this is down to the dedicated efforts of general practice teams and the Whanganui Regional Health Network’s success in targeting patients who have not had a completed cardiovascular disease risk assessment.
 
Mrs Patterson is pleased with the steady progress being made on the new 85 percent Faster cancer treatmenttarget. This quarter’s 67 percent result is a five percent improvement on the 62 percent result achieved in the October to December quarter. The target asks that 85 percent of patients will receive their first cancer treatment (or other management) within 62 days of being referred as having a high suspicion of cancer. The target will increase to 90 percent by June 2017.

Click here for the full National Health Targets results table for 2014/15 Quarter 3.

In the latest issue (attached below):

Access to the full text of the articles is free but registration is required on the Lancet site. 

Constructs of depression and distress in diabetes: Time for an appraisal
Frank J Snoek, Marijke A Bremmer, Norbert Hermanns

The link between depression and diabetes: The search for shared mechanisms
Calum D Moulton, John C Pickup, Khalida Ismail

Depression and diabetes: Treatment and health-care delivery
Frank Petrak, Harald Baumeister, Timothy C Skinner, Alex Brown, Richard I G Holt

Integration efforts across the Canterbury Health System remain pivotal to Canterbury District Health Board's performance in meeting health targets.

The National Health Targets performance summary quarter three results for 2014/2015 show Canterbury has exceeded the Shorter Stays in ED target achieving 96 percent despite increasing demand and capacity restraints within the hospital.

David Meates, Canterbury DHB chief executive, says the "remarkable" result represents the ongoing integration of services across the health system, particularly for older people to help them stay well in their own homes for longer.

"Although attendance has grown continuously since the February 2011 earthquakes, we are seeing little growth among the older population, which is a reflection of the strategies to care for older people in their own homes and communities being well embedded," Mr Meates says.

He says the biggest growth in attendances remain the younger adult population where there's been a 46 percent increase in non-enrolled patients aged 25-29 presenting to ED.

"We have increased focus on capturing home addresses appropriately and ensuring this group are provided with the right information on where to access primary care rather than defaulting to ED."

Primary care efforts particularly from the 24 Hour Surgery on Bealey Ave, Moorhouse Medical and Riccarton Clinic play a key role in the Canterbury Health System successfully managing acute demand. 

Other impressive results this quarter have been in our Improved Access to Elective Surgery delivering 100 percent of our target delivery (12,851 elective surgeries out of our 17,484 annual target).

"This is really outstanding given the theatre capacity constraints. It is a sign our priorities to improve patient flow, as well as ensuring we are tracking, monitoring and responding to any changes quickly, are working.

Performance exceeded the 'Better Help for Hospitalised Smokers to Quit' target where the Canterbury DHB achieved 97 percent of the 95 percent target.

"There's been a big emphasis on staff education, documentation and referrals. Hospital staff are also being supported to take on roles to support smoking cessation previously held by the Smokefree control team."

Quarter three has been a first for Canterbury in achieving the Increased Immunisation target of immunising 95 percent of eligible children.

"Low opt-off decline rates have contributed to this quarter's performance as well as targeted efforts by primary care."

Canterbury DHB continues efforts towards the meeting the Primary Care Health Targets of Better Help for Smokers (83 percent) and More Heart and Diabetes Checks (78 percent).

"We are committed to working closely with our Primary Health Organisations to actively support the delivery of primary care Health Targets. Initiatives include ongoing education, enhanced clinical engagement, and supporting high risk populations."

*Canterbury received an achieved based on improvement against the quarter two results.  

More information about how Canterbury performed in the health targets can be found on our website.

The West Coast health system has improved its performance in most of the Government’s health target categories thanks to efforts of teams across the Coast health system.

West Coast District Health Board Chief Executive David Meates says the performance improvements across the various targets have resulted from the health system working together on the areas that needed more focus.  A greater awareness of programmes designed to help people take responsibility for their own health has also played a part.

In the emergency department target which requires 95% of patients to be admitted, discharged or transferred from an emergency department within six hours, the West Coast DHB has scored an impressive 99.4%.

The West Coast’s elective surgery target is to deliver 1592 surgeries during the year ending June 30.  The DHB is tracking at 111.3% with 1288 elective surgeries delivered to date.

“With our smoking cessation advice and services, we have met both hospital and primary care targets this quarter.  West Coast DHB staff provided 97.8% of hospitalised smokers with smoking cessation advice and support – exceeding the 95% target with our best result yet,” Mr Meates says.

West Coast Primary Health Organisation Executive Officer Helen Reriti says general practices have reported giving 4,575 smokers advice about stopping, in the 12 months ending March 2015, representing 94% of smokers expected to attend general practice during the period.

“It’s particularly pleasing to have exceeded the 90% target for the first time.  Our clinicians have made huge efforts to tackle this issue, alongside the introduction of new technology to support their initiatives,” Ms Reriti says.

“Likewise, with 90.3% we have met for the first time the 90% target of ensuring the eligible enrolled West Coast population have had a cardiovascular risk assessment in the last five years.  That represents a 7.6% increase on our figures for the last quarter,” she says.

The range of approaches used to increase performance included identifying cardiovascular risk assessment champions within general practices; nurse-led clinics in practices; evening clinics and protected appointment time allocations for checks; Poutini Waiora nurses collaborating with general practices; conducting checks at local events; and using technology to remind patients.

High opt-off and declines continue to be challenging in meeting the immunisation target (95% nationally).  On the West Coast 89% are being immunised, however, we are reaching 100% of “high deprivation children” and 93% of all Maori children. 

This is the second time DHBs have been assessed against the new cancer treatment target and 62.5% of West Coast DHB patients received their first cancer treatment (or other management) within 62 days of being referred with a high suspicion of cancer.

Mr Meates says the Coast’s small population poses a challenge in this area. 

“We are missing this target by just one patient. But work is ongoing to improve the capture and quality of the Faster Cancer Treatment data which will improve our performance over the next few quarters.” 

Full information on the West Coast DHB’s Health Target performance can be found here, and information on the Ministry of Health’s Health Targets site here.

The results for Quarter Three of 2014/15 have been released by the Ministry of Health.

Results indicate that in this quarter, the Taranaki DHB has performed well in improving access to elective surgeries. With results ahead of the national average, the DHB is also paving the way towards the new faster cancer treatment goal, currently ranking fourth in the country for this target. Taranaki DHB has also achieved its target of 95 percent for shorter stays in Emergency Departments.

Taranaki DHB Planning, Funding, and Population Health General Manager, Becky Jenkins said, “A focus on the six key areas is important to continue to improve health, reduce inequalities and improve the quality of health services for local people. This quarter’s results have seen Taranaki DHBs maintain performance in a number of areas.”

Taranaki DHB Chief Operating Officer Gillian Campbell said, “In terms of our hospital services, the results show people in Taranaki have improved access to elective surgery and that we are working hard to ensure patients referred with a high suspicion of cancer are treated in a timely manner.”

The health target results for Taranaki DHB are:

Shorter stays in Emergency Departments: Target 95%, Achieved 95%
95 percent of patients seen in Taranaki Emergency Departments were admitted, discharged, or transferred from the department within six hours.

This result can be attributed to Taranaki DHB and Midland Health Network, the network of 99 percent of General Practitioners (GPs) in Taranaki, working closely together to ensure patients receive the right care, at the right place. That is, the Emergency Department for all emergencies, and their GP for other non-urgent medical needs.

The target was achieved nationally for the first time against a continuing increase in the number of emergency department presentations with 4,481 more people attending this quarter when compared to quarter two.

Improved Access to Elective Surgery: Target 100%, Achieved 120%
Taranaki DHB has again achieved over the target of 100% (for the population) for the improved access to elective surgery target, with a 4 percent increase from quarter two 2014/2015 results. Taranaki DHB has delivered this across a wide range of surgical specialities and is ranked second for its performance.

Assisting in this result has been an ongoing focus on ensuring patients are well prepared for surgery, and a continued reduction in day-of surgery-cancellations. Taranaki DHB is also undertaking a project to increase the surgical day procedure rate. This project is supported by the Ministry of Health.

Significant benefits also continue to be realised from the implementation of the Enhanced Recovery After Surgery (ERAS) programmes.

The national elective surgery health target has been achieved with 123,585 elective surgical discharges provided, against a year-to-date target of 115,588. This is 7997 (6.9 percent) more than planned.

Faster Cancer Treatment: Target 85%, Achieved 72%
This is the second quarter of public reporting of the new faster cancer treatment health target results. Nationally, results increased by 1.6 percent compared with the previous quarter to 67.4 percent overall. Data includes patients who received their first cancer treatment between October 2014 and March 2015. No DHBs have met the 85 percent target.

Taranaki DHB plans to continue this strong performance, and its collaborative relationship with the MidCentral DHB, to continue to work towards the target.

The target is 85 percent of patients receive their first cancer treatment (or other management) within 62 days of being referred with a high suspicion of cancer and a need to be seen within two weeks by July 2016, increasing to 90 percent by June 2017. Results cover those patients who received their first cancer treatment between July and December 2014.

Increased Immunisation: Target 95%, Achieved 91%
This quarter, 91 percent of Taranaki eight-month-olds were fully immunised. This is a decrease of 2% from the last quarter. These results are in line with historical expectations for quarter three because of the difficulty in vaccinating children during the summer holidays.

Nationally, the increased immunisation health target, national coverage at eight months was 92.9 percent, an overall decrease of 0.6 percent compared with the previous quarter but 1.5 percent higher than the same quarter in 2013/14.

Taranaki DHB has worked closely with primary care organisations, hospital services, outreach immunisation services, the National Immunisation Register and Well Child Providers on strategies to help improve our immunisation uptake, including early enrolment of new-borns with a GP.

A high level of immunisation coverage (around 95%) is required to prevent community spread of two common infectious diseases - measles and whooping cough. Taranaki DHB and the wider sector are working together to increase activity through to June 2015, with the aim of reaching the 95% target.

Better Help for Smokers to Quit (Hospital Target): Target 95%, Achieved 94%
Taranaki DHB continues to work hard to ensure patients and visitors to its hospitals are given advice about quitting smoking. By supporting smokers to quit, the aim is to improve the health of those around them by reducing exposure to second hand smoke.

A national total of 31,522 hospitalised smokers were offered brief advice and/or cessation support during quarter three, out of a possible 32,980.

Better Help for Smokers to Quit (Primary Care Target): Target 90%, Achieved 86%
Taranaki DHB is committed to working collaboratively with our Primary Care Organisation to continue to strengthen and implement a range of good practices to ensure all patients who smoke are offered or given effective stop smoking support.

More Heart and Diabetes Checks: Target 90%, Achieved 91%
This quarter, 91 percent of the eligible population had heart and diabetes checks. This is a one percent increase on Taranaki’s quarter one results.

Diabetes and cardiovascular disease remains one of the main causes of ill health in Taranaki and Taranaki DHB continues to work hard to provide the best outcomes for these people.

The implementation of a multidisciplinary team to support the care provided by GP practices, and the ongoing education of GP’s and practice nurses in the care and management of diabetic patients in the community, are just two examples.

Results show there were approximately 150,600 more checks provided in the five years to the end of March 2015 compared with the five years to the end of March 2014.

The results of the six national health targets across all 20 District Health Boards (DHBs) have been released today for the January to March 2015 quarter.  We sustained our improvements to achieve the goals again this quarter for Shorter Stays in the Emergency Department, and Better Help for Smokers to Quit for patients admitted to hospital.  A summary of our results for all the national health targets this quarter is provided below.

Just under 96% (9520) of 9961 people were admitted, discharged or transferred from the Emergency Department (ED) within six hours of presenting – A small improvement on last quarter and again achieving the national target.  Compared to the same quarter last year when we had a similar number of people presenting to the Emergency Department, 559 more people had shorter stays in ED this quarter – a sizeable improvement that reflects the concerted effort of a large number of staff to ensure better patient flow processes, and, together with our general practice teams, better manage the demand for acute health care services.

We continue to be ahead of target for the number of people discharged following their elective surgery.  Over this quarter, another 1701 patients were discharged following their elective surgery bringing the total number to 5377 patients who have had their elective surgical procedure over the last nine months – delivering 110% of our planned target year to date.  About 11% of our patients have their planned surgery at other hospitals that provide specialist surgery to residents of the wider region, like Wellington for heart surgery, and Hutt Valley for plastic and burns surgery.

The new national target for faster cancer treatment was published for the first time last quarter.  The target is that by July 2016, 85 percent of patients receive their first cancer treatment (or other management) within 62 days of being referred with a high suspicion of cancer and a need to be seen within two weeks.  Our result this quarter, at 67%, is consistent with last quarter and the same as the national average for this period (results cover those patients who received their first treatment between October 2014 and March 2015).  This target focuses on a sub-set of patients who are referred through a managed, outpatient pathway.  Our aim is to make steady improvements toward this target by examining referral guidelines and pathways to earlier diagnosis and treatment that will ultimately benefit all cancer patients.

The hospital component of the national health target for offering advice and support to quit smoking was achieved for the second consecutive quarter, with a result of 97.0%.  This was a small improvement on the result last quarter and just above the national average (96%).  Of the adult patients admitted to hospital who smoke (about 15% of all admissions), 1111 patients have been offered brief advice and support to quit smoking over the last nine months.

The result for providing better help for smokers to quit in the primary healthcare setting could not be reported in time for publishing this quarter.  This was disappointing, especially as the targeted ‘quit smoking’ campaign that was undertaken over the last few months by our primary health organisation (CentralPHO) and general practice teams is likely to have contributed to a big improvement on our previous results.  We are currently verifying the data and expect that updated data will be published on the health targets website within the next week or so.

Our result for eight-month-old infants being fully immunised on time fell slightly this quarter to 94.4% - just short of the 95% target, which we attained last quarter.  A drop in the rate this quarter is similar to the pattern last year, with the summer holiday period making it a bit more difficult to reach families with infants due for their immunisation.  Our immunisation team, including general practices and outreach services, continue to work together with families to ensure the vast majority of our children are immunised against vaccine preventable diseases.

The proportion of our eligible enrolled population that have had their risk for cardiovascular disease assessed in the last five years was much the same as last quarter.  Although there were another 367 heart and diabetes checks undertaken between January and March, the proportion of the total expected number to have had a risk assessment over the last 12 months fell short of the 90% target, at 85% of the 47,260 eligible enrolled adults.  CentralPHO is continuing to support general practice teams and our Maori and Pacific health providers to enable more people to have a heart and diabetes check to minimise the risk of them having a heart attack or stroke in the next five years.

Chief executive officer Kathryn Cook has thanked staff for their continued efforts to improve on our performance against these targets.

For more details and FAQs about the Health Targets go to: www.health.govt.nz/healthtargets and the 'MyDHB' website.

Health Minister Jonathan Coleman says the latest quarterly health target results show the shorter stays in emergency departments target has been met for the first time.

“DHBs are continuing to improve their performance on the Government’s health targets,” says Dr Coleman.

“Across the country over 250,000 New Zealanders were admitted, discharged or transferred from an emergency department within six hours. Achieving the 95 per cent target for the first time is a significant achievement.

“The number of patients presenting to emergency departments continues to increase. In quarter three, 4,481 more people attended an emergency department compared to the last quarter.

“Reaching the target is a tribute to all the staff working within emergency departments and DHBs. We know that emergency departments only work well when the rest of the hospital is working well too.”

The improved access to elective surgery and the hospital component of the better help for smokers to quit targets were also met:

• 96 per cent of smokers in hospitals were offered advice on how to quit.
• DHBs delivered 7,997 more elective surgical discharges than planned.

“DHBs remain focused on reducing waiting times for elective first specialist assessments and treatment,” says Dr Coleman.

“The extra $98 million for elective surgery in Budget 2015 will provide more New Zealanders with timely surgery. The Government is committed to continuing to deliver increases in elective surgery.”

The results also show good progress on other targets, including:

• The more heart and diabetes checks target increased to 88 per cent.
• The primary care component of the better help for smokers to quit target increased to 89 per cent.
• The new faster cancer treatment health target increased to 67 per cent – this is the second time this target has been reported.

The quarter three (January-March 2015) results can be found at www.health.govt.nz.

The results of district health board performance against six health targets for the third quarter 2014/15 has been released.

The results are available at:  http://www.health.govt.nz/new-zealand-health-system/health-targets/how-my-dhb-performing/how-my-dhb-performing-2014-15

Studies were included if they described an intervention for one or more of six chronic conditions that was delivered in a primary health care setting in Australia, New Zealand, Canada or the United States. Attitudes, beliefs, expectations, understandings and knowledge of patients, their families, Indigenous communities, providers and policy makers were of interest. Published and unpublished qualitative and quantitative studies from 1998 to 2013 were considered. Qualitative findings were pooled using a meta-aggregative approach, and quantitative data were presented as a narrative summary.

Twenty three studies were included. Meta-aggregation of qualitative data revealed five synthesised findings, related to issues within the design and planning phase of interventions, the chronic disease workforce, partnerships between service providers and patients, clinical care pathways and patient access to services. The available quantitative data supported the qualitative findings. Three key features of enablers and barriers emerged from the findings: (1) they are not fixed concepts but can be positively or negatively influenced, (2) the degree to which the work of an intervention can influence an enabler or barrier varies depending on their source and (3) they are inter-related whereby a change in one may effect a change in another.

The authors conclude that future interventions should consider the findings of this review as it provides an evidence-base that contributes to the successful design, implementation and sustainability of chronic disease interventions in primary health care settings intended for Indigenous people.

This is an open access article and can be read in free full text at:  http://dx.doi.org/10.1186/s13012-015-0261-x

Gibson, O., et al. (2015). Enablers and barriers to the implementation of primary health care interventions for Indigenous people with chronic diseases: A systematic review. Implementation Science, 10:71.

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1016/j.diabres.2015.05.037 or contact your DHB library, or organisational or local library for assistance.

IDF Diabetes Atlas Group (2015). Update of mortality attributable to diabetes for the IDF Diabetes Atlas: Estimates for the year 2013. Diabetes Research and Clinical Practice, 21 May [Epub before print]

Topics covered include: Epidemiology of paediatric diabetes: a growing problem? New insights into pathophysiology; Making the diagnosis: effect of correct diagnosis and action; Management of type 1 diabetes; Controversies; Management of type 2 diabetes: limited evidence leads to limited options; Can paediatric diabetes be prevented? Future directions: closing the loop?

Access to the full text of the article is free but registration is required on the Lancet site. 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)60971-0 or contact your local, DHB or organisational library for assistance.

Cameron, F.J. & Wherrett, D.K. (2015). Care of diabetes in children and adolescents: Controversies, changes, and consensus. The Lancet, 385(9982), 2096-2106.

The first definitive summary of the best and safest treatments for kidney disease and diabetes patients has been compiled by Christchurch doctor and researcher Associate Professor Suetonia Palmer.

The international relevance of her work for doctors, patients and those who decide which drugs to fund has been demonstrated by the prestigious Lancet medical journal publishing an article on her study in its latest edition.

The University of Otago, Christchurch researcher together with a global team used innovative statistical analysis to compare hundreds of research studies on the effectiveness of blood-pressure-lowering drugs for patients with kidney disease and diabetes. The result: a one-stop-shop, evidence-based guide on which drugs are safe and effective.

Diabetes and high blood pressure are the most common causes of kidney disease around the world, and people often have both. Chronic kidney disease caused by diabetes always affects both kidneys and generally gets worse over time, often leading to kidney failure requiring dialysis treatment or a kidney transplant.

Associate Professor Palmer says this study is important because diabetes and kidney disease are at epidemic proportions in New Zealand. A common treatment for those with diabetes and kidney disease is blood-pressure-lowering drugs. The aim of these drugs is to prevent kidney damage.

However, doctors and patients face a bewildering array of treatment options as there are many drugs available to lower blood pressure, many used in combination. There are also hundreds of research studies done on the effectiveness of drugs or combinations of drugs. It is not possible for people to identify the best available treatments without scientific advances such as this study.

Associate Professor Palmer works as a nephrologist, or kidney specialist, at the Canterbury District Health Board and commonly sees first-hand how confusing the wide range of treatment options can be for patients, and those who treat them.

Her paper is the first to compare all drug options, and combinations of commonly used drugs, against each other.

Associate Professor Palmer says it is thrilling to have her work recognised by one of the world’s leading medical journals.

“It shows that we are producing research of international value at the University of Otago in Christchurch in collaboration with strong global partnerships.”

The research published in the Lancet journal was funded by the Canterbury Medical Research Foundation. Associate Professor Palmer also receives funding from the Royal Society as a Rutherford Discovery Fellow and the Health Research Council of New Zealand. The research was done in collaboration with researchers at the Universities of Sydney, Ioannina, Copernicus, Calgary, Bari, Alberta, and Novara, and University College London. The Australian authors are Professor Jonathan Craig and Giovanni Strippoli, affiliated with the Sydney School of Public Health.

Read the Lancet article here.

Original Health Navigator NZ material is produced and updated by a team of medical writers and subject experts.

The Health Navigator NZ website is a non-profit community initiative combining the efforts of a wide range of partner and supporter organisations overseen by the Health Navigator Charitable Trust.

A new working group has been established which brings together a team of professionals from the South Island health sector with a focus on child and adolescent diabetes care.

The aim of this group is to improve care across the South Island for young people with diabetes, in particular Type 1 diabetes.  Its establishment is part of a wider strategy overseen by the South Island Alliance’s Child Health group to establish a Regional approach to diabetes service planning, and to achieve consistency in standards and provision of diabetes care.

The group will produce a work plan that will align with strategies already in place - such as those being delivered by the National Clinical Network for Children and Young People with Diabetes.

Members of the group met for the first time in April, recruited from the five South Island DHBs and primary care providers, plus a consumer representative, to discuss the terms of reference, and identify any professional gaps within the group’s membership.

Dr David Barker, Clinical Leader for Children’s Health Southern District Health Board and Chair of the Child Health South Island Alliance Group said, “We are thrilled to be able to bring together a group with expert knowledge of issues relating to diabetes care in a new forum to enable work across the region. This will help to ensure that young diabetes patients receive high quality, accessible and equitable care.”

The group plans to meet monthly. For more information about the group contact Jane.haughey@siapo.health.nz

This journal provides an international multidisciplinary forum with a holistic approach to public health issues, health and medicine, health and social policy, service aspects, developmental aspects, epidemiology, rehabilitation, family and social issues, quality of life and all other aspects of public health over the whole age spectrum. 

This Account focuses on the quality of services Hutt Valley DHB provided during 2013/2014.

Contents include: Health targets; Quality & safety markers; Serious adverse events; Patient experience Receiving care closer to home; Getting in shape before joint surgery; Getting better at home; Helping cancer patients find their way; Encouraging attendance; Community Safety Initiatives HealthPathways; More heart and diabetes checks; Help quit smoking; Disability services; Empowering staff; Giving babies the best possible start; Patient safety initiatives; Open campaign; Care capacity demand management; Electronic whiteboard; Newborn hearing screening; Malnutrition screening & training; Supervisor training; Looking forward; Future Focus.

This Quality Accounts is available to read in full text at:  http://www.huttvalleydhb.org.nz/content/10ff5f6d-fe7e-4a44-8667-5b72672d3214.html

To read the full story on the HRC website, go to:  http://www.hrc.govt.nz/news-and-publications/news-media#brain-stimulation-shows-promise-for-stroke-rehab

The report is available to read in full text at:  http://www.phcris.org.au/phplib/filedownload.php?file=/elib/lib/downloaded_files/publications/pdfs/phcris_pub_8441.pdf

Erny-Albrecht K, Bywood P, Oliver-Baxter J. (2015). The role of primary care in primary and secondary prevention of diabetes and related complications. PHCRIS Policy Issue Review. Adelaide: Primary Health Care Research & Information Service.

HIIRC identified this research via the Ministry of Health Library's Grey Matter newsletter.

This evidence briefing, Supporting self-management: Helping people manage long-term conditions, has been produced by the Centre for Reviews and Dissemination.

"The study focuses in on the content of these new models, which are frequently applied from different disciplinary and professional perspectives and associated with different goals and does so through analyzing approaches to self-management support, service delivery design and decision-support strategies, financing, availability and access. Significantly, it also illustrates the challenges faced by individual patients as they pass through the system".

The book is free to download at:  http://www.euro.who.int/en/about-us/partners/observatory/publications/studies/assessing-chronic-disease-management-in-european-health-systems-country-reports

Nolte, E. & Knai, C. (2015). Assessing chronic disease management in European health systems: Country reports. Brussels: European Observatory on Health Systems and Policies.

WHO presents World Health Statistics 2015 as an integral part of its ongoing efforts to provide enhanced access to comparable high-quality statistics on core measures of population health and national health systems.

To download the report, go to:  http://www.who.int/gho/publications/world_health_statistics/2015/en/

A new national brain research initiative intended to help New Zealanders to age well with a healthy brain will be launched simultaneously in Auckland and Dunedin this month. (22 May)

Brain Research New Zealand - Rangahau Roro Aotearoa, a new government funded Centre of Research Excellence (CoRE), aims to use its unique combination of scientific, clinical and community connections to unlock the secrets of the ageing brain.

The launch will be led by the Minister of Science and Technology, the Hon Steven Joyce, with a video link between researchers gathering at the sites of the CoRE’s key research units, the University of Auckland’s Centre for Brain Research and the University of Otago’s Brain Health Research Centre.

The CoRE is unique in being co-hosted by the University of Otago and the University of Auckland, with collaboration from researchers at University of Canterbury and AUT University, and clinicians at various District Health Boards.

The multi-centre research team will develop a better understanding of ageing-related neurological disorders in order to find new therapies that can lead to improved life-long brain health for all New Zealanders. 

 “We will be applying our cutting edge neuroscience research in partnership with outstanding clinicians and our growing relationships with the community, to develop a truly national, collaborative response to an issue of critical importance to all New Zealanders,” says BRNZ co-director, Professor Cliff Abraham from the University of Otago.

Fellow co-director, Professor Richard Faull from the University of Auckland, says the unique advantage of this CoRE is the collaborative integration of ageing-related neuroscience at New Zealand’s premier tertiary institutions.

“New Zealand has a world-class brain research capability and Brain Research New Zealand (BRNZ) draws on this capability to create a cohesive and mutually reinforcing national team. This collaboration brings researchers engaged in ageing-related neuroscience under one virtual roof, reducing competition and encouraging cooperation.”

BRNZ will seek answers to the increasing burden of ageing-related brain disorders in New Zealand and the world.

It is anticipated that by 2036 there will be 1.2 million New Zealanders aged over 65 years (up to 20 percent of the population), of whom 200,000 will be over 85 years old.

This increase in the number of older New Zealanders will result in large numbers of people living with the effects of ageing-related brain disorders such as stroke, dementia (e.g. Alzheimer’s disease), Parkinson’s disease, and various sensory/motor dysfunctions.

These disorders currently affect one in five of the New Zealand population aged over 65 years, and by 2036 one in four older New Zealanders will have an ageing-related brain disorder, creating a significant economic and social burden.

Dementia cost New Zealand $955 million in 2011 and the net value of the burden of disease was $12.4 billion, while stroke and traumatic brain injury have direct costs of over $250 million per annum.

“This represents a huge challenge that requires the development of a new approach that has a whole-of-life brain-health focus,” says Professor Faull. “To build a national response to meet this challenge, BRNZ will harness the world-class research capacities of our universities, the clinical expertise across our hospitals, in partnership with community organisations supporting people living with the devastating effects of ageing brain disorders.”

Brain Research New Zealand will be a national enterprise that, through a coordinated research, training and education programme, will develop new capacity and capability to address the increasing burden of ageing-related brain disorders.

The launch of Brain Research NZ takes place at 10am on 22 May 2015, at both the University of Auckland’s Grafton Campus and the University of Otago’s Medical School campus in Dunedin.  Media will need to contact Suzi Phillips for access to the launch in Auckland and Megan McPherson for access to the launch at the University of Otago.

Brain Research New Zealand has four main research themes:

• Theme 1 will focus on understanding the ageing brain with a view to developing new therapies. It moves from basic scientific understanding of changes in the ageing brain at the molecular, cellular and network level through to evaluation of potential therapeutics in animal models and humans.
• Theme 2 will centre on the discovery, development and validation of novel biomarkers and disease indicators for normal ageing, neurodegeneration and stroke. These will be used for early identification of susceptible individuals who can then be enrolled in treatment studies in other Themes.
• Theme 3 will expand our understanding of neuroplasticity mechanisms in adulthood and ageing, and allow development of procedures that harness this plasticity to assist rehabilitation therapies or technologies.
• Theme 4 will involve a wide range of community outreach activities, as well as trials of new clinical therapies. The latter will include a national network of Dementia Research Clinics to promote the clinical evaluation and implementation of preventative measures and early interventions developed in the other Themes to minimise ageing-related neurological decline.

Outcomes from the BRNZ CoRE

BRNZ will produce world class collaborative research across the nation that addresses key health and social challenges relating to brain health.

BRNZ will fulfil its mission through internationally leading-edge brain research that will deliver new knowledge on brain ageing and associated neurological disorders.

Over time and in partnership with key stakeholders, (including the Ministry of Health, District Health Boards, and Māori), BRNZ will translate this new knowledge into new treatments, therapies and interventions to provide innovative solutions for ageing-related brain disorders in New Zealand.

To fulfil the mission of Brain Research New Zealand­ - Rangahau Roro Aotearoa we will achieve the following long-term outcomes:

• A Centre of Neuroscience Research Excellence that is nationally and internationally recognised and sought after for its expertise and innovation in the study of the aging brain.
• Improved strategies for prevention, early detection and slowing of progression of ageing-related neurological disorders, through identification of early biomarkers and an improved understanding of the mechanisms of ageing-related neurological disorders.
• Improved clinical practice by translating scientific knowledge into treatments, strategies and care pathways aimed at delaying or moderating ageing-related neurological disorders
• Better health outcomes, improved quality of life and positive ageing for older persons and their families, including reduced physical, emotional, social and financial costs of ageing-related neurological disorders, through public dissemination of the latest research and the creation of partnerships with patients, families, community organisations and non-governmental organisations across New Zealand
• Increased scientific, clinical, translational and leadership capability that will improve research output, patient outcomes, productivity and health industry research capacity
• Improved Maori health and wellbeing during ageing by working with Māori communities to understand their needs and values and build equal relationships, incorporating Mātauranga into innovative research and clinical methods, and by supporting Māori to determine their own pathways to brain health through training of Māori neuroscientists and clinicians

The Centre promotes collaboration amongst those involved in diabetes-related research. They engage with a range of departments within the University of Otago as well as working alongside researchers and healthcare providers throughout New Zealand and internationally.

The Auckland Branch team provides community health promotion, education and awareness; health professional training; mobile diabetes awareness services; membership services, support groups and diabetes supplies. The Auckland Branch can also act as an advocate and speak to employers, health professionals, local and national government on behalf of people with diabetes or people at risk of diabetes.

The number of strokes occurring in men aged between 40 and 54 has rocketed by almost 50% in less than 15 years, according to the Stroke Association.(i)

An analysis of hospital admission data by the charity, to mark Action on Stroke Month 2015, reveals that in 2000, there were over 4,260 hospital admissions for stroke among men aged between 40 and 54 in England. This figure soared to 6,221 in 2014 – an increase of 46%. It is thought that the rise is due to increasing sedentary and unhealthy lifestyles, and changes in hospital admission practice.

The charity’s research shows the number of women aged 40-54 admitted to hospital after a stroke in the last 15 years has also dramatically increased by almost a third (30%) - from 3,529 in 2000, to 4,604 in 2014.(ii) Overall, the number of strokes occurring in people of working age (20-64) has risen by a quarter within the past 15 years.(iii)

Jon Barrick, Chief Executive of the Stroke Association, said: “These figures show that stroke can no longer be seen as a disease of older people. There is an alarming increase in the numbers of people having a stroke in working age. This comes at a huge cost, not only to the individual, but also to their families and to health and social care services.

“The simple truth is that we must do more to raise people’s awareness of risk factors, to help prevent them from having a stroke. With many more stroke patients now receivingemergency medical treatment, we also need the right health and social care services available. People must have the support they need to make the best possible recovery and avoid having to cope for decades with the disabilities that stroke can bring.”

The charity is warning that the rise in working age stroke means more people will be forced to live with the heavy financial impact of the condition. Stroke survivors unable to return to work can struggle to cope with a fall in income, increased household bills and a benefits system which does not recognise the full impact of stroke. Overall, stroke costs the UK economy around £9bn a year. Loss of income, due to death and disability from stroke alone, is over £1.3billion each year.(iv)

A survey of businesses regarding their attitudes on the impact of stroke on their staff, for Action on Stroke Month 2015, showed that:(v)

Just one in 20 employers recognised cognitive difficulties as a symptom of stroke.

When asked why businesses might be reluctant to employ a stroke survivor, two fifths (42%) said that they would have concerns about the impact of a stroke on an employee’s ability to carry out their role.

Half (50%) had not heard of the Government’s Access to Work Scheme.(vi)

Jon Barrick said: “Having a stroke is bad enough, but being written off by your employer through a lack of understanding can be catastrophic. Businesses play a crucial role in helping stroke survivors get back into the workplaceand on the road to recovery. That’s why we’re calling on employers to be aware of the physical and emotional impact of stroke.” 

Brendan Roach, Senior Disability Consultant at Business Disability Forum, added: “Our experience of working with organisations for over 20 years demonstrates that businesses with an effective and well publicised process for making disability-related workplace adjustments are best placed to meet the challenge of risings rates of stroke. That’s why we’re supporting the Stroke Association’s work to encourage employers to understand the needs of stroke survivors and become ‘disability-smart’.”

The Stroke Association provides advice and practical support to help stroke survivors return to employment. For more information, visit www.stroke.org.uk or call 0303 303 3100.

The review broadens the work of other similar reviews by focusing on effectiveness of healthcare practice as well as health outcomes associated with implementing a chronic care model. In addition, relevant case series and case studies were also included.

Of the 77 papers which met the inclusion criteria, all but two reported improvements to healthcare practice or health outcomes for people living with chronic disease. While the most commonly used elements of a chronic care model were self-management support and delivery system design, there were considerable variations between studies regarding what combination of elements were included as well as the way in which chronic care model elements were implemented. This meant that it was impossible to clearly identify any optimal combination of chronic care model elements that led to the reported improvements.

While the main argument for excluding papers reporting case studies and case series in systematic literature reviews is that they are not of sufficient quality or generalizability, the authors found that they provided a more detailed account of how various chronic care models were developed and implemented. In particular, these papers suggested that several factors including supporting reflective healthcare practice, sending clear messages about the importance of chronic disease care and ensuring that leaders support the implementation and sustainability of interventions may have been just as important as a chronic care model’s elements in contributing to the improvements in healthcare practice or health outcomes for people living with chronic disease.

This is an open access article and is available to read in free full text at:  http://dx.doi.org/10.1186/s12913-015-0854-8

Davy, C., et al. (2015). Effectiveness of chronic care models: opportunities for improving healthcare practice and health outcomes: A systematic review. BMC Health Services Research, 15:194.

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1016/j.ijcard.2015.04.230 or contact your DHB library, or organisational or local library for assistance.

Webb, G., et al. (2015). The care of adults with congenital heart disease across the globe: Current assessment and future perspective: A position statement from the International Society for Adult Congenital Heart Disease (ISACHD). International Journal of Cardiology, 195, 326–333.

Thirty studies (48 566 participants) were identified. The authors conclude from the results that "dialysis patients who have markedly higher risks of ulceration or amputation include those with previous foot ulceration or amputation, peripheral neuropathy, diabetes or macrovascular disease. The temporal relationship between these risk factors and the development of foot ulceration and/or limb loss is uncertain and requires further study".

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1093/ndt/gfv114 or contact your DHB library, or organisational or local library for assistance.

Kaminski, M.R., et al. (2015).  Risk factors for foot ulceration and lower extremity amputation in adults with end-stage renal disease on dialysis: A systematic review and meta-analysis. Nephrology Dialysis Transplantation, 5 May [Epub before print]

Eight randomised controlled trials were included. The authors conclude from the results of their analysis that "in patients with cardiovascular disease, influenza vaccination may reduce cardiovascular mortality and combined cardiovascular events. However, studies had some risk of bias, and results were not always consistent, so additional higher-quality evidence is necessary to confirm these findings. Not enough evidence was available to establish whether influenza vaccination has a role to play in the primary prevention of cardiovascular disease".

This review is available to read in free full text at:  http://dx.doi.org/10.1002/14651858.CD005050.pub3 

Clar C, Oseni Z, Flowers N, Keshtkar-Jahromi M, Rees K. (2015). Influen.za vaccines for preventing cardiovascular disease. Cochrane Database of Systematic Reviews,  5, CD005050.

Searches identified 46 calculators that performed simple mathematical operations using planned carbohydrate intake and measured blood glucose. While 59% of apps included a clinical disclaimer, only 30% documented the calculation formula. 91% lacked numeric input validation, 59% allowed calculation when one or more values were missing, 48% used ambiguous terminology, 9% did not use adequate numeric precision and 4% did not store parameters faithfully. 67% of apps carried a risk of inappropriate output dose recommendation that either violated basic clinical assumptions (48%) or did not match a stated formula (14%) or correctly update in response to changing user inputs (37%). Only one app, for iOS, was issue-free according to our criteria. No significant differences were observed in issue prevalence by payment model or platform.

The authors conclude that the majority of insulin dose calculator apps provide no protection against, and may actively contribute to, incorrect or inappropriate dose recommendations that put current users at risk of both catastrophic overdose and more subtle harms resulting from suboptimal glucose control. Healthcare professionals should exercise substantial caution in recommending unregulated dose calculators to patients and address app safety as part of self-management education. The prevalence of errors attributable to incorrect interpretation of medical principles underlines the importance of clinical input during app design. Systemic issues affecting the safety and suitability of higher-risk apps may require coordinated surveillance and action at national and international levels involving regulators, health agencies and app stores.

This is an open access article and is available to read in free full text at:  http://dx.doi.org/10.1186/s12916-015-0314-7

Huckvale, K., et al. (2015). Smartphone apps for calculating insulin dose: A systematic assessment. BMC Medicine, 13:106.

Studies in this issue (attached below):

Nearly 100 experts, engineers, physiologists, clinicians, medical academics and students from around the world will discuss the impact of new technology on helping recovering patients at an international stroke rehabilitation conference in Christchurch next week.

Keynote speakers from the United States, Hong Kong, Australia and New Zealand will talk about neuroscience and neural recovery, clinical research and commercialisation.

The May 10 to 12 conference is being hosted by the University of Canterbury Rose Centre for Stroke Recovery and Research at St George’s Medical Centre. The conference is the only one of its kind in New Zealand to target stroke rehabilitation specialists with a focus on applied biotechnology.

Strokes cost the New Zealand health bill about $450 million a year. The Rose Centre’s deputy director Dr Phoebe Macrae says there is increasing need for novel and innovative treatments, to reduce the burden of strokes, such as mortality, pneumonia and dehydration.

“Research has shown that Maori and Pasifika people in New Zealand have a much higher incidence of suffering a stroke than their European counterparts. This research also highlights that the average age of stroke is significantly younger in these populations, by an average of 10-15 years. Twenty five percent of people who recover from their first stroke will have another one within five years.

“At any point in time, there will be over 32,000 New Zealanders who have survived their initial stroke but are living with the disabilities arising from a stroke. These people require ongoing and intensive rehabilitation to improve their quality of life. 

“Factors such as unhealthy diet, obesity, high blood pressure, smoking and lack of physical exercise will also result in a higher prevalence of stroke. Stroke is the second most common cause of death worldwide and a common cause of disability in adults in developed countries. The incidence of stroke in New Zealand is high compared to other developed countries with over 9000 new stroke events each year and over 2500 deaths attributable to this condition. 

“At the university’s Rose Centre we are focusing on addressing all aspects of post-stroke rehabilitation. We want to develop and provide clinical services for stroke patients that meet patients’ clinical needs and also allow patients to contribute to research that will help others. We are looking to create bioengineering applications that will facilitate recovery by allowing patients greater access to intervention techniques.”

The centre’s director Associate Professor Maggie-Lee Huckabee, Dr Macrae, biomedical engineer Esther Guiu Hernandez, PhD students Kerstin Erfmann, Sarah Davies and Kristin Lamvik and alumni Alex Lippitt are among the speakers at the conference.

http://www.health.govt.nz/publication/general-practice-toolkit-more-heart-and-diabetes-checks-and-better-help-smokers-quit

There is also an interesting link on this website to the UK video: "How to discuss smoking"

This video demonstrates how to use motivational approaches to discuss smoking with our patients (see below)

Six trials were included and the authors conclude from their analysis that "general practice-based health checks are associated with statistically significant, albeit clinically small, improvements in surrogate outcome control, especially among high-risk patients. Most studies were not originally designed to assess mortality".

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.3399/bjgp14X676456 or contact your DHB library, or organisational or local library for assistance.

Si, S., et al. (2015). Effectiveness of general practice-based health checks: A systematic review and meta-analysis. British Journal of General Practice, 64(618), e47-53.

Fifteen studies met the inclusion criteria: one randomized controlled trial, two time series analyses, three controlled before and after studies, five uncontrolled before and after studies, two retrospective observational studies, and two prospective observational studies. Studies were heterogeneous in quality; thus, meta-analysis was not feasible.

Thirteen studies examined prehospital delay, with ten studies reporting a significant reduction in delay times, with a varied magnitude of effect. Eight studies examined thrombolysis rates, with only three studies reporting a statistically significant increase in thrombolysis administration. Five studies examined ambulance usage, and four reported a statistically significant increase in ambulance transports following the intervention. Three studies examining ED presentations reported significantly increased ED presentations following intervention.

Public educational interventions varied widely on type, duration, and content, with description of intervention development largely absent from studies, limiting the potential replication of successful interventions.

The authors conclude that positive intervention effects were reported in the majority of studies; however, methodological weaknesses evident in a number of studies limited the generalisability of the observed effects. Reporting of specific intervention design was suboptimal and impeded the identification of key intervention components for reducing patient delay. They go on to say that studies incorporating a rigorous study design are required to strengthen the evidence for public interventions to reduce patient delay in stroke. 

This is an open access article and can be read in free full text at:  http://dx.doi.org/10.2147/PROM.S54087

Mellon, L., et al. (2015). Stroke warning campaigns: Delivering better patient outcomes? A systematic review. Patient Related Outcome Measures, 6, 61-73.

Studies in this issue (attached below):

The Study of Heart and Renal Protection (SHARP) randomised trial prospectively collected information on kidney disease progression, serious adverse events and hospital care use in a cohort of patients with moderate-to-severe CKD. In a secondary analysis of SHARP data, the impact of participants’ CKD stage, non-fatal cardiovascular events and deaths on annual hospital costs (i.e. all hospital admissions, routine dialysis treatments and recorded outpatient/day-case attendances in United Kingdom 2011 prices) were estimated using linear regression.

7,246 SHARP patients (2,498 on dialysis at baseline) from Europe, North America, and Australasia contributed 28,261 years of data. CKD patients without diabetes or vascular disease incurred annual hospital care costs ranging from £403 (95% confidence interval: 345-462) in CKD stages 1-3B to £525 (449-602) in CKD stage 5 (not on dialysis). Patients in receipt of maintenance dialysis incurred annual hospital costs of £18,986 (18,620-19,352) in the year of initiation and £23,326 (23,231-23,421) annually thereafter. Patients with a functioning kidney transplant incurred £24,602 (24,027-25,178) in hospital care costs in the year of transplantation and £1,148 (978-1,318) annually thereafter. Non-fatal major vascular events increased annual costs in the year of the event by £6,133 (5,608-6,658) for patients on dialysis and by £4,350 (3,819-4,880) for patients not on dialysis, and were associated with increased costs, though to a lesser extent, in subsequent years.

The authors conclude that renal replacement therapy and major vascular events are the main contributors to the high hospital care costs in moderate-to-severe CKD. These estimates of hospital costs can be used to inform health policy in moderate-to-severe CKD.

This is an open access article and can be read in free full text at:  http://dx.doi.org/10.1186/s12882-015-0054-0

Kent, S., et al. (2015). What is the impact of chronic kidney disease stage and cardiovascular disease on the annual cost of hospital care in moderate-to-severe kidney disease? BMC Nephrology, 16:65.

In its new report Patient access to general practice: ideas and challenges from the front line, the College examines a wide range of initiatives to increase patient access to general practice – but warns that this can only be achieved with increased funding and significantly more GPs.

It looks at the five main drivers for improving patient access to general practice – including maximising the potential of technology such as smart phone apps and web-based consultations, and extending opening hours by bringing practices together in ‘federations’ to pool their resources

It also provides case studies of practices that have improved access without compromising patient safety or the quality of care.

To read the report, go to:  http://www.rcgp.org.uk/news/2015/february/~/media/Files/Policy/A-Z-policy/Patient-access-to-general-practice-2015.ashx

Victoria University media release, 24 April 2015

Starting university is a big change for anyone. And it’s even more difficult for students who have to manage an ongoing health issue at the same time.

The National Stroke Foundation of Australia has run 12 public awareness campaigns since 2004. The aim of this study was to measure the effect of campaigns on calls to ambulance for stroke across Australia in exposed regions.