The New Zealand medical journal
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Penetrating thoracic trauma poses a management challenge to the on-call surgeon. A casual and unwary approach can lead to unforeseen complications in the initial height of management of such patients. We present a case of penetrating thoracic trauma where initial management with closed tube thoracostomy resulted in intubation of the stomach that had herniated into the chest through a diaphragmatic rent. Patients with penetrating injuries to the zone between the abdomen and chest should be managed with a high index of suspicion.
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The National Primary Medical Care survey was undertaken to describe primary health care in New Zealand, including the characteristics of accident and medical (A and M) clinic providers, their practices, the patients they see, the problems presented, and the management offered. ⋯ The main impression is that the medical A and M clinics provide episodic treatment for relatively young patients mainly related to a new, short-term problem, particularly an injury or a respiratory illness. This picture is consistent with previous research and the role of similar clinics overseas. Further work is needed to compare A and M clinics with established general practice in relation to the services that are provided as well as the acceptability and quality of these services.
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Trans fats (trans fatty acids) are commonly used for deep frying in restaurants and in the fast food, snack food, fried food, and baked goods industries, often to extend the shelf life of foods. However they are widely considered to be harmful to health. ⋯ Denmark became the first country, in March 2003, to introduce laws regulating the content of trans fats in food (maximum of 2% of edible fats and oils). What are trans fats, what harm do they cause, and should New Zealand also consider imposing mandatory regulations on their use in food? This article explores the issues.
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Stroke units save lives, reduce dependency, and increase the chance of returning home. A 15-bed Acute Stroke Unit (ASU) was opened on the acute hospital campus to complement an established Stroke Rehabilitation Unit (SRU) on a distant campus. The aim of this study was to address whether patient care was improved with the establishment of the ASU. ⋯ Adding an ASU to complement an existing SRU can give major improvements in PoC across many different facets of stroke care. We believe this is one step closer to both the ideals of an overall coordinated stroke service and better overall care for patients with stroke.
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Over the past decade, psychosocial issues have been increasingly identified as risk factors that are associated with the development of chronicity and disability. These psychosocial risk factors are known as Yellow Flags. In New Zealand, in 1997, the Accident Compensation Corporation (ACC) published the Acute Low Back Pain Guide and the Guide to Assessing Psychosocial Yellow Flags in Acute Low Back Pain. The aim of this qualitative study is to understand the experiences of general practitioners (GPs) in the identification and management of psychosocial Yellow Flags in patients with acute low back pain. ⋯ GPs did not use the Guide to Assessing Psychosocial Yellow Flags in Acute Low Back Pain or the screening questionnaire to identify psychosocial risk factors in their patients with low back pain. Investment of resources in GPs is needed to empower them to be effective gatekeepers guarding against chronicity. This demonstrates a need to alter the current ACC Guideline dissemination and implementation.