The New Zealand medical journal
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We report a case of a patient presenting with episodic hypotension, tachycardia and oedema, with an elevated serum IgG kappa paraprotein level. She was diagnosed as having systemic capillary leak syndrome and upon commencing oral theophylline has had no further presentations. The patient has since progressed to multiple myeloma.
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This article explores how primary health care policy changes in New Zealand over the last decade have impacted on primary care access equity and avoidable hospital admissions. ⋯ Changes in primary care access over the decade have led to improvement in ASH indicators for parts of the population, but not for others. ASH rates decreased very significantly for children, especially in the 0-4 age group. These trends began in 2004, with decreases most marked for Pacific children, and those from the most deprived neighbourhoods. Inequalities in ASH rates for children between ethnic groups and levels of deprivation have substantially decreased. On the other hand, there has been a significant increase in ASH rates and inequalities for Pacific peoples in the 45 to 64 age group. Māori in the same age band show a modest reduction in ASH rates, with inequalities compared with the rest of the population remaining unchanged. Inequalities in ASH rates between 45-65 year olds living in different levels of deprivation remain large and unchanged, indicative of the recalcitrant nature of inequalities in primary care access for the adult population. Major policy initiatives undertaken by the government during this period have significantly affected primary care access. These include the New Zealand Health Strategy, the Primary Health Care Strategy, the creation of District Health Boards and Primary Health Organisations, and free care to under 6-year-olds. In the latter part of the decade, high-level target setting by successive Ministers is also affecting system performance. We conclude that the success in reducing inequality in access to primary care for children needs to be intensified, and the same principles applied to the adult population groups.
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As the population ages, the number of elderly patients suffering injuries is increasing. Reports from North America have shown an increasing proportion of elderly admissions with a disproportionate number of deaths. However, this trend has not yet been examined in New Zealand. The aim of this study was to determine unique characteristics of geriatric patients as compared to the general trauma population. ⋯ ACH has seen a significant increase in elderly trauma admissions without a change in catchment or referral pattern. These patients have a higher mortality than those under 65, longer length of stay, and are less likely to return home. Specific education on fall prevention should be increased to lessen the burden on the health system as a whole. Given the linear increase in mortality, specialised geriatric care should be considered starting at age 75.
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In the context of expectations regarding role evolution, including increased interprofessional working, this study aimed to gain insight into how GPs and pharmacists understood the professional role of the pharmacist and its expansion, extension and calls for increased collaboration. ⋯ Attempts to encourage one professional group to expand or extend their practice may be perceived as a threat by those adjacent. Mitigation strategies involve clear communication and acknowledgment that interprofessional trust takes time to establish.