The New Zealand medical journal
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To ascertain the level of acceptance of the PRIME (Primary Response In Medical Emergencies) scheme by rural general practitioners (GPs) in New Zealand. ⋯ The inclusion of rural GPs in emergency care teams needs to be recognised and adequately remunerated, and these issues should be reflected in the ongoing development of pre-hospital emergency service contracts.
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The 'Smokescreen' smoking cessation programme was introduced in Christchurch in 1995, with an initial study showing six-month, self-reported quit rates of 10% and 17% (with a validated deception rate) in primary and secondary care settings. Substantial modifications were made to try to improve this rate in the primary care setting and the programme has been implemented widely. Our primary aim was to estimate programme utilisation and six-month quit rates for enrolled patients in this general primary care setting. We also aimed to use a wide range of patient, practice and environmental variables to estimate any predictive effect on outcome. ⋯ This programme compares favourably with six-month quit rates for NRT-based programmes reported in the international literature of 14-22%. The effectiveness of an NRT-based smoking cessation programme in a general primary care setting appears to have been significantly enhanced by local adaptation, the flexibility of a primary-care-team approach and subsidisation of NRT, together with facilitation responsive to individual practice needs. The success of this programme in helping individual patients quit, as well as its successful implementation in a wide primary care setting, suggests General Practice can play an important role in smoking cessation in a country with a high burden of disease from smoking-related illnesses. The programme is congruent with the current, national, smoking cessation guidelines endorsed by the RNZCGP. Widespread adoption of this kind of model in IPA/primary health organisation (PHO) settings throughout New Zealand should be encouraged and supported.
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To evaluate long-term survival after major abdominal surgery in patients who are 80 years and over and to assess possible predictors of outcome: age, acute vs elective surgery, associated comorbidities and type of surgical procedure. ⋯ Elective surgery is generally well tolerated by the elderly. There is high in-hospital morbidity and mortality in the emergency group; however, long-term survival in those patients who leave hospital is not significantly different to the age-adjusted population. Age should not be used as the only criterion when deciding suitability for surgery in this age group.