The New Zealand medical journal
-
The art of physical examination has continued to be practised by physicians largely unchanged for over 200 years. Ultrasound, once the domain of the radiologist, is now being increasingly used by emergency physicians and intensivists to make rapid, accurate diagnoses at the point-of-care. ⋯ Compared with physical examination, PoCUS may increase diagnostic accuracy and patient satisfaction; reduce unnecessary investigations and healthcare costs; be shared with experts for a second opinion; and have automated decision-support applied to improve diagnosis. Further research is needed to identify the ideal combination of physical and PoCUS techniques to establish a gold-standard 'hybrid' approach to bedside assessment.
-
To estimate rates of presenteeism in the New Zealand senior medical workforce and identify reasons why this workforce feels pressured to work through illness. ⋯ Presenteeism is a widespread behavioural norm in this medical workforce. Choosing whether to work through illness reflects the high value placed on duty of care, but also tensions around defining responsible behaviour in this regard.
-
Randomized Controlled Trial
An open-label six-month extension study to investigate the safety and efficacy of an extract of Artemisia annua for managing pain, stiffness and functional limitation associated with osteoarthritis of the hip and knee.
This six-month single-centre open-label extension study, conducted at the University of Otago, Dunedin, follows from a previously published 12-week pilot double-blind randomised placebo-controlled study of dietary supplement, Arthrem® (ART) in patients with osteoarthritis (OA) of the hip or knee. The pilot double-blind study showed that treatment with ART 150 mg twice-daily was associated with clinically relevant pain reduction. The extension study aims were to assess longer-term safety and efficacy during six months' treatment following the pilot trial. ⋯ ART appears to be a safe and effective alternative for managing the symptoms of OA over an extended period.
-
Randomized Controlled Trial Comparative Study
Costs of bariatric surgery in a randomised control trial (RCT) comparing Roux en Y gastric bypass vs sleeve gastrectomy in morbidly obese diabetic patients.
To provide a longitudinal analysis of the direct healthcare costs of providing laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery service in the context of a randomised control trial (RCT) of obese patients with type 2 diabetes in Waitemata District Health Board, Auckland, New Zealand. ⋯ Among patients with type 2 diabetes and morbid obesity undergoing LSG and LRYGB, health service costs were greater in the year after surgery than in the year before, although prescription costs were lower post-operatively. There was no significant difference in reduction in prescription cost by surgical procedure at 12 months. However, the LRYGB surgery was more expensive than LSG, primarily because of the longer operative time required.
-
A new approach to administering the surgical safety checklist (SSC) at our institution using wall-mounted charts for each SSC domain coupled with migrated leadership among operating room (OR) sub-teams, led to improved compliance with the Sign Out domain. Since surgical specimens are reviewed at Sign Out, we aimed to quantify any related change in surgical specimen labelling errors. ⋯ Improved compliance with administering the Sign Out domain of the SSC can reduce surgical specimen errors. This finding provides further evidence that OR teams should optimise compliance with the SSC.