The New Zealand medical journal
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Right heart thrombi are unusual complications of pulmonary embolism that are associated with a high early mortality. We present a case and transoesophageal echocardiography of a 65-year-old man who presented with pulmonary embolism, following routine knee replacement and was found to have a type A right heart thrombus. Despite the increased risk associated with this presentation, treatment with heparin alone was successful.
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A preoperative surgical safety checklist was implemented into three major hospitals performing elective operations in Christchurch (New Zealand) in 2004. A prospective analysis of the results of this "Time Out Procedure" (TOP) was performed upon its implementation and 4 years later. ⋯ This study suggests that surgical checklists such as the TOP are a useful tool in identification and prevention of wrong site surgery. Our practice with consent and limb marking has improved over the two study periods. However, there continues to be surgeon resistance to these checklists, and further research will help to identify the reasons and possible solutions to this phenomenon.
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In New Zealand laboratories the measurement of glycated haemoglobin (HbA1c) for diagnosis of diabetes is now only reported in SI units of mmol/mol. HbA1c is now recommended as the preferred test to diagnose diabetes in most circumstances. ⋯ For patients with an initial HbA1c result of 41-49 mmol/mol, cardiovascular risk assessment and lifestyle interventions are recommended with repeat HbA1c screening in 6-12 months. For patients whose HbA1c is less than and equal to 40 mmol/mol, repeat screening (including for CVD risk) at intermittent intervals is recommended as per published guidelines.
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Delayed treatment of patients undergoing transfer for primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI) may reduce treatment benefits compared with fibrinolysis at the referring institution. We evaluated the feasibility of helicopter transfer of Whangarei patients to Auckland City Hospital for PPCI. ⋯ Helicopter transfer for PPCI from Whangarei to Auckland City Hospital is a feasible treatment strategy for patients presenting with STEMI. Improvements in treatment times are required if the full benefits of this strategy are to be realised.