The New Zealand medical journal
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The current approach to CPR in New Zealand hospitals is that it is attempted on all patients in cardiac arrest unless a DNR order is in place. Concern has been raised that this approach results in some "unlawful" CPR on the grounds that it is not in the patient's best interests. It has been suggested that policy change is required and one suggestion is a move away from DNR orders to mandatory "For CPR" orders. Ensuring lawfulness of CPR and more importantly quality care for patients is however more likely to be achieved not by policy change but by improved understanding by doctors and patients of the nature of these decisions, and by training programmes and work environments which value and facilitate difficult conversations, mutually respectful relationships and shared decisions.
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To eliminate Central Line Associated Bacteraemia (CLAB) in the Critical Care Complex (CCC)-Intensive Care Unit (ICU) and High Dependency Unit (HDU)-Middlemore Hospital. ⋯ Using an evidenced-based quality improvement approach, it is possible to significantly decrease Central Line Associated Bacteraemia in the Critical Care Complex. In doing so patient morbidity and mortality are reduced and money is saved for other healthcare needs.
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Oral isotretinoin is a highly-effective treatment for severe acne. It is also highly teratogenic. Recently, funded access was widened (from vocationally registered dermatologists only) to include vocationally trained general practitioners and nurse practitioners acting within their scope of practice. This decision has caused some debate. While it is hoped that it will increase access to those living in more deprived areas, there are concerns that there will be an increase in the number of affected pregnancies. This study aims to report on terminations of pregnancy occurring while using isotretinoin in New Zealand. ⋯ While there are some limitations to this study, the results are consistent with recent international research suggesting previous pregnancy rates on isotretinoin have been underestimates. Widening funding of isotretinoin will likely increase the absolute numbers of pregnancies but also has the potential to increase relative numbers. As such, it will be vital that primary care is alert to the risks of isotretinoin use and gain experience in its day-to-day usage. Although access has been widened, all requests for funding will now be recorded on a national database (Special Authority database) to enable closer monitoring of isotretinoin usage.