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Lawton B.A.,University of Otago | Rose S.B.,University of Otago | Raina Elley C.,University of Auckland | Bromhead C.,Aotea Pathology | And 2 more authors.
Journal of Primary Health Care | Year: 2010

Introduction: Genitourinary Chlamydia trachomatis infection is common and associated with considerable personal and public health cost. Effective detection strategies are needed. Aim: To assess feasibility of an opportunistic incentivised chlamydia screening programme in general practice over six months. Methods: This study was designed as a pilot for a randomised controlled trial in primary care. Three general practices were randomly allocated to intervention (two practices) and control groups. The intervention involved practice education, self-sample collection and practice incentives (funding and feedback) for a three-month 'active' intervention period. Feedback and education was discontinued during the second three-month period. Practice-specific nurse- or doctor-led strategies were developed for identifying, testing, treating and recalling male and female patients aged 16-24 years. The main outcome measure was the difference between the practices' chlamydia screening rates over the six months following introduction of the intervention, controlling for baseline rates from the previous year. Results: Chlamydia testing rates during the year prior to the intervention ranged from 2.9% to 7.0% of practice attendances by 16-24-year-olds. The intervention practices had higher rates of screening compared with the control practice (p<0.001) at three months, but both practices reverted to pre-intervention rates by six months. The nurse-led screening strategy was more effective (35% declining to 5.5% over six months) than the doctor-led strategy (15% declining to 1.6% over six months) (p=0.04). Discussion: Incentivised opportunistic chlamydia screening of 16-24-year-old patients attending their general practitioner with a programme involving practice education, feedback and self-sample collection can increase screening rates.


Koerbin G.,ACT Pathology | Koerbin G.,University of Canberra | Sikaris K.A.,Melbourne Pathology | Jones G.R.D.,SydPath | And 3 more authors.
Clinica Chimica Acta | Year: 2014

Although we are in the era of evidence-based medicine, there is still a substantial gap between theory and current practice with the application of reference intervals as decision making tools. Different laboratories may have different reference intervals for the same tests using the same analytical methods and platforms. These differences have the potential to confuse physicians making the assessment and monitoring of patients more difficult by providing discordant information. This paper attempts to demonstrate how to use evidence-based approach for harmonising reference intervals. In order to consider harmonisation we must first have an appreciation of the various factors that influence the determination of that reference interval such as the choice of individuals within the population studied, biological variability of the analyte studied, partitioning, sample collection, analytical aspects such as bias and statistical models.An a priori approach for determining reference intervals, whilst recommended, may be beyond the scope of most laboratories and consideration should be given to the use of a validated indirect a posteriori approach. Regardless of method used, the continuing application of an evidence-based approach in harmonised reference intervals to meet the quality expectations of physicians should be pursued. © 2013 Elsevier B.V.


Florkowski C.,Canterbury Health Laboratories | Crooke M.,Chemical Pathology | Reed M.,Aotea Pathology
Clinica Chimica Acta | Year: 2014

In 2007, an international consensus statement recommended that HbA1c results should be reported world-wide in IFCC units (mmol/mol) and also the more familiar derived percentage units using a master equation. In New Zealand, the HbA1c IFCC units have been successfully implemented and used exclusively since 3rd October 2011 (following a 2. year period of reporting both units) for both patient monitoring and the diagnosis of diabetes, with a diagnostic cut-off of ≥. 50. mmol/mol. The consultation process in New Zealand dates back to 2003, well before the international recommendations were made. It reflects the close cooperation between the clinical and laboratory communities in New Zealand, particularly through the agency of the New Zealand Society for the Study of Diabetes (NZSSD), a key organisation in New Zealand open to all those involved in the care of people with diabetes and the national advisory body on scientific and clinical diabetes care and standards.There was a phased process of consultation designed to increase familiarity and comfort with the new units and the final step was coupled with the adoption of HbA1c as a diagnostic test with some evidence-based pragmatism around using the rounded cut-off.Genuine clinical engagement is vital in such a process. © 2013 Elsevier B.V.


Rose S.B.,University of Otago | Lawton B.A.,University of Otago | Bromhead C.,Aotea Pathology | Jane Macdonald E.,Regional Public Health | Raina Elley C.,University of Auckland
Australian and New Zealand Journal of Public Health | Year: 2010

Objectives: New strategies are needed to reach at-risk populations for Chlamydia screening. Method: Self-sample collection kits containing instructions and all items required for testing were developed and piloted in a three-month trial in primary care. Practice staff offered kits to young people receiving opportunistic Chlamydia screening to pass on to their 'social contacts.' Results: The 'pass it on' approach failed to reach adequate numbers of youth for testing: of 67 kits distributed, three specimens were sent to the laboratory (4.5%). Conclusions: The method of kit distribution trialled here was not successful in reaching at-risk youth for testing outside the primary care setting. Implications: Use of self-sample collection for chlamydia testing outside healthcare settings is likely to be important for increased access to testing. The importance of chlamydia testing needs to be widely promoted and methods for kit distribution to reach at-risk youth identifed. © 2010 The Authors. Journal Compilation.


Fitzgerald A.,New Zealand Guidelines Group | Frizelle F.,Christchurch Hospital | Jeffery M.,Medical Oncologist | Balasingam A.,Christchurch Radiology Group | And 9 more authors.
New Zealand Medical Journal | Year: 2011

Colorectal cancer is an important public health problem and one of the most common cancers registered in New Zealand. In 2009 the New Zealand Guidelines Group were commissioned to produce and evidence-based summary of current New Zealand and international data to inform best practice in the management of people with early bowel cancer. A guideline development team was convened, representing a range of stakeholder groups who met to discuss and agree on the recommendations for a clinical practice guideline. This article summarises the guideline methods and reports the recommendations from the Management of Early Bowel Cancer guideline, published in 2011. ©NZMA.

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