Christchurch, New Zealand
Christchurch, New Zealand

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Priest P.C.,University of Otago | Duncan A.R.,Canterbury District Health Board | Jennings L.C.,Canterbury Health Laboratories | Baker M.G.,University of Otago
PLoS ONE | Year: 2011

Background: Infrared thermal image scanners (ITIS) appear an attractive option for the mass screening of travellers for influenza, but there are no published data on their performance in airports. Methods: ITIS was used to measure cutaneous temperature in 1275 airline travellers who had agreed to tympanic temperature measurement and respiratory sampling. The prediction by ITIS of tympanic temperature (37.8°C and 37.5°C) and of influenza infection was assessed using Receiver Operating Characteristic (ROC) curves and estimated sensitivity, specificity and positive predictive value (PPV). Findings: Using front of face ITIS for prediction of tympanic temperature ≥37.8°C, the area under the ROC curve was 0.86 (95%CI 0.75-0.97) and setting sensitivity at 86% gave specificity of 71%. The PPV in this population of travellers, of whom 0.5% were febrile using this definition, was 1.5%. We identified influenza virus infection in 30 travellers (3 Type A and 27 Type B). For ITIS prediction of influenza infection the area under the ROC curve was 0.66 (0.56-0.75), a sensitivity of 87% gave specificity of 39%, and PPV of 2.8%. None of the 30 influenza-positive travellers had tympanic temperature ≥37.8°C at screening (95%CI 0% to 12%); three had no influenza symptoms. Conclusion: ITIS performed moderately well in detecting fever but in this study, during a seasonal epidemic of predominantly influenza type B, the proportion of influenza-infected travellers who were febrile was low and ITIS were not much better than chance at identifying travellers likely to be influenza-infected. Although febrile illness is more common in influenza A infections than influenza B infections, many influenza A infections are afebrile. Our findings therefore suggest that ITIS is unlikely to be effective for entry screening of travellers to detect influenza infection with the intention of preventing entry of the virus into a country. © 2011 Priest et al.


Ardagh M.W.,University of Otago | Richardson S.K.,University of Otago | Robinson V.,Christchurch Hospital | Than M.,Christchurch Hospital | And 7 more authors.
The Lancet | Year: 2012

At 1251 h on Feb 22, 2011, an earthquake struck Christchurch, New Zealand, causing widespread destruction. The only regional acute hospital was compromised but was able to continue to provide care, supported by other hospitals and primary care facilities in the city. 6659 people were injured and 182 died in the initial 24 h. The massive peak ground accelerations, the time of the day, and the collapse of major buildings contributed to injuries, but the proximity of the hospital to the central business district, which was the most aff ected, and the provision of good medical care based on careful preparation helped reduce mortality and the burden of injury. Lessons learned from the health response to this earthquake include the need for emergency departments to prepare for: patients arriving by unusual means without prehospital care, manual registration and tracking of patients, patient reluctance to come into hospital buildings, complete loss of electrical power, management of the many willing helpers, alternative communication methods, control of the media, and teamwork with clear leadership. Additionally, atypical providers of acute injury care need to be integrated into response plans.


Sheehan D.,University of Canterbury | Wilkinson T.J.,University of Otago | Bowie E.,Canterbury District Health Board
Medical Teacher | Year: 2012

Background: Newly qualified doctors (interns) report that they learn a great deal in the first year of practice, but exactly what is learnt is not well understood. Aims: To document the reflections and perceptions of first year junior doctors in order to reveal and chronicle their informal and often tacit learning in the workplace within a practice methodology framework. Methods: New Zealand interns, from three sites, participated in group interviews modelled on a conversation and joint enquiry style. Results: We found that learning in the first year after graduation falls into three broad themes: (1) concrete tasks, (2) project management and (3) identity formation. Identity formation appeared the most challenging and included getting used to being seen by others as a doctor. Conclusion: All themes have implications for curriculum development and clinical supervision in both undergraduate programmes and during internship. The third theme (identify formation) is the most complex. We draw on a model from management literature, to describe intern education as a process of becoming: as an unfolding and as a transformation of the self over time. We argue that reconfiguring internship as a period of identity formation, and as a self-determined, active process of 'becoming a doctor' provides a wider perspective than enculturation or socialisation theories to understand this significant transition. © 2012 Informa UK Ltd.


Beard M.,Canterbury District Health Board
New Zealand Medical Journal | Year: 2015

The Trans-Pacific Trade Agreement (TPPA) negotiations have been conducted in secrecy over the past four years. In New Zealand, the government has not released any official details of these negotiations and all the information we have about TPPA is derived from leaks. This makes any analysis of the risks and benefits of TPPA difficult to carry out. However, the consistency of the leaked material indicates that the TPPA appears to have major implications for the New Zealand health system, potentially adversely affecting public health initiatives, the control of alcohol and obesity problems, and reducing the availability of some drugs. This article describes the basis for these concerns, and aims to show that the TPPA could interfere with our ability to organise our health systems, now and in the future, for the best interests of all the people of New Zealand. © NZMA.


Scott A.,University of Canterbury | Doughty C.,Canterbury District Health Board
Journal of Mental Health | Year: 2012

Background Peer support has a unique philosophy of practice, which is reflected in the way information is handled.Aims To describe the way peer supporters use documentation in their work and explore tensions this generates. Methods Qualitative study based on two individual or group interviews with each of 37 peer supporters and peer-support managers in Aotearoa New Zealand.Results Peer supporters challenged disciplinary uses of documentation by either keeping minimal information about their interactions with peers, or keeping notes in a collaborative, empowering and transparent manner. This generated tensions with regard to the wider mental health system, particularly in relation to an emerging national database of mental health service use.Conclusions Funders and planners need to be aware of the reasons for some peer-support services' reluctance to participate in mental health information strategies. Peer-support documentation approaches might usefully be adopted across the mental health sector. © 2012 Informa UK, Ltd.


Scott-Thomas A.,University of Otago | Pearson J.,University of Otago | Chambers S.,Canterbury District Health Board
Journal of Breath Research | Year: 2011

2-Aminoacetophenone can be detected in the breath of Pseudomonas aeruginosa colonized cystic fibrosis patients; however, low levels were also detected in a small proportion of healthy subjects. It was hypothesized that food, beverages, cosmetics or medications could be a source of contamination of 2-aminoacetophenone in breath. To determine the potential confounding of these products on 2-aminoacetophenone breath analysis, screening for this volatile was performed in the laboratory by gas chromatography/mass spectrometry and a food challenge study carried out. 2-Aminoacetophenone was detected in four of the 78 samples tested in vitro: corn chips and canned tuna (high pmol mol-1) and egg white and one of the three beers (low pmol mol-1). No 2-aminoacetophenone was detected in the CF medication or cosmetics tested. Twenty-eight out of 30 environmental air samples were negative for 2-aminoacetophenone (below 50 pmol mol-1). A challenge study with ten healthy subjects was performed to determine if 2-aminoacetophenone from corn chips was detectable on the breath after consumption. Analysis of mixed breath samples reported that the levels of 2-aminoacetophenone were immediately elevated after corn chip consumption, but after 2 h the level of 2-aminoacetophenone had reduced back to the 'baseline' for each subject. © 2011 IOP Publishing Ltd.


Rucklidge J.J.,University of Canterbury | Frampton C.M.,University of Otago | Gorman B.,University of Canterbury | Boggis A.,Canterbury District Health Board
British Journal of Psychiatry | Year: 2014

Background: The role of nutrition in the treatment of attention-deficit hyperactivity disorder (ADHD) is gaining international attention; however, treatments have generally focused only on diet restriction or supplementing with one nutrient at a time. Aims: To investigate the efficacy and safety of a broad-based micronutrient formula consisting mainly of vitamins and minerals, without omega fatty acids, in the treatment of ADHD in adults. Method: This double-blind randomised controlled trial assigned 80 adults with ADHD in a 1:1 ratio to either micronutrients (n = 42) or placebo (n = 38) for 8 weeks (trial registered with the Australian New Zealand Clinical Trials Registry: ACTRN12609000308291). Results: Intent-to-treat analyses showed significant between-group differences favouring active treatment on self- and observer- but not clinician-ADHD rating scales. However, clinicians rated those receiving micronutrients as more improved than those on placebo both globally and on ADHD symptoms. Post hoc analyses showed that for those with moderate/severe depression at baseline, there was a greater change in mood favouring active treatment over placebo. There were no group differences in adverse events. Conclusions: This study provides preliminary evidence of efficacy for micronutrients in the treatment of ADHD symptoms in adults, with a reassuring safety profile.


Mudaliar M.M.,Canterbury District Health Board
Water Science and Technology: Water Supply | Year: 2012

The Water Safety Plan (WSP) concept has become a globally recognised and accepted approach to drinking water supply management and operation. Many countries around the world are adopting this proactive, risk-based model for ensuring consistent confidence in drinking water safety, accessibility and affordability. While it is widely accepted that the WSP concept is an appropriate tool for ensuring drinking-water supply efficiency, the process for gathering the required evidence to demonstrate this continues to be rather vague. The problem may lie fundamentally in the way WSPs are developed and implemented. This paper discusses the need for establishing performance targets, identifying key performance indicators and monitoring these to build a body of evidence that would be instrumental in demonstrating whether WSPs are effective or not. © IWA Publishing 2012.


Rajagopal R.,Canterbury District Health Board | Smith M.P.,Canterbury District Health Board
Seminars in Thrombosis and Hemostasis | Year: 2011

New Zealand is a small country of two islands and 4 million people, of which 1 million reside in the South Island. Canterbury Health Laboratories provides laboratory services to the whole of South Island and lower parts of North Island. There are 155 von Willebrand disease (VWD) patients in our South Island database, of which 17 have type 2 and 3 have type 3 VWD. A brief overview of diagnostic services for VWD being followed in our region is detailed in this article. We strive continually to advance the repertoire of diagnostic tests. We also present an analysis of our experience with a flow-based functional von Willebrand factor assay. The VWD patients are managed by hemostasis team members, who also provide screening and educational input to affected families. The Haemophilia Foundation of New Zealand is an active patient support group providing education and support both directed individually and in the group setting, through residential educational camps. © 2011 by Thieme Medical Publishers, Inc.


Scott-Thomas A.,University of Otago | Epton M.,Canterbury District Health Board | Chambers S.,University of Otago
Journal of Breath Research | Year: 2013

Mycobacterium tuberculosis releases four volatile compounds, methyl phenyl-acetate, methyl nicotinate, methyl p-anisate and o-phenylanisole, some of which we have previously been reported to be detected in the breath of tuberculosis patients (Syhre et al 2009 Tuberculosis 89 263-6). These volatiles have the potential to offer a non-invasive and sensitive breath test for the detection of tuberculosis infection. To determine the best sample collection and pre-concentration system a number of variables were examined. The four markers were most stable when breath was collected in a salinized glass sampling bulb compared to either Tedlar® TA, SupelTM Inert Foil or Supel TM Inert Gas bags. Concentration of breath onto thermal desorption cartridges indicated that Tenax® TA was the most universal sorbent for the collection of all four volatiles. Increasing the number of breath exhalations captured and analysed actively increased the detectable level of volatiles. The most important discovery was samples of methyl nicotinate, methyl p-anisate and o-phenylanisole remained stable on Tenax® TA cartridges for over two months at various altitudes. © 2013 IOP Publishing Ltd.

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