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Christchurch, New Zealand

Dickson J.L.,University of Canterbury | Le Compte A.J.,University of Canterbury | Floyd R.P.,University of Canterbury | Geoffrey Chase J.,University of Canterbury | And 2 more authors.
Biomedical Signal Processing and Control | Year: 2013

Hyperglycaemia is a common complication of prematurity and stress in neonatal intensive care units (NICUs). It has been linked to worsened outcomes and mortality. There is currently no universally accepted best practice glycaemic control method, with many protocols lacking patient specificity or relying heavily on ad hoc clinical judgment from clinical staff who may be caring or overseeing care for several patients at once. The result is persistent hypoglycaemia and poor control. This research presents the virtual trial design and optimisation of a stochastic targeted (STAR) approach to improve performance and reduce hypoglycaemia. Clinically validated virtual trials based on NICU patient data (N = 61 patients, 7006 h) are used to develop and optimise a STAR protocol that improves on current STAR-NICU performance and reduce hypoglycaemia. Five approaches are used to maximise the stochastic range of BG outcomes within 4.0-8.0 mmol/L, and are designed based on an overall cohort risk to provide clinically specified risk (5%) of BG above or below a clinically specified level. The best protocol placed the 5th percentile BG outcome for an intervention on 4.0 mmol/L band. The optimised protocol increased %BG in the 4.0-8.0 mmol/L band by 3.5% and the incidence of BG < 2.6 mmol/L by 1 patient (50%). Significant intra- and inter-patient variability limited possible performance gains so that they are unlikely to be clinically substantial, indicating a need for a further increase patient-specific or sub-cohort specific approaches to manage variability. This result sets the direction for future research. © 2012 Elsevier Ltd. Source

Lamb J.,Christchurch Womens Hospital
Nursing praxis in New Zealand inc | Year: 2013

Current research has confirmed that cigarette smoking is a risk factor for cervical cancer. Although more recently, there has been a slight decline in smoking rates, the relationship between tobacco use and cervical cancer remains clear. The development of research-based knowledge with which to inform the profession will assist practitioners to promote smoke-free practices for women and their families. The aim of this study was to identify whether female smokers referred to the colposcopy department at a city hospital required more follow-up visits, treatments and re-referrals than did nonsmokers. This retrospective descriptive study observed new patients (n= 494) who attended a city hospital colposcopy department in 2001 over the following six years. When compared to non-smokers women who smoked were found to be three times more likely to need a third follow-up visit, and twice more likely to need further treatments to remove abnormalities. This study also identified that 71% of Miori women attending the clinic were smokers compared to 44% of non-Maori women. It was also found that MSori women were less likely to attend the colposcopy clinic than were non-Maori. This study highlights to health professionals and to the women who undergo colposcopy, that treatment is more likely to be successful for patients who cease smoking. The results have also supported the importance and relevance of smoke-free education to women. This allows the link to cervical abnormalities and smoking to be explained and smoking cessation assistance offered. This information also highlights the need for Maori women, who are more likely to smoke and have higher rates of non-attendance for appointments, to have services provided that will encourage attendance and smoke-free behaviour. Source

Rodwell J.,Christchurch Public Hospital | Fletcher V.,Christchurch Public Hospital | Hughes R.,Christchurch Womens Hospital
New Zealand Medical Journal | Year: 2010

Aims: Cognitive function in the elderly has a significant impact on prognosis and functional ability during an acute illness requiring hospital admission. Methods: This prospective review was designed to measure how well cognitive function in the elderly was documented by medical staff at admission to hospital. Over a 2-week period, 257 patient admissions were reviewed. Results: Of these, only 153 (59%) had their cognitive function documented on admission and only 14% had their premorbid cognitive function documented. Delirium was only diagnosed in 8 patients (3%) with at least 10 others having descriptions of delirious states without the formal diagnosis. Conclusion: In keeping with other studies, this audit shows that the documentation of cognitive function by medical staff is poor. ©NZMA. Source

Le Compte A.J.,University of Canterbury | Lee D.S.,University of Canterbury | Chase J.G.,University of Canterbury | Lin J.,University of Canterbury | And 2 more authors.
IEEE Transactions on Biomedical Engineering | Year: 2010

Hyperglycemia is a common metabolic problem in premature, low-birth-weight infants. Blood glucose homeostasis in this group is often disturbed by immaturity of endogenous regulatory systems and the stress of their condition in intensive care. A dynamic model capturing the fundamental dynamics of the glucose regulatory system provides a measure of insulin sensitivity ( S I ). Forecasting the most probable future SI can significantly enhance real-time glucose control by providing a clinically validated/proven level of confidence on the outcome of an intervention, and thus, increased safety against hypoglycemia. A 2-D kernel model of SI is fitted to 3567 h of identified, time-varying SI from retrospective clinical data of 25 neonatal patients with birth gestational age 23 to 28.9 weeks. Conditional probability estimates are used to determine S I probability intervals. A lag-2 stochastic model and adjustments of the variance estimator are used to explore the bias-variance tradeoff in the hour-to-hour variation of SI. The model captured 62.6% and 93.4% of in-sample SI predictions within the (25th-75th) and (5th-95th) probability forecast intervals. This overconservative result is also present on the cross-validation cohorts and in the lag-2 model. Adjustments to the variance estimator found a reduction to 10%-50% of the original value provided optimal coverage with 54.7% and 90.9% in the (25th-75th) and (5th-95th) intervals. A stochastic model of SI provided conservative forecasts, which can add a layer of safety to real-time control. Adjusting the variance estimator provides a more accurate, cohort-specific stochastic model of SI dynamics in the neonate. © 2006 IEEE. Source

Joseph K.,Christchurch Womens Hospital
The New Zealand medical journal | Year: 2012

To explore the reasons why women have an abortion soon after delivering an infant and what could reduce unintended pregnancy and abortion in this group of women. Data were collected from anonymous self-complete questionnaires from women who presented to a first trimester Termination of Pregnancy service and who had delivered a live-born infant within the preceding 6 months; and also from the healthcare professionals who are responsible for maternity care to identify the reasons behind the unintended pregnancies, and around Lead Maternity Caregivers' (LMCs') usual practice of postnatal contraceptive provisions, and any barriers to its provision. 22 women were recruited into the study and completed the questionnaire. The majority of women (19) reported that they had discussed contraception with the LMC. However only 4 women were given a prescription for the pill and 2 women were given a prescription for condoms (which was not filled). Almost all women had previously accessed contraception from another provider. 59 LMCs responded. All LMCs reported that they discuss contraception with women, However the majority reported that they discuss contraception with all women at discharge (50) and/or postnatally (49). Only 23 LMCs reported discussing contraception antenatally or at booking. Opportunities to intervene are being missed. These include: discussing contraception with all women at booking and/or antenatally; for LMCs to offer prescriptions for contraception to all women and to encourage them to access the supplies, for LMCs to be trained so they feel confident to advise and supply all contraceptive options. Improvements for women could also be made by providing postnatal women with free consultations to her choice of provider, during pregnancy to organise postnatal contraception. Source

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