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Bartley J.,Counties Manukau District Health Board
Expert Review of Anti-Infective Therapy | Year: 2010

In the preantibiotic era, TB of the skin was treated successfully with UV light. By the 1920s, pulmonary TB was being treated with regular sun exposure. During the last decade, basic laboratory research into the antimicrobial actions of vitamin D has provided new insights into these historical observations. Vitamin D has a critical role in the innate immune system through the production of antimicrobial peptides - particularly cathelicidin. Vitamin D would appear to have an important role in respiratory tract, skin and potentially gut health. A number of autoimmune diseases, including multiple sclerosis, Type I diabetes, systemic lupus erythematosus and rheumatoid arthritis, are associated with vitamin D deficiency. Vitamin D could have an important role in the prevention and possible treatment of these conditions; however, much of the current evidence relates to basic science and epidemiological research. In many situations, appropriate double-blind, randomized controlled trial data to guide clinicians treating infectious and autoimmune disease is still lacking. © 2010 Expert Reviews Ltd. Source


Morton R.P.,Counties Manukau District Health Board | Morton R.P.,University of Auckland
Otolaryngology - Head and Neck Surgery (United States) | Year: 2012

This article discusses how quality-of-life assessment in patients with head and neck cancer might be weighed against survival and how such assessment might be applied in clinical practice. While survival is understandably considered to be the outcome of primary interest, there are several clinical scenarios in which quality of life can be considered as a primary outcome. Quality-adjusted survival is also an important consideration and needs to be incorporated into the results of treatment. However, quality-of-life assessment has hitherto been virtually only a research tool and not been incorporated into clinical practice. Nowadays, speech pathologists and dietitians are integral to the multidisciplinary team that treats patients with head and neck cancer. The main point of this article is to provide a rationale for the proposition that the health psychologist - who is best able to understand and manage the psychosocial issues - should also be included as one of the team. © 2012 American Academy of Otolaryngology-Head and Neck Surgery Foundation. Source


Marshall M.R.,University of Auckland | Dunlop J.L.,Counties Manukau District Health Board
Seminars in Dialysis | Year: 2012

Universal lower dialysate [Na+] is often advocated as a means of improving the dire cardiovascular plight of our dialysis patients. However, there is evidence associating lower dialysate [Na+] and increased morbidity and mortality especially in frailer patients, probably as a result of more frequent intra-dialytic hypotension. In this editorial, we summarize arguments for and against lower dialysate [Na+], and provide recommendations around selecting the most appropriate dialysate [Na+] for specific clinical subsets that may benefit from manipulation of salt and water balance. The lack of overall clarity on relative benefits and risks of lower dialysate [Na+] does not support the case for empirical "across the board" change, and experimental testing in clinical trials is required to determine safe and effective use. © 2012 Wiley Periodicals, Inc. Source


Bartley J.,Counties Manukau District Health Board
Journal of Laryngology and Otology | Year: 2010

Introduction: At the turn of the twentieth century, ultraviolet light was successfully used to treat tuberculosis of the skin. Upper respiratory tract infections had been inversely associated with sun exposure. During the last decade, basic scientific research demonstrated that vitamin D has an important anti-infective role.Method: Review of the relevant literature on the influence of vitamin D on innate immunity and respiratory tract infection.Results: Vitamin D is involved in the production of defensins and cathelicidin - antimicrobial peptides that provide a natural defence against potential microbiological pathogens. Vitamin D supplementation increases cathelicidin production. Low vitamin D levels are associated with an increased incidence of upper respiratory tract infections.Conclusions: Vitamin D appears to play an important role in the regulation of innate immunity in the upper respiratory tract. Optimal vitamin D levels and appropriate dosing schedules have yet to be determined. © JLO (1984) Limited 2010. Source


Gray S.,Counties Manukau District Health Board
The New Zealand medical journal | Year: 2013

To assess the acceptability and feasibility of delivering targeted primary health care in a decile one primary school setting. A pilot public health nurse (PHN)-led clinic was set up in a South Auckland primary school (roll approximately 400). The clinic was based on a previous sore throat clinic model with modifications aimed at improving programme feasibility and effectiveness. The timely identification and treatment of Group A Streptococcal (GAS) throat infections to prevent rheumatic fever (RF), and the prevention and treatment of four skin infections (cellulitis, impetigo, infected eczema and scabies) were the focus. The pilot ran for 15 weeks from April to July 2011. Evaluation included documentation review, key school and healthcare stakeholder interviews and parent questionnaires. The consent rate was 92.2%. Of a total 722 throat swabs taken from 337 students, 94 were GAS positive. Ninety-eight assessments of skin conditions were completed at which 76 had a skin infection diagnosed, the most common infection being impetigo (n=46). Thirty-one skin infections were diagnosed in the first week of the pilot. PHN workload was high with a total of 539 phone calls, 137 home visits and 51 school-based parent consultations. The approach was highly acceptable to the majority of key stakeholders. Extrapolating pilot costs results in an estimated annual cost of $510 per student for the programme. It is likely to be both acceptable and feasible to take this model of delivering targeted primary health care to school aged children and use it on a larger scale. The complexity of providing this type of service should not be underestimated and it is essential that robust processes are in place to ensure smooth, safe running of such a programme. Long-term outcome evaluation will be vital to assess programme effectiveness. Source

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