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Auckland, New Zealand

Azariah S.,Greenlane Clinical Center
New Zealand Medical Journal | Year: 2010

Aim: As there is no New Zealand data, an audit of patients treated for syphilis at Auckland Sexual Health Service (ASHS) was undertaken to see if management conformed to guidelines and was achieving acceptable outcomes. Methods: Cases were initially identified from laboratory data and were categorised as being either infectious or non-infectious according to clinical and laboratory criteria. Management was compared to recommendations from ASHS treatment guidelines and treatment outcome was assessed by serological response. Results: 109 cases of syphilis were identified including 9 with HIV infection (8%). Men who had sex with men were much more likely to be diagnosed with infectious syphilis than heterosexuals (p<0.0001). Fifty-one percent of infectious cases (n=35) were asymptomatic. Ninety-four percent (n=103) of cases were treated with antibiotic regimens appropriate for their clinical stage. Discrepancy in management occurred most often in the early latent and unknown duration categories. Ninety-eight cases (90%) completed the full 12 months serological follow-up period and 97% (n=92) of those had an adequate serological response to treatment. There were no treatment failures in patients with HIV infection. Conclusion: Current care of patients with syphilis at Auckland Sexual Health Service is achieving acceptable outcomes. Criteria for diagnosing infectious syphilis cases need to be standardised as it has implications for management and disease surveillance. MSM are a major risk group for acquisition of infectious syphilis and regular serological screening is recommended as a large proportion will be asymptomatic. ©NZMA. Source

Azariah S.,Greenlane Clinical Center
New Zealand Medical Journal | Year: 2012

Aim Primary care practitioners need practical guidance on how to best manage partner notification for bacterial sexually transmitted infections. This paper reviews published literature on partner notification to determine whether there is good evidence to support the introduction of patient delivered partner therapy for the management of bacterial STI in New Zealand. Method A search of CINAHL, Medline and Cochrane databases was carried out using the search terms partner notification, contact tracing, sexually transmitted infections, sexually transmitted diseases, chlamydia, gonorrhoea and trichomoniasis. After review of the abstracts the identified papers were included in the review if they addressed the research question. Results Most people diagnosed with a bacterial STI would prefer to notify their sexual contacts themselves; therefore health practitioners need to feel competent to discuss and facilitate this process for their patients. Clinicians and patients are prepared to consider the use of patient delivered partner therapy with reservations however there is little evidence to support the effectiveness of this intervention even if it were legal under current New Zealand prescribing law. Conclusion Training of practice nurses, the use of partner notification cards and implementation of systems to improve documentation of management of index cases are all practical ways of achieving better partner notification outcomes in primary care within existing legal frameworks. © NZMA. Source

Chan P.L.,Greenlane Clinical Center
The New Zealand medical journal | Year: 2012

Vertebral fractures are the most common osteoporotic fracture and predict subsequent fracture and mortality. We undertook an audit (Auckland City Hospital, Auckland, New Zealand) to determine whether targeted assessment for incidental vertebral fractures on computed tomography (CT) examinations of the chest or abdomen in older people would detect previously unidentified vertebral fractures. In 175 consecutive patients aged >65 years, sagittal images of the spine were obtained by reformatting data from CT examinations of the chest or abdomen. Vertebral fractures were assessed using a semi-quantitative technique. The prevalence of vertebral fractures was 13%, with 41 vertebral fractures identified in 22 patients; 12/22 (55%) had vertebral fracture mentioned in the formal CT report, and 2/12 patients with contemporaneous plain films had vertebral fracture mentioned in the X-ray report. The vertebral fracture was newly identified in 17 (77%) patients, but vertebral fracture and osteoporosis were each listed in the relevant discharge summary or clinic letter for only 14% of patients, and only 31% of patients with fracture subsequently received osteoporosis treatment. In summary, assessing sagittal spine images reformatted from CT examinations of the chest or abdomen detects previously unidentified vertebral fractures, offering an undervalued opportunity to assess fracture risk and intervene with treatments that prevent fractures and reduce mortality. Source

Chow K.,Waikato Hospital | Mora J.,Greenlane Clinical Center
Journal of Glaucoma | Year: 2012

PURPOSE: To evaluate the practice patterns in the use of glaucoma drainage devices (GDD) and cyclodestruction among consultant ophthalmologists in Australia and New Zealand. MATERIALS AND METHODS: A 22-part questionnaire regarding GDD implantation and cyclodestruction practices was sent to all ophthalmologists registered with the Royal Australian and New Zealand College of Ophthalmologists in 2008 by post or e-mail. RESULTS: Sixty-six percent of 872 questionnaires were returned, of these, 14% were from glaucoma subspecialists. Ten percent of all respondents performed GDD implantations. Molteno drains were the most popular device (69%). The most commonly recognized indications for GDD implantation were a history of 2 failed trabeculectomies (85%), neovascular glaucoma (71%), iridocorneal endothelial syndrome (55%), and uveitic glaucoma (52%). Only a minority of surgeons used intraoperative mitomycin C (38%) or 5-fluorouracil (26%) when implanting GDD. Cyclodestruction had been performed by 20% of all respondents. External diode cyclophotocoagulation was the most preferred treatment mode (73%). Sixty-seven percent treated 180 degrees of the ciliary body during initial treatment. Fifty-five percent treated only the earlier untreated area during retreatment. Only 11% of surgeons who performed cyclodestruction agreed that the indications for cyclodestruction are expanding. CONCLUSIONS: A wide range of practice patterns for GDD implantation and cyclodestruction exist among Australian and New Zealand ophthalmologists. This likely reflects a paucity of good evidence to guide practice. The Australasian indications for GDD implantation were moderately different from the reported practice in America. Well-designed clinical trials are needed to better define the indications and best practice for these 2 important glaucoma treatment modalities. © 2012 Lippincott Williams & Wilkins, Inc. Source

Carroll S.C.,Greenlane Clinical Center | Ng S.G.J.,Waikato Public Hospital
British Journal of Ophthalmology | Year: 2010

Background/aim: To describe the features and outcomes of orbital blowout fracture surgery in children and adolescents <20 years old. Methods: Retrospective chart review of consecutive patients undergoing orbital blowout fracture surgery at a tertiary referral hospital. Results: A single surgeon performed all surgeries between October 2000 and April 2008. All patients had symptoms and signs of orbital soft tissue entrapment and radiographical evidence of orbital blowout fractures involving the orbital floor and/or medial wall. The characteristics and outcomes of 19 consecutive patients undergoing surgery are presented. The median delay from injury to surgery was 7 (range 0e113) days, with 13 cases having late surgery (>72 h post-injury). The median follow-up was 2 months. Two patients had follow-up of less than 1 week. One patient required subsequent strabismus surgery. Of the remaining 16 patients, none had significant diplopia postoperatively. There was a trend to longer recovery times with increasing delay to surgery. Conclusion: Previous series suggest that significant delays between injury and surgery lead to poorer outcomes in young patients with orbital blowout fractures. The data from this series show that despite delays, excellent outcomes can be obtained. Source

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