Murtagh L.,Hogan Lovells |
Gallagher T.H.,University of Washington |
Andrew P.,Waitemata District Health Board
Health Affairs | Year: 2012
Under "disclosure-and-resolution" programs, health systems disclose adverse events to affected patients and their families; apologize; and, where appropriate, offer compensation. Early adopters of this approach have reported reduced liability costs, but the extent to which these results stem from effective disclosure and apology practices, versus compensation offers, is unknown. Using survey vignettes, we examined the effects of different compensation offers on individuals' responses to disclosures of medical errors compared to explanation and apology alone. Our results show that although two-thirds of these individuals desired compensation offers, increasing the offer amount did not improve key outcomes. Full-compensation offers did not decrease the likelihood of seeking legal advice and increased the likelihood that people perceived the disclosure and apology as motivated by providers' desire to avoid litigation. Hospitals, physicians, and malpractice insurers should consider this complex interplay as they implement similar initiatives. They may benefit from separating disclosure conversations and compensation offers and from excluding physicians from compensation discussions. © 2012 Project HOPE-The People-to-People Health Foundation, Inc.
Elley C.R.,University of Auckland |
Robinson E.,University of Auckland |
Kenealy T.,University of Auckland |
Bramley D.,Waitemata District Health Board |
Drury P.L.,Auckland Diabetes Center
Diabetes Care | Year: 2010
OBJECTIVE - To derive a 5-year cardiovascular disease (CVD) risk equation from usual-care data that is appropriate for people with type 2 diabetes from a wide range of ethnic groups, variable glycemic control, and high rates of albuminuria in New Zealand. RESEARCH DESIGN AND METHODS - This prospective open-cohort study used primary-care data from 36,127 people with type 2 diabetes without previous CVD to derive a CVD equation using Cox proportional hazards regression models. Data from 12,626 people from a geographically different area were used for validation. Outcome measure was time to first fatal or nonfatal cardiovascular event, derived from national hospitalization and mortality records. Risk factors were age at diagnosis, diabetes duration, sex, systolic blood pressure, smoking status, total cholesterol-to-HDL ratio, ethnicity, glycated hemoglobin (A1C), and urine albumin-to-creatinine ratio. RESULTS - Baseline median age was 59 years, 51% were women, 55% were of non-European ethnicity, and 33% had micro- or macroalbuminuria. Median follow-up was 3.9 years (141,169 person-years), including 10,030 individuals followed for at least 5 years. At total of 6,479 first cardiovascular events occurred during follow-up. The 5-year observed risk was 20.8% (95% CI 20.3-21.3). Risk increased with each 1% A1C (adjusted hazard ratio 1.06 [95% CI 1.05-1.08]), when macroalbuminuria was present (2.04 [1.89-2.21]), and in Indo-Asians (1.29 [1.14-1.46]) and Maori (1.23 [1.14-1.32]) compared with Europeans. The derived risk equations performed well on the validation cohort compared with other risk equations. CONCLUSIONS - Renal function, ethnicity, and glycemic control contribute significantly to cardiovascular risk prediction. Population- appropriate risk equations can be derived from routinely collected data. © 2010 by the American Diabetes Association.
Prior P.,Waitemata District Health Board
Nursing praxis in New Zealand inc | Year: 2010
The role of practice nurses is a specific feature of the modernisation agenda of the New Zealand health service. Increasing importance is being placed on service improvement through effective decision making and enhanced clinical performance. To contribute to the development of primary health care it is crucial that nurses have the skills to appropriately implement research based and other evidence in practice. This study involved 55 West Auckland practice nurses working in the general practice setting. The aim of the study was to describe nurses' perceptions of their use of evidence-based practice, attitudes toward evidence-based practice and perceptions of their knowledge/skills associated with evidence-based practice. An additional aim was to determine the effect of educational preparation on practice, attitudes and knowledge/skills toward evidence-based practice. A descriptive survey design was selected for this study. The results demonstrated that nurses' attitudes toward evidence-based practice, knowledge and skills relevant to the implementation of evidence-based practice and the educational preparation of the nurses were important factors influencing the effective utilisation and application of research results in practice. Educational interventions are identified as an integral aspect of implementing evidence-based practice and enhancing practice nurses' knowledge and skill relevant to the use of evidence in practice. Further research is needed to assess the contextual factors which can inhibit or promote achievement of evidence-based practice by practice nurses.
Lewis G.N.,Auckland University of Technology |
Rice D.A.,Auckland University of Technology |
Rice D.A.,Waitemata District Health Board |
McNair P.J.,Auckland University of Technology |
And 2 more authors.
British Journal of Anaesthesia | Year: 2015
Background Several studies have identified clinical, psychosocial, patient characteristic, and perioperative variables that are associated with persistent postsurgical pain; however, the relative effect of these variables has yet to be quantified. The aim of the study was to provide a systematic review and meta-analysis of predictor variables associated with persistent pain after total knee arthroplasty (TKA). Methods Included studies were required to measure predictor variables prior to or at the time of surgery, include a pain outcome measure at least 3 months post-TKA, and include a statistical analysis of the effect of the predictor variable(s) on the outcome measure. Counts were undertaken of the number of times each predictor was analysed and the number of times it was found to have a significant relationship with persistent pain. Separate meta-analyses were performed to determine the effect size of each predictor on persistent pain. Outcomes from studies implementing uni- and multivariable statistical models were analysed separately. Results Thirty-two studies involving almost 30 000 patients were included in the review. Preoperative pain was the predictor that most commonly demonstrated a significant relationship with persistent pain across uni- and multivariable analyses. In the meta-analyses of data from univariate models, the largest effect sizes were found for: other pain sites, catastrophizing, and depression. For data from multivariate models, significant effects were evident for: catastrophizing, preoperative pain, mental health, and comorbidities. Conclusions Catastrophizing, mental health, preoperative knee pain, and pain at other sites are the strongest independent predictors of persistent pain after TKA. © 2014 The Author.
Macfarlane V.,Waitemata District Health Board |
Christie G.,Waitemata District Health Board
Drug and Alcohol Review | Year: 2015
Synthetic cannabinoid dependence and withdrawal are not well described in the literature. We aimed to report on the characteristics and treatment course of clients attending a detoxification service for support with synthetic cannabinoid withdrawal in Auckland, New Zealand. Design and Methods: A retrospective audit of electronic and paper files for clients presenting for treatment in association with problematic synthetic cannabinoid use between May 2013 and May 2014 was conducted. Demographic information, reported synthetic cannabinoid use, other substance use, reported adverse effects, withdrawal symptoms and treatment information were recorded using a piloted template. Descriptive statistics were used to summarise the characteristics of the audit sample. Results: In the 12 month period, 47 people presented to detoxification services reporting problems withdrawing from synthetic cannabinoids. Twenty clients were admitted for medical management within an inpatient setting. Coexisting substance dependence apart from nicotine dependence was low. The most common withdrawal symptoms were agitation, irritability, anxiety and mood swings. Withdrawal symptoms were managed with diazepam and quetiapine. Discussion and Conclusions: The harm associated with use of synthetic cannabinoids has had a direct impact on the utilisation of specialist alcohol and drug services in Auckland, New Zealand. Many clients with synthetic cannabinoid withdrawal symptoms required intensive support including medication and admission to an inpatient detoxification unit. Clients withdrawing from synthetic cannabinoids were the third largest group of clients admitted to inpatient detoxification services in Auckland, New Zealand, between May 2013 and May 2014. © 2015 Australasian Professional Society on Alcohol and other Drugs.
Ford J.A.,Assessment Technology Group |
Soop M.,Waitemata District Health Board |
Du J.,Waitemata District Health Board |
Loveday B.P.T.,Waitemata District Health Board |
Rodgers M.,Waitemata District Health Board
British Journal of Surgery | Year: 2012
Background: Intraoperative cholangiography (IOC) is used to detect choledocholithiasis and identify or prevent bile duct injury. The aim of this study was systematically to review the randomized clinical trials of IOC for these two indications. Methods: MEDLINE, Embase, the Cochrane Library, clinicaltrials.gov and the World Health Organization database of clinical trials were searched systematically (January 1980 to February 2011) to identify trials. Two authors performed the literature search and extracted data independently. Primary endpoints were bile duct injury and retained common bile duct (CBD) stones diagnosed at any stage after surgery. Preliminary meta-analysis was undertaken, but the trials were too methodologically heterogeneous and the outcome events too infrequent to allow meaningful meta-analysis. Results: Eight randomized trials were identified including 1715 patients. Six trials assessed the value of routine IOC in patients at low risk of choledocholithiasis. Two trials randomized all patients (including those at high risk) to routine or selective IOC. Two cases of major bile duct injury were reported, and 13 of retained CBD stones. No trial demonstrated a benefit in detecting CBD stones. IOC added a mean of 16 min to the total operating time. Conclusion: There is no robust evidence to support or abandon the use of IOC to prevent retained CBD stones or bile duct injury. Level 1 evidence for IOC is of poor to moderate quality. None of the trials, alone or in combination, was sufficiently powered to demonstrate a benefit of IOC. Further small trials cannot be recommended. © 2011 British Journal of Surgery Society Ltd.
O'Brien A.,Waitemata District Health Board
International Journal of Geriatric Psychiatry | Year: 2016
Objective: The advent of second-generation antipsychotics (SGAs) in the 1990s brought optimism that neuroleptic-induced tardive dyskinesia (TD) may become relegated to history. Whether or not this is the case remains inconclusive, and this review aims to compare the risk of TD in older adults treated with first-generation antipsychotics (FGAs) versus SGAs. Methods: Relevant papers were sourced via a range of electronic databases, with a date range from 1957 to January 2015. Included studies used both a validated rating scale and research diagnostic criteria to report on the prevalence or incidence of TD in older adults exposed to antipsychotic medications. Results: For FGAs, the prevalence estimate was 53% (95% confidence interval [CI] [39.0, 68.4]) for mild TD and 38% (95% CI [25.9, 50.3]) for probable TD. Incidence estimates for probable TD with FGAs were 23% (95% CI [15.3, 30.6]) at 1 year, 42% (95% CI [24.8, 58.4]) at 2 years and 57% (95% CI [45.3, 69.1]) at 3 years. For SGAs, the incidence estimates at 1 year were 7% (95% CI [4.4, 10.2]) for probable TD and 3% (95% CI [1.5, 4.2]) for persistent TD. Conclusions: The risk of probable TD is more than three times lower in older adults receiving SGAs in comparison with FGAs after 1 year of treatment (23% vs 7%). The risk of persistent TD at 1 year with SGAs is particularly low. Evidence is lacking in regard to the longer-term risk of TD with SGAs, although the rates associated with the prolonged use of FGAs are high. Caution is therefore still required, particularly with the protracted use of both FGAs and SGAs. Copyright © 2015 John Wiley & Sons, Ltd.
Sandiford P.,Waitemata District Health Board |
Mosquera D.,Taranaki District Health Board |
Bramley D.,Waitemata District Health Board
British Journal of Surgery | Year: 2011
Background: This study examined trends in abdominal aortic aneurysm (AAA) incidence and mortality in New Zealand (NZ) and compared these with mortality rates from England and Wales. Methods: Cause-specific death data were obtained from the NZ Ministry of Health, UK Office for National Statistics and National Archives (for England and Wales). The NZ National Minimum Data Set provided hospital discharge data from July 1994 to June 2009. Results: In 2005-2007 the age-standardized AAA mortality rate for men was 33·3 per cent less in NZ than in England and Wales (5·21 versus 7·81 per 100 000), whereas for women it was 9·8 per cent less (2·12 versus 2·35 per 100 000). Standardized mortality rates in NZ fell by 53·0 per cent for men and 34·1 per cent for women from 1991 to 2007. Between 1991-1992 and 2005-2007 the probability of a 65-year-old dying from an AAA fell by 28·2 per cent (from 1·872 to 1·344 per cent) in men, and by 6·3 per cent (from 0·837 to 0·784 per cent) in women. New AAA admission and hospital death rates in NZ peaked in 1999 for men, and in 2001 for women, and have since declined sharply. Hospital mortality ratios have also fallen, except for women with a ruptured aneurysm. Conclusion: The burden of AAA disease has been falling since at least 1991 in NZ, and since 1995 in England and Wales. Although survival appears to be improving, most of the reduction is due to lower disease incidence. © 2011 British Journal of Surgery Society Ltd.
Hughes K.,University of Otago |
Flynn T.,University of Otago |
De Zoysa J.,Waitemata District Health Board |
Dalbeth N.,University of Auckland |
Merriman T.R.,University of Otago
Kidney International | Year: 2014
Increased serum urate predicts chronic kidney disease independent of other risk factors. The use of xanthine oxidase inhibitors coincides with improved renal function. Whether this is due to reduced serum urate or reduced production of oxidants by xanthine oxidase or another physiological mechanism remains unresolved. Here we applied Mendelian randomization, a statistical genetics approach allowing disentangling of cause and effect in the presence of potential confounding, to determine whether lowering of serum urate by genetic modulation of renal excretion benefits renal function using data from 7979 patients of the Atherosclerosis Risk in Communities and Framingham Heart studies. Mendelian randomization by the two-stage least squares method was done with serum urate as the exposure, a uric acid transporter genetic risk score as instrumental variable, and estimated glomerular filtration rate and serum creatinine as the outcomes. Increased genetic risk score was associated with significantly improved renal function in men but not in women. Analysis of individual genetic variants showed the effect size associated with serum urate did not correlate with that associated with renal function in the Mendelian randomization model. This is consistent with the possibility that the physiological action of these genetic variants in raising serum urate correlates directly with improved renal function. Further studies are required to understand the mechanism of the potential renal function protection mediated by xanthine oxidase inhibitors. © 2013 International Society of Nephrology.
Waitemata District Health Board | Date: 2016-01-12
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