bluuebunny/crossref_metadata_2025 huggingface dataset:
Understanding and use of antibiotics amongst Samoan people in New Zealand
Authors: Norris Pauline , Churchward Marianna , Fa'alau Fuafiva , Vaai Cecilia
Published: November 2018

INTRODUCTION: Use of antibiotics is high in Samoa and this may affect the expectations and patterns of antibiotic use of Samoans in New Zealand. AIM: This study examined the understanding and reported use of antibiotics amongst Samoans in New Zealand. METHODS: In-depth interviews were held with 13 Samoans in New Zealand. These interviews were analysed and used to develop a questionnaire that was administered to 112 Samoans attending health care facilities in New Zealand. RESULTS: Many participants had little understanding of antibiotics. Less than 2% identified the correct purpose for antibiotics, and 66% thought they were used to relieve pain. Respondents regarded a wide range of medicines (including some which they regularly took) as antibiotics. They frequently attributed colds and flu to environmental conditions (96%), and regarded antibiotics as a useful treatment for them (81%). They reported stopping taking antibiotics before finishing the course. Very few (8%) were aware of antibiotic resistance. DISCUSSION: Health care practitioners cannot assume that patients share a Western scientific understanding of which illnesses are caused by microbes, or what antibiotics are or do. People may have significant confusion about the medicines they take. Samoans, whether they are born in New Zealand or not, may hold traditional Samoan views about health and illness. KEYWORDS: Antibiotics, lay knowledge, URTI (upper respiratory tract infections), Samoa, New Zealand
Is intranasal zinc effective and safe for the common cold? A systematic review and meta-analysis
Authors: D'Cruze Hubert , Arroll Bruce , Kenealy Time
Published: November 2018

OBJECTIVE: To systematically review the evidence for effectiveness of intranasal zinc used to treat a common cold, and pool the results in a meta-analysis. DATA SOURCES: A literature search was undertaken in the Cochrane register of controlled trials, Medline and EMBASE databases. Inclusion criteria were randomised placebo controlled trials in patients with a common cold. RESULTS: Five studies were found. Three were relevant to the issue of treatment of common colds with intranasal zinc and the results were combined in meta-analysis. High doses of intranasal zinc preparation (2.1mg zinc/day) were reported in two studies to shorten the duration and reduce the symptom severity of common cold in healthy adults, when started within 24 to 48 hours of onset of illness. A lower dose study (0.044mg zinc/day) found no benefit in resolution, but did report a significant improvement in symptoms at day 1 and day 3. Combining the three studies, the relative risk for benefit at day 3 was 0.62 (95%CI 0.18 to 2.19) (random effects). There were no studies with children. There were no significant harms reported. CONCLUSION: Results from individual trials suggest some benefit from zinc for symptoms of a common cold, at least in adults. Pooling the results for symptom relief at day 3, in a conservative meta-analysis, suggests a non-significant benefit. Unquantified concerns about permanent anosmia following the use of intranasal zinc may mean that the issues raised will never be scientifically resolved. KEYWORDS: Administration, intranasal, zinc, common cold, meta-analysis, olfaction disorders, review
Essay: A type of lady's corset? Support for older people
Authors: Allen Ruth , Wiles Janine
Published: November 2018

Sub-threshold anxiety and depression are common presentations in primary care. They carry a significant disability burden along with the risk of developing a frank disorder. Intervention options are limited, although there is some evidence that ultra brief interventions may be effective with this patient group. We argue that there is a need for a systematic but ultra brief, minimal contact intervention, that can be delivered by GPs or practice nurses. Such an intervention would be a form of facilitated self-management, a step up from self-help, from which people could be referred on to more intensive treatment or medication if required. MeSH KEYWORDS: Primary health care, mental health, psychotherapy, mental disorders
Barriers to accessing specialist care for older people with chronic obstructive pulmonary disease in rural New Zealand
Authors: Hopley Michelle , Horsburgh Margaret , Peri Kathy
Published: November 2018

INTRODUCTION: Access to health care for people living in rural areas presents many challenges. For people who live with chronic obstructive pulmonary disease (COPD), the ability to access specialist health services facilitates improved health outcomes, however many barriers to accessing specialist health care have been identified. This paper reports on the challenges people living with COPD in rural New Zealand (NZ) face in accessing specialist health care services. METHODS: Nine people living with COPD in a small NZ rural town were interviewed in 2007. FINDINGS: Data analysis, using a general inductive approach found that difficulties with transportation, physical access, communication and finances collectively added up to significant barriers to accessing specialist care for this group of people. CONCLUSION: The findings raise questions about the model of care needed to improve health care for rural people with COPD. Collaborative multidisciplinary teams with specialist respiratory nurses working in the community are proposed to improve care coordination and improve communication for this group of people. KEYWORDS: Rural health services; health services accessibility; pulmonary disease; chronic obstructive; community health nursing
Weight loss in head and neck cancer patients little noticed in general practice
Authors: van Wayenburg Caroline , Rasmussen-Conrad Ellen , van den Berg Manon , Merkx Matthias , van Staveren Wija , van Weel Chris , van Binsbergen Jaap
Published: November 2018

INTRODUCTION: In head and neck cancer patients, weight loss increases morbidity and mortality, and decreases treatment tolerance and quality of life. Early nutritional intervention has beneficial effects on these factors. AIM: We observed patients weight courses after specialists care and surveyed nutrition-related documentation by general practitioners (GPs). METHODS: From a Head and Neck Oncology Centre (HNOC) study, 68 patients were asked to participate in an extended general practice cohort. Twenty-six patients participated in the prospective three-monthly weight measurements during the year after HNOC care. We extracted nutritional information contained in referral letters (n=24) and medical records from the year before referral (n=45) and after HNOC care (n=26). An impaired nutritional status was assigned to weight loss =10% within six months or Body Mass Index (BMI) <18.5 kg/m2 and at risk to weight loss =5% but <10% within six months. RESULTS: Three (12%) participants were nutritionally impaired and two (8%) were deemed at risk. Although GPs suspected a (pre-) malignancy in 11 cases (46%), only two (8%) documented weight loss or BMI and four (17%) nutrition-related complaints in their referral letters. Medical records more often contained information on nutrition-related complaints and tube feeding later in the disease course, as opposed to concern over weight loss or BMI. DISCUSSION: Therefore, we call for nutritional management in general practice, by urging practitioners to assess patients nutritional status throughout the disease course and intervene if necessary. The passing on of related information in case of referral promotes continuity of care. KEYWORDS: Humans; follow-up studies; weight loss; cachexia; family practice; head and neck neoplasms
What resources do Auckland general practitioners use for answering immediate clinical questions and for lifelong learning?
Authors: Gravatt Zachary , Arroll Bruce
Published: November 2018

INTRODUCTION: General practitioners need to search for evidence to remain up-to-date with knowledge and to answer clinical questions that arise during consultations. In the past their main sources of information have been via colleagues and books. AIM: To determine the resources Auckland GPs use to answer clinical questions and to maintain lifelong learning. METHODS: One hundred questionnaires were mailed to Auckland GPs. There were 33 replies (33% response rate). From this sample 10 were chosen at random and all agreed to be interviewed (100% response rate). RESULTS: All participants were using Internet resources to obtain answers to clinical questions. Colleagues were also important for answering immediate questions, but not for future requirements. There is possibly less use of paper book resources. The websites were used to obtain knowledge now and for future need, while paper books were only used for answering immediate questions. DISCUSSION: The use of websites may be increasing in general practice for both immediate knowledge requirements and for lifelong learning. Colleagues are still a source of answers to immediate clinical questions, but textbooks may be less used. Empiric data are needed to monitor changes in answering clinical questions and the issue of lifelong learning requires more research. KEYWORDS: Education, medical, continuing; family practice; information management; information storage and retrieval; medical informatics; Internet
GP practice variation in hospitalisation rates: a study of Partnership Healthenrolled patients
Authors: Barnett Ross , Malcolm Laurence
Published: November 2018

AIM: This project aims to provide information to support the planning and implementation of strategies to reduce hospitalisation. It examines variations in hospital discharge rates between practice populations and the use of special general practice access funding. METHODS: Practice enrolment data for 345 254 patients enrolled with 102 Partnership Health Primary Health Organisation (PHO) general practices were sent to New Zealand Health Information Service. Data linked to the patient National Health Index (NHI) relating to hospital discharges were attached to the practice enrolment data for the two years ending June 2007 and returned to the researchers with the NHI numbers encrypted. Total discharges were 127426.The data were analysed for rates of hospital discharges for different population groups and by general practice. RESULTS: There is a substantial variation in hospital discharge rates between general practices, but this is only partly accounted for by practice population characteristics. Furthermore while there is a strong social gradient in European admissions, this is much less true for Maori. There was also a wide variation between practices in the uptake of High Use Health Cards, special funding for frequent attenders at general practices and Care Plus funding for patients with chronic conditions. Practice deprivation, ethnicity and age only explained a minor part of this variation. DISCUSSION: The high rate of unexplained practice variation in chronic care management and hospitalisation rates, especially for Maori, is of concern. Further investigation of the causes of such variability is needed as a first step in reducing hospitalisation. KEYWORDS: Hospitalization; ethnic groups; data collection
Are unexplained vaginal symptoms associated with psychosocial distress? A pilot investigation
Authors: Cohrssen Andreas , Aslam Uzma , Karasz Allison , Anderson Matthew
Published: November 2018

AIM: Vaginal complaints cannot be definitively diagnosed in approximately one-third of women. We sought to determine if women without a diagnosis had higher levels of psychiatric disorders. METHODS: This was an observational study in an urban family practice clinic. Prior to seeing a clinician, women with vaginal complaints completed the Patient Health Questionnaire (PHQ); symptoms were measured by the Vaginal Complaints Scale (VCS). Patients were then examined and treated by a family physician. At one and two weeks time patients were contacted by phone regarding symptom resolution and clinical outcomes. RESULTS: We enrolled 47 patients; one patient was excluded. A diagnosis was made in 36. Eighteen had bacterial vaginosis, 16 had candida, three trichomonas, two HSV, one chlamydia; there were eight dual diagnoses. PHQ diagnoses were slightly less common in women without an identified cause for their symptoms. We obtained follow-up data from 45 subjects at one week and 34 subjects at two weeks time. At two weeks follow-up, 97% of subjects had complete resolution or improvement of their symptoms. Symptom improvement was equivalent among women with a diagnosis and those without. We estimate 180 subjects would be needed to detect a clinically meaningful difference in PHQ diagnoses. DISCUSSION: Our pilot study did not find an association between psychiatric diagnoses made by the PHQ and unexplained vaginal symptoms. Nearly all patients experienced rapid resolution of symptoms irrespective of whether a diagnosis had been made or not. These findings are limited primarily by the small sample size. KEYWORDS: Vaginitis; psychosocial stress; symptom resolution
Charms & Harms: Ginkgo
Authors: Barnes Joanne
Published: November 2018

SUMMARY MESSAGE: Evidence for the efficacy of ginkgo extracts for cognitive impairment and dementia, intermittent claudication, acute ischaemic stroke, tinnitus and age-related macular degeneration is unconvincing. Ginkgo preparations have been associated with haemorrhagic reactions. Health professionals should be aware of the possibility of (undisclosed) use of ginkgo; use of ginkgo should be avoided, or at least used only with caution, in patients with bleeding disorders and those taking conventional anti-platelet or anticoagulant agents. If using ginkgo, these patients should be advised to be vigilant for signs of bleeding and to seek professional help. Suspected adverse drug reactions should be reported to CARM. As with all herbal medicines, different ginkgo products vary in their pharmaceutical quality, and the implications of this for efficacy and safety should be considered.
Assessing patient safety culture in New Zealand primary care: a pilot study using a modified Manchester Patient Safety Framework in Dunedin general practices
Authors: Wallis Katharine , Dovey Susan
Published: November 2018

INTRODUCTION: Patient safety is a major concern, both in hospitals and in primary care settings. The current focus internationally is on the prospect of improving patient safety through cultural transformation. There are no tools designed to assess and strengthen safety culture in New Zealand (NZ) general practices, but a United Kingdom (UK) group have developed a toolthe Manchester Patient Safety Framework (MaPSaF)to assess safety culture in UK Primary Care Trusts. We aimed to modify the MaPSaF and test its acceptability and utility in the NZ primary care setting. METHODS: We modified the MaPSaF to suit the NZ context and then used it in 12 Dunedin general practices at baseline and at three months. Participants were all practice personnel present in the practice on the day. Participants rated their practice individually on each of the nine MaPSaF dimensions of safety culture, then discussed the dimensions and their scores and chose a practice-wide consensus score for each dimension in turn. These discussions were recorded, transcribed and analysed to determine acceptability and utility of the modified framework in NZ practices. FINDINGS: The framework process took about one hour. Most participants found the process acceptable and useful. The framework directed team discussion about patient safety issues and facilitated communication and prompted some practices to make changes. Some participants from smaller practices deemed the systems advocated in the framework superfluous. CONCLUSION: The framework can be adapted and used in NZ practices to stimulate learning about safety culture and to facilitate team communication. KEYWORDS: Family practice; patient safety; primary care; safety culture
Under-utilisation of preventive medication in patients with cardiovascular disease is greatest in younger age groups (PREDICT-CVD 15)
Authors: Mehta Suneela , Wells Sue , Riddell Tania , Kerr Andrew , Pylypchuk Romana , Marshall Roger , Ameratunga Shanthi , Cheuk Chan Wing , Thornley Simon , Crengle Sue , Harrison Jeff , Drury Paul , Raina Elley C , Bell Fionna , Jackson Rod
Published: November 2018

INTRODUCTION: Blood pressurelowering (BPL) and lipid-lowering (LL) medications together reduce estimated absolute five-year cardiovascular disease (CVD) risk by >40%. International studies indicate that the proportion of people with CVD receiving pharmacotherapy increases with advancing age. AIM: To compare BPL and LL medications, by sociodemographic characteristics, for patients with known CVD in primary care settings. METHODS: The study population included patients aged 3574 with known CVD assessed in primary care from July 2006 to October 2009 using a web-based computerised decision support system (PREDICT) for risk assessment and management. Clinical data linked anonymously to national sociodemographic and pharmaceutical dispensing databases. Differences in dispensing BPL and LL medications in six months before first PREDICT assessment was analysed according to age, sex, ethnicity and deprivation. RESULTS: Of 7622 people with CVD, 1625 < 55 years old, 2862 were women and 4609 lived in deprived areas (NZDep quintiles 4/5). The study population included 4249 European, 1556 Maori, 1151 Pacific and 329 Indian peoples. BPL medications were dispensed to 81%, LL medications to 73%, both BPL and LL medications to 67%, and 87% received either class of medication. Compared with people aged 6575, people aged 3544 were 3040% less likely and those aged 4554 were 1015% less likely to be dispensed BPL, LL medications or both. There were minimal differences in likelihood of dispensing according to sex, ethnicity or deprivation. DISCUSSION: BPL and LL medications are under-utilised in patients with known CVD in New Zealand. Only two-thirds of patients in this cohort are on both. Younger patients are considerably less likely to be on recommended medications. KEYWORDS: Cardiovascular diseases; drug therapy; secondary prevention; primary health care; demography
Language barriers in the community pharmacy: a survey of northern and western Auckland
Authors: Chang Emily , Tsang Bobby , Thornley Simon
Published: November 2018

INTRODUCTION: Community pharmacists play an important role in increasing patient understanding of medication use. Lack of resources to facilitate communication with non-English speaking (NES) patients may be a communication barrier. AIM: To identify obstacles and coping strategies of community pharmacists when counselling NES patients in Aucklands North Shore and West Auckland. METHODS: A cross-sectional survey of 46 community pharmacies in West Auckland and the northern Auckland region was carried out in February 2009. RESULTS: Community pharmacists frequently counsel NES patients (65% reported at least once a week). Use of bilingual staff was the most commonly employed strategy (78% of respondents) to communicate with these customers. Pharmacies that reported serving NES clients at least daily all had bilingual staff, compared with 70% of pharmacies with less frequent NES contact (p=0.017). No pharmacists reported using professional interpreting services. In our sample, telephone interpreting was the most preferred (63% of respondents) method of communicating with such patients, assuming that further services were made available. DISCUSSION: Community pharmacists frequently serve NES patients, with limited access to interpreting services or translated resources. Although pharmacists have, in some way, adapted to the needs of their patients, our survey suggests that accessible professional interpreting services would further improve pharmacist/NES client interaction. KEYWORDS: Communication barriers; community pharmacy services; medication errors
Ethics: Medical ethics: four principles, two decisions, two roles and no reasons
Authors: Kennelly John
Published: November 2018

The four principle view of medical ethics has a strong international pedigree. Despite wide acceptance, there is controversy about the meaning and use of the principles in clinical practice as a checklist for moral behaviour. Recent attempts by medical regulatory authorities to use the four principles to judge medical practitioner behaviour have not met with success in clarifying how these principles can be incorporated into a legal framework. This may reflect the philosophical debate about the relationship between law and morals. In this paper, legal decisions from two cases in which general practitioners have been charged with professional shortcomings are discussed. Difficulties with the application of the four principles (autonomy, beneficence, nonmaleficence and justice) to judge medical practitioner behaviour are highlighted. The four principles are relevant to medical practitioner behaviour, but if applied as justifications for disciplinary decisions without explanation, perverse results may ensue. Solutions are suggested to minimise ambiguities in the application of the four principles: adjudicators should acknowledge the difference between professional and common morality and the statutory requirement to give decisions with reasons.
Potion or Poison? Ginger
Authors: Rasmussen Phil
Published: November 2018

SUMMARY MESSAGE: Evidence to date supports effectiveness of ginger to prevent and reduce postoperative nausea and vomiting, and in some women with morning sickness. Despite anti-inflammatory activities in vitro, clinical evidence of efficacy in inflammatory joint conditions is lacking. Animal and in vitro studies suggest possible protective effects against obesity, diabetes, atherosclerosis and cancer. Safety and any predisposition to drug interactions are dose-related. Ginger appears safe when taken at doses of up to 4 or 6 g daily. Above this dosage adverse interactions may occur with antithrombotic drugs, metronidazole and possibly cyclosporine, although human studies are lacking. Different ginger products vary considerably in their pharmaceutical quality, and the implications of this for dosage, efficacy and safety should be considered.
Viewpoint: Medicines adherence  evidence for any intervention is disappointing
Authors: Bryant Linda
Published: November 2018

Interventions to improve adherence with medicines have been studied for many years. The outcomes, both for improved adherence and clinical indicators, have not been as positive as expected or hoped for. Any improvement in adherence that may occur has not necessarily translated to improved clinical outcomes. The studies are heterogeneous, often of poor quality, with different outcomes and measures of outcome, and with ill-defined interventions, such as a lack of information on specific content of an educational intervention. It appears that interventions are very resource intensive with no cost-effectiveness studies. More research is required into interventions to improve medicines adherence before more health care funding is invested in labour-intensive interventions that appear logical but are not supported by evidence from quality research.
Viewpoint: An enhanced primary health care role following psychological trauma: the Christchurch earthquakes
Authors: Sullivan Sean , Wong Sharlene
Published: November 2018

Following the February 2011 earthquake in Christchurch, New Zealand (NZ), the authors participated in counselling local residents, and debriefing and supervising support teams. Indications were that risk for mental health disorders, including Post-Traumatic Stress Disorder (PTSD), may be elevated in residents, and that this risk may continue for some time. Patients may be de-prioritising their mental health issues when these become normalised throughout the citys population. The authors recommend that primary care patients are assessed using a brief, comprehensive tool (for example, the Case-finding and Help Assessment Tool) that targets many health and behavioural issues identified as increasing in the city following the earthquake. Anxiety and mood disorder symptoms may indicate assessment is appropriate to reduce harm arising from increased risk for PTSD. Concern also is raised for primary health care providers who may have experienced the trauma and additionally may be vicariously affected by patients reported trauma.
Influence of ambient temperature on the correlation between self-monitoring of blood glucose and plasma glucose values in diabetes management
Authors: Kinchiku Shigesumi , Kotani Kazuhiko , Kajiya Shoko , Yodo Kanoko , Maruguchi Yukiko , Uenomachi Hitoshi
Published: November 2018

INTRODUCTION: Self-monitoring of blood glucose (SMBG) helps patients with diabetes mellitus maintain glycemic control. However, few reports exist on whether ambient temperature can influence SMBG values. AIM: To investigate the effect of ambient temperature on the association between SMBG and plasma glucose (PG) values. METHODS: The study was conducted between 2003 and 2010 in diabetic patients (n=2777, male/female = 1216/1561, mean age = 60.5 ±13.6 years) for whom the measurements of SMBG and PG were performed simultaneously (66 197 samples were measured). SMBG and PG were both measured by enzyme methods. Correlation coefficients were determined between SMBG and PG values, and the differences between their values were compared based on the temperature. RESULTS: SMBG and PG were closely correlated at each temperature. The PGSMBG difference was smallest at an ambient temperature of 20°C, around which SMBG differed from PG with temperature; namely, the SMBG value decreased as the ambient temperature increased, while the SMBG value increased as the ambient temperature decreased. DISCUSSION: The present data indicate that the ambient temperature can minimally but significantly influence SMBG values. Further studies about the relevance of these findings on patient self-care are warranted. KEYWORDS: Blood glucose self-monitoring; diabetes mellitus; patient education; self care; skin temperature; temperature
The Green Prescription and older adults: what do general practitioners see as barriers?
Authors: Patel Asmita , Kolt Gregory , Keogh Justin , Schofield Grant
Published: November 2018

INTRODUCTION: Limited research exists that has examined the barriers that older adults (those aged 65 years and older) can encounter when given a Green Prescription (GRx). This study aimed to identify what general practitioners (GPs) perceived their older-aged patients barriers were with regard to carrying out a GRx. This study also identified the strategies that GPs used to assist their older-aged patients in overcoming barriers to physical activity engagement. METHODS: Fifteen GPs from the Auckland region of New Zealand were interviewed individually. An inductive thematic approach was used to analyse data. FINDINGS: GPs identified chronic health conditions, fear of injury, transportation constraints, set routines and lack of confidence as being barriers that some of their older-aged patients have encountered when considering whether to become more physically active and, also, when engaging in actual physical activity. CONCLUSION: Physical activity interventions, such as the GRx programme, can have an important role in helping confer health-related gain for low-active older adults. To ensure that such interventions are successful on a long-term basis, practitioners need to be aware of the barriers that their older-aged patients can encounter when given a prescription for physical activity. KEYWORDS: Green Prescription; older adults; physical activity, primary health care
Mental health promotion for gay, lesbian, bisexual, transgender and intersex New Zealanders
Authors: Adams Jeffery , Dickinson Pauline , Asiasiga Lanuola
Published: November 2018

INTRODUCTION: A number of studies have identified that gay, lesbian, bisexual, transgender, and intersex (GLBTI) people have poorer mental health than the general population. This article describes current mental health promotion and service provision for GLBTI people in New Zealand, and the views of stakeholders on current service delivery and concerns facing the sector. METHODS: An email survey of service providers gathered descriptive data about mental health promotion and services provided for GLBTI people. Data obtained from interviews with key informants and online submissions completed by GLBTI individuals were analysed thematically. FINDINGS: Five organisations provide clear, specific and utilised services and programmes to some or all of the GLBTI populations. Twelve GLBTI-focused mental health promotion resources are identified. The analysis of data from key informants and GLBTI respondents identified factors affecting mental health for these populations occurring at three levelsmacro-social environment, social acceptance and connection, and services and support. CONCLUSION: While GLBTI individuals have the same basic mental health promotion and service provision needs as members of the general population, they have additional unique issues. To enhance the mental health of GLBTI New Zealanders, a number of actions are recommended, including building sector capacity, allocating sufficient funding, ensuring adequate research and information is available, and reducing stigma, enhancing young peoples safety, and supporting practitioners through training and resources. An important role for government, alongside GLBTI input, for improving mental health is noted. KEYWORDS: General practice; mental health; sexuality; social discrimination
Personal medicines storage in New Zealand
Authors: Hewson Campbell , Chi Shen Chong , Strachan Clare , Norris Pauline
Published: November 2018

INTRODUCTION: Poor storage of medicines can reduce their efficacy, yet little is known about how people store medicines in their homes and elsewhere, why these locations are chosen, and whether the conditions are suitable for medicines storage. AIM: To investigate where medicines are commonly stored in New Zealand households, why, and the typical conditions  temperature and relative humidity  in those places of storage. METHODS: Data from a large qualitative study on the meanings of medicines were analysed to explore where people store medicines in their households, and why. A data logger was used to log temperature and relative humidity in common medicine storage places, such as homes and cars. RESULTS: Kitchens and bathrooms were the most commonly reported storage places, with people influenced by convenience, desire to remember to take medicines, and child safety when deciding where to store medicines. High temperatures and humidity were found in kitchens and bathrooms, extreme temperatures in a car and a backpack, and extremely low temperatures in checked-in luggage on a plane. DISCUSSION: Temperature- and humidity-sensitive medicines should not be stored long-term in common storage locations, such as kitchens and bathrooms. Conditions in these places may not comply with the recommended storage conditions given by the manufacturer. Furthermore, medicines should not be left in backpacks or cars, especially if the vehicle is in the sun. Medicines that may degrade upon freezing and thawing  such as protein-containing medicines, emulsions, suspensions and some solutions  should not be stored in the cargo hold of a plane. KEYWORDS: Drug storage; humidity; New Zealand; temperature
Maori experiences and perceptions of gout and its treatment: a kaupapa Maori qualitative study
Authors: Te Karu Leanne , Bryant Linda , Raina Elley C
Published: November 2018

INTRODUCTION: The prevalence of gout among Maori is one of the highest in the world. This study explores the perceptions, understanding and treatment of gout among Maori. METHODS: A qualitative general inductive approach was used, guided by kaupapa Maori principles. Participants included 12 Maori aged 4879 years with gout. Semi-structured interviews were undertaken, taped and transcribed. Themes were identified from transcripts. FINDINGS: Participants described overwhelming sufferance due to gout, which was sometimes considered inevitable. All participants believed or had been informed that gout is caused by food and/or drink. This led to feelings of self-blame and blame from partners and employers. Whanau (family) were a resource for information and a support when independence was limited. Rongoa (traditional medicine) played a role in the lives of rural but not urban participants. Many reported stoicism, putting up with pain and putting others before themselves, as the Maori way. Medicines used for gout management were predominantly non-steroidal anti-inflammatory drugs, colchicine and prednisone, with allopurinol only playing a role late in the disease. Medications were often poorly understood and consequently improperly used. Relationships with health professionals were important, but cultural, financial and time barriers impaired access and understanding. Gout had a huge, negative impact on the lives of participants. CONCLUSION: The quality of lives of many people with gout could be improved by better understanding through educational campaigns for health professionals and the community. Culturally sensitive health care systems and a paradigm shift in gout management and early preventive treatment are needed. KEYWORDS: Drug therapy; ethnic groups; gout; health status disparities; primary health care; qualitative research
Older peoples attitudes towards their regular medicines
Authors: Bagge Michael , Tordoff June , Norris Pauline , Heydon Susan
Published: November 2018

INTRODUCTION: Many qualitative studies examine older peoples attitudes towards their medicines. Often these studies focus on the topic of medicines adherence. In contrast, this study aims to explore the attitudes of older people, aged 75 years and older, towards their regular prescription and non-prescription medicines. METHODS: This study comprised two investigations of people aged 75 years and older. In the first investigation, 20 people were purposefully selected and interviewed, using an oral history approach, about their experiences of medicines over a lifetime. In the second investigation, 40 people were recruited from two internal medicine wards. Semi-structured interviews were undertaken with participants about their experiences of medicine changes after discharge from hospital. All 60 interviews were digitally recorded, transcribed verbatim, coded using NVivo and analysed thematically. FINDINGS: Participants disliked having to take prescription medicines, but the majority believed they were necessary. They also trusted their doctors expertise regarding medicines. Most participants believed it was important to take their prescription medicines regularly, even if they sometimes forgot to take them. They were not anxious about possible side effects. Most participants aimed to limit the use of analgesics and non-prescription medicines which they perceived as unnecessary. CONCLUSION: Even taking into account participants dislike of having to take prescription medicines, they were willing to accept medicines as part of their everyday routine, as they believed they were necessary. This suggests that many older people may be more willing to take their medicines than some studies on adherence in the wider population have indicated. KEYWORDS: Attitudes; elderly; New Zealand; non-prescription drugs; prescription drugs; qualitative research
Shaping the future medical workforce: take care with selection tools
Authors: Poole Phillippa , Shulruf Boaz
Published: November 2018

INTRODUCTION: Medical school selection is a first step in developing a general practice workforce. AIM: To determine the relationship between medical school selection scores and intention to pursue a career in general practice. METHODS: A longitudinal cohort study of students selected in 2006 and 2007 for The University of Auckland medical programme, who completed an exit survey on career intentions. Students are ranked for selection into year 2 of a six-year programme by combining grade point average from prior university achievement (60%), interview (25%) and Undergraduate Medicine and Health Sciences Admission Test (UMAT) scores (15%). The main outcome measure was level of interest in general practice at exit. Logistic regression assessed whether any demographic variables or admission scores predicted a strong interest in general practice. RESULTS: None of interview scores, grade point average, age, gender, or entry pathway predicted a strong interest in general practice. Only UMAT scores differentiated between those with a strong interest versus those with some or no interest, but in an inverse fashion. The best predictor of a strong interest in general practice was a low UMAT score of between 45 and 55 on all three UMAT sections (OR 3.37, p=0.020). Yet, the academic scores at entry of students with these UMAT scores were not lower than those of their classmates. DISCUSSION: Setting inappropriately high cut-points for medical school selection may exclude applicants with a propensity for general practice. These findings support the use of a wider lens through which to view medical school selection tools. KEYWORDS: Cognitive tests; general practice; health workforce; medical student career choice; selection; UMAT
Objective benefits, participant perceptions and retention rates of a New Zealand community-based, older-adult exercise programme
Authors: Keogh Justin , Rice John , Taylor Denise , Kilding Andrew
Published: November 2018

INTRODUCTION: Most exercise studies for older adults have been university- or hospital-based. Little is known about the benefits and factors influencing long-term participation in community-based exercise programmes, especially in New Zealand. AIM: To quantify the objective benefits, participant perceptions and retention rates of a New Zealand community-based exercise programme for adults (60 years or older). METHODS: Study 1 involved assessing the benefits of 12 weeks training on a convenience sample of 62 older adults commencing the never2old Active Ageing programme. Study 2 assessed the perceptions of 150 current participants on a variety of programme components that could act as barriers or facilitators to continued engagement. Study 3 assessed the retention rates of 264 participants in the programme over a two-year period. RESULTS: Significant improvements in many physical functional scores were observed in Study 1 (530 percentile points; p<0.05). Questionnaire responses from participants in Study 2 indicated many perceived benefits (positive responses from 6795% on various questions) and that core components of the programme were rated very highly (6499% on various components). Retention rates were high, with Study 3 finding 57% of participants still engaging in the programme at the end of the two-year period. DISCUSSION: A community-based exercise programme for older adults can improve many objective and subjective measures of physical fitness and functional performance and have good retention rates. General practitioners and other allied health professionals in New Zealand should consider promoting programmes, such as the never2old Active Ageing programme, to their older patients. KEYWORDS: Exercise; muscle stretching exercises; older adults; primary health care; resistance training
Primary care management of group A streptococcal pharyngitis in Northland
Authors: Shetty Anil , Mills Clair , Eggleton Kyle
Published: November 2018

INTRODUCTION: Reducing the rate of acute rheumatic fever nationally by two-thirds by 2017 is a New Zealand Ministry of Health priority. Northland District Health Board (DHB) has high rates of rheumatic fever, disproportionately impacting on Maori children and young people. School-based programmes and general practice both contribute to rheumatic fever prevention in detecting and appropriately treating group A streptococcal (GAS) pharyngitis. AIM: The aim of this study was to assess adherence by general practitioners and school-based sore throat programmes to national guidelines for the management of GAS pharyngitis in Northland. METHODS: Laboratory and pharmaceutical data were obtained for children and young people aged 320 years who had GAS positive throat swabs in Northland laboratory services between 1 April and 31 July 2012. Data were analysed separately for general practice and the school programmes for rheumatic fever prevention. RESULTS: One in five of those children presenting to general practice with a positive throat swab and complete prescription data did not receive treatment according to national guidelines, while appropriate treatment was offered to more than 98% of children accessing school-based programmes. A significant proportion of those seen in general practice received antibiotics not recommended by guidelines, an inadequate length of treatment or no prescription. There were no significant differences in the management of Maori and non-Maori children. DISCUSSION: There is room for improvement in general practice management of GAS pharyngitis in Northland. School-based management of sore throat provides high-quality management for children at high risk of rheumatic fever. KEYWORDS: Pharyngitis; prevention and control; primary health care; rheumatic fever; school health services; Streptococcus pyogenes
Evaluation of a primary care - based programme designed to increase exercise and improve nutrition in patients at risk
Authors: Goodyear-Smith Felicity , McPhee Julia , Duncan Scott , Schofield Grant
Published: November 2018

INTRODUCTION: Evidence is limited regarding the effectiveness of brief interventions delivered through primary care to improve healthy living and increase physical activity. The Healthy As programme delivering brief interventions programmes in primary care to promote physical activity, improved nutrition and weight management was developed, implemented and assessed. This study aimed to identify aspects of the programme that worked well, those that presented problems or barriers, along with suggestions for improvement. METHODS: Three provider organisations in Auckland were contracted to deliver the Healthy As intervention in primary care settings. Semi-structured interviews were conducted with those delivering the risk assessments and providing the intervention from each provider organisation. A thematic analysis approach based on grounded theory was used to analyse the emerging key themes. FINDINGS: The emerging themes related to the holistic nature of the programme, its structure, resources used with participants, engagement of the providers with the participants, and whether the programme was effective in changing behaviour. CONCLUSION: Initial engagement of participants was found to be particularly important for the success of the Healthy As programme. For a patient-centred approach, good communication between the patient and health provider is required to facilitate shared decision-making and self-management prior to implementation of an intervention. Patients need to indicate whether they want help to make changes. Advice on healthy eating and exercise should not be given in isolation. Patients may also need help with mental health or other lifestyle issues before they can actively engage in exercise or weight reduction programmes. KEYWORDS: Exercise; general practice; health behavior; motivational interviewing; nutrition therapy; primary health care
Potion or Poison? Garlic
Authors: Martini Nataly
Published: November 2018

SUMMARY MESSAGE: Garlic has consistently been shown to be superior to placebo in reducing blood pressure; however, the effect on lipids is conflicting and further studies are required. The large variation in garlic products commercially available makes it difficult to determine the true effect of garlic on cardiovascular morbidity and mortality. Garlic has been shown to significantly reduce the severity of symptoms associated with the common cold and the duration of illness, but further evidence is required to validate these findings.
Measuring care alignment in general practice consultations for people with long-term conditions: an exploratory study
Authors: Carryer Jenny , Budge R Claire , Francis Helen
Published: November 2018

ABSTRACT

INTRODUCTION
Chronic care Model (CCM) aims to make the care of people with long term conditions (LTC) planned, proactive and patient-centred. The patient assessment of chronic care (PACIC) and our recently developed modified PACIC (MPACIC) allow patient and provider views to be compared.

AIM
To explore the use of measures of care provision and receipt in primary care long-term conditions management and to assess congruity between patient and provider views of support.

METHODS
For this observational self-report study, 13 pairs of matched patient and provider dyads (patient/general practitioner and patient/practice nurse) were recruited from general practice. Patients with long-term conditions were asked to rate the support provided by their general practitioner and practice nurse, separately, using the PACIC instrument, a measure of care processes. The modified version for providers (MPACIC) was similarly administered, with GPs and PNs (herein referred to as practitioners) rating the care specifically provided to the 13 patients. Aggregated scores were compared and a case study example was used.

RESULTS
For 67% of ratings, patients and practitioners agreed (0 or 1 category difference) on the frequency of self-management support provision. Some disagreement was found for 19% of ratings, and considerable disagreement was found for 15%. The strongest agreement was found with Delivery System Design and the least with Goal Setting. Generally, there was little difference between patient/doctor and patient/nurse agreement.

DISCUSSION
Agreement between patients and practitioners regarding the level of self-management support received and provided was relatively high. This study demonstrates ways the PACIC and MPACIC can be used together to measure patient/practitioner agreement about long-term condition care provision.
Potion or Poison? Cinnamon
Authors: Martini Nataly
Published: November 2018

SUMMARY MESSAGE: Although some trials suggest cinnamon may have a moderate effect in improving glycaemic status indicators, the literature is conflicting and strong scientific validation is lacking. Adverse effects of cinnamon are minimal; however, large doses over a long time period should be avoided. Cassia cinnamon may harm the liver in high doses and caution should be exercised in those with liver damage, concomitant use with drugs that affect the liver, and possibly blood-thinning medication. Patients should monitor their glucose levels, particularly if taking cinnamon with other medications or herbal supplements that may affect blood glucose.