bluuebunny/crossref_metadata_2025 huggingface dataset:
Unsupervised machine learning for detection of phase transitions in off-lattice systems. II. Applications
Authors: Jadrich R. B. , Lindquist B. A. , Piñeros W. D. , Banerjee D. , Truskett T. M.
Published: November 2018

We outline how principal component analysis can be applied to particle configuration data to detect a variety of phase transitions in off-lattice systems, both in and out of equilibrium. Specifically, we discuss its application to study (1) the nonequilibrium random organization (RandOrg) model that exhibits a phase transition from quiescent to steady-state behavior as a function of density, (2) orientationally and positionally driven equilibrium phase transitions for hard ellipses, and (3) a compositionally driven demixing transition in the non-additive binary Widom-Rowlinson mixture.
Phase control of plasmon enhanced two-photon photoluminescence in resonant gold nanoantennas
Authors: Remesh Vikas , Stührenberg Michael , Saemisch Lisa , Accanto Nicolò , van Hulst Niek F.
Published: November 2018

Plasmonic nanoantennas emit two-photon photoluminescence, which is much stronger than their second harmonic generation. Unfortunately, luminescence is an incoherent process and therefore generally not explored for nanoscale coherent control of the antenna response. Here, we demonstrate that, in resonant gold nanoantennas, the two-photon absorption process can be coherent, provided that the excitation pulse duration is shorter than the dephasing time of plasmon mode oscillation. Exploiting this coherent response, we show the pure spectral phase control of resonant gold nanoantennas, with effective read-out of the two-photon photoluminescence.
Two-level hierarchical stripe domains and enhanced piezoelectricity of rapid hot-press sintered BiFeO3 ceramics
Authors: Zheng S. H. , Li Z. W. , Zhang C. X. , Li Y. Q. , Lin L. , Yan Z. B. , Zhou X. H. , Wang Y. P. , Gao X. S. , Liu J.-M.
Published: November 2018

BiFeO3 represents the most extensively investigated multiferroic due to its fascinating ferroelectric domain structures, large polarization, and multiferroic coupling, among many other emergent phenomena. Nevertheless, much less concern with the piezoelectricity has been raised while all these well addressed properties are identified in thin film BiFeO3, and bulk ceramic BiFeO3 has never been given priority of attention. In this paper, we report our experiments on the ferroelectric and piezoelectric properties as well as domain structures of BiFeO3 bulk ceramics synthesized by rapid hot-press sintering. It is revealed that these properties are strongly dependent on the microstructural quality, and the largest piezoelectric coefficient d33 = 55 pC/N with electric polarization as large as 45 μC/cm2 is obtained for the sample sintered at 800 °C, while they are only 30 pC/N and 14 μC/cm2 for the samples sintered in normal conditions at 800 °C. The two-level hierarchical stripe-like and irregular dendrite-like domain structures are observed in these hot-press sintered samples. It is suggested that the enhanced piezoelectric property is ascribed to the two-level hierarchical stripe-like domain structure which may respond more easily to electrical and strain stimuli than those irregular dendrite-like domains. The enhanced remnant polarization should be owing to the improved sample quality and large grains in the properly hot-press sintered samples.
Oxygen vacancy induced photoconductivity enhancement in Bi1-xCaxFeO3-δ nanoparticle ceramics: A combined experimental and theoretical study
Authors: Nandy Subhajit , Kaur Kulwinder , Mocherla Pavana S. V. , Nanda B. R. K. , Sudakar C.
Published: November 2018

Based on experimental and density functional studies, we show that tailoring of oxygen vacancies (OV) leads to large scale enhancement of photoconductivity in BiFeO3 (BFO). The OV concentration is increased by substituting an aliovalent cation Ca2+ at Bi3+ sites in the BFO structure. Furthermore, the OV concentration at the disordered grain boundaries can be increased by reducing the particle size. Photoconductivity studies carried out on spark plasma sintered Bi1-xCaxFeO3-δ ceramics show four orders of enhancement for x = 0.1. Temperature dependent Nyquist plots depict a clear decrease in impedance with increasing Ca2+ concentration which signifies the role of OV. A significant reduction in photoconductivity by 2 to 4 orders and a large increase in impedance of the air-annealed (AA) nanocrystalline ceramics suggest that OV at the grain boundaries primarily control the photocurrent. In fact, activation energy for AA samples (0.5 to 1.4 eV) is larger than the as-prepared (AP) samples (0.1 to 0.5 eV). Therefore, the room temperature J-V characteristics under 1 sun illumination show 2–4 orders more current density for AP samples. Density-functional calculations reveal that, while the defect states due to bulk OV are nearly flat, degenerate, and discrete, the defect states due to surface OV are non-degenerate and interact with the surface dangling states to become dispersive. With large vacancy concentration, they form a defect band that enables a continuous transition of charge carriers leading to significant enhancement in the photoconductivity. These studies reveal the importance of tailoring the microstructural features as well as the composition-tailored properties to achieve large short circuit current in perovskite oxide based solar cells.
On the calculation of the stress tensor in real-space Kohn-Sham density functional theory
Authors: Sharma Abhiraj , Suryanarayana Phanish
Published: November 2018

We present an accurate and efficient formulation of the stress tensor for real-space Kohn-Sham density functional theory calculations. Specifically, while employing a local formulation of the electrostatics, we derive a linear-scaling expression for the stress tensor that is applicable to simulations with unit cells of arbitrary symmetry, semilocal exchange-correlation functionals, and Brillouin zone integration. In particular, we rewrite the contributions arising from the self-energy and the nonlocal pseudopotential energy to make them amenable to the real-space finite-difference discretization, achieving up to three orders of magnitude improvement in the accuracy of the computed stresses. Using examples representative of static and dynamic calculations, we verify the accuracy and efficiency of the proposed formulation. In particular, we demonstrate high rates of convergence with spatial discretization, consistency between the computed energy and the stress tensor, and very good agreement with reference planewave results.
Beyond coffee ring: Anomalous self-assembly in evaporating nanofluid droplet on a sticky biomimetic substrate
Authors: Bansal Lalit , Seth Pranjal , Sahoo Sumita , Mukherjee Rabibrata , Basu Saptarshi
Published: November 2018

Evaporation induced self-assembly is of paramount importance in many fields ranging from optoelectronic devices, blood spatter analysis, food industry, and thin film deposition. In this article, we report the evaporative drying of a nanofluid droplet on an inclined biomimetic sticky substrate obtained by soft lithographically replicating the structures of Rose petals on crosslinked Polydimethylsiloxane and demonstrate the influence of substrate inclination on the transitions in morphodynamics of the final deposit patterns. Based on experimental data and agglomeration kinetics, we present three unique morphologies induced by substrate inclination. First, buckling from the side in an upright droplet due to air cavity in the substrate. Second, sedimentation induced side buckling in an inclined droplet. Finally, cavity from the bottom in an inverted droplet. We provide a detailed physical explanation of the transition in the morphologies by exploring the coupling among droplet-substrate orientation, evaporation, internal flow and particle agglomeration.
Transforming institutional racism at an Australian hospital
Authors: Bourke Christopher John , Marrie Henrietta , Marrie Adrian
Published: November 2018

Objectives The aims of this study were to: (1) examine institutional racism’s role in creating health outcome discrepancies for Aboriginal and Torres Strait Islander peoples; and (2) assess the management of institutional racism in an Australian hospital and health service (HHS). Methods A literature review informed consideration of institutional racism and the health outcome disparities it produces. Publicly available information, provided by an Australian HHS, was used to assess change in an Australian HHS in five key areas of institutional racism: inclusion in governance, policy implementation, service delivery, employment and financial accountability. These findings were compared with a 2014 case study. Results The literature concurs that outcome disparity is a defining characteristic of institutional racism, but there is contention about processes. Transformative change was detected in the areas of governance, service delivery and employment at an Australian HHS, but there was no change in financial accountability or policy implementation. Conclusions The health outcomes of some racial groups can be damaged by institutional racism. An external assessment tool can help hospitals and health services to change. What is known about the topic? Institutional racism theory is still developing. An external assessment tool to measure, monitor and report on institutional racism has been developed in Australia. What does this paper add? This study on institutional racism has useful propositions for healthcare organisations experiencing disparities in outcomes between racial groups. What are the implications for practitioners? The deleterious effects of institutional racism occur regardless of practitioner capability. The role for practitioners in ameliorating institutional racism is to recognise the key indicator of poorer health outcomes, and to then seek change within their hospital or healthcare organisation.
Analysis of FtsZ Crystal Structures Towards a New Target for Antibiotics
Authors: Kusuma Kennardy D. , Griffith Renate , Harry Elizabeth J. , Bottomley Amy L. , Ung Alison T.
Published: November 2018

The bacterial cell division protein FtsZ is conserved in most bacteria and essential for viability. There have been concerted efforts in developing inhibitors that target FtsZ as potential antibiotics. Key to this is an in-depth understanding of FtsZ structure at the molecular level across diverse bacterial species to ensure inhibitors have high affinity for the FtsZ target in a variety of clinically relevant pathogens. In this study, we show that FtsZ structures differ in three ways: (1) the H7 helix curvature; (2) the dimensions of the interdomain cleft; and (3) the opening/closing mechanism of the interdomain cleft, whereas no differences were observed in the dimensions of the nucleotide-binding pocket and T7 loop. Molecular dynamics simulation may suggest that there are two possible mechanisms for the process of opening and closing of the interdomain cleft on FtsZ structures. This discovery highlights significant differences between FtsZ structures at the molecular level and this knowledge is vital in assisting the design of potent FtsZ inhibitors.
Prevalence of acne and its impact on the quality of life in school-aged
adolescents in Malaysia
Authors: Hanisah Arshad , Omar Khairani , Azhar Shah Shamsul
Published: November 2018

AIM: The objective of this study was to determine the prevalence of facial acne and its impact on the quality of life among adolescents attending secondary schools in Muar, Malaysia. METHODS: A cross-sectional study was conducted where 409 samples were selected using stratified cluster random sampling from two secondary schools in Muar, involving Form 1 to Form 5 students. Students were diagnosed clinically and the severity of facial acne was assessed using Global Acne Grading System. A self-reported Cardiff Acne Disability Index was used to assess the quality of life among adolescents who had acne. RESULTS: The prevalence of facial acne among the adolescents was 67.5% (n=276). Facial acne increased with increasing age (p=0.001). It was more common among males (71.1%) than females (64.6%), p=0.165. The males also had a higher prevalence of severe acne (p=0.001). The quality of life was affected by the severity of acne. Students with severe acne had higher levels of Cardiff Acne Disability Index (rho=0.521). CONCLUSION: Facial acne is a common disorder and appears to have a considerable impact on quality of life among adolescents. The above findings should alert health care professionals and the school authorities to actively identify, manage and educate adolescents with facial acne. KEYWORDS: Facial acne, adolescents, Cardiff Acne Disability Index, quality of life
Charms & Harms: St John's Wort (Hypericum perforatum)
Authors: Barnes Joanne
Published: November 2018

SUMMARY MESSAGE: St Johns wort is about as effective as some conventional antidepressants (NNT=42) including certain SSRIs for treating mild to moderate depression and has a favourable adverse effect profile, at least with short-term use. However, it interacts with several other medicines, including digoxin, theophylline, warfarin and oral contraceptives. As with all herbal medicines, different St Johns wort products differ in their pharmaceutical quality, and the implications of this for efficacy and safety should be considered.
General Practice in urban and rural New Zealand: Results of the 2007 RNZCGP membership survey
Authors: Mel Pande Madhukar
Published: November 2018

INTRODUCTION: The provision of primary health care is an integral part of both a country’s health system, and of the overall social and economic development of its communities. An adequate general practice and primary health care workforce is a prerequisite to the provision of good primary health care. Countries with stronger primary health care services have better health and much lower health costs. This paper reports the results of the RNZCGP’s 2007 annual membership survey and discusses workforce development in urban and rural New Zealand (NZ). METHOD: In 2007, the RNZCGP sent a survey form to all its financial members as part of the annual subscriptions mail-out to gather data about College members’ current working patterns and help construct a longitudinal view of work preferences and hours worked per week. RESULTS: The response rate was 59% (1995 members/participants: 1098 males (55%) and 897 females). More female GPs (86%) worked in urban centres than male GPs (83%). NZ European GPs were over-represented (67%) in the South Island when compared to their representation within the total population. Numbers of international medical graduates (IMGs) had increased in urban centres since 2005. All regions experienced a decrease in self-employed GPs. Rural GPs spend more hours per week in general practice than urban GPs. CONCLUSION: The GP workforce is an integral part of the NZ primary health care workforce, and is currently facing many challenges. Stakeholders need to ensure that NZ remains an attractive primary health care environment in order to retain NZ-trained GPs and attract IMGs. KEYWORDS: Family physician, New Zealand, rural health services, manpower
What makes Care Plus effective in a provincial Primary Health Organisation? Perceptions of primary care workers
Authors: Eggleton Kyle , Kenealy Tim
Published: November 2018

INTRODUCTION: Care Plus is a New Zealand chronic care initiative. It provides funding for extra primary care visits for patients with chronic diseases and aims to improve chronic care management, primary health care team work and reduce inequalities in health care. This mixed methodology study aimed to explore characteristics within practices that may contribute to improved clinical outcomes for Care Plus. METHODS: A focus group interview was conducted with a group of health professionals involved in Care Plus in a North Island Primary Health Organisation (PHO). Participants were selected because of their expert status. Interview analysis used a general inductive approach. A questionnaire was sent to all practice nurses to determine prevalence of characteristics derived from the focus group. FINDINGS: Seven primary care workers involved in Care Plus participated in a focus group from which three major themes emerged: nursing factors, practice organisation factors and general practitioner (GP) factors. Sub-themes identified as patient-centredness, assertive follow-up, nursing knowledge, referral to other health professionals, dedicated appointment times, long consultation time, low cost, GP commitment and teamwork were all considered to be characteristics that could lead to improved clinical outcomes. Questionnaire responses from 18 practice nurses suggest that GPs are under-involved with Care Plus. DISCUSSION: Patients with chronic conditions have complex needs. Care Plus is a nationwide initiative providing funding for chronic care. Some characteristics of nurses, practice organisation and GPs may lead to improved clinical outcomes in Care Plus. A number of these characteristics are supported in the literature. KEYWORDS: Chronic disease; primary health care; primary nursing care; disease management; patient care team
Impact on quit attempts of mailed general practitioner 'brief advice' letters plus nicotine replacement therapy vouchers
Authors: Watson Donna , Bullen Chris , Glover Marewa , McRobbie Hayden , Parag Varsha , Walker Natalie
Published: November 2018

AIM: To test whether a personalised letter from general practitioners advising their patients who are smokers to quit, together with an exchange card for one month of nicotine gum, prompts them to make quit attempts, is acceptable and feasible. METHODS: Non-randomised beforeafter ecological study involving general practices in Auckland, New Zealand. Personalised letters with exchange cards for four weeks of nicotine gum were sent to 831 patients within a single Auckland health board area who were recorded as current smokers on their general practitioners files. The comparison group was the population in another Auckland health board area. We measured calls to Quitline and vouchers redeemed at pharmacies from both areas before and after the intervention. Follow-up surveys of recipients and general practitioners assessed acceptability. RESULTS: Quitline calls from baseline to the end of the intervention from the intervention district compared with a comparison district were not significantly higher (5%, 95% CI -212%, p=0.195), but nicotine replacement therapy (NRT) voucher redemptions were significantly higher (9%, 95% CI 316%, p=.005). Almost 9% of the exchange cards were redeemed for NRT. Despite initial difficulties in accurately identifying smokers from their records, responding GPs found the strategy very acceptable. DISCUSSION: The strategy shows potential as a simple way to increase the number of smokers making supported quit attempts through primary care. In the light of the urgent need to increase cessation rates, a randomised trial of this promising approach is warranted. KEYWORDS: Smoking cessation; Quitline, nicotine replacement therapy; general practice; brief advice
Modifying the PACIC to assess provision of chronic illness care: An exploratory study with primary health care nurses
Authors: Carryer Jenny , Budge Claire , Hansen Chiquita , Gibbs Katherine
Published: November 2018

INTRODUCTION: In line with Wagners Chronic Care Model, the Patient Assessment of Chronic Illness Care (PACIC) has been developed to evaluate chronic illness care delivery from the patient's perspective. Modification of the instrument to assess the same aspects of care delivery from the health practitioners perspective would enable individual practitioners to evaluate their own provision of self-management support, and would also enable a more direct comparison between care provided and care received within the chronic illness context. AIM: To explore the potential of a modified PACIC instrument to assess individual health practitioners delivery of care to chronic illness patients with a sample of primary health care nurses. METHODS: Seventy-seven primary care nurses completed the modified PACIC, reworded to ask about care provision rather than receipt of care. An additional seven cultural sensitivity items were included, as were questions about the suitability of the types of chronic illness care and who should be providing the care. RESULTS: The modified PACIC items appear to be appropriate for use with health practitioners. Agreement that the types of care described in the PACIC should be provided was almost unanimous, and the predominant view was that self-management support should be provided by both nurses and doctors. Mean scale scores were higher than those generally reported from studies using the PACIC. DISCUSSION: The results of this first evaluation of a modified PACIC suggest that the original items plus the cultural sensitivity items can be used to assess self-management support by individual health practitioners. KEYWORDS: Chronic illness; self-management; primary health care, nurses
Seeing patients first: creating an opportunity for practice nurse care?
Authors: Kenealy Tim , Docherty Barbara , Sheridan Nicolette , Gao Ryan
Published: November 2018

INTRODUCTION: Practice nurses see patients in both a planned (i.e. scheduled appointment) and an unplanned (i.e. opportunistic) manner. This study aimed to investigate how often and why New Zealand practice nurses see patients prior to the general practitioner and whether they organise their care to support unplanned, opportunistic activity. METHOD: National postal survey from a random sample of 500 general practices, requesting a response from one nurse per practice. Semi-structured telephone interviews with a purposeful sample of respondents. FINDINGS: Responses came from 225 nurses (51% of practices confirmed to be eligible). Nearly all (92%) said their work role was the same as that of others in their practice. Only 13% of nurses routinely saw patients prior to the doctor, while 24% would choose to do so it they could, and 65% thought it important. Positive and negative aspects of seeing patients first are presented. Constraints included time, their role assisting practice workflow and perceptions of patient expectations. Few organised their work to create opportunities for lifestyle interventions. CONCLUSION: The current working environment of practice nurses in New Zealand does not readily support them routinely seeing patients before the general practitioner. We suggest this is a lost opportunity for patient-centred preventive care. KEYWORDS: Practice nursing roles; opportunistic interventions; work organisation; primary health care; chronic conditions
Increasing the uptake of opportunistic chlamydia screening: a pilot study in general practice
Authors: Lawton Beverley , Rose Sally , Raina Elley C , Bromhead Collette , Jane MacDonald E , Baker Michael
Published: November 2018

INTRODUCTION: Genitourinary Chlamydia trachomatis infection is common and associated with considerable personal and public health cost. Effective detection strategies are needed. Aim: To assess feasibility of an opportunistic incentivised chlamydia screening programme in general practice over six months. METHODS: This study was designed as a pilot for a randomised controlled trial in primary care. Three general practices were randomly allocated to intervention (two practices) and control groups. The intervention involved practice education, self-sample collection and practice incentives (funding and feedback) for a three-month active intervention period. Feedback and education was discontinued during the second three-month period. Practice-specific nurse- or doctor-led strategies were developed for identifying, testing, treating and recalling male and female patients aged 1624 years. The main outcome measure was the difference between the practices chlamydia screening rates over the six months following introduction of the intervention, controlling for baseline rates from the previous year. RESULTS: Chlamydia testing rates during the year prior to the intervention ranged from 2.9% to 7.0% of practice attendances by 1624-year-olds. The intervention practices had higher rates of screening compared with the control practice (p<0.001) at three months, but both practices reverted to pre-intervention rates by six months. The nurse-led screening strategy was more effective (35% declining to 5.5% over six months) than the doctor-led strategy (15% declining to 1.6% over six months) (p=0.04). DISCUSSION: Incentivised opportunistic chlamydia screening of 1624-year-old patients attending their general practitioner with a programme involving practice education, feedback and self-sample collection can increase screening rates. KEYWORDS: Primary health care; chlamydia; mass screening; randomized controlled trial
Community pharmacist perceptions of clinical medication reviews
Authors: Bryant Linda , Coster Gregor , McCormick Ross
Published: November 2018

INTRODUCTION: Changes in delivery of health care services has led to pressure for community pharmacists to extend their traditional role and become more involved with patient-focussed services such as medication reviews, in collaboration with general practitioners (GPs). This has not been generally implemented into routine practice, and many barriers have been suggested that inhibit community pharmacists extending their role. These have often focussed on physical or functional barriers. This study explores possible attitudinal factors that prevent increased participation of community pharmacists in medication reviews undertaken in collaboration with GPs. METHODS: Twenty community pharmacist participants who participated in the General Practitioner Pharmacist Collaboration (GPPC) study were interviewed. The GPPC study investigated the outcomes of community pharmacists undertaking a clinical medication review in collaboration with GPs, and the potential barriers. Semi-structured interviews were analysed using a general inductive thematic approach. FINDINGS: Emerging themes were that community pharmacists perceived that they were not mandated to undertake this role, it was not a legitimate role, particularly from the business perceptive, and pharmacists were concerned that they lacked the skills and confidence to provide this level of input. CONCLUSION: While there is concern that community pharmacists skills are underutilised, there are probable attitudinal barriers inhibiting pharmacists from increasing their role in clinical medication reviews. Perceived legitimacy of the service was a dominant theme, which appeared to be related to issues in the business model. Further investigation should consider the use of a clinical pharmacist working within a general practice independent of a community pharmacy. KEYWORDS: Community pharmacy services; drug utilization review; primary healthcare; health plan implementation
Digital monitoring by whole body photography and sequential digital dermoscopy detects thinner melanomas
Authors: Rademaker Marius , Oakley Amanda
Published: November 2018

INTRODUCTION: Population screening for melanoma remains controversial. There are no studies demonstrating that population screening increases survival. As prognosis of melanoma is directly related to Breslow thickness, a surrogate marker of survival is thickness of melanoma. The development of several self-referred, whole-body photography and sequential digital dermoscopy imaging services reflects the publics concern regarding melanoma. AIM: To assess the ability of one of these services to detect melanoma at an early, thin stage. METHODS: Demographic and histological details from 100 melanomas diagnosed through self-referred whole-body photography and sequential digital dermoscopy imaging service compared to those diagnosed through traditional methods from data held by the New Zealand Cancer Registry. RESULTS: There were 52 invasive and 48 in-situ melanomas: 90% superficial spreading type, 6% lentigo-maligna type and 4% nodular on histology. Forty-eight were diagnosed on first visit; the remainder by serial digital dermoscopy. Thirty-five percent of patients reported having had previous primary melanoma. In 60%, patients had been concerned by the lesion, the rest (40%) detected solely by screening. Patients diagnosed by whole-body photography and sequential digital dermoscopy screening had thinner melanomas compared to the Registry data: 69% <0.75 mm Breslow thickness compared to 52% (p=0.0216); only 1.9% thicker than 3 mm compared to 10.8% (p=0.067). DISCUSSION: Melanomas detected by self-referred, whole-body photography with sequential digital dermoscopy service are thinner than melanomas detected by traditional diagnostic methods. It remains to be determined whether earlier diagnosis results in improved survival. KEYWORDS: Dermoscopy; mass screening; diagnosis, melanoma; telemedicine; teledermatology
Tax is a motivating factor to make a quit attempt from smoking: a study before and after the April 2010 tax increase
Authors: MacFarlane Kirsty , Paynter Janine , Arroll Bruce , Youdan Ben
Published: November 2018

INTRODUCTION: Increasing excise tax on tobacco is one of the most powerful and cost-effective smoking interventions. Despite this evidence, there has been no substantial tax increase in New Zealand between 2000 and 2010. In April 2010 a 10% tax increase on factory-made cigarettes and a 24% tax increase on loose leaf tobacco was implemented. AIM: To evaluate the effect of cost as a motivating reason for smokers to make a quit attempt before and after the 2010 tobacco tax increase. METHODS: A regression analysis of a cross-sectional study was conducted. Data were collected from August to October 2009 and compared with data collected in July 2010. RESULTS: In 2009, 25.5% of smokers cited cost as a reason for trying to quit smoking compared with 55.6% in 2010. The adjusted odds of making a quit attempt with cost as a reason were 3.6 (95% CI 2.3–5.6, P=<0.001). Furthermore, smokers were more likely to make a quit attempt in 2010 than in 2009. Thirty percent of smokers made at least one quit attempt in 2009 and 39% made a quit attempt in 2010 (adjusted odds ratio 1.5, 95% CI 0.95–2.3, P=<0.1) DISCUSSION: The recent tax increase on tobacco in New Zealand has resulted in more smokers making an attempt to quit smoking and more smokers identifying cost as a motive for quitting. KEYWORDS: Smoking; smoking cessation; tobacco; taxes; New Zealand
A Pacific Immersion Programme – is it useful in teaching Pacific Health to future doctors in New Zealand?
Authors: Sopoaga Faafetai
Published: November 2018

BACKGROUND AND CONTEXT: Pacific peoples make up approximately 7% of the total population in New Zealand, and are over-represented in poor health statistics. There are very few Pacific peoples in the health workforce. Most Pacific patients will be seen by a non-Pacific health professional when seeking medical care. It is important for all health education institutions, therefore, to include Pacific health as part of their curricula. ASSESSMENT OF PROBLEM: This article outlines the development and evaluation of a Pacific immersion programme to teach medical students about Pacific health. The programme was developed with the assistance of local Pacific community leaders. Learning objectives for students, protocols and processes were developed. These learning objectives and feedback from medical students, staff and host families, formed the basis for evaluating the programme. RESULTS: Students found the programme to be very useful. Host families were satisfied with the experience. Staff support ensured the programme became a required part of learning at the Dunedin School of Medicine. STRATEGIES FOR IMPROVEMENT: The pilot programme was initially offered as an optional choice for students. In the future, all students at the Dunedin School of Medicine will be expected to undertake the programme. A research project looking at changes in knowledge, skills and attitudes of students after the programme will be of value. LESSONS: The programme provided a useful way for teaching Pacific health to undergraduate medical students. Other institutions could consider this method for teaching Pacific health in their curricula. KEYWORDS: Pacific health; health education; Pacific peoples
Community participation in primary care: what does it mean 'in practice'?
Authors: Neuwelt Pat
Published: November 2018

INTRODUCTION: The New Zealand 2001 Primary Health Care Strategy requires primary health organisations (PHOs) to involve communities in their governance and be responsive to communities needs. It is less clear what the implications of this policy are for general practices. This paper presents key findings from a national study undertaken in the wake of the 2001 primary care reforms on the purpose and process of involving communities in primary health care. METHODS: A three-part qualitative process was employed. Initially, key informant interviews were undertaken with a diverse range of primary care policy makers, funders, practitioners and community stakeholders (n=42). A draft framework for involving communities in primary care was developed, and formed the basis of a consultation phase (n=26). The framework was further developed and then piloted in four PHOs around New Zealand. FINDINGS: Views on community participation varied among different stakeholder groups in the sector. Most described it as a complex process of relationship-building over time, and one that is quite distinct from consumer feedback processes in general practice. For community representatives, it was a process of trust-building and information-sharing between communities and health professionals. These relationships enabled people to feel comfortable seeking care, and professionals to mould services to peoples needs. CONCLUSION: This research highlights that community is much more than a setting of care. As citizens, members of disadvantaged communities are partners with general practices and PHOs, working with them to improve health equity by ensuring that services are responsive to their needs. KEYWORDS: Community participation; participation; primary health care; primary healthcare; health equity
Access in New Zealand to antidotes for accidental and intentional drug poisonings
Authors: Abbott Victoria , Creighton Michaela , Hannam Janelle , Vincent Timothy , Coulter Carolyn
Published: November 2018

INTRODUCTION: Access to antidotes for the treatment of drug poisonings can impact on morbidity and mortality. Treatment for drug poisonings usually occurs at the nearest emergency department; however, health professionals working in primary care are often the first point of contact for patients. As New Zealand has a small, diffuse population, and poisonings are a rare event, it can be difficult to anticipate what antidotes are required. AIM: The aim of the study was to determine what antidotes are frequently used and stocked in hospital pharmacies. METHODS: A survey was sent out to all 25 hospital pharmacies, excluding private and satellite hospitals. The survey contained questions about the stocking, and prior use, of over 30 antidotes. Also included were open-ended questions asking about reasons for not stocking antidotes and procedures for procuring antidotes in an emergency. RESULTS: Twenty out of 25 hospital pharmacies completed the survey. Most hospital pharmacies were found to stock large quantities of commonly used antidotes and low quantities of uncommonly used antidotesbut in sufficient quantity to treat one to two patients. A low number of poisonings was the most common reason cited for not stocking antidotes, followed by high cost. Most hospitals had clear guidelines for procuring and lending antidotes in an emergency. DISCUSSION: New Zealand hospital pharmacies stock adequate quantities of most antidotes, including antidotes that are expensive and rarely required, but which may be needed urgently. Hospital pharmacies also have clear procurement procedures for obtaining other antidotes in an emergency. KEYWORDS: Antidote stocking; access to antidotes; drug poisoning
Early connections: effectiveness of a pre-call intervention to improve immunisation coverage and timeliness
Authors: Goodyear-Smith Felicity , Grant Cameron , Poole Tracey , Petousis-Harris Helen , Turner Nikki , Perera Rafael , Harnden Anthony
Published: November 2018

INTRODUCTION: Children who have missed or delayed immunisations are at greater risk of vaccine-preventable diseases and getting their first scheduled dose on time strongly predicts subsequent complete immunisation. Developing a relationship with an infants parents and general practice staff soon after birth followed by a systematic approach can reduce the number of delayed first immunisations. AIM: To assess the effectiveness of a general practicebased pre-call intervention to improve immunisation timeliness. METHODS: Clustered controlled trial of general practices in a large urban district randomised to either delivery of pre-call intervention to all babies at aged four weeks or usual care. RESULTS: Immunisation timeliness for infants receiving the primary series of immunisations among their nominated Auckland general practices was higher than expected at 98% for the six week event. The intervention was statistically but not clinically significant. Coverage was significantly lower among infants with no nominated practice which reduced overall coverage rate for the district. DISCUSSION: Pre-call letters with telephone follow-up are simple interventions to introduce into the practice management system and can be easily implemented as usual standard of care. Early identification of newborn infants, primary care engagement and effective systems including tracking of infants not enrolled in general practices has the greatest potential to improve immunisation coverage rates even further. KEYWORDS: Randomized controlled trial; immunization; vaccination; general practice; intervention studies
Nutritional risk amongst community-living Maori and non-Maori older people in Hawkes Bay
Authors: McElnay Caroline , Marshall Bob , OSullivan Jessica , Jones Lisa , Ashworth Tracy , Hicks Karen , Forrest Rachel
Published: November 2018

INTRODUCTION: Maintaining good nutrition is vital for healthy ageing. Poor nutrition increases the risk of hospitalisation, disability and mortality. Research shows clinical malnutrition is preceded by a state of nutritional risk and screening can identify older people at risk of poor nutrition or who currently have impaired nutritional status. AIM: To assess the population prevalence of nutritional risk amongst community-living Maori and non-Maori older people in Hawkes Bay. METHODS: A postal survey of 1268 people aged 65 years or older on the electoral roll for Hawkes Bay was conducted. Nutritional risk was measured using the SCREEN II questionnaire. RESULTS: Responses from 473 people were received (43.8% male, 49.9% female, 6.3% unspecified) with an estimated average age of 74 years. Nutritional risk was present amongst 56.5% of older people with 23.7% at risk and 32.8% at high risk. Maori were 5.2 times more likely to be at nutritional risk than non-Maori. Older people living alone were 3.5 times more likely to be at nutritional risk than those living with others. The most frequent risk factors were low milk-product intake, perception of own weight being more or less than it should be, and low meat and alternatives intake. Skipping meals and low fruit and vegetable intake were additional frequent risk factors for Maori. DISCUSSION: Both living situation and ethnicity are associated with nutritional risk. Further investigation is needed to confirm these findings and to determine issues specific for older Maori, including barriers to good nutrition and opportunities for nutritional improvement. KEYWORDS: Maori; nutritional status; older people
Exploring the opinions and perspectives of general practitioners towards the use of social networking sites for concussion management
Authors: Ahmed Osman , John Sullivan S , Schneiders Anthony , Moon Sam , McCrory Paul
Published: November 2018

INTRODUCTION: Social networking sites (SNSs) are increasingly being used for health-related purposes. Many patients now use sites such as Facebook to discuss symptoms, seek support, and search for advice on health conditions, including concussion. Innovative methods of delivering health information using these technologies are starting to emerge and it is important to seek the input of key stakeholder groups (including general practitioners) to establish their feasibility and to highlight areas of concern. AIM: This study aimed to seek the opinions of general practitioners towards the use of SNSs in concussion management. METHODS: Semi-structured interviews were captured with a digital voice recorder and analysed using interpretative description methodology. Participants were general practitioners whose caseload included persons with a concussion between the ages of 16 and 30 years, and who had treated a patient with a concussion in the past 12 months. FINDINGS: The clinical experience of the participants ranged from 3 to 35 years and 50% of the participants had a Facebook account themselves. While all participants were positive towards the use of SNSs for this purpose, concerns were raised regarding the issues of privacy and moderation. CONCLUSION: SNSs, particularly Facebook, have the potential (if correctly utilised) to be a viable adjunct to traditional concussion management programmes. In order for SNSs to be successfully used in this manner, the quality of information shared needs to be accurate and patients using them need to ensure that they get adequate cognitive rest. KEYWORDS: Brain concussion; general practitioners; health education; internet; social networking
Management of skin infections in Pacific children prior to hospitalisation
Authors: Ete-Rasch Elaine , Nelson Katherine
Published: November 2018

INTRODUCTION: Hospital admissions for childhood skin infections in New Zealand (NZ) are on the increase. Pacific children make up a high number of those who are admitted. This study describes the parents of Pacific childrens understanding and management of skin sores in the home prior to the sores becoming infected and requiring hospital admission. METHODS: A descriptive qualitative approach combined with the Pacific research frameworks of Faafaletui and the Metaphor of Kakala were used to elicit parents understanding and management of childrens skin sores in the home. The semi-structured interviews were conducted in English or Samoan, and all transcribed into English. FINDINGS: Mothers of 11 Pacific children admitted with skin infections between 2006 and 2008 were interviewed. The childrens infections started with insect bites in some cases. Parents actively sought treatment to ensure childrens optimal health was maintained. Initial management included a watch and see approach for some, until deterioration was noted. CONCLUSION: This is the first known study in New Zealand that has captured childrens experiences when sustaining a skin infection/s and the activities that took place while seeking treatment in the community. Although most of the children received medical attention in primary health care (PHC), this did not prevent the need for hospital admission. The acuteness and seriousness of childrens health on admission shows that preventive efforts need to increase and the early management of infections in PHC settings needs to be better understood. KEYWORDS: Children; Pacific health, primary health care; skin infections
Assessing readiness to work in primary health care: the content validity of a self-check tool for physiotherapists and other health professionals
Authors: Stewart Jenny , Haswell Kate
Published: November 2018

INTRODUCTION: The New Zealand Primary Health Care Strategy has emphasised the importance of well-coordinated service teams in managing complex chronic conditions. There is international evidence that physiotherapists can contribute effectively to the prevention and management of these conditions. However, there are few examples of physiotherapists in New Zealand (NZ) engaging in primary health care (PHC). It has been recognised that professional development is necessary to optimise physiotherapists participation in PHC. AIM: The aim of this study was to both design a self-check tool that physiotherapists could use as an initial step in preparing to work in PHC and to assess the content validity of the tool. METHODS: A literature review informed the development of the self-check tool. The tool was reviewed by members of the Physiotherapy New Zealand PHC working party to establish content validity. RESULTS: The tool was found to have excellent content validity with an overall score of 0.937, exceeding the acceptable index of 0.8. Item validity was excellent or acceptable for all except two items, which were subsequently modified in the final tool. DISCUSSION: This investigation provides initial support for the tools potential use by physiotherapists as a means of determining their readiness to work in PHC. It could have application beyond individual professional development to the wider context of team and organisational development. Additionally, with minor modifications the tool could have broader application to other professional groups. KEYWORDS: Continuing education; New Zealand; physiotherapy; primary health care; validity and reliability
The impact of patient and practice characteristics on retention in the diabetes annual review programme
Authors: Keenan Rawiri , Amey Janet , Lawrenson Ross
Published: November 2018

INTRODUCTION: Despite more than 10 years of the diabetes annual review (DAR) programme, ensuring the annual return of diabetic patients for review remains a challenge for primary care. Regardless of future arrangements for diabetes review programmes, regular review of patients remains clinically important. AIM: To investigate the effect of patient and practice characteristics on the retention of patients continuously enrolled with the same practice in the DAR programme. METHODS: We undertook a retrospective, observational study of a cohort of enrolled diabetic patients who had a DAR in the July 2006  June 2007 reporting year and remained enrolled with the same practice for the following three years. Controlling for death and migration, retention rates were calculated for age, gender, ethnicity, rurality, practice funding type and practice nurse (PN) to general practitioner (GP) ratio. RESULTS: The study included data from 78 practices and 6610 patients with Type 2 diabetes. Non-Maori and those aged 60 years and over were more likely to be retained in the programme. For practice factors, those with a higher PN to GP ratio had a significant retention advantage. Rurality and funding type was not shown to have a significant role in retention. DISCUSSION: Results support the view that both patient and practice factors influence a patients retention within the DAR programme. The PN to GP ratio may be an important factor in the retention of patients in a DAR programme and warrants further research and consideration when planning future primary care models. KEYWORDS: Chronic disease; diabetes mellitus; general practice; nurses; primary health care; rural health
Viewpoint: The New Zealand Centre for Adverse Reactions Monitoring: a source of practice-based evidence
Authors: Savage Ruth
Published: November 2018

The database of the New Zealand Centre for Adverse Reactions Monitoring (CARM) is an example of the practice-based evidence discussed in the June issue of the Journal of Primary Health Care. Databases of reported adverse drug reactions (ADRs) were established to generate hypotheses to be tested about previously unrecognised adverse reactions and interactions. Occasionally they are sufficient evidence in themselves. They can also identify prescribing practices that might increase the potential for ADRs to occur and provide feedback into guidelines in terms of the consequences of their use or non-use. Well-documented ADR reports can also highlight risk factors, thus providing a valuable contribution to risk benefit assessments in individual patients. Examples are discussed that support the use of ADRs as practice-based evidence in a non-hierarchical system in which case reports and case series, observational studies and randomised clinical trials contribute in a flexible relationship depending on the issue under investigation.