title: How do colorectal cancer patients rate their GP: a mixed methods study

authors: Blackmore, Tania Louise

subjects: Science & Technology

abstract: Background: New Zealand (NZ) has a high incidence of colorectal cancer (CRC) and low rates of early diagnosis. With screening not yet nationwide, the majority of CRC is diagnosed through general practice. A good patient-general practitioner (GP) relationship can facilitate prompt diagnosis, but when there is a breakdown in this relationship, delays can occur. Delayed diagnosis of CRC in NZ receives a disproportionally high number of complaints directed against GPs, suggesting deficits in the patient-GP connection. We aimed to investigate patient-reported confidence and ratings of their GP following the diagnostic process. 
Methods: This study is a mixed methods analysis of responses to a structured questionnaire and free text comments from patients newly diagnosed with CRC in the Midland region of NZ. A total of 195 patients responded to the structured questionnaire, and 113 patients provided additional free text comments. Descriptive statistics were used to describe the study population and chi square analysis determined the statistical significance of factors possibly linked to delay. Free text comments were analysed using a thematic framework. 
Results: Most participants rated their GP as ‘Very good/Good’ at communication with patients about their health conditions and involving them in decisions about their care, and 6.7% of participants rated their overall level of confidence and trust in their GP as ‘Not at all’. Age, gender, ethnicity and a longer diagnostic interval were associated with lower confidence and trust. Free text comments were grouped in to three themes: 1. GP Interpersonal skills; (communication, listening, taking patient symptoms seriously), 2. Technical competence; (speed of referral, misdiagnoses, lack of physical examination), and 3. Organisation of general practice care; (appointment length, getting an appointment, continuity of care). 
Conclusions: Māori, females, and younger participants were more likely to report low confidence and trust in their GP. Participants associate a poor diagnostic experience with deficits in the interpersonal and technical skills of their GP, and health system factors within general practice. Short appointment times, access to appointments and poor GP continuity are important components of how patients assess their experience and are particularly important to ensure equal access for Māori patients.

text: How do colorectal cancer patients rate their GP: a mixed methods study Background: New Zealand (NZ) has a high incidence of colorectal cancer (CRC) and low rates of early diagnosis. With screening not yet nationwide, the majority of CRC is diagnosed through general practice. A good patient-general practitioner (GP) relationship can facilitate prompt diagnosis, but when there is a breakdown in this relationship, delays can occur. Delayed diagnosis of CRC in NZ receives a disproportionally high number of complaints directed against GPs, suggesting deficits in the patient-GP connection. We aimed to investigate patient-reported confidence and ratings of their GP following the diagnostic process. 
Methods: This study is a mixed methods analysis of responses to a structured questionnaire and free text comments from patients newly diagnosed with CRC in the Midland region of NZ. A total of 195 patients responded to the structured questionnaire, and 113 patients provided additional free text comments. Descriptive statistics were used to describe the study population and chi square analysis determined the statistical significance of factors possibly linked to delay. Free text comments were analysed using a thematic framework. 
Results: Most participants rated their GP as ‘Very good/Good’ at communication with patients about their health conditions and involving them in decisions about their care, and 6.7% of participants rated their overall level of confidence and trust in their GP as ‘Not at all’. Age, gender, ethnicity and a longer diagnostic interval were associated with lower confidence and trust. Free text comments were grouped in to three themes: 1. GP Interpersonal skills; (communication, listening, taking patient symptoms seriously), 2. Technical competence; (speed of referral, misdiagnoses, lack of physical examination), and 3. Organisation of general practice care; (appointment length, getting an appointment, continuity of care). 
Conclusions: Māori, females, and younger participants were more likely to report low confidence and trust in their GP. Participants associate a poor diagnostic experience with deficits in the interpersonal and technical skills of their GP, and health system factors within general practice. Short appointment times, access to appointments and poor GP continuity are important components of how patients assess their experience and are particularly important to ensure equal access for Māori patients.

year: 2021-04-08

title: Significance of an early date from an adzed tree stump in Northland

authors: Higham, Thomas F.G.

abstract: Ogle, Jones, Sutton and Wallace (1998) have recently investigated the radiocarbon dating of a tree stump ('Ogle's stump’) which had evidence of adze marks, near the site of Taumatawhana pa, Houhora, Northland. The conventional radiocarbon age of 938 ± 31 BP was obtained at the Institute of Geological and Nuclear Sciences Ltd (formerly INS) laboratory in 1971. Ogle et al.(1998) considered the 'inbuilt age' of the wood (see McFadgen, 1982) and assessed its contribution to the radiocarbon determination. In this brief paper we re-evaluate that methodology and question the conclusion of Ogle et al. (1998) that the date is reliable. We are particularly concerned with the comparison of the date with an associated radiocarbon result obtained by Elliot et al. (1995) from a nearby site at Lake Taumatawhana, which we think is misleading.

text: Significance of an early date from an adzed tree stump in Northland Ogle, Jones, Sutton and Wallace (1998) have recently investigated the radiocarbon dating of a tree stump ('Ogle's stump’) which had evidence of adze marks, near the site of Taumatawhana pa, Houhora, Northland. The conventional radiocarbon age of 938 ± 31 BP was obtained at the Institute of Geological and Nuclear Sciences Ltd (formerly INS) laboratory in 1971. Ogle et al.(1998) considered the 'inbuilt age' of the wood (see McFadgen, 1982) and assessed its contribution to the radiocarbon determination. In this brief paper we re-evaluate that methodology and question the conclusion of Ogle et al. (1998) that the date is reliable. We are particularly concerned with the comparison of the date with an associated radiocarbon result obtained by Elliot et al. (1995) from a nearby site at Lake Taumatawhana, which we think is misleading.

year: 1998

title: Advancements in running shoe technology and their effects on running economy and performance – a current concepts overview

authors: Hébert-Losier, Kim

subjects: Athletics

abstract: Advancements in running shoe technology over the last 5 years have sparked controversy in athletics as linked with clear running economy and performance enhancements. Early debates mainly surrounded ‘super shoes’ in long-distance running, but more recently, the controversy has filtered through to sprint and middle-distance running with the emergence of ‘super spikes’. This Current Concepts paper provides a brief overview on the controversial topic of super shoes and super spikes. The defining features of technologically advanced shoes are a stiff plate embedded within the midsole, curved plate and midsole geometry, and lightweight, resilient, high-energy returning foam that–in combination–enhance running performance. Since the launch of the first commercially available super shoe, all world records from the 5 km to the marathon have been broken by athletes wearing super shoes or super spikes, with a similar trend observed in middle-distance running. The improvements in super shoes are around 4% for running economy and 2% for performance, and speculatively around 1% to 1.5% for super spikes. These enhancements are believed multifactorial in nature and difficult to parse, although involve longitudinal bending stiffness, the ‘teeter-totter effect’, the high-energy return properties of the midsole material, enhanced stack height and lightweight characteristic of shoes.

text: Advancements in running shoe technology and their effects on running economy and performance – a current concepts overview Advancements in running shoe technology over the last 5 years have sparked controversy in athletics as linked with clear running economy and performance enhancements. Early debates mainly surrounded ‘super shoes’ in long-distance running, but more recently, the controversy has filtered through to sprint and middle-distance running with the emergence of ‘super spikes’. This Current Concepts paper provides a brief overview on the controversial topic of super shoes and super spikes. The defining features of technologically advanced shoes are a stiff plate embedded within the midsole, curved plate and midsole geometry, and lightweight, resilient, high-energy returning foam that–in combination–enhance running performance. Since the launch of the first commercially available super shoe, all world records from the 5 km to the marathon have been broken by athletes wearing super shoes or super spikes, with a similar trend observed in middle-distance running. The improvements in super shoes are around 4% for running economy and 2% for performance, and speculatively around 1% to 1.5% for super spikes. These enhancements are believed multifactorial in nature and difficult to parse, although involve longitudinal bending stiffness, the ‘teeter-totter effect’, the high-energy return properties of the midsole material, enhanced stack height and lightweight characteristic of shoes.

year: 2022